NURSING as an ART

The art of nursing refers to the highly valued qualities of care, compassion and communication- three
core principles guiding nursing practice

How does a nurse demonstrate caring?

A caring environment fosters a person's development while letting them choose the actions that
best suit them

Given similar situations, why is one nurse judged to be “caring while another is said to be “uncaring”?
Because caring is contextual, a nursing approach used with a client in one situation may be ineffective in
another. Caring responses are as varied as clients’ needs, environmental resources, and nurses’
imaginations.

Common caring patterns include

a. knowing the client

b. nursing presence
c. empowering the client –if reluctant – educate, provide foster caring environment
d. compassion – participate nsg interventions-procedures, share information-education,
involvement
e. Competence – knowledge, effective-efficient

Caring is at the heart of nursing’s identity; indeed, the root of the word nursing means “nurturance” or
“care”

PROFESSIONALIZATION OF CARING
When nurses feel free to concentrate their attention on others, they can make a positive
difference to clients. The ability to give clients focused attention means leaving the egocentric self
behind. Students of nursing can develop this ability by studying the meaning of caring in nursing.
CARING AS “HELPING THE OTHER GROW”

Milton Mayeroff (1990), a noted philosopher, has proposed that to care for another person is to help
him grow and actualize himself.

Recognizing the other as having potential and the need to grow, the caregiver does not impose
direction, but allows the direction of the other person’s growth to help determine how to respond.0

Caring practice involves connection, mutual recognition, and involvement (cooperation) between
nurse and client.

NURSE THEORIST/NURSE SCHOLARS/AUTHORS

CARING PRACTICE MODELS (These theories and models are grounded in humanism and the
idea that caring is the basis for human science. )

A. Culture Care Diversity and Universality (Madeleine Leininger) - often regarded as the founder of this
nursing discipline
-Transcultural nursing focuses on both the differences and similarity.
 -means being sensitive to cultural differences as you focus on individual patients, their
needs, and their preferences. Show your patients your respect for their culture by asking them about it,
their beliefs, and related health care practices.
— including beliefs and values, religion, lifestyle, and family history — into medical
care
EXAMPLE: You could describe a mother's love for her child as transcultural, since it exists in all human
cultures. Something that's true across all cultures of people, no matter how different, can be described
with the adjective transcultural. The key to the word's meaning is found in the prefix trans, or "across"
in Latin.

B. Theory of Bureaucratic Caring (Marilyn Anne Ray’)

- focuses on caring in organizations (e.g., hospitals) as cultures. –ACCORDING TO SKILLS
- “Spiritual-ethical caring for nursing does not question whether or not to care in complex systems,
but intimates how sincere deliberations and ultimately the facilitation of choices for the good of
others can or should be accomplished”
Examples of bureaucracy are all around us. Workplaces, schools, governments, all typically have
hierarchical structures with individuals filling positions based on skill or merit (real or perceived).
-all responsibilities need to be delegated to employees to maximize efficiency. everyone is treated
equally and work responsibilities are divided by each teams' areas of expertise.

C. Caring, the Human Mode of Being (Sister Simone Roach) - All individuals are caring, and develop
their caring abilities by being true to self, being real, and being who they truly are. Thus, caring is not
unique to nursing.
-care for others not because they are required to do so by their jobs, but because they are human
beings and this trait of caring is intrinsic to all humans

D. Nursing as Caring (Anne Boykin and Savina O. Schoenhofer) -emphasize the importance among
individuals in diverse cultures.
-Through fully appreciating the life world of others, the nurse energizes self and others to grow as
caring individuals
-“Caring begins with being present, open to compassion, mercy, gentleness, loving kindness, and
equanimity toward and with self before one can offer compassionate care to others”

E. Theory of Human Care (Jean Watson) -defines health to include the entire mind, body, and soul.
-care is the basis for nursing’s role in society; indeed, nursing’s contribution to society lies in its moral
commitment to human care. Nursing as human care goes beyond the realm of ethics
- being present, open to compassion, mercy, gentleness, loving kindness, and equanimity toward and
with self before one can offer compassionate care to others
• The nurse must care for the self in order to care for others. • Nurses must remain committed to
human care ideals. • Cultivation of a higher/deeper self and a higher consciousness leads to caring. •
Human care can only be demonstrated through interpersonal relationships.
- theory can be applied in caregiving settings through interactions between caregivers and patients. As
the two interact and get to know one another, the relationship strengthens as the nurse shifts from
treating an illness to caring for the whole individual.

