skh april 2015

Samaja Karyada Hejjegalu Vol. V, No-2, April 2015 -

SAMAJAKARYADAHEJJEGALU

SOCIAL WORK FOOT-PRINTS

A Peer Reviewed Quarterly Social Work Journal

Copyright : SAMAJAKARYADA HEJJEGALU

Contentsjr

1. Editors Desk - 121Ramesha M.H.

2. Evolution of Nursing as a Profession - 123K. Prabakar

3. Sustainability and Social Work - 149T.K.Nair

4. Family Relations in Living Arrangementsand the Quality of Life of Older Persons - 167

Smita Bammidi5. Organ Shortage Crisis and Health Care :

Revisiting the Challenges and Prospects - 187Abdul Azeez E.P.

6. Rights of Rural Children from ProtectionPerspective - 201

N.V. Vasudeva Sharma7. Olinda Pereira Karnatakas Social Works

Finest IconMAq gg PlP idPAi PvzdAig - 211

Ramesha M.H.8. AzQAi - 219

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Editors Desk

Samajakaryada Hejjegalu (Social Work Journal) is in its fifthyear of publication and the present issue contains five Englisharticles, three Kannada articles and one bi-lingual feature on aprominent social worker. Perhaps this is the only journal inIndiawhich has peer-reviewed regional language articles. Fromthis issue , the journal proposes to have a feature on a womansocialworker of eminence.

Evolution of Nursing asa Profession by K. Prabakar tracesthe historicaldevelopment of nursing as a profession in differentsocieties. The article discusses the professional characteristics ofnursingand the personality requirements of a nurse. Professionalaccountability and professional ethics of nurses are examined indetail by Prabakar. The article concludes with the development ofnursing in India. The article will be of great use toall humanservice professionals and students in these fields of practice.

April 22is World Earth Day and hence it is appropriate tohave an article on Sustainability and Social Work by T.K.Nairin the April issue. The article has three sections. In the first section,the author presents briefly the elements of Planet Earth and theenvironmental destruction that has been taking place for decades.Part two is a summary of the famous book LivingPathwayswritten by M. Nadarajah, a former student and nowaclose associate of T.K.Nair. In the third section, Nair criticallyanalyses the poor response of social work profession to theenvironmental crisis engulfing humanity.

Smita Bammidis research-based article Family RelationsinLiving Arrangements and the Quality of Life of Older Personsexplains that Living Arrangement (LA ) is a basic determinantand an indicator of the care and nature of informal supportsavailable to the old persons in their families and therefore theirQuality of Life (QOL). Smitas study is a departurefrom the usualstudies on the situation of the elderly in India. An interestingfinding of Smita is that son is the hardest person to live with or toget along with in the households followed by the daughter-in-law.

Emergence of medical technology for human organ transplantis one of the crucial elements in maintaining health and in

Ramesha M.H. Editors Desk

sustaining life. Though the technology is getting more and moreadvanced, the difficulty in securing the needed organs in time hasbeen a major constraint. The large gap between demand and supplyof organs is a threat for the survival of many patients in criticalcondition in the country. The article Organ Shortage Crisis andHealth Care : Revisitingthe Challenges and Prospects by AbdulAzeez is timely and very significant.

Children constitute 39 per cent of the total population in Indiaand about three-quarters of the child population are in rural areas.N.V.Vasudeva Sharma,in his article Rights of Rural Childrenfrom ProtectionPerspective, writesthat most of the rights of ruralchildren are violated. He adds that there is an urgent need for theappropriate district levelstatutory juvenile justice body to act onthe poor or non-implementation of the different measures initiatedby the state and central governments.

Progress of Higher Education in India : An Overview byGovindaraju analyses the structure and growth of higher educationinstitutions, gross enrolment rates , andteacher-student ratio,among other aspects. Research and development issues andchallenges in the Indian higher education system are discussedcriticallyby Govindarajuin this article.

S.S.Madivalar and R.Devaraj describethe developmentworkof NIVRUTH Trust in the article Improving the Livelihoods ofSmall Farmers through Dairy Farming and the Role of anOrganisation: A Study of VarkoduVillage in Mysore District.The article concludes that if the smallfarmers, particularly thewomen, engage themselves in dairy farming and fodder cultivation,there could be good improvement in their quality of life.

Sex workers are a highly exploited and neglected group ofwomen in Indian society. B.Bharati, in the article Tradition andCommercialisation of Sexual Exploitation, makes an attempt tounderstand the different dimensions of traditions in the sexualexploitation of women and the ruthlesscommercialisation of theirservice or trade.

Dr. Olinda Periera , outstandingsocial work educator andhuman service practitioner, has been chosen by the advisory boardof Samajakaryada Hejjegalu as the first social worker to be featuredin the new initiative of the journal. Dr.Henry J DDouza, Professorof Social Work atthe University of Omaha, pays glowing tributeto his and his wifes mentor in the feature.

Ramesha M.H.Editor

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Evolution of Nursing as a ProfessionK. Prabakar

Dr. K. PrabakarCEO, Apollo Knowledge, Chennai

AbstractThe article traces the evolution of nursing as a globally

recognizedprofession from an intuitive art in the homes. Thehistorical development of nursing by Egyptians, Greeks, Romans,Chinese, Hindus, Christians, and Arabs is discussed. Nursing in themodern era, with its low and high points, and the contribution ofFlorence Nightingale as the turning point in the development andrecognition of nursing arealso examined in the article. Theprofessional characteristics of nursing, the personal qualitiesneededfor a professional nurse, code of ethics, and professionalaccountability are the other key components of the article.

Nursing evolved as an intuitive response to the desire to keeppeople healthy as well as to provide comfort and assurance to thesick. The essence of this desire was reflected in the caring, comforting,nourishing and cleansing the patients by the care givers. Simpleprocedures for the care of the sick were adopted, skills in practisingthese remedies were improved, and knowledge of the efficient systemwas passed on from one generation to another. Beginning as anart in the homes where a member of the family cared for the sick,it has today developed as a highly skilled service to meet the healthneeds of the community and society, and a professional service toprevent illness as well as to care for the sick.

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K. Prabakar Evolution of Nursing as a Profession

Historical BackgroundIt is extremely difficult to trace how prehistoric society dealt with

their sick. One of the earliest evidences of compassion for the sickcomes from the Neanderthal stage of human evolution (about1,00,000 years back). From one of the burials of an old man, it isseen that the old man has suffered a bone deformation cripplinghim. Palaeontologists say that the old man lived long after he wascrippled and his death was not due to this deformity. Obviously hecould not have survived without being a good hunter. With thedeformity he could not have hunted. He must have been lookedafter by others of his group.

The study of various civilizations provides an insight into theconcept of health and health care practised in different societies.The civilization of Mesopotamia believed that health care wasreligion-oriented. The practitioners were herb doctors, knife doctorsand spell doctors equivalent to the present day intensivists, surgeonsand psychiatrists.

The Egyptians believed that medicine was divine and the personin-charge was the priest physician. The priest was elevated to therank of God, temples were built in his name and the sick peoplewere taken to the site for healing. The Egyptians developed the artof embalming the body after the death for preserving the same inthe pyramids.

The Greeks also considered medicine as divine. Apollo, the SunGod, was considered the God of medicine. The dynasties of curativemedicine and preventive medicine came into existence. Priestphysicians were in-charge of the temples and the sick people werebrought to the temples and kept for relief. The greatest Greekphysician Hypocrites studied and classified diseases based onobservation and reasoning. He challenged the tradition of magicin medicine and initiated a new approach by applying clinicalmethods in medicine. Greeks rejected the supernatural theory ofdisease and looked upon disease as a natural process.

The contribution of Romans was mainly in the field ofcomparative anatomy and experimental physiology. The greatestRoman medical teacher Galen felt that health preceded disease and

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hence it was important to preserve health first, before working onthe factor of cure.

The Chinese medicine is acclaimed to be the worlds firstorganized body of medical knowledge dating back to 2700 BC.This is based on two principles: The Yang and the Yin, Yang is theactive masculine principle and the Yin is the negative feminineprinciple. The balance of these opposing forces meant good health(Dolon, 1973). The Chinese had great faith in their traditionalmedicine and it was fully integrated with modem medicine. TheChinese developed the art of acupuncture and this was considereda universal panacea.

