Fundamentals of Nursing I. Recipients of Nursing 1. Consumer- an individual, a group of people or a community that uses a service or commodity 2.

Patient- a person who is waiting for an ongoing medical treatment or care 3. Client- a person who engages the advice or service of another who is qualified to provide this service Focus of Nursing 1. Health Promotion- helping people develop resources to maintain or enhance their health and well being  Food nutrition  Exercise  No smoking

II.

2. Healthy maintenance- actions that help client to maintain their health status.
Elderly is taught to exercise to maintain muscle strength and mobility. 3. Health restoration- helping people to improve health following health problems or illness  Dressing of wounds 4. Care of the dying- involves comforting and caring for people of all ages while they are dying. III. Settings for Nursing 1. Hospitals 2. Nursing Home/ Home for the Aged 3. Community/ Public Health 4. Ambulatory care 5. Nursing School, occupational Health and others (self-employed, insurance claims, reviewers, etc.) Nurse Practice Acts  Regulate the practice of Nursing  Formalized contract between society and the profession  Serve a public purpose and also meet the needs of the profession  Grants the public a mechanism to ensure minimum standards for entry into the profession to distinguish the unqualified Standards of Clinical Nursing Practice  Describes the responsibilities to which the nurses are accountable a. b. c. d. I. Reflects the values and priorities of the nursing profession Provide direction for professional nursing practice Provide framework for the evaluation of nursing practice Defines the profession’s accountability to the public an the client outcomes for which the nurses are responsible

IV.

V.

Career Mobility Kinds of Mobility 1. Vertical Mobility- advancing upward within a hierarchy. Example: staff nurses to head nurses to supervisor to chief nurse 2. Horizontal Mobility- refers to ability to change practice setting. Example: Hospital to School to Nursing Home to Community

II.

Trends in Nursing Trend- in general direction or a prevailing tendency or inclination 1. Broadening Focus a. From the care of the ill person to the care of people in illness and in health, and from care of only the patient to the care of client. The family or support person and the community b. Holistic philosophy
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Concern is not only toward a health problem but toward the response of the total person, in the health of the whole person. c. Measurement of nursing practice into the community 2. Scientific Basis  In the past, nursing relied on intuition, experience, observation  Today more on research based 3. Technology/Mechanization a. Proliferation of technologic equipment used in the care of clients in hospitals and homes b. The increasing costs of home self-care equipment c. The use of computers in many areas of health care 4. Reviewed focus on caring a. The increasing number of professional book and articles about balancing, caring and technical skills b. Many studies regarding on caring on an aspect of nursing c. Increasing recognition in nursing of the needs of clients in technologic environments 5. Involvement in health policy- decision making NURSING THEORIES I. Addresses the following: 1. Person or client- the recipient of nursing care (includes individuals, families, groups and communities) 2. Environment- the internal and external surroundings of the client 3. Health illness- the client’s state of well being 4. Nursing- a discipline from which client care interventions are provided

II. Purposes 1. Provide direction and guidance for: a. Structuring professional nursing practice, education and research b. Differentiating the focus of nursing from other professions In Practice: 1. Assist nurses to describe, explain and predict everyday experiences 2. Serve to guide assessment, intervention, and evaluation of care 3. Provide rationale for collecting reliable and valid data about the health status of clients, which are essential for effective decision making and implementation 4. Help to establish criteria to measure the quality of nursing care 5. Help build a common nursing terminology to use in communicating with other health professionals. Ideas are developed and words defined 6. Enhance autonomy (independence and self governance) of nursing through defining its own independent functions In Education: 1. Provide a general focus for curriculum design 2. Guide curricular decision making In 1. 2. 3. Research Offer a framework for generating knowledge and new ideas Assist in discovering knowledge gaps in the specific field of study Offer a systematic approach to identify questions for study. Select variable, interpret findings and validate nursing interventions. Selected Nursing Theories I. General Theories: 1. Nightingale’s Environmental Theories  Florence Nightingale “Mother of Modern Nursing.”  5 Environmental Factors: 1. Pure or fresh air
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2. Pure water 3. Efficient drainage 4. Cleanliness 5. Light- direct sunlight Deficiencies in these five factors produced lack of health or illness

