NCM 103 Mid

Nursing
as an
ART
NCM 103
Level 1
By: Lourdes Ivaliz C. Iledan, RN, MN

Course Outline:
A. CARING
1. CARING 3. CARING
2. 6 C’S OF
PRACTICE FOR SELF
CARING
MODELS AND OTHERS
Course Outline:
B. COMMUNICATION
2. 4. COMMUNI-
1. PROCESS THERAPEUTIC 3. HELPING CATION AND
AND MODES COMMUNI- RELATIONSHIP THE NURSING
CATION *** PROCESS
B.2 THERAPEUTIC COMMUNICATION
A. Elements
B. Characteristics
C. Goals
D. Phases
E. Techniques
Course Outline:
C. TEACHING
3. HEALTH
RESTORATION
1. HEALTH 2. DISEASE AND
PROMOTION PREVENTION
MAINTENANCE
REHABILITATION
What is CARING?
Caring is sharing deep
and genuine concern
about the welfare of
another person.
Fun Fact: Root of the word Nursing came from a

Latin word “Nutricius” means “Nurturance” or
“Care”.
PROFFESIONALIZATION
OF
CARING
❖ The Nurse’s PRESENCE provides
COMFORT for the Client.
❖ The SENSE OF DIGNITY of the
Caring Practice involves client is enhanced by the personal
Connection, Mutual care of nurses.
Recognition, and Involvement How?

✓ By LEAVING the egocentric self of
between Nurse and Client.
the nurse’s behind, thereby
providing the ability to give a
CLIENT’S-FOCUSED ATTENTION.
Caring as “Helping the Other Grow”
Milton Mayeroff (1990)
• To care for another person is to help him GROW and
ACTUALIZE himself, that develops over TIME, resulting in
a deepening and transformation of the RELATIONSHIP.
• Recognizing the other as having potential and the need to

grow, the caregiver does not impose direction, but allows
the direction of the other person’s GROWTH to help
determine how to respond.
MAYEROFF (1990) DEFINES
MAJOR INGREDIENTS OF CARING:
1 . K N O W I N G - UNDERSTANDING the other’s
needs and how to respond to
these needs
2 . A L T E R N A T I N G R H Y T H M S - signifies
moving back and forth between
the immediate and long-term
meanings of behavior,
CONSIDERS THE PAST
3 . P A T I E N C E - enables the other to grow in his
OWN WAY AND TIME
4 . H O N E S T Y - includes AWARENESS and

OPENNESS to one’s OWN FEELINGS and a
GENUINENESS in caring for the other
5 . T R U S T - involves LETTING GO, to allow the other

to grow in his own way and own time
6 . H U M I L I T Y - means ACKNOWLEDGING that
there is always more to learn, and
that learning may come from any
source
7. HOPE - is BELIEF in the possibilities of the

other’s growth
8 . C O U R A G E - is the SENSE OF GOING INTO THE

UNKNOWN, informed by insight from
past experiences
How Does A
Nurse
Demonstrate
Caring?
1. KNOWING THE CLIENT
2. NURSING PRESENCE
3. EMPOWERING THE CLIENT
4. COMPASSION
5. COMPETENCE
1. KNOWING THE CLIENT
❑ Knowing the CLIENT AND FAMILY ultimately involves the
nurse and client in a caring transaction.
❑ By attending broadly to personal, ethical, aesthetic, and
empirical knowledge, the nurse UNDERSTANDS EVENTS as
they have meaning in the life of the client.
❑ The nurse’s knowing the client ultimately increases the
possibilities for THERAPEUTIC INTERVENTIONS to be
perceived as relevant.
❑ Ex: The Nurse asks: What is the client’s history? Needs?
Desires?
2. NURSING PRESENCE
❑ By being emotionally present to the client and family, the
nurse conveys that they and their experiences matter.
❑ Being present is a way of sharing in the meanings, feelings,
and lived experiences of the client.
❑ Physical presence is combined with the promise of
availability, especially during a time of need.
❑ Ex: This may be as simple as responding promptly to a call
bell on a hospital unit or as complex as sitting with a
parent who has just lost a child in a neonatal intensive care
unit.
3. EMPOWERING THE CLIENT
❑ This empowering relationship includes mutual respect,
trust, and confidence in the OTHER’S ABILITIES AND
MOTIVES.
❑ The caring behavior of ENABLING “facilitating the other’s

passage through life transitions and unfamiliar events”.
❑ Enabling also includes coaching, informing, explaining,

supporting, assisting, guiding, focusing, and validating.
❑ Nurses both ADVOCATE for (verb) and are ADVOCATES

(noun) for clients and families.
❑ Ex: Teaching the client self-care.

4. COMPASSION
❑ Nurse’s should be WARM AND EMPATHETIC,
COMPASSIONATE AND CONCERNED.
❑ To demonstrate empathy, the nurse must be able to

Identify With The Client, Appreciating The Pain And
Discomfort Of Illness, Or Imagine “Walking In His Shoes”
In Regard To Some Part Of The Client’s Life Experience.
❑ COMFORT is often associated with compassionate care

and many nursing interventions are carried out to
provide comfort.
❑ Ex: bathing, positioning, talking, touching, and listening

are often performed to increase the client’s comfort level.
5. COMPETENCE
❑ The competent nurse employs the NECESSARY
KNOWLEDGE, JUDGMENT, SKILLS, and MOTIVATION to
respond adequately to the client’s needs.
❑ Nurse’s UNDERSTANDS the client’s condition, treatment,
and associated care.
❑ The nurse’s abilities to assess, plan, implement, and
evaluate a plan of care are FOCUSED on MEETING THE
CLIENT and FAMILY NEEDS.
❑ Practice of these skills requires a high level of cognitive,
affective, technical, and administrative skills:
CARING PRACTICE MODELS
(NURSING THEORIES ON CARING) :
I. Culture Care Diversity and Universality (Leininger)
II. Theory of Bureaucratic Caring (Ray)
III. Caring, the Human Mode of Being (Roach)
IV. Nursing as Caring (Boykin and Schoenhofer)
V. Theory of Human Care (Watson)
VI. Theory of Caring (Swanson)
Theory I.
CULTURE
CARE
DIVERSITY AND
UNIVERSALITY
LEININGER defines “CARE” as a:
“Distinct, Dominant, Unifying, and

Central Focus of Nursing.”
“Assistive, Supportive, and Enabling

Experiences or Ideas Towards Others with
Evident or Anticipated Needs, to Ameliorate or
Improve A Human Condition or Lifeway.”
ASSUMPTION IN LEININGER’S
THEORY:
❖ That nurses must understand different

cultures in order to function effectively.
❖ Transcultural nursing focuses on both

the differences and similarities among
individuals in diverse cultures.
❖ To provide care that is congruent with

cultural values, beliefs, and practices, the
nurse must UNDERSTAND these
differences and similarities.
CULTURALLY CONGRUENT CARE
INVOLVES THREE ACTION –
DECISION CARE APPROACHES:
(1) Preservation of the client’s familiar

lifeways,
(2) Accommodations that help clients adapt
to or negotiate for satisfying care, and
(3) Repatterning nursing care to help the
client move toward wellness.
Theory II.
THEORY OF
BUREAUCRATIC
CARING
Marilyn Anne
Ray
❖ The Theory of Bureaucratic Caring
suggests that Caring In Nursing is
CONTEXTUAL and is Influenced by the
ORGANIZATIONAL STRUCTURE.
❖ In Ray’s research (Coffman, 2010), THE MEANING OF

CARING IS VARIED IN THE EMERGENCY DEPARTMENT,
INTENSIVE CARE UNIT, ONCOLOGY UNIT, AND OTHER
AREAS OF THE HOSPITAL. Ex. Oncology unit had a value
of a more intimate, spiritual caring than in ICU who values
more in critical care nursing.
❖ CARING IS INFLUENCED BY ROLE AND POSITION A

PERSON HELD. Ex: STAFF NURSES valued caring in
terms of its relatedness to clients, whereas
ADMINISTRATORS valued caring as more system related,
such as safeguarding the economic well-being of the
hospital.
Theory III.
CARING, THE
HUMAN
MODE OF
BEING
Sr. Simone
Roach
❖ Roach (2013) focuses on caring as a
PHILOSOPHICAL CONCEPT and proposes that
CARING IS THE HUMAN MODE OF BEING.
❖ All individuals are caring, and develop their

caring abilities by being True To Self, Being Real,
and Being Who They Truly Are.
❖ Caring is NOT UNIQUE TO NURSING.

