FUNDAMENTALS OF NURSING
MODULE 1
Test Coverage:
M1 – Nursing as a profession
M2- History of Nursing
Lesson 1: history
Lesson 2: Overview of professional nursing practice
Lesson 3: Nursing as an art
M3 –Health & illnesses
Lesson 1: Models of health and illness
Lesson 2: Determinants of Health
Lesson 3:Levels of preventive Care
MODULE 1:
NURSING AS A PROFESSION
PROFESSION
 An occupation or calling requiring advanced training and
experiences in some specific or specialized body of
knowledge which provide service to society in specific
field.
OTHER DEFINITION OF PROFESSION
 A calling or a vocation requiring an intensive and
specialized education in the field of science or the liberal
arts and has specialize training.
 A calling or vocation or undertaking in which its members
should have acquired specific and distinct values,
knowledge, training or by experience so that they may
competently utilize it in the service of others
 Any undertaking in which a person, whom for a fee or free,
provides a distinctive service using scientific and
specialized body of knowledge and skills
CRITERIA OF A PROFESSION
ACCORDING TO WILLAM SHEPARD
 Must have developed a scientific technique which is the
result of tested experience.
 Must require the exercise of discretion and judgment as
to time and manner of the performance of duty. This is in
contrast to the kind of work which is subject to
standardization in terms of unit performance or time
element.
 Must have a group of consciousness designed to extend
scientific knowledge in technical language
 Must have sufficient self-impelling power to retain its
members throughout life. It must not be used as a mere
stepping stone to other occupation.
 Must recognize its obligations to society by insisting that
its members live up to an established code of ethics.
ACCORDING TO FLEXNER
 A profession applies its body of knowledge in practical
services that are vital to human welfare, and especially
suited to the tradition of seasoned practitioners shaping
the skills of newcomers to the role.
LOREY MANALO
 It constantly enlarges the body of knowledge it uses and
subsequently imposes on its members a lifelong
obligation to remain current in order to “do no harm”.
 A profession functions autonomously (with authority) in
the formulation of professional policy and in
monitoring its practice and practitioners.
ACCORDING TO FLENEX
 It utilizes in its practice a well- defined and well-
organized body of knowledge that is intellectual in
nature and describes its phenomena of concern
 A profession has a clear standard of educational
preparation for entry into practice
 A profession is distinguished by the presence of
specific culture, norms, and other values that are
common among its members.
 Entrusts the education of its practitioners to
institutions of higher education
 Applies its body of knowledge in practical
services which are vital to human and social
welfare
 Functions autonomously in the formulation o
professional policy and in the control of professional
activity
 Attracts individuals of intellectual and personal
qualities who exalt service above the personal gain
and who recognize their chosen occupation as a life
work
 Strives to compensate its practitioners by providing
freedom to act on opportunity for continuous
professional growth, and economic security
ACCORDING TO GENEVIEVE K & ROY W. BIXLER
 Utilizes in its practice a well-defined and well-
organized body of specialized knowledge which is on
the intellectual level of higher learning.
 Constantly enlarges the body of knowledge it uses,
and improves its techniques of education and service
by the use of scientific method
PROFESSIONAL NURSING
 Is a person who has completed a basic nursing
education program and is licensed in his/ her country
or state to practice professional nursing
 It is the performance, for fee or salary, of fee or salary
of professional services such as undertaking
responsible nursing care, the observation of
symptoms, accurate reporting and recording,
supervision of other, execution of valid doctor’s order.
QUALIFICATION AND ABILITIES OF A
PROFESSIONAL NURSE
A professional nurse must possess specific qualifications &
abilities.
A. PROFESSIONAL PREPARATION:
 have a license to practice nursing in the country
 have a Bachelor of Science degree in Nursing;
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 be physically and mentally fit
The personal qualities and professional proficiencies of a
nurse include.
B. PERSONAL QUALITIES & PROFESSIONAL
PROFICIENCIES
 interest and willingness to work and learn with
individuals/ groups in a variety of setting.
 A warm personality and concern for people
 resourcefulness and creativity as well as a EXPANDED NURSING ROLES
well- balanced emotional condition
 capacity and ability to work cooperatively with others
 initiative to improve self & service
 competence in performing work through the use of
nursing process
 skill in decision-making, communicating, and relating
with others and being research oriented
 active participation in issues confronting nurse &
nursing
ROLES AND RESPONSIBILITIES OF
PROFESSIONAL NURSE
ROLE
 A socially expected behavior pattern, associated with
an individual’s function in various social group.
RESPONSIBILITY
 a legal or moral duty or obligation to deal with.
ROLES AND PROFESSIONAL NURSE
CARE PROVIDER A assist the client physically and
psychologically while preserving the client’s dignity. It
involves full care for the completely dependent client, partial
care for the partially dependent client, & supportive-educative
care to assist clients in attaining their highest possible level of
health.
COMMUNICATOR A nurses identify client problems and then
communicate these verbally or in writing to other members of
the health team
TEACHER A helps client learn about their health and the health
care procedures they need to perform to restore or maintain their
health
COUNSELOR à help the client recognize and cope with
stressful psychological or social problems to develop
improved personal relationships and to promote
personal growth
CLIENT ADVOCATE à the nurse acts to protect the client and
his rights, promotes what is best for the client.
CHANGE AGENT à the nurse initiates change and assists the
client make modifications in their behavior & lifestyle to
promote health
LEADER à the nurse helps the client make decisions in
establishing and achieving goals to improve his well-being
CASE MANAGER à the nurse work with the multi-
disciplinary health care team to measure the effectiveness of the
case management plan & to monitor outcomes, gives directions,
and delegates nursing activities to ancillary workers and
evaluates their performance
RESEARCHER à the nurse participates in scientific
investigation and uses research findings in practice.
NURSE PRACTITIONER a nurse who has an advanced
education and is a graduate of a nurse practitioner program
(family nurse practitioner, pediatric nurse practitioner)
NURSE SPECIALIST a nurse who has an advanced degree
or expertise and is considered to be an expert in a specialized
area (gerontology, oncology)
NURSE ANESTHETIST carries out preoperative visits and
assessments, administer anesthetics for surgery.
NURSE MIDWIFE gives prenatal and postnatal care and
manages deliveries in normal pregnancies
NURSE RESEARCHER employed in academic institutions,
teaching hospitals and research centers
NURSE ADMINISTRATOR functions include budgeting, staffing
and planning programs (head nurse, supervisor, director of
nursing services)
NURSE EDUCATOR – employed in nursing programs,
educational institutions, and in hospital staff education.
Responsible for classroom and often clinical teaching (Clinical
Instructor)
NURSE ENTREPRENEUR – manages health-related business
(Owner of a home care)
NURSING AS A PROFESSION
An occupation or vocation with a unique body of knowledge,
attitude and skills acquired through advanced training and
experience in order to provide specialized services and various
care for others.
CHARACTERISTIC OF A PROFESSION AS APPLIED
TO NURSING PRACTICE (ADHERES TO COMMON
CODE OF ETHICS)
CHARACTERISTIC OF PROFESSION AS APPLIED
TO NURSING PRACTICE
 Mastery of craft
 Accountability
 Competence
 Caring profession
 Ethical
 Service oriented
 Professional relationship with his patient and other
member of health care team
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 Autonomy & Altruism
 Adhere to a common code of ethics
CHARACTERISTIC OF PROFESSION AS APPLIED
TO NURSING PRACTICE
1. MASTER OF CRAFT -requires well-defined skills
continuously and exclusively performed
2. ACCOUNTABILITY- Being liable for any resulting acts
or conduct based on his professional decisions
implemented, committed or performed
3. COMPETENCE- refers to the possession of required
skills, knowledge and capacity in providing safe care to
patients. These skills are acquired through theoretical
and related learning in school and hospital exposures.
It should be applied at all times when a nurse is actively
practicing his profession.
4. ETHICAL- Being equipped with the morality of human
conduct, values and standards. It is the rightness and
the wrongfulness of human action
5. CARING PROFESSION- Nursing requires diligent
efforts in caring for any client, both sick and well. It is
the only profession wherein, monetary consideration is
not the primary reason in providing care, but most of
all, service to humanity. Nurses are supposed to have
a truly caring attitude for all of her clients regardless of
their economic and social status
6. SERVICE ORIENTED- The main goal of professional
nursing practice is to deliver optimum level of health for
all, both sick and well regardless whether capable
of payment or an indigent, as the essence of the phrase
that “nursing is service” to others
7. PROFESSIONAL RELATIONSHIP-Nurses must have
a patient centered behavior. Such behavior is focused
on solving patient’s assessed problems and needs.
Care should be holistic and professional nurses must
provide disciplined care through active and
continuous collaboration with other members of the
health care team.
8. AUTONOMY AND ALTRUISM
 Profession grants authority and independence to nurse
practitioners to perform specific professional functions
 Failure of the nurse to comply would expose her to
possible professional liabilities. It is also the duty of a
nurse to be ever mindful of the conduct of his
colleagues and other members of the health care
team.
 Although our profession grants autonomy, such must
still be regulated and should adhere with the existing
nursing laws, Code of Ethics, policies and guidelines.
 She has the responsibility to look at the conduct and
demeanor of other health providers to see to it that
tasks are properly carried out and patients are properly
protected.
11 KEY RESPONSIBILITIES OF A NURSE
 Nursing Process
 Safe & Quality Nursing Care
 Health Education
 Legal Responsibility
 Management of Resources & Environment
 Quality Improvement
 Research
 Personal & Professional Development
 Communication
 Collaboration & Team Work
 Record Management
SCOPE OF NURSING PRACTICE
• A person shall be deemed practicing nursing when he/
she singly or in collaboration with another, initiates and
performs nursing services to individuals, families, and
communities in any health care setting.
• It includes but is not limited to nursing care dung
conception, labor, delivery, infancy, childhood, toddler,
pre-school, school- age, adolescence, adulthood, and
old age.
• It shall be the duty of the nurse to:
• Provide nursing care through the utilization of the
nursing process;
• Establish linkages with community resources, and
coordination with the health team;
• Provide health education to individuals, families, and
communities;
• Teach, guide, and supervise students in nursing
education programs including the administration of
nursing services in varied settings such as hospitals,
and clinics; and
• Undertake nursing and health human resource
development training, and research
SCOPE OF NURSING PRACTICE
 Promoting health & wellness
 Preventing illness
 Restoring Health
 Caring for the dying
PROMOTING HEALTH & WELLNESS
WELLNESS- is a process that engages in activities and
behaviors that enhance quality of life and maximize personal
potential
 Nurses promote wellness in clients who are both
healthy & ill
 involves activities that enhance healthy lifestyle
PREVENTING ILLNESS
The goal of illness prevention programs is to maintain optimal
health by preventing disease.
 activities that prevent illness
 includes immunization, prenatal and infant care,
prevention of STD
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RESTORING HEALTH through graduate study in nursing (either master’s or