1. Virginia Henderson  Formulated a definition of the unique function of nursing  Basic to definition are various Assumption about the individual: 1. Needs to maintain physiologic and emotional balance 2. Requires assistance to achieve health and independence or a peaceful death 3. Needs the necessary strength or achieve or maintain health  These needs give direction to the nurse’s role

2. Martha Roger’s Science of unitary Human Beings  It views the person as an irreducible whole, the whole being greater than its parts  Whole is differentiated from holistic (used to mean only the sum of all parts)  Unitary Man 1. Is an ineducible, four dimensional energy field identified by pattern 2. Manifests characteristics different from the sum of its parts 3. Interacts continuously and creatively with the environment 4. Behaves as a totality 5. As a sentient being, participate creatively in changes 2. Dorothy Orem’s Self-Care deficit theory 3 Related Theories 1. Self care theory- learned behaviors that individuals initiate and perform on their own behalf the life, health and well being 3 Self Care requisites a. Universal requisites- common to all people include the maintenance of air, water, food elimination, activity and rest, solitude and social interaction, prevention of hazards to life and well being and the promotion of human functioning. b. Developmental requisites- associated with conditions that promote known developmental processes throughout life cycle c. Health deviation requisites- relate to defects and deviations from normal structure and integrity that impair an individual’s ability to perform self care. 1. Self care theory- asserts that people benefit from nursing because they have health-related limitations in providing self care 2. Nursing system- form when nurses prescribe design, and provide nursing that regulates the individual’s self-care capabilities and meets therapeutic self-care requirements Types: a. Wholly compensatory mechanisms are required for individuals unable to control or monitor their environmental process information b. Partially compensatory systems are for individuals who are unable to perform some (but not all) self care activities c. Supportive- educative (developmental) systems- are designed for persons who to perform self care measure and need assistance to do so. I. Systems Theories:
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1. Sister Callista Roy Adaptation Model (1970)  Focuses on the individual as a bio psychosocial adaptive system 3 Classes of Stimuli 1. Focal stimulus- The internal or external stimulus most immediately confronting the person and contributing to behavior. 2. Contextual stimuli- all other internal or external stimuli present 3. Residual stimuli- beliefs, attitude, or traits having an indeterminate effect on the person’s behavior but whose effects are not validated. 2. Imogene King’s Goal Attainment Theory (1971) The client and nurses are personal systems or subsystems, with interpersonal and social systems. To identify problems and to establish goals, the nurse and client perceive one another, act and react, interact and transact (purposeful interactions that lead to goal attainment). 3. Betty Newman Health Care Systems model (1972) based on the individual’s relationship to stress, the reaction to it, and reconstruction factors that are dynamic in nature. 4. Dorothy Johnson’s Behavioral System Model A behavioral system is patterned repetitive and purposeful Compose of seven subsystems: a. Attachment- affiliative-provides survival and security. Its consequential is so social inclusion, intimacy and the formation and maintenance of a strong social bond b. Dependency- promote helping behavior that calls for a nurturing response, its consequences are approval attention or recognition, and physical assistance. c. Ingestive- satisfies appetite. It is governed by social and psychological considerations as well as biologic. d. Eliminative- excretes body wastes e. Sexual- functions dually for pro- creation and gratification f. Achievement- attempts to manipulate the environment. It controls or masters on aspects of the self or environment to some standard of excellence g. Aggressive- protects and preserves and protects the self and society within the limits improved by the society. I. Interpersonal/Caring Theories 1. Hildegard Peplau’s Psychodynamic nursing theory An understanding of one’s own behavior to help others identify felt difficulties and applying principles of human relations to problems arising during experience Phase of Nurse-Patient Relationship a. Orientation- patient seeks help and the nurse assists the patient to understand the problems and the extent of need for help b. Identification- the patient assumes a posture of dependence, interdependence or independence in relation to the nurse (relatedness). The nurse’s focus is to assure the person that the nurse understands the interpersonal meaning of the patient situations. c. Exploitation- the patient desires full value from what the nurse offers through the relationship, the patient uses available services on the basis of self interest and needs power shifts from the nurse to the patient. d. Resolution- old needs and goals are put aside and new ones adapted once older needs are resolved, newer and more mature ones emerge 1. Madelaine Leininger’s Transcultural Care Theory (1978)  Postulates that caring and culture are inextricably linked

