NURSING AS A PROFESSION

WHAT IS PROFESSION?
- defined as an occupation that requires special knowledge, skill and preparation.

THERE ARE TWO TERMS RELATED TO PROFESSION NEED TO BE

DIFFERENTIATED:
Professionalism
 refers to professional character, spirit, or methods
 for nurses, it always meant healing the sick, nurturing the wounded, placing patients first,
providing holistic care, and educating new professionals
 Nursing professionalism owes much to the influence of Florence Nightingale.

Professionalization
 it is a social process by which any trade or occupation transforms itself into a true profession of
the highest integrity and competence.

CRITERIA OF A PROFESSION
1. SPECIALIZED EDUCATION
- important aspect of professional status

In the United States today, there are five means of entry into registered nursing:

• Hospital Diploma

• Associate Degree

• Baccalaureate Degree

• Master's Degree

• Doctoral Degree
2. BODY OF KNOWLEDGE
 As a profession, nursing is establishing a well-defined body of knowledge and expertise
 There are nursing conceptual frameworks contribute to the knowledge base of nursing and give
direction to nursing practice, education, and on-going research.

3. SERVICE ORIENTATION
 a service orientation differentiates nursing from an occupation pursued primarily for profit.
Many consider altruism the hallmark of a profession.

4. ONGOING RESEARCH
 is a process in which decisions are made that result in a detailed plan or proposal for a study, as
well as the actual implementation of the plan.

5. CODE OF ETHICS
 Nursing as developed its own codes of ethics and in most instances has set up means to monitor
the professional behavior of its members.

PURPOSES:

-Standards

-Guidelines

-Distinguish

-Protect

6. AUTONOMY
 Means having the authority to make decisions and the freedom to act in accordance with one’s
professional knowledge base. (Skar R. J Clin Nurs. 2010)

TO BE AUTONOMOUS, A PROFESSIONAL GROUP MUST BE:

 Granted legal authority to define the scope of its practice
 Describe its particular function and roles
 Determine its goals and responsibilities in delivering of its services.

7. PROFESSIONAL ORGANIZATION
 Operation under the umbrella of a professional organization differentiates a profession from an
occupation.
PERSONAL QUALITIES OF A NURSE (6C’S)
1. Care
 the care we deliver helps the individual person and improves the health of the whole
community

2. COMPASSION
 is how care is given through relationships based on empathy, respect and dignity
 It can also be described as intelligent kindness, and is central to how people perceive their care.

3. COMPETENCE
 the ability to understand an individual’s health and social needs
 and the expertise, clinical and technical knowledge to deliver effective care and treatments
based on research and evidence

4. COMMUNICATION
 is central to successful caring relationships and to effective team working
 Communication is the key to a good workplace with benefits for those in our care and staff alike.

5. COURAGE
 Enables us to do the right thing for the people we care for.
 Having a strong values and confident in meeting the challenges.

6. COMMITMENT
 A commitment to our patients and populations is a cornerstone of what we do.
 We need to build on our commitment to improve the care and experience of our patients.

PROFESSIONAL QUALITIES
 Caring nature
 Be empathetic
 Be organized
 Be adaptable
 Have physical and mental endurance
 Be a quick thinker
 Be hard working

PERSONAL QUALITIES
Philosophy of life-
contributes to personal growth that relate to the moral values and shapes the aspect of the
character.

Good personality-
consists of deeper traits which come from the heart.

CONTEMPORARY NURSING PRACTICES

DEFINITION:
 According to Florence Nightingale, “the act of utilizing the environment of the patient to assist
him in his recovery”
 According to Virginia Henderson, “the unique function of the nurse is to assist the individual,
sick, or well, in the performance of those activities contributing to health or its recovery (or to
peaceful death) that he would perform unaided if he had the necessary strength, will, or
knowledge, and to do this such a way to help him gain independence as rapidly as possible”

CERTAIN THEMES ARE COMMON TO MANY OF THESE DEFINITIONS:

 Nursing is caring
 Nursing is an art
 Nursing is a science
 Nursing is client centered
 Nursing is holistic
 Nursing is adaptive
 Nursing is concerned with health promotion, health maintenance, and health restoration
 Nursing is a helping profession

RECIPIENTS OF NURSING
Consumer
is an individual, a group of people, or a community that uses a service or commodity

Patient
is a person who is waiting for or undergoing medical treatment and care

Client
is a person who engages the advice or services of another who is qualified to provide this service

SCOPE
Promoting health and wellness

Preventing illness

Restoring Health

Caring for dying

OVERVIEW ON THE NATURE OF PROFESSIONAL NURSING PRACTICE
 Roles and Functions of a Nurse
 Benner’s Stages of Nursing Expertise
 NSNAI Code of Academic and Clinical Conduct

ROLES AND FUNCTIONS OF A NURSE

1. CAREGIVER
assist the client physically and psychologically while preserving the client’s dignity

2. COMMUNICATOR
communicates with clients, support persons and colleagues to facilitate all nursing actions in order to
clearly and accurately met client’s health care needs

3. TEACHER
provides effective and efficient health teaching and assesses the client’s learnings

4. CLIENT ADVOCATE
protects and represents the client

assists clients in exercising their rights and help them speak up and decide for themselves

5. COUNSELOR
help the clients to recognize and cope with stressful psychological or social problems, develop personal
relationship and promote personal growth

6. CHANGE AGENT
supports clients to modify their behavior and lifestyle, if necessary

7. LEADER
influences others to collaborate in order to accomplish a certain goal

8. MANAGER
manages the nursing care of the client

delegates nursing activities to ancillary workers and other nurses, supervises and evaluates their
performance along the way

9. CASE MANAGER
plan, coordinate and monitor the activities with the other members of health care team

10. RESEARCH CONSUMER

use research to improve client care and discover new things

11. EXPANDED CAREER ROLES

 NURSE PRACTITIONER
 CLINICAL NURSE SPECIALISTS
 NURSE ANESTHETIST
 NURSE MIDWIFE
 NURSE RESEARCHER
 NURSE ADMINISTRATOR
 NURSE EDUCATOR
 NURSE ENTREPRENEUR
 FORENSIC NURSE

Core Competency & Key Areas of Responsibilities

Key Areas of Responsibilities:
A.Safe and Quality Nursing Care

B.Management of Resources & Environment

C.Health Education

D.Legal Responsibility

E.Ethico-moral Responsibility

Core Competency & Key Areas of Responsibilities

 Personal & Professional Development
 Quality Improvement
 Research
 Records Management
 Communication
 Collaboration & Teamwork

BENNER’S STAGES OF NURSING EXPERTISE

STAGE 1: NOVICE
 has no experience in the situations in which are expected to perform
 lacks confidence to demonstrate safe practice and requires continual verbal and physical cues
 practice is within a prolonged time period and is unable to use discretionary judgement
STAGE 2: ADVANCED BEGINNER
 demonstrate marginally acceptable performance because of the prior experience in actual
situations
 efficient and skillful in parts of the practice area but requires occasional supportive cues
 may/may not be within a delayed time period, knowledge is still developing

STAGE 3: COMPETENT
 demonstrated by who has been on the job in the same or similar situations for two or three
years
 able to demonstrate efficiency, is coordinated and has confidence in his/her actions
 a plan establishes a perspective, and the plan is based on considerable conscious, abstract,
analytic contemplation of the problem
 conscious and deliberate planning helps achieve efficiency and organisation
 care is completed within a suitable time frame without supporting cues

STAGE 4: PROFICIENT
 perceives situations as a whole rather than in terms of chopped up parts or aspects
 understand a situation as a whole because they perceive its meaning in terms of long-term goals
 learns from experience what typical events to expect in a given situation and how plans need to
be modified in response to these events
 can easily recognise when the expected normal picture does not materialise
 improves decision making by having holistic understanding
 it becomes less laboured because of having a perspective on which of the many existing
attributes and aspects in the present situation are the important ones

STAGE 5: EXPERT
 has an intuitive grasp of each situation and zeroes in on the accurate region of the problem
without wasteful consideration of a large range of unfruitful, alternative diagnoses and solutions
 operates from a deep understanding of the total situation
 performance becomes fluid and flexible and highly proficient
 has an highly skilled analytic ability