doctoral degree
 focuses on the ill client, and it extends from
early detection of disease through helping the client NURSING EDUCATION
during the recovery period - Teachers in the Nursing education programs

NURSES ACTIVITIES INCLUDES THE FF:

 providing direct care to the ill person
 performing diagnostic and assessment
procedures
 consulting with other health care
professionals about client problems
 teaching clients about recovery activities
 rehabilitating clients to their optimal
functional level following physical or mental illness,
injury or chemical addiction
CARING FOR DYING
 Involves comforting and caring for people of
all ages who are dying
 Includes helping clients live as comfortably as
possible until death and helping support persons cope
with death
 Nurses carrying out these activities work in
homes
, hospitals, and extended care facilities, like hospices,
are specifically designed for this purpose.
FIELDS IN NURSING
 Hospital or Intuitional Nursing
 Public health nursing or community health nursing
 Privat duty or special duty nursing
 Industrial or occupational health nursing
 Nursing education
 Military nursing
NURSING IN OTHER FIELDS
SCHOOL NURSING
- The school nurse is for the school’s activities
in the areas of health service, health education, and
environmental health, and safety
CLINICAL NURSING
- Clinic nursing requires that a nurse possess
general skills. The nurse acts as a receptionist.
Answers phone, does the billing, takes x- rays, and
ECGs, changes dressings, gives injections, and
assists in physical examination.
MILITARY NURSING
- The nurse corps. The military nurse works at
different health settings with various levels of
responsibilities
PRIVATE DUTY NURSING
- A private duty nurse is a registered nurse who
undertakes to give comprehensive nursing care to a
client on a one-to-one ratio. She/ he is an independent
contractor
INDUSTRIAL/ OCCUPATIONAL HEALTH NURSING
- Is the specialty practice that provides and
delivers healthcare services to workers. The practice
focuses on promotion, protection, and supervision of
workers’ health within the context of safe and healthy
work environment

INTITUTIONAL NURSING
- Nursing in hospitals and related health
facilities such as extended care facilities, nursing
homes, and neighborhood clinics, comprises all of the
basic components of comprehensive patient care and
family health

PUBLIC HEALTH NURSING

- Refers to the practice of nursing in the local,
national, and city health departments which include
health centers and public schools. It is community
health nursing in the public sector

INDEPENDENT NURSING PRACTICE

- The nurse is self-employed and provides
professional nursing services to clients/ patients and
their families. While some independent nursing
practitioners set up their clinics near a hospital (as in
the case of the Psychiatric Nursing Specialists, Inc.),
most of them are community- based.

ADVANCED PRACTICE NURSING

- This field of nursing is synonymous with
specialization. This advanced practice requires the
knowledge skills and supervised skills obtained

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MODULE 2:
LESSON 1: HISTORY OF NURSING
NURSING- “ nutrix” (latinword, “nutricius”)
 that nourishes, foster, protects as a
SCIENCE and ART a blending of art, science & spirit.
 a service to the individual which helps to regain, or to
keep a normal state of body and mind
TRADITIONAL ROLE OF NURSING
 Humanistic care
 Nurturing
 Comforting
 Supporting
HISTORICAL PERSPECTIVES IN CONTEMPORARY
NURSING
WOMEN’S ROLE
 traditionally, female roles of wife, mother, daughter and
sister have always included the care and nurturing of
other family members.
 women, who in general occupied a subservient and
dependent role, are called on to care for others in the
community who are ill
 care provided is related to physical maintenance and
comfort
HISTORY OF NURSING
INITUATIVE
 the perception of knowledge that is pure instinctive and
untaught
 WOMEN- Endowed biologically with a tender,
compassionated nature.
 Which is readily adapted to her family’s need for
nursing care; functioned as primitive nurses in tribal
societies
 PRE-HISTORIC MAN was nomadic
 Nursing as a practice originated in the dim past when
some mother among the cave dwellers cooled the
forehead of her sick child with water from the brook (Dr.
William Osler)
 Law of preservation (survival of the fittest)
 Abandonment of the aged and infirm – act of necessity
not of cruelty
NURSING IN ANCIENT CIVILIZATION
 Belief that disease was embedded on superstition and
magic
 Practical theories of medical care emerged and
observe the following:
- midwives provided care for the mothers and infant
during birthing
- -wet nurses often suckled and care for infant children
of wealthy families
- -often the care provided for the sick was related to
physical maintenance and comfort
- -these roles are filled in by female slaves >Slave nurse
was dependent on the master, healer or pries
PRIMITIVE MEN
 believed that illnesses were caused by the invasion of
the victim’s body by an evil spirit or black magic
(voodoo)
 believed that the medicine man (shaman or witch
doctor) could heal using “white magic”
 medicine men used hypnosis, charms, dances,
incantations, purgatives, massages, fire, water, herbs
or other vegetation, some animals, use of trephine
(drilling a hole in the skull with a rock or stone without
anesthesia)
NURSES AT THIS TIME
 comforting
 practicing midwife
 wet nurse to child
 performing neighboring act (without training or
direction)
 more on natural instinct
NURSING IN THE NEAR EAST
 from nomadic life to agrarian life to urban community
life.
 Nursing duty of slaves, wives, sisters or mothers
BABYLONIA CODE OF HAMMURABI
- Earliest documentation of law governing the practice of
medicine
- Government- controlled, well regulated practice
medicine; mention of nursing.
EGYPT
 Art of embalming (contribution to anatomy)
 record of 250 recognizable diseases
 no mention of nursing; it is assumed that nurses were
the role of slaves or patient’s families
 Hebrew people
 Old Testament (Book of Leviticus) - laws of controlling
the spread of communicable diseases, cleanliness,
preparation of food, purification of man and his food,
rituals of circumcision
 Moses- “the father of Sanitation” - nurses – midwives
and wet nurses (compassionate, tender maternal
instincts)
NURSING IN THE FAR EAST
CHINA
 belief of spirits and demons
 knowledge of “MATERIA MEDICA” (pharmacology)
 prescribed methods of treating wounds, infections and
muscular inflections
 care of the sick is assumed as the function of family
members
 Prohibited the dissection of the human body
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 The Christian value of “love thy neighbor as thyself”