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 Major areas of nursing that focuses on comparative study and

analysis of different cultures and subcultures in the world, with respect to their behavior, nursing care and health values, beliefs and patterns

Goal  To develop a scientific and humanistic body of knowledge in order to provide culture- specific and culture universal nursing practices

1. Jean Watson’s Science of Caring (1979)
  

Caring is central to nursing The unifying focus for practice There are two major assumptions: a. Care and lone constitute the primal and universal psychic energy b. Care and lone are requisite for out survival and the nourishment of humanity

Some assumptions of caring by Watson

 Human caring in nursing is not just an emotion concern, attitude
 or benevolent desire. Caring connotes a personal response Caring responses accept a person not only as they are now, but also for what the person may become. Documentation and Report

I.

Purposes of Client Record 1. Planning client care 2. communication 3. Legal communication 4. Research 5. Education 6. Quality assurance monitoring 7. Statistics 8. Accrediting and licensing 9. Reimbursement Types of Records 1. Source- Oriented Medical Records (traditional records) 2. Problem- Oriented Clinical Research – Client data are recorded and arranged according to the problem the client has, rather than according to the source of information. Components: a. Baseline data b. Problem list c. Initial list of orders of care plans d. Progress notes 1. Computer Records

I. 1.

Formats for Nursing Documentation Nursing Care Plan Types a. Traditional care plan- written for each client b. Standardized care plans- developed to save documentation time 2. Critical Pathways- includes interventions for a client with a specific diagnosis. Kardex- information accessible Progress notes Methods: a. Narrative charting: description of information i. Chronological charting: records data in sequence as time moves forward b. SOAP format: SOAPIE/SOAPIER/APIE c. PIE charting Discharge notes and referral summary
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3. 4.

1.

II.
1. 2. 3. 4. 5. 6. 7.

8.

9. 10. 1. 2. 3. III.

Guidelines for Charting Timing Confidentially – a private record of the client’s care Permanence Signature Accuracy Appropriateness Completeness Use of standard terminology Brevity Legal awareness Reporting change-of-shift reports telephone reports telephone orders Conferring - to consult another person or persons for advice, information, ideas or instructions 1. nursing conference 2. nursing rounds Referring – to send or direct a person to another or place for help or treatment Wellness, Health, Illness

Definitions Health

• •

is a status of complete physical, mental and social well being and not merely the absence of disease or infirmity (WHO 1947) Not a condition, it is an adjustment. It is not a state but a process. The process adapts to individual not only to our physical, but also our social environments Is a state of well being Engaging an attitudes and behaviors that enhances quality of life and maximize personal potential

Wellness

• •

• •

Well-Being • A subjective perception of balance, harmony and validity Illness A highly personal state, in which the person feels unhealthy or ill, may or may not be related to disease Disease An alteration in body functions resulting in a seduction of capabilities or a shortening of the normal life span

Models of Health and Illness 1. Judith Smith 4 models: a. Clinical Model  View people as physiologic system with related functions  Health is identified by the absence of signs and symptoms of disease or injury  The state of not being sick  Opposite of health is disease or injury b. Role performance  Health is defined according to the individual’s ability to fulfill society roles that is to perform work  According to this model, people who can fulfill the roles a re healthy even if they appear clinically ill
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c. Adaptive model (Dubo)  Health is a creative, disease is a failure in adaptation; or mal-adaptation  Aim of treatment 1. To restore the ability of the person to adapt or to cope

d. Eudaimonistic Model
 

Health is seen as a condition of actualization or realization of a person’s potential In this model, the highest aspiration of people is fulfillment and complete development. Illness is a condition that prevents self-actualization

