CONCEPTS OF MAN, HEALTH and ILLNES

CONCEPTS OF MAN
 Man is an individual with vital reparative process to deal with disease and desirous of
health but passive in terms of influencing the environment or nurse
 The concept of man forms the first foundational component of Nursing. To be able to
provide individualized, holistic, humane, ethical and quality nursing care
HEALTH
Florence Nightingale -defined health as a state of being well and using every power the
individual possesses to the fullest extent.  The World Health Organization (WHO) (1948) - a
state of complete physical, mental, and social well-being, and not merely the absence of
disease or infirmity.
ILLNESS
A highly personal state in which the person’s physical, emotional, intellectual, social,
developmental, or spiritual functioning is thought to be diminished

1. FACTORS & ISSUES AFFECTING HEALTH and ILLNESS     Many variables influence a
patient’s health beliefs and practices.  Internal and external variables influence how a person
thinks and acts. Health beliefs usually influence health behavior or health practices and likewise
positively or negatively affect a patient’s level of health. 
 Internal Variables-include a person’s developmental stage, 
intellectual background, perception of functioning, and emotional and spiritual factors.
 Developmental Stage. A person’s thought and behavior patterns change throughout
life.
 Intellectual Background. A person’s beliefs about health are  shaped in part by the
person’s knowledge, lack of knowledge, or  incorrect information about body functions
and illnesses, educational  background, and past experiences.
 Perception of Functioning. The way people perceive their  physical functioning affects
health beliefs and practices.
 Emotional Factors. The patient’s degree of stress, depression, or fear can influence
health beliefs and practices
 Spiritual Factors. Spirituality is reflected in how a person lives his or her life, including
the values and beliefs exercised, the relationships established with family and friends,
and the ability to find hope and meaning in life
  External Variables-influencing a person’s health beliefs and practices include family
practices, socioeconomic factors, and cultural background
 Family Practices. The way that patients’ families use health care    services generally
affects their health practices.
 Socioeconomic Factors. Social and psychosocial factors increase the     risk for illness
and influence the way that a person defines and reacts     to illness.
 Cultural Background. Cultural background influences beliefs, values,     and customs. It
influences the approach to the health care system,     personal health practices, and the
nurse-patient relationship. Cultural     background also influences an individual’s beliefs
about causes of     illness and remedies or practices to restore health.

INDIVIDUAL HEALTH- include the person’s total character, self-identity,   and perceptions. The
person’s total character encompasses be emotional state, attitudes, values, motives, abilities,
habits, and appearances. The person’s self-identity encompasses perception of self as a
separate and distinct entity alone and in interactions with others. The person’s perceptions
encompass the way the person interprets the environment or situation, directly affecting how he
or she thinks, feels, and acts in any given situation.
 Concept of Individuality; To help clients attain, maintain, or regain an optimal level of
health, nurses need to understand clients as individuals.
 Concept of Holism; Nurses are concerned with the individual as a whole, complete, or
holistic person, not as an assembly of parts and processes.
 Concept of Homeostasis; The concept of homeostasis was first introduced by Cannon
(1939) to describe the relative constancy of the internal processes of the body, such as
blood oxygen and carbon dioxide levels, blood pressure, body temperature, blood
glucose, and fluid and electrolyte balance.
o Equilibrium- balance, through adaptation to that environment
o Homeostasis- is the tendency of the body to maintain a state of balance or equilibrium
while continually changing.
o Physiological homeostasis- means that the internal environment of the body is
relatively stable and constant.
             
Homeostatic mechanisms have four main characteristics
1.They are self-regulating. means that homeostatic mechanisms come into play automatically
in the healthy person.
2. They are compensatory. tend to counteract conditions that are abnormal for the person.
                                   
Two general types of systems:
A. closed- does not exchange energy, matter, or information with its environment; it receives no
input from the environment and gives no output to the environment. 
B. Open- energy, matter, and information move into and out of the system through the system’s
boundary.