INDIA
 hospitals that use an intuitive form of asepsis
 proficiency in the practice of medicine and surgery
 Writings of Shushurutu (300 – 200 B.C.)
 List of function and qualification of nurses
 mention of nurse (priest-nurses) taking care of
patients; functions also as pharmacists, masseurs,
physical therapists and cooks.
and Christ’s parable of the Good Samaritan had a
significant impact on the development of nursing
 during the 3rd and 4th centuries, several wealthy
matrons of the Roman empire (such as Fabiola)
converted to Christianity and used their wealth to
provide houses of care and healing (the forerunner
of hospitals) for the poor, the sick and the homeless
THE PERIOD OF APPRENTICE NURSING

IN ANCIENT INDIA  Nursing care performed by people directed by more

experienced nurses
Early hospitals were staffed by male nurses and required four(4)  ‘’on the job’’ training without formal education
qualifications:  Religious orders of the Christian church
 Military, secular and mendicant(begging) religious
 knowledge orders
 cleverness
 devotedness PARABOLONI BROTHERHOOD
 purity of mind and body - Organization of men providing nursing care to the sick
and dying during the plague in Alexandria
women serve as midwives and nursed ill family members
THE CRUSADERS
NURSING IN GREECE AND ROME - The military religious orders established hospitals and
staffed them with men who served as nurses
IN ANCIENT GREECE AND ROME
ST. ELIZABETH OF HUNGARY
Care of the sick and injured was advanced in mythology and - “Patroness of Nurses”
reality. - used her wealth to make lives for the poor
- built hospital for the sick & needy
ASKLEPIOS - provided orphans and fed them from 300 to 900
- Greek god; chief healer persons daily.

EPIGONE TEUTONIC KNIGHTS(GERMAN)

- Wife of asklepios the soother - established tent hospitals for the wounded

HYGERIA KNIGHTS OF ST. JOHN OF JERUSALEM (ITALIAN)

- Daughter: goddess of health: embodiment of the nurse
NURSING OF GRECO-ROMAN CULTURE
 Nursing was the task of untrained slaves
 Introduced ‘’CADUCEUS’’ the insignia of the medical
profession today
 Women were not tasked or given instruction regarding
nursing due to perception of inferiority of females to
males
HIPPOCRATES
- Father of scientific medicine only a medical student
should remain with the patient.
TRANSISTION FROM PAGAN TO CHRISTIAN NURSING
ROME
 Care is given by slaves or Greek physicians
FABIOLA
- Gave service to the less fortunate members of the
Roman society in her repentance for her sins;
- Gave nursing care to the patients herself in her
hospital(the first hospital in the Christian world.)
ROLE OF RELIGION IN THE DEVELOPMENT OF
NURSING
- devoted to religious life and nursing
- discipline was strict
KNIGHTS OF ST. LAZARUS
- nursing care of Lepers in Jerusalem
RISE OF ORGANIZED CHARITY
 St. Vincent de Paul
 Louise de Marillac
 Community of Sisters of Charity
-were dedicated to doing God’s work in nursing the sick, the
poor, the orphaned and the widowed
DARK PERIOD OF NURSING
THE REFORMATION AND NURSING
 the “dark period of nursing”
 closing of hundreds of hospitals
 nursing became the work of “dregs” of society
 nurses took bribes, abused alcohol, were uneducated
and untrained
 nurses worked 7 days a week without relief with very
poor working conditions
 Extends from 17th to the 19th century
 Period of reformation until the US Civil War
 Extends from 17th to the 19th century

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 Martin Luther destroyed unity of Christian Faith FLORENCE NIGHTINGALE

 Wrath of Protestantism swept away everything
connected with Roman Catholicism in schools, - “Mother of Modern Nursing” The Period of Educated
orphanage, & hospitals Nursing Lady with a Lamp
 Properties of Hospitals & School was confiscated - born May 12, 1820 in Florence, Italy
 Nurses fled to their lives - the Crimea and St. Thomas’ Hospital
 Nursing became the work of the least desirable women - established Nightingale school
& worked 7 days a week, sleep in a cubby hole near - wrote Notes on Nursing and Notes on Hospital
the hospitals ward or patient and ate scrap food when - her education was rounded out by a continental tour
they could find them - A Victorian Lady, developed her self-appointed goal :
 In England, hundreds of hospitals were closed “to change the profile of nursing”
 No provision for the sick - compiled notes of her visits to hospitals and her
observation of the sanitary facilities and social
problems.
LEADERS THA BROUGHT ABOUT REFORM
SYMBOL OF THE NURSE-her uniform
JOHN HOWARD
- Started as an ordinary housedress covered with a
- a prison reformer, helped in improving the life condition
large- sized apron for protection
of the prisoners
EUPHEMIA VAN RENSALLER
MOTHER MARY AIKENHAND
- Adopted a uniform with a cap that was later adopted by
- established Irish Sister of Charity
her classmates
PASTOR THEODOR FLIEDNER & FREDERIKA MUNSTER
GLOVES FOR PROTECTION
FLIEDNER
- was invented through the efforts of Dr. William Halsted
- established the institute for the training of
for use of his wife, Caroline Hampton who has delicate
Deaconnesses of Kaiserwerth Germany.
hands and for relief of her dermatitis
REQUIREMENT FOR ENTERING THE SCHOOL WERE:
SPANISH-AMERICAN WAR
- -Start of the Army Nurse Corps through the efforts of
 character of reference from the clergyman Dr. Anita Newcomb McGee whereas Clara Louise
 A certificate of health from a physician Maas became known for her service in the war though
 permission from their nearest relative she served without rank
- She also engaged in medical research on YELLOW
NURSING IN AMERICA FEVER

VENERABLE ELIZABETH SETON 2OTH CENTURY

Founder of Sister of Charity of Emmitsburg(1809)
FIRST DECADE
- American reforms:
- Nurses’ society of Philadelpia organized a school of • Development of the nursing and related nursing fields
nursing under Dr. Joseph Warrngton in 1863 • “mushrooming” of nursing schools and hospitals
- Women’s Hospital in Philadelphia established a six • nursing instructors taught more on the “how” not the
months course in nursing “why” of nursing.
MADAME JEANNE MANCE OF FRANCE START OF AGE OF SPECIALIZATION
- Fist laywomen’’
- Worked as a nurse in North America • Development of Private Duty Nursing, settlement
- Founded the hotel Deieu in montreal and her supplies house nursing
came from France • Establishment of Nursing Organization
- Sister hospitallers of St. Joseph • American Nurses Association
• National League for Nursing Education
PRE-CIVIL WAR NURSING
- Nursing was carried by catholic and protestant 1913-1937
religious orders
- Augustinian nuns • Standards were set for:
- Ursuilline Sister • Curriculum
- Deconessess of Kairserswerth • education
- Protestant Sisters of Charity • professional registries
- St. John’s Sisterhood
- Sisterhood of all saints.
PERIOD OF EDUCATED NURSING WORLD WAR 1