NATIONAL STUDENT NURSES’ ASSOCIATION CODE OF ACADEMIC AND CLINICAL

CONDUCT
 Advocate for the rights of all clients.
 Maintain client confidentiality.
 Take appropriate action to ensure the safety of clients, self and others.
 Provide care for the client in a timely, compassionate and professional manner.
 Communicate client care in a truthful, timely and accurate manner.
 Actively promote the highest level of moral and ethical principles and accept responsibility of
our actions.
 Promote excellence in nursing by encouraging lifelong learning and professional development.
  Treat others with respect and promote an environment that respects human rights, values and
choice of cultural and spiritual beliefs.
 Collaborate in every reasonable manner with the academic faculty and clinical staff to ensure
the highest quality of client care.
 Use every opportunity to improve faculty and clinical staff understanding of the learning needs
of nursing students.
 Encourage faculty, clinical staff and peers to mentor nursing students.
 Refrain from performing any technique or procedure for which the student has not been
adequately trained.
 Refrain from any deliberate action or omission of care in the academic or clinical setting that
creates unnecessary risk or injury to the client, self or others.
 Assist the staff nurse or preceptor in ensuring that there is a full disclosure and that proper
authorizations are obtained from clients regarding any form of treatment or research.
 Abstain from the use of alcoholic beverages or any substances in the academic and clinical
setting that impair judgement.
 Strive to achieve and maintain an optimal level of personal health.
 Support access to treatment and rehabilitation for students who are experiencing impairments
related to substance abuse and mental or physical health issues.
 Uphold school policies and regulations related to academic and clinical performances, reserving
the right to challenge and critique rules and regulations as per school grievance policy.

1. Advocate for the rights of all clients.

1.1 Advocacy

1.2 Rights of clients

2. Maintain client confidentiality.

2.1 Confidentiality

2.2 Academic Setting

2.3 Special Circumstances

3. Take appropriate action to ensure the safety of clients, self and others.
3.1 Appropriate action to ensure safety of clients

3.2 Safety of self

3.3 Safety of others

4. Provide care for the client in a timely, compassionate and professional manner.
4.1 Timely care

4.2 Compassionate care

4.3 Professional care

5. Communicate client care in a truthful, timely and accurate manner.
5.1 Truthful communication

5.2 Timely communication

5.2 Accurate communication

6. Actively promote the highest level of moral and ethical principles and accept responsibility
of our actions.
6.1 Promote the highest level of moral and ethical principles

6.2 Accepting responsibility of our actions

7. Promote excellence in nursing by encouraging lifelong learning and professional

development.
7.1 Excellence in nursing

7.2 Encouraging lifelong learning

7.3 Professional development

8. Treat others with respect and promote an environment that respects human rights, values
and choice of cultural and spiritual beliefs.
8.1 Treat others with respect

8.2 Promote an environment that respects human rights

8.3 Values

8.4 Choice of cultural and spiritual beliefs

9. Collaborate in every reasonable manner with the academic faculty and clinical staff to
ensure the highest quality of client care.
9.1 Collaborate in every reasonable manner

10. Use every opportunity to improve faculty and clinical staff understanding of the learning
needs of nursing students.
10.1 Nursing is a fast paced ever-changing field that leaves little or no room for error

11. Encourage faculty, clinical staff and peers to mentor nursing students.
11.1 Encourage faculty

11.2 Encourage staff

11.3 Encourage peers

12. Refrain from performing any technique or procedure for which the student has not been
adequately trained.
12.1 Operating within appropriate scope of practice

13. Refrain from any deliberate action or omission of care in the academic or clinical setting
that creates unnecessary risk or injury to the client, self or others.
13.1 Academic or clinical setting

13.2 Creating unnecessary risk of injury to the client, self or others

13.3 Refraining from any deliberate action or omission of care that creates unnecessary risk to the
client, self or others

14. Assist the staff nurse or preceptor in ensuring that there is a full disclosure and that
proper authorizations are obtained from clients regarding any form of treatment or research.
14.1 Assist staff or preceptor

14.2 Ensuring that there is full disclosure

14. 3 Proper authorizations are obtained from clients

14.4 Regarding any form of treatment or research

15. Abstain from the use of alcoholic beverages or any substances in the academic and clinical
setting that impair judgement.
15.1 Abstain the use of alcoholic beverages or any substances that impair judgement

15.2 In the academic and clinical setting

16. Strive to achieve and maintain an optimal level of personal health.

16.1 Optimal level of personal health

16.2 Striving to achieve and maintain

17. Support access to treatment and rehabilitation for students who are experiencing
impairments related to substance abuse and mental or physical health issues
17.1 Support access to treatment and rehabilitation for students experiencing impairment

17.2 Mental or physical health issues

18. Uphold school policies and regulations related to academic and clinical performances,
reserving the right to challenge and critique rules and regulations as per school grievance
policy.
18.1 Uphold, school policies and regulations related to academic and clinical performance

18.2 Reserving right to challenge and critique rules and regulations as per school grievance policy
 HISTORY OF NURSING IN THE WORLD

HISTORY OF NURSING
1. ancient civilizations
2. egyptian civiliations
3. hebrews
4. ancient greeks
5. early christian period
6. middle ages
7. renaissance period
8. industrial revolution
9. 2oth century
10. period of contemporary nursing
11. war period

ANCIENT CIVILIZATIONS
 Experimentation with herbs and plants
 Nurses act as a domestic servant
 Illness attribute to evil spirits

HERODOTUS – of Halicarnassus, was a Greek Historian and regarded as the “Father of History”

PERIOD OF INTUITIVE NURSING (Primitive Era)

● Was practiced since prehistoric times among primitive tribes.

● And lasted until the Christian Era

● Nursing is untaught and instinctive

Beliefs and Practices of Prehistoric Man

● Nursing was a function that belonged to a woman.

● He believed that illness was caused by the invasion of the victims and evil spirit.
● He believed in “Shaman” or medicine man or witch doctor that uses Whitemagic

He also practiced

“Trephening” (drilling a hole on the skull with a rock or stone without the benefit oF anethesia as a last
resort to drive evil spirits from the body of the afflicted)

THE EHYPTIAN CIVILIZATION

Hammurabi
a first king of Babylonian Empire.

Hammurabi's Code - one of the first written codes of law in recorded history.
Xenodochium– house for the sick
Imhotep - God of healing and medicine, the second king of Egypt’s third dynasty, who was later
worshipped as the god of medicine in Egypt and in Greece, where he was identified with the Greek god
of medicine, Asclepius. Architect of the step pyramid built at the necropolis of Ṣaqqārah in the city of
Memphis.

EGYPTIAN CIVILIZATION (ca 3000 BC)

● Practice of prophylaxis by the medicine man and high priest

● Emphasis on personal hygiene, cleanliness within & outside the body

● Sanitation measures

● Mummification

● recognized 250 different diseases

● developed drugs and procedures

● 480 B.C. (neurosurgery)

Hebrews (c.a. 1400 BC)

● Founders of public hygiene

● Moses “father of Sanitation”

● Mosaic Health Code pertained to every aspect of individual, family & community hygiene

a. Principles of personal hygiene (rest, sleep, hours of work, cleanliness)

b. Environmental sanitation

1. Inspection of food

2. Methods of dispose
3. Detecting and reporting diseases

4. Practice of isolation, quarantine, fumigation and disinfection

5. Detailed instructions on the correct way of hand washing

Ancient Greeks
Asclepius - God of medicine and healing in ancient Greek mythology.
Asclepius represents the healing aspect of the medical arts.
Hygieia - daughter of Asclepius.
- Goddess of health, cleanliness and sanitation and afterwards, the moon.

-She was associated with the prevention of sickness and the continuation

of good health.

Panacea - Daughter of Asclepius & granddaughter of Apollo

- Said to have potion which she healed sick

- The panacea was supposed to be remedy that would cure all disease and prolong life indefinitely.

Hippocrates - “Father of Medicine”

- exponent of the science of preventive medicine

- introduced the philosophy of the interrelationship between physical and mental health.

“A healthy mind dwells in a healthy body”

- Treat patient as a whole

- Changed magic medicine into science of medicine

- Taught physicians to use eyes and ears

- The Hippocratic Oath is an oath traditionally taken by physicians pertaining to the ethical practice of
medicine.