An open system depends on the quality and quantity of its;

(1) input-consists of information, material, or energy that enters the system.
(2) Throughput-After the input is absorbed by the system, it is processed in a way
useful to the system.
(3) output-from a system is energy, matter, or information given out by the system as
a result of its processes
(4) feedback-the mechanism by which some of the output of a system is  returned to
the system as input.

TYPES OF FEEDBACK
1. Negative feedback-inhibits change
They tend to be regulated by negative feedback systems. a set of interacting
identifiable parts or components.
2. Positive feedback-stimulates change
They may require several feedback mechanisms to correct only one
physiological imbalance. the mechanism by which some of the output of a system is
returned to the system as input.

Prerequisites for a person to develop psychological homeostasis

1. A stable physical environment in which the person feels safe and secure. For
example, the basic needs for food, shelter, and clothing must be met consistently from
birth onward.
2. . A stable psychological environment from infancy onward, so that feelings of trust
and love develop. Growing children and adolescents need kind but firm and consistent
discipline, encouragement, and support to be their own unique selves.
 3. A social environment that includes adults who are healthy role models. Children learn
the customs and values of society from these individuals
4. A life experience that provides satisfactions. Throughout life, people encounter many
frustrations. People deal with these better if enough satisfying experiences have
occurred to counterbalance the frustrating ones.

MASLOWS HEIRARCHY OF NEEDS

Maslow's hierarchy of needs is an idea in psychology proposed by American Abraham

Maslow in his 1943.

 Physiological needs. Needs such as air, food, water, shelter, rest, sleep, activity, and
temperature maintenance are crucial for survival.
 Safety and security needs. The need for safety has both physical and psychological
aspects. The person needs to feel safe, both in the physical environment and in
relationships.
 Love and belonging needs. The third level of needs includes giving and receiving
affection, attaining a place in a group, and maintaining the feeling of belonging.
 Self-esteem needs. The individual needs both self-esteem (i.e., feelings of
independence, competence, and self-respect) and esteem from others (i.e., recognition,
respect, and appreciation). 
 Self-actualization. When the need for self-esteem is satisfied, the  individual strives for
self-actualization, the innate need to develop one’s maximum potential and realize one’s
abilities and qualities.

Criteria of mentally healthy person

❖ Positive attitude

❖ Conscious of his actions 

❖ Acceptance of himself

❖ Sense of identity
❖ Changes & grows throughout life

❖ Acts in a unified manner

Two needs that are fulfilled by the mentally healthy person (William Glasser)
The need:
1.to be love and be loved and 
2.the need to feel that one is worthwhile to self and to others. a person fulfills these needs by
doing that which is realistic, responsible and right.
 Health- is a fundamental right of every human being. It is a state of integration of body
and mind.  Man moves from the health spectrum to the illness spectrum. Some people 
think of themselves as healthy and well if they are not ill and ill if they are not well. 
However, there is no exact point at which health ends and illness begins as both are relative in
nature.
- is the ability to maintain homeostasis or dynamic equilibrium. (Walter Cannon)
- is being well and using one’s power to the fullest extent and is maintained through
prevention of disease via environmental factors. (Nightingale)
- is viewed in terms of individual’s ability to perform 14 components of nursing care
unaided. (V.Henderson) Terms
Health- World Health Organization (WHO) in 1948- Is a state of complete physical, mental and
social well-being, and not merely the absence of disease or infirmity.
- a multidimensional concept that includes different interdependent an interrelated aspects
of; social health, well-being, mental health
physical health
       Wellness- is a state of well-being.
     Well-being - a subjective perception of vitality and feeling well can 15 be described 
objectively, experienced, and measured and can be plotted on a continuum
- a component of health.
 Disease- objective dysfunction or alteration in functioning.
 Illness- subjective dysfunction or alteration in functioning or the human experience of
disease.
 