Theory IV. ❖ RESPECT for people as caring individuals and
respect for what matters to them are assumptions
underlying the theory of nursing as caring.
NURSING ❖ Nurse KNOWING SELF as a caring person.
AS CARING ❖ This AWARENESS OF SELF allows the nurse to

AUTHENTICALLY CARE for others in nursing
practice.
❖ From the perspective of the theory of nursing as

caring, the nurse approaches each client as a
caring person, WHOLE AND COMPLETE in the
moment.
❖ The idea of wholeness includes the understanding

that PEOPLE ARE NOT PERFECT, BUT
CONSTANTLY GROWING AND CHANGING.
Theory V.
THEORY
OF HUMAN
CARE
❖ Watson’s Theory Of Human Care views Caring as
the ESSENCE and the MORAL IDEAL of Nursing.
❖ Watson emphasizes Nursing’s Commitment to

CARE OF THE WHOLE PERSON as well as a
Concern for the Health of Individuals and Groups.
❖ The Nurse and Client are COPARTICIPANTS in the

client’s movement toward HEALTH AND
WHOLENESS.
❖ This human connection is labeled

TRANSPERSONAL HUMAN CARING, through
which the nurse enters into the experience of the
client, and the client can enter into the nurse’s
experience.
❖Watson emphasizes that the practice of nursing is both
TRANSPERSONAL and METAPHYSICAL.
❖While the nurse maintains professional OBJECTIVITY

as a Scientist, Scholar, Clinician, and Moral Agent, the
nurse is also SUBJECTIVELY engaged in the
INTERPERSONAL RELATIONSHIP with the client.
❖This TRANSPERSONAL CONTACT has the potential to

touch the higher, SPIRITUAL SENSE OF SELF, or the
SOUL. Such contact, which touches the soul, has the
power to generate the SELF HEALING PROCESS.
Theory VI.
THEORY
OF
CARING
❖ Swanson defines Caring as “A NURTURING WAY OF
RELATING TO A VALUED ‘OTHER,’ TOWARD WHOM
ONE FEELS A PERSONAL SENSE OF COMMITMENT
AND RESPONSIBILITY.”
❖ An ASSUMPTION of her theory is that a client’s

WELL-BEING SHOULD BE ENHANCED through the
caring of a nurse who understands the COMMON
HUMAN RESPONSES TO A SPECIFIC HEALTH
PROBLEM.
❖ The theory focuses on CARING PROCESSES AS

NURSING INTERVENTIONS.
❖ Swanson’s theory was developed through

INTERACTIONS WITH PARENTS AT THE TIME OF
PREGNANCY, MISCARRIAGE, AND BIRTH.
CARING PROCESSES FROM
SWANSON’S THEORY OF CARING
PROCESS AND
DEFINITION SUBDIMENSIONS
I. KNOWING
• Avoiding assumptions
Striving to understand
• Centering on the one cared
an event as it has for
meaning in • Assessing thoroughly
the life of the other • Seeing cues
• Engaging the self of both
PROCESS AND
II. BEING WITH
Being emotionally • Being there
present to the other • Conveying ability

• Sharing feelings
• Not burdening
PROCESS AND
III. DOING FOR
• Comforting
Doing for the other as
• Anticipating
he/she would do for the
• Performing competently/
self if it were at all skillfully
possible • Protecting
• Preserving dignity
PROCESS AND
IV. ENABLING
• Informing/explaining
Facilitating the other’s
• Supporting/allowing
passage through life
• Focusing
transitions and
• Generating alternatives/
unfamiliar events thinking it through
• Validating/giving feedback
PROCESS AND
V. MAINTAINING
BELIEF • Believing in/holding in
esteem
Sustaining Faith in the
other’s capacity to get • Maintaining a hope-filled
attitude
through an event or
transition and face a
• Offering realistic optimism
future with meaning • “Going the distance”

1. EMPIRICAL KNOWING ranges
from factual, observable phenomena
1. The (e.g., anatomy, physiology,
Science of chemistry) to theoretical analysis
4. PERSONAL KNOWING is Nursing (e.g., developmental theory).
when the nurse is aware of
his or her own attitudes
and behavior and views the
client as a unique individual 4. The 2. The
who is free to choose and Therapeutic Moral
create her or his own life. Use of Self Component
2. ETHICAL KNOWING
focuses on “matters of
obligation or what ought
to be done” and goes
3. The beyond simply observing
Art of
the nursing code of ethics.
Nursing
3. AESTHETIC KNOWING is the art of nursing and is expressed by the

individual nurse through his or her creativity and style in meeting the needs of
clients (empathy, compassion, holism, and sensitivity).
How to take care of Self
& Others ?
❖ CARING FOR SELF means taking the time to
NURTURE ONESELF. This involves initiating and
maintaining behaviors that promote healthy living
and well-being examples of these activities include:
• HEALTHY LIFESTYLE (e.g., nutrition, activity &
exercise, recreation).
• MIND–BODY THERAPIES (e.g., guided imagery,
meditation, yoga).
❖ Self-care focuses on care of the self in the
deepest sense: SELF AWARENESS & SELF-
ESTEEM.
❖Individuals with high self-esteem can critically
problem solve and tackle obstacles more
effectively.
❖Self-care practices build self-esteem, leading to
feelings of comfort and accomplishment.
❖ The student nurse matures as
a practitioner by REFLECTING
ON PRACTICE. Through
reflection, nurses can grow
and participate more fully in
CARING-HEALING
RELATIONSHIPS.
Reference:
Audrey Berman, et.al (2016).

Kozier & Erb's Fundamentals of
Nursing Concepts, Process, and
Practice 10th Edition. Pearson.
Chapter 25, pages 398 – 410.
Part 2:
COMMUNICATION NCM
103
Level 1

COMMUNICATION is the interchange Communication
of information between two or more
is a CRITICAL
SKILL for
people; in other words, the exchange
nursing.
of ideas or thoughts.
In NURSING, communication Integral part of

the HELPING
is a dynamic process used to RELATIONSHIP
gather assessment data, to
teach and persuade, and to
express caring and comfort.
I. PROCESS AND
MODES OF
COMMUNICATION
METHODS OF COMMUNICATION:
ØTalking And Listening
ØWriting And Reading
ØPainting
ØDancing
ØStorytelling
*** Ideas and thoughts are expressed to others not only