3 kinds of Refuge for Sick

Secular- directed by physicians – spas and resorts.
Religious – sanctuaries of gods
Attendants – were basket bearers who looked after the sick.
ROMANS
- Contributed to the field of sanitation (building of Aqueducts, purification of water supply)

- Appointing of public health medical officers

- Establishment of hospitals which emphasized both preventive and curative aspects of care

EARLY CHRISTIAN PERIOD

● Christian church expressed succor to orphans, poor, travelers and the sick.

● Deaconesses (given to women with good social standing) visited the sick.

● Order of Deaconesses- organized visiting of the sick

- called visiting nurses

- forerunner of CHN

- endeavored to practice the corporal works of mercy (feeding the hungry, caring for the sick, burying
the dead)

PHOEBE - a friend of St Paul and the first Deaconess and first visiting nurse.
Fabiola - A Roman matron of rank. She was one of the company of noble Roman women who.
- Influence of St. Jerome

- gave up all earthly pleasures and devoted themselves to the practice of Christian asceticism and to
charitable work

-She erected a fine hospital at Rome & she gave large sums to the churches and religious communities at
Rome, and at other places in Italy.

-All her interests were centered on the needs of the Church and the care of the poor and suffering

Hotel dieu of Beaune

- One of the most charming old hospitals in France, and one quite typical of hospitals established in
medieval times.

- Reputed to be the oldest existing hospital which has continuously occupied its original building.

- This hospital has a history as colorful as its steep, gabled roofs.

MIDDLE AGES (1100 -1300)

- Charitable institutions or sanctuaries intended for the aged, poor and sick people.

- Nursing during this era was either done by charitable institutions or poor people who worked for the
rich.

- Nuns and sisters works as a staff nurse in the hospitals

- Caregiver are not required to have a formal training

- Nurses went to the community and hospitals were built also medical schools increase.

- Europe men risked their lives to provide nursing care

- A group of men, the Parabolani, in 300 AD started a hospital and provided nursing care during theBlack
Plague epidemic.

INFLUENCE OF CRUSADE IN NURSING

Crusades – Christian military expeditions to recapture the Holy Land from Muslims
-In 1244 there are approximately 19,000 hospitals in Western Europe.

-There is a spread of leprosy

-after a thousand years there was no attempt to organized nurse

3 TYPES OF ORGANIZATION
1. Military order
2. Religious order
3. Secular ordering

Military Order
Knight Hospitallers – men who went to battle and them retired to nurse the sick.
Knight of St. John – also known as Knights Hospitaller, a Christian organization that began as an
Amalfitan hospital founded in Jerusalem in 1080 to provide care for poor, sick or injured pilgrims to the
Holy Land.

St. John of God and St. Camillus de Lellis - Two patron saints of nurses stem from this period. Both
stated as soldiers but later turned to nursing.

St. Camillus de Lellis - Started the sign of red cross and developed the first ambulance service. The
Order of St. Lazarus of Jerusalem originated in a leper hospital. It was originally established to treat
virulent diseases such as leprosy

RELIGIOUS ORDER
-Institutions managed by clergy. Throughout the dark middle ages the hospitals and nursing system
were connected by religious bodies.
- Nurses were provided by male and female monastic orders.

-Nurses wore regular clothes.

Care of the sick- done by volunteers like St. Catherine of Siena, her lamp represented the sick at Sienna
-Sisters advanced from probations to wearing white robe to wearing hood.

Name of oldest foundations:

 Hotel Dieu in Paris

 St. Thomas and St. Bartolome’s in London
 The order of St. Augustine and St. John of Jerusalem

SECULAR ORDER
Third order of St. Francis of Assisi. The members of this organization were devoted their time and energy
on enhancing the lives of their friends, neighbors in the community where they lived.

Caring for the sick and poor was one of the order’s important activities to both men and women who
serve as nurses.

There were many Catholic orders caring for the sick during the Middle Ages. Even the secular orders
were associated with the Church. Educated by apprenticeship, lacking knowledge of hygienic measures,
and practicing under very primitive conditions, the care provided was, nonetheless, humane and caring.

● Order of Saint Vincent de Paul

● Sisters of Charity

RENAISSANCE
Renaissance period (a.d. 1400-1550)
- Interest in arts and science emerged.

- Geographic explorations by Europeans

- Society was filled with thieves due to social deprivations.

- care of the sick was entrusted to those who were proven guilty of a crime or theft

- caretakers were not given humane facilities like food & quarters, so all the more they got buried into
evil deeds like stealing the patient’s foods, accepting bribes.

- Need for care of sick and poor escalated

- Hospitals were for the weak, aged, contagious disease, physically and mentally ill.

- A fee was charged for the hospitalization

- Bubonic Plague epidemic, killing 25 to 50% Europe’s Population

Thomas Sydenham
- Founder of clinical medicine and epidemiology.

-Emphasized the detailed observation of patients & maintained accurate record.

- he has been call “the English Hippocrates”

-First person to set an example of clinical methodology.

-Said that a doctor must rely on his own observation and clinical experience and he appeared to have
practiced largely common sense medicine.

REFORMATION PERIOD (1550’s)

-The religious upheaval led by Martin Luther destroyed the unity of Christian faith.

-The wrath of Protestantism swept away everything connected with Roman Catholicism.

-Properties of hospital and schools were confiscated.

-Nurses fled for their lives, In England many hospital were closed.

-No one to take care for sick.

-Nursing became the work of the least desirable of women, took bribes from patients, stole the patient’s
food and used alcohol as a tranquilizer.

-Nurses sank in lowest level, Medical instruction continued along primitive lines.

Women's movement (1848)

-Women’s are not considered equal to men.

-no right to vote or be educated.

-Women’s rights convention in Seneca Falls, NY signaling the beginning of social unrest

-with suffrage, rights of women were advocated & nursing profession advanced.

-1900’s women were accepted to colleges and universities

INDUSTRIAL REVOLUTION (1700’S-1800’S)

-This was a time of free thought, individualism, and the beginning of capitalism and democratic forms of
government.

-Gradually brought forth a more equitable living style for the people.
-Capitalists were protected by law in his exploitation of workers. There were child labor and sweatshops
where disease and accidents were the norm.

-Hospitals remained places where the poor went to die.

-Oppression of women

INDUSTRIAL REVOLUTION (1700’S-1800’S)

Mother Mary Catherine McAuley- founded the Sisters of Mercy, religious order emphasizing in
nursing the poor and sick.

-Emancipation of women-fight for human rights a step in

developing nursing profession

-Proliferation of factories with introduction of technology.

FRANCE- barbers function as surgeons.

-leeching, giving enemas and tooth extraction

-women make beds, scrubs floors and bathe the poor in almshouses.

-factory workers endured long hours of work.

-Medical schools were founded – Royal College of Surgeon in

London (1800)
-End of 18th Century- no standards for nurses working in the Hospitals

20th Century – Machine Age

-Increased poverty

-workers are exploited

-development of other nursing services aside from hospital service: private duty, public health, school,
government, maternal)

A. Age of Specialization

College & Post graduate nursing education programs

B. Standards are Set

1913-1937

standard curriculum

textbooks
C. World War I

Nurse were assisted by the National Red Cross

D. The Great Depression

October 29, 1929 (Black Friday)

Financial crisis – unemployed nurses

Military Nurses

Period of Contemporary Nursing

This period includes scientific and technological developments and many of the social changes occurring
since 1945.

World Health Organization –established by the United Nations to assist in fighting disease by
providing health information and improving the nutrition, living standard and environmental conditions
of all people.

Trends:

-scientific and technological research

-use Atomic energy for medical diagnosis and treatment

-use sophisticated equipment for diagnosis and therapy.

The advent of space medicine also brought about the development of aerospace nursing.

Colonel Pearl E. Tucker – developed a comprehensive one-year course to prepare nurses for
aerospace nursing at Cape Kennedy

-Nursing involvement in community health is greatly emphasized to support Primary Health Care.

-Technologic efficiency has relieved nurses from a numerous tedious task.

-The nurse of the modern times is constantly assuming responsibilities of patient care that were

formerly the sole prerogative of the physician

RELIGIOUS INFLUENCES
The strong influence of religions on the developments of nursing started in India (800-600 B.C.) and
flourished in Greece and Ireland in 3 B.C. with male-nurse priests.