Components of wellness
1.Environmental. The ability to promote health measures that improve the standard of living
and quality of life in the community.
This includes influences such as food, water, and air.
2.Social. The ability to interact successfully with people and within the environment of which
each person is a part, to develop and maintain intimacy with significant others, and to develop
respect and tolerance for those with different opinions and beliefs.
3.Emotional. The ability to manage stress and to express emotions appropriately. Emotional
wellness involves the ability to recognize, accept, and express feelings and to accept one’s
limitations.
4.Physical. The ability to carry out daily tasks, achieve fitness (e.g., 17 pulmonary,  
cardiovascular, gastrointestinal), maintain adequate nutrition and proper  body fat, avoid
abusing drugs and alcohol or using tobacco products, and  generally practice positive lifestyle
habits.
Components of wellness
5.Spiritual. The belief in some force (nature, science, religion, or a higher power) that serves to
unite human beings and provide meaning and purpose to life. It  includes a person’s own
morals, values, and ethics. 
6.Intellectual. The ability to learn and use information effectively for personal, family, and
career  development. Intellectual wellness involves striving for continued growth and learning to 
deal with new challenges effectively.
7.Occupational. The ability to achieve a balance between work and leisure time. A person’s
beliefs  about education, employment, and home influence personal satisfaction and 
relationships with others.

Models of Health and Wellness

 Clinical Model
The narrowest interpretation of health occurs in the clinical model. People are viewed as
physiological systems with related functions, and health is identified by the absence of signs
and symptoms of disease or injury. It is considered the state of not being “sick.” In this model,
the opposite of health is disease or injury.

Role Performance Model

Health is defined in terms of an individual’s ability to fulfill societal roles, that is, to
perform his or her work. People usually fulfill several roles (e.g., mother, daughter, friend), and
certain individuals may consider non work roles the most important ones in their lives
Adaptive Model
In the adaptive model, health is a creative process; disease is a failure in adaptation, or
maladaptation. The aim of treatment is to restore the ability of the person to adapt, that is, to
cope. According to this model, extreme good health is flexible adaptation to the environment
and interaction with the environment to maximum advantage

Models of Health and Wellness

Eudaimonistic Model
The Eudaimonistic model incorporates a comprehensive view of health. Health is seen as a
condition of actualization or realization of a person’s potential. Actualization is the apex of the
fully developed personality, described by Abraham Maslow In this model the highest aspiration
of people is fulfillment and complete development, which is actualization. Illness, in this model,
is a condition that prevents self-actualization

Agent–Host–Environment Model
The agent–host–environment model of health and illness, also called the ecologic
model, originated in the community health work of Leavell and Clark (1965) and has been
expanded into a general theory of the multiple causes of disease. The model is used primarily in
predicting illness rather than in promoting wellness, although identification of risk factors that
result from the interactions of agent, host, and environment are helpful in promoting and
maintaining health.

A.H.E.M. Three dynamic interactive elements

1.Agent. Any environmental factor or stressors (biologic, chemical, mechanical, physical, or
psychosocial) that by its presence or absence 
(e.g., lack of essential nutrients) can lead to illness or disease
2. Host. Person(s). who may or may not be at risk of acquiring a 
disease. Family history, age, and lifestyle habits influence the host’s 21 reaction.
3. Environment. All factors external to the host that may or may not predispose the person to
the development of disease. Physical environment includes climate, living conditions, sound
(noise) levels, and economic level. Social environment includes interactions with others and life
events, such as the death of a spouse.
 Health–Illness Continua
Health–illness continua (grids or graduated scales) can be used to measure a person’s
perceived level of wellness. Health and illness or disease can be viewed as the opposite ends of
a health continuum

DUNN’S HIGH-LEVEL WELLNESS GRID

Dunn (1959) described a health grid in which a health axis and an environmental axis
intersect. The grid demonstrates the interaction of the environment with the illness–wellness
continuum. The health axis extends from peak wellness to death, and the environmental axis
extends from  very favorable to very unfavorable. The intersection of the two axes forms four
quadrants of health and wellness:

DUNN’S HIGH-LEVEL WELLNESS GRID

1.High-level wellness in a favorable environment. An example is a person who implements

healthy lifestyle behaviors and has the biopsychosocial, spiritual, and economic resources to
support this lifestyle.
2.Emergent high-level wellness in an unfavorable environment. An example is a woman
who has the  knowledge to implement healthy lifestyle practices but does not implement
adequate self-care practices because of family responsibilities, job demands, or other 
factors.
3.Protected poor health in a favorable environment. An example is an ill person (e.g., one
with multiple fractures or severe hypertension) whose needs are met by the health care system
and who has access to appropriate medications, diet, and health care instruction.
4.Poor health in an unfavorable environment. An example is a young child who is starving in
a drought- stricken country.