by spoken or written words but also by GESTURES or
BODY ACTIONS.
2 MAIN
v Communication is a PROCESS.
v Built in a TRUSTING
PURPOSES:
RELATIONSHIP. 1. To Influence Others
v EFFECTIVE communication is
2. To Gain Information
essential for the establishment of a
NURSE-CLIENT RELATIONSHIP.
N URSES WHO COMMUNIC ATE EFFECTIVELY
ARE BETTER ABLE TO :
1. Collect Assessment Data
2. Initiate Interventions
3. Evaluate Outcomes Of Interventions
4. Initiate Change That Promotes Health
5. Prevent The Safety And Legal Problems Associated
With Nursing Practice
COMMUNICATION CAN OCCUR
IN 2 WAYS:
1. INTRAPERSONAL Level - Within A
Single Individual (SELF –TALK)
2. INTERPERSONAL Level And Group
Levels – Involve Others
Example
Student Nurse Self-talk
FACE-TO-FACE THE
Communication
COMMUNICATION
PROCESS
TWO-WAY
PROCESS involving
the SENDING &
the RECEIVING
of a message.
Process is
ONGOING.
4 COMPONENTS OF
COMMUNICATION:
ENCODING is the selection
of specific signs or symbols
1. SENDER – a person or (codes) to transmit the
group who wishes to message, such as which
communicate a message to language and words to use,
FEEDBACK can be either another: SOURCE-ENCODER. how to arrange the words, &
Verbal, Nonverbal, or Both. what tone of voice and
gestures to use.
2. MESSAGE – is what is
4. RESPONSE – is the
actually said or written, the
message that the Receiver
body language that accompanies
RETURNS to the Sender: the words, and how the message
FEEDBACK. is transmitted.
DECODE Is to relate
the message
perceived to the 3. RECEIVER – is the
receiver’s storehouse LISTENER, who must listen,
of knowledge & observe, and attend:
experience & to sort DECODER.
out the meaning of
the message.
1. VERBAL
COMMUNICATION
uses the spoken or 3 MODES
written word OF
2. NONVERBAL
COMMUNICATION
COMMUNICATION
uses other forms, such
as gestures or facial
expressions, and touch
3. ELECTRONIC
COMMUNICATION in
which an individual can
send a message, by
computer or any devices,
to another person or
group of people
NURSES NEED TO CONSIDER THE FOLLOWING
WHEN CHOOSING WORDS TO SAY OR WRITE:
a) Pace and Intonation - manner of speech, as in the rate or
rhythm and tone
b) Simplicity - commonly understood words
c) Clarity and Brevity - direct and simple
d) Timing and Relevance - sensitivity to the client’s needs and
concerns
e) Adaptability – adjustments are individualized
f) Credibility – worthiness of belief, trustworthiness,
and reliability
a) Humor - used with care
(laughter is the best medicine)
TO OBSERVE NONVERBAL BEHAVIOR
EFFICIENTLY REQUIRES A SYSTEMATIC
ASSESSMENT OF THE PERSON’S OVERALL:
a) Physical Appearance
b) Posture
c) Gait
d) Facial Expressions
e) Gestures
f) Culture
*** Nonverbal communication either reinforces

or contradicts what is said verbally.
A D V A N T A G E S:
1) Fast
ELECTRONIC
2) Efficient
COMMUNICATION
3) Legible
4) Continuity Of Care
DISADVANTAGES:
1) Privacy Issue
2) Confidentiality Issue
3) Potential Misuse Of Information
4) Socio-economics
Factors a) Development
Influencing b) Gender
the
Communication c) Values And Perceptions
Process: d) Personal Space: DON’T!
Intimate: 0 to 11/2 feet ELDERSPEAK
is a speech style
Personal: 11/2 to 4 feet similar to baby
Social: 4 to 12 feet talk that gives the
Public: 12 feet and beyond message of
dependence and
e) Territoriality incompetence and
is seen as
f) Roles And Relationships
patronizing by
g) Environment older adults.
h) Congruence
i) Interpersonal Attitudes
j) Boundaries
II. THERAPEUTIC
COMMUNICATION
Promotes UNDERSTANDING and can help establish a
CONSTRUCTIVE RELATIONSHIP between the Nurse
and the Client.
q ATTENTIVE LISTENING
q VISIBLY TUNING IN
THERAPEUTIC
COMMUNICATION
TECHNIQUES
They are specific responses that
encourage the expression of feelings
and ideas and convey acceptance and
respect.
TECHNIQUE DESCRIPTION EXAMPLES
• Accepting • Sitting quietly

• USING pauses or (or walking
SILENCE silences that with the client)
may extend for and waiting
several seconds attentively until
or minutes the client is able
without to put thoughts
interjecting any and feeling into
verbal response. words.
• PROVIDING • Using statements • “Can you tell me

or questions that how it is for you?”
GENERAL (a) encourage the • “Perhaps you
LEADS client to would like to talk
verbalize, (b) about...”
choose a topic of • “Would it help to
conversation, and discuss your
(c) facilitate feelings?”
continued • “Where would you
verbalization. like to begin?”
• “And then what?”
• BEING • Making • “Rate your pain on a

scale of zero to ten.”
SPECIFIC statements (specific statement)
& that are • “Are you in pain?”
(general statement)
TENTATIVE specific rather • “You seem
than general, unconcerned about
and tentative your diabetes.”
(tentative
rather than statement)”
absolute.
• Asking broad questions • “I’d like to hear more

• USING OPEN that lead or invite the about that.”
-ENDED client to explore • “Tell me more. . . .”
QUESTIONS (elaborate, clarify,
describe, compare, or • “How have you been
illustrate) thoughts or feeling lately?”
feelings. • “What brought you to
• Open-ended questions the hospital?”
specify only the topic to • “What is your
be discussed and invite opinion?”
answers that are longer • “You said you were
than one or two words. frightened yesterday.
How do you feel
now?”
• Providing appropriate • Putting an arm over
• USING forms of touch to
reinforce caring
the client’s shoulder.
TOUCH feelings. Because
• Placing your hand
over the client’s hand.
tactile contacts vary
considerably among
individuals, families,
and cultures, the
nurse must be sensitive
to the differences in
attitudes and practices
of clients and self.
• Actively listening for • Client: “I couldn’t
• RESTATING the client’s basic manage to eat any
& PARA- message and then dinner last night—not
PHRASING repeating those even the dessert.”
thoughts and/or
• Nurse: “You had
feelings in similar
words. This conveys difficulty eating
that the nurse has yesterday.”
listened and understood • Client: “Yes, I was
the client’s basic very upset after my
message and also offers family left.”
clients a clearer idea of
what they have said.
• SEEKING • A method of making the • “I’m puzzled.”
client’s broad overall • “I’m not sure I understand
CLARIFICATION meaning of the message that.”
more understandable.
• It is used when paraphrasing
• “Would you please say that
is difficult or when the again?”
communication is rambling • “Would you tell me more?”
or garbled. • “I meant this rather than
• To clarify the message, the that.”
nurse can restate the basic • “I’m sorry that wasn’t very
message or confess confusion clear. Let me try to explain
and ask the client to repeat in another way.”
or restate the message.
• Nurses can also clarify their
own message with
statements.
• PERCEPTION • Client: “My husband never
gives me any presents.”
CHECKING OR • A method similar to • Nurse: “You mean he has
SEEKING clarifying that never given you a present
CONSENSUAL for your birthday or
verifies the meaning Christmas?”
VALIDATION of specific words • Client: “Well—not never.
rather than the He does get me something
overall meaning of a for my birthday and
message. Christmas, but he never
thinks of giving me
anything at any other
time.”
• OFFERING • Suggesting one’s • “I’ll stay with you

