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Civil Service 2014 Room Assignment For Nursing

For other uses, see Nursing (disambiguation).

"Nurse" and "Nurses" redirect here. For other uses, see Nurse (disambiguation).

A British nurse caring for a baby

Occupation
NamesNurse

Activity sectors

Nursing
Description
CompetenciesCaring for general well-being of patients

Education required

Qualifications in terms of statutory regulations according to national, state, or provincial legislation in each country

Fields of
employment

Nursing is a profession within the health care sector focused on the care of individuals, families, and communities so they may attain, maintain, or recover optimal health and quality of life. Nurses may be differentiated from other health care providers by their approach to patient care, training, and scope of practice. Nurses practice in many specialties with differing levels of prescription authority. Many nurses provide care within the ordering scope of physicians, and this traditional role has shaped the public image of nurses as care providers. However, nurse practitioners are permitted by most jurisdictions to practice independently in a variety of settings. In the postwar period, nurse education has undergone a process of diversification towards advanced and specialized credentials, and many of the traditional regulations and provider roles are changing.[1][2]

Nurses develop a plan of care, working collaboratively with physicians, therapists, the patient, the patient's family and other team members, that focuses on treating illness to improve quality of life. In the United States and the United Kingdom, advanced practice nurses, such as clinical nurse specialists and nurse practitioners, diagnose health problems and prescribe medications and other therapies, depending on individual state regulations. Nurses may help coordinate the patient care performed by other members of a multidisciplinary health care team such as therapists, medical practitioners and dietitians. Nurses provide care both interdependently, for example, with physicians, and independently as nursing professionals.

History[edit]

Main articles: History of nursing and Timeline of nursing history

Traditional[edit]

Nursing historians face the challenge of determining whether care provided to the sick or injured in antiquity was nursing care.[3] In the fifth century BC, for example, the Hippocratic Collection in places describes skilled care and observation of patients by male "attendants", who may have been early nurses.[4] Around 600 BC in India, it is recorded in Sushruta Samhita, Book 3, Chapter V about the role of nurse as "the different parts or members of the body as mentioned before including the skin, cannot be correctly described by one who is not well versed in anatomy. Hence, any one desirous of acquiring a thorough knowledge of anatomy should prepare a dead body and carefully, observe, by dissecting it, and examine its different parts."

Before the foundation of modern nursing, members of religious orders such as nuns and monks often provided nursing-like care.[5] Examples exist in Christian,[6]Islamic[7] and Buddhist[8] traditions amongst others. Phoebe, mentioned in Romans 16 has been described in many sources as "the first visiting nurse".[9][10] These traditions were influential in the development of the ethos of modern nursing. The religious roots of modern nursing remain in evidence today in many countries. One example in the United Kingdom is the use of the historical title "sister" to refer to a senior nurse in the past.[11]

During the Reformation of the 16th century, Protestant reformers shut down the monasteries and convents, allowing a few hundred municipal hospices to remain in operation in northern Europe. Those nuns who had been serving as nurses were given pensions or told to get married and stay home.[12] Nursing care went to the inexperienced as traditional caretakers, rooted in the Roman Catholic Church, were removed from their positions. The nursing profession suffered a major setback for approximately 200 years.[13]

19th century[edit]

Florence Nightingale laid the foundations of professional nursing after the Crimean War.[15] Her Notes on Nursing (1859) became popular. The Nightingale model of professional education, having set up the first school of nursing that is connected to a continuously operating hospital and medical school, spread widely in Europe and North America after 1870.[16] Nightingale was also a pioneer of the graphical presentation of statisticaldata.[17]

Other important nurses in the development of the profession include:

  • Agnes Hunt from Shropshire was the first orthopedic nurse and was pivotal in the emergence of the orthopedic hospital The Robert Jones & Agnes Hunt Hospital in Oswestry, Shropshire.
  • Agnes Jones, who established a nurse training regime at the Brownlow Hill infirmary, Liverpool, in 1865.
  • Linda Richards, who established quality nursing schools in the United States and Japan, and was officially the first professionally trained nurse in the US, graduating in 1873 from the New England Hospital for Women and Children in Boston
  • Clarissa Harlowe "Clara" Barton, a pioneer American teacher, patent clerk, nurse, and humanitarian, and the founder of the American Red Cross.
  • Saint Marianne Cope, a Sister of St Francis who opened and operated some of the first general hospitals in the United States, instituting cleanliness standards which influenced the development of America's modern hospital system.[18]

Catholic orders such as Little Sisters of the Poor, Sisters of Mercy, Sisters of St. Mary, St. Francis Health Services, Inc. and Sisters of Charity built hospitals and provided nursing services during this period.[citation needed] In turn, the modern deaconess movement began in Germany in 1836.[19] Within a half century, there were over 5,000 deaconesses in Europe.[20]

Formal use of nurses in the modern military began in the latter half of the nineteenth century. Nurses saw active duty in the First Boer War, the Egyptian Campaign (1882)[21] and the Sudan Campaign (1883).[22]

20th century[edit]

Further information: Women in nursing

Hospital-based training came to the fore in the early 1900s, with an emphasis on practical experience. The Nightingale-style school began to disappear. Hospitals and physicians saw women in nursing as a source of free or inexpensive labor. Exploitation of nurses was not uncommon by employers, physicians and educational providers.[23]

Many nurses saw active duty in World War I, but the profession was transformed during the second World War. British nurses of the Army Nursing Service were part of every overseas campaign.[24] More nurses volunteered for service in the US Army and Navy than any other occupation.[25][26] The Nazis had their own Brown Nurses, 40,000 strong.[27] Two dozen German Red Cross nurses were awarded the Iron Cross for heroism under fire.[28]

The modern era saw the development of undergraduate and post-graduate nursing degrees. Advancement of nursing research and a desire for association and organization led to the formation of a wide variety of professional organizations and academic journals. Growing recognition of nursing as a distinct academic discipline was accompanied by an awareness of the need to define the theoretical basis for practice.[29]

In the 19th and early 20th century, nursing was considered a women's profession, just as doctoring was a men's profession. With increasing expectations of workplace equality during the late 20th century, nursing became an officially gender-neutral profession, though in practice the percentage of male nurses remains well below that of female physicians in the early 21st century.[30][31]

Definition[edit]

Although nursing practice varies both through its various specialties and countries, these nursing organizations offer the following definitions:

Nursing encompasses autonomous and collaborative care of individuals of all ages, families, groups and communities, sick or well and in all settings. Nursing includes the promotion of health, prevention of illness, and the care of ill, disabled and dying people. Advocacy, promotion of a safe environment, research, participation in shaping health policy and in patient and health systems management, and education are also key nursing roles.