DIFFERENTIATES  HEALTH STATUS, BELIEFS, AND PRACTICES

1. Health status. State of health of an individual at a given time. A report of health status
may include anxiety, depression, or acute illness and thus describe the individual’s
 problem in general. Health status can also describe such specifics as pulse rate and
body temperature.
2. Health beliefs. Concepts about health that an individual believes are true. Such beliefs
may or may not be founded on fact. Some of these are influenced by culture, such as
the “hot–cold” system of some Hispanic Americans. In this system, health is viewed as a
balance of hot and cold qualities within a person. Citrus fruits and some fowl are
considered cold foods, and meats and bread are hot foods
3. Health behaviors. The actions people take to understand their health state, maintain an
optimal state of health, prevent illness and injury, and reach their maximum physical and
mental potential. Behaviors such as eating wisely, exercising, paying attention to signs
of illness, following treatment advice, avoiding known health hazards such as smoking,
taking time for rest and relaxation, and managing one’s time effectively are all examples.

VARIABLES INFLUENCING HEALTH STATUS, BELIEFS, AND PRACTICES

1. Internal Variables- include biologic, psychological, and cognitive    dimensions. They
are often described as non-modifiable variables because, for the most part, they cannot
be changed.
2. BIOLOGIC DIMENSION- Genetic makeup, sex, age, and developmental level all
significantly influence a person’s health.
3. PSYCHOLOGICAL DIMENSION- Psychological (emotional) factors  influencing health
include mind–body interactions and self- concept
4. COGNITIVE DIMENSION- Cognitive or intellectual factors influencing health include
lifestyle choices and spiritual and religious beliefs.
5. External Variables- include the physical environment, standards of living, family and
cultural beliefs, and social support networks.
6. External Variables- include the physical environment, standards of living, family and
cultural beliefs, and social support networks.
7. STANDARDS OF LIVING- An individual’s standard of living (reflecting occupation,
income, and  education) is related to health, morbidity, and mortality. Hygiene, food 
habits, and the ability to seek health care advice and follow health  regimens vary among
high-income and low-income groups.
8. FAMILY AND CULTURAL BELIEFS- family passes on patterns of daily living an
lifestyles to offspring. Eg., a man who was abused as a child may physically abuse his
own  children. Physical or emotional abuse may  cause long-term health  problems.
 9. SOCIAL SUPPORT NETWORKS- Having a support network (family, friends, or a
confidant) a job satisfaction helps people avoid  illness. Support persons  also help the
individual confirm that illness exists.   
10. ENVIRONMENT- Geographic location determines climate, and    climate affects  health.
For instance, malaria and malaria-related    conditions  occur more frequently in tropical
rather than temperate   climates.

ILLNESS AND DISEASE

 Illness is a highly personal state in which the person’s physical, emotional, intellectual,
social, developmental, or spiritual functioning is thought to be diminished.
 Disease can be described as an alteration in body functions resulting in a reduction of
capacities or a shortening of the normal life span.
 Etiology is the causation of a disease or condition.