F. Theory of Caring (Swanson)

The theory focuses on caring processes as nursing interventions. Swanson’s theory was developed
through interactions with parents at the time of pregnancy, miscarriage, and birth.
-outlines five caring processes: knowing, being with, doing for, enabling, and maintaining belief

The Six C’s of Caring in Nursing

1. COMPASSION Awareness of one’s relationship to others, sharing their joys, sorrows, pain, and
accomplishments. Participation in the experience of another.
2. COMPETENCE Having the “knowledge, judgment, skills, energy, experience and motivation required
to respond adequately to the demands of one’s professional responsibilities” (Roach, 2013).
3. CONFIDENCE Comfort with self, client, and others that allows one to build trusting relationships.
4. CONSCIENCE Morals, ethics, and an informed sense of right and wrong. Awareness of personal
responsibility.
5. COMMITMENT The deliberate choice to act in accordance with one’s desires as well as obligations,
resulting in investment of self in a task or cause.
6. COMPORTMENT Appropriate bearing, demeanor, dress, and language that are in harmony with a
caring presence. Presenting oneself as someone who respects others and demands respect.

Caring for Self

Mayeroff (1990) describes caring for self as helping oneself grow and actualize one’s possibilities. Self-
care, when defined as responding to one’s own needs to grow, is the opposite of the self-complacency
that often accompanies egocentricity.
Caring for self means taking the time to nurture oneself. This involves initiating and maintaining
behaviors that promote healthy living and well-being. Although different activities may be helpful to
different people, some examples of these activities include:
• A healthy lifestyle (e.g., nutrition, activity and exercise, recreation)
• Mind–body therapies (e.g., guided imagery, meditation, yoga).
In its code of ethics, the American Holistic Nurses Association (2012) states that “the nurse has a
responsibility to model health care behaviors. Holistic nurses strive to achieve harmony in their own
lives and assist others striving to do the same.” Individuals with high self-esteem can critically problem
solve and tackle obstacles more effectively. Self-care practices build self-esteem, leading to feelings of
comfort and accomplishment.
• The student nurse matures as a practitioner by reflecting on practice. Through reflection, nurses can
grow and participate more fully in caring-healing relationships.
EARLY BELIEFS and Practices

-cause of a disease - believed to be due to either another person, an enemy, or a witch or evil spirits.
-Belief in special gods of healing, with the priest -physician (called “word doctors”) as intermediary.
-If they used leaves or roots, they were called herb doctors (“herbolarios”)
-Filipinos who became sick were usually cared for by the female family members or friends in the home.
-early Filipinos subscribed to superstitious belief and practices in relation to health and sickness
-herb men were called “herbicheros” meaning one who practiced witchcraft.
-Persons suffering from diseases without any identified cause were believed bewitched
by “mangkukulam” or “manggagaway”.
-Midwives assisted in childbirth. During labor, the “mabuting hilot” (good midwife) was called in.

1. FLORENCE NIGHTINGALE - The lady with the lamp

 Transformed the military hospitals by setting up sanitation practices such as handwashing and
washing of clothes regularly.
 She is recognized as the FIRST nursing theorist for her work “Notes on Nursing: What It Is &
What It is Not”
 Developed the Environmental Theory
2. CLARA BARTON - Established the American Red Cross
She persuaded the Congress in 1882 to ratify this treaty so that the Red Cross could perform
humanitarian efforts in time of peace.
3. LINDA RICHARDS – was America’s FIRST trained NURSE
 Introduced the nurse’s notes & doctors orders, Also initiated the practice of nurses wearing
uniforms, Credited for her pioneer work in psychiatric & industrial nursing
4. MARY MAHONEY - 1ST African American professional nx
She constantly worked for the acceptance of African Americans in Nsg and for the promotion of equal
opportunities.
5. LILLIAN WALD - Founder of PUBLIC HEALTH NURSING
First to offer trained nursing services to the poor in the New York slums called the Henry Street
Settlement
6. HARRIET TUBMAN - Provided care and safety to slaves fleeing to the North on the Underground
Railroad.

Nurse – originated from the Latin word “Nutrix” meaing “to nourish”.
Nursing is indeed an art and science. Science helps to explain the work of a nurse, while art addresses
the human connections, empathetic communication, and dedicated care and compassion that make
nursing a critical element of healthcare
 nursing describe the nurse as a person who nourishes, foster and protects and who is
prepared to take care of sick, injured and aged people.
 The central focus of nursing is the patient (the person receiving care) and included the physical,
emotional, social and spiritual dimensions of that person.

Skills a nurse must possess:

1. Cognitive
2. Technical
3. Interpersonal
4. Ethical and Legal
Scope of Nursing:
1. Health Promotion
2. Prevent illness
3. Restore Health
4. Facilitate coping with disability or death

1. HEALTH PROMOTION
a. Is the framework of nursing activities
b. The nurse considers the patients self awareness, health awareness and use of
resources while providing care
c. Facilitates decision about lifestyle that enhance quality of life and encourage
acceptance of responsibility for one’s own health.
d. increase health awareness by assisting in the understanding that health is more
than just being ill, and by teaching that certain behaviors and factors can
contribute to or diminish health.
e. teaches self- care activities to maximize achievement of goals that are realistic and
attainable; serves as a role model.
f. encourages health promotion by providing information and referrals.