Theodor Fliedner- revived the churched order of Deaconesses to care for those in a hospital he had
founded. He had profound influence in nursing because Florence Nightingale had her training at the
Kaiserswerth Institute.
-Deaconesses of Kaiserswerth became famous because they were the only ones formally trained in
nursing.

Father Basil Moreau- Founded the Nursing Sisters of the Holy Cross in LeMans, France in 1841.
Father Sorin- brought four sisters to Notre Dame in South Bend Indiana in 1841.

WAR PERIOD

American Civil War (1861-1865)

Women played a major role in nursing and sanitation efforts during the Civil War, paving the way for
their entry into the nursing profession in greater numbers after the war, as well as paving the way for
further professionalization of the nursing field.

World War I (1914-1918)

● the duty of an army nurses much more varied than in civilian nursing profession.

● They needed to be decisive and quick-thinking when determining treatment, cleaning wounds and
attending to minor surgery.

● Physical strength and high level of efficiency i required

● endured excessive workload and a lack of staff to meet the demands.

● The conditions made life more difficult to a nurse.

● also at risk of contracting contagious disease.

● experienced same hardships as the soldiers.

● The harsh, foreign climate, inadequate basic necessities and consequent dysentery were all endured
by the female nurses as well.

World War II (1939-1945)

● Casualties created an acute shortage of caregiver.

● The Cadet Nurse Corps was established in response to a marked shortage of nurses.

● Auxiliary health care workers became prominent.

● Practical nurses, aides, and technicians provided much of actual nursing care under the instruction and
supervision of better prepared nurses.

● Medical specialties also arose at that time to meet the needs of hospitalized clients.
NURSING PIONEERS
Harriet Tubman (born Araminta Ross, c. 1820 – 10 March 1913)
- was an African-American abolitionist, humanitarian, and Union spy during the U.S. Civil War.

- thirteen missions to rescue over seventy slaves using the network of antislavery activists and safe
houses known as the Underground Railroad. Known as “The Moses of Her People”

Sojourner Truth (1797–November 26, 1883)

- The self-given name, from 1843, of Isabella Baumfree.

- An American abolitionist and women's rights activist.

- Truth was born into slavery in Swartekill, New York.

- Her best-known speech, Ain't I a Woman?, was delivered in 1851 at the Ohio Women's Rights
Convention in Akron, Ohio.

Dorothea Lynde Dix (April 4, 1802 – July 17, 1887)

- was an American activist on behalf of the indigent insane.

- created the first generation of American mental asylums.

- During the Civil War, she served as Superintendent of Army Nurses.

Clarissa Harlowe Barton (December 25, 1821-April 12, 1912)

- A pioneer of America teacher nurse, & Humanitarian.

- She has been described as having a "strong and independent spirit"and is best remembered for
organizing the American Red Cross.

Lillian D. Wald (1867–1940)

- was a nurse, social worker, public health official, teacher, author, editor, publisher, women's rights
activist, and the founder of American community nursing.

- founder of visiting nursing in the United States and Canada.

- Provide nursing care to indigent

- first community health nurse

- Established Henry Street Settlement Service in New York

- Supported education for the mentally challenged

- Advocate more lenient immigration lawsIsabel Adams Hampton Robb (1860–1910)

- Was one of the founders of modern American nursing theory and one of the most important leaders in
the history of nursing.

- she implemented an array of reforms that set standards for nursing education.

- One of her most notable contributions to the system of nursing education was the implementation of a
grading policy for nursing students.

- President of American Society of Superintendents of Training Schools for Nurses (now known as
National League for Nursing), and of the organization that became the American Nurses Association.

- She was also one of the founders of the American Journal of Nursing.

Jane Arminda Delano March 13, 1862 Montour

Falls, New York, United States – died April 15, 1919 in Savenay, Loire-Atlantique, France.

- She started work in 1887 at a Jacksonville, Florida hospital treating victims of a yellow fever epidemic.

- She demonstrated her superior executive and administrative skills and developed innovative nursing
procedures.

- A leading pioneer of the modern nursing profession, Delano almost single-handedly created American
Red Cross Nursing when she united the work of the American Nurses Association, the Army Nurse Corps,
and the American Red Cross. Through her efforts, emergency response teams were organized for
disaster relief and over 8,000 registered nurses were trained and ready for duty by the time the United
States entered World War I.

- During the course of the War, more than 20,000 of her nurses played vital roles with the United States
military.Mary Breckinridge (February 17, 1881-May 19, 1965)

- She also was known as Mary Carson Breckinridge.

- was an American nurse-midwife and the founder of the Frontier Nursing Service.

- Introduced a model rural health care system, to provide professionals services.

- She created a decentralized system of nursemidwives, district nursing centers, and hospital facilities.

- Originally called the Kentucky Committee for Mothers and Babies, later the Frontier Nursing Service
(FNS), the system lowered the rate of death in childbirth in Leslie County, Kentucky, from the highest in
the nation to substantially below the national average.

- Thanks to FNS, nurse-midwives were no more than six miles away from any patients. Providing both
preventive and curative nursing, FNS continues to serve this region.
Florence Nightingale, (12 May 1820 – 13 August 1910)
- "The Lady with the Lamp", was a pioneer of modern nursing, a writer and a noted statistician.

- Florence's older sister was named Parthenope. Her parents were William Edward Nightingale (1794–
1875) and Frances Nightingale née Smith (1789–1880).

- Inspired by what she took as a Christian divine calling, experienced first in 1837 at Embley Park and
later throughout Florence's life, she committed herself to nursing (though discouraged by her parents).

- Florence Nightingale's most famous contribution came during the Crimean War, which became her
central focus when reports began to filter back to Britain about the horrific conditions for the wounded.

- By 1859, she set up the Nightingale Training School at St. Thomas' Hospital on 9 July 1860.

- The first trained Nightingale nurses began work on 16 May 1865 at the Liverpool Workhouse Infirmary.

- She also campaigned and raised funds for the Royal Buckinghamshire Hospital in Aylesbury, near her
family home.

Nightingale’s Beliefs
● Holistic framework inclusive of illness and health

● Need for theoretical basis

● Liberal Education as foundation for nursing practice

● Importance of creating an environment that promotes healing

● Need for the body of nursing knowledge distinct from medical knowledge.

Nightingale’s Concept
● Having systematic method of assessing patient

● Individualized care on the basis of patients needs and preferences

● Maintaining confidentiality

● Nurses should be formally educated and function as client advocate

Environmental factors affecting health

Adequate ventilation has also been regarded as a factor contributing to changes of the patient's process
of illness recovery. Defined in her environmental theory are the following factors present in the patient's
environment:

● Pure or fresh air

● Pure water
● Sufficient food supplies

● Efficient drainage

● Cleanliness

● Light (especially direct sunlight)

Any deficiency in one or more of these factorscould lead to impaired functioning of life processesor
diminished health status.

Mary Eliza Mahoney (May 7, 1845 – January 4, 1926)

- was the first African-American to study and work as a professionally trained nurse in the United States,
graduating in 1879.

- In 1908, she co-founded the National Association of Colored Graduate Nurses (NACGN).

- The NACGN eventually merged with the American Nurses Association (ANA) in 1951.

- She is commemorated by the biennial Mary Mahoney Award of the ANA for significant contributions in
advancing equal opportunities in nursing for members of minority groups.

- She encouraged respect for cultural diversity.

Adah Belle Samuels Thoms (January 12, 1870 –February 21, 1943).
- African American nurse who co founded the National Association of Colored Graduate Nurses.

- Acting director of the Lincoln School for Nurses (New York), and fought for African Americans to serve
as army nurses during World War I.

- She was among the first nurses inducted into the American Nurses Association Hall of Fame when it
was established in 1976.

- President of the NACGN from 1916-1923, and played a critical role in lobbying for the rights of African
American women to serve in the United States military during World War I.

- Campaigned the American Red Cross permit black nurses to enroll.

Linda Richards (July 27, 1841-April 16,1930)

- first professionally trained American nurse.

- She established nursing training programs in the United States and Japan.

- first system for keeping individual medical records for hospitalized patients.