presence, interest, until your daughter
SELF or wish to arrives.”
understand the • “We can sit here
client without quietly for a while; we
making any don’t need to talk
demands or unless you would like
to.”
attaching conditions
• “I’ll help you to dress
that the client must
to go home, if you
comply with to like.”
receive the nurse’s
attention.
• GIVING • Providing, in a simple • “Your surgery is
INFORMATION and direct manner, scheduled for 11 am
specific factual tomorrow.”
information the client • “You will feel a pulling
may or may not sensation when the tube
request. When is removed from your
information is not abdomen.”
known, the nurse • “I do not know the
states this and answer to that, but I
indicates who has it or will find out from Mrs.
when the nurse will King, the nurse in
obtain it. charge.”
• ACKNOWLEDGING • Giving recognition, in • “You trimmed your
a nonjudgmental beard and mustache
way, of a change in and washed your
behavior, an effort hair.”
the client has made, • “I notice you keep
or a contribution to a squinting your eyes.
communication. Are you having
• Acknowledgment difficulty seeing?”
may be with or • “You walked twice as
without far today with your
understanding, verbal walker.”
or nonverbal.
• CLARIFYING • Helping the client • Client: “I vomited this
clarify an event, morning.”
TIME OR situation, or • Nurse: “Was that after
SEQUENCE happening in breakfast?”
relationship to time. • Client: “I feel that I
have been asleep for
weeks.”
• Nurse: “You had your
operation Monday,
and today is Tuesday.”
• PRESENTING • Helping the • “That telephone
REALITY client to ring came from
differentiate the the program on
real from the television.”
unreal. • “Your magazine is
here in the
drawer. It has not
been stolen.”
• Helping the client expand • Client: “My wife says she will
• FOCUSING on and develop a topic of look after me, but I don’t
importance. It is important think she can, what with the
for the nurse to wait until children to take care of, and
the client finishes stating they’re always after her
the main concerns before about something—clothes,
attempting to focus. homework, what’s for dinner
that night.”
• The focus may be an idea
• Nurse: “Sounds like you are
or a feeling; however, the worried about how well
nurse often emphasizes a shecan manage.”
feeling to help the client
recognize an emotion
disguised behind words.
• REFLECTING • Directing ideas, • Client: “What can I
feelings, questions, or do?”
content back to • Nurse: “What do you
clients to enable think would be
them to explore their helpful?”
own ideas and • Client: “Do you think
feelings about a I should tell my
situation. husband?”
• Nurse: “You seem
unsure about telling
your husband.”
• SUMMARIZING • Stating the main • “During the past half
points of a discussion hour we have talked
AND about. . . .”
to clarify the relevant
PLANNING points discussed. This • “Tomorrow afternoon we
technique is useful at may explore this further.”
the end of an • “In a few days I’ll review
interview or to review what you have learned
about the actions and
a health teaching
effects of your insulin.”
session. It often acts as
• “Tomorrow, I will look at
an introduction to
your feeling journal.”
future care planning.
BARRIERS TO
COMMUNICATION
Non-Therapeutic Responses
• STEREOTYPING • Offering generalized • “Two-year-olds
and oversimplified are brats.”
beliefs about groups of
people that are based • “Women are
on experiences too complainers.”
limited to be valid. • “Men don’t cry.”
• These responses • “Most people don’t
categorize clients and
have any pain after
negate their
uniqueness as this type of
individuals. surgery.”
• AGREEING • Similar to judgmental • Client: “I don’t think
responses, agreeing Dr. Broad is a very
AND and disagreeing imply good doctor. He
DISAGREEING that the client is doesn’t seem
either right or wrong interested in his
and that the nurse is clients.”
in a position to judge
this. • Nurse: “Dr. Broad is
head of the
• These responses deter
department of
clients from thinking
through their position surgery and is an
and may cause a client excellent surgeon.”
to become defensive.
• Attempting to protect a • Client: “Those night
• BEING person or health care
nurses must just sit
DEFENSIVE services from negative
around and talk all
comments.
• These responses prevent night. They didn’t
the client from expressing answer my light for
true concerns.
• The nurse is saying, “You
over an hour.”
have no right to complain.” • Nurse: “I’ll have you
• Defensive responses protect know we literally
the nurse from admitting run around on
weaknesses in the health
care services, including nights. You’re not
personal weaknesses. the only client, you
know.”
• CHALLENGING • Giving a response that • Client: “I felt nauseated after
that red pill.”
makes clients prove • Nurse: “Surely you don’t think
their statement or I gave you the wrong pill?”
point of view. • Client: “I feel as if I am dying.”
• These responses • Nurse: “How can you feel that
way when your pulse is 60?”
indicate that the nurse • Client: “I believe my husband
is failing to consider doesn’t love me.”
the client’s feelings, • Nurse: “You can’t say that;
making the client feel why, he visits you every day.”
it necessary to defend
a position.
• Asking for information • Client: “I was speeding
• PROBING chiefly out of curiosity along the street and
rather than with the didn’t see the stop
intent to assist the sign.”
client. • Nurse: “Why were you
• These responses are speeding?”
considered prying and • Client: “I didn’t ask
violate the client’s the doctor when he
privacy. was here.”
• Asking “why” is often • Nurse: “Why didn’t
probing and places the you?”
client in a defensive
position.
• Asking questions that • “Who do you think
• TESTING make the client you are?” (forces
admit to something. people to admit
• These responses their status is only
permit the client only that of client)
limited answers and • “Do you think I am
often meet the not busy?” (forces
nurse’s need rather the client to admit
than the client’s. that the nurse really
is busy)
• REJECTING • Refusing to discuss • “I don’t want to
certain topics with discuss that. Let’s
the client. talk about. . . .”
• These responses often • “Let’s discuss other
make clients feel that
the nurse is rejecting
areas of interest to
not only their you rather than
communication but the two problems
also the clients you keep
themselves. mentioning.”
• Directing the • “I can’t talk now. I’m on
• CHANGING communication into areas my way for coffee break.”
TOPICS of self-interest rather
than considering the
• Client: “I’m separated from
my wife. Do you think I
AND client’s concerns is often a
self-protective response
should have sexual relations
with another woman?”
SUBJECTS to a topic that causes • Nurse: “I see that you’re
anxiety. 36 and that you like
• These responses imply gardening. This sunshine is
that what the nurse good for my roses. I have a
considers important will beautiful rose garden.”
be discussed and that
clients should not discuss
certain topics.
• UNWARRANTED • Using clichés or • “You’ll feel better
REASSURANCE comforting soon.”
statements of • “I’m sure
advice as a means everything will turn
to reassure the out all right.”
client. • “Don’t worry.”
• These responses
block the fears,
feelings, and other
thoughts of the
client.
• Giving opinions and • “That’s good
• PASSING approving or (bad).”
JUDGMENT disapproving
• “You shouldn’t do
responses, moralizing,
or implying one’s that.”
own values. • “That’s not good
• These responses imply enough.”
that the client must • “What you did
think as the nurse
thinks, fostering was wrong
client dependence. (right).”
• Telling the client • Client: “Should I
• GIVING what to do. These move from my
COMMON responses deny the home to a
client’s right to be nursinghome?”
ADVICE an equal partner. • Nurse: “If I were
• Note that giving you, I’d go to a
expert rather than nursing home,
common advice is where you’ll get
therapeutic. your meals cooked
for you.”
III. THE HELPING
RELATIONSHIP
NURSE–CLIENT RELATIONSHIPS
are referred to by some as
INTERPERSONAL
RELATIONSHIPS, by others as
THERAPEUTIC RELATIONSHIPS,
or as HELPING RELATIONSHIPS.
1. Help clients manage their
problems in living more effectively
and DEVELOP UNUSED OR
UNDERUSED OPPORTUNITIES
MORE FULLY.
2. Help clients become better at
THREE
HELPING THEMSELVES in their
EVERY DAY LIVES.
BASIC 3. Help clients develop an ACTION

-ORIENTED PREVENTION
GOALS MENTALITY in their lives.
Of a HELPING RELATIONSHIP
*** A helping relationship may develop
over WEEKS of working with a client, or
WITHIN MINUTES.
THE KEYS TO THE HELPING

RELATIONSHIP ARE:
(a) The development of TRUST and
ACCEPTANCE between the Nurse and the
Client, and
(b) An UNDERLYING BELIEF that the Nurse
CARES and SINCERELY WANTS TO HELP
the Client.
4 SEQUENTIAL 1. Pre-Interaction Phase
PHASES OF THE 2. Introductory Phase
HELPING 3. Working Phase
RELATIONSHIP: 4. Termination Phase
TASK
The nurse reviews
SKILLS
pertinent assessment Organized data
I. PRE-
data & knowledge, gathering; recognizing
INTERACTION
considers potential limitations
PHASE
areas of concern, and seeking assistance
and develops plans for as required.
interaction
TASK
• Both client and nurse identify each
SKILLS
• A relaxed, attending
other by name.
• When the nurse initiates the
II. relationship, it is important to explain
the nurse’s role to give the client an
attitude to put the
INTRODUCTORY idea of what to expect. client at ease. It is
PHASE • When the client initiates the
relationship, the nurse needs to help
not easy for all
the client express concerns and reasons clients to receive
1. OPENING THE for seeking help.
• Vague, open-ended questions, such as help
RELATIONSHIP “What’s on your mind today?” are
helpful at this stage.
TASK SKILLS
2. Because the client initially

Attentive listening,
paraphrasing, clarifying, and
CLARIFYING may not see the problem

other effective communication
techniques discussed in this
THE clearly, the nurse’s major chapter.

