FUNDAMENTALS OF NURSING

I.NURSING AS A PROFESSION
Profession – an occupation that requires an extensive education or calling that requires
special knowledge, skill and preparation.
It is distinguished from other kinds of occupations by:

 Requirement of prolonged; specialized training to acquire body knowledge.

 An orientation of an individual toward service, either to a community or an organization.
Professionalism – refers to professional character, spirit, or methods.
Professionalization – process of becoming professional, acquiring characteristics considered
to be professional.
TOP QUALITIES OF A PERSONAL AND A PROFESSIONAL NURSE

 A caring nature
 Be empathetic
 Writing everything down (in detail)
 Be organized
 Be emotionally stable
 Be adaptable
 Have physical and mental endurance
 Be a quick thinker (and have great judgement)
 Be hard-working
II. FIELDS OF NURSING (3 Categories)
Non-degree:
Degree:
Graduate Studies and Specialization:
Fields of Nursing may also be based on the recipient of care, clients or consumer:

 Individuals (newborns, infants, children, teens, adults and elders)

 Families
 Communities
Fields of Nursing based on Specialization:

 General Nursing
 Medical Nursing
 Surgical Nursing
  Maternal and Child Nursing
 Psychiatric or Mental Health Nursing
 Intensive Care Nursing
 Dialysis Nurse
 Community Health Nurse
 Rehabilitation Nursing
 Oncology nursing
 Plastic Surgery Nurses
 Corrections facility Nurses
 Home care Nursing (Special Nurse)
 Radiology Nurse
 Academe/Nurse Educator and Administrator
 Certified registered nurse anesthetist
III. DEVELOPMENT OF MODERN NURSING
Florence Nightingale is one of the nurses who have made notable contributions both
nursing’s history and women’s history.
Virginia Henderson created a modern worldwide definition of nursing.
Martha Rogers a catalyst for theory development.
 Educational programs available for nurses include practical or vocational nursing,
registered nursing, graduate nursing and continuing education.
 The acute care hospital was the main practice setting open to most nurses.
 Today, many nurses work in hospitals but increasingly they work in clients’ homes,
community agencies, ambulatory clinics, long-term care facilities, health maintenance
organizations (HMOs) and nursing practice centers.
Different definitions of nursing with common themes:

 Nursing is caring.
 Nursing is an art.
 Nursing is a science.
 Nursing is a client centered.
 Nursing is holistic.
 Nursing is adaptive.
 Nursing is concerned with health promotion, health maintenance, and health
restoration.
IV. LEVEL OF PROFICIENCY
 Novice – Has no professional experience.
 Beginner – Can note current meaningful situational components, but not prioritize
between them.
 Competent – Begins to understand actions in terms of long-range goals.
 Proficient – Perceives situations as whole, rather than in terms of aspects.
 Expert – Has intuitive grasp on the situation and zeros on the accurate region of the
problem.
PATRICIA BENNER’S FROM NOVICE TO EXPERT
I. NOVICE – A nursing student or any nurse transitioning to a new specialty.
II. ADVANCED BEGINNER – A nurse who has some experience, including mere
observation.
III. COMPETENT – A nurse in the same setting for 2-3 years: able to anticipate and plan
long-term goals for specific patient population.
IV. PROFICIENT - A nurse in the same setting for 2-3 years: able to understand situations
as a whole and makes decisions based on previous experiences.
V. EXPERT – A nurse with intuitive understanding of clinical situations: able to anticipate
potential problems, can be a mentor to the nurses.
V.ROLES AND RESPONSIBLITIES OF PROFESSIONAL NURSE
AUTONONOMY

 Initiation of independent interventions.