 Begun on June 15 1860 Arousal of social • The patriotism of Edith Cavell

consciousness • “mata hari” served wounded soldiers during World War
1

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• The establishment of the Army Nurse Corps.
Armistice Period
- Due to the aftermath of war, the need for public health
nurses came about to provide service for the
community
The Great Depression
- Most nurses were without employment
- Most nursing schools reduced enrolment
- Admission to nursing schools became more rigid and
students were dropped for the slightest infraction
Preparation for War
- Creation of the United States Cadet Nurse Corps
through the Nurse Training Act (Public Law no. 74)
Nurses in the Armed Forces
- The difference between WWI and WWII nurses
- induction of officer’s rating, stationing in different
military installations, the nurses went together with the
troops not as volunteers but part of the troop
THE PERIOD OF CONTEMPORARY NURSING
• after World War II to present
• Scientific and technological development and social
changes marks this period
• start of nursing as a profession
• revision of the Nursing Code of Ethics in the 1950s
placement of emphasis on the different nursing fields
• start of patient- centered nursing
EVENTS AND TRENDS
• establishment of WHO by United Nation
• Use of Atomic Energy for medical diagnosis and
treatment
• Utilization of computers for collecting date, teaching,
establishing diagnosis, maintaining inventory, making
payrolls, record keeping & billing
• Use of sophisticated equipment
• advent of spare medicine also developed aerospace
nursing
COLONEL TUCKER
• Developed a comprehensive one-year course to
produce nurses for aerospace nursing at Cape,
Kennedy
• Health is perceived as a fundamental human, law were
legislated to provide such right
• Technological advancement has relieved the nurses
from numerous tedious tasks
• Development of expanded role of the nurse.
INFLUENCES ON CONTEMPORARY NURSING
National Accreditation
- Start of accreditation of programs nursing education by
different groups
- Formation of the National Nursing Accrediting Service
Research in Nursing
- Start of promotion of research investigations and
training researches to improve the practice of nursing
- Start of publications of nursing books, articles, journals,
etc.
Practical Nurses
- a.k.a. aide, attendant, auxiliary nurse, subsidiary
worker, ancillary worker, vocational or non-
professional nurse.
- Are permitted to administer care according to their
ability and preparation.
- Assists in caring for the sick under the direction of a
licensed physician or a registered professional nurse.
Influences in contemporary nursing education
- Committee on careers in nursing
- for recruitment of nurses
- Basic baccalaureate programs in nursing
- Associate degree programs in nursing
- Evolving levels of nursing preparation
- practical nursing
- professional nurse
- master nurse
- doctor nurse
HISTORY OF NURSING IN THE PHILIPPINES
Early Beliefs and Practices
• Diseases and their causes and treatment
were shrouded with mysticism and superstitions.
Belief about causation of disease:
• Another person (and enemy or witch)
Evil spirits
• belief that evil spirits could be driven away by persons
with powers to expel demons
• belief in special Gods of Healing, with the priest-
physician ( called “word doctors”) as intermediary. If they
used leaves or roots, they were called herb doctors
(“herbolarios”)
Early care for the sick
- Difficult childbirth and some diseases (called pamao)
were attributed to “nonos”
Midwives assisted in childbirth
- during labor, the “mabuting hilot” (good midwife) was
called in If the birth became difficult, witches were
supposed to be the cause To disperse their influence,
gunpowder was exploded from a bamboo cane close
to the head of the sufferer.
- Difficult childbirth and some diseases (called pamao)
were attributed to “nonos”
- Midwives assisted in childbirth -during labor, the
“mabuting hilot” (good midwife) was called in
- If the birth became difficult, witches were supposed to
be the cause
- To disperse their influence, gunpowder was exploded
from a bamboo cane close to the head of the sufferer.
HEALTHCARE DURING SPANISH REGIME
• religious orders exerted their efforts to care
for the sick by building hospitals in the different parts of
the Philippines.
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 ART APPRECIATION
The earliest hospitals were:
Hospital Real de Manila (1577)
- it was established mainly to care for the Spanish King’s
soldiers, but also admitted Spanish civilians; founded
by Gov. Francisco de Sande.
San Lazaro Hospital (1578)
- founded by Brother Juan Clemente and was
administered for many years by the HOSPITALLIERS
OF SAN JUAN DE DIOS ; built exclusively for patients
with leprosy.
Hospital de Indios (1586)
- established by the Franciscan order; service was in
general supported by alms and contributions from
charitable persons
Hospital de Aguas Santas (1590)
- established in Laguna; near a medicinal spring,
founded by Brother J. Bautista of the Franciscan Order
San Juan de Dios Hospital (1596)
- founded by the Brotherhood of Misericordia and
administered by the Hospitalliers of San Juan de Dios;
support was derived from alms and rents; rendered
general health service to the public.
NURSING DURING PHILIPPINE REVOLUTION
JOSEPHINE BRACKEN
- Wife of Jose Rizal
- Installed a field hospital in an estate house in Tejeros;
provided nursing care to the wounded night and day.
MRS. ROSA SAVILLE DE ALVERO
- Converted their house into quarters for the Filipino
soldiers, during the Philippine American War that broke
out in 1899.
DONA MARIA AGONCILLO DE AGUINALDO
- 2nd wife of Emilio Aguinaldo; provided nursing care to
the Filipino soldiers during the revolution.
- PRESIDENT OF THE FILIPINO RED CROSS
BRANCH IN BATANGAS
MELCHORA AQUINO (Tandang Sora)
- Nursed the wounded Filipino soldiers and gave them
shelter and food.
CAPITAN SOLOME
- Revolutionary leader in Nueva Ecija; provided nursing
care to the wounded when not in combat
AGUENDA KAHABAGAN
- Revolutionary leader in Laguna, also provided nursing
services to her troops.
TRINIDAD TECSON
- ‘’INA NG BIAC NA BATO’’
- Stayed in the hospital at Biac na Bato to care for
wounded soldiers.
ST. PAUL’S SCHOOL OF NURSING (Manila, 1907)
- Established by the Archbishop of Manila, the most
reverent Jeremiah Harty under the supervision of the
Sisters of St. Paul de Chartres located in Intramuros
- Provided general hospital services
- Had a free dispensary and dental clinic
- Opened its training school for nurses in 1908, with Rev.
Mother Melanie as superintendent and Miss E.
Chambers as Principal.
PHILIPINE GENERAL HOSPITAL SCHOOL OF NURSING
(1907)
- Began in 1901 as a small dispensary mainly for “Civil
Officers and Employees” in the City of Manila. It later
grew into the Civil Hospital.
- In 1906, Mrs. Mary Coleman Master, an educator
advocated for the idea of training Filipino girls for the
profession of nursing with the approval of Government
officials, she first opened a dormitory for girls enrolled
at the Philippine Normal Hall and the University of the
Philippines.
- In 1907, with the support of Governor General Forbes,
and the Director of Health among others, she opened
classes in nursing under the Auspices of the Bureau of
Education
- Julia Nichols and Charlotte Clayton, taught the
students nursing subjects
- American physicians also served as lecturers
- In 1910, Act No. 1976 modified the organization of the
school, placing it under the supervision of the Director
of Health. The Civil Hospital was abolished; the
Philippine General Hospital was established. The
School became known as the Philippine General
Hospital School of Nursing.
- As chief nurse, Elsie McCloskeyGaches, introduced
several improvements in the school
- The course was made attractive and more practical.
ANASTACIA GIRON-TUPAS, the first Filipino nurse to
occupy the position of chief nurse and superintendent
in the Philippines, Rise succeeded her.
ST. LUKE’S HOSPITAL OF SCHOOL OF NURSING (Quezon
City, 1907)
- An episcopalian institution
- Began as a small dispensary in 1903
- In 1907, the school opened with three Filipino girls
admitted. These girls had their first year in combined
classes with the Philippine General School of Nursing
and St. Paul’s Hospital School of Nursing.
- In the period of organization between 1900 to 1910, the
first year nursing students of the Philippine General
Hospital, St. Luke’s Hospital and St. Paul’s Hospital
had a common first year course, known as the central
school idea in nursing education.
- The three schools selected their own students, based
on the following requirements:
- Educational preparation, at least completion of 7 th
grade
- Sound physical and mental health
- Good moral character
- Good family and social standing
- Recommendations from 3 different persons well-
known in the community
- The 3 groups of students from these schools were later
fused into one class, lived in the same dormitory, and
received the same instructions in anatomy and
physiology, massage, practical nursing , materia
medica, bacteriology and English.
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 ART APPRECIATION
MARY JOHNSTON HOSPITAL AND SCHOOL OF NURSING
(Manila, 1907)
- Started as a small dispensary on Calle Cervantes (now
Avenida RIzal) it was called the BETHANY
DISPENSARY and funded by the Methodist Mission for
the relief of suffering among women and children.
- In 1907, Sr. Rebecca Parrish, together with registered
nurses Rose Dudley and Gertrude Dreisback,
organized the Mary Johnston School of Nursing.
- The nurses’ training course began with three Filipino
young girls fresh from elementary grades as the first
students
- In 1908, MR. D.S.B. Johnson of Minnesota donated as
a memorial to his wife $12,500 for a hospital building.
- In 1911, the Philippine Assembly appropriated a
monthly sum of P500 for the hospital, in appreciation
for its services during the cholera epidemics in the
previous years.
- Later, 11,000 was provided by the assembly for the
construction of a maternity and milk station and
dispensary
- At the outbreak of World War II, it became an
emergency hospital where the wounded were treated.
- Was allowed to operate as a hospital even during the
Japanese Occupation
- Burned down in 1945, it was reconstructed through
contributions of Methodists in America
- It re-opened in 1947 at the Harris Memorial, LIBRADA
JAVALERA was the first Filipino director of the school.
PHILIPPINE CHRISTIAN MISSION INSTITUTE SCHOOLS OF
NURSING
- Sallies Long Read Memorial Hospital School of
Nursing (Laoag, Ilocos Norte, 1903)
- Mary Chiles Hospital School of Nursing (Manila, 1911)
established by DR. W.N. Lemon in a small house on
Azcarraga, Sampaloc, Manila
- In 1913, MISS MARY CHILES of Independence,
Montana, donated a large sum of money with which the
present building at Gastambide was bought The
Tuason Annex was donated by ESPERANZA
TUASON, a Filipino philantropist
- Frank Dunn Memorial Hospital (Vigan, Ilocos Sur,
1912)
San Juan De Dios Hospital School of Nursing
- In 1953, through the initiative of DR. BENITO VALDEZ,
the board of inspectors and the executive board of the
hospital passed a resolution to open a school of
nursing. The school has been run by the DAUGHTERS
OF CHARITY since then. DR. GREGORIO SINGIAN,
introduced the following reforms when he was
appointed medical director in 1920 the first six months
of training was considered a trial period. Students who
incurred a failure in two or three subjects were
dismissed.
- a separate building was provided for the library
- a kitchen was constructed for classes in dietary
chemistry
- laboratory classes for bacteriology and chemistry were
introduced
- anatomic charts and specimens for experiments were
acquired
- a new and spacious dormitory for students and nurses
was built
- In 1945, during the fight in Intramuros, the hospital was
destroyed.
EMMANUEL HOSPITAL SCHOOL OF NURSING (Capiz,
1913)
- – In 1913, the American Baptist Foreign Mission
Society sent DR. P.H. J. LERRIGO to Capiz, for the
purpose of opening a hospital.
- MS. ROSE NICOLET assisted him.
- The school offered a 3-year training course for an
annual fee of P100.
- MS. CLARA PEDROSA was the first filipino principal
SOUTHERN ISLANDS HOSPITAL SCHOOL OF NURSING
(Cebu, 1918)
- Established in 1911, under the Bureau of Health
- The school opened in 1918 with Anastacia Giron,
Tupas as the organizer
- Miss Visitacion Perez was the first principal.
UNIVERSITY OF SANTO TOMAS COLLEGE OF NURSING
(1946)
- –At the same time, the ideals of Christian charity
permeated this course
- in its first year of existence, its enrollees consisted of
students from different school of nursing whose studies
were interrupted by the war
- in 1947, the Bureau of Private Schools permitted UST
to grant the title of Graduate Nurse to the 21 students
who were of advanced standing from 1948 to present
- The college has offered excellent education leading to
a BACCALAUREATE DEGREE (B.S.N.)
- SOY TACIANA TRINANES was the first directress.
- The idea of opening the college began in a conference
between MS. JULITA SOTEJO and then UP
PRESIDENT GONZALES
- Nurses who attended the biennial convention in May
1946 endorsed the idea
- In April 1948, the University Council approved the
curriculum, and the Board of Regents recognized the
profession as having equal standing as medicine, law,
engineering, etc.
- Miss Sotejo was its dean
- began as the UST School of Nursing Education on
February 11, 1941
- was unique since it operated as a separate entity from
the Santo Tomas University Hospital
- the courses of instruction were designed to conform to
the latest and modern advances in nursing, science
and education.
MANILA CENTRAL UNIVERSITY COLLEGE OF NURSING
(1947)
- First offered the BSN course in 1947
- it served as the clinical field for practice
- MS. CONSUELO GIMENO was its first principal.
FIRST COLLEGE OF NURSING IN PHILIPPINES
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 ART APPRECIATION
ANASTACIA GIRON TUPAS
- First Filipino nurse to hold the position of Chief Nurse
and Superintendent
- Founder of the Philippine Nurses Association