The earliest contribution of ancient Hindu society to medicineis reflected in the vedas. Out of the four vedas, the Atharva-vedacontained innumerable incantations and charms for diseases, anddiscourses on injuries, sanity, health and fertility. Among thesecompendiums of ancient knowledge was Ayur-veda (Ayur meanslife and Veda means knowledge) or the science of life. In ancientIndia, the celebrated authorities in Ayurvedic medicine were Atreya,Charaka, Susruta and Vaghbatt, The practitioners of ayurvedasubscribe to the Tridosha theory of disease. The doshas or humorsare Vata (wind), Pitta (gall) and Kapha (mucus). Disease wasexplained as a disturbance in the equilibrium of the three humors.When there is a balance and harmony between these three, the personis said to be healthy (Park, 1996).

The contributions of the civilizations reflect a high degree ofempiricism, and scientific observation in the clinical role of thedoctors. However, there was no identifiable nurse or organizationof nurses other than the continued role of the individualcompassionate nurse figure - the mother. Though there was asignificant progress in the field of medicine the contribution to thefield of nursing was almost nil during this phase.

From the moment the significance of Christs teachings penetratedthe thinking of the early Christians, special places were set aside intheir homes for hospitality and the care of the sick. These werecalled Christrooms, showing a literal interpretation of the words ofChrist. These rooms whether in the home of a bishop, deaconess orother person, were called diakonia. Xenodochia was the name given

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to the shelters built for the sick and poor pilgrims, and nosocomiawas the name given to hospitals built by St. Zoticus inConstantinople during the reign of Emperor Constantine. TheChristian Bishop St. Basil built up a Xenodochiam called Basiliasin Caesarea in Palestine (Dolon, 1973).

The early Christian period (till 500 AD) created a base to nurturenursing. Charity and love in action based on the teachings of Christwere apparent in nursing which took root during this period. Thefirst organized visiting the sick began with the establishment of theorder of Deaconesses and they endeavoured to practise corporalworks of mercy. This work included the basic human needs such asto feed the hungry, to give water to the thirsty, to clothe the naked,to visit the imprisoned, to shelter the homeless, to care for the sick,and to bury the dead. Charity was considered as the greatest socialreform during that period.

After the order of Deaconess, a group of noble Roman matronsdistinguished themselves in the field of nursing. They were womenof wealth, intelligence and social leadership. They founded hospitals,convents and monasteries and worked for the good of others. Thesenurses were not just comforters, but they were also nurturers,observers, listeners, counsellors, and teachers, and gave care to thepatient and the family. These intellectually and socially skilled leadersidentified the basic ingredients of nursing care through carefulassessment of needs. They realized the dependency of the acutelyill patients upon their nurse for vital life processes.

The nurses role of healer as well as builder of health was achievedby cleaning up the filth and squalor, and by rectifying humanindignities and degradation. Nurses, in effect, were early socialreformers. The site of health delivery occurred where the need existed- in the community, in the hospital, in the home, in the hostel of apilgrim, and in a home for the elderly. The nurses during this periodwere motivated by a strong spiritual force and were independentpractitioners.

With the fall of the Roman Empire the medical schools establishedduring that period disappeared. Europe was devastated by variousdiseases like plague, smallpox, leprosy, and TB. The practice ofmedicine reverted back to the primitive medicine dominated by

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superstitions and dogma. Glorification of spirits became the acceptedpattern of behaviour. Dissection of the human body for medicalresearch was prohibited. There was no progress of medicine in thisperiod. This period is therefore called the Dark ages of medicine(Park, 1996).

During the middle ages religious institutions helped in preservingthe ancient knowledge, at the same time rendered active medicaland nursing care. The middle age was quite turbulent and the worldchanged politically to a great extent. During the medieval timesthere was a rise and fall of feudalism in Europe and this had a greateffect on the common man. It was a time of famine accompaniedby miseries and serious illness. Though medical care and nursingcare were needed these were not available to them. However,feudalism gradually disappeared in the 13th century.

This period also saw the establishment of hospitals. The firsthospital on record in England was built in York in 937 AD and achain of hospitals came up from Persia to Spain. Early medievalhospitals rarely specialised in the treatment of the sick; On thecontrary, the sick were received for catering to their bodily wantsand spiritual needs. The monasteries during this period gaveopportunities for women to pursue a career in which they couldsatisfy their intellectual and spiritual aspirations, and develop nursingskills (Park, 1996). At the close of the middle ages there were hospitalsall over Europe.

When Europe was passing through the Dark Age, the Arabstook over the rest of the civilization, They translated the Graeco -Roman medical literature into Arabic. They developed their ownsystem of medicine by borrowing largely from Greeks and Romans,and the new system they developed was called the Unani system ofmedicine, They founded schools of medicine and hospitals inBaghdad, Demascus, Cairo and other cities. Leaders in arabicmedicine were the Persians. The greatest contribution of Arabs wasin the field of Pharmacology as they introduced a large number ofdrugs both herbal and chemical. They invented the art of writingprescriptions and introduced a wide range of syrups, oils, pills,powders, and aromatic waters. The Golden age of Arabic medicinewas between 800 -1300 AD (Park, 1996).

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During the renaissance many medical and nursing schools werestarted. The period witnessed nurses, both women and men,providing nursing care to people of all ages in a variety of settings.Nurses expanded their role while continuing to use intellectual skillsand judgments in the execution of physical as well aspsychological nursing care (Dolon, 1973).

Nursing sank to its lowest level in the countries in which Catholicorganizations were banned. The state closed churches and therewas little provision for the institutional care of the sick. When thedemand became great, lay persons were made to run the hospitalsbecause of social necessity. There was no honour to work in ahospital. Nursing lost its social standing. Nurses at that time weremostly recruited from lower classes. The low status of women inthe social structure also contributed to this situation. The CatholicChurch gave women more freedom and opportunity to move aboutin the world. The Protestant church did not think much of freedomfor women and the nursing services. Many women were assignednursing duties in lieu of serving jail sentences (Rao, 1996). ThisDark Period of Nursing between 1550 - 1850 saw nursingconditions at their worst. Nursing was of a very poor standard dueto the poor salary and miserable living conditions of the nurses.The work places also contributed to the depressing situation andnursing work was considered to be the most menial. These poorconditions made women feel that there was no future for them asnurses. Due to these factors there was a rapid deterioration in thecare of the sick. After the counter reformation (Catholic revival)through the Society of Jesuits founded by Ignatius Loyala, aSpanish noblemen, religious orders were reopened and they triedto bring back some of the traditions. Some humanitarians like St.Vincent De Paul, John Howard, and Charles Dickens did much torelieve the depressing situation during that time (Rao, 1996).

Eighteenth century also witnessed notable achievements inconquering certain diseases, devising diagnostic equipments,developing humane treatment for the mentally ill and expandingthe basis for chemistry and physics (Dolon, 1973).

Nineteenth century was marked by the demand for liberation ofwomen who were forced to live a life without educational and



career opportunities. However, leadership of great women like SusanB Anthony, Elizabeth Blackwell and Florence Nightingale wasremarkable. They created history in their areas of operation. SusanAnthony fought for the rights of women for higher education andan opportunity to practice profession. Elizabeth Blackwell struggledto gain admission to medical school and finally she gained thedegree of doctor of medicine. She was responsible for founding theWomens Medical College of the New York Infirmary for Womenand Children (Dolon, 1973).

The social reformers of the early nineteenth century had focusedattention on the plight of the poor and on the needs for reform inprisons, hospitals and nursing. Leadership in the social aspects ofliving and in nursing was needed. The person who responded tothis exigency was Florence Nightingale who cannot be consideredas the product of her time but rather must be regarded as one ofthose rare and gifted people who transcend the period of their ownexistence, and whose plans and accomplishments represent thethinking of a much later period of history (Dolon, 1973).

Florence Nightingale was born on 12th May 1820 at Florencein Italy. After her education, she became interested in politics andthe social conditions of the people. She felt she had a special purposefor her life. She decided to take up nursing. In this journey, shebecame familiar with the nursing of Roman Catholic sisterhoodand American missionaries. She felt the need for systematic trainingfor nursing. She took up a nursing programme in 1847 inKaiserworth and completed it. She considered it as her spiritualhome and once again studied nursing under the Sisters of Charityat Maisondela providence. After returning to London, Nightingalesfirst position was the Superintendent of the Establishment for GentleWomen during illness. She planned for the patients and the doctorswith great skill, and was successful. Within a short time she wasasked to become the superintendent of nurses at Kings CollegeHospital where she began her work. She was called to go to Crimeawith a mission of mercy to help the wounded soldiers of the Crimeanwar.

