1. INTRODUCTION Ms.Vahitha Arun Lecturer, CON JIPMER

2. Introduction Health in its broadest sense is a dynamic state in which the individual adapts to changes in internal and external environments to maintain a state of well being. The internal environment includes many factors that influence health, including genetic and psychological variables, intellectual and spiritual dimensions and disease processes. The external environment includes factors outside the person that may influence health, including factors outside the person that may influence health, including the physical environment, social relationships, and economic variables because both environments continuously change, the person must to maintain a state of well being. Health and illness therefore must be defined in terms of individual. Health is also closely related to an individuals work place and home life and stressors can be the result of those environments. 3. CONCEPT OF HEALTH Health is considered by many as the opposite of illness or disease. For some, it means well developed or adequately nourished body, capable of various activities and able to withstand physical stress. All communities have their concepts of health integrated as a part of their culture. Widely differing culture groups share the concept of health as a state of balance and harmony. 4. The WHO has defined as a state of complete physical, mental, social, spiritual well being and not merely the absence of disease or infirmity. The concept of wholeness or completeness is emphasized and health is seen as more than a physical state. An individuals health is never static and is always in a dynamic equilibrium with his environment. Physical well being is measurable although it is varying ranges and validity. As regards mental well being, measurable standards vary from culture and hence the criteria for mental well being may differ from one country to another or from place to place within the same country. Social well being may be regarded as a state of predisposing condition of health. 5. DIMENSIONS OF HEALTHHEALTH SERVICESPHYSICALVOCATIONALMENTALEMOTINALSPIRITUALSOCIALDIMENSIONS OF HEALTHENVIRONMENTAL 6. MULTIPLE FACTS OF HEALTH-WHO 1.2.3.Health a tridimensional state: Health is a state of complete physical, mental and social well being and not merely the absence of disease or infirmity. Health a fundamental right: The enjoyment of the highest attainable standards of health is one of the fundamental rights of every human being, without distinction of race, religion, and political belief and economic and social condition. Health for peace and security: The health for all is fundamental to the attainment of peace and security and is dependent upon the fullest cooperation of individuals 7. 4. Health a government responsibility: Government has a responsibility for the health of their people, which can be fulfilled only by the provision of adequate health and social measures. 5. Health and health information: The extension to all people of the benefits of medical, psychological and related knowledge is essential to the fullest attainment of health. 6. Health and people cooperation : Informed opinion and active cooperation on the part of the public, are of the utmost importance in the improvement of health of the people. 7. Health and health care: Unequal development in different countries in the promotion of health and control of disease, especially communicable disease is a common danger. 8. 8. Health and child development: Healthy development of a child is of basic importance the ability to live harmonically in changing total environment is essential to such development. 9. Health gain for all: The achievement of any state in the promotion and protection of health is of value to all. 9. MODEL OF HEALTH AND ILLNESS.HEALTHHIGH-LEVEL WELLNESSRISK FACTORS FOR FUNCTIONING IN ALL DIMENSIONSILLNESSSEVERE ILLNESS 10. CONCEPT OF DISEASE Disease can be considered as something more than mere deviation from health, each disease being a distinct entity, with distinguishing qualities in its pathologic process, its typical clinical appearance and often its characteristic epidemiologic pattern of distribution in terms of time, place and person The concept of disease also may vary from one society to another society. There will be no difficulty in distinguishing an illness which severe enough to necessitate bed rest and treatment. 11. FACTORS AFFECTING HEALTH HUMAN BIOLOGY GENETIC INHERITANCE DEVELOPMENTAL PROCESS EXTERNAL ENVIRONMENT PHYSICAL BIOLOGICAL PSYCHOSOCIALSOCIAL SUPPORT STRUCTURE FUNCTIONHEALTH SOCIOCULTURAL FACTORS NORMS CULTURE ATTITUDE BEHAVIOURAVAILABILITY OF HEALTH SERVICESSOCIOECONOMIC FACTORS OCCUPATION EDUCATION POLITICALSYSTEM 12. CONCEPTS OF HEALTH, ILLNESS AND SICK BEHAVIORS It is useful for the nurse to be aware of the behavioral components of health, illness and sick role behavior Every person develops a system of health beliefs and attitudes and these tend to fall within the framework provided by society or cultural heritage. Health behavior activities a person engages in, when feeling well, to take measures to prevent disease and illness or to detect them before symptoms appear. Illness behavior activities a person engages, when feeling ill, that will lead to the defining of the state of health and that will gain help. Sick role behavior, activities a person engages in believing himself ill. 13. ILLNESS-ILLNESS BEHAVIOR Illness is not merely the presence of disease process. It involves the ways persons monitor their bodies, definite and interpret their symptoms, take remedial actions and use their health care system. The important internal values influencing the way clients behave when they are ill. A clients illness behavior can also be affected by the nature of the illness. Acute illness involves symptoms of relatively short duration that are usually severe and may affect functioning in any dimension. Chronic illnesses persists, usually longer than 6 months, and can affect functioning in any dimension. External variables influencing a clients illness behavior include the visibility of symptoms, social groups, cultural background, economic variables, accessibility of the health care system and social support. 14. STAGES OF ILLNESS BEHAVIOR I. Symptom experience 1. During the initial stage , a person is aware that something is wrong. A person usually recognizes a physical sensation or a limitation but does not suspect a specific diagnosis. 2. The persons perception of symptoms includes awareness of a physical change such as pain, a rash or a lump. II. Assumption of the sick role 1. The assumption of the sick role results in emotional changes, such as withdrawal or depression and physical changes. 