CAESURA TAN
- First Filipino to receive a masteral degree in Nursing
abroad

SOCORRO SIRILAN
- Pioneered in Hospital Social Service in San Lazaro
Hospital where she was the Chief Nurse.

ROSA MILITAR
- A pioneer in nursing education

SOR RICARDA MENDOZA

- A pioneer in nursing education

SOCORRO DIAZ
- First editor of the PNA magazine called ‘’The
Message’’

CONCHITA RUIZ
- First full time editor of the newly name PNA Magazine
‘’The Filipino Nurse’’

LORETO TUPAZ
- Dean of Philippine Nursing
- Florence Nightingale of ILO-ILO

EARLY INSTITUTION OF CHILD WELFARE CORE COMPETENCY STANDARDS FOR NURSING

HEALTH AND NURSING ORGANIZATION
• Hospicio de San Jose (MANILA 1782)
• Asylum of San Jose (CEBU)
• Asylum of Looban (MANILA)
• Colegio de Santa Isabel (Naga City) -took care of poor
girls.
• Gota de Leche (MANILA 1907)-milk station. Its objective
was to promote health in infants through proper feeding.
• Liga Nacional Filipianiana para La Protection de la
Primera Infacia- worked for the passage of child welfare
legislations.
• Public Welfare Board-took over the work of the Liga in
1915; conducted a systematic campaign on child hygiene
in 1917.
• Philippine Nurses Associations- national organization
in Filipino Nurses.
• National League of Nurses- the association of nurses
employed by the department of health.
• Catholic Nurse Guild of the Philippines
2012 NATIONAL NURSING COMPETENCY
STANDARD
PRACTICE IN THE PHILIPPINES
• Safe & quality nursing practice
• Management of resources & environment
• Health education
• Legal responsibility
• Ethico – moral responsibility
• Personal & professional development
• Quality improvement
• Research
• Record management
• Communication
• Collaboration & teamwork
• Unifying framework for nursing practice, education,
regulation
• Guide in nursing curriculum development Framework
in developing test syllabus for nursing profession
entrants
• Tool for nurses’ performance evaluation Basis for
advanced nursing practice, specialization
• Framework for developing nursing training curriculum
• Public protection from incompetent practitioners
Yardstick for unethical, unprofessional nursing
practice.

• The Professional Regulations Commission-Board of CORE VALUE

Nursing came up with a resolution No. 24, Series 2012
stating that all nursing graduates must acquire 3 roles • Love of God
in their BSN program. • Caring and Love of People
• The roles are that of a clinician, manager and • Love of Country.
researcher.