— International Council of Nurses[32]

The use of clinical judgment in the provision of care to enable people to improve, maintain, or recover health, to cope with health problems, and to achieve the best possible quality of life, whatever their disease or disability, until death.

— Royal College of Nursing (2003) [33]

Nursing is the protection, promotion, and optimization of health and abilities; prevention of illness and injury; alleviation of suffering through the diagnosis and treatment of human responses; and advocacy in health care for individuals, families, communities, and populations.

— American Nurses Association[34]

The unique function of the nurse is to assist the individual, sick or well, in the performance of those activities contributing to health or its recovery (or to peaceful death) that he would perform unaided if he had the necessary strength, will or knowledge.

— Virginia Avenel Henderson[35]

As a profession[edit]

The authority for the practice of nursing is based upon a social contract that delineates professional rights and responsibilities as well as mechanisms for public accountability. In almost all countries, nursing practice is defined and governed by law, and entrance to the profession is regulated at the national or state level.

The aim of the nursing community worldwide is for its professionals to ensure quality care for all, while maintaining their credentials, code of ethics, standards, and competencies, and continuing their education.[32] There are a number of educational paths to becoming a professional nurse, which vary greatly worldwide; all involve extensive study of nursing theory and practice as well as training in clinical skills.

Nurses care for individuals of all ages and cultural backgrounds who are healthy and ill in a holistic manner based on the individual's physical, emotional, psychological, intellectual, social, and spiritual needs. The profession combines physical science, social science, nursing theory, and technology in caring for those individuals.

To work in the nursing profession, all nurses hold one or more credentials depending on their scope of practice and education. In the United States, a licensed practical nurse (LPN) (also referred to as a licensed vocational nurse, registered practical nurse) works independently or with a registered nurse (RN). The most significant differentiation between an LPN and RN is found in the requirements for entry to practice, which determines entitlement for their scope of practice. For example, Canada requires a bachelor's degree for the RN and a two-year diploma for the LPN. A registered nurse provides scientific, psychological, and technological knowledge in the care of patients and families in many health care settings. Registered nurses may earn additional credentials or degrees.

In the United States, multiple educational paths will qualify a candidate to sit for the licensure examination as a registered nurse. The Associate Degree in Nursing (ADN) is awarded to the nurse who has completed a two-year undergraduate academic degree awarded by community colleges, junior colleges, technical colleges, and bachelor's degree-granting colleges and universities upon completion of a course of study usually lasting two years. It is also referred to as Associate in Nursing (AN), Associate of Applied Science in Nursing (AAS), or Associate of Science in Nursing (ASN).[36] The Bachelor of Science in Nursing (BScN) is awarded to the nurse who has earned an American four-year academic degree in the science and principles of nursing, granted by a tertiary education university or similarly accredited school. After completing either the LPN or either RN education programs in the United States, graduates are eligible to sit for a licensing examination to become a nurse, the passing of which is required for the nursing license. The National Licensure Examination (NCLEX) test is a multiple choice exam nurses take to become licensed. It costs two-hundred dollars to take the NCLEX. It examines a nurses ability to properly care for a client. Study books and practice tests are available for purchase.[37]

Nurses may follow their personal and professional interests by working with any group of people, in any setting, at any time. Some nurses follow the traditional role of working in a hospital setting. Other options include: Pediatrics, Neonatal, Maternity, OBGYN, Geriatrics, Ambulatory, or Nurse Anesthetists. There are many other options nurses can explore depending on the type of degree and education acquired. RNs may also pursue different roles as advanced practice registered nurses.

Nurses are not truly doctor's assistants. This is possible in certain situations, but nurses more often are independently caring for their patients or assisting other nurses.[38] Registered Nurses treat patients, record their medical history, provide emotional support, and provide follow-up care. Nurses also help doctors perform diagnostic tests. Nurses are almost always working on their own or with other nurses. Nurses will assist doctors in the emergency room or in trauma care when help is needed.[39]

Gender issues[edit]

Main article: Men in nursing

Despite equal opportunity legislation, nursing has continued to be a female-dominated profession.[40] For instance, the male-to-female ratio of nurses is approximately 1:19 in Canada and the United States.[41][42] This ratio is represented around the world. Notable exceptions include Francophone Africa, which includes the countries of Benin, Burkina Faso, Cameroon, Chad, Congo, Côte d'Ivoire, the Democratic Republic of Congo, Djibouti, Guinea, Gabon, Mali, Mauritania, Niger, Rwanda, Senegal, and Togo, which all have more male than female nurses.[43] In Europe, in countries such as Spain, Portugal, Czech Republic and Italy, over 20% of nurses are male.[43] In the United Kingdom, 11% of nurses and midwives registered with the NMC are male.[44] The number of male-registered nurses in the United States between 1980 and 2000s doubled.[45]

There are many myths about nursing, including the profession and the people that work as a nurse. One of the most common myths is that all nurses are females. The nursing industry is dominated by females, but there are male nurses in the profession as well. A study in 2011 shows that 91% of all nurses in the United States were female, and 9% were male. Although females are more common, male nurses receive the same pay. .[46] Male nurses have the highest percentage as nurse anesthetists, rating at 41%.

Theory and process[edit]

Main articles: Nursing theory and Nursing process

Nursing practice is the actual provision of nursing care. In providing care, nurses implement the nursing care plan using the nursing process. This is based around a specific nursing theory which is selected based on the care setting and population served. In providing nursing care, the nurse uses both nursing theory and best practice derived from nursing research.[47]

In general terms, the nursing process is the method used to assess and diagnose needs, plan outcomes and interventions, implement interventions, and evaluate the outcomes of the care provided. Like other disciplines, the profession has developed different theories derived from sometimes diverse philosophical beliefs and paradigms or worldviews to help nurses direct their activities to accomplish specific goals.

Scope of activities[edit]

Activities of daily living assistance[edit]

Main article: Activities of daily living assistance

Assisting in activities of daily living (ADL) are skills required in nursing as well as other professions such as nursing assistants. This includes assisting in patient mobility, such as moving an activity intolerant patient within bed. For hygiene, this often involves bed baths and assisting with urinary and bowel elimination.