2. Emotional changes may be simple or complex depending on the severity of the illness, the degree of disability and anticipated length of the illness. 15. III. Medical care contact 1. If symptoms persist despite home remedies, become severe or require emergency care, the person is motivated to seek professional health services. 2. In this stage the client seeks expect acknowledgement of the illness, as well as treatment in addition, the client seeks an explanation of the symptoms, the cause of the symptoms, the course of the illness for future health. 3. Clients illness can be validated at any point on the health illness continuum. A health professional may determine that they do not have an illness or that illnesses are present and may belief threatening. 16. IV. Dependent client role 1. After accepting the illness and seeking treatment, the client enters the fourth stage of illness behavior. 2. The client depends on health care professionals for relief of symptoms. The client accepts the care, sympathy and protection from the demands and stresses of life. 3. It is socially permissible for clients in the dependent role to be relieved of normal obligations and tasks. V. Recovery stage 1. The final stage of illness behavior-recovery and rehabilitation- can arrive suddenly, such as when a fever subsides. 2. The final stage is not prompt, long term care may be required before the client is able to resume an optimal level of functioning. 3. In the case of chronic illness, the final stage may involve an adjustment to a prolonged reduction in health and functioning. 17. IMPACT OF ILLNESS OF FAMILY I. Behavioral and emotional changes 1. People react differently to illness. Individual behavioral and emotional reactions depend on the nature of the illness, the clients attitude towards it, the reaction of others to it, and the variables of illness behavior. 2. Severe illness, particularly one that is life threatening, can lead to more extensive emotional and behavioral change such as anxiety, shock, denial, anger and withdrawal. II. Impact of family roles 1. When an illness occurs, the roles of client and family may change. Such a change may be subtle and short term or drastic and long term. 2. An individual and family generally adjust more easily to short term changes in most cases . 3. Long term changes, require an adjustment process similar to the grief process. The family and client often require specific counseling and guidance to assist them in coping with role changes. 18. III. Impact on body changes 1. Some illnesses result in changes in physical appearance, and clients and families react differently to these changes. 2. Withdrawal is an adaptive coping mechanism that can assist the client in making the adjustments. IV. Impact of self concepts 1. It is individuals mental image of themselves, including how they view their strengths and weaknesses in all aspects of their personalities. 2. Self concept depend on parts of body image and roles but also include other aspects of the psychological and spiritual self. 3. Self concept changes because of illness may no longer meet the expectations of the family, leading to tension or conflict. 19. V. Impact of family dynamics 1. Family dynamics is the process by which the family functions, make decisions, give support to individual members and copes with everyday changes and challenges. 2. If a parent in a family becomes ill, family activities and decision making often come to a habit as the other family members wait for the illness to pass, or they delay action because they are reluctant to assume the ill persons roles or responsibilities. 20. HEALTH ILLNESS CONTINUUM According to Neuman, health on a continuum is the degree of client wellness that exist at any point in time ranging from an optimal wellness condition, with available energy at its maximum, to death, which represents total energy depletion. According to health illness continuum model, health is a dynamic state that continuously alters as a person adapts to changes in the internal and external environments to maintain a state of physical, emotional, intellectual, social, developmental and spiritual well being. The continuum is thought of a complex, dynamic process that includes physical, psychological and social components. There are adoptive and maladaptive behavioral responses to internal and external stimuli. 21. Health and illness tend to merge but may represent patterns of adoptive change along the continuum the direction of change may be reversible, depending on the quality of the individuals adoptive efforts. The individual at the illness end of the continuum is characterized by feeling of uncertainty, helplessness, loss of control, loss of identity and incapacity for problem solving. As the patient is in the sick role, there is incapacity to meet other social roles, the person has sought diagnosis and treatment. Less for along the illness end of the continuum, as illness behavior are brought in to play, the person may be tired, rundown and irritable with complaints of loss of sleep, appetite, dependence, self absorption, minor illnesses such as colds and infections. 22. Between illness and wellness there is the ambiguous area where no symptoms are present and the person is neither especially well nor especially ill.At the health end of the continuum, as health behaviors are utilized, the persons are not only unaware of disease and with out pain, fatigue or somatic complications but also tends to be resistant to infections, industrious, vigorous and physically agile, with a strong sense of identity and autonomy, caring out usual social roles and needing no health careThe goal in preventive health care is to maintain equilibrium between health and illness, with balance in favor of maximum wellness for the individual. 23. HEALTH ILLNESS CONTINUUMHEALTHHIGH LEVEL WELLNESSRISK FACTORS FUNCTIONING INALL DIRECTIONSILLNESSSEVERE ILLNESS 24. BODY DEFENSES :IMMUNITY &IMMUNIZATION Immunity - Lasting resistance to infections 1. Active immunity can be acquired in three ways Following clinical infection eg. Chickenpox Following subclinical infection eg. Polio Following immunization with antigen Humroal immunity comes from B cells which proliferate and manufacture specific antibodies after antigen presentation by macrophages. Cellular immunity it is mediated by T cells which differentiate into subpopulations able to help B lymphocytes. The T cells do not secrete antibody but are responsible for recognition of antigen.(activation of macrophages) 25. Combination of the above In addition to the B &T lymphoid cells which are responsible for recognizing self and non self, very often, they operative with one another and with certain accessory cells such as macrophages and human K cells and their joint functions constitute the complex events of immunity. It is superior to passive immunity a) The duration of the protection b) Severe reactions are rare c) Protective efficacy of active immunization is high d) Less expensive than passive immunization 26. 