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 ART APPRECIATION
MODULE 2:
LESSON 2: OVERVIEW OF THE PROFESSIONAL
NURSING PRACTICE
CORE COMPETENCY STANDARDS FOR NURSING
PRACTICE IN THE PHILIPPINES
SOCIALIZATION TO NURSING
- The standards of education and practice for the
professions are determined by the members of
profession, rather than by outsiders.
- The education of the professional involves a complete
socialization process, more far reaching in its social
and attitudinal aspects and its technical features than
is usually is required in other kinds of occupation
STAGE 1 NOVICE
 No experience (e.g. nursing student)
 Performance is limited, inflexible and governed by
context free rules and regulations rather than experience.
BENNER’S STAGES OF NURSING EXPERTISE
 Novice
 Advance beginner
 Competent
 Proficiency
STAGE 2 ADVANCED BEGINNER
 Demonstrate marginally acceptable performance
 Recognizes the meaningful ‘’aspects’’ of the a real
situation
 Has experienced enough real situations to make
judgments about them.
STAGE 3 COMPETENT
 Has 2 to 3 years of experience
 Demonstrate organizational and planning abilities
 Differentiates important factors from less important
aspects of care
 Coordinates multiple complex care and command.
STAGE 4 PROFICIENCY
 Has 3 to 5 years experience
 Perceives situation as a whole rather than in terms of
parts, as in stage 2
 Uses maxim as guides for what to consider in a
situation
 Has a holistic understanding of client which improves
decision making
 Focuses on a long term goal.
STAGE 5 EXPERT
 Performance is fluid, flexible and highly proficiency
 No longer requires rule, guidelines or maxims to
connect an understanding to the situation to
appropriate action.
 Demonstrate highly skilled intuitive and analytic ability
in new situation
 Inclined to take a certain action because ‘’ it felt right’’
ETHICAL CODE
 systematic guides for developing ethical behavior
 answer normative questions of what beliefs and values
should be morally accepted.
OVERVIEW OF THE CODE OF ETHICS FOR NURSES
 Promulgation of the Code of Ethics for Registered
Nurses the Philippine Nursing Act of 2002 (Article III of
R.A. 9173)
 The principal basis is the Code of Good Governance
for the Profession in the Philippines.
 All the principles under the said Code were adopted
and integrated as they apply to the nursing profession.
 A set of guidelines, regulations or measures
 Consultation was made last October 23, 2003 at Iloilo
City with the accredited organizations of registered
nurses, the PNA Inc., and other affiliate organizations
of Registered nurses, decided to adopt a new Code of
Ethics under the aforementioned new law.
ARTICLE 1 (PREMEABLE)
- Section 1 - Health is the fundamental right of every
individual. The Filipino registered nurse, believing in
the worth & dignity of each human being, recognizes
the primary responsibility to preserve health at all cost.
This responsibility encompasses promotion of health,
prevention of illness, alleviation of suffering, and
restoration of health. However, when the foregoing are
not possible, assistance towards a peaceful death shall
be his/ her obligation.
- Section 2 -To assume this responsibility, registered
nurses have to gain knowledge and understanding of
man’s cultural, social & spiritual, physiological,
psychological, and ecological aspects of illness,
utilizing the therapeutic process. Cultural diversity and
political and socio-economic status.
- Section 3 -The desire for the respect and confidence
of clientele, colleagues, co-workers, and the members
of the community provides the incentive to attain and
maintain the highest possible degree of ethical
conduct.
ARTICLE II REGISTERED NURSES AND PEOPLE
Section 4
ETHICAL PRINCIPLES
1. Values, customs, and spiritual beliefs held by
individuals shall be respected.
2. Individual freedom to make rational and
unconstrained decisions shall be respected.
3. Personal information acquired in the process of
giving nursing care shall be held in strict confidence.
Section 5
GUIDELINES TO BE OBSERVED:
Registered Nurses must
a. Consider the individuality and totality of patients when
they administer care.
b. Respect the spiritual beliefs and practices of patients
regarding diet and treatment.
c. Uphold the rights of individuals.
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 ART APPRECIATION
d. Take into consideration the culture and values of patients
in providing nursing care. However, in the event of conflicts
their welfare and safety must take precedence.
ARTICLE III REGISTERED NURSES AND PRACTICES
Section 6
ETHICAL PRINCIPLES
1. Human life is inviolable.
2. Quality and excellence in the care of the patients are the
goals of nursing practice.
3. Accurate documentation of actions and outcomes of
delivered care is the hallmark of nursing accountability.
Section 7
GUIDELINES TO BE OBSERVED:
Registered Nurses must
a. Know the definition and scope of nursing practice which
are in the provisions of R.A. No. 9173, known as the
“Philippine Nursing Act of 2002” and Board Resolution No.
425, Series of 2003, the Rules and Regulations implementing
the Philippine Nursing Act of 2002”.
b. Be aware of their duties and responsibilities in the
practice of their profession as defined in the “Philippine
Nursing Act of 2002” and the IRR.
c. Acquire and develop the necessary competence in
knowledge, skills, and attitudes to effectively render appropriate
nursing services through varied learning situations.
d. If they are administrators, be responsible in providing
favorable environment for the growth and development of
Registered Nurses in their charge.
Section 8
ETHICAL PRINCIPLE
4. Registered Nurses are advocates of the patients; they shall
take appropriate steps to safeguard their rights and privileges.
GUIDELINES TO BE OBSERVED:
Registered Nurses must
a. Respect the “Patients’ Bill of Rights” in the delivery of
nursing care.
b. Provide the patients or their families with all the pertinent
information except those which may be deemed harmful to their
wellbeing.
c. Uphold the patient’s rights when conflict arises regarding
management of their care.
Section 10
GUIDELINES TO BE OBSERVED:
Registered Nurses must
c. Decline any gift, favor or hospitality which might be interpreted
as capitalizing on patients.
d. Not demand and receive any commission, fee or emolument
for recommending, or referring a patient to a physician, a co-
nurse or another health care worker; not to pay any commission,
fee or other compensations to the one referring or
recommending a patient to them for nursing care.
e. Avoid any abuse of the privilege relationship which exists with
patient and of the privilege access allowed to their property
residence or workplace.
ARTICLE IV REGISTERED NURSES AND CO WORKERS
Section 11
ETHICAL PRINCIPLES
1.The Registered Nurse is in solidarity with other members of
the health care team in working for the patient’s best interest.
2.The Registered Nurse maintains collegial and collaborative
working relationship with colleagues and other health care
providers.
Section 12
GUIDELINES TO BE OBSERVED:
Registered Nurses must
a. Maintain their professional role/ identity while working with
other members of the health team
b. Conform with group activities as those of a health team and
should be based on acceptable, ethico-legal standards
c. Contribute to the professional growth and development of
other members of the health team.
d. Actively participates in professional organizations.
e. Not act in any manner prejudicial to other professions.
f. Honor and safeguard the reputation and dignity of the
members of nursing and other profession; refrain from making
unfair and unwarranted comments or criticisms on their
competence, conduct, and procedures; or not do anything that
will bring discredit to a colleague and to any member of other
professions.
g. Respect the rights of their co-workers
ARTICLE V REGISTERED NURSES, SOCIETY AND
ENVIRONMENT
Section 13
ETHICAL PRINCIPLES
1.The preservation of life, respect for human rights, and
promotion of healthy environment shall be a commitment of a
Registered Nurse.
2.The establishment of linkages with the public in promoting
local, national and international efforts to meet health and
social needs of the people as a contributing member of society
is a noble concern of a Registered Nurse.
Section 14
GUIDELINES TO BE OBSERVED:
Registered Nurses must
a. Be conscious of their obligations as citizens, and, as such,
be involved in community concerns.
b. Be equipped with knowledge of health resources within the
community, and take active roles in primary health care.
c. Actively participate in programs, projects, and activities that
respond to the problems of society.
d. Lead their lives in conformity with the principles of right
conduct and proper decorum
e. Project an image that will uplift the nursing profession at all
times.
ARTICLE VI REGISTERED NURSES AND THE
PROFESSION
Section 15
ETHICAL PRINCIPLES
1.Maintenance of loyalty to the nursing profession and
preservation of its integrity are ideal.
2.Compliance with the by-laws of the accredited professional
organizations of which the Registered Nurse is a member is a
lofty duty.
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 ART APPRECIATION
3. Commitment to continual learning and active participation in
the development and growth of the profession are
commendable obligations.
4. Contribution to the improvement of the socio-economic
conditions and general welfare of nurses through appropriate
legislation is a practice and a visionary mission.
Section 16
GUIDELINES TO BE OBSERVED:
Registered Nurses must
a. Be members of the Accredited Professional Organization
(PNA)
b. Strictly adhere to the nursing standards
c. Participate actively in the growth and development of the
nursing profession
d. Strive to secure equitable socio-economic and work
conditions in nursing through appropriate legislation and other
means.
e. Assert for the implementation of labor and work standards.
CODE OF GOOD COVERNANCE
- promulgated by the Professional Regulation
Commission on July 23, 2003 states that the hallmark
of all professionals is their willingness to accept a set
of professional and ethical principles which they will
follow in the conduct of their daily lives. The
acceptance of these principles requires the
maintenance of a standard of conduct higher than what
is required by law.
- This code is adopted by the PRC and the 42
Professional Regulatory Boards to cover an
environment of good governance in which all Filipino
professionals shall perform their duties.
 Service to others
- a commitment to a life of sacrifice and genuine
selflessness
 Integrity and Objectivity
- Should perform responsibilities with the highest sense
of integrity and imbued with nationalism & spiritual
values
- maintain objectivity, be free of conflicts of interest
- refrain from engaging in activity that would prejudice
their abilities to ethically carry out their duties.
 Professional Competence
- Knowledge, technical skills, attitudes and experience,
undertaking only those professional services they can
reasonably deliver.
- An obligation to keep up with new knowledge and
techniques, upgrade the level of competence, taking
part in lifelong continuing education program.
 Solidarity and Teamwork
- Shall maintain and support one professional
organization for all its members.
 Social and Civic Responsibility
- Shall always carry out their professional duties with
due consideration of the broader interest of the public
- Service them with professional concern consistent with
their responsibilities to society
- As Filipino, contribute to the attainment of the country’s
national objectives.
 Global Competitiveness
- Shall remain open to the challengers of a dynamic and
interconnected world, rise up to the global standards
and maintain levels or professional practices fully
aligned with global practices.
 Equality of All Professions
- shall treat their colleagues with respect and strive to be
fair in their dealings with one another
- No one group of professionals is superior or above
others -All professions perform an equally important,
yet distinct service to society.
MODULE 2:
LESSON 3: NURSING AS AN ART
NURSING AS AN ART
 Nursing is an art and if it is to be made an art, it is
requires as exclusive a devotion, as hard a
preparation, as any painter’s or sculpture’s work, for
what is having to do with the living body- the temple of
God’s spirit? It is one of the fine arts; I had almost said,
the finest of the arts.
A. Nursing profession
B. Art means
C. Purpose of nursing
D. Why nursing is an art?
NURSING PROFESSION
 As a UNIQUE profession, it is practice with the earnest
concern for the ART of CARE and the SCIENCE OF
HEALTH.
 The NURSING profession involves a humanistic blend
of scientific knowledge and holistic nursing practice.
ART MEANS
 Art is the process or product of deliberately arranging
elements in a way that appeals to the senses or
emotions.
 ‘’both human creative skill or its application’’
 Concise oxford dictionary (1996)
PURPOSE OF ART
- "a purpose of art involves communication of emotions
to invoke a response"
WHY IS NURSING AN ART
 Nursing is itself an art. It can be drama, it can be
dialogue, it can be a comedy. The patient can be
viewed as an inspiration to and participant in the art of
nursing
 It is an art as it involves personal encounters with
people particularly the ill and afflicted.
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 ART APPRECIATION

 A nurse can meet a patient needs by creating a

comfortable climate thus establishing commitment to Maintaining belief
healing. Therefore, the nurse may stimulate patient to - Is sustaining faith in the other’s capacity to get through
regain control to his recorvery. an event or transition and face a future with meaning.