Medication[edit]

Nurses do not have the authority to prescribe medications, with some exceptions. All medications administered by nurses must be from a medication prescription from a licensed practitioner. Nurses are legally responsible for the drugs they administer and there may be legal implications when there is an error in a prescription and the nurse could be expected to have noted and reported error. In the United States, nurses have the right to refuse any medication administration that they deem to be harmful to the patient.[48] In the United Kingdom there are some nurses who have taken additional specialist training that allows them to prescribe certain medications.[49]

Patient education[edit]

See also: Patient education

The patient's family is often involved in the education. Effective patient education leads to fewer complications and hospital visits.[50]

Specialities[edit]

Main article: List of nursing specialties

Nursing is the most diverse of all healthcare professions. Nurses practice in a wide range of settings but generally nursing is divided depending on the needs of the person being nursed.

The major populations are:

  • communities/public
  • family/individual across the lifespan
  • adult-gerontology
  • pediatrics
  • neonatal
  • women's health/gender-related
  • mental health

There are also specialist areas such as cardiac nursing, orthopedic nursing, palliative care, perioperative nursing, obstetrical nursing, oncology nursing, nursing informatics, telenursing.

Practice settings[edit]

Nurses practice in a wide range of settings, from hospitals to visiting people in their homes and caring for them in schools to research in pharmaceutical companies. Nurses work in occupational health settings[51] (also called industrial health settings), free-standing clinics and physician offices, nurse-led clinics, long-term care facilities and camps. They also work on cruise ships and in military service. Nurses act as advisers and consultants to the health care and insurance industries. Many nurses also work in the health advocacy and patient advocacy fields at companies such as Health Advocate, Inc. helping in a variety of clinical and administrative issues.[52] Some are attorneys and others work with attorneys as legal nurse consultants, reviewing patient records to assure that adequate care was provided and testifying in court. Nurses can work on a temporary basis, which involves doing shifts without a contract in a variety of settings, sometimes known as per diem nursing, agency nursing or travel nursing. Nurses work as researchers in laboratories, universities, and research institutions. Nurses have also been delving into the world of informatics, acting as consultants to the creation of computerized charting programs and other software.

Occupational hazards[edit]

Internationally, there is a serious shortage of nurses.[53] One reason for this shortage is due to the work environment in which nurses practice. In a recent review of the empirical human factors and ergonomic literature specific to nursing performance, nurses were found to work in generally poor environmental conditions. Some countries and states have passed legislation regarding acceptable nurse-to-patient ratios.

The fast-paced and unpredictable nature of health care places nurses at risk for injuries and illnesses, including high occupational stress. Nursing is a particularly stressful profession, and nurses consistently identify stress as a major work-related concern and have among the highest levels of occupational stress when compared to other professions. This stress is caused by the environment, psychosocial stressors, and the demands of nursing, including new technology that must be mastered, the emotional labor involved in nursing, physical labor, shift work, and high workload. This stress puts nurses at risk for short-term and long-term health problems, including sleep disorders, depression, mortality, psychiatric disorders, stress-related illnesses, and illness in general. Nurses are at risk of developing compassion fatigue and moral distress, which can worsen mental health. They also have very high rates of occupational burnout (40%) and emotional exhaustion (43.2%). Burnout and exhaustion increase the risk for illness, medical error, and suboptimal care provision.[54]

In the United States, the Occupational Health Safety Network (OHSN) is an electronic surveillance system developed by the National Institute for Occupational Safety and Health (NIOSH) to address health and safety risks among health care personnel, including nurses. It focuses on three high risk and preventable events:

  • Musculoskeletal injuries from patient handling activities;
  • Slips, trips, and falls
  • Workplace violence

Hospitals and other healthcare facilities can upload the occupational injury data they already collect for analysis and benchmarking with other de-identified facilities, in order to identify and implement timely and targeted interventions.[55]

Nurses are also at risk for violence and abuse in the workplace.[56] Violence is typically perpetrated by non-staff (e.g. patients or family), whereas abuse is typically perpetrated by other hospital personnel. 57% of American nurses reported in 2011 that they had been threatened at work; 17% were physically assaulted.[54]

Prevention[edit]

There are a number of interventions that can mitigate the occupational hazards of nursing. They can be individual-focused or organization-focused. Individual-focused interventions include stress management programs, which can be customized to individuals. Stress management programs can reduce anxiety, sleep disorders, and other symptoms of stress. Organizational interventions focus on reducing stressful aspects of the work environment by defining stressful characteristics and developing solutions to them. Using organizational and individual interventions together is most effective at reducing stress on nurses.[54]

Worldwide[edit]

Australia[edit]

Main article: Nursing in Australia

Catholic religious institutes were influential in the development of Australian nursing, founding many of Australia's hospitals – the Irish Sisters of Charity were first to arrive in 1838 and established St Vincent's Hospital, Sydney in 1857 as a free hospital for the poor. They and other orders like the Sisters of Mercy, and in aged care the Sisters of the Little Company of Mary and Little Sisters of the Poor founded hospitals, hospices, research institutes and aged care facilities around Australia.[57][58]

A census in the 1800s found several hundred nurses working in Western Australia during the colonial period of history, this included Aboriginal female servants who cared for the infirm.[59]

The state nursing licensing bodies amalgamated in Australia in 2011 under the federal body AHPRA (Australian Health Practitioner Registration Authority).[60] Several divisions of nursing license is available and recognized around the country.

  • Enrolled nurses may initiate some oral medication orders with a specific competency now included in national curricula but variable in application by agency.
  • Registered nurses hold a university degree (enrolled nurses can progress to registered nurse status and do get credit for previous study)
  • Nurse practitioners have started emerging from postgraduate programs and work in private practice.
  • Mental health nurses must complete further training as advanced mental health practitioners in order to administer client referrals under the Mental Health Act.

Australia enjoys the luxury of a national curriculum for vocational nurses, trained at TAFE colleges or private RTO. Enrolled and registered nurses are identified by the department of immigration as an occupational area of need, although registered nurses are always in shorter supply, and this increases in proportion with specialization.

In 1986 there were a number of rolling industrial actions around the country, culminating when five thousand Victorian nurses went on strike for eighteen days. The hospitals were able to function by hiring casual staff from each other's striking members, but the increased cost forced a decision in the nurses' favor [61]

European Union[edit]

In the European Union, the profession of nurse is regulated. A profession is said to be regulated when access and exercise is subject to the possession of a specific professional qualification. The regulated professions database contains a list of regulated professions for nurse[62] in the EU member states, EEA countries and Switzerland. This list is covered by the Directive 2005/36/EC.

