nursing fundamentals

NURSING FUNDAMENTALS

By: Erwin G. Bodiongan

Nursing

• is a caring profession

• A unique profession with an earnest concern for the art of care and the science of health.

Nursing

The unique function of the nurse is to assist the individuals, sick or well, in the performance of those activities contributing to health or its recovery (or to peaceful death) that he would perform unaided if he had the necessary strength, will, or knowledge, and to do this in such a way as to help him gain independence as rapidly as possible.

Nursing as a Profession

A profession possesses the following primary characteristics:

•Education•Theory•Service•Autonomy•Code of Ethics•Caring

Roles and Functions of a Professional Nurse

• Care Provider- supports the client and is concerned with

client’s needs• Communicator / Helper- communicates with clients, support persons

and colleagues to facilitate nursing actions


• Counselor- helps the client recognize and cope with

problems, and to promote personal growth• Client Advocate- promotes what is best for the client, ensure

needs are met, and protect the client’s rights.


• Change Agent- initiates changes and assists the client make

modifications in the lifestyle to promote health

• Leader- initiates actions, helps the client make

decisions to improve his well–being


• Collaborator- works in a combined effort with all those

involved in care delivery that will achieve a common goal

• Manager- plans, gives directions, develops staffs,

monitors operations, give rewards, etc.


• Researcher- participates in scientific investigations and

uses research findings in practice• Teacher- provides health teaching to effect behavior

change which focuses on acquiring new knowledge or technical skills

The caregiver role of the nurse emphasized:

a. Implementing nursing care measuresb. Providing direct nursing carec. Recognition of needs of clientsd. Observation of the client’s responses to

illness

The manager role of the nurse is best demonstrated when he / she:

a. Plans nursing care with the patientb. Works together with the nursing teamc. Initiates nursing action with co-workersd. Speak in behalf of the patient

The most important communication skill to be developed by the nurse manager is:

a. Firmnessb. Assertivenessc. Questioningd. Attentive listening

Nursing Care Delivery Models

• Total Patient Care• Primary nursing• Case Management• Functional Nursing• Team Nursing


• Total Patient Care- also called case method- the registered nurse is responsible for all

aspects for one or more clients’ care- shift-based focus- for continuity of care, the staff needs to

communicate clearly the client’s needs from shift to shift


• Primary Nursing- the registered nurse is responsible for all

aspects for one or more clients’ care 24 hrs a day, 7 days a week

- associates provide some care but the primary nurse coordinates and communicates it


• Case Management- a case delivery approach that coordinates and

links health care services to clients and families

- a professional nurse assuming responsibility for client care from admission through and following discharge


• Functional Nursing- this model involves the division of tasks with

nurses assuming responsibility for certain tasks

- task–focused, not client–focused - communication is not always clear since no

one nurse is responsible for the overall care of the client


• Team Nursing- delivery of nursing care by staff of various

educational preparations in a team- team members provide client care to group of

clients under the direction and coordination of the RN team leader

What is the most common nursing care delivery model in

the Philippines?

Types of Nursing Interventions

• Independent or nurse–initiated interventions- health teachings, feeding assistance• Dependent or physician–initiated

interventions- catheterization, administering medications• Interdependent or collaborative interventions- client’s diet, client’s exercise

Nurse Jim found out that one of his patients is having a fever. Which independent intervention can he perform on the client?

a. Get a thermometer and take the client’s temperature

b. Check the client’s chart and give the appropriate medication

c. Perform a tepid sponge bath on the clientd. Call the doctor

Stages of Nursing Expertise (NACPE)by Patricia Benner

• Novice• Advanced Beginner• Competent• Proficient• Expert

• Novice- no experience- limited, inflexible- governed by rules and regulations rather than

experience


• Advanced Beginner- 1–2 yrs experience- marginally acceptable performance- has experience enough real situations to make

judgments about them


• Competent- 2–3 yrs experience- demonstrates organizational and planning

activities- coordinates multiple complex care demands


• Proficient- 3–5 yrs experience- perceives situations as wholes rather than

parts- has holistic understanding- focuses on long-term goals


• Expert- 5+ yrs experience- performance is fluid, flexible and highly

proficient- demonstrates highly skilled intuitive and

analytical ability in new situations- take certain actions because “it felt right.”


A nurse with 2–3 years of experience who has the ability to coordinate multiple complex nursing care demands is at which stage of Benner’s stages of nursing expertise?

a. Advanced Beginnerb. Competent c. Proficientd. Expert

4 Major Concepts in Nursing Theories (PEHN)

Person

Environment

HealthNursing

Nursing Theories and Models

• Florence Nightingale- born from a British family in Florence, Italy- received her early training from Kaiserswerth,

Germany- developed and described the first theory of

nursing – the Environmental Theory


• Virginia Henderson- definition of nursing- identified 14 basic needs

• Faye Glenn Abdellah- patient–centered approaches to nursing- 21 nursing problems