2. Leavell and Clark’s Agent – Host – Environment model or Ecologic Model  Used in predicting illness rather than in promoting wellness  3 dynamic interactive elements: 1. Agent – any environmental factor or stressor (biologic, chemical, mechanical, physical or psychosocial) that by its presence or absence led to illness or disease 2. Host – person(s) who may or may not be with risk of acquiring a disease. Family history age and lifestyle habits influence the host reaction 3. Environment – all factors to the host that may or may not predispose the person to the development of disease 1. Health – illness Continua – describes health as a dynamic state. That is continually changing internally and externally to maintain state of balance. a. Dunn’s – high level wellness  Explores the concept of wellness as it relates to family, community, environment, and society  He believes that family wellness enhances wellness in individuals  Travis illness – Wellness Continuum Ranges from high-level wellness to premature death 1. Health belief models a. Rosentock – proposed a health belied model intended to predict which individuals would or would not use such preventive measures as screening for early detection of cancer b. Becker – modified the health belief model to include the following components: 1. Individual perceptions (susceptibility, seriousness, threat) 2. Modifying factors (demographic, age, sex, etc., socio psychological pressures [social pressure or influences], structural variables, and cues to action) 3. Likelihood of action  Health Status – problem – true states or to anxiety, depression or acute illness  Health Beliefs – concepts about health that an individual believes to be true: May or may not be founded on fact  Health Behaviors – actions people take to understand their health state. Maintain an optimal state of health, prevent illness and injury and reach their physical and mental potential Stages of Health Seeking Stage 1 – symptom experience Stage 2 – self treatment and self medication Stage 3 – communication to others Stage 4 – assessment of symptoms (for tentative diagnosis) Stage 5 – sick role assumption Stage 6 – concern Stage 7 – efficacy of treatment Stage 8 – selection of treatment (treatment, cost, defer health professional’s advice) Stage 9 – treatment Stage 10 – assessment of effectiveness of treatment (if treatment not effective, may return to earlier stage) Stage 11 – recovery and rehabilitation
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Illness Behaviors- any activity undertaken by a person who feels ill, to define the state of his health and discover a suitable remedy Aspects of Sick Role (Parsons) a. Clients are not held responsible for their condition b. Clients are excused from certain social roles and tasks c. Clients are obliged to try to get well as quickly as possible d. Clients or their families are obliged to seek competent help Criteria to determine if one is ill (Bowmen) a. Presence of symptoms b. Perception of how they feel c. Ability to carry out daily activities Effects of illness    1. 2. 3. 4. 5. 6.

a. Depends on 3 factors: The member of the family who is ill The seriousness and length of the illness The cultural and social customs the family follows
a. Changes in the family role change task reassignment and increased demands on time increased stress financial problems loneliness as a result of separation and pending loss change in social customs

Promoting Health and Wellness  Health Promotion – activity undertaken for the purpose of achieving a higher level of health and well being A. Levels of Prevention  Primary Prevention generalized health promotion and specific protection against disease. It precedes disease or dysfunction and is applied to generally healthy individuals or groups: - Immunizations - Health education nutrition - Nutrition - Family planning  Secondary Prevention – emphasizes early detection of disease, prompt intervention and health maintenance for individuals experiencing health problems, it includes prevention of complications and disabilities - Screening surveys (HPN, DM) - Regular medication and dental check ups - Assessing growth and development of children  Tertiary Prevention – begins after an illness when a defect or disability is fixed, stabilized or irreversible. Its focus is to help rehabilitate individuals and restore them to an optimum level of functioning within the constraints of the disability. B. Types of Health Promotion Programs 1. Information dissemination – most basic that raises the level of awareness/knowledge 2. Health appraisal/wellness assessment programs for risk-factors 3. Life style and behavior change programs 4. Worksite wellness programs 5. Environmental control programs C. Nurse’s role in Health Promotion 1. Model healthy life style behaviors and attitudes 2. Facilitate client’s involvement in the assessment, implementation, evaluation of health goals

