NCM 103 Fundamentals of Nursing

Southern Luzon State University
College of Allied Medicine
NCM 103 FUNDAMENTALS OF

NURSING
Module 5
COMMUNICATION IN NURSING
Dear students,
This module is dedicated to the students of Southern Luzon
State University at College of Allied Medicine in support to distant
learning during this time of pandemic, we hope that the students who
read this book will prepare you to shape your future in health care.
Southern Luzon State
University Brgy Kulapi,
Lucban Quezon
roracion@slsu.edu.ph
mquintos@slsu,edu.ph
09276449263
09232620275
https://classroom.google
.com/c/MjcxNTI3NDExMj
U5?cjc=wzwg4f5
NCM 103 FUNDAMENTALS OF NURSING | Prepared by: PROF. MARIA ROWENA S. ORACION
PROF. MELENA QUINTOS
– SY 2020-2021
OVERVIEW
Communication is a process in which people affect one another through change

of information, ideas and feelings. As a member of the health team, nurses need to
communicate information about clients accurately, timely, in an effective manner.
Documentation/recording is a vital aspect of nursing practice. Generally, health
personnel communicate through discussion, reports and records. Reports include both
oral and written exchange of information between caregivers. At the end of each
work shift in the hospital and other agencies nurses give both verbal and written
reports to the next shift.
The quality of client care greatly depends on the caregiver’s ability to

communicate with one another. All health care providers require the same
information about the clients so that they can plan an organized, comprehensive care
plan. Unless this care plan is communicated to all members of the health care team,
care becomes fragmented, repetition of task occurs and therapies may be delayed or
even may affect client outcome, resulting in delayed recovery.
The well-known adage, “if you give a man a fish, you feed him for a day, but if
you teach a man how to fish, you feed him for a lifetime,” signifies the importance of
client education. The teaching – learning process empowers clients and usually enables
them to achieve a higher level of wellness or to manage specific healthcare needs.
LEARNING OBJECTIVES
At the end of the subject the student will be able to:
 Discuss the Modes and Characteristics of communication

 Establish trusting relationship with the patients and other membersd of the
health team
 Incorporate effective communication skills using techniques necessary to meet
patient needs.
– SY 2020-2021
DISCUSSION
Modes of Communication
Verbal Communication. Uses spoken or written words.
Nonverbal Communication. Uses gestures, facial expression, posture/gait, body

movements, physical appearance (also body language), eye contact, tone of voice.
Characteristics of Communication
1. Simplicity. Includes use of commonly understood words, brevity and
completeness.
2. Clarity. Involves saying exactly what is meant. The nurse also needs to speak
slowly and enunciate words well. Repeat the message as needed. Reduce
distractions.
3. Timing and Relevance. Require choice of appropriate time and consideration
of the client’s interests and concerns. Ask one question at a time. Wait for an
answer before making another comment.
4. Adaptability. Involves adjustment on what the nurse says and how it is said
depending on moods and behavior of the client.
5. Credibility. Means worthiness of belief. To become credible, the nurse
requires adequate knowledge about the topic being discussed. The nurse should
be able to provide accurate information, to convey confidence and certainly in
what she says. Most importantly, she should be a good role model for what she
teaches.
Components of Communication
Sender Message Receiver

(Encoder) (Decoder)
Response (Feedback)
 Communication is a basic component of human relationships and nurse-client

relationships.
 Non-verbal communication is a more accurate expression of a person’s thought’s
and feelings than verbal communication.
– SY 2020-2021
 When assessing nonverbal behaviors, consider cultural influences. Variety of

feelings can be expressed by a single non-verbal expression. E.g., head nodding
does not always mean agreement.
 Effective communication is reciprocal interaction (two-way process) based on
trust and aimed at identifying client needs and developing mutual goals.
 Trust is the foundation of a positive nurse-client relationship. It develops ang
empathy from the nurse. The client initially may test the nurse’s confidence
such as sharing that he expects remain confidential.
 Covert communication represents inner feelings that a person may be
uncomfortable talking about. Such communication may be revealed through non-
verbal modes. Validation is required for overt communication. It is an attempt
to confirm the observer’s perception through feedback, interpretation and
classification.
 Therapeutic Communication is a fundamental component in all phases of the
nursing process, and for establishing effective nurse – client relationship.
 Effective nurse – client relationship is a helping relationship which is growth-
facilitating and provides support comfort and hope.
The Characteristics of an Effective Nurse-Client Relationship are as follows:

1. An intellectual and emotional bond between the nurse and the patient and is focused
on the patient.
2. Respects the client as an individual-his ability to participate in his care, ethnic and
cultural factors, family relationships and values.
3. Respects client’s confidentially.
4. Focuses on the client’s well-being.
5. Based on mutual trust, respect and acceptance.
Documenting and Reporting

 Documentation serves as a permanent record of client information and care.
 Reporting takes place when two or more people share information about client
care, either face to face or by telephone.
Purposes of Client’s Record/Chart

1. Communication. Provides efficient and effective method of sharing information.
It allows to convey meaningful data about the client.
2. Legal Documentation. It is admissible as evidence in a court pf law.
3. Research. Provides valuable health-related data for research.
4. Statistics. Provides statistical information that can be utilized for planning
people’s future needs.
– SY 2020-2021
5. Education. Serves as an educational tool for students in health discipline.

6. Audit and Quality Assurance. Monitors the quality of care received by the
client and the competence of health care givers.
7. Planning Client Care. Provides data which the entire health team uses to plan
care for the client.
8. Reimbursement. Provides the basis for decisions regarding care to be provided
and subsequent reimbursement to the agency, to cover health-related expenses.
Types of Records
A. Source Oriented medical record (Traditional client record)
 Each person or department makes notations in a separate section/s of the
client’s chart.
Five Basic Components of the Traditional Client Record

1. Admission sheet
2. Physician’s order sheet
3. Medical history
4. Nurse’s notes
5. Special records and reports (referrals, X-ray reports, laboratory findings, report
of surgery, anesthesia record, flow sheets, vital signs, I&O, medications)
B. Problem-oriented medical record (POMR or POR)

 Data about the client are recorded and arranged according to the source of
the information.
 The record integrates all data about the problem, gathered by the members
of the health team.
Four Basic Components of POMR/POR

1. Database. Contains all the initial information about the client.
2. Problem list. Contains all the aspects of the person’s life requiring health
care.
3. Initial list of orders or care plans.
4. Progress notes:
 Nurse’s or narrative notes (SOAPIE format)
S – subjective data
O – objective data
A – assessment
P – planning
I – intervention
E – evaluation
– SY 2020-2021
 Flow sheets (data that are monitored)

 Discharge notes or referral summaries
Kardex
 Provides a concise method of organizing and recording data about client,
making information readily accessible to all members of the health team.
 It is a series of flip cards usually kept in portable file.
 It is a way to ensure continuity of care from one shift to another from one
day to the next.
 It is a tool for change – of – shift report. But endorsement is not simply
reciting content of Kardex. The health care needs of the client is still
primary basis for endorsement.
 Kardex usually includes the following data:
o Personal data (demographic data)
o Basic needs
o Allergies
o Diagnostic tests
o Daily nursing procedures
o Medications and intravenous (IV) therapy, blood transfusions
o Treatments like oxygen therapy, steam inhalation, suctioning, change of
dressings, mechanical ventilation
 Entries are usually in pencil so that they can be changed as client’s condition
changes. This implies the Kardex is for planning and communication purposes
only.
Characteristics of Good Recording