2. Passive immunity When antibodies produced in one body is transferred to another to induce protection against diseases known as passive immunity. By administer of an antibody- containing preparation (immunoglobulins and antiserum) By transfer of maternal antibodies through placenta By transfer of lymphocytes- to induce passive cellular immunity Herd immunity : Level of resistance of a community against particular diseases. 27. Immunizing agents vaccines 1. live BCG,OPV,MMR 2. killed cholera and rabies 3. toxoids- TT Immunoglobulins 1.human Ig-HBV,varicella 2. non human- Dt Immunization Protecting the greatest number of people against some specific disease. 28. HEALTH CARE SERVICES HEALTH PROMOTION it is the process of enabling people to increase control over and to improve health. (i). Health education (ii) Environmental modification (iii) Nutritional interventions (iv) Life style and behavioral changes Health education Most cost effective intervention. The extension to all people of the benefits of medical, psychological and related knowledge is essential to the fullest attainment of health. The target groups are general public, patients, priority groups, health providers, community leaders and decision makers. 29. Environmental modifications : A comprehensive approach of health promotion requires environmental modifications such as safe water installation of sanitary latrines, control of insects and rodents, improvement of housing etc.Nutritional interventions : Comprise of food distribution, nutritional improvement of vulnerable groups, child feeding programmes, food fortification, nutrition education etc.Life style and behavioral changes: It involves organizational, political, social and economic interventions designed to facilitate environmental and behavioral adaptations that will improve and protect health. 30. PREVENTION To avoid disease altogether is the ideal but it is possible only in a limited number of cases. The following are currently available specific protection Immunization Use of specific nutrients Chemoprophylaxis Protection against occupational hazards Protection against accidents Avoidance of allergens Control of consumer product quality and safety of foods, drugs, cosmetics etc. 31. Health protection is defined as the provision of conditions for normal mental and physical functioning of the human being individually and in the group. It includes the promotion of health, prevention of sickness and curative and restorative medicines in all its aspects. Diagnosis and treatment Early detection and treatment are the main interventions of disease control. The earlier the disease is diagnosed and treated the better it is from the point of view of prognosis and preventing the occurrence of further cases and long term disability. 32. Rehabilitation : It has been defined as the combined and coordinated use of medical, social, educational and vocational measures for training and retraining the individual to the highest possible level of functional ability. It includes all measures aimed at reducing the impact on disabling and handicapping conditions and enabling them to achieve social integration (active participation in the main stream of community life) a) Medical rehabilitation-restoration of function b) Vocational rehabilitation- restoration of the capacity to earn a livelihood c) Social rehabilitation-restoration of family and social relationships d) Psychological rehabilitation- restoration of personal dignity and confidence 33. Continuing care The care for sick/ill healthy to continued throughout the life after the period of rehabilitation also in all aspects of physical, mental, social, spiritual to attain the maximum health. 34. HEALTH CARE TEAM Definition : it is defined as a group of persons who share a common health goal and common objectives, determined by community need toward the achievement of which each number of the team contributes in accordance with her/his competence and skills and respecting the functions of others. The auxiliary is the essential member of the health team. The team must have a leader. The leaders should be able to evaluate the team adequately and should know the motivation of each member in order to stimulate and enhance their potentialities. 35. Aims : this aims to produce the right mix of health personnel for providing full health coverage for entire population. Hospital team: physician, asst.physician, nurse, dietician, pharmacist, p hysiotherapist, radiologist, health assistants, lab technician, social worker and chaplin etc. Community team : physicians,, nurse, dietician, pharmacist ,lab technicians, health assistants, social workers, trained dais, health educators, statistical analyzer etc. It is important for each team member to have a specific and recognized function in the team and to have freedom to exercise his/her particular skills. 36. TYPES OF HEALTH CARE AGENCIES The health care system is intended to deliver the health care services. It constitutes the management sector and involves organizational matters. It operates the context of the socioeconomic and political frame work of the community.In India there are 5 major health care sectors/agencies which differ from each other by the health technology applied by the source of the funds for operation 37. PUBLIC HEALTH SECTOR A) PHC a) primary health center b) sub center B) Hospitals/health centers a) community health centers b)Rural hospitals c) District hospitals d) Specialist hospitals e) Teaching hospitals C) Health insurance scheme a) Employee state insurance b) Central Govt. health scheme D) Other agencies a) Defense services b) Railways 1. 38. 2. PRIVATE SECTORS a) Private hospitals, polyclinics, nursing homes and dispensaries. b) General practitioners and clinics. 3.INDIGENOUS SYSTEM OF MEDICINE a) Ayurveda and siddha b) Unani and tibbi c) Homeopathy d) Unregistered practitioners. 4.VOLUNTARY HEALTH AGENCIES Indian red cross society, Hind Kusht nivaran sangh etc 5.NATIONAL HEALTH PROGRAMMES NMCP- 1953 NLCP-1955 etc.. 39. HOSPITALS : TYPES, ORGANISATIONS AND ITS FUNCTIONS DEFINITION/MEANING Hospital is an institution suitably located, constructed, organized, staffed to supply scientifically, efficiently and unhindered, all or any recognized part of the complex requirements for the prevention, diagnosis and the treatment of physical, mental and medical aspects of social ills with functioning facilities for training new workers in many special profession, technical and economical fields, essential to the discharge of its proper function and with adequate contacts with physicians, other hospitals, medical schools and all accredited health agencies engaged with better health programmes. 