2. PREVENT ILLNESS
a. to reduce the risk for illness, to promote good health habit and maintain optimal
functioning.
b. the motivation for illness prevention is to avoid or achieve early detection of
illness.
c. educational program
d. community program and resources that encourage healthy lifestyle

3. RESTORE HEALTH
a. these focus on the individual with an illness and range from detection of disease
to rehabilitation and teaching during recovery.
b. performing diagnostic measurements and assessment that detect an illness such
as taking blood pressure and monitoring blood sugar.
c. Referring questions and abnormal findings to other health care providers as
appropriate
d. Providing direct care of the person who is ill by such measures as giving physical
care, administering medications, and carrying out procedures and treatments.

4. FACILITATE COPING WITH DISABILITY or DEATH

a. Nurses also facilitate patient and family coping with altered function, life crisis and
death.
b. Nurses provide care to both patients and families during end of life care and the
do so in hospitals, long term care facilities and homes.
c. Nurses are active hospice program which assist patient and their families in
preparing for death and in living as comfortably as possible until death occurs.
ROLES and FUNCTIONS OF THE NURSE
Caregiver -Assist the client physically & psychologically while preserving the client’s dignity.
Communicator – Nurses identify the problem and communicate these verbally or in writing to other
members of the health care team.
Teacher –help the clients learn about their health and health care procedures, Assesses client’s learning
needs, readiness to learn, sets specific goals, apply teaching strategies and measure learning.
Client advocate – Acts to protect the client, Assist the client in exercising their rights and help them
speak up for themselves
Counselor – Helping clients recognize and cope with stressful psychologic or social problems , To
develop improved interpersonal relationship and promote personal growth
Change agent – Assist clients to make modifications in their behavior
Leader – Influences others to work together to accomplish a specific goal
Manager – Delegates nursing activities to ancillary workers, and other nurses , Supervises and evaluates
their performance, Requires knowledge about the organizational structure, authority, and delegation
Case manager – Works with primary or staff nurses to oversee the care of a specific caseload, Provides
some level of direct care to the client and family
Researcher - Nurses often use research to improve client care, Investigates nursing problems to refine
and expand nursing knowledge

Your personal appearance -often reveals more about the REAL YOU than any words you may say.
Self-respect is the basis upon which personal appearance is established.
Posture - It presents some clues to your personality
Grooming - Hair should be neat and clean

FIVE (5) Stages if Nursing Expertise

1. Novice - NO EXPERIENCE (E.g. Nursing Student), Limited performance, Governed by context-free
rules & regulations rather than experience
2. Advance beginner - Marginally acceptable performance, Recognizes meaningful aspects of a
real situation, Has experienced enough real situations to make judgements about them
3. Competent - Demonstrates organizational & planning abilities, Coordinates multiple complex
care demands
4. PROFICIENT- 3-5 years of experience, Has holistic understanding of the client , Focuses on long
term goals
5. EXPERT - Performance is fluid, flexible, and highly proficient, No longer requires rules,
guidelines, Highly skilled intuitive and analytic ability

HEALTH

- A state of optimal functioning of well-being.

- It is often a subjective state.
- According to Who it includes physical, social and mental components and is not merely the
absence of disease or infirmity.

ILLNESS

- Alteration in health, response of the person to a disease.

- Abnormal process in which the person’s level of functioning is changed when compared with a
previous level.
CLASSIFICATION OF ILLNESSES

Acute illness – rapid onset of symptoms and lasts only a relatively short time.

Chronic illness – irreversible, persistent and usually longer than 6 months. Affects functioning in one or
more system.

Note: the causation of a disease or condition is called etiology.

STAGES OF ILLNESS

Stage 1: experiencing symptoms

- The first indication of illness recognizing one or more symptoms.

Stage 2: assuming sick role

- Gives up normal activities and assume a “sick role”.

Stage 3: assuming a dependent role

- Characterized by the patient’s decision to accept the diagnosis and follow the prescribed
treatment plan.

Stage 4: achieving recovery and rehabilitation

- Recovery and rehabilitation might begin in the hospital and conclude at home.

CHARACTERISTICS OF CHRONIC ILLNESS

- It is permanent change
- It causes or is caused by, irreversible alteration in normal anatomy and physiology.
- It requires special patient education for rehabilitation.
- It requires a long period of care or support.

Examples:

- Heart disease, stroke, cancer, diabetes (type 1 and 2) and arthritis.

Causes:

 Modifiable health risk behaviors

- Excessive alcohol consumption, lack of exercise, poor nutrition and usage of tobacco.
 Non – modifiable health risk behaviors
- Family history and genetic disposition.
FACTORS AND ISSUES AFFECTING HELATH AND ILLNESS

Risk factors

Age – school-aged children are at high risk for communicable disease.

- After menopause, women are more likely to develop cardiovascular disease.

Genetic Factors – family history of cancer or diabetes predisposes a person developing a disease.

Physiologic Factors – pregnancy places increase risk on both the mother and the developing fetus.

Health habits – smoking increases the probability of lung cancer.

- Poor nutrition can lead to a variety of health problems.

Lifestyle – multiple sex relationship increases the risk of sexually transmitted disease (gonorrhea or
AIDS).