1. Brevity.
 Entries are 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.
2. Use of link/permanence.
 Avoid felt pen or pencil for permanence of data because the client’s
chart can be used as an evidence in a legal court.
3. Accuracy.
 Chart objective facts, not your interpretations or opinions.
 E.g.
o Correct: ate 50% of the food served.
o Incorrect: ate with poor appetite.
– SY 2020-2021
o Correct: Refused medications.

o Incorrect: uncooperative
o Correct: seen crying.
o Incorrect: depressed.
 Place complaint of the client in quotation marks to indicate that it is his
statement.
 E.g. complained of “chest pain radiating down the left arm.”
 Objective data are also to be charted.
 E.g. skin cold and clammy. Diaphoretic. Prefers to sit up. Vital signs
taken as follows: Temp=37.6֯C, PR=110/min, RR+26/min, BP=146/90
mmHg
 Describe behaviors rather than feelings to allow other health team
members to determine the actual problems of the client.
 Refusal of medications and treatments must be documented.
4. Appropriateness.
 Only information that pertain to the client’s health problems and care
are recorded.
 Any other personal information that is conveyed to the nurse is
inappropriate for the record.
5. Completeness and chronology/organization/sequence/timing.
 Notes should appear on each succeeding line.
 Continuous charting is done for each entry unless a time change occurs.
No need for a new line for each new idea or entry.
 Date is entered in the date column on the first line of every page of
nurse’s notes and whenever the date changes.
 Time is entered in the time column whenever a new time entry occurs.
 Avoid time changes in the text of the nurse’s notes.
 Avoid double chart. If something appears on a particular sheet, it does
not need to appear on the nurse’s notes, unless there is an alteration
from the normal, e.g., body temperature, blood pressure.
 Avoid squeezing information into a space because you forgot to chart it
earlier. Add the information on the first available line. Write the time
the event occurred, not the time you entered the information.
The following information should be charted:

 Physician’s visit.
 Times the patient leaves and returns to the unit, mode of
transportation and destination.
 Medications should be charted immediately after given.
 Treatments should be charted immediately after given.
– SY 2020-2021
6. Use of standard terminology.

 Us only those abbreviations and symbols approved by the institution;
spell correctly; use proper grammar.
7. Signed.
 Affix signature, place at the end of the charting, at the right hand
margin of the nurse’s notes.
 Sign each entry with your full name and status, e.g., SN for student
nurse, RN for registered nurse.
 Script, not printing, is used for the signature.
8. In case of ERROR.
 Correct errors by drawing a single (horizontal) line through the error.
 Write the word error above the line, then sign your signature.
 No ink eradication, erasures or use of occlusive materials.
 E.g., ERROR JU
Pulse 180 beats/min 108 beats/min
9. Confidentiality.
 Only the health personnel who participate in the care of the client are
allowed to read the chart.
10. Legal awareness.
 Chart only what you personally have done, observed, heard, smelled, or
felt.
 Do not discard any part of the client record.
11. Legible.
 Writing must be clear and easily read by the others.
 If writing is not legible, then print.
12. Do not use the word “patient” or “pt” in the chart; the chart
belongs to the patient. All information in the chart pertain to the patient.
13. A horizontal line drawn to full up a partial line. This is to prevent
other persons from adding information in the nurses’ notes
 E.g., _____________________________. Rowena Salvo, RN
Reporting
Types of Reporting
1. Change-of-shift reports or endorsement.

 For continuity of care.
 It is based on health care needs of the client.
– SY 2020-2021
 It is not mere reciting the content of the Kardex.

2. Telephone reports.
 Provide clear, accurate, and concise information.
 The nurse documents telephone report by including the following
information:
a. When the call was made.
b. Who made the call/report.
c. Who was called.
d. To whom information was given.
e. What information was given.
f. What information was received.
3. Telephone orders.
 Only RN’s may receive telephone orders.
 The order needs to be verified by reporting it clearly and precisely.
 The order should be countersigned by the physician who made the order
within prescribed period of time (within 24 hours)
4. Transfer reports.
 This is done when transferring a client from one unit to another.
Commonly Used Abbreviations
Abbreviation Latin English

a.c. ante cebum Before meals
ad. Lib. ad libitum As desired
ADL Activities of daily living
Ax. axillary
Bid Bis in die Twice a day
BMR Basal metabolic rate
BP Blood pressure
c.c. cum with
Cap capsula Capsule
Gtt gutta drop
h.s. Hora somni hours of sleep
IM intramascular
IV intravenous
mcgtt microdrop
Od Omni die Once a day
– SY 2020-2021
OD Oculus dexter Right eye

o.m. Omni mane Every morning
OS Oculus sinister Left eye
OU Oculus uterque Both eyes
p.c. Post cebum After meals
p.o. Per orem By mouth
p.r.n. Pro re nata As necessary
q.h. Quaque hora Every hour
q.i.d Quarter in die Four times a day
s.s. sine without
s.c. Sub cutem Subcutaneously
ss. semis One-half
Stat. statim Immediately
Tid. Ter in die Three times a day
Teaching and Learning (Client Education/Patient Teaching)
Learning
 A change in human disposition or capability that persists over a period of time.
 Reflected by a change of behavior.
Theories of Learning
 Behaviorism. The transfer of knowledge could occur if the new situation
closely resembled the old situation. (Thorndike)
 Cognitism. Learning is a complex cognitive (intellectual) activity. (Lewin)
Learning must be an individualized process. People do the best they can for
themselves relative to their unique perceptions.
 Humanism. There is a natural tendency for people to learn and that learning
flourishes in an encouraging environment. Involves providing options for the
person and the resources and equipment for learning capacity for self-
determination and freedom to make choices. It involves respect for human
dignity.
Principles of Teaching and Learning

1. Meet priority needs first. Basic needs must be met first before an individual
can be expected to engage in learning new skills and behaviors. E.g., relieve
client’s pain first before giving health teachings.
– SY 2020-2021
2. Make learning relevant. Patients are more likely to learn information that they
consider useful and relevant to their needs. E.g., teach people in the community
the use of herbal plants for treatment of illness.
3. Keep learning goals realistic. Patients are more likely to succeed with learning
if the goals are realistic. E.g., teach the daughter of an elderly client on how
to monitor blood sugar level of the client.
4. Relate new information to previous learning. Patients are more likely to learn
new information that corresponds to previous experience and learning. E.g.,
teach clients on the different food groups before planning well-balanced diet.
5. Include significant others. Patients are more likely to continue new behaviors
if significant other are included in the planning and teaching. E.g., teach the
wife of the client with hypertension on how to prepare low sodium, low fat, low
cholesterol diet.
6. Consider individual learning strengths and weaknesses. Data regarding the
patient’s intellectual and physical capabilities should guide the choice of
appropriate teaching materials. E.g., use various teaching materials like audio
– visual aids, models, articles, equipment to facilitate learning.
7. Choose appropriate instructional strategies. The patient’s learning style
preferences should guide the choice of teaching strategies. Some individuals
are visual learners, others are auditory learners and other are kinesthetic
learners. Most people are combination of different modes of learning. E.g.,
use of lectures, demonstrations, discussion, role playing.
8. Provide for practice and feedback. Patients, especially in the learning of
technical skills will need to practice their new activities. Positive feedback
throughout the practice will reinforce correct performance and encourage the
person to master the task. E.g., allow the client to manipulate equipment and
articles.
Domains of Learning (Bloom)