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3. Teach clients self care strategies to enhance fitness, improve nutrition,
manage stress and enhance relationships 4. Assist individuals, families, communities to increase levels of health 5. Teach clients to be effective health care consumers 6. Assist individuals, families, communities to develop and choose health – promoting options 7. Guide client’s development in effective problem solving and decision making 8. Reinforce the client’s personal and family health promoting behaviors 9. Advocate in the community for changes that promote healthy environment HOLISTIC CONCEPT OF FAITH AND I HOLISTIC CONCEPT OF HEALTH AND ILLNESS 1. Personal responsibility for health and illness 2. Importance of healthy daily living 3. Relationship of body, mind and spirit 4. Illness as a growth experience 5. Importance of nurturing an affiliative behaviors 6. Priority placed on high level wellness not just absence of disease 7. Integration of many therapies, ancient and modern 8. Importance of attitude in health and illness NURSING HISTORY 1. Philippine History • 1909- Three (3) female graduated as “qualified medical and surgical nurse.” • 1920- First board examination for nurses was conducted • 1921- Filipino nurses associates was established (now Philippines Nurses Association) • 1953- Republic Act 877- Known as the nursing practice law was approved 2. Medical History Mother acted as caretaker No care is given or training is evident Care by Care by Care by Nursing Sairey 1. Middle Ages crusaders prisoners religious orders care won’t down to the lowest level as depicted by Charles Dicken in character of

4.1. 4.2. 4.3. 4.4.

1. Nightingale era: 19th- 20th century

The Crimean war stimulates changes Social change brings change in human value Nursing involves as an art and science Formal nursing education and nursing service begins

2. 20th century

Licensure of nurses started alization of hospital and diagnosis ing of nurses in diploma program lopment of baccalaureate and advanced degree programs ROLES AND FUNCTIONS OF NURSES

1. Care giver- The provision of care to client based on

knowledge and skill and with consideration for physical, emotional, and spiritual needs. As a care giver, the nurse integrates all of the other roles and uses the nurse process to promote wellness, prevent illness, maintain health and facilitate coping.

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2. Communicator- the use of effective interpersonal and therapeutic communication skills to establish and maintain helping relationships with client of all ages in a wide variety of health 3. Teacher- the use of communication and interpersonal skills to meet learning needs of client and their families. The nursing processes used to develop and carry out individualized teaching plans Teaching is an interactive process between a teacher and one or more learners in which specific learning objectives or desired behavior changes are achieved

1. Counselor- effective use of communication skills enables
the nurse to provide information, make appropriate referrals and facilitate client’s problem solving and decision making abilities. 2. Leader- The assertive self-confident practice of nursing necessary care of clients, functioning in groups, and affecting change 3. Researcher- A various level, nurses conduct or take part in research to improve client care 4. Advocate- The protection of human and legal rights based on the belief that clients hear the right to make their decision about health and life The nurse acts as a client advocate by informing clients of their rights by making sure they have necessary knowledge to make informed decisions, and by supporting clients in the decisions they make Advocates are one who pleads the cause of another or argues or pleads for a cause or proposal 1. Manager- The nurse manages nursing care of an individual, families, and communities, delegates nursing activities to ancillary workers, other nurses, supervises and evaluates their performance 2. Decision maker- The nurse, before taking any action interprets available information and decides the best approach the individual client. These decisions can be made alone, with the client and the family, or with other health care professionals

• •

3. Change Agent- An individual, such as nurse operating to
change the status in a system so that the individual/s involved must release how to perform their roles. Example: Many patients are now, came for in and out of school settings.