At that time when schools of nursing were unknown sheassembled her staff in less than a week. She had in her group 38

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nurses. Nightingale and her 38 nurses were given charge of 1500patients at the Barrack hospital. The hospital conditions wereextremely poor. The death rate was 42%. In two months, she hadtransformed the hospital into an efficiently managed institution. Insix months she had reduced the death rate to 2% and had won therespect of most surgeons. She utilised scientific methods of gatheringdata and was skilled as a statistician presenting the factual evidencein the most graphic way. Doctor Winslow referred to her as theLady with the Slide Rule as well as a Lady with the Lamp ofcompassion (Dolon, 1973).

It should be noted that Florence Nightingale made very clearthe distinction between persons professionally qualified for thepractice of nursing, and the knowledge essential for every womanwho can be called at any time to render nursing service in someform. Students today marvel at the current pertinence of these basicprinciples of good nursing care and how clearly Nightingaledelineated the role of identification for nurses. Florence Nightingalewas not interested in simply keeping people alive; she stressed thatNursing is helping people to live.

The Nightingale Training School for Nurses, which opened in1860, was a completely independent educational institution. Thesize of the classes was small which permitted a high degree ofselectivity with only 15 to 30 students. In 1865 Florence Nightingalecontributed two books on nursing in a community setting.Nightingale helped in founding the first Community NursingAssociation in Liverpool.

There were two major components to nursing in her thinking :sick nursing and health nursing. This involved the preservationof wellness as well as the care of illness. She said that nursingproper is therefore to help the patients suffering from disease to live,just as health nursing is to keep or to put the constitution of ahealthy human being in such a state as to have no disease. TheCommunity Health Home Care Services have continued under thisaegis of nursing to the present. She defined nursing as that carewhich put a person in the best possible condition or nature to restoreor to preserve health, to prevent or to cure disease or injury.Nightingale stressed that the sick person must be treated and not the



disease. She identified a nurse the sick and not the sicknessphilosophy many years before Dr. Osler pronounced his famousstatement: it is better to know the patient who has the disease thanthe disease the patient has (Dolon 1973).

After Florence Nightingale, other nursing professionals like MaryAdelaide Nutting, Isabel Hampton, Lavania L Dock and FrederickaFliedner contributed much to the development of nursing.

Certain hospitals for many years accepted men to a short coursein nursing. The men were called attendants but not nurses. In1888, at Bellevue Hospital in New York, the Mills School wasestablished with a two year course; its graduates were also called asattendants, following the custom of the time. In 1943 there werefour schools of nursing for men only; the Mills School, New York,the Pennsylvania Hospital School of Nursing for Men and the twoAlexian Brothers hospitals in Chicago and St. Louis. Many moremen opted for nursing programmes and by 1948 the number ofmale student nurses increased.

The period that followed World War I saw a greater demand fornurses. It opened up new fields of specialisation, accelerated theeducational process to create public consciousness with regard tothe importance of good nursing. The World War taxed the medicaland nursing resources of the world to the maximum. Twocatastrophic episodes of World War I-the epidemic of pneumoniain 1917 and the pandemic outbreak of influenzea in 1978-emphasized the need for well-prepared nurses.

World War II also had a profound influence on nursing. In theUnited States almost revolutionary changes came about as a directresult of it. Many nurses were needed for the great army campsestablished throughout the country, and many responded to thegovernments appeal. In 1940, the nursing leaders had comprehendedthe potential need and had formed the Nursing Council of NationalDefence, composed of representatives from all the national nursingbodies. In 1942 this body became the National Nursing Council forWar Service.

With the inception of Nursing Section of the World HealthOrganisation in 1949, Oliver Baggallay was appointed chief andshe continued in this office until 1954. Miss Baggallay graduated

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from St. Thomas in London and had been secretary of the FlorenceNightingale International Foundation from 1934 to 1949. In July1954, Lyle Creelmana, graduate of Vancouver General HospitalSchool of Nursing, became the chief of the Nursing Section of theWorld Health Organisation. She had been public health nursingadministrator in the Nursing Section of WHO since 1949. Herguidance and counsel had been extended in the area of public healthnursing to all, throughout the world.

Nursing a ProfessionOver the years people doubted whether nursing is a profession

or is it a semi-profession. The doubts are not centered whether ornot the nurses have professional attitude or professionalorganizations but on whether the nurses meet the criteria ofprofessionalism. Then what is Nursing? Is Nursing an art or ascience? Is the Nurse a professional? If nursing is to be a profession,what are the criteria for it to be a profession? To understand theseand related issues there is a need to first study the definitions ofNursing.

Beginning with the simplest definition, a nurse is a person whonourishes, fosters and protects - a person who is prepared to care forthe sick, injured and aged. In this sense Nurse is used as a nounand is derived from the Latin word Nutrix which means nursingmother. Dictionary meaning of a nurse includes suckles ornourishes, to take care of. In this way nurse is used as verb,deriving from the Latin word nutrix meaning to suckle ornourish. According to Schulman (1972) nursings long historicalorientation has been based on a concept of mother- surrogate, arole characterised by affection, intimacy and physical proximitywith an orientation for meeting the needs of the dependent ward,providing for protection and identification.

Florence Nightingales (1859) Notes on Nursing describe thenurses role as one that would put the patient in the best conditionsfor nature to act upon him. Nursing in its broadest sense may bedefined as an art and science which involves the whole patient -body, mind and spirit ; promotes his spiritual, mental and physicalhealth by teaching and by example ; stresses health education and



health preservation as well as ministration to the sick; involves thecare of the patients environment - social and spiritual as well asphysical; and gives health service to the family and the communityas well as to the individual.

A classic definition used by nurses internationally is that ofVirginia Henderson (1966), distinguished American Nursingeducator and writer : The unique function of the nurse is to assistthe individual, sick or well, in the performance of those activitiescontributing to health or its recovery (or to peaceful death) that hewould perform unaided if he had the necessary strength, will orknowledge. And to do this, in such a way, as to help him gainindependence as rapidly as possible. She is the master of this part ofher function as she initiates and controls it. In addition, she helpsthe patient to carry out therapeutic plan as initiated by the physician.She also, as a member of the medical team, helps other members, asthey in turn help her, plan and carry out the total programmewhether it be for the improvement of health or the recovery fromillness or support in death.

Schlotfeldt (1978) states that Nursing is an essential service to allof mankind. That service can be succinctly described in terms of itsfocus, goal, jurisdiction and outcome as that of assessing andenhancing the general health status, health assets and health potentialsof all human beings. It is a service provided for persons who areessentially well, those who are infirm, ill, or disabled, those whoare developing and those who are declining. Nurses serve all people-sometimes individuals and sometimes collectives. They appropriatelyprovide primary and long term care and as professionals areindependently accountable for the execution and consequences ofall nursing services

Fagin (1978) maintains that primary care has been the academicdiscipline of nursing, since its public health evolution in the earlydays of nursing. Nursing is defined as including the promotionand maintenance of health, prevention of illness, care of patientsduring acute phases of illness and rehabilitation and restoration ofhealth.

The ANA (1973) standards of practice states, Nursing practiceis a direct service, goal directed and adaptable to the needs of the

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individual, family and community during health and illness.Professional practitioners of nursing bear primary responsibility andaccountability for the nursing care clients/ patients receive.

Nursing is the process of recognising, understanding and meetingthe health needs of any person or society and it is based uponconstantly changing body of scientific knowledge (Zwemer, 1996).

According to the American Nursing Association, nursing meansthe performance for compensation of any act in the observation ofcare and counsel of the ill, injured and infirm or in the maintenanceof health or prevention of illness of others or in the supervisionand teaching of other personnel, or the administration ofmedications and treatments as prescribed by a licensed physician ordentist; requiring substantial specialised judgment and skill, andbased on knowledge and application of the principles of biological,physical and social sciences.

From a period of time lasting approximately from the 1950sthrough the 1970s or mid 1980s nursing periodically was reviewedagainst the characteristics of a profession that had been establishedin the sociological literature. The activities for which nurses wereresponsible, the legal ramifications of practice, and particularly theeducation of future nurses were subjected to the scrutiny ofsociologists and nursing leaders found it challenging to examinenursing against established standards. The characteristics of aprofession have been discussed by many scholars. According to themgenerally a profession will:

Possess a well defined and well organized body of knowledgethat is on an intellectual level and can be applied to theactivities of the group;

Enlarge a systematic body of knowledge and improveeducation and service through use of the scientific method;

Educate its practitioners in institutions of higher education; Function autonomously in the formulation of professional

policy and in the control of professional activity; Develop within the group a code of ethics; Attract to the profession individuals who recognize this

occupation as their life work and who desire to contribute tothe good of society through service to others;



Strive to compensate its practitioners by providing autonomy,continuous professional development, and economic security(Bixler and Bixler, 1945, Pavalko 1971).