- In 1885 she helped to establish Japan's first nursestraining program.

- She was elected as the first president of the American Society of Superintendents of Training Schools,
and served as head of the Philadelphia Visiting Nurses Society. She retired from nursing in 1911, at the
age of seventy.

Lavinia Lloyd Dock (1858-1956)

- Compiled the first, and long most important, manual of drugs for nurses, Materia Medica for Nurses
(1890).

- She strove not only to improve the health of the poor but also to improve the profession of nursing
through her teaching, lecturing, and writing.

- . She played a major role as a contributing editor to the American Journal of Nursing.

- She also did most of the work for A History of Nursing (4 vols, 1907–12, later revised and abridged).

Margaret Higgins Sanger (September 14, 1879 –September 6, 1966)

- an American birth control activist, an

advocate of negative eugenics, and the

founder of the American Birth Control League

(which eventually became Planned Parenthood).

- Woman's choice to decide how and when, if ever, she will bear children.

- In her drive to open the way to universal access to birth control, Sanger was ahead of her time.

Shirley Titus (1892-1967).

- Nurse, Educator, Administrator- advocated improved economic security of nurses.

- Championed nursing's responsibility to improve the economic security

- Her 1943 article, Economic Security Is Not Too Much to Ask, asserted that as employed professionals,
nurses need the protection of, and the legal right to, collective bargaining.

History of Nursing in the Philippines

Treatment for Disease and what cause them are formed by
mysticism and superstition
1. Causation of disease:

a. Beliefs that it could be from another person or a witch

b. Evil spirits

2. Persons with powers to expel demons are believed that could driven away evil spirits.

3. People believed in special gods of healing, with the priestphysician (called “word doctors”) as
intermediary. If they used leaves or roots, they were called herb doctors (“Herbolarios).

Earliest Hospitals established during the Spanish Regime:

1. Hospital Real de Manila (1577)- care for the spanish king’s soldiers, founded by Gov. Francisco de
Sande.

2. San Lazaro Hospital (1578)- founded by Bro. Juan Clemente, administered by Hospitalliers of San
Juan De Dios, exclusively for patient with Leprosy

3.Hospital de Indio (1586)- by Franciscan order, suppported by alms & contributions for charitable
persons.

4.Hospital de Aguas Santas (1590)- established in Laguna near medicinal spring, founded by BRO. J.
Bautista of the Franciscan Order.

5.San Juan de Dios Hospital (1596)- founded by brotherhood of Mesiricordia and run by Hospitalliers
of San Juan de Dios, support from alms & rents, general services for people.

Nursing During the Philippine Revolution

The prominent persons involved in nursing works were:

Josephine Bracken
 Wife of Jose Rizal
 Installed a field of hospital in an estate house in Tejeros Provided nursing care to the wounded
night and day

Rosa Sevilla de Alvero

 Converted their house into quarters for the Filipino soldiers during the Philippine-American war
(1899)

Doña Hilaria de Aguinaldo

 Wife of Emilio Aguinaldo
 Organized the Filipino Red Cross under the inspiration of Apolinario Mabini

Doña Maria Agoncillo de Aguinaldo

 Second wife of Emilio Aguinaldo
 Provided nursing care for the Filipino soldiers during the revolution
  President of the Filipino Red Cross branch in Batangas

Melchora Aquino (Tandang Sora)

 Nurse the wounded Filipino soldiers and gave them shelter and food

Capitan Salome
 Revolutionary leader in Nueva Ecija
 Provided nursing care to the wounded when not in combat

Agueda Kahabagan
 Revolutionary leader in Laguna who provided nursing services to her troop

Trinidad Tecson (Ina ng Biak na Bato)

 Stayed in the hospital in Biak na Bato to care for the wounded soldiers

Hospitals and Schools of Nursing

Iloilo Mission Hospital School of Nursing (Iloilo City,1906)

 It was ran by the Baptist Foreign Mission Society of America.
 Miss Rose Nicolet, a graduate of New England Hospital for women and children in Boston,
Massachusetts. (1st Superintendent)
 Miss Flora Ernst, an American nurse took charge of the school in 1942

St. Paul’s Hospital School of Nursing (Manila, 1907)

 The hospital was established by the Archbishop of Manila.
 The Most Reverend Jeremiah Harty, under the supervision of the Sisters of St. Paul de Charters

Philippine General Hospital School of Nursing (1907)

- mainly for “Civil officers & Employees” in the city of Manila & became Civil Hospital

St.Luke’s Hospital School of Nursing (Quezon City, 1907)

– hospital in Episcopalian Institution, began as a small dispensary. Opened with 3 fil girls admitted.

Philippine Christian Mission

Institute Schools of Nursing

a.Sallie Long Read Memorial

Hospital School of Nursing (Laoag, Ilocos Norte, 1903)
a.Sallie Long Read Memorial Hospital School of Nursing (Laoag, Ilocos Norte, 1903)

b.Mary Chiles Hospital School of Nursing (Manila, 1911)

c.Frank Dunn Memorial Hospital (Vigan, Ilocos Sur, 1912)

Mary Johnston Hospital and School of Nursing (Manila, 1907)

“Bethany Dispensary” founded by Methodist Mission for the relief of suffering among women &
children.

Emmanuel Hospital School of Nursing(Capiz, 1913)

San Juan de Dios Hospital School of Nursing (Manila, 1913)

Southern Islands Hospital School of Nursing (Cebu, 1918)

Other schools of Nursing established were the ff:

a. Zamboanga General Hospital School of Nursing (1921)

b. Chinese General Hospital School of Nursing (1921)

c. Baguio General Hospital School of Nursing (1923)

d. Manila Sanitarium and Hospital School of Nursing(1930)

e. St. Paul’s School of Nursing in Iloilo City (1946)

f. Northern General Hospital and School of Nursing (1946)

g. Siliman University School of Nursing (1947)

1st Colleges of Nursing in the Philippines

 University of Santo Tomas College of Nursing (1946)
 Manila Central University College of Nursing
 University of the Philippines College of Nursing
Nursing Leaders in the Philippines
1.Anastacia Giron-Tupas – 1st filipino Nurse as chief nurse superintendent , founder of PNA.
2.Cesaria Tan- 1st filipino To receive a Masters degree in nursing abroad.
3.Socorro Sirilan- pioneered chief nurse in San Lazaro Hospital
4.Rosa Militar- a pioneer in school health education.
5.Sor Ricarda Mendoza-a pioneer in nursing education.
6.Socorro Diaz- 1st editor of PNA magazine called “TheMessage”.
7.Conchita Ruiz- 1st full-time editor of the newly named PNAmagazine “The Filipino Nurse”
8.Loreta Tupaz- “Dean of the Philippine Nursing”; FlorenceNightingale of Iloilo
 NURSING PROCESS
Format for NCP

The nursing process is a series of organized steps designed for

nurses to provide excellent care.

Purpose:
To identify a client’s health status and actual or potential health care problems or needs, to
establish plans to meet the identified needs, and to deliver specific nursing interventions to
meet those needs.
Client: individual, family, or group
Components of nursing process

 Assessment
 Diagnosis
 Planning
 Implementation
 Evaluation
Assessment: data collection:-

 Subjective data … pain

 Objective data …fever
Diagnosis: determining the problem.
Planning: developing a plan for care.
Implementation: applying the plan.
Evaluation: evaluating the outcomes.

ASSESING
o COLLECT DATA
o ORGANIZE DATA
o VALIDATE DATA
o DOCUMENT DATA

ASSESMENT

 Is the systematic and continuous collection, organization, validation, and documentation

of data.
 A continuous process carried out during all phases of the nursing process.
 All phases of the nursing process depend on the accurate and complete collection of
data.
PURPOSE:
To establish a data base.