40. WHO-DEFINITION Hospital is an integral part of a social and medical organization, the function which is to provide for the population complete health care, both curative and preventive and whose out patient services reach out to the family and its home environment, the hospital is also a center for the training of health worker and for biosocial research. 41. TYPES OF HOSPITALS Length of stay of patient chronic care hospitals Acute care hospitals (i)(ii) Clinical basis (iii) ownership/control basis Public Voluntary Private/charitable/nursing homes Corporate hospitals 42. (iv) Classification based on objectives Teaching hospital General hospital Specialized hospital Isolation hospitals (v) Based on size Teaching hospital District hospital Taluk hospital PHC 43. (vi)Classification according to ministry Union Govt / Govt of India State Govt Local bodies Autonomous Private hospitals Voluntary hospitals (vii)According to system Allopathic Ayurveda Homeopathic Unani Hospitals of other systems of medicine 44. FUNCTIONS (i) Patient care care of the sick and injured and restoration of the health of a diseased person which any discrimination. (ii) Diagnosis and treatment of disease (iii) Out patient services (iv) Medical education and training provides professional and technical education for many classes of health personnel. (v) Medical and nursing research since because of accumulation of different types of patients, the hospital provides the basis for scientific investigation. (vi) Prevention of disease and promotion of health it provides services to surrounding population that may be preventive care and promoting their health. 45. HEALTH PROMOTION AND PREVENTION OF DISEASE(LEVELS) Health promotion:- It is the process of enabling people to increase control over and to improve health. This is intended to strengthen the host through a variety of approaches. (i) Health education (ii) Environmental modifications (iii) Nutritional interventions (iv) Lifestyle and behavioral changes. 46. 1.Primary prevention: Primary prevention can be defined as action taken prior to the onset of disease which removes the possibility that a disease will ever occur. It is applied at the prepathogenic period; it includes health promotion and specific protection.a. Health promotion: The first level of prevention is by promoting and maintaining the health of the host by nutrition, health education, good heredity and other health promotion activities. b. specific protection: It may be directed towards the agent like disinfection of contaminated particles, materials, water, food, and other particles on the assumption that the agent has escaped into these vehicles or environment. 47. 2. Secondary prevention : It can be defined as action which halts the progress of a disease at its incipient stage and prevents complications. The specific interventions are early diagnosis and adequate treatment. 3. Tertiary prevention: It can be defined as all measures available to reduce or limit impairment and disabilities, minimize suffering caused by existing departures and disabilities, minimize suffering caused by existing departures from good health and to promote the patients adjustments to irremediable conditions. It includes disability limitation and rehabilitation. 48. PRIMARY HEALTH CARE Definition Primary health care is essential health care made universally accessible to individuals and families in the community, by means acceptable to them, through their full participation and at a cost that the community and country can afford. It forms an integral part both of the countrys health system of which it is the nucleus and the overall social and economic development of the community 49. PRIMARY HEALTH CARE SERVICES Health education Maternal and child health careimmunizationProviding essential drugsPrevention of illnessPrimary health care includes services such as Prevention and control of epidemic diseasesAdequate nutritionTreatment of minor illness and minor injuriesPromotion of mental health Adequate and safe water supply 50. PRINCIPLES OF PRIMARY HEALTH CARE Equitable distribution Community participation Coverage and accessibility Intersectoral coordination Appropriate health technology Human resource Referral system Logistics of supply The physical facilities Control and evaluation 51. Role of nurse in primary health care Facilitative role Developmental role Supportive role Training Management Supervision Program implementation Program evaluation Policy making Program planning Clinical role 52. CONCLUSION 53. UNIT II - NURSING AS A PROFESSION INTRODUCTION Nursing in todays world is completely different from the nursing practiced in the past. It is expected to change drastically in the present and in future. Nursing has changed dramatically in response to the societal needs and influences. All through the years nurses and nursing struggled to prove it as science, acquire autonomy and professionalization and at last in many parts of the world it is considered as a science, as a profession with gaining autonomy in specified areas. 54. THE LIBERAL MEANING OF THE WORD NURSE N- NOBILITY, KNOWLEDGEU UNDERSTANDING, USEFULNESSR ResponsibilityS- SIMPLICITY, SYMPATHYE Efficiency, equanimity 55. ESSENTIAL QUALITIES OF A NURSE Honesty Loyalty Discipline and obedience Courtesy Dignity Personal appearance Tact, sympathy, sense of humor and patience Optimistic outlook Observation and adaptability Gentleness and quietnessEconomy Sense of responsibility 56. DEFINITIONS OF NURSING INTERNATIONAL COUNCIL OF NURSING (ICN) 1973 Nursing is to assist the individual(sick or well) in the performance of those activities contributing to health, its recovery (or to a 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. AMERICAN NURSES ASSOCIATION Nursing is the protection, promotion and optimization of health abilities; prevention of illness and injury; alleviation of suffering through the diagnosis and treatment of human responses; and advocacy in health care for individuals, families, communities and populations. 57. VIRGINIA HENDERSON The unique function of the nurse is to assist the individual, sick or well, in the performance of those activities contributing to health or its recovery( or to peaceful death) that he would perform unaided if he had the necessary strength, will or knowledge.FLORENCE NIGHTINGALE The act of utilizing the environment of the patient to assist him in his recovery.CANADIAN NURSES ASSOCIATION 1987 Nursing practice as a dynamic, caring and helping relationship in which the nurse assists the client to achieve and obtain optimal health. 