Iran[edit]

Nursing educational program in Iran is similar to the nursing educational program in other countries from some aspects. Holding secondary school diploma and passing the entrance exam is necessary for the admission in this course. Entrance exam to governmental universities and Azad University is held on separate basis. Duration of associate degree course of operating room and anesthesia is 2 years, bachelor's degree in nursing is 4 years and master's degree in nursing is 2- 2.5 years and PhD degree in nursing is 4–5 years.

In the beginning, nursing educational program was the part of medical educational program. On the basis of this structure, the nurse follows the instruction of physician without any question. Nowadays, nursing educational program in Iran has been progressed and after the year 1992 considering the community base care, the nursing educational program also has changed. At present nursing education is held in 43 governmental nursing colleges and 63 nursing colleges of Azad University. Governmental universities' students do not have to pay tuition fee, but in Azad University, which is a private university, the students must pay necessary expenses. The PhD degree program is held only in governmental universities under the supervision of Ministry of Health and Ministry of Sciences.

In bachelor's degree program, nursing students start the clinical work from 2nd term and pass till the completion of 6th term simultaneously with theoretical subjects. 7th and 8th terms are allocated for training program. At present nursing educational program in throughout Iran is the same and is compiled under the supervision of Supreme Council of Ministry of Health, Treatment and Medical Education. Nursing students take the theoretical subjects, training and internship courses in various sections of educational hospitals and hospitals that affiliated to universities. Students' learning, in clinical sections is performed under the direct supervision and guidance of nursing instructors, but in the final year, activities of students mainly performs under the supervision of nursing personnel and alternate supervision of nursing instructors.

Students, during the years of study have opportunity to create relation with patients in the various sections especially intensive care units and to achieve experiences. Students' progress in clinical environments is from simple issues toward harder issues. At present practical nursing degree and associate degree Nursing Program has been canceled and Iranian nurses must hold bachelor's degree to work in Iran from accredited universities confirmed by the Ministry of Health.[63]

Nursing Groups in Iran[edit]

Nurse is a person who is holding four years university degree and executes works relating to nursing profession including taking care of patients, perform health and medical services, educational, research and managerial affairs. At present annually 6000 persons are graduated in the bachelor's degree program in nursing.

A person who is holding secondary school diploma in nursing and have completed 2 years program in nursing and cooperate in activities of nurses in medical sections under the supervision of nurses.

A person who is holding secondary school diploma and passing short term program for the execution of initial cares of patients under the supervision of nurses.

  • Operating Room Technician

These persons after obtaining secondary school diploma and passing university's entrance exam and completing 2 years program are in charge of performing professional duties in operation room for preparing patients for surgery and necessary cooperation with surgeons at the time of surgery. These persons by passing the exam are eligible to continue uncontinuous bachelor's degree course in nursing.

These persons after obtaining secondary school diploma and passing university's entrance exam and completing 2 years program in Anesthesia, are in charge of performing profession duties in the operating room in the field of anesthesia including preparing the patients for anesthesia and necessary cooperation with anesthesiologists at the time of operation. These persons by passing exam are eligible to continue uncontinuous bachelor's degree course in nursing.

  • Emergency medical technician

These persons after obtaining secondary school diploma and passing entrance exam of university and obtaining technician diploma are in change of performing affairs including rendering first aid services to the patients and emergency victims resulting from accidents with motor vehicles, explosion, debris, falling from height, fractures, burns, poisonings, cuts, drowning, industrial accidents (cutting of limbs), patients with heart diseases and baby delivering.

Nurses after obtaining bachelor's degree and passing the entrance exam are eligible to continue their study in geriatric nursing, pediatric nursing, medical surgical nursing, community health nursing, psychiatric nursing and nursing education. These persons after graduation mainly become in charge of nurses' education or management of medical sections. Duration of this program is 2.5 years. At present annually 150 persons are graduated in master's degree program in nursing.

Nurses by holding master's degree after passing entrance exam, are eligible to continue their study in PhD in the field of Nursing. Duration of this program is 4 years and the graduates mainly will work in educational and research sections. At present annually 20 persons are graduated in this program.[64]

Nursing jobs in Iran[edit]

According to the censes at present approximately 120,000 nurses are working in Iran in various sections. Most of them are working in hospitals and health centers belong to Ministry of Health, Treatment & Medical Education. Also, nurses are working in the hospitals affiliated to social security organization, armed forces, private sector and charity sector.

Within the last years of independence, nurses' activities are established in offices of consultancy and rendering nursing services at home. Nurses by establishment these centers can render consultant and care services to the client.

At present to work as a nurse only holding accredited academic degree is sufficient, but there are programs for nurses to take RN examination after graduation.

Also, upon the approval and execution of continuous educational act, the Iranian nurses should obtain score of 15 every year in various educational courses held by the Ministry of Health of Universities, Scientific Associations and Nursing organization.[64]

Iranian Nursing Organization (INO)[edit]

Having an independent organization that defends the rights of nurses and to follow up nurses' problems was the long time wishes of Iranian nurses. Before Islamic revolution in 1979, efforts in this respect finally led to the establishment of the Iranian Nurses Association and activities were taken in this respect. After the victory of Islamic revolution, this association also canceled its activities and after that, number of associations mainly with political and professional formation was established, but the main problem of nurses was still present. Gradually in the year 1994 with the efforts of numbers of persons mostly nursing students and faculty member, the preliminary step was taken for the establishment of nursing organization. This preliminary nucleus started its work in the name of Nursing Coordination council with the instruction of students.

This council had correspondences with the president, speaker of parliament, ministry of health, treatment and medical education in connection with problems of nursing society. Also this organization had correspondence with nursing colleges for unity throughout the country.

After this date till March 2001, a number of state seminars were held in various cities and finally on March 5.2001, generalities of formation of Nursing Organization was entered in the agenda of the Islamic Consultative Assembly, and finally approved in an open session on Aug.12.2001. Finally with the procurement of comments of Guardian's Organization in Jan.2002, Establishment Act of Nursing Organization was approved by the parliament.