Nursing leaders believe that nursing is an unique profession as ithas borrowed various concepts and skills from biologic sciences,social sciences, and medical sciences. Nursing researchers are workingtowards developing an organized body of knowledge which isunique to nursing. There are nursing professionals who are workingto advance the standing of nursing through the development ofcode of ethics, standards of practice and peer review. As a result ofall this nursing has emerged as a profession.

A profession should have the ability to grow and changeaccording to the requirements in this dynamic world. The growthis expected to be systematic over a period duly supported by scientificmethods. Provision of nursing care is a problem solving process.The nurse first gathers data about her patient, then identifies theproblem. An approach to the problem is selected and carried out.Finally, the result of this approach, in terms of consequences forthe patient are evaluated. By using this process, the nurse canindividualize her care and be accountable by providing ascientifically based service. Nursing diagnosis is the title given tothe stage of identifying the problem.

Research activities in nursing have added value to the establishedbody of knowledge in this discipline. Tangible proof for this growthis the added literature in the nursing textbooks. All this reflects thecontinued growth of the body of knowledge in nursing.

Nursings heritage, like that of medicine, was founded in anapprenticeship beginning. Students were assigned to experiencedpractitioners who taught the skills with which they were familiar.Once those skills were acquired, the student moved into the worldof employment. The earliest programmes of education were locatedin hospitals rather than in universities. Today by far the majority ofnursing programmes preparing registered nurses are located in schoolor collegiate settings affiliated to medical universities.

Critics review professions against standards for professions. Theyplace emphasis on the ability of any group to develop its own policyand to function fairly autonomously. This has always been a

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problem for nursing. Traditionally the nurse works under thedirection of the patients physician, often in a hospital setting. Thephysician writes the orders for medical care that are to beimplemented by the nurse, and the agency or hospital sets the policiesunder which that care is delivered. Only in the last 50 years hasnursing made significant inroads in defining the unique role of thenurse in care as opposed to cure of the patient. Today nursesare responsible for planning and implementing the nursing carepatients are to receive and are also accountable for the care provided.Nursing diagnosis, once challenged as an inappropriate responsibilityfor nurses, has become a standard of good nursing care. Althoughnurses continue to carry out the medical instructions by physicians,a more collaborative relationship is beginning to occur and thecontribution of the nurse is receiving more recognition.

The general standard for professional behavior of nurses in theUnited States is the American Nursing Association Code for Nurses.This document was developed by the ANA and is periodicallyrevised to address current issues in practice. The InternationalCouncil of Nurses, housed in Geneva, Switzerland, has alsodeveloped a code for nurses that reiterates many of the behavioursoutlined in the ANA code. The international code sets the standardsfor ethical practice by nurses throughout the world.

Bixler and Bixler (1945) emphasize in their listing of criteria forprofessions that a profession should attract people of intellectualand personal qualities who place service above personal gain andwho recognize their chosen occupation as a lifework. Pavalko (1971)also identifies as a significant criterion the sense of commitment themembers have toward work as a lifetime or at least a long-termpursuit rather than as a stepping stone to another profession. Studiesof nursing indicate that most individuals gaining educationalpreparation for nursing remain within the profession althoughconcern has been voiced regarding the burnout that occurs fromstress. Today there is a tendency for individuals to enter theprofession of nursing at one educational level and to continue toadvance in practice and education by pursuing additional degreesand experience.

The criteria of professions includes concepts like altruism, service



to the public and dedication, and these must be the motivating forcefor the individual to take to the profession of nursing care. Theimage of nursing as a profession had a strong religious heritagesupported by the concept of giving of self to the profession.

The heritage of nursing is a rich one. The history of nursing hasgiven us a complete picture regarding the growth and thedevelopment of the profession and the contributions of variousnursing leaders. The vision of the great nurses of the past has todevelop nursing practice with ethical standards for the good of thesociety. Quality nursing care has become a very important factorfor the survival of a health care institution. Todays nurse is requiredto possess all round personality, necessary general education,professional education, and a high degree of commitment andmaturity to work as a nurse.

Nursing PracticeThe important personal qualities needed for a professional nurse

are a caring attitude, a willingness to put service before personalgain, poise, self discipline, honesty, courage, a pleasant and neatpersonal appearance, and good health.

A caring attitude usually comes with being able to express asense of spiritual love to the fellow human being. Professionally itincludes concern and empathy. Putting service first rather thanpersonal gain is extremely important in spite of the changes in ethicsand values, which are taking place in the nurses professional workand relationships with patients. A well balanced and a stablepersonality is a requirement for the nursing profession as nurseswill have to take full control of the emotions, mental activities andactions under pressure. It is important for an individual nurse to beself disciplined to develop into a good quality professional nurse.Self discipline supported by being truthful, sincere and fair will notonly make a good nurse but also a good individual. A nurse willhave to be courageous in handling difficult times while treating apatient. A neat clean pleasant appearance with good health and awell balanced life will help a nurse to be good and effective in aprofession (Ann, 1996).

The most important goal of a hospital organization is to provide

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the best and the immediate medical treatment to the patients. In amodem hospital the health team providing treatment to the patientsconsists of doctors and nurses. The doctor focuses on the curativeaspects and the nurse focuses on the care process. The nurse is thekey figure to articulate the therapeutic process and shares theresponsibility of acting as a mediator between the patient and thedoctor. She infuses confidence in the doctor, in the patients and inthe treatment process. By virtue of playing complex and delicateroles, the nurse has become indispensable in the modern therapeuticsystem. The central values of health care are a responsibility of thenurses and the doctors. The real inspiration and hope for progressis given by the nurses among other health professionals. Ethics playa very important part in determining the values of the nursingprofession. The moral and ethical dimensions in health care arereflected by the performance of the individuals concerned. Thenature of nursing practice is an important factor in the genesis ofissues in relation to the moral and ethical problems connected withpeople or institutions.

Moral and ethical problems in a hospital can be divided intothree categories: moral uncertainty, moral dilemmas and moraldistress. Moral uncertainty arises when one is unsure of what moralprinciples or values to apply. Moral dilemma arises when two ormore moral principles apply but they support mutually inconsistentcourses of action. Moral distress arises when one knows the rightthing to do but institutional constraints make it impossible to pursuethe right course of action. These problems are symptoms of crisis ofrapid change in the health care delivery system. Nurses play a centraland varied role in patient care and the management of health caredelivery. They are educated in different levels with a variety ofacademic qualifications and they practice many specialities. Theyperform many different jobs in patient care and administration.Nurses face many ethical conflicts in relation to their job.

The practice of nursing means the performance for compensationof professional services requiring substantial specialised knowledgeof the biological, physical, behavioural, psychological andsociological sciences and of nursing theory. It is the basis forassessment, diagnosis, planning, intervention and evaluation in the



promotion and maintenance of health, the case finding andmanagement of illness, injury or infirmity, the restoration ofoptimum function, or the achievement of dignified death. Nursingpractice includes administration of medication and treatmentprescribed by persons authorised by law apart from wardadministration, teaching, counselling, supervision, delegation andevaluation of practice. These services are performed under thesupervision of a registered nurse and utilise standardised proceduresleading to predictable outcomes in the observation and care of theill, injured and infirm, to safeguard and maintain life and healthof the patients. Each registered nurse is directly accountable andresponsible to the patient for the quality of nursing care rendered.

Nursing functions can be classified as maintaining or restoringnormal life functions, observing and reporting science of actual orpotential change in a patients status, assessing his/her physical andemotional state and immediate environment, formulating andcarrying out a plan for the provision of nursing care based onmedical regimen including administration of medications andtreatment, interpretation of treatment and rehabilitative regimens,counselling families in relation to other health related services andteaching.

In one study, nursing educators project the evolving functionsof nursing as data gathering, including history taking andassessment; nursing diagnosis (and some aspects of medicaldiagnosis); nursing intervention; evaluation, including evaluationof nursing team performance, evaluation of community resources;and administration, including carrying 24 hour responsibility fornursing care (Torres, 1975).

Yura and Walsh (1973) state that the term nursing process wasnot prevalent in the nursing literature until the mid 1960s, withlimited mention in the 1950s. In 1967, a faculty group at the CatholicUniversity of America specifically identified the phases of nursingprocess as assessing, planning, implementing and evaluating of theservices. The nursing process is described as an orderly systematicmanner of determining the clients problems, making plans to solvethem, initiating the plan or assigning others to implement it and

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evaluating the extent to which the plan was effective in resolvingthe problems identified.