4. Rehabilitator- the nurse assists the client return to maximal functioning through teaching and helping the clients to cope with changes associated with illness or disability EXPANDED CAREER ROLES AND FUNCTIONS OF NURSES 1. Clinical Specialists- a nurse with an advanced degree education or experience who is considered to be an experts in a specialized area of nursing, carries out direct client care, consultation, teaching clients, families, staff, and conducting research. • Example enterostomal therapist, geriates, infection-control, medical surgical, natural and child, oncology, quality assurance, nursing process. 2. Nurse practitioner- a nurse with an advanced degree, certified for a special area of client care work in a variety of health care settings of in an independent practice to make health assessments and deliver primary care.
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3. Nurse anesthetist- A nurse who completes a course of study in an anesthesia school
carries out pre-operative status of clients.

4. Nurse midwife- A nurse who completes a program in midwifery, provides prenatal and
postnatal care and delivers babies to woman with uncomplicated pregnancies

5. Nurse Entrepreneurs- a nurse who usually has an advanced degree and manages a
health related business. The nurse maybe involved in education, consultation, or research, for example.

6. Nurse educator- A nurse, usually with advanced degree, who teaches in educational or
clinical settings, teaches theoretical knowledge and clinical skills, conducts research.

7. Nurse administrator- a nurse who functions at various levels of management in health
care settings, responsible for the management and administration of resources and personnel involved in giving silent care. Florence Nightingale was born in 1820 to a wealthy family in England. The Crimean War and a request by the British to organize nursing care for a military hospital in Turkey gave Miss Nightingale an opportunity for achievement. She was responsible for elevating the status of all nurses. HER CONTRIBUTIONS ARE THE FOLLOWING: 1. Recognizing that nutrition is an important part of nursing care 2. Instituting occupational and recreational therapy for the sick 3. Identifying personal needs of the patient and the role of the nurse in meeting those needs. 4. Establishing standards for hospital management 5. Establishing nursing education 6. Establishing a respected occupation for woman 7. Recognizing the two components of nursing health and illness 8. Believing that nursing separate and distinct from medicine 9. Stressing the need for continuing educator the nurse Florence Nightingale elevated the status of nursing a respected occupation, improved the quality of nursing care and founded modern nursing education. THE ART OF NURSING • NURSING IS CARING- nurses give care, they also demonstrate non possessive caring about for others. • NURSING IS SHARING- nurses share themselves with each other, with other members of the health team and with clients. • NURSING IS LAUGHING- nurses who laugh with others know that humor is a part of comfort and belonging. • NURSING IS CRYING- nurses accepts tears from others and themselves as a normal response to both happiness and sadness • NURSING IS TOUCHING- nurses touch to comfort massage, give care, touching says, “I care” and “I know what to do to help you.” • NURSING IS HELPING- nurses help others in two broad areas: understanding and taking action • NURSING IS BELIEVING IN OTHERS- nurses believe that others have the desire and ability to reach their individual potential in all areas of human functioning. • NURSING IS TRUSTING- nurses demonstrate trust in others by accepting people as they are and by always expecting positive results from actions. • NURSING IS BELIEVING IN SELF- nurses believe they have the knowledge and ability to help others maintain wellness • NURSING IS LEARNING- nurses learn new or expanded knowledge and skills throughout their career. • NURSING IS RESPECTING- nurses demonstrate respect for others through unconditional acceptance ensuring privacy, and individualizing care • NURSING IS LISTENING- nurses listen to what is said verbally but also equally attentive to what is not said • NURSING IS DOING- nurse carry out assessments and interventions with knowledge and skill to give safe comprehensive client care.
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NURSING IS FEELING- nurses are in the sorrows, joys, frustrations, and satisfaction of others.