The first election of board of directors throughout the country was performed on Sept.20.2002 and members of 85 boards of directors of districts were elected throughout the country with the direct vote of nurses. The board of directors of the first Supreme of Organization, was elected on Dec.8.2002.[65]

United Kingdom[edit]

Main article: Nursing in the United Kingdom

To practice lawfully as a registered nurse in the United Kingdom, the practitioner must hold a current and valid registration with the Nursing and Midwifery Council. The title "Registered Nurse" can only be granted to those holding such registration. This protected title is laid down in the Nurses, Midwives and Health Visitors Act, 1997.[66] From April 2016, nurses in the United Kingdom are expected to revalidate every three years which involves providing evidence of further development and active practice.[67][68]

First and second level[edit]

First-level nurses make up the bulk of the registered nurses in the UK. They were previously known by titles such as registered general nurse (RGN), registered sick children's nurse (RSCN), registered mental nurse (RMN) and registered nurse (for the) mentally handicapped (RNMH). The titles used now are similar, including registered nurse adult (RNA), registered nurse child (RNC), registered nurse mental health (RNMH) and registered nurse learning disabilities (RNLD). Second-level nurse training is no longer provided; however, they are still legally able to practice in the United Kingdom as a registered nurse. Many have now either retired or undertaken conversion courses to become first-level nurses. They are entitled to refer to themselves as registered nurses as their registration is on the Nursing & Midwifery Council register of nurses, although most refer to themselves as ENs or SENs.

Advanced practice[edit]

  • Nurse practitioners – Most of these nurses obtain a minimum of a master's degree, and a desired post grad certificate. They often perform roles similar to those of physicians and physician assistants. They can prescribe medications as independent or supplementary prescribers, although are still legally regulated, unlike physician's assistants. Most NPs have referral and admission rights to hospital specialties. They commonly work in primary care (e.g. GP surgeries), A&E departments, or pediatrics although they are increasingly being seen in other areas of practice. In the UK, the title "nurse practitioner" is legally protected.
  • Specialist community public health nurses – traditionally district nurses and health visitors, this group of research and publication activities.
  • Lecturer-practitioners (also called practice education facilitators) – these nurses work both in the NHS, and in universities. They typically work for 2–3 days per week in each setting. In university, they train pre-registration student nurses (see below), and often teach on specialist courses for post-registration nurses
  • Lecturers – these nurses are not employed by the NHS. Instead they work full-time in universities, both teaching and performing research.

Managers[edit]

Many nurses who have worked in clinical settings for a long time choose to leave clinical nursing and join the ranks of the NHS management. This used to be seen as a natural career progression for those who had reached ward management positions, however with the advent of specialist nursing roles (see above), this has become a less attractive option.

Nonetheless, many nurses fill positions in the senior management structure of NHS organizations, some even as board members. Others choose to stay a little closer to their clinical roots by becoming clinical nurse managers or modern matrons.

Nurse education[edit]

Nursing in the United Kingdom

Pre-registration[edit]

To become a registered nurse, one must complete a program recognised by the Nursing and Midwifery Council (NMC). Currently, this involves completing a degree, available from a range of universities offering these courses, in the chosen branch specialty (see below), leading to both an academic award and professional registration as a 1st level registered nurse. Such a course is a 50/50 split of learning in university (i.e. through lectures, assignments and examinations) and in practice (i.e. supervised patient care within a hospital or community setting).

These courses are three (occasionally four) years' long. The first year is known as the common foundation program (CFP), and teaches the basic knowledge and skills required of all nurses. Skills included in the CFP may include communication, taking observations, administering medication and providing personal care to patients. The remainder of the program consists of training specific to the student's chosen branch of nursing. These are:

  • Adult nursing.
  • Child nursing.
  • Mental health nursing.
  • Learning disabilities nursing.

As of 2013, the Nursing and Midwifery Council will require all new nurses qualifying in the UK to hold a degree qualification.[69] However, those nurses who hold a diploma, or even a certificate in nursing are still able to legally practice in the UK, although they are able to undertake university modules to obtain enough credits to top up to a degree.

Midwifery training is similar in length and structure, but is sufficiently different that it is not considered a branch of nursing. There are shortened (18 month) programs to allow nurses already qualified in the adult branch to hold dual registration as a nurse and a midwife. Shortened courses lasting 2 years also exist for graduates of other disciplines to train as nurses. This is achieved by more intense study and a shortening of the common foundation program.[70]

As of 2016[update] student nurses in England and Wales can apply a bursary from the government to support them during their nurse training, and may also be eligible for a student loan, although there has been speculation that this will not be available in the future.[71] Student nurses in Scotland still receive a standard bursary which is not means tested, and their tuition fees continue to be paid – however, they are not eligible for student loans.

Before Project 2000, nurse education was the responsibility of hospitals and was not based in universities; hence many nurses who qualified prior to these reforms do not hold an academic award.

Post-registration[edit]

After the point of initial registration, there is an expectation that all qualified nurses will continue to update their skills and knowledge. The Nursing and Midwifery Council insists on a minimum of 35 hours of education every three years, as part of its post registration education and practice (PREP) requirements.[72]

There are also opportunities for many nurses to gain additional clinical skills after qualification. Cannulation, venipuncture, intravenous drug therapy and male catheterization are the most common, although there are many others (such as advanced life support), which some nurses undertake.

Many nurses who qualified with a diploma choose to upgrade their qualification to a degree by studying part-time. Many nurses prefer this option to gaining a degree initially, as there is often an opportunity to study in a specialist field as a part of this upgrading. Financially, in England, it was also much more lucrative, as diploma students get the full bursary during their initial training, and employers often pay for the degree course as well as the nurse's salary.[73]

To become specialist nurses (such as nurse consultants, nurse practitioners etc.) or nurse educators, some nurses undertake further training above bachelor's degree level. Master's degrees exist in various healthcare related topics, and some nurses choose to study for PhDs or other higher academic awards. District nurses and health visitors are also considered specialist nurses, and to become such they must undertake specialist training. This is a one-year full-time degree.

All newly qualifying district nurses and health visitors are trained to prescribe from the Nurse Prescribers' Formulary, a list of medications and dressings typically useful to those carrying out these roles. Many of these (and other) nurses will also undertake training in independent and supplementary prescribing, which allows them (as of 1 May 2006) to prescribe almost any drug in the British National Formulary. This has been the cause of a great deal of debate in both medical and nursing circles.[74]

Canada[edit]

Main article: Nursing in Canada

History[edit]

Canadian nursing dates back to 1639 in Quebec with the Augustine nuns.[75] These nuns were trying to open a mission that cared for the spiritual and physical needs of patients. The establishment of this mission created the first nursing apprenticeship training in North America.[75] In the nineteenth century, some Catholic orders of nursing were trying to spread their message across Canada. Most nurses were female and only had an occasional consultation with a physician. Towards the end of the nineteenth century, hospital care and medical services had been improved and expanded. Much of this was due to Nightingale's influence. In 1874 the first formal nursing training program was started at the General and Marine Hospital in St. Catharines in Ontario.[75]

Education[edit]