The focus of clinical practice, clinical research and nursingeducation depends heavily on the systematic and orderlyarrangement of the nursing process. A major thrust in nursing todayis identification and the use of conceptual frame work. The NursingProcess was a forerunner in the presentation of theories that guideand support nursing (Yura and Walsh, 1973). From the mid-1960sto the early 1970s, there was much discussion about the nursingprocess which emphasized on the assessment phase of the process.Nurses were so enamoured with the systematic way of performingnursing, but they became bogged down in data collection. A numberof assessment tools were developed. The concept of health wasassumed to be subjective, relative and dynamic, it is a state that issubject to the modification by invasion of pathogens by thefunctional ability, adaptability and reserve capacity of a person (Yura& Walsh, 1973). Four factors were used as a basic frame work,essential to the concept of health in long term clients: demographiccharacteristics, physical status, psychological status, and self carepractices. Extensive testing for reliability and validity produces aninstrument that can assist the nurse in classifying clients accordingto the types of the care they need.

Professional EthicsTo become a nurse is not just a matter of learning particular

knowledge and skills, or adopting forms of behaviour appropriateto the context. It is also a matter of assimilating the attitudes andvalues of the nursing profession in a way, which can influence thethinking, the personality and the lifestyle of the individual concerned.There is a combination of knowledge, skill and acquired moralresponsibility, which is a part of the process of nursing education.Those entering the nursing profession may fail to realize the difficultdecisions one has to take which can question ones own personalconvictions and values. Doctors are highly specialized and skilled,and they are often seen to be dealing with the matters of life anddeath of a patient. As nursing sometimes is carried out by lay peoplein a family apart from professionally qualified nurses it makes it



difficult for new corners to the profession to appreciate theresponsibilities and complexities involved in the nursing process andtherefore encounter moral conflicts. The risk of conflict betweenthe personal and the professional values are at its peak during theearly years of professional life as the incumbent has to get adaptedto the values of the profession. The socialization process helps theindividual to build personal moral convictions and values whichare required to balance the emotional responses when they enterinto the nursing profession. Professional nursing within anorganization relies on the notion of roles rather than individuals(Kath & Boyd, 1995).

Nursing ethics is a part and parcel of professional nursing. Theapplicability of a fidelity rule concerns with implicit promises. Theprinciple of confidentiality and patients expectations that nursingstaff will promise to undertake their duties with a required degreeof skill and care according to Beauchamp and Childresssframework is dependent on four moral principles. They are theprinciples of respect for autonomy, the principle of beneficence, theprinciple of nonmaleficence, and the principle of justice (Edwards,1996).

The challenge in a health care unit is the creation of healingenvironment for patients. Florence Nightingale demonstratedthrough her work, the specific requirements, attention and aspectsof patient care which promote healing. Three decades ago, EdmundPellegrino, physician and noted medical ethicist, commented onworking relationships between nurses and physicians as a majorchallenge in the patient care environment. The working relationshipbetween and among nurses and patients are an ethically significantaspect in patient care environment. The compassionate patient carerequires a collegial and collaborative working relationship bothwithin nursing, and between nurses and doctors. A collegial orcollaborative working relationship is defined as working togetherwith mutual respect for the contribution and accountability of eachprofession to the shared goal of quality patient care (Aroskar, 1998).

Nurses who work in critical care units are confronted with ethicalissues, which produces mental and moral distress. The primarychallenge which confronts the nurses and the physicians are cost

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containment on one side and resource allocation on the other sideduring the course of the treatment. The other challenges whichconfront them are the values of individuals involved, communicationpattern, trust, integrity, role responsibilities, and role conflicts.

Values are inculcated through family upbringing and training.The values which are learned are modified by education and workexperience. Ethical conflicts may arise between various professionalcare givers as they have different work experiences and differentvalues on issues connected with patient care such as what comprisesinformed consent, extent or invasiveness of treatment, when to stoptreatment, or when to resuscitate. The nurses sometimes are alsocaught in quandary between physicians and the patients withconflicting values about termination of life sustaining treatment.

Two important factors that affect communication between nursesand doctors are gender and prestige. Though the image of the nurseas the physicians handmaiden is fading, still this influence continues.Sometimes the nurses opinion not valued by the doctors and thenurses are afraid to confront and challenge them. They have a fearof intimidation as the doctors are more powerful and hence nursesare not assertive particularly in the Indian context. The nurses areobedient soldiers in just following strictly the physicians orders oftreatment.

Trust and integrity play a very important role in effective nursephysician relationship. Patient conditions may change rather quicklyand unexpectedly. Although the nurse may know what interventionsare necessary she waits for the physicians order to act beyond thestandard protocols of treatment. However some of the nurses carryout certain actions required for managing a patient once she has atrust that the concerned consultant will back her actions. Nursesare torn between the loyalty to the physician and the patient asnurse - physician relationship depends on trust between each otherand violating it can create an imbalance in the system.

The major role of nurses is to carry out the doctors orders. Theknowledge base of bedside nursing care for a nurse is much morethan that of a physician. The critical care nurses have a majorresponsibility of monitoring the patient and provide earlyintervention in case of an emergency. Nurses have more intense



exposure to the patient and hence expect to be involved in the decisionmaking process about the patients care. However when physiciansdo not share this perspective it leads to lack of understandingbetween each others responsibilities creating mental distress thereby affecting the patient care.

The ethical work environment should support a collaborativeteam approach by blurring professional boundaries and clarificationof values, as well as the process to monitor and evaluate ethicalperformance. Necessary protocols and critical pathways for treatmenthave to be developed which can bring in consensus between doctorsand nurses in the delivery of effective and efficient patient care.

The principle of confidentiality has a long tradition amongsthealth care professionals, and for doctors it has its origin in theHippocratic Oath. For nurses, respecting confidences is often seenas having two practical applications: firstly, respecting the confidencesof the patient and, secondly, respecting the confidences of colleagues.Health professionals have a special duty to respect the confidencesof the patient as part of their professional responsibility. This typeof responsibility has been described by Hart (1994) as roleresponsibility. Professor Hart suggests that if a person occupies adistinctive place or office within society and as a result has dutiesattached to this position, then that person is responsible for fulfillingwhatever duties are recognised as part of that role within society.The role responsibility is not restricted to the professional roles butalso to other roles like parents (Fletcher & Holt, 1995).

Rushton and Brooks-Brunn (1997) have proposed a strategy fordeveloping environments that support ethical practice. Although theyfocus on end-of-life care, their recommendations are pertinent forall ethical issues in a health care environment. They identified sixkey points to use in assessing an organisations structure to monitorethical performance: (1) performance reporting that includes ethicalbehaviour, (2) employees considering ethical aspect part of theirjob, (3) recognition of employees who provide ethical leadership,(4) procedures for dealing with ethical code violations, (5)mechanisms for accountability to the public and patients, and (6)assessing frequency of use of conscientious objection (taking a standon an ethical issue different from that of the majority). These

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assessment criteria can be used by the health care institutions togauge their progress in enhancing the organizational cultures tofunctions at a higher ethical level (Corley, 1995).

Professional AccountabilityIn the health services sector the doctor, the nurse and the

organization become the service provider and the patient is thepurchaser. The introduction of the purchaser and provider concepthas raised the issue of accountability in the health care services.The concept of accountability impinges on nurses the ways in whichit does not impinge many other non-professional occupations.Nursing as a profession demands training and registeredqualification in order to practice the profession. The nurses areaccountable to the patients and to the hospitals for their practiceand this accountability is regulated by statutory bodies (Watson,1981).

The average nurse appears to believe that accountability isfollowing procedure and making sure one is covered by havingthe right kind of note or record and refer back to when somethinggoes wrong or where for whatever reason the acquisition is made.Nursing accountability is moral responsibility narrowed down tothe role of a nurse. Nurse is one element of the health care unit. Sothe nature of accountability to the patients is moulded by theparticular political, economic and administrative forms which theinstitution takes.

There are two ways through which the gap between the patientand the institutional ends are reconciled. The reconciliation takesthe form of self regulation otherwise called lateral accountability.The nurses keep a check on each other for the best interests of thepatients. The other takes the form of upward accountability, that is,the nurses are checked by the authorities for the best interests of thepatients.

The first type depends an notions of honourable, gentlemanly,lady like behaviour which underlies reputation and justifies publictrust. The second rests on authority, the rule of experts and discipline(Hunt, 1994).

Nurses may be expected to account for their actions and to explain



procedures on a day to day basis to the patients. Such accountabilityis quite informal and the nurse is not obliged to be accountable inthe fullest sense to the patients and relatives. It has been argued thatnurses could be viewed as being accountable for rather than tothe patients and relatives.