- Events that increase stress (ex. divorce, retirement, work relater pressure) may precipitate
accidents and illness.

Environment – working and living environment such as hazardous materials and poor sanitation may
contribute to disease.

MODEL OF HEALTH AND ILLNESS

1. Agent-host environment model

2. Health-illness continuum

3. The high level wellness model

 4. The health belief model

5. Health promotion model

HEALTH “a state of complete physical, mental and social well-being and not merely the absence of
disease or infirmity” – WHO
TYPES OF HEALTH CARE SERVICES

a. Primary – health promotion and illness prevention

2 primary goals: increase quality and years of healthy life and eliminate health disparities

(ex. proper nutrition, exercise, stress reduction)

b. Secondary – diagnosis and treatment

Routine screening of the population and focused screening of those at increases risk of developing a
certain condition (ex. mammograms, voluntary HIV testing, regular dental exams)

c. Tertiary – rehabilitation, health restoration and palliative care

Goal: help people move to their previous level of health or to their highest level they are capable of
given their current health status.

Primary Secondary Tertiary

Who Healthy High risk Post-treatment
How Health education Early screening and o Rehabilitation
treatment o Discharge
instructions
o Maintenance
medications
o Palliative/supportive
care
Why Prevent further
complications

TYPES OF HEALTH CARE AGENCIES AND SERVICES

1. Public health – government agencies are established at the local state to provide public health
services.
2. Physician’s office – clients usually go to their physician’s office for routine screening, illness
diagnosis and treatment.
3. Ambulatory care centers – have diagnostic and treatment facilities providing medical, nursing,
laboratory, and radiological services and they MAY or MAY NOT be associated with an acute
care hospital.

LEVELS OF HEALTH CARE DELIVER AND SERVICES

Level No. of beds

Special tertiary: Psychiatric hospital/heart and lung Depends upon the hospital
center
Tertiary: National/general/provincial/ 100 or 300 – 1500 beds
 residential hospital
Secondary: Provincial-ER/OPD/private/district 50 – 100/200 beds
hospital
Primary: BHS/RHU, community clinics/lying- 10 – 20 beds/20 – 100 beds
in/puericulture centers/private
practitioners

4. Hospitals – vari in size from the 12-bed rural hospital to the 1,500 beds metropolitan hospital.
5. Long-term care facilities – extend care facilities formerly called nursing homes, are now often
multilevel campuses that include independent living quarters for seniors, assisted living facilities
that provide levels of personal care for those who are chronically ill.
6. Rehabilitation centers – independent community centers or special units.
7. Home health care agencies – is a wide range of health care services that can be given in your
home for an illness or injury.
8. Day care centers – serve many functions for many age groups.

Some provide care for infants and children while parents are ate work.

Other centers provide care and nutrition for adults who cannot be left at home.

Elder care centers often provide care involving socializing, exercise programs, and stimulation.

9. Crisis centers – these centers provide emergency services to the clients experiencing life crisis.

Values: God fearing-committed to serve-competent

We don't listen to hear, we listen to respond.” This often creates a lot of conflict in relationships.--Ask
more questions
What does it mean to listen to understand rather than listen to respond?
Listening with the intent to understand means you're paying attention not to voice your own thoughts
but to understand someone else's point of view

Communication can be described as helpful or unhelpful. The former encourages a sharing of

information, thoughts, or feelings between two or more people. The latter hinders or blocks the transfer
of information and feelings.

Nurses who communicate effectively are better able to collect assessment data, initiate interventions,
evaluate outcomes of interventions, initiate change that promotes health, and prevent the safety and
legal problems associated with nursing practice.
The communication process is built on a trusting relationship with a client and support people. Effective
communication is essential for the establishment of a nurse–client relationship.

Face-to-face communication - involves a sender, a message, a receiver, and a response, or feedback. In

its simplest form, communication is a two-way process involving the sending and the receiving of a
message. Because the intent of communication is to elicit a response, the process is ongoing; the
receiver of the message then becomes the sender of a response, and the original sender then becomes
the receiver.
 SENDER - a person or group who wishes to communicate a message to another, can be
considered the source-encoder.
MESSAGE - what is actually said or written, the body language that accompanies the words, and
how the message is transmitted.
RECEIVER - is the listener, who must listen, observe, and attend.
RESPONSE - the message that the receiver returns to the sender. It is also called feedback.
FEEDBACK - can be either verbal, nonverbal, or both. Non-verbal examples are a nod of the
head or a yawn. Either way, feedback allows the sender to correct or reword a message.

Verbal communication - is largely conscious because people choose the words they use. The words
used vary among individuals according to culture, socioeconomic background, age, and education.

Nonverbal communication -sometimes called body language, includes gestures, body movements, use
of touch, and physical appearance, including adornment. --often tells others more about what a person
is feeling than what is actually being said, because nonverbal behavior is controlled less consciously than
verbal behavior.