Classification of Illness and Disease

1.Acute illness is typically characterized by symptoms of relatively short duration, the
symptoms often
 appear abruptly and subside quickly and depending on the cause, may or may not require
intervention by health care professionals
2.Chronic illness is one that lasts for an extended period, usually 6 months or longer, and often
for the person’s life. Chronic illnesses usually have a slow onset and often have periods of
remission, when the symptoms disappear, and exacerbation, when the symptoms reappear.
-Illness behavior- a coping mechanism, involves ways individuals
describe, monitor, and interpret. their symptoms, take remedial actions,
and use the health care system
Illness Behaviors
Parsons (1979) four aspects of the sick role
Rights:
1. Clients are not held responsible for their condition. Even if the illness was partially
caused by an individual’s behavior (e.g., lung cancer from smoking), the individual is not
capable of reversing the condition on his or her own.
2. Clients are excused from certain social roles and tasks. E.g, an ill parent would not be
expected to prepare meals for the family. 
Obligations:
3. Clients are obliged to try to get well as quickly as possible. The ill person should follow
legitimate advice regarding a specialized diet or activity restrictions that could help with
recovery.
4. Clients or their families are obliged to seek competent help. E.g, the ill person should
contact the primary care provider rather than relying solely on his or her own ideas of how to
recover.
Suchman (1979) Five stages of illness
STAGE 1: SYMPTOM EXPERIENCES
At this stage the person comes to believe something is wrong. Either someone
significant mentions that the person looks unwell, or the person experiences some symptoms
such as pain, rash, cough, fever,or bleeding. The unwell person usually consults others about
the symptoms or feelings, validating with support people that the symptoms are real. At this
stage the sick person may try home remedies.

Suchman (1979) Five stages of illness

STAGE 1:THREE ASPECTS
1.The physical experience of symptoms
2.The cognitive aspect (the interpretation of the symptoms in terms that have some meaning to
the person)
3.The emotional response (e.g., fear or anxiety).

STAGE 2: ASSUMPTION OF THE SICK ROLE

The individual now accepts the sick role and seeks confirmation from family and friends.
Often people continue with self-treatment and delay contact with health care professionals as
long as possible. Stage 1 three aspects, at this stage people may be excused from normal
duties and role expectations. When symptoms of illness persist or increase, the person is
motivated to seek professional help

STAGE 3: MEDICAL CARE CONTACT

Sick people seek the advice of a health professional either on their own initiative or at
the urging of significant others. When people seek professional advice
Three types of information should be obtained
1.Validation of real illness
2.Explanation of the symptoms in understandable terms
3.Reassurance that they will be all right or prediction of what the outcome will be

STAGE 4: DEPENDENT CLIENT ROLE

After accepting the illness and seeking treatment, the client becomes dependent on the
professional for help. People vary greatly in the degree of ease with which they can give up their
independence, particularly in relation to life and death. Role obligations—such as those of wage
earner, parent, student, sports team member, or choir member, complicate the decision to give
up independence.

STAGE 5: RECOVERY OR REHABILITATION

During this stage the client is expected to relinquish the dependent role and resume former
roles and responsibilities

2. HEALTH CARE DELIVERY SYSTEM

- is the totality of services offered by all health disciplines. the major purpose of a health
care system was to provide care to people who were ill or injured.

Primary health care -focuses on improved health outcomes for an entire population. It
includes primary care and health education, proper nutrition, maternal/child health care, family
planning, immunizations, and control of diseases.

TYPES OF HEALTH CARE SERVICES

Secondary Prevention: Diagnosis and Treatment
-The largest segment of health care services was dedicated to the diagnosis and
treatment of illness. Hospitals and physicians’ offices have been the major agencies offering
these complex secondary prevention services. Also included as a health promotion service is
early detection of disease. Eg; early detection services include regular dental exams from
childhood throughout life and bone density studies for women at menopause to evaluate for
early osteoporosis.
Tertiary Prevention: Rehabilitation, Health Restoration, and Palliative Care

GOAL
1.Tertiary prevention is to help people move to their previous level of health (i.e., to their
previous capabilities) 
2.The highest level they are capable of given their current health status

TYPES OF HEALTH CARE SERVICES

(a)Primary prevention-  consists of health promotion and illness prevention
(b)Secondary prevention- consists of diagnosis and treatment
(c)Tertiary prevention- consists of rehabilitation, health restoration, and palliative care.