 Having the authority to make decisions and the freedom to act in accordance with
one’s professional knowledge base…
ACCOUNTABILITY

 Responsible professionally and legally for the type and quality of nursing care.
 Remain current and competent in nursing care and scientific knowledge and technical
skills.
 Caregiver
 Communicator
 Teacher
 Client advocate
 Counsellor
 Change agent
 Leader
 Manager
 Research consumer
MAN – HEALTH, WELLNESS, ILLNESS
What is Health and its concepts?
1. FLORENCE NIGHTINGALE (1860-1969) defined health as a state of being well ang using
every power the individual possesses to the fullest extent.
2. THE WORLD HEALTH ORGANIZATION (WHO) (1948) defines health as “a state of
complete physical, mental, and social well-being, and not merely the absence of
disease or infirmity.”
3. TALCOTT PARSONS (1951), an eminent American sociologist and creator of the
concept “sick role,” conceptualized health as the ability to maintain normal roles.
4. U.S PRESIDENT’S COMMISSION ON HEALTH NEEDS OF THE SAID, health is not a
condition, it is an adjustment. It is not a state but a process.
5. THE AMERICAN NURSES ASSOCIATION, in its social policy statement (2010), states,
“Health and illness are human experiences, health nor does optimal health preclude
illness”
6. a state of well-being
 self-responsibility; an ultimate goal
 a dynamic, growing process;
 daily decision making in the areas of nutrition, stress management, physical fitness,
preventive health care
 emotional health
 the whole being of the individual
What is Well-being and its concepts?
Well-being is a subjective perception of vitality and feeling well, can be described objectively,
experienced, and measured, can be plotted on a continuum.
Nurses need to clarify their understanding of health, wellness, and well-being for the
following reasons:
a. Nurses definitions of health largely determine the scope and nature of nursing
practice.
b. People’s health beliefs influence their health practices.
SEVEN COMPONENTS OF WELLNESS
1. Environmental
2. Occupational
3. Intellectual
4. Spiritual
5. Physical
6. Emotional
7. Social
What is Illness and its concepts?

 State in which a person’s physical, emotional, intellectual, social developmental or

spiritual functioning is diminished or impaired.
 It is condition characterized by a deviation from a normal, healthy state.
Three Stages of Illness
1. Stage of Denial – refusal to acknowledge illness, anxiety, fear irritability and
aggressiveness.
2. Stage of Acceptance – turns to professional help for assistance.
3. Stage Recovery (Rehabilitation) – The patient goes through of resolving loss of
impairment of function.
The Health-Illness Continuum
Illness area Well area
Death – Illness – Normal Health – Good health – High-level wellness
Death Well-being
The Levels of Prevention
PRIMARY PREVENTION

 Definition: An intervention implemented before there is evidence of a disease or injury

 Intent: Reduce or eliminate causative risk factors (risk reduction)
 Example: Encourage exercise and healthy eating to prevent individuals from becoming
overweight.
SECONDARY PREVENTION

 Definition: An intervention implemented after a disease ha begun, but before it is

symptomatic.
 Intent: Early identification (through screening) and treatment
 Example: Check body mass index (BMI) at every well checkup to identify individuals
who are overweight or obese.
TERTIARY PREVENTION

 An intervention implemented after a disease or injury is established

 Intent: Prevent sequalae (stop bad things from getting worse)
 Example: Help obese individuals lose weight to prevent progression to severe
consequences.
  COMMUNICATION
- is central to successful caring relationships.
Listening is important for effective understanding and communication.

 Communication is the interchange of information between two or more people; the

exchange of ideas or thoughts.
 Methods, talking and listening or writing and reading, painting, dancing, and
storytelling, gestures and body actions.
 The intent of any communication is to obtain a response.
 It has two purposes; to influence others and to gain information.

THE SEVEN C’S OF COMMUNICATION

1. Content
2. Continuity & Consistency
3. Clarity
4. Context
5. Channels
6. Credibility
7. Capability

SENDER – encode & decode (intrapersonal)

Message (interpersonal)
Message (Response/feedback) (interpersonal)
RECEIVER – decode & encode (intrapersonal)

MODES OF COMMUNICATION
1. VERBAL – spoken or written word
2. NON-VERBAL – gestures/facial expressions or touch
3. ELECTRONIC – technological means; email
THERAPEUTIC COMMUNICATION TECHNIQUES
Broad opening statements