Doing for
- Is doing for the other as he or she would do for the self
if it were at all possible

Enabling
- Is facilitating the other’s passage through life
transitions (e.g. birth, death and unfamiliar events)

“The Nursing as an Art, derives its philosophical pedestal from

the consideration of life as a fundamental value and unfolds the
art of care-healing cased with moral, philosophical, mental,
social and scientific values of every epoch"
CONCEPTS RELATED TO THE ART OF NURSING
 Caring
 Compassion
 Optimism
 Empathy

CARING: AN INTEGRAL PART OF NURSING

 ‘’The essence of Nursing is caring’’-Jean Watson

CARING MEANS
- A word of being ‘’connected’’
- Caring means that persons, events, projects and things
matter to the people.
- An inherent feature of nursing practice where it enables
nurses help clients to recover in the face of illness to
give meaning to the illness and to maintain or re-
establish connection
- Caring allows the commitment and the consciousness
of the nurses to go beyond the physical surface to
reach the human center of the person.
- It is the ESSENCE and CENTRAL UNIFYING AND
DOMINANT DOMAIN that distinguishes nursing from
the other health disciplines
- Act of CARING refers to the direct and indirect
nurturant and skillful activities, processes and
decisions that assist people in ways that are emphatic,
compassionate and supportive, and that are
dependent on the needs, problems and values of the
individual being assisted.

CARE IN NURSE PRACTICES

 Providing presence
 Comforting
 Listening
 Knowing the client
 Spiritual caring
 Family care.

CARING: FIVE PROCESSES

Knowing
- Is striving to understand an event as it has meaning in
the life of other