58. BASIC NURSING PRINCIPLES SAFETY : It is the protection to hazards to patients and members of the health team from the possible mechanical, chemical, thermal, bacteriological and psychological injuries. THERAPEUTIC EFFECTIVENESS: It is the result of the work, that is whether the purpose of the procedure is fully achieved or out. COMFORT : Every nursing procedure is aimed for the comfort of the patient. It should give the satisfaction to the patient, relatives and nurse on completion of the work. 59. USE OF RESOURCES The use of time energy and material should be economic. A procedure should not be cancelled due to the want of one or two items required if they are not extremely essential. In such situations adjustment can be done by improving materials with the available resources. GOOD WORKMANSHIP It is the skill in doing the procedure. There is great difference in doing things by a fresh hand and an experienced hand. Nursing is learning by doing not merely by reading. INDIVIDUALITY The likes and dislikes are different persons. So when we are planning nursing care to a person, his needs are to be anticipated and problems are to be identified and feelings are to be considered. 60. CONCEPTS OF NURSING CONCEPTS o Concepts are basically vehicles of thought that involves images. o Concepts are words that describe objects, properties, or events and are basic components of theory. o Nursing refers to the process of caring for the health of human beings and assisting individuals in meeting their needs while also teaching them the basics of caring for themselves. o The responsibilities of the nursing profession are to promote good health, to prevent illness when possible, to promote healing in those who are ill and to ease the suffering of dying patients. o The concept of nursing extends beyond the health care facility to the community and society as a whole, and views individual health and the environment as closely related. o Nursing is defined as care that is tailored to the needs of individuals and that is provided in an efficient and effective manner. 61. CONCEPTS OF NURSINGPersons Needs Cultures Wholeness Development Behavior 2. Health Wholeness Healing Self care Wellness Coping Illness Stress/crisis 62. Environmenthealth care systemsSocial supportPhysicalSocioculturalFamilyNursing : caring in the human health experience 63. SCOPE OF NURSING Nurses provide care for 3 types of clients. They are Individuals Families Communities. The scope of nursing practice involves 4 areas. They are 1. Promoting health and wellness: Wellness is a process of enhancing the quality of life and improve personal potential. Nurses promote wellness in clients who are both well and ill. This may include activities like enhancing healthy lifestyles, improving nutrition and physical fitness, preventing drug or alcohol misuse etc. 64. 2. Preventing illness The goal of illness prevention is to maintain optimal health by preventing disease. This may include nursing activities like immunizations, prenatal and infant care, prevention of sexually transmitted diseases. 3. Restoring health It focuses on the client, and it extends from early detection of disease through helping the client during the recovery period. This includes providing direct care to the ill person, performing diagnostic and assessment procedures, consulting with other health care professionals about client problems, teaching clients and rehabilitating clients. 4. Caring for the dying This area of nursing involves comforting and caring for people of all ages who are dying. The ultimate concept is to undergo a painless and peaceful death in case of terminally ill clients and also be treated with human dignity 65. NURSING AS A PROFESSION Profession has been defined as that requires extensive education or a calling that requires special knowledge, skill and preparation. Profession is an occupation with moral principles that are devoted to the human and social welfare. Professional nursing is a service devoted to the promotion of human and social welfare. Professionalization is the process of becoming professional that is of acquiring characteristics considered to be professional. Professional nurse is a health worker, a graduate from a recognized school who is identified by law as a registered nurse whether graduated from a B.Sc or a diploma program. 66. Criteria for profession: specialized education is an important aspect of professional status. Body of knowledge: As a profession, nursing is establishing a well defined body of knowledge and expertise. A number of nursing conceptual frameworks contribute to the knowledge base of nursing and give direction to nursing practice, education and ongoing research. Service orientation: nursing as a tradition of service to others. This service, however, must be guided by certain rules, policies or codes of ethics. Ongoing research: since the 1960s nursing research has focused on practice related issues. Code of ethics: ethical code change as the needs and values of society change Autonomy: A profession is autonomous, if it regulates itself and sets standards for its members. 67. CHARACTERISTICS OF A PROFESSIONAL NURSE Good physical and mental health Truthful and efficient in technical competence Cleanliness, tidy, neat and well groomed Confidence in others and itself Intelligence Open minded, cooperative, responsible able to develop good interpersonal relations.Leadership quality Positive attitudes Self-belief towards human care and cure Convey cooperative attitudes towards co-worker.Responsible towards family and society 68. PROFESSIONAL ETIQUETTESBe gentle and polite in your talkGreet your seniors, co-workers, your patientKeep your dress neat and tidy Help the seniors to carry a heavy load if you find them on the way Be punctual always Keep eye contact and sit face-to-face when listening to some one.Knock at the door and wait for the answer before you enter into others room Excuse yourself before you interfere with others engaged in talking or doing some work. You should not give and receive any gifts or present especially from the patients and their relatives. 69. Criteria of a profession According to Wickenden Renders a specialized service based upon advanced specialized knowledge and skill and dealing with its problems primarily on an intellectual plane rather than on a physical or a manual labor plane. Involves a confidential relationship. Is charged with a substantial degree of public obligation Enjoys a common heritage of knowledge, skill, and status. Performs its services to a substantial degree in the general public interest. Is bound by a distinctive ethical code in its relationships with clients, colleagues and the public. 