 Allow the patient to pick topic

 Take initiative to express self
 Set direction of the convo.
 ex: when would like to begin? What are you thinking about?
Offering general ideas

 encourage client to continue

 the nurse is interested in what comes next
 ex: Go on. And then? Tell me about it.
Exploring

 examines certain ideas, experiences, or relationships more fully

 ex: tell me more about that. What kind of relationship do you have with your
children?
Focusing

 helps patient focus on certain point when they are jumping from topic to topic
 ex: you’ve mentioned many things. Let’s go back to your thinking of “giving up”.
Silence

 provides to the patient to put thoughts or feelings into words, regain composure or
continue talking.
 ex: maintain an interested, expectant silence.
Accepting

 indicated the patient has been understood. It does indicate agreement and non-
judgmental
 ex: Uhm, Yes. I’m following you, nodding.
Giving recognition

 awareness of change in personal efforts.

 Does not imply good or bad, right or wrong.
 ex: You’ve finished list of things to do.
Offering self

 offers presence, interest, and desire to listen to the patient

 ex: I’ll sit with you for a while. I’m available if you need to talk.
Making observations

 calls attention to the patient’s physical behavior or emotional state.

 verbalizing what the nurse perceives
 ex: you appear tense. I noticed that you are biting your lip.
Acknowledging feelings (empathy)

 help patient to know that their feelings are understood and accepted.
 ex: Patient: I hate it here. I wish I could go home.
Nurse: It must be difficult to stay in a place you hate.
Reflecting

 directing questions, feelings and ideas back to the patient

 acknowledges the patient’s right to have opinions and make decisions.
 ex: Patient: everyone ignores me.
Nurse: ignores you?
Providing information

 make facts available in order to assist in decision-making or drawing conclusions.

 ex: My purpose for being here is…
This medication is for your high blood pressure.
Clarifying

 to make clear that which is vague

 maximize understanding between the nurse and patient
 ex: I am not sure I follow you.
Can you give me an example of a time you thought everyone hated you.
Seeking consensual validation

 searching for mutual understanding especially when slang terms has been used
 ex: tell me whether my understanding of it agrees with yours.
Verbalizing implied thoughts or feelings

 To voice what the patient has implied

 To verify impressions to help the patient more fully aware of feelings expressed.
 ex: Patient: I can’t talk to you because it’s a waste of time.
Nurse: Do you feel that no one understands?
Sharing humor

 discharge energy through comic enjoyment of the imperfect.

  Can reduce tension and promote mental well-being
 Must be used carefully and sparingly
 ex: this gives a whole meaning to “just relax”.
Encouraging comparison

 brings out recurrent themes by looking at similarities or differences

 ex: Has this ever happened before? Have you had similar experience?
Placing the event in time or in sequence

 help patient see cause

 identify patterns or events and actions
 ex: When did this happen? Was it before or after?
Presenting reality

 indicated what is real without arguing

 presenting the facts of a situation
 ex: I see no one else in the room. Your mother is not here I am the nurse.
Voicing doubt

 expressing uncertainty about the reality of the patient’s perception

 patient become aware that others do not perceive things in the same way
 this is not an attempt to get the patient change the pov
 ex: Really? That’s hard to believe that’s unusual.
Attempting to translate into feelings

 seeking to verbalize patient’s feelings that are expressed only indirectly

 ex: Patient: I’m dead inside
Nurse: Are you saying you are lifeless?
Sharing hope

 communicating a sense of possibility to achieve their potential

 commenting on the positive aspects of the patient’s behavior, performance or
response
 ex: I believe you will find a way to face your situation because I’ve seen your courage
and creativity
Encouraging formulation of an action plan

 asking patient to consider kinds of behavior likely to be appropriate in future

 ex: next time this come up, how would you handle it?
Summarizing

 concise review of the key aspects of the interaction to bring a sense of satisfaction and
closure
 ex: During the past hour, you and I discussed…
Self-disclosure

 generalized sharing of personal experiences about the self to benefit the patient
 ex: I went for counselling and it really helped… what are your thoughts about seeing a
therapist?
Confrontation

 helps the patient become aware of inconsistencies in feelings, attitudes, beliefs or

