NURSING

FUNDAMENTALS

By: Erwin G. Bodiongan

 Nursing
• is a caring profession

• A unique profession with an

earnest concern for the art of
care and the science of health.
 Nursing
The unique function of the nurse is to assist
the individuals, sick or well, in the
performance of those activities contributing
to health or its recovery (or to peaceful
death) that he would perform unaided if he
had the necessary strength, will, or
knowledge, and to do this in such a way as to
help him gain independence as rapidly as
possible.
 Nursing as a Profession
A profession possesses the following primary
characteristics:

•Education
•Theory
•Service
•Autonomy
•Code of Ethics
•Caring
 Roles and Functions of a
Professional Nurse
• Care Provider
- supports the client and is concerned with
client’s needs
• Communicator / Helper
- communicates with clients, support persons
and colleagues to facilitate nursing actions
 Roles and Functions of a
Professional Nurse
• Counselor
- helps the client recognize and cope with
problems, and to promote personal growth
• Client Advocate
- promotes what is best for the client, ensure
needs are met, and protect the client’s rights.
 Roles and Functions of a
Professional Nurse
• Change Agent
- initiates changes and assists the client make
modifications in the lifestyle to promote
health
• Leader
- initiates actions, helps the client make
decisions to improve his well–being
 Roles and Functions of a
Professional Nurse
• Collaborator
- works in a combined effort with all those
involved in care delivery that will achieve a
common goal
• Manager
- plans, gives directions, develops staffs,
monitors operations, give rewards, etc.
 Roles and Functions of a
Professional Nurse
• Researcher
- participates in scientific investigations and
uses research findings in practice
• Teacher
- provides health teaching to effect behavior
change which focuses on acquiring new
knowledge or technical skills
The caregiver role of the nurse emphasized:

a. Implementing nursing care measures

b. Providing direct nursing care
c. Recognition of needs of clients
d. Observation of the client’s responses to
illness
The manager role of the nurse is best
demonstrated when he / she:

a. Plans nursing care with the patient

b. Works together with the nursing team
c. Initiates nursing action with co-workers
d. Speak in behalf of the patient
The most important communication skill to be
developed by the nurse manager is:

a. Firmness
b. Assertiveness
c. Questioning
d. Attentive listening
 Nursing Care Delivery Models
• Total Patient Care
• Primary nursing
• Case Management
• Functional Nursing
• Team Nursing
 Nursing Care Delivery Models
• Total Patient Care
- also called case method
- the registered nurse is responsible for all
aspects for one or more clients’ care
- shift-based focus
- for continuity of care, the staff needs to
communicate clearly the client’s needs from
shift to shift
 Nursing Care Delivery Models
• Primary Nursing
- the registered nurse is responsible for all
aspects for one or more clients’ care 24 hrs a
day, 7 days a week
- associates provide some care but the primary
nurse coordinates and communicates it
 Nursing Care Delivery Models
• Case Management
- a case delivery approach that coordinates and
links health care services to clients and
families
- a professional nurse assuming responsibility
for client care from admission through and
following discharge
 Nursing Care Delivery Models
• Functional Nursing
- this model involves the division of tasks with
nurses assuming responsibility for certain
tasks
- task–focused, not client–focused
- communication is not always clear since no
one nurse is responsible for the overall care of
the client
 Nursing Care Delivery Models
• Team Nursing
- delivery of nursing care by staff of various
educational preparations in a team
- team members provide client care to group of
clients under the direction and coordination
of the RN team leader
 What is the most common
nursing care delivery model in
the Philippines?
 Types of Nursing Interventions
• Independent or nurse–initiated interventions
- health teachings, feeding assistance
• Dependent or physician–initiated
interventions
- catheterization, administering medications
• Interdependent or collaborative interventions
- client’s diet, client’s exercise
Nurse Jim found out that one of his patients is
having a fever. Which independent intervention
can he perform on the client?