Nurses are not unique in this and they share accountability of akind involving patients and relatives with the medical profession.The situation for the medical profession is however very clear inlegal terms. Doctors do not have to take account of the wishes ofthe relatives of an incompetent adult patient in arriving at a decisionto treat the patient or not.

The complicated nature of the accountability can be seen fromthe above. At one extreme nurses are fully accountable to thestatutory body and on the other extreme nurses exercise visibleaccountability daily to the bodies very close to them professionallyand within the profession for aspects of nursing which are accountedfor to bodies outside nursing (Watson, 1981).

Development of Nursing in IndiaIn the past, the progress of nursing in India was hindered due to

a number of reasons such as the low status of women, purdhasystem among Muslim women, the caste system, illiteracy, poverty,political unrest and the image of the nursing profession. SinceIndependence, many changes for the betterment of nursing professionhave taken place in tune with the advancement of technology andprofessional expertise.

Military nursing was the earliest type of nursing in India. In1664 the East India Company started a hospital for soldiers inMadras. This was followed by a civilian hospital and the hospitalswere looked after by the staff of the military hospital. In 1797, ahospital for the poor called Lying in Hospital was built in Madras.The government started a training school for midwifes in 1854 inthis hospital. In 1871, a training school for nurses was started. Thefaculty for this institution came from England. Due to the efforts ofFlorence Nightingale in 1861, the reforms in military hospitals ledto the reforms in the civilian hospitals. The government hospitalfor women and children at Egmore is one of the earliest and the

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chief midwifery training schools in Madras. In 1885, the RoyalVictoria Caste and Gosha Hospital was started. The MethodistMission Kalyani Hospital, Mylapore, and Christian Rainy Hospital,Royapuram were started by the Missionaries (Rao, 1996).

In India, there was a lot of prejudice for sending educated girlsfrom the families of the Hindu and Muslim communities to takeup nursing as a profession. Only Christian girls came forward totake up this profession. The Americans and the Britishers startedmany schools of nursing between 1880 and 1900, and the first twowell known nursing schools were established in Madras and Bombayin 1884 and 1886, respectively. The mission hospitals played a veryimportant part in starting short programmes in nursing so that morenurses were available for taking up the job in one of their hospitals.

Ida Scudder started her work in a small hospital in Vellore forwhich she raised funds in America, and it was opened in 1902. Shefelt the need for training nurses very early and contemplated to starta nursing school with the help of Delia Houghton who was anAmerican nurse in 1909. The origin of the school and itsdevelopment had a great influence in South India (Abraham,1996).

Scudder, along with the fellow American nurse, Delia Houghton,started a medical school in 1918 in the hospital premises. Houghtonwas the founder of nursing profession in India. In 1946, the nursingschool got recognition by the Madras University as a College ofNursing and the first Dean of the College was Florence Tailor. In1968, the MSc programme was started.

After World War II, the practice of nursing in India reachedgreater heights. The Indian nurses started preparing themselves foradministrative and teaching positions which were till then handledby the English nurses. In 1943, the health survey and developmentcommittee was appointed for studying the conditions of nursing inIndia. The report of the committee known as Bhore Committeewas published in 1946 which described the nursing conditions asdeplorable and stressed the importance of having educated Indianwomen join the profession in order to raise the standard of nursing.

The Indian Nursing Council Act was passed by an Ordinanceon December 31, 1947. The council was constituted in 1949. Thepurpose of the council was to co-ordinate the activities of the State



Registration Councils and to set standards for nursing educationand practice.

In 1908, the Trained Nurses Association of India (TNAI) wasformed. In 1912, the TNAI got affiliated to the Nursing Council.The Nursing Journal of India published in 1909 was the officialorgan of the TNAI.

Nursing as a profession in India today provides an opportunityfor service. With present trends leading towards greater opportunities,supported by growing social and professional recognition, theprofession of nursing is becoming more open and challenging aswell.

ReferencesAbraham, M. Religion, Caste and Gender: Missionaries andNursing1996 History in South India. Bangalore: B I Publications.Ann, M.T. Guide to Nursing Management and Leadership. St. Louis:1996 Mosby.ANA Standards of Nursing Practice. Kansas: ANA.1973Aroskar, M.A. Administrative Ethics: Perspectives on Patients and1998 Community-based Care .The Online JournalofIssues in

Nursing, Topic 8.Bixler,G.,& The Professional Status of Nursing . American JournalBixler,R. of Nursing, 45:730-735.1945Corley, M.C. Moral Distress of Critical Care Nurses. American1995 Journal of Critical Care, 4(4):280-285.Dolan, J.A. Nursing in Society: A Historical Perspective. New Delhi: CBS.1973Edwards,S.D. NursingEthics: A Principle-based Approach. Hampshire:1996 Palgrave Macmillan.Fagin, C.M. Primary Care as an Academic Discipline. Nursing1978 Outlook, 26(12): 750-753.Fletcher, N. & Ethics, Law and Nursing. Manchester : ManchesterHolt, J. University.1995 Hart, H.L.A. The Concept of Law. Oxford: OUP.1994Henderson, V. The Nature of Nursing. Washington, DC: National1966 League for Nursing.

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Hunt, G. (ed.). Nursing and the Concept of Care. New York: Routledge.1994Kath,M.M. & Nursing Ethics. London: Churchill Livingstone.Boyd, K.M.1995 Nightingale,F. Notes on Nursing : What It Is and What It Is Not. (Fascimile1859 Edition).Philadelphia: J.B.Lippincott.Park K. Parks Textbook of Preventive and SocialMedicine. Jabalpur:1996 Banarasidas Bhanot.Pavalko,R.M. Sociology of Occupations and Professions. Itasca: IL Peacock1971 Publishers.Rao, S.K. Introduction to Community Health Nursing. Madras: B I1996 Publications.Rushton,C. M., EnvironmentsThat Support Ethical Practice. New& Brooks- Horizon ,5(1) :20-29.Brunn,J.A.1997Schulman,J. Experience of a Nurse Practitioner in a General1972 Medical Clinic .JAMA, 279(11) :1453-1461.Schlotfeldt, R.M. The Professional Doctorate : Rationale &1978 Characteristics. American Journal of Nursing, 60: 492-

494.Torres, G. Curriculum Implications of the Changing Role of the1975 Professional Nurse. NLN Publications.Yura, H.P., & The Nursing Process. New York:Appleton Century Croft.Welsh, M.B.1973Watson, J. Nursings Scientific Quest. Nursing Outlook, 29(7):413-1981 416.Zwemer, A.J. Professional Adjustment Ethics for Nurses in India. Chennai1996 B I Publications.



Sustainability and Social WorkT.K.Nair

Dr.T.K.NairDevelopment and CSR Consultant

Prakriti Rakshathi Rakshitah(Nature Protects When Protected)

AbstractThe article has three parts .The environmental crisis facing Mother

Earth is described in the introductory part. The second sectionSustainability and Spirituality is a summary of the meditations onsustainable cultures and cosmologies in Asia and the associatedwritings of Nadarajah in his seminal, visual-textual book LivingPathways. The final part looks at the expected role of social workprofession in the environmental justice movement and thedisappointing reality.

Mother EarthMother Earth is the only planet that supports life .Scientists

estimate that the Earth came into being about 4.6 billion years ago(Ignacimuthu, 2010) .Three concepts are used interchangeably inthe discussion on the planet Earth: nature, environment and ecology.Nature refers to the physical world comprising all living and non-living components. All living forms from microbes to human beingsincluding plants with diverse shapes, sizes, statures and coloursconstitute the living components. Light, air, water, soil, temperature,

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energy and a whole host of things are the non-living components.Environment means all those components that surround us andaffect us in many ways. Ecology refers to the scientific study ofliving beings, their habitation, and the interaction between andamong the living and non-living components .Environment is anintegral part of all human beings. We need to breathe air, to drinkwater, and to eat fruits, vegetables, etc for our survival. We dependon plants, animals, minerals, which, in turn, depend on the Earth.Abuse of even a fraction of the environment will have far reachingeffects on our lives by upsetting the equilibrium in the interdependentrelationship between the living and non-living components of theEarth. Destruction of the environment causes serious humansuffering. Our Earth continues to tolerate disappearance of forests,degradation of land, desertification, extinction of plants, birds,animals and other species; and pollution of air, water and land.The environmental crisis is caused solely by the behaviour, greedand consumption of the humans. The present environmental crisisis as much a socio-economic and socio-political problem as muchit is an environmental one.