AIMS OF NURSING/SCOPE OF NURSING 1. Promoting Wellness & Health • Activities carried out to promote wellness involve public and individual education, legislation and direct contact with clients. These activities are aimed at improving health by identifying factors that would put the individual at risks for becoming sick or injured, and in teaching to maintain or improve optimal functioning Encouraging and providing periodic physical examination and screening for such disease processes as high blood pressure, diabetes, cancer Conducting community health education through health fairs and mental health programs Providing health and education in nursing homes, university students health services and public school nursing Promoting environmental and occupational safety Supporting legislation and maintaining health, for example, the child safety seat program. 1. Preventing Illness • The objectives of illness- prevention activities do not reduce the risk of illness to promote good health habits, and to maintain the individual’s optimal functioning. Health promotion is carried out by organizations and institution as well as by nurses promotes health teaching and by personal example. Hospital educational program in areas such as prenatal care for pregnant woman, “stop smoking” programs, and stress reduction seminars Community programs and resources that encourage healthy lifestyles, including aerobics exercises Literature and television information on diets, and the importance of good health habits. 1. Restoring Health • Activities involves restoring of health encompass those most traditionally considered to be the nurse’s responsibility and probably are an area in which majority of practicing nurse are employed. These are forces on the individual with an illness but ranges from early detection of a disease to rehabilitation and teaching during recovery. Direct care of the person who is ill by such measures are physical care administration of medications, and carrying procedures and treatments Performing diagnostic measurements and examinations (taking BP, measuring blood sugars) that detect the illness Referring questions and abnormal findings to other health care providers Planning teaching, and carrying out rehabilitation for illness such as heart attacks, arthritis, and strokes. Working in mental health and chemical-dependent programs 1. Facilitating Coping/ care of the dying • Nurses also facilitate client and family coping with altered functions and health. Altered function results in a decrease in an individual’s ability to carry out activities of daily and expected roles. Nurses can facilitate an optimal level of function through understanding and accepting the individual and family, maximizing strengths and potential knowledge and referrals to community support system. Comforting and caring for people of ages who are dying. Helping clients live as comfortably as possible until death and helping support persons cope to death. Nurse provides care to both patients and families during the terminal illness, and they do so in hospitals. Rehabilitations- process by which a person returns to a maximally functioning role in society following an illness, accident and other disables. Concepts: 1. Maximizing an individual’s abilities and resources to promote optimum growth and functioning by focusing on the individual’s decision-making abilities 2. Begins with preventive care in the initial stage of the accident or disease up to the restorative phase and adaptation of a new life 3. Reaching maximum achievable independents
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4. Restoration to the fullest, physical, mental, social, vocational, economic capacity possible for a given end 5. Becomes more responsive and participative member of the community and family- only if the individual no longer regard himself as disabled 6. Rehabilitation nursing is an “attitude” along with the knowledge, skills that must be basic to all phases of patient care 7. Should be infuse with the into general and the maintenance and preventive aspects should be on going throughout individual’s life Rehabilitation Nursing is vital part of health care, not just a phase of it. Focus is ability not a disability, which requires training, education and strengthening goals. GOAL 1. To help prepare the disabled person assume the fullest life possible by maximizing capabilities and modifying behavior to satisfy human needs 2. To provide supportive environment that encourage independence while helping the person adapt to a different lifestyle. The emphasis is on “how to” and “why” and involves active patient participation. SPECIFIC GOALS 1. To restore potential functions of the individual 2. To maximize existing capabilities 3. To provide support 4. To prevent deformities and complication 5. To assist clients perform his ABC with maximum or no assistance depending on higher level of disability 6. To promote continuity of care when the client is discharged or transferred. GOALS OF COMPREHENSIVE REHABILITATION PLAN 1. Physical goal involves focus on potential strengths, enhancement of body awareness, assisting the patient in making meaning out of disorder. 2. Emotional Goal: Identifies and enhances primary support system, understands defense mechanism, teaches progressive relaxation and other methods of reducing anxiety and tension. 3. Metal Goal • Provide divers on activities • Identify previous coping patterns, and survival strategies and access • Provide opportunities for choices, really orientation • Enhance autonomy and ability or tenderness to function independently • Provide consistent understanding, strengths and friendliness 4. Psychological orientation • Achievement of self care and mobility does not guarantee reintegration of social functioning. Each case must be treated on an individual bases to promote psychosocial orientation • Encourage self transcendence which help individual to focus self on others 5. Spiritual goal (not religion) • Consist of discussing the meaning of disorder from a spiritual perspective reflecting with discussing the life history of the patient and assessing spiritual resources. Process of Aging: • Chronological age ○ Is the number of years a person has live ○ Serves as a criteria in society for certain activities, such as driving, employment and the collection of retirement benefits ○ Categories Young old Middle old Old-old • (ages 65-75) (ages 75-84) (ages 85- older)