Primary Prevention: Health Promotion and Illness Prevention GOALS:

1. Increase quality and years of healthy life
2. Achieve health equity and eliminate health disparities
3. Create healthy environments for everyone
4. Promote health and quality life across the life span
-Primary prevention programs address areas such as adequate and proper nutrition,
weight control and exercise, and stress reduction. Health promotion activities emphasize the
important role clients play in maintaining their own health and encourage them to maintain the
highest level of wellness they can achieve.

TYPES OF HEALTH CARE SERVICES

Tertiary Prevention: Rehabilitation, Health Restoration, and Palliative  Care

-Rehabilitative care emphasizes the importance of assisting clients to function
adequately in the physical, mental, social, economic, and vocational areas of their lives.
Rehabilitation may begin in the hospital, but will eventually lead clients back into the community
for further treatment and follow-up once health has been restored.

TYPES OF HEALTH CARE AGENCIES AND SERVICES

1. Hospital- provide acute inpatient services, outpatient clinic or ambulatory care services,
and emergency department services.
2. Hospice services- the hospice movement subsumes a variety of services given to
clients who are terminally ill, their families, and support persons.

3. Public Health- Government (official) agencies are established at the local, state, and
federal levels to provide public health services. Local health departments are responsible for
developing programs to meet the health needs of the people, providing the necessary nursing
and other staff and facilities to carry out these programs, continually evaluating the
effectiveness of the programs, and monitoring changing needs.

❖R.A, 1082  “RURAL HEALTH ACT” 

❖Implemented in 1953

❖Called for the employment of RHU personnel (physicians, dentists, nurses, midwives, sanitary
inspectors)

❖RHU personnel are assigned in barrios to help alleviate their  health conditions especially on
preventable diseases

4. Ambulatory care centers- are used in many communities. Most ambulatory care
centers have diagnostic and treatment facilities that provide medical, nursing, laboratory, and
radiologic services, and they may or may not be associated with an acute care hospital.  The
term ambulatory care center has replaced the term clinic
5. Occupational Health Clinics- The industrial (occupational) clinic is gaining importance
as a setting for employee health care. Today, more companies recognize the value of healthy
employees and encourage healthy lifestyles by providing exercise facilities and 
coordinating health promotion activities.
6. Extended (Long-Term) Care Facilities- Extended care facilities, formerly called nursing
homes, are now often multilevel campuses that include independent living quarters for seniors,
assisted living facilities, skilled nursing facilities (intermediate care), and extended care (long-
term care) facilities that provide levels of personal care for those who are chronically ill or are
unable to care for themselves without assistance
7. Retirement and Assisted Living Centers- Retirement or assisted living centers consist
of separate houses, condominiums, or apartments for residents. Residents live relatively
independently; however, many of  these facilities offer meals, laundry services, nursing care,
transportation, and social activities. Some centers have an affiliated hospital to care for
residents with short-term or long-term illnesses. Often these centers also work collaboratively
with other community services including case managers, social services, and a hospice agency
to meet the needs of the residents who live there. The retirement or assisted living center is
intended to meet the needs of people who are unable to remain at home but do not require
hospital or nursing home care. Nurses in retirement and assisted living centers provide limited
care to residents, usually related to the administration of medications and minor treatments, but
conduct significant care coordination and health promotion activities 
8. Rehabilitation centers- usually are independent community centers or special units,
play an important role in assisting clients to restore their health and recuperate.
9. Day Care Centers- provide care for infants and children while parents work, or provide
care and nutrition for adults who cannot be left at home alone but do not need to be in an
institution, provide care involving socializing, exercise programs, and stimulation.
10. Rural Care- provide emergency care to clients in rural areas; to continue to make
available primary care access and improve emergency care for rural residents
11.Crisis Centers- provide emergency services to clients experiencing life crises.