Therapeutic communication promotes understanding and can help establish a constructive relationship
between the nurse and the client.
-The therapeutic helping relationship is client and goal directed.

Active listening - the most important technique in nursing and is basic to all other techniques. It
involves paying attention to the total message, both verbal and nonverbal, and noting whether these
communications are congruent.
EMPATHY-the ability to understand and share the feelings of another.
-the ability to sense other people's emotions, coupled with the ability to imagine what someone
else might be thinking or feeling.

Sympathy - is acknowledging someone else's pain, but empathy is choosing to feel the pain with them.
Sympathy says, “I care about you,” and empathy says, “I'm hurting with you.”

Empathetic person, here are some signs that show that you have this tendency:
• You are good at really listening to what others have to say.
• People often tell you about their problems.
• You are good at picking up on how other people are feeling.
• You often think about how other people feel.
• Other people come to you for advice.

DESCRIPTION-
Using silence - Accepting pauses or silences that may extend for several seconds or minutes without
interjecting any verbal response.
Providing general leads - Using statements or questions that (a) encourage the client to verbalize, (b)
choose a topic of conversation, and (c) facilitate continued verbalization.
Being specific and tentative - Making statements that are specific rather than general, and tentative
rather than absolute.
Using openended questions - Asking broad questions that lead or invite the client to explore (elaborate,
clarify, describe, compare, or illustrate) thoughts or feelings. Open-ended questions specify only the
topic to be discussed and invite answers that are longer than one or two words
Using touch - Providing appropriate forms of touch to reinforce caring feelings. Because tactile contacts
vary considerably among individuals, families, and cultures, the nurse must be sensitive to the
differences in attitudes and practices of clients and self.
Restating or paraphrasing - Actively listening for the client’s basic message and then repeating those
thoughts and/or feelings in similar words. This conveys that the nurse has listened and understood the
client’s basic message and also offers clients a clearer idea of what they have said.
Seeking clarification - A method of making the client’s broad overall meaning of the message more
understandable. It is used when paraphrasing is difficult or when the communication is rambling or
garbled. To clarify the message, the nurse can restate the basic message or confess confusion and ask
the client to repeat or restate the message. Nurses can also clarify their own message with
statements.
Perception checking or seeking consensual validation - A method similar to clarifying that verifies the
meaning of specific words rather than the overall meaning of a message.
Offering self - Suggesting one’s presence, interest, or wish to understand the client without making any
demands or attaching conditions that the client must comply with to receive the nurse’s attention.
Giving information - Providing, in a simple and direct manner, specific factual information the client may
or may not request. When information is not known, the nurse states this and indicates who has it or
when the nurse will obtain it
Acknowledging - Giving recognition, in a nonjudgmental way, of a change in behavior, an effort the
client has made, or a contribution to a communication. Acknowledgment may be with or without
understanding, verbal or nonverbal.
Clarifying time or sequence - Helping the client clarify an event, situation, or happening in relationship
to time.
Presenting reality - Helping the client to differentiate the real from the unreal
Focusing - Helping the client expand on and develop a topic of importance. It is important for the nurse
to wait until the client finishes stating the main concerns before attempting to focus. The focus may be
an idea or a feeling; however, the nurse often emphasizes a feeling to help the client recognize an
emotion disguised behind words
Reflecting - Directing ideas, feelings, questions, or content back to clients to enable them to explore
their own ideas and feelings about a situation.
Summarizing and planning - Stating the main points of a discussion to clarify the relevant points
discussed. This technique is useful at the end of an interview or to review a health teaching session. It
often acts as an introduction to future care planning.

FOUR (4) SEQUENTIAL PHASES, each characterized by identifiable tasks and skills:
1. Preinteraction Phase – planning stage, nurse has information about the client before the
first face-to-face meeting
2. Introductory Phase – orientation phase, sets the tone for the rest of the relationship.
3. Working Phase – exploring and understanding thoughts and feelings, and facilitating and
taking action.
4. Termination Phase – nurse and client accept feeling of loss.

The relationship must progress through the stages in succession because each builds on the one before.
Communication is an integral part of the nursing process. Nurses use communication skills in each
phase of the nursing process. Communication is also important when caring for clients who have
communication problems. Communication skills are even more important when the client has sensory,
language, or cognitive deficits.
Assessing - To assess the client’s communication abilities, the nurse determines communication
impairments or barriers and communication style.
Impairments to Communication - include language deficits, sensory deficits, cognitive impairments,
structural deficits, and paralysis. The nurse must assess each to determine their presence.
Language Deficits - Determine the client’s primary language for communicating and whether a fluent
interpreter is required.
Sensory Deficits - The ability to hear, see, feel, and smell are important adjuncts to communication.
Cognitive Impairments -Any disorder that impairs cognitive functioning (e.g., cerebrovascular disease,
Alzheimer’s disease, and brain tumors or injuries) may affect a client’s ability to use and understand
language.
Structural deficits - of the oral and nasal cavities and respiratory system can alter a person’s ability to
speak clearly and spontaneously. Examples include cleft palate, artificial airways.
Paralysis - If verbal impairment is combined with paralysis of the upper extremities that impairs the
client’s ability to write, the nurse should determine whether the client can point, nod, shrug, blink, or
squeeze a hand.
Style of Communication - In assessing communication style, the nurse considers both verbal and
nonverbal communication.