I. Collecting Data
 Is the process of gathering information about a client’s health status
DATABASE – is all information about a client

 Nursing health history

 Physical Assessment
 1st care provider’s Hx & PA
 Laboratory & Diagnostic test results, etc.
TYPES OF DATA
Subjective (Sx) – covert data; apparent only to the person affected ex. Pain, dizziness
Objective (Signs) – overt data; detectable by an observer; can be measured or tested against an
accepted standard.
TYPES:

 Constant data – information that does not change over time

 Variable data – can change quickly, frequently or rarely
SOURCE OF DATA
Primary – the client himself (best source)
Secondary – all information sources other than the client

 Support people
 Client records
 Health Care Professionals
 Literature
Components of Nursing Health History

 Biographic data
 Chief complaint or reason for visit
 History of present illness
 Past history
 Family history of illness
 Lifestyle
 Social data
 Psychologic data
 Patterns of health care
Data Collection Methods
1. Observation – is a conscious, deliberate skill that is developed through effort and with an
organized approach.
2. Interview – is a planned communication or conversation with a purpose.
2 Approaches:
1. Directive Interview – highly structured and elicits specific information
2. Nondirective Interview – also known as rapport-building interview; the nurse allows the
client to control the purpose, subject matter and pacing.
Types of Interview Questions
1. Closed question – used in directive interview; restrictive & generally requires
yes or no or short factual answers.
2. Open-ended question – used in nondirective interview; invite the client to
explore their feelings.
3. Neutral question – is a question the client can answer w/o direction or
pressure from the nurse.
4. Leading question – directs the client’s answer

Planning the Interview and Setting

 Time – when client is physically comfortable and free of pain
 Place – well-lighted, well-ventilated room that encourages communication
 Seating arrangement – less formal atmosphere
 Distance – neither too close or too far
o Proxemics- is the study of use of space
 Language – use language that both parties can understand

Stages of Interview
Opening (Introduction) – establish rapport & orient the interviewee
Body (Development) – nurse must use communication technique for effective interview
Closing (Termination) – when information needed has been obtained; important in
maintaining the rapport & trust & for facilitating future interactions

Data Collection Methods

Examining
 PE or PA is a systematic data collection method that uses observation (5 senses) to
detect health problems.
 To conduct the examination, the nurse uses inspection, auscultation, palpation &
percussion.
 Cephalocaudal (head-to-toe approach)
  Body systems approach
 Screening Examination (review of systems) – brief review of essential functioning of
various body parts or systems

II. Organizing Data

 Nurse uses a written format that organizes the assessment data systematically.
 Often referred to as a:
o Nursing health history
o Nursing assessment
o Nursing database form
 Nursing models provide formats for collecting and organizing client data.
o Gordon’s Typology of 11 Functional Patterns
o Orem’s Self-care Model
o Roy’s Adaptation Model

Gordon’s Typology of 11 Functional Patterns

 Health Perception/Health Management Pattern
 Nutritional/Metabolic Pattern
 Elimination Pattern
 Activity-Exercise Pattern
 Sleep-Rest Pattern
 Cognitive-Perceptual Pattern
 Self-Perception/Self-Concept Pattern
 Role-Relationship Pattern
 Sexuality-Reproductive Pattern
 Coping/Stress-Tolerance Pattern
 Value-Belief Pattern

Orem’s Self-Care Model

Six (6) self-care requisites common to men, women and children are as follows:
1. The maintenance of a sufficient intake of air, water, and food.
2. The provision of care associated with elimination processes and excrements.
3. The maintenance of balance between activity and rest.
4. The maintenance of balance between solitude and social interaction.
5. The prevention of hazards to human life, human functioning, and human well being.
6. The promotion of human functioning and development within social groups in accordance
with human potential, known human limitations, and the human desire to be normal.

Roy’s Adaptation Model

1. Physiologic needs

 Activity & rest

 Nutrition
 Elimination
 Fluid & Electrolytes
 Oxygenation
 Protection
 Regulation: temperature
 Regulation: the senses
 Regulation: endocrine system
2. Self-Concept
3. Role function
4. Interdependence

Wellness Models
Nurses use wellness models to assist clients to identify health risks and to
explore lifestyle habits and health behaviors, beliefs, values, and attitudes that
influence the level of wellness.
 Health History
 Physical fitness evaluation
 Nutritional assessment
 Life-stress analysis
 Lifestyle and health habits
 Health beliefs
 Sexual health
 Spiritual health
 Relationships
 Health risk appraisal
Non-Nursing Models
These frameworks are narrower than the models required in nursing. The nurse usually
needs to combine these with other approaches to obtain complete history.
Body Systems Model
 Integumentary system
 Respiratory system
 Cardiovascular system
 Nervous system
 Musculoskeletal system
 Gastrointestinal system
 Genitourinary system
 Reproductive system
 Immune system

Maslow’s Hierarchy of Needs

 physiological needs
 safety needs
 love and belonging needs
 esteem needs
 and self-actualization needs

Developmental Theories
 Havighurst’s age periods and developmental tasks
 Freud’s 5 stages of development
 Erikson’s 8 stages of development
 Piaget’s phases of cognitive development
 Kohlberg’s stages of moral development

III. Validating Data

The act of ‘double-checking’ or verifying data to confirm that it is accurate and factual.

 Ensure that assessment information is complete.

 Ensure that objective & related subjective data agree.
 Obtain additional information that may been overlooked.
 Differentiate between cues and inferences.
o Cues –are subjective or objective data that can be directly observed by the nurse
 o Inferences – are the nurse’s interpretation or conclusions made based on the
cues.
 Avoid jumping to conclusions and focusing in the wrong direction to identify problems.

IV. Documenting Data

 To complete the assessment phase, the nurse records the client data.
 Accurate documentation is essential and should include all data collected about the
client’s health status.
 Data are recorded in a factual manner and not interpreted by the nurse

Diagnosing
 Analyze data
 Identify health problems, risk, and strengths
 Formulate diagnostic statements

 Is a process which results to a diagnostic statements of nursing diagnosis.

 It is the clinical act of identifying problems.
 To diagnose in nursing, it means to analyze assessment information and
derive meaning from this analysis.
 Nurses use critical thinking skills to interpret assessment data and identify
client strengths and problems.
 1973, identification and development of nursing diagnosis began
 Kristine Gebbie and Mary Ann Lavin perceived a need to identify nurse’s
roles in an ambulatory care setting
 Saint Louis University School of Nursing and Allied Health Professions
sponsored the 1st National Conference to identify nursing diagnoses.
 Purpose of NANDA (North American Nursing Diagnosis Association) is to
define, refine, and promote a taxonomy of nursing diagnostic terminology
of general use to professional nurses.
 Taxonomy is a classification system or set of categories arranged based on a
single principle or set of principles.
 Members of NANDA are staff nurses, clinical specialists, faculty, directors of
nursing, deans, theorists, and researchers.
 They currently approved over 170 nursing diagnosis labels for clinical use
and testing.
  In 2001, Taxonomy It was revised to Taxonomy II.

Diagnosing - reasoning process

Diagnosis – a statement or conclusion regarding the nature of a phenomenon
Diagnostic labels – standardized NANDA names for the diagnoses
Nursing Diagnosis – a client’s problem statement, consisting of the diagnostic label plus
etiology

Types of Nursing Diagnosis

1. Actual Diagnosis – is a client problem that is present at the time of the nursing
assessment
2. Risk Nursing Diagnosis – is a clinical judgment that a problem does not exist,
but the presence of risk factors indicates that a problem is likely to develop unless
nurses intervene
3. Wellness Diagnosis – describes human responses to levels of wellness in an
individual, family or community that have a readiness for enhancement.
4. Possible Nursing Diagnosis – is one in which evidence about a health problem
is incomplete or unclear. This requires more data either to support or refute it.
5. Syndrome Diagnosis – is a diagnosis that is associated with a cluster of other
diagnosis.

Components of a NANDA Nursing Diagnosis

1. Problem (Diagnostic label) & Definition – describes the client’s health problem
or response for which nursing therapy is given.
 Purpose of the problem statement is to direct the formation of client goals
and desired outcomes.
 To be clinically useful, diagnostic labels need to be specific.
Qualifiers – are words that have been added to some NANDA labels to give
additional meaning to the problem statement
 Deficient – inadequate in amount, quality, degree; insufficient; incomplete
 Impaired – made worse, weakened, damaged, reduced, deteriorated
 Decreased – lesser in size, amount, or degree
 Ineffective – not producing the desired effect
 Compromised – to make vulnerable to threat
2. Etiology (Related & Risk Factors)
 The etiology component of a nursing diagnosis identifies one or more
probable causes of the health problem, gives direction to the required
nursing therapy, and enables the nurse to individualize the client’s care.
3. Defining Characteristics
 Are the cluster of signs and symptoms that indicate the presence of a
particular diagnostic label.
 Actual Nsg. Dx – S/Sx
 Risk Nsg. Dx – no S/Sx ( Fx that cause the client to be more vulnerable to
the problem)

Nsg. Dx Vs. Med Dx

 Nursing Dx is a statement of nursing judgment and refers to a condition
that nurses, by virtue of their education, experience, and expertise, are
licensed to treat.
 Medical Dx is made by a physician and refers to a condition that only a
physician can treat.