All Canadian nurses and prospective nurses are heavily encouraged by the Canadian Nurses Association to continue their education to receive a baccalaureate degree. They believe that this is the best degree to work towards because it results in better patient outcomes. In addition to helping patients, nurses that have a baccalaureate degree will be less likely to make small errors because they have a higher level of education. A baccalaureate degree also gives a nurse a more critical opinion, which gives him or her more of an edge in the field. This ultimately saves the hospital money because they deal with less problematic incidents. All Canadian provinces and territories except for the Yukon and Quebec require that all nurses must have a baccalaureate degree.[75] The basic length of time that it takes to obtain a baccalaureate degree is four years. However, Canada does have a condensed program that is two years long.[75]

Nursing specialty certification is available through the Canadian Nurses Association in nineteen practice areas. Some of those specialties are cardiovascular nursing, community health nursing, critical care nursing, emergency nursing, gerontological nursing, medical-surgical nursing, neuroscience nursing, oncology nursing, orthopedic nursing, psychiatric/mental health nursing, and rehabilitation nursing.[75] Certification requires practice experience and passing a test that is based on competencies for that specialty.

Public opinion[edit]

Canadian nurses hold a lot of responsibility in the medical field and are considered vital. According to the Canadian Nurses Association, "They expect RNs to develop and implement multi-faceted plans for managing chronic disease, treating complex health conditions and assisting them in the transition from the hospital to the community. Canadians also look to RNs for health education and for strategies to improve their health. RNs assess the appropriateness of new research and technology for patients and adjust care plans accordingly".

Japan[edit]

Main article: Nursing in Japan

History[edit]

Nursing was not an established part of Japan's healthcare system until 1899 with the Midwives Ordinance.[76] From there the Registered Nurse Ordinance came into play in 1915. This established a legal substantiation to registered nurses all over Japan. A new law geared towards nurses was created during World War II: the Public Health Nurse, Midwife and Nurse Law, established in 1948.[75] It established educational requirements, standards and licensure. There has been a continued effort to improve nursing in Japan. In 1992 the Nursing Human Resource Law was passed.[75] This law created the development of new university programs for nurses. Those programs were designed to raise the education level of the nurses so that they could be better suited for taking care of the public.

Types of nurses[edit]

Japan only recognizes four types of nursing and they are Public Health Nursing, Midwifery, Registered Nursing and Assistant Nursing.

Public health[
Florence Nightingale was an influential figure in the development of modern nursing. No uniform had been created when Nightingale was employed during the Crimean War. Often considered the first nurse theorist, Nightingale linked health with five environmental factors:(1) pure or fresh air, (2) pure water, (3) efficient drainage, (4) cleanliness, and (5) light, especially direct sun light. Deficiencies in these five factors resulted in lack of health or illness.[14] Both the role of nursing and education were first defined by Nightingale.
A recruiting poster for Australian nurses from World War I
A nurse in Indonesia examining a patient
A nurse at Runwell Hospital, Wickford, Essex, in 1943
A video describing occupational hazards that exist among nurses
 