A common error at this
PROBLEM task is to help clarify the stage is to ask too many

questions of the client.
problem. Instead focus on priorities.
3. STRUCTURING TASK
AND Nurse and client develop a
degree of trust and verbally
SKILLS
FORMULATING agree about (a) location, Communication skills
frequency, and length of
THE CONTRACT meetings; (b) overall purpose of listed above and ability
(Obligations the relationship; (c) how to
confidential material will be
To Be Met By handled; (d) tasks to be overcome resistive
Both The Nurse accomplished; and (e) duration behaviors if they occur.
and indications for termination
And Client) of the relationship.
TASK SKILLS
Nurse and client Listening and attending
accomplish the tasks skills, empathy, respect,
III. WORKING outlined in the genuineness, concreteness,
self-disclosure, and
PHASE introductory phase, confrontation.
enhance trust and Skills acquired by the client
rapport, and develop are Non-defensive listening
caring. and self-understanding.
TASK
1. EXPLORING The nurse assists the client to
explore thoughts and feelings
AND and acquires an understanding SKILLS
of the client.
UNDERSTANDING The client explores thoughts
Attentive Listening
THOUGHTS AND and feelings associated with
problems, develops the skill of
FEELINGS listening, and gains insight into
personal behavior.
TASK
The nurse plans programs
within the client’s capabilities
SKILLS
2. and considers long- and short Decision-making and
-term goals.
FACILITATING The client needs to learn to goal-setting skills.
take risks (i.e., accept that Also, for the nurse:
AND TAKING either failure or success may reinforcement skills;
be the outcome).
ACTION The nurse needs to reinforce for the client: risk
successes and help the client taking.
recognize failures
realistically.
TASK
SKILLS
Nurse and client
accept feelings of loss. For the nurse:
IV. The client summarizing skills;
TERMINATION accepts the end of for the client:
PHASE the relationship ability to handle
without feelings of problems
anxiety or independently.
dependence.
WAYS IN DEVELOPING A HELPING
RELATIONSHIP:
1. Listen Actively 6. Use Your Ingenuity.
2. Help To Identify What The 7. Be Aware Of Cultural

Person Is Feeling Differences
3. Empathize 8. Maintain Client

Confidentiality
4. Be Honest 9. Know Your Role and Your
Limitations.
5. Be Genuine and Credible 10. Respect
IV. COMMUNICATION &
THE NURSING PROCESS
Nurses Use Communication Skills In
EACH PHASE Of The Nursing
Process.
i. ASSESSING
Ø To assess the client’s communication abilities, the
nurse determines COMMUNICATION IMPAIRMENTS or
BARRIERS and COMMUNICATION STYLE.
Ø Remember that CULTURE may influence when and

how a client speaks.
Ø Language varies according to AGE and

DEVELOPMENT. With CHILDREN, the nurse observes
Sounds, Gestures, and Vocabulary.
(A.) IMPAIRMENTS TO COMMUNICATION
(1.) LANGUAGE DEFICITS – Assess: For The Primary Language

- Use An Interpreter
(2.) SENSORY DEFICITS – Assess: Hear; See; Feel; & Smell.

- Be Watchful: Medical Alert Bracelet; Hearing Aid;
Lip Reading; & Use Of Sign Language
(3.) COGNITIVE IMPAIRMENTS – Assess: Cerebrovascular

Disease; Alzheimer’s Disease; and Brain Tumors Or
Injuries; Medications Taken)
(4.) STRUCTURAL DEFICITS – Assess: Cleft Palate; Artificial Airways (ex.

Tracheostomy).
(5.) PARALYSIS – Assess: Verbal Impairments with Paralysis

(ability to write and act).
(B.) STYLE OF COMMUNICATION
(1.) VERBAL COMMUNICATION – Assess: THE CONTENT OF THE MESSAGE,
THE THEMES, AND VERBALIZED EMOTIONS.
• COMMUNICATION PATTERN - slow, rapid, quiet, spontaneous, hesitant,

& evasive.
• VOCABULARY USED - changes from the vocabulary normally used (ex: a

person who normally never swears).
• Hostility, Aggression, Assertiveness, Reticence, Hesitance, Anxiety, or

Loquaciousness (Incessant Verbalization) in communication.
• DIFFICULTIES WITH VERBAL COMMUNICATION, such as Slurring,

Stuttering, Inability To Pronounce A Particular Sound, Lack Of
Clarity In Enunciation, Inability To Speak In Sentences,
Loose Association Of Ideas, Flight Of Ideas, Or The
Inability To Find Or Name Words Or Identify Objects.
• REFUSAL OR INABILITY TO SPEAK.

(2.) NONVERBAL COMMUNICATION
Assess: Nonverbal Communication In Relation To The

Client’s CULTURE.
Pay Particular Attention:

ü Facial Expression
ü Gestures
ü Body Movements
ü Affect
ü Tone Of Voice
ü Posture
ü Eye Contact
ii. DIAGNOSING
(based on NANDA)
( a . ) I M P A I R E D V E R B A L C O M M U N I C A T I O N-
“decreased, delayed, or absent ability to
receive, process, transmit, and/or use a system
of symbols
- RECEPTIVE (e.g., difficulty hearing) or
EXPRESSIVE (e.g., difficulty speaking)
- Not applicable if with psychiatric ailment
(b.) ANXIETY
(c.) SITUATIONAL LOW SELF-ESTEEM
(d.) POWERLESSNESS
(e.) SOCIAL ISOLATION
(f.) IMPAIRED SOCIAL INTERACTION
iii. PLANNING
GOAL: To Reduce Or Resolve The Factors Impairing
The Communication.
THE CLIENT:
q Communicates that needs are being met.
q Begins to establish a method of communication:
ü Signals yes/no to direct questions using vocalization or

agreed on physical cue (i.e., eye blink, hand squeeze).
ü Uses verbal or nonverbal techniques to indicate needs.
q Perceives the message accurately, as evidenced by
appropriate verbal and/or nonverbal responses.
q Communicates effectively:
ü Using dominant language
ü Using translator/interpreter
ü Using sign language
ü Using word board or picture board
ü Using a computer
q Regains maximum communication abilities.
q Expresses minimum fear, anxiety, frustration, and

depression.
q Uses resources appropriately.

iv. IMPLEMENTING
vNursing Interventions To Facilitate Communication With Clients
Who Have Problems With Speech Or Language Includes:
(a.) MANIPULATING THE ENVIRONMENT
(b.) PROVIDING SUPPORT
(c.) EMPLOYING MEASURES TO ENHANCE

COMMUNICATION
(d.) EDUCATING THE CLIENT AND SUPPORT

PERSON
v. EVALUATING
(a.) CLIENT COMMUNICATION – Client has positive
response.
Ex: The client stated, “I listened more
closely to my daughter yesterday and
found out how she feels about our divorce.”
(b.) NURSE COMMUNICATION – P R O C E S S