behaviors
 ex: you say you have already decided what to do, yet you are still talking a lot about
your options.
Recommend or suggest options (do not advise)

 allows the patient to consider options they may not have previously considered
 ex: have you thought about?...
HELPING RELATIONSHIPS
 Nurse-client relationships are referred to by some as interpersonal relationships.
 Others as therapeutic relationships and helping relationships.
Helping is a growth-facilitating process that strives to achieve three basic goals;
1. Help clients manage their problems in living more effectively and develop unused or
underused opportunities more fully.
2. Help clients become better at helping themselves in their everyday lives.
3. Help clients develop an action-oriented prevention mentality in their lives.
Phases of Helping Relationship
1. Pre-interaction Phase
2. Introductory Phase
3. Working Phase
4. Termination Phase
TEACHING-CLIENT EDUCATION

 Client education is multifaceted, involving promoting, protecting, and maintaining

health.
  It involves teaching about reducing health risk factors, increasing a person’s level of
wellness, and taking specific protective health measures.
1. Teaching Clients and Their Families
2. Teaching Health Personnel
3. Teaching in The Community
TEACHING

 Health promotion
 Disease prevention
 Health Restoration and Maintenance
 Rehabilitation
APPROACHES TO PROBLEM SOLVING

 TRIAL & ERROR – a number of approaches are tried until a solution is found.
 INTUITION – relies on nurse’s inner sense. The understanding or learning of things
without the conscious use of reasoning.
 RESEARCH PROCESS – formalized, logical, systematic approach to problem solving.
TEACHING-HEALTH promotion

 WHO definition: “enables people to increase control over their own health”
 It covers a wide range of social and environmental interventions that are designed to
benefit and protect people’s health and quality of life by addressing and preventing
the root causes of ill health, not just focusing on treatment and cure.”
 Health promotion is a behavioral social science that draws from the biological,
environmental, psychological, physical and medical sciences to promote health and
premature death through education-driven voluntary behavior change activities.
TEACHING-DISEASE PREVENTION

 Disease prevention is a procedure through which individuals, particularly those with

risk factors for a disease, are treated in order to prevent a disease from occurring.
 Treatment normally begins before signs & symptoms occur.
 Disease prevention involves actions to reduce or eliminate exposure to risks that might
increase the chances that an individual or group will incur disease, disability, or
premature death.
 The purpose of health promotion and Disease Prevention is to positively influence the
health behavior of individuals and communities as well as the living and working
conditions influence their health.
 Health promotion and disease prevention program address social determinants of health,
which influence modifiable risk behaviors.
 Health maintenance is a guiding principle in health care that emphasizes health
promotion and disease prevention rather than the management of symptoms and illness.
 Health restoration is induction of a return to a previous state, as a return to health or
replacement of a part to normal position.

TEACHING-REHABILITATION
 Rehabilitation is defined as “a set of interventions designed to optimize
functioning and reduce disability in individuals with health conditions in
interaction with their environment.”

IV. THE NURSING PROCESS

 Is a systematic, rational method of planning and providing individualized nursing
care.
Its purposes are:
 To identify client’s health status, and actual or potential healthcare problems or
needs.
 To establish plan to meet the identified needs.

DISTINCTIVE CHARACTERISTICS OF THE NURSING PROCESS
 Client Centeredness
 Focus on problem solving and decision making
 Its cyclic and dynamic nature
FIVE PHASES OF THE NURSING PROCESS
I. ASSESSING – Collect, Organize, Validate, and Document Data.
II. DIAGNOSING – Analyze data, identify problems, risks, strengths, and formulate
diagnostic statements.
III. PLANNING – Prioritize problems/Diagnoses, formulate goals or outcomes, select and
write nursing interventions.
IV. IMPLEMENTING – Reassess the client, determine the nurse’s need for assistance,
implement nursing interventions, supervised delegated care, document nursing
activities.
V. EVALUATING – Collect data related to outcomes, compare data with outcomes, relate
nursing actions to client goals/outcomes, draw conclusions about problem status,
continue, modify or terminate the client’s care plan.
FIRST PHASE OF THE NURSING PROCESS
I. ASSESSING
 Is the systematic and continuous collection, organization, validation, and
documentation of data or info.
 A continuous process carried out during all phases.
 Assessments vary according to their purpose, timing, time available, and client
status.
Nursing assessments focus on a client’s responses to a health problem that include the
client’s perceived needs, health problems, related experience, health practices, values, and
lifestyles.
The four different types of assessments are:
1. Initial nursing assessment
2. Problem-focused assessment
3. Emergency assessment
4. Time-lapsed reassessment