a. Get a thermometer and take the client’s

temperature
b. Check the client’s chart and give the
appropriate medication
c. Perform a tepid sponge bath on the client
d. Call the doctor
Stages of Nursing Expertise (NACPE)
by Patricia Benner
• Novice
• Advanced Beginner
• Competent
• Proficient
• Expert
Stages of Nursing Expertise (NACPE)
by Patricia Benner
• Novice
- no experience
- limited, inflexible
- governed by rules and regulations rather than
experience
Stages of Nursing Expertise (NACPE)
by Patricia Benner
• Advanced Beginner
- 1–2 yrs experience
- marginally acceptable performance
- has experience enough real situations to make
judgments about them
Stages of Nursing Expertise (NACPE)
by Patricia Benner
• Competent
- 2–3 yrs experience
- demonstrates organizational and planning
activities
- coordinates multiple complex care demands
Stages of Nursing Expertise (NACPE)
by Patricia Benner
• Proficient
- 3–5 yrs experience
- perceives situations as wholes rather than
parts
- has holistic understanding
- focuses on long-term goals
Stages of Nursing Expertise (NACPE)
by Patricia Benner
• Expert
- 5+ yrs experience
- performance is fluid, flexible and highly
proficient
- demonstrates highly skilled intuitive and
analytical ability in new situations
- take certain actions because “it felt right.”
A nurse with 2–3 years of experience who has
the ability to coordinate multiple complex
nursing care demands is at which stage of
Benner’s stages of nursing expertise?

a. Advanced Beginner
b. Competent
c. Proficient
d. Expert
4 Major Concepts in Nursing
Theories (PEHN)

Environment

Person

Nursing Health
 Nursing Theories and Models
• Florence Nightingale
- born from a British family in Florence, Italy
- received her early training from Kaiserswerth,
Germany
- developed and described the first theory of
nursing – the Environmental Theory
 Nursing Theories and Models
• Virginia Henderson
- definition of nursing
- identified 14 basic needs

• Faye Glenn Abdellah

- patient–centered approaches to nursing
- 21 nursing problems
 Nursing Theories and Models
• Lydia Hall
- Key concepts of Care, Core and Cure

• Myra Levin
- Four Conservation Principles (energy,
structural integrity, personal integrity, social
integrity
 Nursing Theories and Models
• Lydia Hall
- Key concepts of Care, Core and Cure

• Myra Levin
- Four Conservation Principles (energy,
structural integrity, personal integrity, social
integrity
 Nursing Theories and Models
• Dorothy E. Johnson
- conceptualized the Behavioral System Model

• Imogene King
- postulated the Goal Attainment Theory
 Nursing Theories and Models
• Madeleine Leininger
- developed the Transcultural Nursing Model

• Dorothea Orem
- developed the Self–Care Theory and the Self–
Care Deficit Theory
 Nursing Theories and Models
• Betty Neuman
- proposed the Health Care System Model

• Martha Rogers
- conceptualized the Science of Unitary Human
Beings
 Nursing Theories and Models
• Sister Callista Roy
- presented the Adaptation Model

• Jean Watson
- conceptualized the Human Caring Model
 Nursing Theories and Models
• Ida Jean Orlando
- conceptualized the Dynamic Nurse– Patient
Relationship Model

• Ernestine Weidenbach
- developed the Clinical Nursing – A Helping Art
Model
 Nursing Theories and Models
• Hildegard Peplau
- introduced the Interpersonal Model
- 4 phases of the nurse–client relationship:
(OIER)
1.Orientation
2.Identification
3.Exploitation
4.Resolution
 Nursing Theories and Models
• Rosemarie Rizzo Parse
- introduced the concepts of Man–Living–
Health Theory or the Theory of Human
Becoming
The four concepts common to nursing that
appear in each of the current conceptual models
are:

a. Person, Nursing, Environment, Medicine

b. Person, Health, Nursing, Support System
c. Person, Environment, Health, Nursing
d. Person, Environment, Psychology, Nursing
 Nursing Theories and Models
• Florence Nightingale

Environmental Theory

• Virginia Henderson

14 Basic Needs
 Nursing Theories and Models
• Faye Glenn Abdellah

21 Nursing Problems

• Lydia Hall

Care, Core, Cure (Concepts)