R E C O R D I N G is a verbatim
(word-for-word) account of conversation
(Taped or Written)
NURSE & PHYSICIAN
COMMUNICATION
ü Prepare before calling the primary care provider to report a
client problem.
ü You will be using the SBAR METHOD.
ü However, you also need to think about what information may
be asked of you and be prepared to answer those
questions. This means knowing the most recent client
assessment data, including vital signs, laboratory data,
and other tests, if appropriate.
ü Have the client’s medical record, MAR, and other
flow sheets as needed available to you.
WHAT IS SBAR:
Situation,
Background,
Assessment,
Recommendation
Model?
A FRAMEWORK FOR NURSE–HEALTH
EXAMPLE OF USING SBAR
CARE PROVIDER COMMUNICATION
S = SITUATION: What is the situation you are S: Health care provider called. Nurse has given
calling about? Provide your name, health name and unit of health care agency. “I’m calling
agency, client name, and brief information about about Sally Somers, a 19-yearold admitted this
the problem. morning with a ruptured appendix. She is now 6
hours postop and has not voided.
B = BACKGROUND: Provide information pertinent
to the current situation, such as admitting B: Her bladder is distended. She is complaining of
diagnosis, date of admission, and important urgency to void but unable to do so even with
clinical information that relates to the call. sitting on commode, running water, etc.
Everything else is stable.
A = ASSESSMENT: This refers to the current
condition of the client (e.g., VS, oxygen
saturation, pain scale, level of consciousness) and A: She is very uncomfortable and crying because of
any change in the assessment since the previous her urinary retention.
communication. Indicate the severity of the
problem.
R = RECOMMENDATION: What is your R: “Could you give an order for a straight urinary
recommendation for resolving the problem or catheterization?”
what do you need from the health care provider
(e.g., come see the client, transfer to another
unit, or an order for a medication)?
Reference:
Audrey Berman, et.al. (2016). Kozier & Erb's

Fundamentals of Nursing Concepts, Process, and Practice
10th Edition. Pearson. Chapter 26, pages 411 – 435.
Introduction 2012
2011 Joint Commission

International includes
more specific
1992 Joint Commission
International includes mandates to the
standard for standard (PFE)

American Hospital
PATIENT FAMILY This requirement means
Association passed A
EDUCATION (PFE)
that providers must
PATIENT’S BILL OF “Perform a learning needs
RIGHTS “Help patients ASSESSMENT that
Mandating CLIENT better Participate includes the patient’s
EDUCATION as a right in their care and Cultural and Religious
of all clients. State nurse make Informed Beliefs, Emotional
practice acts include Care Decisions”. Barriers, Desire and
client teaching as a Motivation to Learn,
function of nursing, Physical or Cognitive
thereby making teaching Limitations, and Barriers
a Legal and Professional to Communication.”
Responsibility.
Teaching Is A System Of Activities
Intended To Produce Learning.
 The Teaching Process Is Intentionally

Designed To Produce Specific Learning.
 The TEACHING–LEARNING PROCESS

Involves Dynamic Interaction Between
Teacher And Learner.
 The Teaching Process And

The Nursing Process Are Much Alike.
1. Collect data; analyze client’s 1. Collect data; analyze client’s
learning strengths & deficits. strengths and deficits.
2. Make educational diagnoses. 2. Make nursing diagnoses.
3. Develop teaching plan: 3. Plan nursing goals/desired
• Write learning outcomes. outcomes and select
• Select content & time interventions.
frame.
• Select teaching strategies.
4. Implement teaching plan. 4. Implement nursing strategies.
5. Evaluate client learning based on 5. Evaluate client outcomes based
achievement of learning on achievement of goal criteria.
outcomes.
NURSES TEACHES WHO?
1) Nurse teach CLIENTS and their FAMILIES or SIGNIFICANT
OTHERS in the Hospital, Primary Care Clinics, Urgent Care,
Managed Care, The Home, and Assisted Living and Long-
term Care Facilities.
2) Nurses teach LARGE AND SMALL GROUPS of Learners in

COMMUNITY HEALTH EDUCATION PROGRAMS.
3) Nurses also teach PROFESSIONAL

COLLEAGUES and other Health Care
Personnel in Academic Institutions such as
Vocational Schools, Colleges, and
Universities, and in Health Care Facilities
such as Hospitals or Nursing Homes.
• Increasing A Person’s Level Of Wellness
• Growth And Development Topics
• Fertility Control P M I
• Hygiene
R O O
• Nutrition
O T N
• Exercise
• Stress Management
• Lifestyle Modification
• Resources Within The Community
• Health screening (e.g., blood glucose levels, blood
pressure, blood cholesterol, Pap test, mammograms,
vision, hearing, routine physical examinations)
• Reducing health risk factors (e.g., lowering
cholesterol level)
• Specific protective health measures (e.g.,
immunizations, use of condoms, use of sunscreen, use
of medication, umbilical cord care)
• First aid
• Safety (e.g., using seat belts, helmets, walkers)
• Information About Tests, Diagnosis,
Treatment, Medications
• Self-care Skills Or Skills Needed To
Care For Family Member
• Resources Within Health Care Setting
and Community
• Adaptations In Lifestyle
• Problem-solving Skills
• Adaptation To Changing Health Status
• Strategies To Deal With Current Problems (e.g., home
IV skills, medications, diet, activity limits, prostheses)
• Strategies To Deal With Future Problems (e.g., fear of
pain with terminal cancer, future surgeries, or treatments)
• Information About Treatments and Likely Outcomes
• Referrals To Other Health Care Facilities or Services
• Facilitation Of Strong Self-image
• Grief And Bereavement Counseling
REFERENCE:
Audrey Berman, G. F. (2016). Kozier

& Erb's Fundamentals of Nursing
Concepts, Process, and Practice 10th
Edition. Pearson CHAPTER 27 PAGES
438-460.
FUNDAMENTALS of NURSING
NCM 103 R
By: Ms. Rosalinda P. Paderog

CLASSROOM POLICIES
● Attendance
● Attitude
● Academic honesty
● Interactive learning
● Mutual respect
• Is a systematic, rational
method of planning and
providing care to
patients.
Enables a
comprehensive and
effective plan of care to
be designed and
implemented for the
patient.
Steps
DATA COLLECTION METHOD
• 1. OBSERVING
• 2. INTERVIEWING
• 3. EXAMINING
TYPES OF INTERVIEW
QUESTIONS
• CLOSED-ENDED QUESTIONS
● are restrictive and generally require only
“yes” or “no” factual answers
● OPEN – ENDED QUESTIONS
● it elaborate, clarify feelings or thoughts
● begin with “what”, “how”
• Example:
a. Are you feeling nervous?
b. What brought you to the hospital?
3.EXAMINING
Done to obtain objective data
Technique: IPPA
For the abdomen: IAPerPa
Steps
Steps
EXAMPLE
EXAMPLE
scenario
• The patient verbalized of constant fatigue
and is manifesting generalized body
weakness that she is unable to tolerate
performing activities of daily living.
SAMPLE DRILL
• PLANNING AND OUTCOME
IDENTIFICATION
a systematic phase of the
nursing process that
involves decision making
and problem solving
●To design a plan of care
for and with the patient
that, once implemented,
results in the prevention,
reduction or resolution of
patient's health problems
and attainment of patient's
health expectations.
*Several tasks in the planning phase:
1. List of nursing diagnosis is prioritized
2. Client-centered long and short term

goals and outcomes are identified and
written
3. Specific interventions are developed
4. The entire plan of care is recorded in

the client’s record
• Goal – an aim or an end
– Outcome – results achieved; end

product of nursing care; patient
outcomes are measurable changes
in patient behavior or state of
health
EXAMPLE
EXAMPLE
3.
CATEGORIES
4. RECORDING the NCP
● Is a written guide that organizes data
about a patient's care
● Guide that directs the effort of the nursing
team
PURPOSE
• To assist the patient in achieving valued
health outcomes – promote health,
prevent disease and illness, restore
health, and facilitate coping with altered
functioning
Focus Charting
• Focus on client concerns and strengths