󰁇󰁆󰁎󰁌 󰁅󰁁 󰁌󰁐󰁆󰁎󰀿

󰁍󰁫󰁩󰁬󰁧󰁹󰁼󰁺󰁬 󰁌󰁰󰁦󰁮󰁫󰁧󰁦󰁲󰁫󰁥󰁧 󰁡󰁥󰁺 󰁚󰁎󰁌

󰁂󰁆󰁒󰁌 󰁅󰁁 󰁌󰁐󰁆󰁎󰀿

󰁙󰁬󰁴󰁲󰁬󰁮󰁪󰁬󰁺 󰀰, :46󰀲

󰁔󰁍󰁆󰁉󰁌 󰁅󰁁 󰁌󰁐󰁆󰁎󰀿

󰁒󰁬󰁦󰁩󰁠󰁬󰁺󰁹 󰁉󰁦󰁮󰁴󰀮󰁖󰁼󰁫󰁺󰁫󰁧󰁥 󰁀󰁦󰁭󰁭

󰁆󰁂󰁂󰁚󰁌󰁙󰁙󰀿

󰁍󰁬󰁥󰁧󰁦󰁺󰁢 󰁘󰁥󰁥󰁢 󰁚󰁢., 󰁒󰁬󰁦󰁩󰁠󰁬󰁺󰁹 󰁉󰁦󰁮󰁴, 󰁊󰁦󰁨󰁼󰁫󰁥 󰁉󰁫󰁲󰁻

󰁁󰁍󰁅󰁅󰁚󰀿

 6󰁹󰁲

󰁈󰁚󰁅󰁜󰁔 󰁇󰁅󰀿

6

󰁇󰁥. 󰁍󰁆󰁙󰁒 󰁇󰁆󰁎󰁌 󰁁󰁋󰁚󰁙󰁒 󰁇󰁆󰁎󰁌 󰁎󰁋󰁂󰁂󰁍󰁌 󰁇󰁆󰁎󰁌 󰁙󰁩󰁠󰁥󰁥󰁭 󰁈󰁺󰁦󰁢󰁼󰁦󰁲󰁬󰁢 󰁁󰁺󰁥󰁮

6󰁆󰁊󰁌󰁍󰁍󰁌󰁚󰁆 󰁙󰁆󰁎󰁙󰁅󰁇 󰁇󰁆󰁂󰁍󰁆󰁇󰁈

󰁂󰁅󰁇 󰁎󰁆󰁚󰁋󰁆󰁇󰁅 󰁎󰁆󰁚󰁉󰁅󰁙 󰁎󰁌󰁎󰁅󰁚󰁋󰁆󰁍 󰁙󰁒󰁆󰁒󰁌 󰁜󰁇󰁋󰁑󰁌󰁚󰁙󰁋󰁒󰁛󰀮󰁙󰁆󰁇 󰁁󰁌󰁚󰁇󰁆󰁇󰁂󰁅

:󰁆󰁉󰁍󰁋󰁊󰁅󰁇 󰁏󰁅󰁌󰁍 󰁍󰁜󰁋󰁙

󰁙󰁌󰁉󰁅󰁇󰁂󰁆󰁚󰁛 󰁙󰁉󰁀󰁅󰁅󰁍

󰀹󰁆󰁉󰁍󰁋󰁊󰁅󰁇 󰁚󰁆󰁎󰁋󰁌 󰁈󰁜󰁎󰁆󰁒󰁋󰁇

󰁂󰁅󰁇 󰁎󰁆󰁚󰁋󰁆󰁇󰁅 󰁎󰁆󰁚󰁉󰁅󰁙 󰁎󰁌󰁎󰁅󰁚󰁋󰁆󰁍 󰁙󰁒󰁆󰁒󰁌 󰁜󰁇󰁋󰁑󰁌󰁚󰁙󰁋󰁒󰁛󰀮󰁙󰁆󰁇 󰁁󰁌󰁚󰁇󰁆󰁇󰁂󰁅

󰀲󰁆󰁈󰁆󰁙󰁌󰁇 󰁚󰁌󰁇󰁆󰁒󰁅 󰁊󰁆󰁍󰁂󰁅

󰁊󰁆󰁈󰁜󰁋󰁅 󰁉󰁌󰁇󰁒󰁚󰁆󰁍 󰁜󰁇󰁋󰁑󰁌󰁚󰁙󰁋󰁒󰁛

󰀼󰁆󰁈󰁅󰁂󰁋󰁍󰁍󰁆 󰁎󰁆󰁇󰁜󰁌󰁍 󰁎󰁆󰁂󰁚󰁋󰁆󰁈󰁆

󰁂󰁅󰁇 󰁎󰁆󰁚󰁋󰁆󰁇󰁅 󰁎󰁆󰁚󰁉󰁅󰁙 󰁎󰁌󰁎󰁅󰁚󰁋󰁆󰁍 󰁙󰁒󰁆󰁒󰁌 󰁜󰁇󰁋󰁑󰁌󰁚󰁙󰁋󰁒󰁛󰀮󰁙󰁆󰁇 󰁁󰁌󰁚󰁇󰁆󰁇󰁂󰁅

󰀱󰁆󰁍󰁉󰁆󰁇󰁒󰁚󰁆 󰁊󰁌󰁚󰁇󰁆󰁚󰁂󰁅 󰁜󰁈󰁆󰁍󰁂󰁌

󰁉󰁌󰁇󰁒󰁚󰁆󰁍 󰁋󰁍󰁅󰁉󰁆󰁇󰁂󰁋󰁆 󰁉󰁅󰁍󰁍󰁌󰁈󰁌 󰁅󰁁 󰁙󰁉󰁋󰁌󰁇󰁉󰁌 & 󰁒󰁌󰁉󰁀󰁇󰁅󰁍󰁅󰁈󰁛

󰀸󰁆󰁍󰁋󰁉󰁅󰁈 󰁚󰁆󰁜󰁍 󰁍󰁋󰁇󰁒󰁅

󰁑󰁅󰁉󰁆󰁒󰁋󰁅󰁇󰁆󰁍 󰁙󰁉󰁀󰁅󰁅󰁍

󰀰󰁆󰁎󰁊󰁚󰁅󰁙󰁋󰁅 󰁀󰁆󰁚󰁅󰁍󰁂 󰁂󰁌 󰁈󰁜󰁟󰁎󰁆󰁇

󰁜󰁇󰁋󰁑󰁌󰁚󰁙󰁋󰁒󰁛 󰁅󰁁 󰁍󰁜󰁟󰁅󰁇 (󰁍󰁜󰁟󰁅󰁇 󰁉󰁅󰁍󰁍.)