 Nursing Theories and Models
• Myra Levin

4 Conservation Principles

• Dorothy E. Johnson

Behavioral Systems Model

 Nursing Theories and Models
• Imogene King

Goal Attainment Theory

• Madeleine Leininger

Transcultural Nursing Model

 Nursing Theories and Models
• Dorothea Orem

Self–Care Deficit Theory

• Betty Neuman

Health Care System Model

 Nursing Theories and Models
• Martha Rogers

Science of Unitary Human Beings

• Sister Callista Roy

Adaptation Model
 Nursing Theories and Models
• Jean Watson

Human Caring Model

• Ida Jean Orlando

Dynamic Nurse–Patient
Relationship Model
 Nursing Theories and Models
• Ernestine Weidenbach

A Helping Art Model

• Hildegard Peplau

Interpersonal Model
 Nursing Theories and Models
• Rosemarie Rizzo Parse

Man – Living – Health Theory or

Theory of Human Becoming
 History of Nursing

Period of Intuitive Nursing

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

Period of Apprentice Nursing

• Extends from the founding of religious nursing
orders in the 11th century to the
establishments of nursing training schools in
the 1800s
• It is called the period of “on the job” training
 History of Nursing

Military Religious Orders (The Crusades)

• Knights of Saint John of Jerusalem
• Knights of Saint Lazarus

Secular Orders
• Order of St. Francis of Assisi, The Beguines,
Benedictines, Augustinians
 History of Nursing

Important Personages in the Period of

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

Dark Period of Nursing

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

Period of Educated Nursing

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

Period of Contemporary Nursing

•Covers the period after World War II to the
present
•Scientific and technological developments as
well as social changes mark this period.
 History of Nursing in the
Philippines
Early beliefs and practices:
• Causes of disease
- another person (enemy or witch)
- Evil spirits
• Diseases could be driven by people with
powers
• Believe in gods, word healers, herbolarios
 History of Nursing in the
Philippines
Early beliefs and practices:
• Causes of disease
- another person (enemy or witch)
- Evil spirits
• Diseases could be driven by people with
powers
• Believe in gods, word healers, herbolarios
 History of Nursing in the
Philippines
Earliest hospitals established:
• Hospital Real de Manila (1577)
- for Spanish soldiers and civilians
• San Lazaro Hospital (1578)
- for patients with leprosy
• Hospital de Indio (1586)
- for the general population
 History of Nursing in the
Philippines
Earliest hospitals and school of nursing
• Iloilo Mission Hospital School of nursing (1906)
- first nurses board examination (1944)
• St. Paul’s Hospital School of Nursing (1907)
• Philippine General Hospital School of Nursing
- 1907
 History of Nursing in the
Philippines
First Colleges of Nursing in the Philippines
• UST College of Nursing (1946)
• Manila Central University College of Nursing
(1947)
• University of the Philippines College of Nursing
(1948)
 History of Nursing in the
Philippines
First Colleges of Nursing in the Philippines
• UST College of Nursing (1946)
• Manila Central University College of Nursing
(1947)
• University of the Philippines College of Nursing
(1948)
Nursing Leaders in the Philippines
• Anastacia Giron-Tupaz
- first Filipino nurse to hold the position of chief
nurse superintendent at PGH
- founder of PNA
• Francisca Delgado
- first president of PNA
Nursing Leaders in the Philippines
• Cesaria Tan
- first Filipino to receive a Master’s degree
- founder of PNA
• Rosa Militar
- pioneer in school health education
• Loreto Tupaz
- Florence Nightingale of Iloilo
 Philippine Nurses Association
• Originally the “Filipino Nurses Association”
founded in Sept. 2, 1922 in a meeting of 150
nurses presided by Mrs. Tupas
• Accepted as member organization of the
International Council of Nurses in 1929
• Renamed the PNA in 1966
• Nurses’ Week every last week of October
 Basic Human Needs
• Each individual has unique characteristics, but
certain needs are common to all people called
basic human needs.
• Human needs are physiologic and psychologic
conditions that an individual must meet to
achieve a state of health and well-being.
Abraham Maslow’s Hierarchy of
Basic Human Needs
 Physiologic Needs
• Oxygen
• Fluids
• Food
• Pain-free
• Clothing (body temperature)
• Elimination
• Rest and sleep
 Safety and Security Needs
• Physical Safety
• Psychological safety
• Shelter
 Love and Belongingness Needs
• To love and be loved
• To care and be cared for
• For affection, associate, belong, friends, peers
• Relationships
 Self–Esteem Needs
• To love and be loved
• To care and be cared for
• For affection, associate, belong, friends, peers
• Relationships
 Self–Actualization Needs
• The need to be self–fulfilled
• The need for spiritual fulfillment