1. Cognitive domain. Includes intellectual skills. E.g., the diabetic client after
attendance of diabetes education comprehends, diabetes process, its signs and
symptoms and complications.
2. Affective domain. Include feelings, emotions, interests, attitudes and
appreciation. E.g., the diabetic client values the importance of daily foot care
to prevent development of diabetic ulcer.
3. Psychomotor domain. Includes motor skills. E.g., the diabetic client is able to
perform self-monitoring of blood glucose correctly and accurately.
Factors Facilitating Learning
– SY 2020-2021
1. Motivation. The desire to learn, it is generally greatest when the client

perceives and recognizes the need will be met through learning. E.g., the client
with hypertension needs to know the effects of alcohol before he recognizes
the need to stop drinking alcohol.
2. Readiness. Reflects motivation at specific time. Willingness and ability to
learn. This involves physical, emotional and cognitive readiness. E. g. the client
may search out information by asking questions, reading books or articles
talking to others, showing interests.
3. Active involvement. If the learner actively participates in planning and
discussion, learning is faster and retention is better. The learner gains self-
confidence in his ability to learn.
4. Feed Back. It is the evaluation of person’s performance in meeting goal.
Positive feedback such as praise, positively worded corrections and suggestions
of alternative methods enhance success in learning.
5. Simple to complex. Materials should be logically organized, from simple to
complex to enhance learning.
6. Repetition. Facilitates retention of newly-learned material. Provide adequate
time for practice of psychomotor skills. Summarize content, rephrase and
approach the material from another point of view to reinforce learning.
7. Timing. The shorter the length of time from learning to application, the
greater the amount of material retained.
8. Environment. The learning environment should be physically and physiologically
comfortable – free from distractions such as noise; with adequate lighting;
good ventilations and room temperature; with privacy; free from anxiety-
provoking situation.
Factors Inhibiting Learning

1. Emotions. E. g. depression, anxiety
2. Physiologic factors. E. g. pain, acute illness, impaired mobility, decreased level
of energy.
3. Cultural barriers. E. g. language barrier difference in health beliefs, customs
and practices.
Teaching
 A system of activities aimed to produce learning.
 Involves dynamic interaction between teacher and learner.
 Trust and respect basically characterized the relationship between the
teacher (nurse) and the learner (patient).
– SY 2020-2021
Learning/Teaching Guidelines
1. Teaching activities should help the clients meet individual learning objectives,
as determined by the client and the nurse. E. g. demonstrate to the diabetic
client how to hold the syringe when teaching on self-injection of insulin.
2. Rapport between teacher and learner is essential. The relationship between the
nurse and the patient must be accepting and constructive.
3. The teacher should use the patient’s previous learning in the present situation
to encourage learning of new skills.
4. The nurse-teacher must be able to communicate clearly and accurately. Is able
to provide current or updated materials.
5. Nurses often need to communicate effectively with individuals and small/large
groups.
6. A knowledge of the clients and the factors that affect their learning should
be determined before planning and teaching.
7. When a client is involved in planning, learning is often enhanced.
8. Teaching that involves a number of the client’s senses often enhances learning.
9. The anticipated behavioral changes that indicate that learning has taken place
must always be adapted to the client’s lifestyle and resources.
– SY 2020-2021
EVALUATION
CRITICAL THINKING EXERCISES NO. 5
Communication in Nursing
Announcements on quiz will be posted to

our google classroom (class stream)
REFERENCES
Potter & Perry, (2015). Fundamentals of Nursing, Philippines, Mosby ELSEVIER, 7th
Edition
Daniels, Wilkins, et al, (2010). Fundamentals of Nursing, Nursing Human Functions
Kozier & Erb’s, (2017). Fundamentals of Nursing Concepts, Process and Practice,
Berman, Synder et. al,
Philippine, Pearson Education South Asia, 10th Edition, Volume 1 & 2
– SY 2020-2021
Critical Thinking Exercise No.4

Name________________ Date_____________
Part I. Multiple Choice. Answer in CAPITAL LETTERS.
1. Which of the following statements clearly defines therapeutic

communication?
a. Therapeutic communication is an interactional process which is
primarily directed by the nurse.
b. Therapeutic communication conveys feelings of warmth, acceptance and
empathy from the nurse to a patient in a relaxed atmosphere.
c. Therapeutic communication is a reciprocal interaction based on trust
and aimed at identifying patient needs and developing mutual goals.
d. Therapeutic communication is the assessment component of the nursing
process.
2. Which of the following concepts is most important in establishing

therapeutic nurse – patient relationship?
a. The nurse must fully understand the patient’s feelings, perceptions and
reactions before goals can be established.
b. The nurse must be a role model for health - fostering behaviors.
c. The nurse must recognize that the patient may manifest maladaptive
behavior during illness.
d. The nurse needs to understand that the patient mat test her before he
can accept and trust her.
3. Which communication skill is most effective in dealing with covert

communication?
a. validation b. listening c. evaluation d. clarification
4. Which of the following are qualities of good recording?

1. brevity a. 1,2
2. completeness and chronology b. 3,4
3. appropriateness c. 1,2,3
4. accuracy d. 1,2,3,4
– SY 2020-2021
5. All of the following entries are correct EXCEPT?

a. Complained of chest pain
b. Chest pain relieved after administration of nitroglycerin sublingually
c. Able to ambulate to the bathroom without assistance.
d. Vital signs 120/84,82,18
6. The accepted method for signing a nurse’s note is:

a. R. O/R.N.
b. Maria Rowena Oracion, Clinical Instructor
c. Maria Rowena S, Oracion
d. Maria Rowena S.Oracion, R.N.
7. Which of the following teaching method is most appropriate for teaching a

diabetic client on self - injection of insulin?
a. Detailed explanations
b. Demonstration
c. Use of pamphlets
d. Filmstrip
8. The most important characteristics of effective nurse-patient

relationship is that:
a. It is growth – facilitating.
b. It is based on mutual understanding.
c. It fosters hope and confidence.
d. It involves primarily emotional bond.
9. Which of the following statements is most likely to promote a client’s