Being with
- Is being emotionally present to the other

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MODULE 3:
LESSON 1: HEALTH AND ILLINESS
DEFINITION OF HEALTH
The World Health Organization defines health as "state of
complete physical, mental and social well being, not merely the
absences of disease or infirmity" (WHO,1947). Health is a state
of being that people define in relation to their own values,
personality and lifestyle. Pender and colleagues(2015) define
health as the actualization of inherent and acquired human
potential through goal-directed behavior, competent self-care
and satisfying relationships with others while adjustments are
made as needed to maintain structural integrity and harmony
with the environment.
HEALTH AND ILLNESS
- The holistic concept of health is contained in the
expression of wholeness. Health is a relative state in
which one is able to function well physically, mentally,
socially, and spiritually to express the full range of
one’s unique potentialities within the environment in
which one lives. Both health and illness are dynamic
processes and each person is located on a graduated
scale or continuous spectrum (continuum) ranging
from wellness and optimal functioning in every aspect
of one’s life, at one end, to illness culminating in death,
at the other.(Syalastog et al, 2017)
- A model is a theoretical way of understanding a
concept or idea. Model represents different ways of
approaching complex issues. Because health and
illness are complex concepts, models explain the
relationships between this concepts and a patients
attitudes towards health and health behaviors.
HEALTH BELIEFS
are persons ideas, convictions and attitudes about health and
illness. They may be based on the factual information or
misinformation, common sense or myths or reality or false
expectations.
POSITIVE HEALTH BEHAVIORS
- are activities related to maintaining, attaining, or
regaining good health and preventing illness. Ex.
immunization, proper sleep patterns, adequate
exercise etc
.
NEGATIVE HEALTH BEHAVIORS
- include actual practices or potentialy harmful to health
such as smoking, alcohol abuse, poor diet etc.
- Illness is a state in which a person's physical,
emotional, intellectual, social developmental, or
spiritual functioning is diminished or impaired.
CLASSIFICATION OF ILLNESS
ACUTE ILLNESS
 usually, short term and severe.
 Symptoms appear abruptly, are intense, and often
subside after a relatively short period.
 affects functioning in any dimension
CHRONIC ILLNESS
 persists, usually longer than 6 months affects
functioning in any dimension.
 Patients fluctuate between maximal functioning and
serious health relapses that are sometimes life
threatening.
HEALTH BELIEF MODEL
Health beliefs
- are a person's ideas, convictions, and attitudes about
health and illness
- It is based on factual information or misinformation,
common sense, or myths. influences health behavior
and can positively or negatively affect a patient's level
Positive health behaviors
- are activities related to maintaining, attaining, or
regaining good health preventing illness. (Includes
immunizations, proper sleep patterns, adequate
exercise, and good nutrition.)
- Implementation is dependent on an individual's
awareness of how to live a healthy life and the person's
ability and willingness to carry out such behaviors in a
healthy lifestyle.
Negative health behaviors
- include activities that are actually or potentially
harmful to health, such as smoking, drug or alcohol
abuse, poor diet, and refusal to take necessary
medications or to care for oneself.
First component:
• involves the individual's
perception of susceptibility to an illness.
Example:
A patient needs to recognize the familial link for coronary artery
disease. After recognizing this link, the patient will perceive a
personal risk of heart
Second component:
• Patient's perception of the seriousness of the illness.
• Demographic and sociopsychological variables,
perceived threats of the illness, and cues to action
(e.g., mass media campaigns and advice from family,
friends, and medical professionals) all influence and
modify this perception
Third component:
• The likelihood that the patient will take preventive
action, results from the patient's perception of the
benefits of and barriers to taking action.
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• Preventive action includes lifestyle changes,
increased participation in recommended medical
therapies, or a search for medical advice or treatment
HEALTH PROMOTION MODEL (PENDER,
MURDAUGH, AND PARSONS, 2002)
• Defines health as a positive, dynamic state, not merely the
absence of disease.
• Was proposed as a framework for integrating the
perspectives of nursing and behavioral science and the
factors that influence health behaviors (Pender and others,
2002).
 Describes the multidimensional nature of people as
they interact within their environment to pursue health
(Fender and others, 2002).
 Focuses on the three functions of a patient's cognitive-
perceptual factors (individual perceptions), modifying
factors (demographic and social), and participation in
health-promoting behaviors (likelihood of action).
 Focus of this model is to explain the reasons that
individuals engage in health activities.
 Also organizes cues into a pattern to explain the
likelihood of a patient developing health promotion
behaviors (Pender, 1993, 1996).
HOLISTIC HEALTH MODEL
 sometimes called complementary or alternative
medicine, is generally a comprehensive view of the
person as a biopsychosocial and spiritual being
(Edelman and Mandle, 2002).
TRAVIS’S ILLNESS AND WELLNESS CONTINUUM
 The intent is to empower patients to engage in their
own healing process (Edelman and Mandle, 2002).
 Holistic health consists of concepts of energy, holism,
the mind-body - connection, and balance in order to
expand the definition of health.
 A broader definition of health is applicable to more
patients in increasingly diverse populations and will
optimize health outcomes (Saylor, 2003).
 Involves the use of a variety of techniques that in the
past the health community viewed as "experimental" or
"alternative."
 Most widely used holistic interventions include
aromatherapy, biofeedback, breathing exercises,
massage therapy, meditation, music therapy,
relaxation therapy, therapeutic touch, and guided
imagery.
 Most holistic therapies are easy to learn and apply to
almost any nursing setting and to all stages of health
and illness.
Examples:
1. Health care providers use reminiscence in the geriatric
population to help relieve anxiety for a patient dealing
with memory loss or meditation for a cancer patient
dealing with the difficult side effects of chemotherapy.
2. Surgeons use music therapy in the operating room to
create a soothing environment.
3. Relaxation training is useful in any setting to distract a
patient during a painful procedure, such as a dressing
change. Breathing exercises help patients deal with the
shortness of breath that accompanies some chronic
respiratory diseases.
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ILLNESS and WELLNESS CONTINUUM
 Can be used to measure a person’s level of wellness.
 Health and illness or disease can be viewed as the
opposite ends of a health continuum.
MASLOW’S HIERARCHY OF NEEDS
Premise: Unsatisfied needs motivate human beings and that
individuals have to meet certain lower level needs before they
are able to satisfy higher level needs
Basic physiological needs
Lowest level of needs E.g. water, food, sleep, and sex
 When these needs are not met, an individual feels sick,
irritated, or complains of pain or discomfort which
motivates an individual to satisfy the need (Maslow,
1970)
Safety needs
Second level
 Includes establishing stability and consistency.
includes the security of a home and a family.
Example:
a woman living in an abusive home is unable to move to the
next level of love and belongingness because she is constantly
concerned for her safety.
Love and belongingness:
Third level
 A desire to belong to groups.
 Consists of the need to feel love by others and to be
accepted.
Self-esteem:
Fourth level
 Self-esteem results from mastery of a task and also
includes the recognition gained from others.
Self-actualization:
Highest level
 The desire to become everything that one is capable of
becoming.
 Concerned with maximizing his or her potential.
 An understanding of Maslow's hierarchy of needs pro-
vides you with a framework to meet patient needs and
specifically prioritize care for your patients.
 •Ensure that basic needs of individuals are met.
 Also, all the levels have a varying element of depth for
the individual (Benson and Dundis, 2003).
TRANSTHEORETICAL MODEL OR STAGES OF
CHANGE
 The TTM operates on the assumption that people do
not change behaviors quickly and decisively. Rather,
change in behavior, especially habitual behavior,
occurs continuously through a cyclical process. The
TTM is not a theory but a model; different behavioral
theories and constructs can be applied to various
stages of the model where they may be most effective.
 The TTM posits that individuals move through six
stages of change: precontemplation, contemplation,
preparation, action, maintenance, and termination.
Termination was not part of the original model and is
less often used in application of stages of change for
health-related behaviors. For each stage of change,
different intervention strategies are most effective at
moving the person to the next stage of change and
subsequently through the model to maintenance, the
ideal stage of behavior.
STAGES OF CHANGES
PRE- CONTEMPLATION
 The person does not think about changing his or her
behavior in the next 6 months.
 May be uninformed or under informed about the
consequences of the risk behavior(s).
CONTEMPLATION
 The person acknowledges having a problem, seriously
considers changing a specific behavior, actively
gathers information, and verbalizes plans to change
the behavior in the near future (e.g., next 6 months).
PREPARATION (DETERMINATION)
 In this stage, people are ready to take action within the
next 30 days. People start to take small steps toward
the behavior change, and they believe changing their
behavior can lead to a healthier life.
ACTION
 Occurs when the person actively implements
behavioral and cognitive strategies of the action plan
to interrupt previous health risk behaviors and adopt
new ones. Requires the greatest commitment of time
and energy.
MAINTENANCE
 The person strives to prevent relapse by integrating
newly adopted behaviors into his or her lifestyle.
 This stage lasts until the person no longer experiences
temptation to return to previous unhealthy behaviors.
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TERMINATION
 The ultimate goal where the individual has complete
confidence that the problem is no longer a temptation
or threat.
 It is as if they never acquired the habit in the first place
(Prochaska et al., 2002, p. 102).
MODULE 3:
LESSON 2: DETERMINANTS OF HEALTH
 Many factors combine together to affect the health of
individuals and communities. Whether people are
healthy or not, is determined by their circumstances
and environment. To a large extent, factors such as
where we live, the state of our environment, genetics,
our income and education level, and our relationships
with friends and family all have considerable impacts
on health, whereas the more commonly considered
factors such as access and use of health care services
often have less of an impact. (WHO,2017)
NON- MODIFIABLE
1. Age
2. Sex
3. Genetic endowment
MODIFIABLE
1.Health Behaviors
2.Lifestyle
3.Individual Influences
4.Interpersonal Influence
5.Community Influence
6.Environmental Influence
7. Health Care System Influence
FACTORS THAT INFLUENCE OR DETERMINE THE
HEALTH OF INDIVIDUALS AND COMMUNITIES
NON – MODIFIABLE: AGE
 Age increases susceptibility to certain illnesses (e.g.,
the risk of heart disease increases with age for both
genders)
 Risks of birth defects and complications of pregnancy
increase in women bearing children after age 35.
 Many kinds of cancer pose a greater risk for persons
over age 45 than for younger persons.
 Often closely associated with other risk factors, such
as family history and personal habits. Educate patients
about the importance of regularly scheduled checkups
for their age group.
NON-MODIFIABLE: SEX
 influences distribution of diseases
 Females/ Males: osteoporosis /stomach ulcers;
autoimmune disorders/ abdominal hernias; lupus
/resp. diseases; rheum. arthritis/ ASHD;
anorexia/bulimia hemorrhoids; gallbladder disease/
TB; thyroid disease; obesity
NON-MODIFIABLE: GENETIC ENDOWMENT
 Individual biology
 Genetic makeup and physical and mental health.
PHYSICAL ENVIRONMENT
 Where a person works or lives increases the likelihood
that certain illnesses will occur
 A person's home environment often includes
conditions that pose risks, such as unclean, poorly
heated or cooled, or overcrowded dwellings which
increases the likelihood that a person will contract and
spread infections and other diseases.
 Some kinds of cancer and other diseases are more
likely to develop when industrial workers are exposed
to certain chemicals or when people live near toxic
waste disposal sites
 Screening for these environmentally based risk factors
is directed at the short-term effects of the exposure and
the potential for long-term effects (Edelman and
Mandle, 2002).
MODIFIABLE: HEALTH BEHAVIOR
 Responses, actions, and reactions to internal stimuli
and external conditions are able to influence health
through their interaction with each other and with the
person's social and physical environments.
MODIFIABLE: LIFESTYLE
 Lifestyle practices and behaviors have positive or
negative effects on health.
 Practices with potential negative effects are risk
factors.
EXAMPLE:
LIFESTYLE
- Include overeating or poor nutrition, insufficient rest
and sleep, and poor personal hygiene.
- Other habits that put a person at risk for illness include
tobacco use, alcohol or drug abuse, and activities
involving a threat of injury such as skydiving or
mountain climbing.
- Some habits are risk factors for specific diseases (e.g.
excessive sunbathing increases the risk of skin cancer,
and being overweight increases the risk of
cardiovascular disease)
- Educate your patients and the public on wellness-
promoting lifestyle behaviors.
FACTORS AFFECTING HEALTH STATUS
1. Individual Influences
2. Interpersonal Influence
- Interpersonal influences are a person's perceptions concerning
the behaviors, beliefs, or attitudes of others.
3. Interpersonal Influence
- Family, peers, and health professionals are sources of
interpersonal influences that can influence a person's health-
promoting behaviors.
- Includes expectations of significant others, social support (e.g.,
emotional encouragement), and learning through observing
others or modeling.
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4. Community Influence are at risk for developing complications or worsening
- Cultural/social interactions influence how a person perceives, conditions.
experiences, and  Activities are directed at diagnosis and prompt
copes with health and illness intervention, thereby reducing severity and
- Cultures have distinctive ideas about health, and these are enabling the patient to return to a normal level of
transmitted from health as early as possible (Edelman and
parents to children Mandle, 2002).
- Home remedies may be perceived as superior to conventional  It includes screening techniques and treating early
medicines stages of disease to limit disability by averting or
- Social support networks Family, friends, confidantes, co- delaying the consequences of advanced disease.
workers
TERTIARY PREVENTION
5.Enviromental Influence
 Tertiary prevention occurs when a defect or disability
GEOGRAPHY
is permanent and irreversible
- determines climate
- which effects health  Involves minimizing the effects of long-term disease
- •tropics - malaria or disability by interventions directed at preventing
- •climate - asthma complications and deterioration (Edelman and
Mandle, 2002).
ENVIRONMENT
- •Pollution - air, water, soil
- •Carcinogens - asbestos
- •Radiation - machines, UV
- •Acid rain - main component is
sulfur dioxide of industrial origin;
thought to damage forests, lakes,
rivers

6. Health Care System Influence

6.1. Rural environments present unique challenges for
health care access. shortages of medical personnel
in rural areas
6.2. Transportation and distance barriers to care
6.3. Increasing economic destabilization of rural health care
services.

MODULE 3:
LESSON 3: LEVELS OF PREVENTIVE CARE
LEVELS OF PREVENTIVE CARE
Prevention, as it relates to health, is really about avoiding
disease before it starts. It has been defined as the plans for, and
the measures taken, to prevent the onset of a disease or other
health problem before the occurrence of the undesirable health
event.

PRIMARY PREVENTION

 True prevention
 Precedes disease or dysfunction, and applied to
patients considered physically and emotionally
healthy.

EXAMPLES:
•Health education, immunization, nutritional programs, physical
fitness activities etc.

SECONDARY PREVENTION

 Secondary prevention focuses on persons who are

experiencing health problems or illnesses and who

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