Other NANDA nursing diagnoses (Herdman & Kamitsuru, 2014) used for clients experiencing
communication problems that involve impaired verbal communication as the etiology could include the
following:
North American Nursing Diagnosis Association - standardized terms and codes for patient problems or
life processes expressed as nursing diagnoses (OBSERVATIONS)

FOUR CATEGORIES OF NURSING DIAGNOSES:

1. problem focused diagnosis
2. risk diagnosis
3. health promotion diagnosis
4. syndrome

Accurate nursing diagnoses are critical, as they form the foundation for planning and implementing an
effective plan of care tailored to the needs of individual patients.

Examples of outcome criteria to evaluate the effectiveness of nursing interventions and achievement
of client goals follow.

1. Implementing
Nursing interventions to facilitate communication with clients who have problems with speech
or language include manipulating the environment, providing support, employing measures to
enhance communication, and educating the client and support person.

2. Evaluating
Evaluation is useful for both client and nurse communication.

3. Client Communication To establish whether client outcomes have been met in relation to
communication, the nurse must listen actively, observe nonverbal cues, and use therapeutic
communication skills to determine that communication was effective.
 4. Nurse Communication For nurses to evaluate the effectiveness of their own communication
with clients, process recordings are frequently used.

A process recording is a verbatim (word-for-word) account of a conversation. It can be taped or written

and includes all verbal and nonverbal interactions of both the client and nurse. One method of writing a
process recording is to make two columns on a page. The first column lists what the nurse and the client
said along with the associated nonverbal behavior.
PRELIM QUIZES with Answers.
1. She is know as the “Lady with the lamp”? (Florence Nightingale)
2. She is known for introducing nurses notes and doctors orders? (Linda Richards)
3. Florence Nightingale played an important role in addressing problems to sick and injured
soldiers during Crimean War. (True)
4. Lilian Wald is considered as the Founder of Public Health Nursing. (True)
5. According to early beliefs and health practices the cause of disease are believe to be due to
either another person, an enemy, or a witch or evil spirits. (True)
6. Filipinos who became sick were usually cared for by the female family members or friends in the
home. (True)
7. In the early times, when they use leaves or roots, they were called herb doctors or __?
(Herbolarios)
8. The early Filipinos subscribed to superstitious belief and practices in relation to health and
sickness. Herb men were called _____ meaning one who practiced witchcraft. (Herbicheros)
9. Why is nursing an art and science? (As a professional nurse you will learn to deliver care artfully
with compassion, caring and respect for each patient’s dignity and personhood.)
10. Stages of Nursing Expertise. (Novice, Advance Beginner, Competent, Proficient and Expert)
11. Roles and Functions of the Nurse (Caregiver, Communicator, Teacher, Client Advocate,
Counselor, Change Agent, Leader, Manager, Case Manager and Researcher)
12. Which term best describes the science of nursing? (Hands-on care such as giving bath)
13. The Nurse teaches the senior high students about the effect of smoking. This program will meet
which of the aim of nursing? (Preventing illness)
14. It is the person who nourishes, foster and protects and prepared to take care of sick. (Nurse)
15. The nurse facilitated decisions about lifestyle that enhance quality of life and encourage
acceptance of responsibility for one’s health. (Health Promotion)
16. The nurse provide care of the person who is ill such measure by giving physical care,
administering medication and carrying out procedures and treatment. (Restore Health)
17. The nurse encourage healthy lifestyle such as aerobic exercise and physical classes. (Prevent
illness)
18. Nurses are active in hospice program which assist patients and their families in preparing for
death. (Facilitate coping with disability and death)
19. Teaches health care activities to maximize achievement of goals. (Health promotion)
20. Referring questions and abnormal findings to other healthcare provider. (Restore heath)
21. You are caring for a high risk pregnant client who is in a life threatening situation. The fetus is
also at high risk for death. Clinical decisions are being made that concern you because some of
these treatments and life saving measures promote the pregnant woman’s life at the same time
that they significantly jeopardize the fetus’ life and viability and other decisions can preserve the
fetus’s life at the expense of the pregnant woman’s life. Which role of the nurse is the priority at
this time? (Advocate)
22. What nursing role uses effective interpersonal and therapeutic communication skills to establish
and maintain helping relationship with patients of all ages. (Communicator)
23. As independent practitioners, nurses are primarily responsible for the (promotion of health and
prevention of illness.)
24. Nurses role which uses communication skills to assess, implement and evaluate individualized
teaching plans to meet learning needs. (Teacher)
25. The act of utilizing the environment of the patient to assist him in his recovery is theorized by
(Nightingale)
26. Health promotion is defined as (behavior by a desire to actively avoid illness, detect it early or
maintain functioning within the constraints of illness.)
27. She is recognized as the FIRST nursing theorist for her work “Notes on Nursing: What It Is &
What It is Not” (Florence Nightingale)
28. She constantly worked for the acceptance of African Americans in Nursing and for the
promotion of equal opportunities. (Mary Mahoney)