compliance in performing post – operative deep breathing, coughing and
turning exercises?
a. “You will be given adequate medication is these exercises will cause you
pain.”
b. “Deep breathing, coughing and turning exercises will promote good
breathing, body circulation. This will prevent complications.”
c. These exercises will promote maximum respiratory ventilation, prevent
thrombophlebitis and atelectasis.”
– SY 2020-2021
10. When using printed material to teach diabetic patient about foot care, the
nurse should:
a. Read the material to the patient.
b. Allow the patient to read the material.
c. Give the material to a family member to read the patient.
d. Read the material to evaluate its clarity, accuracy and effectiveness.
11. The patient asks the nurse, “do you think, I have the cancer?” The most
appropriate response of the nurse is:
a. “I will refer you to your doctor.”
b. “If I were you, I will not worry unnecessarily.”
c. “You sound concerned about what the doctor may find.”
d. “You will undergo different tests before cancer can be diagnosed.”
12. The patient is scheduled for proctosigmoidoscopy. She says she is

nervous. The most appropriate response to be made by the nurse is:
a. “You need not worry. You have the best doctor in the hospital.”
b. “I don’t blame you for feeling that way. If I were in your position, I
would feel the same.”
c. “Why do you feel that way? Don’t you trust God?”
d. “You sound really upset. Would you like to sit and talk about it?”
13. Which of the following behavior should the nurse recognize when caring
for elderly patients?
a. Most elderly resent being cared for by people not related to them.
b. Many elderly patients need support in maintaining their independence.
c. Elderly patients refuse to change old habits.
d. Most elderly are unable to learn new skills.
14. The nurse can best evaluate that the patient is learning by:
a. his ability to repeat what was thought.
b. a desired change in his behavior.
c. verbal acknowledgements that he understands.
d. his ability to get a good score from a questionnaire.
15. Therapeutic communication begins with:

a. giving initial care.
b. showing empathy.
c. interacting with patient.
d. knowing your patient.
– SY 2020-2021
16. Which of the following responses is appropriate when a patient request to

be discharged at once?
a. “I will notify the supervisor about your request.”
b. “You can only be discharged after the doctor has given a medicate
clearance.”
c. “I will notify your doctor, so I can inform him about your request.”
d. “I understand your request but please sign this special form.”
17. From your admission interview of a patient, you obtained a history of
allergies. You can best communicate this information by:
a. placing allergy alert in Kardex.
b. writing in the patient’s chart.
c. informing his attending physician.
d. taking note when giving medications.
18. Which of the following techniques can be most helpful in accessing the
degree of distress and discomfort of a newly admitted patient?
a. review the nurse’s notes
b. performing physical assessment.
c. active listening on what the patient says.
d. observation of the patient’s behavior.
19. Which of the following factors will least likely facilitate learning of a
patient:
a. motivation to learn.
b. active participation in the learning activity.
c. influencing the client to change his health beliefs.
d. positively worded corrections.
20. Which of the following principles must be given consideration by the nurse
when giving patient teaching to an elderly client?
a. use audio – visual aids to facilitate learning.
b. provide opportunity for independence to learn.
c. provide lecture for at least 2 hours.
d. Proceed from complex to simple material.
– SY 2020-2021
NCM 103 FUNDAMENTALS OF

NURSING
Module 6
THE NURSING PROCESS
Dear students,
This module is dedicated to the students of Southern Luzon
State University at College of Allied Medicine in support to distant
learning during this time of pandemic, we hope that the students who
read this book will prepare you to shape your future in health care.
Southern Luzon State
University Brgy Kulapi,
Lucban Quezon
roracion@slsu.edu.ph
mquintos@slsu,edu.ph
09276449263
09232620275
https://classroom.google
.com/c/MjcxNTI3NDExMj
U5?cjc=wzwg4f5
– SY 2020-2021
OVERVIEW
The cornerstone of the nursing profession is nursing process. Skills in utilizing

the nursing process is essential for the clinical application of knowledge and theory in
nursing practice.
Nursing process continue to evolve. It used to be a 3 step process, then 4 step

process (APIE), now a 6 step process (ADOPIE)- Assessment, Diagnosis, Outcome,
Identification, Planning, Implementation and Evaluation.
Nursing process is synonymous with the problem- solving approach for

discovering the health care and nursing care needs of the clients. Therefore, through
the nursing process, Nursing was able to build its own scientific body of knowledge.
This elevated Nursing from a vocation into a profession.
This Module will help you acquire the necessary knowledge, skill and attitude
for applying the nursing process, towards quality, comprehensive, ethical and
humanistic care of clients.
LEARNING OBJECTIVES
At the end of the subject the student will be able to:
 Discuss the Concept of Nursing Process.

 Formulate efficient Family nursing Care Plan
 Integrate the knowledge of how to assess, diagnose and then plan. Implement
and evaluate nursing care for patient with different needs
– SY 2020-2021
DISCUSSION
The Nursing Process
1. Lydia Hall - originated the term Nursing Process in 1955. She introduced three
steps of nursing process; note observation, ministration of care and validation.
2. Dorothy Johnson - identified three steps of nursing process as follows;
assessment, decision and nurse’s action (1959).
3. Ida Jean Orlando - identified three steps of nursing process; client’s behavior,
nurse’s reaction and nurse’s actions (1961).
4. Yura and Walsh suggested the four components of nursing process namely
assessing, planning, implementing and evaluating (1967).
5. Knowles described nursing process as discover, delve, decide, do and discriminate
(1967).
6. American Nurses Association introduce the following innovations in the nursing
process:
 Diagnosis distinguished as separate step of nursing process (1973).
 Diagnosis of actual and potential health problems delineated as integral part of
nursing practice (1980).
 Outcome identification differentiated as a distinct step of the nursing process.
Therefore, the six steps of the nursing process are as follows: Assessment,
Diagnosis, Outcome Identification, Planning, Implementation and Evaluation
(1991).
The Nursing Process is:
Organized
Systematic Efficient
Goal-Oriented Effective
Humanistic Care
a. Organized and Systematic

 The nursing process is composed of 6 sequential and interrelated steps.
b. Humanistic
 The plan of care is developed and implemented with great consideration
to the unique needs and concerns of the individual client.
 It is individualized.
 It involves aspects of human dignity.
– SY 2020-2021

c. Efficient
 Relevant to the needs of the client.
 Promotes client satisfaction and progress.
d. Effective
 Utilizes resources wisely in terms of human, time and cost resources,
Phases of the Nursing Process
Six Phases of the Nursing Process (ADOPIE)
1. Assessment. Is collecting, validating. Organizing and recording data about client’s

health status (may be an individual, family or community).
Purpose: to establish a data base.
– SY 2020-2021
Activities during Assessment
a. Collection of data. Gathering information about the client, considering the

physical, psychological, emotional, socio-cultural, and spiritual factors that may
affect his/her health status.
Types of Data
i. Subjective Data (symptoms). Those that can be described only by the
person experiencing it, e.g. vertigo, pain, tinnitus (vertigo is dizziness;
tinnitus is ringing of the ears).
ii. Objective Data (signs). Those that can be observed and measured, e.g.
pallor, diaphoresis, BP= 120/80, reddish urine.
Methods of Collection of Data

i. Interview. Planned purposeful conversation.
ii. Observation. E.g. use of senses, use of units of measure, physical
examination techniques, interpretation of laboratory test.
Sources of Data
i. Primary: Patient/Client.
ii. Secondary: family members, significant others, patient’s record/chart,
health team members, related literature.
b. Verifying/Validating Data. Making sure your information is accurate.
c. Organizing Data. Clustering facts into groups of information.
2. Diagnosing. Is a process which results to a diagnostic statement or 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.
Purpose: To identify the client’s health care needs and to prepare diagnostic
statements.
Nursing Diagnosis is a statement of client’s potential or actual alteration of health

status.
– SY 2020-2021
It uses the critical-thinking skills of analysis. Uses PRS/PES format.