Sustainability and SpiritualityOur business as usual approach in our social existence hides a

dangerous crisis engulfing us; that is, the crisis of sustainability,says Nadarajah (2014). A quintessential sociologist, anuncompromising social activist, a crusading journalist, and a creativedocumentary maker, Nadarajah has devoted his entire life workingon the interconnected issues of development, urbanism, culture,communication, environment and sustainability. A serious studentof historical materialism, Nadarajah found the class-reductionistexplanation of Marxism inadequate in understanding non-classissues like ethnicity, culture, feminism and environmentalism, andin addressing the complex problems of contemporary local andglobal societies. Based on his extensive research, he proposed a non-workerist model of historical materialism, and the prestigiousJawaharlal Nehru University (JNU) awarded PhD to Nadarajah

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for his thesis. His pathbreaking dissertation was published as a booktitled Culture,Gender and Ecology: Beyond Workerism in 1999.Dr.Nadarajah contributed numerous columns to the print media inMalaysia and wrote books on urban crisis, culture, politics and otherthemes including one co-edited volume for the UN University atTokyo. In this volume, the Urban Crisis, he proposed theKanazawa Approach to the role of culture in the sustainabilityof cities. The Asian Public Intellectual Fellowship of the NIPPONFoundation in 2005 took him to many ethnically and religiouslydiverse and culturally rich communities in Asia on what Nadarajahterms as a serious research pilgrimage leading to the publicationof a classic volume LIVING PATHWAYS. The book containsbeautiful photographs of the splendour of nature as well as its painfuldimensions captured imaginatively by the lens of Nadarajah, a giftedphotographer. The book comprises uncaptioned photographs onone side and text on the other side. The text is divided into differentsections or meditations on the cosmologies of the Asian region,which the reader may use for self introspection and social analysis,while the photographs may help as aids to look into rather thanas mere pictures to look at. The photographs add intensity to themeditations.

Gratification of human needs of the ever increasing globalpopulation steadily led to the mindless use of the environment. Butthe last two and a half centuries after the industrial revolutionwitnessed humongous destruction of the environment because ofthe rambunctious consumption patterns in the developed Westernsocieties led by the United States, and also because of the efforts ofthe developing countries to be in the high consumption club.Alarmed by the deterioration of the global environment, the UnitedNations constituted the World Commission on Environment andDevelopment with the then Prime Minister of Norway Gro HarlemBrundtland as its chairperson to study the global environmentalimpact of development and industrial activities. The Commissionsreport known as Brundtland report was brought out in 1987 withthe title Our Common Future. The UN document on sustainable

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development recognized that environment and development areinseparable entities. The three cornerstones of this recognition areeconomic growth, environmental protection and social equity.Intergenerational equity and justice is underscored by the UNsustainable development report. However the report placed the majoronus of sustainable development on big business and governments,thereby exposing the soul of sustainable deveopment to agents ofabuse.

UNs sustainable development is a highly contested concept thathas many meanings and implications. Sustainable development hasbecome a political compromise between growth andenvironmental sustainability that is acceptable to the pro-growthdelegations at the United Nations and that works within a neo-liberal agenda according to Nadarajah.The sustainable developmentorientation in practice does not dramatically change businesspractices for the better. On the other hand, it opens new ways ofcommodification to organize business within a sustainabledevelopment regime. Thus the mainstream explanation ofsustainable development fits well within the anthropocentric,procapitalist market growth model asserts Nadarajah. He adds thatthe UN definition of sustainable development does not at allencompass an understanding of Asian concerns and traditions asthis definition has been borne out of Western experiences in dealingwith the problems caused by commodification, exploitation, profitmotive and alienation characteristic of capitalist growth-orienteddevelopment.

Nadarajah argues that increasing urbanization; moving out ofthe youth from the villages to embrace the shiny facade of urbanismbreaking the cultural transmission line; chasing the Americandream; growing influence of the American way of life ; and theattraction to conspicuous, vulgar consumerism and consumptionhave made serious inroads into the sustainable cultures of Asiansocieties. Americanism as a concept and practice has many positivefeatures: a love of freedom, the pursuit of happiness, the dignity oflabour, and justice for all. Unfortunately, these positive features have

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been reshaped by the negative consequences of nationalism,American exceptionalism and predatory corporate capitalismdictated by the market and military forces. American state and itseducation system overtly and covertly promote the view that theAmerican culture is superior to other cultures. Nadarajah assertsthat jingoists strongly believe in the concept of social Darwinism;that is, the stronger superior cultures will overtake the weaker inferiorcultures in a survival of the fittest. American cultural imperialismcontinues to be a conscious and persistent dark side of theAmerican dream.The souls of Asian nations have been integratingthe ideals of the American dream, and this is clearly manifested inthe numerous high-end upmarket sites all across urban Asia.

The environmental cost of Americanization of Asia and the restof the world is enormous claims Nadarajah. At this rate, the Earthneeds to be cloned several times if each one of us consumed asmuch as the average American does. Nadarajah strongly feels thatAsia cannot simply afford Americanism as Asians cannot live amindless private life of mass consumption. The popular belief ofthe Americans that Earth has limitless resources for consumptionleads to a silently destructive process. Asia inadvertently consumedthe urban commodity culture of the West, but also their hegemonicanthropocentrism, which is a form of philosophical ecologyseparating humans from the natural world in the most extremeways. Urbanism has affected the relationship of human beings withnature. Nature is tamed, packaged and re-presented as commoditiesto us, says Nadarajah. Theme parks and artificial beaches areexamples. The present shape of urbanism is pathological. Nadarajahfeels that the mainstream urbanism is poised to grow into acomplex disease if not addressed with urgency. The growth-oriented development strategies and urbanism affect natural balancein a drastic manner. For instance Japan has become a super-agedsociety with fewer children raising serious concerns of caring forthe beneficiaries of longevity. Europe is also facing a childlessfuture. Childlessness is becoming a reality in Asia too lamentsNadarajah. And without children, we do not really have a future.

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Political emancipation is not accompanied by intellectualindependence in Asian countries. Although many theoreticalperspectives originating in Europe and the United States have notwithstood in alien environments, these are widely followed in AsianUniversities. Asian world of ideas and of practices has been hijacked.Even before countries in Asia could decide upon their modes ofdevelopment, they were suffocated with imported solutions. Thecultural hegemony of the West is a form of enslavement which hasbeen presented intelligently as a liberating philosophy to the Asiansocieties with the sole purpose of material progress.

There are many trajectories of development in the Asiancountries. But it is the mainstream mega - metropolitan developmentthat Asia proudly exhibits to the world instead of the micro-developmental sustainable initiatives in different regions. Theprojection of this achievement and Asian triumph is at a great costwarns Nadarajah. He adds that Asians have become blind citizensof urban centres and mega-cities, and this becoming is taken forgranted. The recycling of Western images in the form of Asianurban life, with its inherent blind speed, impacts human beingsin various negative ways accelerating the stress levels leading tosuicides, mental illnesses and crimes. Asian societies want to movefrom the periphery to the centre of mainstream development;that is, to move from Asia to America. The present form of urbanism,the empire of now, is based on a dangerously erroneousassumption that the resources that are being consumedindiscriminately will never run out. But when these resources arefinally used up, what then asks Nadarajah.

Consumption is the end of a complex process, and sustainableprinciples have to be part of each stage for real sustainableconsumption to be possible. Nadarajahs search took him to Asiasindigenous societies which managed their consumption sustainablyin contrast to the urban-centred capitalist societies. He adds thatdeep within the Asian context, there was no notion of sustainabledevelopment. On the other hand, these cultures engaged themselveswith the practice of sustainability, which is intimately integrated



with spiritual practices. The difference between sustainabledevelopment and sustainability is like the difference between havingand being.

Sustainability is a way of life within an indigenous cosmologyof sustainability that promotes the concept that each human beingis organically a part of the larger narrative, explains Nadarajah. Hesays that the future of emancipatory politics is sustainability, andthe future of sustainability is spirituality. Spirituality is not the sameas religion. Spiritual sustainability encourages non-materialism andnon-materialistic development. A holistic cosmology once framedthe world view and world feel of human beings, there by establishingan intimate relationship between nature and human beings. But amechanistic cosmology now dominates human societies and lifehas become a struggle for survival and domination.

Nadarajah explains the cosmology of sustainability as a triadicrelationship of fundamental realities comprising: Human world(relationships and society), Natural world (flora, founa and non-living things), and Spiritual world (gods, spirits). In Asiasindigenous communities, the cosmologies of sustainability arenurtured by the triadic relationship of fundamental realities. Anothercomponent of cosmology of sustainability is the conception ofpersonhood, specifically the belief and practice of inter-being. Thisbelief suggests that there is no atomised individual as viewed inthe Western construct, but only interconnected individuals, whoare dependent beings interwoven into a web with neither beginning,nor end.