1. It is a complete state of physical, mental and social well-being and not merely the absence of
disease. (Health)
2. An alteration in the body’s functions resulting in a reduction of capacities or shortening of the
normal life span. (Acute Illness)
3. One of the interactive elements where environmental factors by its presence or absence can
lead to illness or disease (One of the interactive elements where environmental factors by its
presence or absence can lead to illness or disease. (Agent)
4. A model that illustrates arrows pointing in opposite directions and joined at a neutral point
where movement to the right indicates increasing level of wellness and health. (Dunn’s high
level of wellness grid)
5. Bone density studies for women at menopause stage to evaluate for early osteoporosis is
considered as a (Secondary prevention)
6. An interprofessional health care services for the dying, provided at home or another health care
setting (Hospice health care services)
7. Paramedics and fireman are also called (Emergency medical personnel)
8. A diabetic patient came to emergency room due to severe infection in the nail caused by fungus
in the ingrown toe nail. As a nurse you are aware that the patient needs to be referred to a
(Podiatrist)
9. A patient admitted with diagnosis of cystic fibrosis needs to utilize an incentive spirometer as
part of his breathing treatment. This patient would be referred to a (Respiratory therapist)
10. The act of utilizing the environment of the patient to assist him in his recovery. It is also a unique
function who assists an individual whether sick or well. (Nursing)
11. Scope of nursing EXCEPT (Treatment of various diseases and conditions)
12. An illness classified as irreversible, persistent and usually longer that 6 months. Affects
functioning in one or more system. (Chronic Illness)
13. The causation of a disease or condition is called _____________. (Etiology)
14. A stage of illness characterized by the patient’s decision to accept the diagnosis and follow the
prescribed treatment plan. (Stage 3)
15. three EXAMPLEs OF CHRONIC ILLNESS (Heart Disease, Stroke, Cancer)
16. Family history and genetic disposition are NON-MODIFIABLE HEALTH RISK BEHAVIORS. (True)
17. School-aged children are at high risk for communicable disease. (True)
18. After menopause, women are more likely to develop cardiovascular disease (True)
19. Family history of cancer or diabetes predisposes a person developing a disease. (True)
20. Family history of cancer or diabetes predisposes a person developing a disease. (True)
21. Pregnancy places increased risk on both the mother and the developing fetus. (True)
22. useful in examining the cause of disease in an individual. (Agent- Host environment model)
23. view health as a constantly changing state, with high level wellness and death being on opposite
ends of a graduated scale or continuum. (High Level Wellness Model)
24. A functioning to one's maximum potential while maintaining balance and a purposeful direction
in the environment. (Health illness continuum)
 25. model includes individual perceptions, modifying factors, and variables likely to affect initiating
action. (Health belief model)
26. Model was designed by Nola J. Pender to be a “complementary counterpart to models of health
protection.” (Health promotion model)
27. IT IS the totality of services offered by all health disciplines. (Health Care Delivery System)
28. A TYPE OF HEALTH CARE SERVICES THAT FOCUSES ON Proper nutrition, Exercise, Stress
Reduction FOR HEALTH PROMOTION & ILLNESS PREVENTION. (Primary)
29. THE Goal FOR THIS TYPE OF HEALTH CARE SERVICES IS TO Help people move to their previous
level of health or to their highest level they are capable of given their current health status.
(Tertiary)
30. SIX HEALTH CARE PROVIDERS. (Dentist, Nutritionist, Pharmacist, Dietician, Podiatrist, Nurse,
Social Worker, Respiratory Therapist, Physician, Physical Therapist, Occupational Therapist)

TEST 2
1. Which of the following statement is correct about HEALTH?
- Often subjective state and optimal functioning or well- being
2. The following statement is true about ILLNESS, EXCEPT
- Response of the person to a disease
3. The following are examples of Acute Illness, EXCEPT:
- Coronary heart disease
4. Acute illness is defined as?
- Rapid onset of symptoms
5. Accepts the sick role and seeks confirmation from family and friends. What stage of illness?
- Assuming sick role
6. The person may be excused from normal duties and role expectations. What stage of illness?
- Assuming sick role
7. Expected to relinquish the dependent role. Most patients complete this stage of illness?
- recovery and rehabilitation
8. Seeks the advice of a health professional and accept the diagnosis and follow treatment plan.
- Assuming dependent role
9. The patient comes to believe something is wrong. What stage of illness?
- Experiencing symptoms
10. The patient looks unwell, or experiences some physical symptoms such as fever, cold and cough.
- Experiencing symptoms
11. The patient becomes dependent on the professional for help.
- Experiencing symptoms