Physiological Age: ○ Is the elimination of age by body function ○ Not useful in determining a person’s age because it is very difficult or even impossible to pinpoint the exact changes of body function
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Functional age ○ A person’s ability to contribute to society and benefit others and himself ○ It’s based on the fat that not all individuals of the same chronological age function at the same level

Theories of Aging • Biological Theories ○ It attempts to explain physical aging as an involuntary process, which eventually leads to cumulative changes in cells, tissues, and fluids A. Intrinsic Biological Theory ○ Maintains that aging changes crisis from internal, pre determined causes A. Extrinsic Biological Theory ○ Maintains that environmental factors lead to structural alterations, which in turn, cause degenerative changes.

1. Cross Link Theory- Strong chemical bonding between organic molecules in the 2.
body causes increased stiffness, chemical instability and insolubility of connective tissue and DNA. Sources: Lipids CHON CHO and Nucleic Acids Free radical Theory- Increased

3. Immunologic Theory- An aging immune system is less able to distinguish body cells from foreign cells, as a result, it begins to attack and destroy body cells as if they were foreign. This may explain the adult onset of such conditions as UM, rheumatic heart disease and arthritis.

4. Wear and Tear Theory- body cells, structures and functions wear out or are
overused through exposure to internal and external stressors. Effects from the residual damage accumulate, the body can no longer resist stress, and death occurs. • Psychosocial Theories 1. Psychological Theory- attempt to explain age related changes in cognitive function, such as, intelligence, memory, learning and problem solving Developmental Theories ○ Describe specific life stages and tasks associated with each stage 1. Activity Theory- successful aging and life satisfaction depend on maintaining a high level of activity 2. Continuity Theory- an individual remains essentially the same despite life changes. This theory focuses more on personality and individual’s behavior overtime. 3. Disengagement theory- progressive and social disengagement occurs with age. Decreased participation in society resulting from age-related changes in health, energy, income and social roles. 4. Social exchange theory- social behavior involves doing what’s valued and rewarded by society. Diminished resources and increase dependency, leading to unequal contribution to society and reduced power and value; decreased number or roles available in society. Understanding Aging By Dr. Letty KUan Aging: • Is a slow process of growth towards maturity of mind, body and spirit • Growing old is reaching a “happy plateau” but one must understand and accept what is aging • It brings a decreasing amount of energy over long periods of activities; hence slowing down and moderation in our activity involvement is one reality of aging we all must
Fundamentals of Nursing Page 14 of 15

realize and accept it is a fact to reckon with that what is desirable is to feel comfortable with one’s age and never should one aspire to become caricatures of either age or youth Aging is a reality and must be accepted as a process towards fulfillment of a total self. Developing positive attitudes towards aging while still young contributes a great deal to feeling comfortable while growing old.

Elderly terms: • Elderly- is a classification of age group to any person reaching the mid 70’s up to the 80’s decade of life • Geriatics- a term given to people who are old or who behave old. There is so much structural and functional deficit, that they require support and care. This term signify care given to old sick people • Gerontology- means a study of the growing process of aging or normal, healthy and functional individuals • Gerone- term given to people who are old but gracefully able to function as useful citizens at home and in the community Aging 1. 2. 3. 4. 5. 6. Process is Dependent upon Many Factors: Healthy genetic background Happy, fulfilled, childhood foundation Successful middle aged life experience Healthy surroundings Relaxation Recreation and nutrition

Elements of Life’s Early Imprints: 1. Importance of Love 2. The hug-factor 3. Good parental and sibling modeling roles 4. The sense of humor and relaxation 5. The value of work

“In his heart a man plans his course, but the Lord determines his steps.” Proverbs 16:9

Fundamentals of Nursing Page 15 of 15

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