P problem
R related factors
S signs and symptoms
P problem
E etiology
S signs and symptoms
Activities during Diagnosing
 Organize cluster or group data. E.g. pallor, dyspnea, weakness, fatigue, RBC
4m/cu.mm, Hgb=10g/dl, pertains to problem with oxygenation.
 Compare data against standards. Standards are accepted norms, measures, or
patterns for purposes of comparison. E.g. the standard color of the sclera is
white, the standard color of urine is amber.
 Analyze data after comparing with standards.
 Determine the client’s health problems, health risks, and strengths.
 Formulate Nursing Diagnoses Statements.
Examples of Nursing Diagnoses
 Anxiety related to insufficient knowledge regarding surgical experience.

 Risk of injury related to sensory and integrative dysfunction as manifested by
altered mobility and faulty judgement.
 Ineffective airway clearance related to tracheobronchial infection as
manifested by weak cough, adventitious breath sounds, and copious green
sputum production.
Comparison of Correct and Incorrect Nursing Diagnoses:
 Correct: High risk for ineffective airway clearance related to thick, copious
mucus secretions.
Incorrect: High risk for ineffective airway clearance related to pneumonia
 Correct: High risk for injury related to disorientation.
Incorrect: High risk for injury related to absence of side rails.
 Correct: High risk for self-concept disturbance related to the effects of
mastectomy (surgical removal of breast).
– SY 2020-2021
Incorrect: Mastectomy related to cancer.
3. Outcome Identification. Refers to formulating and documenting measurable,

realistic, client-focused goals. It provides the basis for evaluating nursing
diagnosis.
Purposes:
 To provide individualized care.
 To promote client participation.
 To plan care that is realistic and measurable.
 To allow involvement of support people.
Activities during Outcome Identification
 Establish priorities.
 A priority is something that takes precedence in position, deemed the most
important among several items. Priority setting is a decision-making process
that ranks the order of nursing diagnoses in terms of importance to the client.
 Establishing priorities involves the following:
a. Life-threatening situations should be given highest priority, e.g.
difficulty in breathing, hemorrhage, suicidal tendencies.
b. Use of principle of ABC’s (airway, breathing, circulation); airway should
always be given the highest priority.
c. Use Maslow’s hierarchy of needs; Physiologic needs are given priority
over psychosocial needs.
d. Consider something that is very important to the client, e.g. pain, anxiety.
e. Clients with unstable condition should be given priority over those with
stable conditions. E.g. attend to the client with fever before attending
to the client who is scheduled for physical therapy in the afternoon.
f. Consider amount of time, materials, equipment required to care for
clients. E.g. attend to the client who requires dressing change for postop
wound before attending to the client who requires health teachings and
is ready for discharged late in the afternoon.
g. Actual problems take precedence over potential concerns.
h. Attend to the client before equipment, e.g. assess the client before
checking contraptions like IV fluids, urinary catheter, drainage tubes.
– SY 2020-2021
 Nursing diagnoses are classified as high-priority, medium-priority and low-

priority.
 High priority nursing diagnoses are those that are potentially life-threatening
and require immediate action. Examples include Impaired Gas Exchange,
Ineffective Breathing Pattern, and Self-Directed Risk for Violence.
 Medium priority nursing diagnoses are those that could result in unhealthy
consequences, such as physical or emotional impairment, but not life
threatening. Examples include Fatigue, Activity Intolerance, Ineffective
Coping, and Dysfunctional Grieving.
 Low priority nursing diagnoses involve problems that usually can be resolve
easily with minimal interventions and are unlikely to cause significant
dysfunction. Examples include sensation of hunger in a client who is on NPO
(nothing per orem), in preparation for a diagnostic procedure; minimal pain on
the third post-operative day related to ambulation.
 Establish client’s goal and outcome criteria.
o A client goal is an educated guess, made as a broad statement about
what the client’s state will be after the nursing intervention is carried
out.
o Behavioral goals are written to indicate a desired state. They contain an
action verb and a qualifier that indicate the level of performance that
needs to be achieved.
o Examples of behavioral verbs used in client goals are as follows:
calculate distinguish participate
classify draw practice
communicate explain recall
compare express recite
define identify record
demonstrate list state
describe name use
construct maintain verbalize
contrast perform
 The qualifier is a description of the parameter for achieving the goal.

Example, “Ambulates safely with one-person assistance;” “Demonstrates
signs of sufficient rest before surgery;” “Identifies actual and high-risk
environmental hazards;” “States the importance of adopting appropriate
health maintenance benaviors.”
– SY 2020-2021
 Goals may be short- or long term. Short term goal (STG) can be met in
a relatively short period (within days or less than a week). A long term
(LTG) requires more time (several weeks or months).
 Outcome criteria are specific, measurable, realistic statements of goal

attainment. Outcome criteria are written in a manner that they answer
the questions: who, what actions, under what circumstances, how well
and when.
Therefore, the characteristics of well stated outcome criteria are as
follows:
S specific
M measurable
A attainable
R realistic
T time framed.
Examples of goals and outcome criteria as follows:
1) Goal: the client will report a decreased anxiety level regarding surgery.
Possible Outcome Criteria
 During client teaching, the client discuss fears and concerns regarding
surgical procedure.
 After client teaching, the client verbalizes decreased anxiety.
 The client identifies a support system and strategies to use to reduce
stress and anxiety related to surgical experience.
2) Goal:
 The client will demonstrate safety habits when performing ADL’s and
injury prevention.
 The client uses call light system for assistance at each need to use
bathroom immediately after instruction by the nurse.
 The client demonstrates safety practices in dressing hygiene.
 The client uses over-the-bed lights, non-skid slippers when transferring
to chair or out of bed.
 The client identifies modification for home safety (removal of throw
rugs, installation of hand rails in hallway and stairway) 12 hours after
nurse’s instruction about home remedy.
– SY 2020-2021
3) Goal: the client will mobilize pulmonary secretions.