󰀻󰁆󰁎󰁋󰁙󰁅󰁍󰁆 󰁊󰁌󰁇󰁏󰁆󰁎󰁋󰁇 󰁉󰁆󰁙󰁒󰁆󰁇󰁌󰁂󰁆

󰁜󰁇󰁋󰁑󰁌󰁚󰁙󰁋󰁒󰁛 󰁅󰁁 󰁊󰁆󰁈󰁜󰁋󰁅

64󰁆󰁇󰁉󰁀󰁌󰁒󰁆 󰁏󰁆󰁇 󰁎󰁋󰁉󰁀󰁆󰁌󰁍 󰁒󰁆󰁇

󰁜󰁇󰁋󰁑󰁌󰁚󰁙󰁋󰁒󰁛 󰁅󰁁 󰁊󰁆󰁈󰁜󰁋󰁅

66󰁆󰁇󰁂󰁆󰁍 󰁏󰁆󰁙󰁅󰁇 󰁆󰁇󰁒󰁋󰁖󰁜󰁋󰁇󰁆

󰁂󰁅󰁇 󰁎󰁆󰁚󰁋󰁆󰁇󰁅 󰁎󰁆󰁚󰁉󰁅󰁙 󰁎󰁌󰁎󰁅󰁚󰁋󰁆󰁍 󰁙󰁒󰁆󰁒󰁌 󰁜󰁇󰁋󰁑󰁌󰁚󰁙󰁋󰁒󰁛󰀮󰁙󰁆󰁇 󰁁󰁌󰁚󰁇󰁆󰁇󰁂󰁅

6:󰁆󰁇󰁂󰁆󰁛󰁆 󰁃󰁌󰁇󰁏󰁋󰁌 󰁒󰁆󰁎󰁋󰁇󰁆󰁛󰁆

󰁔󰁀󰁋󰁍󰁋󰁔󰁔󰁋󰁇󰁌 󰁉󰁅󰁍󰁍󰁌󰁈󰁌 󰁅󰁁 󰁙󰁉󰁋󰁌󰁇󰁉󰁌 & 󰁒󰁌󰁉󰁀󰁇󰁅󰁍󰁅󰁈󰁛󰀮󰁉󰁆󰁍󰁆󰁙󰁋󰁆󰁅

6󰀹󰁆󰁇󰁈󰁌󰁍󰁌󰁙 󰁚󰁅󰁘󰁌󰁍󰁍 󰁔󰁆󰁇󰁋󰁇󰁈󰁊󰁆󰁒󰁆󰁇

󰁔󰁀󰁋󰁍󰁋󰁔󰁔󰁋󰁇󰁌 󰁉󰁅󰁍󰁍󰁌󰁈󰁌 󰁅󰁁 󰁙󰁉󰁋󰁌󰁇󰁉󰁌 & 󰁒󰁌󰁉󰁀󰁇󰁅󰁍󰁅󰁈󰁛󰀮󰁉󰁆󰁍󰁆󰁙󰁋󰁆󰁅

6󰀲󰁆󰁇󰁋󰁌󰁑󰁆󰁙 󰁚󰁆󰁛󰁎󰁜󰁇󰁂󰁅 󰁂󰁋󰁟󰁅󰁇

󰁙󰁆󰁋󰁇󰁒 󰁍󰁅󰁜󰁋󰁙 󰁜󰁇󰁋󰁑󰁌󰁚󰁙󰁋󰁒󰁛

6󰀼󰁆󰁇󰁇󰁆󰁈󰁜󰁌 󰁚󰁋󰁉󰁀󰁋󰁌 󰁆󰁇󰁉󰁀󰁌󰁒󰁆

󰁂󰁅󰁇 󰁎󰁆󰁚󰁋󰁆󰁇󰁅 󰁎󰁆󰁚󰁉󰁅󰁙 󰁎󰁌󰁎󰁅󰁚󰁋󰁆󰁍 󰁙󰁒󰁆󰁒󰁌 󰁜󰁇󰁋󰁑󰁌󰁚󰁙󰁋󰁒󰁛󰀮󰁙󰁆󰁇 󰁁󰁌󰁚󰁇󰁆󰁇󰁂󰁅

6󰀱󰁆󰁔󰁅󰁙󰁒󰁅󰁍 󰁏󰁆󰁙󰁔󰁌󰁚 󰁏󰁌󰁁󰁁 󰁑󰁆󰁍󰁍󰁅

󰁔󰁀󰁋󰁍󰁋󰁔󰁔󰁋󰁇󰁌 󰁉󰁅󰁍󰁍󰁌󰁈󰁌 󰁅󰁁 󰁙󰁉󰁋󰁌󰁇󰁉󰁌 & 󰁒󰁌󰁉󰁀󰁇󰁅󰁍󰁅󰁈󰁛󰀮󰁉󰁆󰁍󰁆󰁙󰁋󰁆󰁅

6󰀸󰁆󰁚󰁈󰁜󰁌󰁍󰁍󰁌󰁙 󰁈󰁌󰁇󰁇󰁋󰁌 󰁁󰁆󰁏󰁆󰁚󰁂󰁅

󰁙󰁆󰁋󰁇󰁒 󰁍󰁅󰁜󰁋󰁙 󰁜󰁇󰁋󰁑󰁌󰁚󰁙󰁋󰁒󰁛

6󰀰󰁆󰁚󰁋󰁟 󰁂󰁋󰁅󰁙󰁂󰁆󰁂󰁅 󰁂󰁜󰁉󰁜󰁙󰁋󰁇

󰁂󰁅󰁇 󰁎󰁆󰁚󰁋󰁆󰁇󰁅 󰁎󰁆󰁚󰁉󰁅󰁙 󰁎󰁌󰁎󰁅󰁚󰁋󰁆󰁍 󰁙󰁒󰁆󰁒󰁌 󰁜󰁇󰁋󰁑󰁌󰁚󰁙󰁋󰁒󰁛󰀮󰁙󰁆󰁇 󰁁󰁌󰁚󰁇󰁆󰁇󰁂󰁅

6󰀻󰁆󰁚󰁚󰁆󰁏󰁌 󰁍󰁌󰁙󰁒󰁌󰁚 󰁂󰁌󰁂󰁅󰁎󰁅

󰁔󰁀󰁋󰁍󰁋󰁔󰁔󰁋󰁇󰁌 󰁉󰁅󰁍󰁍󰁌󰁈󰁌 󰁅󰁁 󰁙󰁉󰁋󰁌󰁇󰁉󰁌 & 󰁒󰁌󰁉󰁀󰁇󰁅󰁍󰁅󰁈󰁛󰀮󰁉󰁆󰁍󰁆󰁙󰁋󰁆󰁅

:4󰁆󰁘󰁋󰁇󰁈󰁆󰁇 󰁚󰁜󰁙󰁒󰁅󰁎 󰁈󰁅󰁇󰁂󰁅

󰁊󰁆󰁈󰁜󰁋󰁅 󰁙󰁉󰁀󰁅󰁅󰁍 󰁅󰁁 󰁊󰁜󰁙󰁋󰁇󰁌󰁙󰁙 󰁒󰁌󰁉󰁀󰁇󰁅󰁍󰁅󰁈󰁛

:6󰁆󰁛󰁆󰁇 󰁙󰁋󰁈󰁚󰁆󰁂󰁌 󰁊󰁆󰁇󰁋󰁒󰁅

󰁙󰁆󰁋󰁇󰁒 󰁍󰁅󰁜󰁋󰁙 󰁜󰁇󰁋󰁑󰁌󰁚󰁙󰁋󰁒󰁛

󰁋󰁎󰁔󰁅󰁚󰁒󰁆󰁇󰁒 󰁚󰁌󰁎󰁋󰁇󰁂󰁌󰁚󰁙󰀿

6. 󰁑󰁌󰁚󰁋󰁁󰁛 󰁛󰁅󰁜󰁚 󰁆󰁔󰁔󰁍󰁋󰁉󰁆󰁒󰁋󰁅󰁇 󰁇󰁜󰁎󰁊󰁌󰁚 󰁅󰁇 󰁒󰁀󰁌 󰁂󰁆󰁛 󰁅󰁁 󰁌󰁐󰁆󰁎󰁋󰁇󰁆󰁒󰁋󰁅󰁇 󰁁󰁚󰁅󰁎 󰁒󰁀󰁌 󰁚󰁅󰁅󰁎 󰁘󰁆󰁒󰁉󰁀󰁌󰁚󰁙/󰁔󰁚󰁅󰁉󰁒󰁅󰁚󰁙 󰁆󰁙󰁙󰁋󰁈󰁇󰁌󰁂 󰁋󰁇 󰁛󰁅󰁜󰁚 󰁚󰁅󰁅󰁎.:. 󰁊󰁌 󰁔󰁜󰁇󰁉󰁒󰁜󰁆󰁍, 󰁚󰁌󰁔󰁅󰁚󰁒 󰁒󰁅 󰁛󰁅󰁜󰁚 󰁊󰁜󰁋󰁍󰁂󰁋󰁇󰁈 / 󰁚󰁅󰁅󰁎 󰁆󰁙󰁙󰁋󰁈󰁇󰁎󰁌󰁇󰁒 󰁊󰁌󰁁󰁅󰁚󰁌 󰀱󰀿󰀹4 󰁆󰁎. 󰁍󰁆󰁒󰁌 󰁌󰁐󰁆󰁎󰁋󰁇󰁌󰁌󰁙 󰁘󰁋󰁍󰁍 󰁇󰁅󰁒 󰁊󰁌 󰁆󰁂󰁎󰁋󰁒󰁒󰁌󰁂.

󰁊󰁜󰁋󰁍󰁂󰁋󰁇󰁈󰀿

 󰁖󰁼󰁫󰁺󰁫󰁧󰁥 󰁀󰁦󰁭󰁭