Nsg Dx Vs. Collaborative Problems

Collaborative Problem - is a type of potential problem that nurses manage using
both independent and dependent interventions.
  Collaborative problems are present when a particular disease or treatment
is present; that is, each disease or treatment has specific complications that
are always associated with it.

The Diagnostic Process

Critical thinking – is a cognitive process during which a person reviews data and
considers explanations before forming an opinion.
Analysis – is the separation into components (deductive reasoning)
Synthesis – is the act of putting the parts into a whole (inductive reasoning)
 3 Steps:
1. Analyzing data
2. Identifying health problems, risks and strength
3. Formulating diagnostic statements

1. Analyzing Data
A. Compare Data with Standards
 Nurses draw knowledge and experience to compare client data to norms
and standards and identify significant and relevant cues.
 Norm or standard is generally accepted measure, rule, model, or pattern.
B. Clustering cues
 Data clustering or grouping cues is a process of determining the relatedness
of facts and determining whether any patterns are present.
 Beginning of synthesis.
C. Identifying Gaps and Inconsistencies in Data
 Inconsistencies are conflicting data.
 Skillful assessment minimizes gaps and inconsistencies in data.
2. Identifying Health Problems, Risks, and Strengths
 This is primarily a decision-making process.
A. Determining Problems and Risks
 After clustering the data, the nurse and the client together identify
problems that support tentative actual, risk and possible diagnoses.
 Nurse must determine if the client’s problem is Nsg. Dx, Med. Dx or
collaborative problem.
B. Determining Strengths
 The nurse and the client also establish the client’s abilities, resources and
abilities to cope.
 Strengths can be an aid to mobilizing health and regenerative processes.

3. Formulating Diagnostic Statements

A. Basic Two-Part Statement
1. Problem (P): statement of the client’s response (NANDA label)
2. Etiology (E): factors contributing to or probable causes of the responses
B. Basic Three-Part Statement (PES format)
1. Problem (P): statement of the client’s response
2. Etiology (E): factors contributing to or probable causes of the response
3. Signs & Symptoms (S): defining characteristics manifested by the client
C. One-Part Statement
 Wellness diagnoses and syndrome diagnoses, consist of NANDA label only.
 An etiology may not be needed.
 NANDA has specified that any new wellness diagnoses will be developed as one-part
statements beginning with the words Readiness for Enhanced

Variations of Basic Formats

1. Writing unknown etiology when the defining characteristics are present but the
nurse does not know the cause or contributing factors.
2. Using the phrase complex factors when there are too many etiologic factors or
when they are too complex to state in a brief phrase.
3. Using the word possible to describe either the problem or the etiology.
4. Using secondary to to divide the etiology into two parts, thereby making the
statement more descriptive and useful. (pathophysiologic, disease process or
medical diagnosis)
5. Adding a second part to the general response or NANDA label to make it more
precise.

Collaborative Problems
 Carpenito-Moyet has suggested that all collaborative (multidisciplinary)
problems begin with the diagnostic label Potential Complication (PC)
 An etiology might be helpful in suggesting interventions. Nurses should
write the etiology when:
A. It clarifies the problem statement
B. It can be concisely stated
C. It helps to suggest nursing actions

Avoiding Errors in Diagnostic Reasoning

 Verify
 Build a good knowledge base and acquire clinical experience
 Have a working knowledge of what is normal
 Consult resources
 Base diagnoses on patterns – that is, on behavior over time – rather than
on an isolated incident.
 Improve critical-thinking skills
  The development of taxonomy of nursing diagnosis label is an ongoing process.
 The organizing principles for the NANDA Taxonomy II are the seven axes: diagnostic
concept, time, unit of care, age, potentiality, descriptor and topology.
 Work is progressing on a unified standardized nursing language that includes NANDA
nursing diagnosis, a nursing interventions classification (NIC), and a nursing outcomes
classification (NOC).

PLANNING
 Prioritize problems/diagnoses
 Formulate goals/desired outcomes
 Select nursing interventions
 Write nursing interventions
The formulation of guidelines that establish the proposed course of nursing
action in the resolution of nursing diagnosis and the development of the client’s
plan of care
Four Critical Elements
 Identification of Priorities
 Setting Goals & developing Expected Outcome
 Planning Nursing Interventions
 Documenting

Initial Planning – involves development of beginning of care by the nurse who

performs the admission assessment and gathers the comprehensive admission
assessment data

Ongoing Planning – entails continuous updating of client’s plan of care

Discharge Planning – involves critical anticipation and planning for the client’s
needs after discharge

Developing NCPs
The end product of the planning phase of the nursing process:
1. Informal nursing care plan – strategy of action that exists in the
nurse’s mind
2. Formal nursing care plan – a written or computerized guide that
organizes information about the client’s care
a. Standardized care plan – groups of clients with common needs
b. Individualized care plan – made to meet the unique needs of a specific
client

Standardized Approaches to Care Planning

Standardized care plans – are preprinted guides for the nursing care of a client
who has a need that arises frequently in the agency
Protocols – are preprinted to indicate the actions commonly required for a
particular group of clients.
Policies & procedures – are developed to govern the handling of frequently
occurring situations.
Standing order – is a written document about policies, rules, regulations, or
orders regarding client care. This gives the nurse the authority to carry out
specific actions under certain circumstances, if the physician is unavailable.
Guidelines for Writing Nursing Care Plans
1. Date and sign the plan
2. Use category headings
3. Use standardized or approved medical or English key words rather than
complete sentences to communicate your ideas unless the agency policy dictates
otherwise
4. Be specific
5. Refer to procedure books or other sources of information rather than including
all the steps on a written plan
6. Tailor the plan to the unique characteristics of the client by ensuring that the
client’s choices, such as preferences about the times of care and the method used
are included.
7. Ensure that the nursing plan incorporates in preventive and health
maintenance aspects as well as restorative ones.
8. Ensure that the plan contains interventions for ongoing assessment of the
client
9. Include collaborative and coordination activities in the plan.
10. Include plans for the client’s discharge and home care.

Planning Process
1. Priority setting – is the process of establishing a preferential sequence for
addressing nursing diagnoses and interventions
 Life-threatening problems – high priority
 Health-threatening problems – medium priority
 Normal developmental needs/requires minimal nursing support – low
priority
Factors need to be considered in setting priorities
1. Client’s health values and beliefs
2. Client’s priorities
3. Resources available to the nurse and client
4. Urgency of the health problem
5. Medical treatment plan

Goal – general statement of that indicates the desired change in the client’s health status
Expected outcome – is a detailed, specific statement that describes the methods through
which the goal will be achieved

Short term goal – a statement written in an objective format demonstrating an expectation

to be achieved in resolution of the nursing diagnosis in a short period of time, usually few
minutes to hours or days

Long term goal - a statement written in an objective format demonstrating an expectation to

be achieved in resolution of the nursing diagnosis over a longer period of time usually weeks to
months
Components of Goals and Expected Outcomes
 Subject – identifies the person who will perform the desired behavior or
meet the goal
 Behavior or verb– describes what the patient will do to achieve the goal
o Use of measurable verbs
 Criteria of performance – standards indicating the nature of actions (how
long, how far, how much)
 Conditions or modifiers– an optional component, refer to the aid or
conditions which facilitates performance
Behavior
 Will verbalize
 Will ambulate
 Will report
 Will eat
 Will demonstrate
Criteria of performance
 Understanding of medication regimen
 Length of the hall
 Decrease pain level of 4 or less
 Seventy five percent of meal served
 Decrease BP within 48 hrs
Conditions
 With assistance of physical therapy
 With the administration of analgesics
 With assistance of family
 With use of medication and diet therapy
Measurable Verbs
 Identify
 State
 Demonstrate
 Exercise
 Cough
 Describe
 List
 Share
 Communicate
 Walk
 Perform
 Verbalize
 Express
 Stand
 Describe
 Relate
 Hold
 Sit
 Discuss
 Reestablish