• Progress notes organized into DAR
format
▪ Data
• Assessment phase
▪ Action
• Planning and implementing phase
▪ Response
• Evaluation phase
Copyright © 2016
Kozier & Erb's Fundamentals of Nursing, Tenth Edition, Global Edition
Pearson Education Limited
Audrey Berman | Shirlee Snyder | Geralyn Frandsen
All Rights Reserved
COMMUNICATION TOOLS
SITUATION Introduce yourself and the patient and
briefly state the issue that you want to
discuss.
BACKGROUND Describe the background or context

(patient’s diagnosis, admission date, medical
diagnosis, and treatment to date.)
Summarize the patient’s condition and state

ASSESSMENT what you think the problem is.
Identify any new treatments or changes

RECOMMENDATION ordered and provide opinions or
recommendations for further action.
Box 15–6 Sample SBAR Communication Tool
Copyright © 2016
Kozier & Erb's Fundamentals of Nursing, Tenth Edition, Global Edition
Pearson Education Limited
Audrey Berman | Shirlee Snyder | Geralyn Frandsen
All Rights Reserved
NCM 103 FUNDAMENTALS LECTURE QUIZ
MS. ILEDAN
Question 1
The nurse teaches a client with Arterio-Venous Fistula on how to dress the surgical site
after discharge. The action of the nurse demonstrates most clearly on which CARING
activity?
Response: Empowering the client
Correct answer: Empowering the client
Score: 1 out of 1 Yes
Question 2
A nurse is caring for a patient newly diagnosed with testicular cancer. The patient felt
hopeless and asked the nurse to help him cope up with the situation. The nurse explains
that she will be just sitting beside him and will listen to him if he wants to talk about his
condition. This is an example of what type of knowledge?
Response: Aesthetic Knowing
Correct answer: Aesthetic Knowing
Question 3
According to Milton Mayeroff the ingredients of caring are the following, Except?
Response: One Rhythm
Correct answer: One Rhythm
Question 4
A young woman comes to a clinic for the first time for a gynecological examination.
Which nursing behavior applies Swanson’s caring process of “KNOWING” the patient?
Response: Recognizing that the patient is modest and maintaining her privacy during
the examination
Correct answer: Recognizing that the patient is modest and maintaining her privacy
during the examination
Question 5
Which example best illustrates the principle of Knowing The Client?
Response: The nurse collects a urine specimen to send to the lab, and explains to the
client the reason for the test.
Correct answer: The nurse listens as the client describes how he has been caring for his
diabetes at home.
Score: 0 out of 1 No
Question 6
True or False: According to Swanson’s Theory: To care for another person is to help
him grow and actualize himself, that develops over time, resulting in a deepening and
transformation of the relationship.
Response: False
Correct answer: False
Question 7
The student nurse are given an assignment of reflective journaling. The framework of
reflective journaling includes the following, Except?
Response: What did it mean?
Correct answer: What are your plans?
Question 8
A 40-year-old client who comes to the clinic for a routine physical exam asks the nurse
how much exercise is recommended for a healthy lifestyle. Which answer is most
appropriate?
Response: Moderate activity for 20 minutes two to three times a week
Correct answer: Vigorous activity for 25 minutes three days a week
Question 9
The six C’s of caring in nursing are:
Response: Compassion, Confidence, Commitment, Comportment, Conscience, and
Competence.
Correct answer: Compassion, Confidence, Commitment, Comportment, Conscience,
and Competence.
Question 10
A nurse, sitting quietly in a chair, breathing deeply, and focusing on the mental image of
a crystal is using which mind–body therapy?
Response: Meditation
Correct answer: Meditation
Question 11
True or False: Trust means letting go of the person and allowing them to grow at their
own pace.
Response: True
Correct answer: True
Question 12
True or False: Self-care focuses on care of the self in the lightest sense of their Self
Awareness & Self-Esteem. Individuals with high self-esteem can critically problem solve
and tackle obstacles more effectively. Self-care practices build self-esteem, leading to
feelings of comfort and accomplishment.
Response: False
Correct answer: False
Question 13
An experienced nurse is explaining the use of touch from a caring perspective. What
information does the nurse include in the discussion with the student about touch?
Response: Touch forms a connection between nurse and patient.
Correct answer: Touch forms a connection between nurse and patient.
Question 14
In order for the nurse to demonstrate caring, the following factors should be
considered, Except:
Response: Knowing the folks
Correct answer: Knowing the folks
Question 15
By being professional the nurse should apply this principle of caring to the patient.
Response: Caring practice involves connection, mutual recognition, and involvement
between nurse and client.
Correct answer: Caring practice involves connection, mutual recognition, and
involvement between nurse and client.
Question 16
All of the statement about touch are true, Except?
Response: There is never a problem with using touch at any time.
Correct answer: There is never a problem with using touch at any time.
Question 17
An example of a nurse caring behavior that families of acutely ill patients perceive as
important to patients’ well-being is:
Response: Asking permission before performing a procedure on a patient.
Correct answer: Asking permission before performing a procedure on a patient.
Question 18
The nurse sits with the client and holds the client’s hand as his pain decreases. This
situation is an example of which caring practice?
Response: Nursing presence
Correct answer: Nursing presence
Question 19
The following are strategies for creating work environments that support nurse caring
interventions, Except?
Response: Increasing technological support
Correct answer: Increasing technological support
Question 20
Always begin your day with a positive affirmation so that you will be able to bring
positive aura to your patient. Being positive means the following, Except?
Response: I am happy only when I am loved.
Correct answer: I am happy only when I am loved.
Question 21
A patient is fearful of upcoming surgery and a possible cancer diagnosis. He discusses
his love for the Bible with his nurse, who recommends a favorite Bible verse. Another
patient tells the nurse that there is no place in nursing for spiritual caring. The nurse
should reply by saying:
Response: “Spiritual, mind, and body connections can affect health.”
Correct answer: “Spiritual, mind, and body connections can affect health.”
Question 22
Which nursing theory is depicted by a model with spiritual-ethical caring in the center,
surrounded by technologic, physical, legal, political, economic, social-cultural, and
educational systems?
Response: Theory of bureaucratic caring
Correct answer: Theory of bureaucratic caring
Question 23
The nursing student reviews the pathophysiology of myocardial infarction in
preparation for the next day’s clinical experience. This activity is an example of which
type of knowledge development?
Response: Empirical knowing
Correct answer: Empirical knowing
Question 24
A hospice nurse sits at the bedside of a male patient in the final stages of cancer. He
and his parents made the decision that he would move home and they would help him
in the final stages of his disease. The family participates in his care, but lately the nurse
has increased the amount of time she spends with the family. Whenever she enters the
room or approaches the patient to give care, she touches his shoulder and tells him that
she is present. This is an example of what type of Touch?
Response: Interpersonal touch