• Lydia Hall- Key concepts of Care, Core and Cure

• Myra Levin- Four Conservation Principles (energy,

structural integrity, personal integrity, social integrity


• Dorothy E. Johnson- conceptualized the Behavioral System Model

• Imogene King- postulated the Goal Attainment Theory


• Madeleine Leininger- developed the Transcultural Nursing Model

• Dorothea Orem- developed the Self–Care Theory and the Self–

Care Deficit Theory


• Betty Neuman- proposed the Health Care System Model

• Martha Rogers- conceptualized the Science of Unitary Human

Beings


• Sister Callista Roy- presented the Adaptation Model

• Jean Watson- conceptualized the Human Caring Model


• Ida Jean Orlando- conceptualized the Dynamic Nurse– Patient

Relationship Model

• Ernestine Weidenbach- developed the Clinical Nursing – A Helping Art

Model


• Hildegard Peplau- introduced the Interpersonal Model- 4 phases of the nurse–client relationship:

(OIER)1.Orientation2.Identification3.Exploitation4.Resolution


• Rosemarie Rizzo Parse- introduced the concepts of Man–Living–

Health Theory or the Theory of Human Becoming

The four concepts common to nursing that appear in each of the current conceptual models are:

a. Person, Nursing, Environment, Medicineb. Person, Health, Nursing, Support Systemc. Person, Environment, Health, Nursingd. Person, Environment, Psychology, Nursing


• Florence Nightingale

• Virginia Henderson

Environmental Theory

14 Basic Needs


• Faye Glenn Abdellah

• Lydia Hall

21 Nursing Problems

Care, Core, Cure (Concepts)


• Myra Levin

• Dorothy E. Johnson

4 Conservation Principles

Behavioral Systems Model


• Imogene King

• Madeleine Leininger

Goal Attainment Theory

Transcultural Nursing Model


• Dorothea Orem

• Betty Neuman

Self–Care Deficit Theory

Health Care System Model


• Martha Rogers

• Sister Callista Roy

Science of Unitary Human Beings

Adaptation Model


• Jean Watson

• Ida Jean Orlando

Human Caring Model

Dynamic Nurse–Patient Relationship Model


• Ernestine Weidenbach

• Hildegard Peplau

A Helping Art Model

Interpersonal Model


• Rosemarie Rizzo Parse

Man – Living – Health Theory or Theory of Human Becoming

History of Nursing

Period of Intuitive Nursing• Prehistoric man was a nomad and was ruled

by law of self-preservation• Nursing was a woman’s function• Nursing was performed out of compassion• Believed in magic and evil spirits• Believed in medicine man called “shamans” or

witch doctors

History of Nursing

Period of Apprentice Nursing• Extends from the founding of religious nursing

orders in the 11th century to the establishments of nursing training schools in the 1800s

• It is called the period of “on the job” training

History of Nursing

Military Religious Orders (The Crusades)• Knights of Saint John of Jerusalem• Knights of Saint Lazarus

Secular Orders• Order of St. Francis of Assisi, The Beguines,

Benedictines, Augustinians

History of Nursing

Important Personages in the Period of Apprentice Nursing:•St. Claire – gave nursing care to the sick and afflicted•St. Elizabeth of Hungary – a princess who became known as the “Patroness of Nurses”•St. Catherine of Siena – the first “lady with the lamp”

History of Nursing

Dark Period of Nursing•From 17th to 19th century, from the reformation to the U.S. Civil War•The reformation destroyed the unity of the Christian church and hundreds of hospitals, schools and orphanages were closed•Nursing became the work of least desirable women

History of Nursing

Period of Educated Nursing•Began with the establishments of nursing schools (ex. St. Thomas Hospital School of Nursing under Florence Nightingale)•Development of Nursing was the result of wars, social consciousness and emancipation of women

History of Nursing

Period of Contemporary Nursing•Covers the period after World War II to the present•Scientific and technological developments as well as social changes mark this period.

History of Nursing in the Philippines

Early beliefs and practices:• Causes of disease- another person (enemy or witch)- Evil spirits• Diseases could be driven by people with

powers• Believe in gods, word healers, herbolarios


Earliest hospitals established:• Hospital Real de Manila (1577)- for Spanish soldiers and civilians• San Lazaro Hospital (1578)- for patients with leprosy• Hospital de Indio (1586)- for the general population


Earliest hospitals and school of nursing• Iloilo Mission Hospital School of nursing (1906)- first nurses board examination (1944)• St. Paul’s Hospital School of Nursing (1907)• Philippine General Hospital School of Nursing- 1907


First Colleges of Nursing in the Philippines• UST College of Nursing (1946)• Manila Central University College of Nursing

(1947)• University of the Philippines College of Nursing

(1948)

Nursing Leaders in the Philippines

• Anastacia Giron-Tupaz - first Filipino nurse to hold the position of chief

nurse superintendent at PGH- founder of PNA• Francisca Delgado- first president of PNA

Nursing Leaders in the Philippines

• Cesaria Tan- first Filipino to receive a Master’s degree- founder of PNA• Rosa Militar- pioneer in school health education• Loreto Tupaz- Florence Nightingale of Iloilo

Philippine Nurses Association

• Originally the “Filipino Nurses Association” founded in Sept. 2, 1922 in a meeting of 150 nurses presided by Mrs. Tupas

• Accepted as member organization of the International Council of Nurses in 1929

• Renamed the PNA in 1966• Nurses’ Week every last week of October

Basic Human Needs

• Each individual has unique characteristics, but certain needs are common to all people called basic human needs.