70. According to Flexner Uses a specialized body of knowledge on the level of higher learning in its practice.(intellectual) Constantly enlarges its body of knowledge and improves its service through scientific methods.(scientific) Educate its practitioners in institutes if higher education(requires higher education) Offers services which are vital to human and social welfare(essential) Makes its own policies and controls its own activities(selfgoverning) Attracts those who put service above personal gain and accept their occupation as their life work.(altruism or service oriented) Strives to provide freedom of action, opportunity for continuous professional growth and economic security. 71. Nursing as a professionIntellectualProfessional growth and economic securityScientificAltruism or service orientedRequires higher educationSelfgoverningEssential 72. PHILOSOPHYThe study of the fundamental nature of knowledge, reality and existence esp when considered as an academic discipline.A set of views and theories of a particular philosopher concerning such study or an aspect of it. 73. PHILOSOPHY OF NURSING Philosophy of nursing states our thoughts on what we believe to be true about the nature of the profession of nursing and provide a basis for nursing activities. It endorses ethical values we hold as basic and bases our beliefs in theory. Nurses are responsible for lifelong learning, accountability for their practice and participation in interdisciplinary activities. The statement of philosophy is defined as an explanation of the systems of beliefs that determine how a mission or a purpose is to be achieved. 74. NURSING SERVICE PHILOSOPHY The nursing service philosophy is a statement of beliefs that flows from and is congruent with the institutions philosophy. The belief system of the nursing philosophy should reflect the nursing division members ideas and ideals for nursing and should be endorsed by others. 75. COMPONENTS OF NURSING SERVICE PHILOSOPHY 1.Nursing /nursing practice Nursing is a health care service mandated by society, the practice of nursing stems from the beliefs and ideals of the nursing service department. In the first area, nursing theory, the task of the nurse manager is to decide whether and how to incorporate theory. Three different methods may be considered. i. One method is to use an eclectic approach, selecting ideas and constructs from various nursing theories and incorporating these in to philosophy. ii. A second method is to use one theory throughout the philosophy. iii. A third approach is to adopt a theory, then attach the entire document describing the theory to the philosophy and refer to the theory at appropriate places in the philosophy. 76. Asecond set of values related to nursing/nursing practice center around practice, education and research.2.Patient /client The patient is the main reason for the institutions existence, examine patients rights. Beliefs concerning patients rights will be influenced in part by institutional policies and practices. 3. Nurses Nurses are essential in the day-to-day operations of the hospital organization They are the providers of nursing acts which result in quality care. To keep the organization smoothly, it is necessary to address values related to and beliefs about nurses. 77. PHILOSOPHY OF NURSING EDUCATION Philosophy of nursing education is the written statement of the believes, values, attitudes and ideas which the faculty as a group agreed upon in relation to the nursing educational programme such as health, disease, nursing, nurse, nursing profession, education, learner, society, patient, nursing education and preparation of nurses. Philosophy of nursing education is a perfect combination of nursing and philosophy of education, more precisely, philosophy of nursing and philosophy of education is the application of the fundamental belief of nursing and education in the field of nursing. The objectives formulated with a philosophical basis of education focus on the student life and the all round development. 78. FACTORS INFLUENCING PHILOSOPHY OF NURSING EDUCATION The philosophical values and beliefs of the institution The environment where the education takes place The student and activities Health needs of the society The culture and background of the people Developments in nursing, medicine and allied fields. Philosophy of nursing service administration The goals and objectives of the health care delivery system The disease pattern, the health awareness and health facilities available. The available resources in terms of man, money and materials. 79. OBJECTIVESObjectives are the ends toward which activity is aimedthey are the end results toward which activity is aimed.Objectives are goals, aims, or purposes that organizations wish over varying periods of timeMcFarland 80. CHARACTERISTICS OF OBJECTIVES SMART Specific: clear about what, where, when, and how the situation will be changed. Measurable: able to quantify the targets and benefits. Achievable: able to attain the objectives. Realistic : able to obtain the level of change reflected in the objective. Time bound: stating the time period in which they will each be accomplished. 81. OTHER CHARACTERISTICS Each organization or group of individuals have some objectives. Objectives may be broad or they may be specifically mentioned Objectives may be clearly defined. Objectives have hierarchy. Organizational objectives have social sanction, that is, they are created within the social norms. An organization may have multiple objectives Organizational objectives can be changed. 82. OBJECTIVES OF NURSING Examples of objectives in nursing The department of nursing will; Provide quality nursing services to our patients by preventing illness, promoting and restoring their health. Provide individualized holistic patient care utilizing the nursing process. Establish effective communication, cooperation and coordination with all health professionals and administrative services involved in the planning and delivery of patient care. Foster a positive work atmosphere based on team spirit and trust among nursing staff and members of the health team to ensure job satisfaction. 83. Contd.. Maintain standards of professional practice among nurses by implementing a continuous in-service training programme. Assess and evaluate our quality of nursing care on an on going basis through quality improvement and nursing audits. Initiate and carry out research, surveys, studies etc., aimed at improving quality of patient care Participate in the teaching learning experience of students by providing guidance and assistance in the use of hospital resources. Develop staff readiness and efficiency to respond promptly in disaster and war situations. 