Correct answer: Caring touch
Question 25
In a reflective journal, a nursing student writes this statement about a comatose client
on the hospice unit: “The Do-Not-Resuscitate order was not on the chart, and none of
the nurses knew what measures should be taken if the client stopped breathing.” This
statement most clearly reflects which of the Four Ways of Knowing?
Response: Ethical
Correct answer: Ethical
Question 26
Respect for people as caring individuals and respect for what matters to them.
Nurse knowing self as a caring person.
This awareness of self allows the nurse to authentically care for others in nursing
practice.
These assumptions are seen in what type of Caring Theory?
Response: Theory of Nursing as Caring by Boyden and Schoenhofer
Correct answer: Theory of Nursing as Caring by Boyden and Schoenhofer
Question 27
Nurses should know how to self-care first before providing care to others. The
following are forms of self-care, Except:
Response: Storytelling about the patient’s condition.
Correct answer: Storytelling about the patient’s condition.
Question 28
The following statement are true about how a nurse demonstrates caring to the family
members, Except?
Response: Only the family members has the right to decide for the patient.
Correct answer: Only the family members has the right to decide for the patient.
Question 29
Mayeroff discussed about "allowing the other to grow in his own way and time". This
behavior most clearly reflects which major ingredient of caring?
Response: Humility
Correct answer: Patience
Question 30
Leininger’s theory, Culture Care Diversity and Universality, would provide the best
framework for assessing which nursing situation?
Response: The Aeta parents of an infant prefer to use hot/cold therapies to prevent
seizures so they withhold the prescribed seizure medication (phenobarbital).
Correct answer: The Aeta parents of an infant prefer to use hot/cold therapies to
prevent seizures so they withhold the prescribed seizure medication (phenobarbital).
Score: 1 out of 1
NCM 103 LEC

1st Quiz - Ms. Paderog
Question 1
Which of the following statements concerning the nursing process is accurate?
Question 2
Subjective data are apparent only to the person affected. TRUE
Question 3
In a nursing diagnosis "Ineffective airway clearance, related to increased secretions", the
problem here is the increased secretions. FALSE
Question 4
The nurse decides to seek wound care alternatives for a client’s ulcer that is not healing after 2
weeks of treatment. The nurse is functioning on the evaluation phase of the nursing process.
TRUE
Question 5
Which of the following assessment techniques uses short tapping strokes on the surface of the
skin to create vibrations of underlying organs? PERCUSSION
Question 6
Which nursing diagnosis should the nurse identify as a priority? INEFFECTIVE AIRWAY
CLEARANCE
Question 7
Focus assessment is performed during any physiologic or psychologic crisis of the client to
identify life-threatening problems. FALSE
Question 8
The basic three-part nursing diagnosis statement is called the PES format and includes the
problem, etiology, and signs and symptoms. TRUE
Question 9
Who among the following first referred to nursing as a “process”?
Question 10
Which of the following data is subjective? A PATIENT IS NAUSEATED AT THE SIGHT OF FOOD
Question 11
While conducting a dressing change, the nurse notes a new area of skin breakdown that was
caused from the tape used to secure the dressing. In which phase of the nursing process is the
nurse working?
Question 12
The nurse explains the purpose of the diagnosis phase, which one is not included? SPECIFY
GOALS AND OUTCOMES
Question 13
Which of the following is an objective data? THE ECG MONITOR SHOWING TACHYCARDIA
Question 14
The nursing diagnoses includes only those health states that nurses are educated on and
licensed to treat. TRUE
Question 15
After gathering all the necessary data. What must the nurse do next? CLUSTER THE DATA
Question 16
Specifying goals and outcomes is part of the diagnosing phase. FALSE
Question 17
Implementation is that part of the nursing process in which the nurse applies knowledge to
perform interventions. TRUE
Question 18
The nursing process is composed of 5 steps. Which of the following is the correct sequence of
these steps? ASSESSING, DIAGNOSIS, PLANNING, IMPLEMENTING, EVALUATING
Question 19
Which of the following is an example of an open-ended question the nurse may use? HOW
WOULD YOU DESCRIBE YOUR SLEEP PATTERN
Question 20
MATCH THE STEP OF THE NURSING PROCESS LISTED WITH THE RELATED TASK. ANSWERS
WILL BE USED MORE THAN ONCE. WRITE THE NUMBER ONLY IN THE BLANK PROVIDED.
1. ASSESSING
2. DIAGNOSING
3. PLANNING
4. IMPLEMENTING
5. EVALUATING
Question 21
Which of the following assessment techniques involves careful visual observation?
INSPECTION
Question 22
When was the first comprehensive book on nursing process published? 1967
Question 23
The ER Nurse was asking the client about his health history. The nurse is collecting data from a
- PRIMARY
Question 24
A patient has a violent spell of coughing. What type of data is this? OBJECTIVE
Question 25
"A patient worries about her children during her hospital stay."
What type of data is this? SUBJECTIVE
Question 26
Dependent interventions are those activities carried out under the physician's orders or
supervision or according to specified routines. TRUE
Question 27
A wellness diagnosis is associated with a cluster of other diagnoses. FALSE
Question 28
Repositioning the client every 2 hours is a dependent nursing intervention. FALSE
Question 29
The correct order in abdominal examination is: INSPECTION, AUS, PERCU, PALPA
Question 30
The admitting physician will be able to provide necessary information and is considered the
best source of data. FALSE
Question 31
Evaluating the outcome of the interventions is part of the implementing phase. FALSE
Score: 1 out of 1

NCM 103 Mid

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NCM 103 Mid

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Nursing

By: Lourdes Ivaliz C. Iledan, RN, MN

Fun Fact: Root of the word Nursing came from a

Recognition, and Involvement How?

• Recognizing the other as having potential and the need to

4 . H O N E S T Y - includes AWARENESS and

5 . T R U S T - involves LETTING GO, to allow the other

7. HOPE - is BELIEF in the possibilities of the

8 . C O U R A G E - is the SENSE OF GOING INTO THE

3. EMPOWERING THE CLIENT

nurse and client in a caring transaction.

❑ By attending broadly to personal, ethical, aesthetic, and

empirical knowledge, the nurse UNDERSTANDS EVENTS as

they have meaning in the life of the client.

❑ The nurse’s knowing the client ultimately increases the

possibilities for THERAPEUTIC INTERVENTIONS to be

❑ Ex: The Nurse asks: What is the client’s history? Needs?

nurse conveys that they and their experiences matter.

❑ Being present is a way of sharing in the meanings, feelings,

and lived experiences of the client.

❑ Physical presence is combined with the promise of

availability, especially during a time of need.

❑ Ex: This may be as simple as responding promptly to a call

bell on a hospital unit or as complex as sitting with a

parent who has just lost a child in a neonatal intensive care

❑ The caring behavior of ENABLING “facilitating the other’s

❑ Enabling also includes coaching, informing, explaining,

❑ Nurses both ADVOCATE for (verb) and are ADVOCATES

❑ Ex: Teaching the client self-care.

❑ To demonstrate empathy, the nurse must be able to

❑ COMFORT is often associated with compassionate care

❑ Ex: bathing, positioning, talking, touching, and listening

“Distinct, Dominant, Unifying, and

“Assistive, Supportive, and Enabling

❖ That nurses must understand different

❖ Transcultural nursing focuses on both

❖ To provide care that is congruent with

(1) Preservation of the client’s familiar

❖ In Ray’s research (Coffman, 2010), THE MEANING OF

❖ CARING IS INFLUENCED BY ROLE AND POSITION A

❖ All individuals are caring, and develop their

❖ Caring is NOT UNIQUE TO NURSING.

NURSING ❖ Nurse KNOWING SELF as a caring person.

AS CARING ❖ This AWARENESS OF SELF allows the nurse to

❖ From the perspective of the theory of nursing as

❖ The idea of wholeness includes the understanding

❖ Watson emphasizes Nursing’s Commitment to

❖ The Nurse and Client are COPARTICIPANTS in the

❖ This human connection is labeled

❖While the nurse maintains professional OBJECTIVITY

❖This TRANSPERSONAL CONTACT has the potential to

❖ An ASSUMPTION of her theory is that a client’s

❖ The theory focuses on CARING PROCESSES AS

❖ Swanson’s theory was developed through

present to the other • Conveying ability

future with meaning • “Going the distance”

3. AESTHETIC KNOWING is the art of nursing and is expressed by the

Audrey Berman, et.al (2016).

By: Lourdes Ivaliz C. Iledan, RN, MN

In NURSING, communication Integral part of

*** Ideas and thoughts are expressed to others not only

*** Nonverbal communication either reinforces

• Accepting • Sitting quietly