On the whole, self – actualization is the essence

of mental health
The following are characteristics of basic human
needs except:

a. Needs may be met in different ways

b. Needs have uniform priorities to all
individuals
c. Needs are interrelated
d. Needs may be deferred
Who among the following clients should be
attended to first by the nurse?

a. The client with coughs and colds

b. The client with pain on the chest
c. The client with fever due to infection
d. The client who is for discharge
 Health and Illness
• Health is the ability to maintain the internal
milieu.
• Health is being well and using one’s power to
the fullest extent.
• Health is the ability to maintain homeostasis
or dynamic equilibrium.
• Health – is a state of complete, physical,
mental and social well-being (WHO).
 Health and Illness
• Wellness is well–being.
• It involves engaging in activities and behaviors
that enhance quality of life and maximize
personal potential.
• Wellness is a choice.
• Well is the loving acceptance of one’s self.
 Health and Illness

High Level Wellness

• An integrated method of functioning that is
oriented towards maximizing one’s
potentialities with in the limitation of his
environment.
• This concept connotes the ability to perform
ADL or to function independently.
Health – Illness Continuum
(Harbert Dunn)
 Health and Illness

Illness
• is a personal state in which a person feels
unhealthy
• a person’s physical, emotional, intellectual,
social, development or spiritual functioning is
diminished or impaired compared with
previous experience.
 Health and Illness

Disease
• is an alteration in body functions resulting in
reduction of capacities or a shortening of the
normal life span.
 Health and Illness

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

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

3. Medical care contact

• seeks advice of professionals for the
following reasons
a. validation of real illness
b. explanation of symptoms
c. reassurance or prediction of outcome
 Stages of Illness

4. Dependent Patient Role

• dependent on the health professional
• becomes passive and accepting
• may regress to an earlier behavioral stage
5. Recovery / Rehabilitation
• gives up the sick role and returns to former
roles and functions
 Classification of Diseases

A.According to Etiologic Factors

• Traumatic – due to an injury
• Allergic – abnormal body response
• Neoplastic – abnormal cell growth
• Idiopathic – unknown cause
• Degenerative – degeneration of cells or
tissues,organs
• Iatrogenic – results from treatments
 Classification of Diseases

A. According to Etiologic Factors

• Hereditary – defect in the genes
• Congenital – defect in development, present
a birth
• Metabolic – disturbance or abnormality in
metabolism
• Deficiency – inadequacy of essential dietary
factors
 Classification of Diseases

B. According to Duration or Onset

• Acute – short duration and severe
• Chronic – longer duration, may be 6 mos.,
characterized by remissions and
exacerbations
• Sub–acute – severe but longer than acute
 Classification of Diseases

Remissions
– period during which the disease is controlled
and symptoms are not obvious

Exacerbations
– the disease becomes more active again at a
future time, with recurrence of pronounced
symptoms.
 Classification of Diseases

C.Other Description of Diseases

• Organic – changes in the normal structure
• Functional – abnormal responses to stimuli
• Occupational – factors are associated with
work
• Familial – occurs in several individuals in the
family
 Classification of Diseases

C. Other Description of Diseases

• Venereal – acquired thru sexual relations
• Epidemic – large numbers of individuals in a
community at the same time
• Endemic – present continuously or recurs in
a community
• Pandemic – extremely widespread
• Sporadic – occasional cases occur
 Three Levels of Prevention
by Leavell and Clark
1. Primary Prevention
• Prevent a disease or condition
• Health promotion
• Specific protection
• e.g. quit smoking, avoid alcohol, exercise,
good diet, immunization
 Three Levels of Prevention
by Leavell and Clark
2. Secondary Prevention
• Health maintenance
• Early diagnosis / detection / screening
• Prompt treatment to limit disability
• e.g. annual physical exam, regular pap’s test,
monthly BSE, sputum exam,
 Three Levels of Prevention
by Leavell and Clark
3. Tertiary Prevention
• Occurs after a disease or disability has
occurred and the recovery process has begun
• Rehab
• e.g. self-monitoring of blood glucose,
physical therapy after CVA