• Human needs are physiologic and psychologic conditions that an individual must meet to achieve a state of health and well-being.

Abraham Maslow’s Hierarchy of Basic Human Needs

Physiologic Needs

• Oxygen• Fluids• Food• Pain-free• Clothing (body temperature)• Elimination• Rest and sleep

Safety and Security Needs

• Physical Safety• Psychological safety• Shelter

Love and Belongingness Needs

• To love and be loved• To care and be cared for• For affection, associate, belong, friends, peers• Relationships

Self–Esteem Needs

• To love and be loved• To care and be cared for• For affection, associate, belong, friends, peers• Relationships

Self–Actualization Needs

• The need to be self–fulfilled• The need for spiritual fulfillment

On the whole, self – actualization is the essence of mental health

The following are characteristics of basic human needs except:

a. Needs may be met in different waysb. Needs have uniform priorities to all

individualsc. Needs are interrelatedd. Needs may be deferred

Who among the following clients should be attended to first by the nurse?

a. The client with coughs and coldsb. The client with pain on the chestc. The client with fever due to infectiond. The client who is for discharge

Health and Illness

• Health is the ability to maintain the internal milieu.

• Health is being well and using one’s power to the fullest extent.

• Health is the ability to maintain homeostasis or dynamic equilibrium.

• Health – is a state of complete, physical, mental and social well-being (WHO).

Health and Illness

• Wellness is well–being.• It involves engaging in activities and behaviors

that enhance quality of life and maximize personal potential.

• Wellness is a choice.• Well is the loving acceptance of one’s self.

Health and Illness

High Level Wellness• An integrated method of functioning that is

oriented towards maximizing one’s potentialities with in the limitation of his environment.

• This concept connotes the ability to perform ADL or to function independently.

Health – Illness Continuum(Harbert Dunn)

Health and Illness

Illness• is a personal state in which a person feels

unhealthy• a person’s physical, emotional, intellectual,

social, development or spiritual functioning is diminished or impaired compared with previous experience.

Health and Illness

Disease• is an alteration in body functions resulting in

reduction of capacities or a shortening of the normal life span.

Health and Illness

Precursors of Illness• Heredity- DM, hypertension, cancer• Behavioral factors- smoking, alcohol drinking, wrong diet• Environmental factors- overcrowding, poor sanitation

Stages of Illness

1. Symptom experience• transition stage• the person believe something is wrong2. Assumption of the sick role• acceptance of the illness• seeks advice, support for decision

Stages of Illness

3. Medical care contact• seeks advice of professionals for the

following reasonsa. validation of real illnessb. explanation of symptomsc. reassurance or prediction of outcome

Stages of Illness

4. Dependent Patient Role• dependent on the health professional• becomes passive and accepting• may regress to an earlier behavioral stage5. Recovery / Rehabilitation• gives up the sick role and returns to former

roles and functions

Classification of Diseases

A. According to Etiologic Factors• Traumatic – due to an injury• Allergic – abnormal body response• Neoplastic – abnormal cell growth• Idiopathic – unknown cause• Degenerative – degeneration of cells or

tissues,organs• Iatrogenic – results from treatments


A. According to Etiologic Factors• Hereditary – defect in the genes• Congenital – defect in development, present

a birth• Metabolic – disturbance or abnormality in

metabolism• Deficiency – inadequacy of essential dietary

factors


B. According to Duration or Onset• Acute – short duration and severe• Chronic – longer duration, may be 6 mos.,

characterized by remissions and exacerbations

• Sub–acute – severe but longer than acute


Remissions– period during which the disease is controlled

and symptoms are not obvious

Exacerbations– the disease becomes more active again at a

future time, with recurrence of pronounced symptoms.


C. Other Description of Diseases• Organic – changes in the normal structure• Functional – abnormal responses to stimuli• Occupational – factors are associated with

work• Familial – occurs in several individuals in the

family


C. Other Description of Diseases• Venereal – acquired thru sexual relations• Epidemic – large numbers of individuals in a

community at the same time• Endemic – present continuously or recurs in

a community• Pandemic – extremely widespread• Sporadic – occasional cases occur

Three Levels of Preventionby Leavell and Clark

1. Primary Prevention• Prevent a disease or condition• Health promotion• Specific protection• e.g. quit smoking, avoid alcohol, exercise,

good diet, immunization


2. Secondary Prevention• Health maintenance• Early diagnosis / detection / screening• Prompt treatment to limit disability• e.g. annual physical exam, regular pap’s test,

monthly BSE, sputum exam,


3. Tertiary Prevention• Occurs after a disease or disability has

occurred and the recovery process has begun• Rehab• e.g. self-monitoring of blood glucose,

physical therapy after CVA

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