84. CHARACTERISTICS OF NURSINGQualities of nurses Communication skills Emotional stability Empathy Flexibility Attention to detail Interpersonal skills Physical endurance Problem solving skills Quick response Respect 85. ROLE OF A NURSE/FUNCTIONS OF A NURSECARE GIVERRESEARCHERTEACHERMANAGERCOUNSELORCHANGE AGENT 86. Care giver/care provider The traditional and most essential role Functions as nurture, comforter, provider Mothering actions of the nurse Provides direct care promotes comfort of client Activities involves knowledge and sensitivity to what matters and what is important to clients Shows concern for client welfare and acceptance of the client as a person Teacher Provides information and helps the client to learn or acquire new knowledge and technical skills encourages compliance with prescribed therapy. Promotes healthy lifestyle Interprets information to the client. 87. Counselor Helps client to recognize and cope with stressful psychological or social problems To develop and improve interpersonal relationships and to promote personal growth. Focuses on helping a client to develop new attitudes, feelings and behaviors rather than promoting intellectual growth. Change agent Initiate changes or assist clients to make modifications in themselves or in the system of care. Client advocate Promotes what is best for the client, ensuring that the clients needs are met and protecting the clients rights. Provides explanation in clients language and support clients decisions. 88. Manager Plans, give direction, develop staff, monitors operations, give the rewards fairly and represents both staff and administrations as needed. Researcher Participates in scientific investigation and must be a consumer of research findings. Must be aware of the research process, language of research, a sensitive to issues related to protecting the rights of human subjects. 89. EXPANDED ROLE OF THE NURSE 1. 2.Clinical specialistsA nurse who has completed a masters degree in specialty and has considerable clinical expertise in that specialty. She provides care to individuals, participates in educating health care professionals and ancillary, acts as a clinical consultant and participates in research. Nurse practitionerA nurse who has completed either as certificate program or a masters degree in a specialty and is also certified by the appropriate specialty organization. She is skilled at making nursing assessments, performing P.E, counselling, teaching and treating minor and self limiting illness. 90. 3. Nurse midwife- a nurse who completed a program in midwifery, provides prenatal and postnatal care and delivers babies to woman with uncomplicated pregnancies. 4. Nurse anesthetist- a nurse who completed the course of study in an anesthesia school and carries out pre operative status of clients. 5. Nurse educator- a nurse usually with advanced degree, who beaches in clinical or educational settings, teaches theoretical knowledge, clinical skills and conduct research. 6. Nurse entrepreneur- a nurse who has an advanced degree, and manages health related business. Nurse administrator-a nurse who functions at various levels of management in health settings; responsible for the management and administration of resources and personnel involved in giving patient care. 91. CATEGORIES OF NURSING PERSONNELCATEGORIES OF NURSING PERSONNELEDUCATIONPRINCIPAL VICE PRINCIPAL PROFESSOR ASSOCIATE PROFESSOR ASSISTANT PROFESSOR LECTURER ASST.LECTUREHOSPITALNURSING SUPERINTENDENT DEPUTY NURSING SUPERINTENDENT ASSISTANT NURSING SUPERINTENDENT WARD SISTER STAFF NURSE NURSE ASSISTANTSCOMMUNITYDIATRICT PUBLIC HEALTH NURSE COMMUNITY HEALTH NURSE SECTOR HEALTH NURSE MPHW OR VILLAGE HEALTH NURSE 92. ETHICAL ISSUES IN NURSING Ethics are the rules or principles that govern right contact. Ethics are designed to protect the rights of human being. Ethics are characteristics of a healthy profession. NURSING ETHICS o The nursing ethics provide professional standards for nursing activities which protect the nurse and the patient. o In 1973, the ICN adopted code of ethics. o The fundamental responsibility of the nurse is four fold-to promote health, to prevent illness, to restore health and to alleviate suffering. o Nurses render health services to the individual, the family and the community and coordinate their services with those of related groups. 93. CODE OF ETHICS Nurses and people: The nurses primary responsibility is to those people who require nursing care. The nurse holds in confidence personal informations and use judgment in sharing this information. Nurses and practice: The nurse maintains the highest standards of nursing care possible within the reality of a specific situation. The nurse when acting in a professional capacity should at all times maintain standards of personal conduct which credit upon the profession. Nurses and society: The nurse shares with other citizens the responsibility for initiating and supporting action to meet the health and social needs of the public. 94. Nurses and co workers: The nurse maintains a cooperative relationship with coworkers in nursing and other fields. The nurse takes appropriate action to safeguard the individual when his care is endangered by a co-worker or any other person. Nurses and profession : The nurse acting through the professional organization participates in establishing and maintaining equitable social and economic working conditions in nursing. 95. ETHICAL PRINCIPLES Ethical principles are defined as basis for nurses decisions on consideration of consequences and of universal moral principles when making clinical judgments. The primary and basic principles are Respect for persons Respect for autonomy Beneficence Nonmaleficience Justice The secondary principles are Veracity Confidentiality Fidelity 96. o o o o oRespect for persons According to ANA, the most fundamental principle of professional behavior is the respect for persons. This principle not only applies to the clinical settings but to all lifes situations. This principle emphasizes that all people should treat others as a worthy individual. In nursing practice this principle should be simplified. Thus, respect for persons generally means respecting a clients autonomy.Respect for autonomy o Respecting a clients rights, values and choices is synonymous to respecting a persons autonomy. o Informed consent is a method that promotes and respects a persons autonomy. o For a client to make an autonomous decision and action, he or she must be offered enough information's and options to make up his or her mind free of coercion or external and internal influences. 