 After the teaching session, the client will demonstrates proper
coughing techniques.
 The clients drinks at least six glasses of water per day while in the
hospital.
 The caregiver or significant other demonstrate proper techniques of
chest physiotherapy including percussion, vibration and postural
drainage before discharge.
4. Planning. Involves determining beforehand the strategies or course of actions to

be taken before implementation of nursing care. To be effective, involve the client
and his family in planning.
Purposes
 To identify the client’s goals and appropriate nursing interventions.
 To direct client care activities.
 To promote continuity of care.
 To focus charting requirements.
 To allow for delegation of specific activities.
Plan nursing intervention

 To direct activities to be carried out in the implementation phase.
 Nursing interventions are “any treatment, based upon clinical judgement
and knowledge, that a nurse performs to enhance client outcomes”
(McClosky and Bulechek, 2000). They are used to monitor health status;
prevent, resolve or control a problem; assist with activities of daily living
(ADL’s); or promote optimum health and independence (Lefevre, 2001)
 Nursing interventions are also nursing orders.
 Nursing interventions are independent, dependent and interdependent
activities that nurses carry out to provide client care.
Write a nursing care plan

 The nursing care plan is a written summary of the care that a client is to
receive. It is the “blueprint” of the nursing process.
 The plan of care is nursing centered. This is essential to identify the scope
and depth of the nursing practice. By focusing on the treatment of human
– SY 2020-2021
response to actual or potential health problems, the nurse remains in the

nursing practice domain.
 The plan of care is a step by step process. This is evidenced by the following:
a. Sufficient data are collected to substantiate nursing diagnoses.
b. At least one goal must be stated for each nursing diagnosis.
c. Outcome criteria must be identified for each goal.
d. Nursing interventions must be specifically designed to meet the
identified goal.
e. Each intervention should be supported by a scientific rationale. The
scientific rationale is the justification or reason for carrying out the
intervention.
f. Evaluation must address whether each goal was incompletely met,
partially met or completely unmet.
SAMPLE NURSING CARE PLAN
Nursing Diagnosis
(Use the NANDA- accepted list of nursing diagnoses. List in priority order.
Use the diagnostic label and “related to” [related factor], followed by
“manifested by” [supporting defining characteristics])
Risk for injury related to sensory and integrative dysfunction manifested

by altered mobility and faulty judgement.
Client Goal
(One or more client’s goals established from nursing diagnosis. A broadly
stated objective that indicates an overall picture of the states of the client if
the problem is resolved)
Client will demonstrate safety habits when performing ADL’s and injury
prevention.
Client Outcome Criteria

(Specific, measurable, realistic statements that can be evaluated to judge
goal attainment. Stated as behavioral objectives, they include a verb, a short
phase describing the specific measure to be accomplished, and a time
reference).
– SY 2020-2021
 Client uses nurse call light system for assistance for each need to use
bathroom immediately after instruction by the nurse.
 Client demonstrates safety practices in dressing and hygiene.
 Client uses over the bed lights, nonskid slippers each time transferring
to chair or out of bed.
Nursing Interventions Scientific Rationale
(Write Nursing Interventions/ nursing (Gives reason for carrying out the
orders that are related to the goal. intervention. Demonstrates synthesis of
Interventions include who, what, when, physiologic, psychological and
and how the order is to be carried out.) pathophysiological concepts.)
1. Position bed in lowest position. 1. Low bed position minimizes

distance to floor if client falls.
2. Place client call light system 2. A call light allows client to call for
within reach of hand and give help.
instruction.
3. Explain all safety modifications 3. Client and family will feed safer
of the client’s room: removal of if they are aware of safety
clutter, providing a clear path to promotion strategies.
bathroom, use a night light, and
installing brakes on bed and
chairs and placement of call light.
4. Perform frequent visual checks 4. Client may attempt to get out of
of patient. bed or chair without calling for
assistance.
5. Use safety belt in all transfer if 5. A safety belt allows for
the client is unsteady or has control/monitoring of client
difficulty with balance. movement without trauma to any
body part.
6. Evaluate the client’s ability to use 6. Clients with hip muscle weakness
toilet; obtains raised toilet seat may be unable to rise from low
or grab bars if indicated. toilet seat. Grab bar may assist
the weak person to move slowly
and safely.
7. Assist client to perform hygiene 7. Mirror provides client with visual
at sink with large mirror; reinforcement of activity.
– SY 2020-2021
encourage client to scan the

whole visual field.
8. Discuss floor plan of home with 8. Client and support person need to
client and support person. Make be involved in planning from
suggestions for modifications client’s safety in the home.
that will lead to a safer
environment.
o Client identifies modification for home safety (removal of throw
rugs, installation of hand rails in hallway, better lightning on
hallway and stairway) 12 hours after nurse’s instruction about
home safety,
o Nursing Interventions and Scientific Rationale
5. Implementation. Is putting the nursing care plan into action.
Purpose: To carry out planned nursing interventions to help the client attains
goal and achieve optimal level of health.
Activities:
 Reassessing. To ensure prompt attention to emerging problems.

 Set priorities. To determine the order in which nursing interventions
are carried out.
 Perform nursing intervention. These may be independent, dependent or
collaborative measures.
 Record actions. To complete nursing interventions, relevant
documentation should be done.
Critical to remember: Something that is not written is

considered not done.
Requirement of Implementation
1. Knowledge. Include intellectual skills like problem solving, decision

making and teaching.
2. Technical skills. To carry out treatments and procedures.
3. Communication skill. Use of verbal and non-verbal communication to carry
out planned nursing intervention.
– SY 2020-2021
4. Therapeutic use of self. It is being willing and being able to care.
6. Evaluation. Is assessing the client’s response to nursing interventions and then

comparing the response to predetermined standards or outcome criteria.
Purpose: To appraise the extent to which goals and outcome criteria of
nursing care been achieved.
Activities:
 Collect data about client’s response.
 Compare the client’s response to goals and outcome criteria.
 The four possible judgments that may be made are as follows:
 The goals was completely met.
 The goals was partially met.
 The goals was completely unmet.
 New problems or nursing diagnoses have developed.
 Analyze the reasons for the outcomes.
 Modify care plan as needed.
Characteristics of Nursing Process
1. Problem oriented. It is comparable with scientific problem solving approach.

2. Goal oriented.
3. Orderly, planned and step by step.
4. Open to accepting new information during its application. It is flexible to meet the
unique needs of clients, family, group or community (dynamic).
5. Interpersonal. It requires that the nurse communicate directly and consistently
with the client.
6. Permits creativity among nurses and clients in devising ways to solve the health
problems.
7. Cyclical. Steps may overlap because they are interrelated.
8. Universal. It is applicable to individuals, families and communities.
Benefits of the Nursing Process for the Clients
1. Quality client care. It meets standards of care.

2. Continuity of care.
– SY 2020-2021
3. Participation by the clients in their health care. This reflects respect for human
dignity.
Benefits of the Nursing Process to the Nurse
1. Consistent and systematic nursing education.

2. Job satisfaction.
3. Professional growth.
4. Avoidance of legal action.
5. Meeting professional nursing standards.
6. Meeting standards of accredited hospitals.
The Heart of the Nursing Process
K knowledge S skills and C caring
 Knowledge. Broad, varied

 Skills
Manual Intellectual Interpersonal
Technical Skills Critical thinking To establish positive

interpersonal relationships, with
clients, co-workers (requires
communication skills)
Careful deliberate, goal

directed- to solve problems
Make decisions
Good habits of inquiry
Check evidence
Keeping an open mind
Avoid jumping into conclusion
– SY 2020-2021
Caring- Willingness and Ability to care
Being able to care

Understanding ourselves
To be able to understand others
To be more objective/non-judgmental
 Requires ability to listen empathetically.