Nadarajah is of the view that sustainability and spirituality aretwo sides of a single reality: one side looks inward and the otherside looks outward. If one reframes this reality, the issue ofsustainability is a spiritual crisis instead of a crisis that revolvesaround mere consumer goods and production values. Cosmologiesof sustainability are inherent features of Asian history andexperience, which go far beyond the mainstream discourse ofsustainable development and which are still preserved among Asiasindigenous peoples. The voice of the indigenous culture is the most

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global in spirit, perspective and practice. It is cosmovision(Dankelman, 2002). Cosmovision refers to ways certain populationgroups interpret life, the world around and the cosmos. Therelationships between the social world, the natural world and thespiritual world are central to peoples cosmovision.

The global crisis of sustainability is a multi-dimensional crisiswhich is felt more by the poor communities across the world.For them, it is a permanent crisis. Nadarajah observes that evenfor academics and analysts, there will never be a situation withoutthe poor among us. The suffering of the poor is never seen as thecrisis that is. Instead, it is taken as a natural part of the system andthe society of the non-poor is not shaken by it. Foor the poor, crisisis the way life is, and they deal with that on a day-to-day basis.

Nadarajah advocates for a new cosmology, a cosmology ofsustainability. The root of our inability to deal with ourunsustainable behaviour really lies in the domain of the routinised,taken-for-granted every day-ness of our lives. We are often boththe perpetrators and victims of the world we have created byconscious action or silent acceptance. Science and technology alonecannot help solve the crisis created by the development pathwayschosen by us, because science and technology developed by us areinherent components of the root causes of the global crisis ofsustainability. Instead of the growth-oriented capitalist wisdom ofthe weak sustainability approach, the proponents of the strongsustainability approach argue that we transform our needs to sustainthe Earth rather than trying to transform Earth to suit our needs.This approach moves away from anthropocentrism to biocentricegalitarianism. Many Asian communities offer simple andbeautiful messages of and for life. The only thing preventing thesesimple messages from becoming our ways of conscious self-development and social organization is the lack of individual andcollective will cultural, social and politicalto nurture themagainst imperialistic and hegemonic materialistic and hedonisticcosmologies.



Sustainability and Social WorkAbout 3.7 million years ago, Laetoli, a site in Tanzania, had

Hominin footprints on its soil, which are still preserved in volcanicash. But in a short span of about two hundred years, and morespecifically during the nineteenth and twentieth centuries, thedevelopment strategies and technological processes adopted byhumans, whose footprints had spread across all parts of the globe,have caused grave threat to the environment and human life onEarth. All industrial nations are big polluters of air, land and water.Enormous tracts of tropical rainforests are destroyed. Deserts arespreading in all parts of the world due to deforestation and landdegradation. Ozone layer is being depleted exposing living organismsto excessive ultra-violet radiation. Bio-diversity is disappearing atan alarming rate. The other forms of environmental destruction arelegion. These problems loom over our planet and affect all livingbeings. Devastation of the environment affects all regions, races andcultures as it is a universal threat. Because of the globalization ofthe market economy and corporate practices all natural systems onEarth are disintegrating. The present crisis is caused merely by thebehaviour of the humans. Mahatma Gandhi cautioned: Earthprovides enough to satisfy every mans needs, but not to every mansgreed. Human greed is at the root of the existential crisis of thetwenty-first century humans.

An illustration of the environmental crisis in Gods OwnCountry, Kerala, is the Endosulfan Tragedy. The state-ownedPlantation Corporation of Kerala preferred endosulfan aerialspraying of its cashew plantations from 1978 to 2001 despite protestsfrom environmental activists. The tragedy of families exposed toendosulfan is heartrending: children born with bone deformities,epilepsy, mental retardation, congenital malformation,hydrocephalus, congenital heart diseases, neuro-behaviouraldisorders, etc in many villages in Kasaragod district. Abortions,cancer, and other illnesses were reported for adults. More than 4,000deaths took place during this period due to the harmful effects ofendosulfan.The state government was guilty of laxity and apathy

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though peoples protests were mounting. Finally, the collectivepressure from the media, civil society, political parties and othergroups made the government to put an end to the endosulfanpesticide use. Judicial intervention sealed further adventurism fromthe officialdom.

The pesticide-induced tragedy in Kerala is not an isolated event.It is one of the countless environmental disasters causing enormousloss of human lives in all countries in the world. Behind these liethe current levels of consumption which are not at all sustainableby the Earth, and these vary between economically developed andeconomically developing countries. According to ecofuture.org ,ifall countries in the globe were to match the current levels ofAmerican consumption, then it is estimated that the Earth couldsustain only one-half billion people, while at current African levelsthe Earth could sustain 40 billion people. Human population andconsumption continue to grow at a fast pace, while the resources ofthe Earth are finite. If we fail to take cognizance of this ecologicalcrisis and to act on it appropriately, that inaction will result in thedestruction of the very Earth that sustains human life.

The critical condition of the planet and the impoverishmentand destitution of an increasing proportion of the worlds populationare rooted in a global economic system devoted to profit, growth,and monopolization of resources by fewer and fewer playersnamely transnational corporations and the international financialsystems that support them (Hoff,1997). A sustainable approach todevelopment should encompass different types of sustainabilitylinked as an integrated whole. Nadarajah (2014) suggests fivecategories and their concerns.

Environmental/Ecological Sustainability Biological diversity Population management, resource planning, space use

management Inter-species equity



Economic Sustainability Dematerialising the economy, market alternatives, appropriate

technologies Efficient resource allocation, foot print management, use/

waste management More equitable access to resources for all Glocalism (that is, the adaptation of a product or service

specifically to each locality in which it is marketed )

Political Sustainability Human rights Democratic development, multi stakeholder participation Good governance, accountability, transparency, trust

Social Sustainability Improved income distribution with reduced income

differential, both locally and globally Gender equity and equality, equity and equality for indigenous

peoples and people with disabilities Social investment in health and education, and in the family Emphasis on peoples participation and empathy

Cultural Sustainability General sensitivity to cultural factors, enlightened localism Cultural diversity and dialogical transaction Values contributing to non-anthropomorphism /

dematerialisation Long term time sense and holismThe environmental justice movement in the world for ensuring

the human rights of all people to live in a clean and healthyenvironment has a history of over five decades initiated by the UnitedNations and its related agencies and divisions. The environmentalhuman right is the right to live in an environment free from toxicpollution and to have control over local natural resources (Hancock,2003 ). The UN Conference on the Human Environment held in

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Stockholm in 1972 was the first global conference on environmentand its declaration, popularly known as the Stockholm Declaration,was a landmark document which stated in no uncertain terms theright to a healthy environment, and led to the formation of theUnited Nations Environment Programme. The Earth Summit (UNConference on Environment and Development) held in Rio deJaneiro in 1992 stated that poverty as well as excessive consumptionby the affluent place damaging stress on the environment (un.org ).

The World Summit on Sustainable Development (Earth Summit2) held at Johannesburg in 2002 endorsed the MillenniumDevelopment Goals (MDGs) for specific change in 8 areas by 2015in all countries:

1. Poverty and hunger,2. Primary education,3. Gender equality,4. Child mortality,5. Maternal health,6. Disease (particularly HIV/AIDS and Malaria) control,7. Environmental sustainability, and8. Responsibility of developed countries towards developing

countries.The goal of environmental sustainability (Goal 7) specifies four

targets:1. To integrate the principles of sustainable development into

policies and programmes of the governments,2. To reduce biodiversity loss,3. To halve the proportion without access to safe drinking water

and basic sanitation, and4. To achieve a significant improvement in the lives of at least

100 million slum dwellers.Goals 1 to 6 are closely interlinked to Goal 7 (The Millennium

Development Goals Report, 2008).Social work as a helping profession arose as a humanitarian

response to the excesses and adverse effects of capitalism experiencedat the levels of individuals, families and communities. Implanted



from the United States in many countries including India, socialwork has global presence, but the professional recognition and focusof practice areas of social work have substantial difference betweenthe developed and the developing countries. The present discussionon social work is, therefore, centred around the practices in theWest. The early phase of social work practice was heavily dependenton psychoanalysis. In time, influenced by sociology and ecology,social work shifted to the Person-in-Environment (PIE) perspectivewhich is based on the acceptance that a person and his or herbehaviour cannot be understood adequately without the analysisof the different a

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