PROVIDERS OF HEALTH CARE

1. Nurse-The role of the nurse varies with the needs of the client, the nurse’s credentials,
and the type of employment setting. An RN assesses a client’s health status, identifies health
problems, and develops and coordinates care. Licensed vocational nurse (LVN), in some states
known as a licensed practical nurse (LPN), provides direct client care under the direction of an
RN, physician, or other licensed practitioner. Advanced practice registered nurses (APRN’s)
provide direct client care as NPs, nurse midwives, certified registered nurse anesthetists, and
clinical nurse specialists
2. Alternative (Complementary) Care Provider Alternative or complementary health
care -refers to those practices not commonly considered part of Western medicine.
Chiropractors, herbalists, acupuncturists, massage therapists, reflexologists, holistic health 
healers, and other health care providers
3. Case Manager- The case manager’s role is to ensure that clients receive fiscally sound,
appropriate care in the best setting.
4. Dentist- Dentists diagnose and treat mouth, jaw, and dental problems.
5. Dietitian or Nutritionist- A dietitian has special knowledge about the diets required to
maintain health and to treat disease.
6. Emergency Medical Personnel Providers are associated with ambulance
or emergency medical services agencies (e.g., fire departments) that provide first-responder
care in the community.
7. Occupational Therapist. An occupational therapist (OT) assists clients with impaired
function to gain the skills to perform activities of daily living
8.Paramedical Technologist- Laboratory technologists, radiologic technologists, and nuclear
medicine technologists are just three kinds of paramedical technologists in the expanding field
of medical technology. 
 Paramedical means having some connection with medicine.
 Laboratory technologists examine specimens such as urine, feces,
blood, and discharges from wounds to provide exact information that
facilitates the medical diagnosis and the prescription of a therapeutic
regimen.
 The radiologic technologist assists with a wide variety of x-ray film
procedures, from simple chest radiography to more complex fluoroscopy.
 The nuclear medicine technologist uses radioactive substances to
provide diagnostic information and can administer radioactive materials
as part of a therapeutic regimen.
9. Pharmacist- A pharmacist prepares and dispenses pharmaceuticals in hospital and
community settings. The role of the pharmacist in monitoring and evaluating the actions and
effects of medications on clients. A clinical pharmacist is a specialist who guides primary care
providers in prescribing medications, work directly with clients and with other health care team
members to ensure safe integration of medications into the client’s
10. Physical Therapist- The licensed physical therapist (PT) assists clients with
musculoskeletal problems. Physical therapists treat movement dysfunctions by means of heat,
water, exercise, massage, and electric current. The functions of a PT include assessing client
mobility and strength, providing therapeutic measures (e.g., exercises and heat applications to
improve mobility and strength), and teaching new skills (e.g., how to walk with an artificial leg)
11.Physician- The physician is responsible for medical diagnosis and for determining the
therapy required by a person who has a disease or injury. The physician’s role has traditionally
been the treatment of disease and trauma (injury); however, many physicians include health
promotion and disease prevention in their practice

12. Podiatrist- Doctors of podiatric medicine (DPM) diagnose and treat foot and ankle
conditions. They are licensed to perform surgery and prescribe 
medications.
13. Respiratory Therapist- A respiratory therapist is skilled in therapeutic measures used in
the care of clients with respiratory problems.
14. Social Worker- A social worker counsels clients and their support persons regarding
problems such as finances, marital difficulties, and adoption of children. They are particularly
familiar with both public and private resources available to clients according to their
socioeconomic qualifications.
15. Spiritual Support Personnel- Chaplains, pastors, rabbis, priests, and other religious or
spiritual advisers serve as part of the health care team by attending to the spiritual needs of
clients
16. Unlicensed Assistive Personnel- Unlicensed assistive personnel (UAPs) are health
care staff who assume delegated aspects of basic client care. These tasks include bathing,
assisting with feeding, and collecting specimens

 FACTORS AFFECTING HEALTH CARE DELIVERY

1. Increasing Number of Older Adults

2. Advances in Technology
3. Economics
4. Women’s Health
5. Uneven Distribution of Services
6. Access to Health Insurance
7. The Homeless and the Poor
8. Health Insurance Portability and Accountability Act
9. Demographic Changes