 INITIAL ASSESSMENT
 TIME PERFORMED: Performed within specified time after admission to a health care
agency.
 PURPOSE: To establish a complete database for problem identification, reference,
and future comparison.
 EXAMPLE: Nursing admission assessment.
 PROBLEM-FOCUSED ASSESSMENT
 TIME PERFORMED: Ongoing process integrated with nursing care.
 PURPOSE: To determine status of a specific problem identified in an earlier
assessment.
 EXAMPLE: Hourly assessment of client’s fluid intake and urinary output in an ICU.
 EMERGENCY ASSESSMENT
 TIME PERFORMED: During any physiological or psychological crisis.
 PURPOSE: To identify life-threatening problems.
 EXAMPLE: Rapids assessment of an individual’s airway, breathing status, and
circulation during a cardiac arrest. Assessment of suicidal tendencies or potential for
violence.
 TIME-LAPSED REASSESSMENT
 TIME PERFORMED: Several months after initial assessment
 PURPOSE: To compare client’s current status to baseline data previously obtained
  EXAMPLE: Reassessment of client’s functional health patterns in a home care or
outpatient setting or in a hospital at shift change.

i. COLLECTING DATA – DATA COLLECTION METHOD

TYPES OF DATA
a. Primary Secondary Sources
DATABASE – SUBJECTIVE & OBJECTIVE
b. Sources of Data

 Data Collection – the process of gathering info. about client’s health status.

THREE TYPES OF DATA COLLECTION METHODS:

1. Observing
2. Interviewing
3. Examining

 OBSERVING
 Gather data by using senses.
 A conscious deliberate skill developed through effort and with an organized approach.
 Involves distinguished data in meaningful manner.
 Must be organized.
Particular sequence:
 Clinical signs of client’s distress.
 Threats to the client’s safety, real or anticipated.
 Presence of functioning of associated equipment.
 The immediate environment.
 INTERVIEWING
 Is planned communication or a conversation with a purpose.
Two approaches to interviewing:
  Directive
 Nondirective
Types of interview questions:
 Closed ended
 Open-ended
 Neutral
 Leading
Planning interview and setting arrangement:
1. Time
2. Place
3. Distance
4. Seating arrangement
5. Language
Stages of an interview
1. Opening (establish rapport and orientation)
2. Body
3. Closing
 EXAMINING
 Physical examination or physical assessment is a systematic data collection method
that uses observation (the senses of sight, hearing, smell and touch) to detect health
problems.
 Techniques of inspection, palpation, and percussion.
 Cephalocaudal or head-to-toe approach.
 Body systems, screening examination, or review of systems approach.
TYPES OF DATA

Subjective data
 Referred to as symptoms or covert data
 Apparent only to person affected and can be described or verified by that
person.
 Objective data
 Referred as signs or overt data
 Detectable by an observer or can be measured or tested against accepted
standard.
 ORGANIZING DATA
 Referred to as nursing health history, nursing assessment, or nursing database form.
 Uses a format that organizes assessment data systematically.
FORMATS:
1. Conceptual models or frameworks.
2. Wellness models
3. Non-nursing models

 VALIDATING DATA
 Is the act of double-checking or verifying data to confirm that it is accurate and
factual.
Validating data helps the nurse complete these tasks:
 Ensure that the nursing assessment is complete.
 Ensure that the objective and subjective data agree.
 Obtain additional information that may have been overlooked.
 Differentiate between cues and inferences.
 Avoid jumping to conclusions and focusing in the wrong direction to identify
problems.