 Listen with intent.
 Enter into another’s way of thinking and viewing the world.
 Connecting with another’s feelings and perceptions.
 Identifying with another’s struggles, frustrations and desires.
 Then, being able to detach from feelings and returning to our own frame of
reference.
Willingness to Care
 Keep the focus on what is best for the patient.
 Respect the beliefs/values of others.
 Stay involved.
 Maintain a healthy lifestyle.
Caring Behaviors
1. Inspiring someone/instilling hope and faith.
2. Demonstrating patience, compassion and willingness to persevere.
3. Offering companionship.
4. Helping someone stay in touch with positive aspects of his life.
5. Demonstrating thoughtfulness.
6. Bending the rules when it really counts.
7. Doing the “little things”.
8. Keeping someone informed.
9. Showing your human side by sharing “stories”.
– SY 2020-2021
EVALUATION
CRITICAL THINKING EXERCISES NO. 5
Communication in Nursing
Announcements on quiz will be posted to

our google classroom (class stream)
REFERENCES
Potter & Perry, (2015). Fundamentals of Nursing, Philippines, Mosby ELSEVIER, 7th
Edition
Daniels, Wilkins, et al, (2010). Fundamentals of Nursing, Nursing Human Functions
Kozier & Erb’s, (2017). Fundamentals of Nursing Concepts, Process and Practice,
Berman, Synder et. al,
Philippine, Pearson Education South Asia, 10th Edition, Volume 1 & 2
– SY 2020-2021
Critical Thinking Exercises

Nursing Process
Name______________ Score_________
Part 1. Write TRUE if the statement is correct and FALSE if the statement is incorrect.
______ 1. The nursing process is composed of sequential and interrelated process.
______ 2. The primary source of data during assessment is patient’s chart.
______ 3. Nursing diagnosis is a statement that describes the health care needs of the client.
______ 4. Priority setting primarily considers ranking of nursing diagnosis in terms of importance
to client.
______ 5. When providing client care, psychosocial needs are given priority over physiologic
needs.
______6.High priority nursing diagnosis are those that are potentially life-threatening and require
immediate action.
______ 7. The client goal is specific, measurable, realistic statements of expected outcome of
nursing care.
______ 8. The plan of care is nursing centered and it identifies the scope and depth of the nursing
practice.
______ 9. Therapeutic use of self involves being able and being willing to care.
______ 10. Nursing process is universal because it is applicable to individual, families and
communities.
Part II. Multiple Choice. Answer in CAPITAL LETTERS.
______ 11. Which of the following is not subjective data.

A. dizziness C. anxiety
B. chest pain D. bluish discoloration of the skin
______ 12. Which of the following is incorrect statement of nursing diagnosis?
a. High risk for ineffective airway clearance related to pneumonia
b. High risk for injury related to dizziness
c. Constipation related to decreased activity and fluids as manifested by small,
hard, formed stools every three months
d. Anxiety related to insufficient knowledge regarding surgical experience.
______ 13. Which of the following would not be a basis in establishing priorities in client care?
a. Actual problems take precedence over potential concerns.
b. Attend to equipment and contraptions first such as IV fluids, urinary catheter,
drainage tubes before the client.
c. Airway should always be given highest priority.
– SY 2020-2021
d. Clients with unstable conditions should be given priority over those with stable
conditions.
______ 14. Which of the following is an incorrect statement of an outcome criteria.
a. Ambulate 30 feet with cane before discharge,
b. Discuss fears and concerns regarding the surgical procedure during pre-op
teaching.
c. Demonstrate proper coughing techniques after the teaching sessions.
d. Reestablish normal pattern of bowel elimination.
______ 15. The following are specific activities during evaluation EXCEPT:
A. collecting data C. Measuring goal attainment

B. Performing nursing interventions D. revising or modifying
– SY 2020-2021
Critical Thinking Exercises

Nursing Process
KEY with Rationalization
Part 1. Write TRUE if the statement is correct and FALSE if the statement is incorrect.
1. TRUE. The nursing process is composed of sequential and interrelated steps. ADOPIE
(Assessment, Diagnosis, outcome identification, planning, Implementation and Evaluation)
2. FALSE. The primary source of data during assessment is patient not the patiert’s chart.
3. TRUE. Nursing diagnosis is a statement that describes the health care needs of the client.
4. TRUE. Priority setting primarily considers ranking of nursing diagnosis in terms of importance
to client.
5. FALSE. When providing client care, consider Maslow’s hierarchy of needs. Give priority to
physiologic needs before psychosocial needs.
6. TRUE. High priority nursing diagnosis are those that are potentially life-threatening and require
immediate action.
7. FALSE. A client broad statement about the client’s state will be, after the nursing intervention is
carried out. Outcome criteria are specific, measurable, realistic statements of goal attainment.
8. TRUE. The plan of care is nursing centered and it identifies the scope and depth of the nursing
practice.
9. TRUE. Therapeutic use of self involves being able and being willing to care.
10. TRUE. Nursing process is universal. It is applicable to individual, families and communities.
Part II. Multiple Choice. Answer in CAPITAL LETTERS.
11. D. bluish discoloration of the skin is an objective data, A,B, and C are all subjective data
12. A. Is incorrect statement of nursing diagnosis. B, C and D are correct statement of nursing
diagnoses.
13. B. Attend to the client first before equipment A, C and D are basis for establishing priorities in
client care.
14. D. Outcome criteria should be specific, measurable, attainable, realistic and time-bound. A<B
and C are correct statements of outcome criteria
– SY 2020-2021
15. B. The nurse performs nursing interventions during the implementation phase of the nursing
process. A, C and D are activities done by the nurse during evaluation.
Critical Thinking Exercise No.4

Name________________ Date_____________
Part I. Multiple Choice. Answer in CAPITAL LETTERS.
21. Which of the following statements clearly defines therapeutic

communication?
e. Therapeutic communication is an interactional process which is
primarily directed by the nurse.
f. Therapeutic communication conveys feelings of warmth, acceptance and
empathy from the nurse to a patient in a relaxed atmosphere.
g. Therapeutic communication is a reciprocal interaction based on trust
and aimed at identifying patient needs and developing mutual goals.
h. Therapeutic communication is the assessment component of the nursing
process.
22. Which of the following concepts is most important in establishing

therapeutic nurse – patient relationship?
e. The nurse must fully understand the patient’s feelings, perceptions and
reactions before goals can be established.
f. The nurse must be a role model for health - fostering behaviors.
– SY 2020-2021
g. The nurse must recognize that the patient may manifest maladaptive
behavior during illness.
h. The nurse needs to understand that the patient mat test her before he
can accept and trust her.
23. Which communication skill is most effective in dealing with covert

communication?
a. validation b. listening c. evaluation d. clarification
24. Which of the following are qualities of good recording?