97. o o o o o o o o o o oNonmaleficience It means duty to do no harm. Avoiding deliberate harm, risk of harm that occurs during the performance of nursing actions. Considering the degree of risk permissible Determining whether the use of technological advances provides benefits that outweigh risks. Beneficence It is doing or active promotion of good Providing health benefits to the clients Balancing the benefits and risks of harm Considering how a client can be best helped. Justice It is the promotion of equity or fairness in every situation a nurse encounters. Ensuring fair allocation of resources Determining the order in which clients should be treated. 98. Secondary principles for ethical conduct. Veracity duty to tell the truth Confidentiality duty to respect privileged information Fidelity duty to keep promises 99. VALUES Values are freely chosen, enduring beliefs or attitudes about the worth of a person, object, idea or action. Freedom, courage, family and dignity are examples of values. Values frequently derive from a persons cultural, ethnic and religious background; from societal traditions; and from the values held by peer group and family. Values form a basis for behavior. Once a person becomes aware of his/her values, those values become an internal control for behavior; thus a persons real values are manifested in consistent patterns of behavior. 100. Values exist within a person and affect the persons relationship to others. A value system is the organization of a persons values along a continuum, that is from most important to least important. Values form the basis of purposive behavior, which refers to actions that a person performs "on purpose, with the intention of reaching some goal or bringing about a certain result. Thus, purposive behavior is based on a persons decisions or choices, and these decisions or choices are based on the persons underlying values. Values are that which we seek to achieve or maintain according to our life as the standard of evaluation. Values are the motive power behind purposeful action. They are the ends to which we act. Without them, life would be impossible. Life requires self generated action to sustain itself. Without values, one could not act, and death would follow. 101. Values specifies a relationship between a person and a goal. A value requires a valuer-a particular person who aims to achieve or maintain something. An object cannot have value in itself. Value is relational, and so requires a person and a goal. The goal to which one aims is called the value, but the relationship is always required. This means an object cannot be a value in itself. Values are essential to ethics. Ethics are concerned with human actions, and the choice of those actions. Ethics evaluates those actions, and the values that underlie them. It determines which values should be pursued, and which shouldnt. Ethics is a code of values. 102. VALUES CLARIFICATION o Values clarification is a process by which people identify, examine, and develop their own individual values. o A principle of values clarification is that no, one set of values is right for everyone. o When people are able to identify their values, they can retain or change them and thus act on the basis of freely chosen rather than unconscious values. o Values clarification promotes personal growth by fostering awareness, empathy and insight. o A widely used theory of values clarification was developed in1966 by Raths, Harmin andSimon. This valuing process includes cognitive, affective and behavioral components, referred to as choosing, prizing and acting. 103. TYPES OF VALUES There are 3 types of values. They are A. Terminal values B. Instrumental values C. Professional values.TERMINAL VALUES i. Family security (defined as taking care of loved ones). ii. Happiness (defined as contentedness, freedom from inner conflict). iii. A sense of accomplishment(defined as a feeling of fulfillment) 104. INSTRUMENTAL VALUES i. Honesty (defined as sincere, truthfulness) ii. Responsible (defined as dependable and reliable) iii. Intellectual (defined as intelligent and reflective) PROFESSIONAL VALUES i. Human dignity ( defined as awareness of a patients beliefs and values and to honor them) ii. Equality (defined as the right to be treated equally without discrimination) iii. Prevention of suffering( defined as freedom from pain and anxiety) 105. VALUES IN NURSING AltruismConcern for the welfare of others Equality. Having the same rights, privileges or status. Nurses promote and uphold the provision of quality nursing care for all people. Esthetics Qualities of objects, events and persons that provide satisfaction. Nurses value the promotion of an ecological, social and economic environment which supports and sustains health and well being. Nurses respect the rights of persons to make informed choices in relation to their care. 106. Humandignity Inherent worth and uniqueness of an individual. Nurses respect persons individual needs, values and culture in the provision of nursing care. JusticeUpholding moral and legal principles. Nurses promote and uphold the provision of quality nursing care for all people and nurses hold in confidence any information obtained in a professional capacity and use professional judgment in sharing such information. TruthFaithfulness to fact or reality. Nurses respect the accountability and responsibility inherent in their roles. 107. ADVOCACY Definition Act of arguing on behalf of a particular issue, idea or person; pleading, supporting a cause. A process of actions intended to bring about change in attitudes of individuals, groups, institutions and governments.Ability to influence, transforms, mobilize and allocate resources we do this every day.Organized efforts and actions based on what is to make what should be reality. 108. NEED FOR ADVOCACYDeveloping knowledge/skills Empowerment to assist in being at the table Educate others about patient care issues Ultimate goal of positively impacting patient care Doing the right thing for your patient They are respected, needs met, have a voice when most vulnerable. Speaking out to assure adequate resources available to perform job. 109. SITUATIONS FOR ADVOCACYPatient safety issues Competing priorities Patient acuity/staffing issues Collegial relationships Workplace safety Healthy work environment Called to advocacy 110. NURSES TIP FOR ADVOCACY Emphasis on partnering with / caring for patients/ families Unique relationship Collaborate with other health care professionals to promote community, national and international efforts. Commit to continuous learning through education, skill development, evidence base practiceTrusted, impeccable character, inspirational and compassionate; held to higher standard. 111. BARRIERS OF ADVOCACYApathy-not caringDisempowermentFeelings of inadequacy; preparedness, message Lack of knowledge, education, tools, strategyLack of time on part of advocates. 112. CONCLUSION