Planning
General Guidelines in Formulation of Goals/ Expected Outcome
 S - Specific (singular goal or outcome)
 M – Measurable
 A - Attainable
 R - Realistic
 T - Time bound
Ng Dx: Chronic Pain r/t inflammation of joints Goal:
e.g. After 8 hours of nursing intervention the client will be able to alleviate pain perception as
manifested by:
Expected Outcome:

 Verbalize decrease of pain from 7 to 2 in a scale of 10

 Identify factors that influence the pain experience
 Client and significant other administer pain medication appropriately

Planning: Planning Nursing Intervention

Nursing Intervention – an action performed by a nurse that helps the client to
achieve the results specified by the goals and expected outcome
Categories:
Independent – nursing actions that do not require direction or an order
from another health care professional
Interdependent – actions that are implemented in a collaborative manner
by the nurse with other health care professional
Dependent – actions that require an order from another health care
professional
Rationale – an explanation based on theories and scientific principles of natural
and behavioral sciences and the humanities

Nursing Interventions Classification (NIC)

 It describes the interventions that nurses perform.
 This taxonomy consists of three levels:
o Level 1, domains
o Level 2, classes
o Level 3, interventions
 More than 514 interventions have been developed
  Each broadly stated intervention includes a label, a definition, and a list of
activities that outline the key actions of nurses in carrying out the
intervention.

Common Errors in Goal Setting and Outcome identification

 Focus on the nurses action when writing goals
 Statement of unrealistic goal for client
 Goal lacks time frame
 More than one task or behavior to be accomplished in one goal statement
 Focus on the nurses action when writing goals
 Statement of unrealistic goal for client
 Goal lacks time frame
 More than one task or behavior to be accomplished in one goal statement

IMPLEMENTING
 Reassess the client
 Determine the nurse’s need for assistance
 Implement the nursing interventions
 Supervise delegated care
 Document nursing activities

Implementation
Involves the execution of the nursing plan of care derived during the planning phase of the
nursing process
Activities include:

 Ongoing assessment
 Establishment of priorities
 Allocation of resources
 Initiation of nursing interventions
 Documentation of intervention and client response
Delegation – the process of transferring a selected nursing task in a situation to an individual
who is competent to perform that specific task
Tasks that cannot be delegated:
o Assessment
o Evaluation
o Health Teaching

Types of Management Systems

Functional Nursing - an approach that divides care into tasks to be completed and uses various
levels of personnel depending on the complexity of assignment
- each member of the staff performs his/her assigned task for each client
Team Nursing – approach that uses variety of personnel (professional, technical, & unlicensed
assistants) in the delivery of nursing care
Primary Nursing – the professional nurse assumes responsibility for total client care for small
number of client
Case Management – the nurse assumes responsibility for planning, implementing, coordinating
and evaluation of care for a given client, regardless of the client’s location at any given time.

Types of Nursing Intervention

Standing Order – standardized intervention that is written, approved and signed by a health
care practitioner that is kept on file within health care agencies to be used in predictable
situations or in circumstances requiring immediate attention
Protocol – a series of standing orders or procedures that should be followed under certain
specific conditions

Implementation
 Nursing Intervention Activities
 Assisting in ADL
 Delivering skilled therapeutic interventions
 Monitoring and surveillance of response to care
 Teaching
 Discharge planning
 Supervising and coordinating nursing personnel
EVALUATING
 Collect data related to outcomes
 Compare data with outcomes
 Relate nursing actions to client goals/outcomes
 Draw conclusions about problem status
 Continue, modify, or terminate the client’s care plan
Involves determining whether the client goals have been met, have been partially met, or have
not been met
Purposes:

 To determine client’s progress or lack of progress toward achievement of expected

outcome
 To determine effectiveness of nursing care in helping clients achieve the expected
outcome
 To determine the overall quality of care provided
 To promote nursing accountability

Evaluation MUST:
 Be performed as a systematic process
 Occur on an ongoing process
 Lead to revision of the plan of care when needed
 Involve the client, significant others, and other members of the healthcare team
 Be documented

Methods of Evaluation
 Establishment of standards
 Collecting data
 Determining goal achievement
 Relating nursing actions to client status
 Judging the value of nursing intervention
 Reassessing client’s status
 Modifying the plan of care
 Critical thinking and evaluation

DOCUMENTING AND REPORTING

Documentation
  Discussion – is an informal oral consideration of a subject by two or more health care
personnel to identify a problem or establish strategies to resolve a problem.
 Report – is oral, written, or computer-based communication intended to convey
information to others.
 Record – is written or computer-based.
 Recording, charting or documenting – is the process of making an entry on a client
record
 Clinical record, chart or client record – is a formal, legal document that provides
evidence of a client’s care.

GUIDELINES FOR DOCUMENTATION OR CHARTING

 Documentation or charting is the process of recording vital information about the client.
It is part of the client's record and becomes part of a legal document.
 The following rules for charting narrative notes will assist you to maintain an acceptable
chart;
1. Use ink, not felt pen or pencil. Black is best.
2. Correct errors by drawing a single line through the error write the word error above it,
and then sign your signature. The error must be readable. Ink eradication, erasures, or use of
occlusive materials are not acceptable.
3.Signs each entry with your first initial, last name, and status e.g., SN for student nurse, or
RN for registered nurse. Script, not printing, is used for the signature. Each signature should
appear at the right hand margin of the nurse's notes,
4.Notes should appear on each succeeding line. Lines should not be omitted in the nurses'
notes. A horizontal line is drawn to "fill-up" a partial line. Continuous charting is done for each
entry unless a time change occurs. You do not need a new line for each new idea or statement.
5. Entries should be concise. Complete sentences are not required. Start each entry with a
capital letter and end the entry with a period even if the entry is a single word or phrase
6. The date is entered in the date column on the first line of every page of nurses' notes and
whenever the date changes.
7.Time is entered in the time column whenever a new time entry occurs. Do not put
time changes in the text of the nurses' notes. If only one time is entered for block charting,
enter the last time you were with the patient.
 8. Chart objective facts, not your interpretations. For example, Chart: ate 100%, not
good appetite. If the patient offers complaints, place the complaint in quotation marks to
indicate that it is his statement. For example, "c/ o chest pain radiating down left arm.“
9. Objective data is to be charted as well. In addition to the statement offered by the
patient, the nurse should chart observations: Skin cold and clammy. Diaphoretic. Vital signs
stable.
10. Refusal of medications and treatments must be documented. A circle is placed
around the time the medication or treatment is to be given in the appropriate area of the chart.
An explanation as to the reason medication was not given is entered in the nurse's notes
11. Sign each entry before it is replaced in the chart rack. An entry is not to be left
unsigned. If all the charting is completed for the shift at one time, a single signature is placed at
the end of the charting.
12. Accuracy is important. Describe behaviors rather than feelings. This allows other
health team members to determine the actual problems of the patient.
13. Chart only those abbreviations and symbols approved by the facility Information can
be misinterpreted or misleading when unfamiliar abbreviations are used.
14. Spell correctly, using proper terminology and grammar.
15. Write legibly. If writing is not legible, then print.
16. Chart only what you personally have done or observed. An exception to this rule is
what you are responsible for charting for nonprofessional personnel.
17. Do not use the word "patient" or "pt" in the chart. The chart belongs to that patient.
18. Do not double-chart. If something appears on a flow sheet, it does not need to
appear on the nurse's narrative record unless there is an alteration from normal.
19. Do not squeeze information into a space because you forgot to chart it earlier. Add
the information on the first available line. Write in the time the event occurred, not the time
you entered the information.
20. The following information should be charted.

 Physician’s visit
 Times patient leaves and returns to the unit, mode of transportation, and
destination.
 Medications, (chart immediately after given). Include dosage, route of
administration if parenteral where given.
 Treatments (chart immediately after given)
HAHAHHA NATAPOS KA DIIIINNNN HAHHAA MAG REVIEW
KAANNNNAAAA NG IBA PANG SUBS.