1. brevity a. 1,2
2. completeness and chronology b. 3,4
3. appropriateness c. 1,2,3
4. accuracy d. 1,2,3,4
25. All of the following entries are correct EXCEPT?

e. Complained of chest pain
f. Chest pain relieved after administration of nitroglycerin sublingually
g. Able to ambulate to the bathroom without assistance.
h. Vital signs 120/84,82,18
26. The accepted method for signing a nurse’s note is:

e. R. O/R.N.
f. Maria Rowena Oracion, Clinical Instructor
g. Maria Rowena S, Oracion
h. Maria Rowena S.Oracion, R.N.
27. Which of the following teaching method is most appropriate for teaching a
diabetic client on self - injection of insulin?
e. Detailed explanations
f. Demonstration
g. Use of pamphlets
h. Filmstrip
28. The most important characteristics of effective nurse-patient

relationship is that:
e. It is growth – facilitating.
f. It is based on mutual understanding.
– SY 2020-2021
g. It fosters hope and confidence.

h. It involves primarily emotional bond.
29. Which of the following statements is most likely to promote a client’s

compliance in performing post – operative deep breathing, coughing and
turning exercises?
d. “You will be given adequate medication is these exercises will cause you
pain.”
e. “Deep breathing, coughing and turning exercises will promote good
breathing, body circulation. This will prevent complications.”
f. These exercises will promote maximum respiratory ventilation, prevent
thrombophlebitis and atelectasis.”
30. When using printed material to teach diabetic patient about foot care, the
nurse should:
e. Read the material to the patient.
f. Allow the patient to read the material.
g. Give the material to a family member to read the patient.
h. Read the material to evaluate its clarity, accuracy and effectiveness.
31. The patient asks the nurse, “do you think, I have the cancer?” The most
appropriate response of the nurse is:
e. “I will refer you to your doctor.”
f. “If I were you, I will not worry unnecessarily.”
g. “You sound concerned about what the doctor may find.”
h. “You will undergo different tests before cancer can be diagnosed.”
32. The patient is scheduled for proctosigmoidoscopy. She says she is

nervous. The most appropriate response to be made by the nurse is:
e. “You need not worry. You have the best doctor in the hospital.”
f. “I don’t blame you for feeling that way. If I were in your position, I
would feel the same.”
g. “Why do you feel that way? Don’t you trust God?”
h. “You sound really upset. Would you like to sit and talk about it?”
33. Which of the following behavior should the nurse recognize when caring
for elderly patients?
e. Most elderly resent being cared for by people not related to them.
f. Many elderly patients need support in maintaining their independence.
– SY 2020-2021
g. Elderly patients refuse to change old habits.

h. Most elderly are unable to learn new skills.
34. The nurse can best evaluate that the patient is learning by:
e. his ability to repeat what was thought.
f. a desired change in his behavior.
g. verbal acknowledgements that he understands.
h. his ability to get a good score from a questionnaire.
35. Therapeutic communication begins with:

e. giving initial care.
f. showing empathy.
g. interacting with patient.
h. knowing your patient.
36. Which of the following responses is appropriate when a patient request to

be discharged at once?
e. “I will notify the supervisor about your request.”
f. “You can only be discharged after the doctor has given a medicate
clearance.”
g. “I will notify your doctor, so I can inform him about your request.”
h. “I understand your request but please sign this special form.”
37. From your admission interview of a patient, you obtained a history of
allergies. You can best communicate this information by:
e. placing allergy alert in Kardex.
f. writing in the patient’s chart.
g. informing his attending physician.
h. taking note when giving medications.
38. Which of the following techniques can be most helpful in accessing the
degree of distress and discomfort of a newly admitted patient?
e. review the nurse’s notes
f. performing physical assessment.
g. active listening on what the patient says.
h. observation of the patient’s behavior.
39. Which of the following factors will least likely facilitate learning of a
patient:
e. motivation to learn.
f. active participation in the learning activity.
– SY 2020-2021
g. influencing the client to change his health beliefs.

h. positively worded corrections.
40. Which of the following principles must be given consideration by the nurse
when giving patient teaching to an elderly client?
e. use audio – visual aids to facilitate learning.
f. provide opportunity for independence to learn.
g. provide lecture for at least 2 hours.
h. Proceed from complex to simple material.
– SY 2020-2021

NCM 103 Fundamentals of Nursing

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

NCM 103 Fundamentals of Nursing

Uploaded by

Copyright:

Available Formats

Southern Luzon State University

College of Allied Medicine

NCM 103 FUNDAMENTALS OF

Communication is a process in which people affect one another through change

The quality of client care greatly depends on the caregiver’s ability to

At the end of the subject the student will be able to:

 Discuss the Modes and Characteristics of communication

Verbal Communication. Uses spoken or written words.

Nonverbal Communication. Uses gestures, facial expression, posture/gait, body

Sender Message Receiver

 Communication is a basic component of human relationships and nurse-client

 When assessing nonverbal behaviors, consider cultural influences. Variety of

The Characteristics of an Effective Nurse-Client Relationship are as follows:

Documenting and Reporting

Purposes of Client’s Record/Chart

5. Education. Serves as an educational tool for students in health discipline.

Five Basic Components of the Traditional Client Record

B. Problem-oriented medical record (POMR or POR)

Four Basic Components of POMR/POR

 Flow sheets (data that are monitored)

Characteristics of Good Recording

o Correct: Refused medications.

The following information should be charted:

6. Use of standard terminology.

1. Change-of-shift reports or endorsement.

 It is not mere reciting the content of the Kardex.

Commonly Used Abbreviations

Abbreviation Latin English

OD Oculus dexter Right eye

Teaching and Learning (Client Education/Patient Teaching)

Principles of Teaching and Learning

Domains of Learning (Bloom)

Factors Facilitating Learning

1. Motivation. The desire to learn, it is generally greatest when the client

Factors Inhibiting Learning

CRITICAL THINKING EXERCISES NO. 5

Announcements on quiz will be posted to

Daniels, Wilkins, et al, (2010). Fundamentals of Nursing, Nursing Human Functions

Philippine, Pearson Education South Asia, 10th Edition, Volume 1 & 2

Critical Thinking Exercise No.4

Part I. Multiple Choice. Answer in CAPITAL LETTERS.

1. Which of the following statements clearly defines therapeutic

2. Which of the following concepts is most important in establishing

3. Which communication skill is most effective in dealing with covert

4. Which of the following are qualities of good recording?

5. All of the following entries are correct EXCEPT?

6. The accepted method for signing a nurse’s note is:

7. Which of the following teaching method is most appropriate for teaching a

8. The most important characteristics of effective nurse-patient

9. Which of the following statements is most likely to promote a client’s

12. The patient is scheduled for proctosigmoidoscopy. She says she is

15. Therapeutic communication begins with:

16. Which of the following responses is appropriate when a patient request to

NCM 103 FUNDAMENTALS OF

THE NURSING PROCESS

The cornerstone of the nursing profession is nursing process. Skills in utilizing

Nursing process continue to evolve. It used to be a 3 step process, then 4 step

Nursing process is synonymous with the problem- solving approach for

At the end of the subject the student will be able to:

 Discuss the Concept of Nursing Process.

The Nursing Process

The Nursing Process is:

a. Organized and Systematic