12. The patient resumes normal activities and responsibilities.

- The patient resumes normal activities and responsibilities
13. Physician validates illness and explains the symptoms.
- Assuming sick role
14. Prompt intervention to alleviate health problems is part of
- Tertiary prevention
15. The following are part of tertiary prevention EXCEPT
 - use of specific immunization
16. What is the purpose of primary prevention?
- Decreases the risk of exposure of the individual or community to disease
17. Which of the following belongs to primary prevention, EXCEPT:
- smoking cessation
18. they are the purpose of secondary prevention, EXCEPT
- promoting health and preventing disease process
19. The following are example of secondary preventive care, EXCEPT:
- Occupational therapy
20. Which is most true about Health and Illness?
- Health and illness are individually defined by each person
21. The agent- host- environment model of health and illness is based on the concept of?
- Risk factors
22. What do Health illness continuum and high level of wellness model demonstrate?
- health as constantly changing rate
23. The following are characteristics of chronic illness, EXCEPT?
- Self-treatment that relieves symptoms
24. As a nurse, how will you promote healthy lifestyle to others?
- Being a role model
25. Risk factors is defined as?
- Increase a person’s chance for illness
26. A smoking cessation class for relatives of lung cancer patients is being prepared by the nurse.
Once they understand the advantages of smoking cessation, the nurse thinks the class will
successfully convert many smokers to nonsmokers. Which model of healthcare is the nurse
using?
- Health promotion model
27. A nurse meets the following goals: helps a patient maintain health and helps a patient with an
illness. Which factors assist the nurse in achieving these goals? (Select all that apply.)
- Understands the challenges of today’s health care system
- Identifies actual and potential risk factors
- Experiences compassion fatigue
28. Which of the following actions exemplify the focus of secondary preventive care? (Select all that
apply.)
- Performing range-of-motion exercises on a patient
- Referring a patient with a new colostomy to a support group
29. Which is true of primary facilities?
- Their services are provided on an out-patient basis.
30. Which of the following hospitals is NOT categorize as tertiary health care facility?
- Corazon C. Aquino Hospital

Quiz
FALSE1. Theory of bureaucratic caring is based on the assumption that nurses must understand different
cultures in order to function effectively.
FALSE 2. It was Boykin and Schoenhofer who attributes the Six C’s of caring.
TRUE 3. Caring is sharing deep and genuine concern about the welfare of another person.
TRUE 4. The art of nursing refers to the highly valued qualities of care, compassion and communication-
three core principles guiding nursing practice
5-10. six C’s
11. Caring for self is very helpful to different people, some examples of these activities are the following,
EXCEPT
- avoiding healthy patterns.
12. The six C’s of caring framework was developed by which theorist?
- Roach
13. The theory of Human caring which views caring as the essence and the moral ideal of nursing was
developed by which theorist?
- Watson

QUIZ!!!!!
1.) It is a word- for –word account of a conversation.
- Process recording
2.) The following are factors that influence the communication process EXCEPT
- Expression
3.) These are gestures, body movements and use of touch that often tell others about a person’s feeling.
- Nonverbal communication
TRUE 4. To establish whether client outcomes has been met in relation to communication the nurse must
use therapeutic communication skills.
FALSE 5. In the introductory phase of helping relationship the nurse has information prior to their actual
face to face meeting and is similar to planning state.
FALSE 6. Challenging clients is considered as a therapeutic technique in communication.
TRUE 7. Acknowledging is a therapeutic technique in communication.
TRUE 8. E-mail’s that are used in health care facilities to report lab results is an example of electronic
communication.
TRUE 9. The receiver in the communication process is the listener.
TRUE 10. Evaluation is useful for both client and nurse communication.

11. When working with an older adult who is hearing impaired, which technique would NOT improve
communication?
- Exaggerate lip movements to help the patient lip read.
12. A nurse is talking with a young adult patient about the purpose of a new medication. The nurse says,
“I want to be clear. Can you tell me in your own words the purpose of this medicine?” This exchange is
an example of an element of the transactional communication process called
- obtaining feedback
13. A Korean-speaking patient does not appear to understand the nurse’s information on wound care.
Which action should the nurse take?
- Use a professional interpreter to provide wound care education in Korean.
14. A patient is evaluated in the emergency department after causing an automobile accident while being
under the influence of alcohol. Which statement would be MOST therapeutic when assessing the patient?
- “Tell me what happened before, during, and after the automobile accident tonight.”
15. The patient concludes that the nurse is willing and able to help him and feel comforted. What channel
of communication is being use?
- visual
16. The following are CORRECT about Interpersonal Communication, EXCEPT
- Communication happens within the individual
17. Nurse SArah complains to her preceptor that she has no time for therapeutic communication with her
patients. Which of the following is the BEST strategy to help the nurse find more time for this
communication?
- Include communication while performing tasks such as changing dressings and checking vital
signs.
18. Which of the following is NOT considered nonverbal communication?
- Pitch and rate
19. What is the term that refers to professional character and set of attributes that implies responsibility
and commitment?
- Professionalism