B. CONCEPT OF NURSING
Nursing as a Profession, an Art & a Science
What is Nursing?
 Florence Nightingale- the act of utilizing the environment of the    patient to assist him
in his recovery
 Virginia Henderson- The unique function of the nurse is to assist the individual, sick or
well, in the performance of those activities  contributing to health or its recovery (or to
peaceful death) that he would perform unaided if he had the necessary strength, will, or
knowledge, and to do this in such a way as to help him gain independence as rapidly as
possible
Other definitions;
 Nursing is caring. Nursing is an art. Nursing is a science. Nursing is client centered.
 Nursing is holistic. Nursing is adaptive. Nursing is concerned with health promotion,
health maintenance, and health restoration. Nursing is a helping profession

SCOPE OF NURSING
1.PROMOTING HEALTH AND WELLNESS-enhance healthy lifestyles such as improving
nutrition & physical  fitness, preventing alcohol & drug abuse, preventing accidents & injury in
the home or workplace.
2.PREVENTING ILLNESS-immunization, prenatal & infant care
3.RESTORING HEALTH-early detection of disease to through helping the client during 
recovery period. e.g. giving medication, baths, BP taking, other treatment & procedures.
4.PAIN/SUFFERING-relief from pain & provide comfort patient
5.CARING FOR THE DYING-creation of spiritual environment Nurses provide care for three
types of clients: 
1. individuals
2. families
3. communities
ROLES AND FUNCTIONS OF THE NURSE
 Caregiver
o The caregiver role has traditionally included those activities that assist the client
physically and psychologically while preserving the client’s dignity.
 Communicator
o Nurses identify client problems and then communicate these verbally or in writing
to other members of the health care team
 Teacher
o The nurse helps clients learn about their health and the health care procedures
they need to perform to restore or maintain their health
 Client Advocate
o A client advocate acts to protect the client, the nurse may represent the client’s
needs and wishes to other health professionals, such as relaying the client’s
request for information to the health care provider, also assist clients in
exercising their rights and help them speak up for themselves.

ROLES AND FUNCTIONS OF THE NURSE

o Counselor
Counseling is the process of helping a client to recognize and cope with stressful
psychological or social problems, to develop improved interpersonal relationships, and to
promote personal growth.
o Change Agent
  Assisting clients to make modifications in their behavior, act to make changes in a
system, such as clinical care, if it is not helping a client 
return to health.
o Leader
A leader influences others to work together to accomplish a specific goal.
o Manager
The nurse manages the nursing care of individuals, families, and communities. The
nurse manager also delegates nursing activities to ancillary workers and other nurses, and
supervises and evaluates their performance.
ROLES AND FUNCTIONS OF THE NURSE
o Case Manager
Nurse case managers work with the multidisciplinary health care team to measure the
effectiveness of the case management plan and to monitor outcomes
o Research Consumer
Nurses often use research to improve client care. In a clinical area, nurses need to 
(a) have some awareness of the process and language of research
(b) be sensitive to issues related to protecting the rights of human 
Subjects.
(c) participate in the identification of significant researchable problems
(d) be a discriminating consumer of research findings

ROLES AND FUNCTIONS OF THE NURSE

Expanded Career Roles
Nurses are fulfilling expanded career roles, such as those of NP, clinical nurse specialist,
nurse midwife, nurse educator, nurse researcher, and nurse anesthetist, all of which allow
greater independence and autonomy
Expanded Career Roles for Nurses
o NURSE PRACTITIONER
nurse practitioner (NP) has an advanced education and is a graduate of a nurse
practitioner program
o CLINICAL NURSE SPECIALIST
A clinical nurse specialist has an advanced degree or expertise and is
considered to be an expert in a specialized area of practice (e.g., gerontology,
oncology).
o NURSE ANESTHETIST
A nurse anesthetist has completed advanced education in an accredited program
in anesthesiology. The nurse anesthetist carries out preoperative visits and
assessments, and administers general anesthetics for surgery under the supervision of a
physician prepared in anesthesiology. The nurse anesthetist also assesses the
postoperative status of clients.
 o NURSE MIDWIFE
A nurse midwife has completed a program in midwifery and is certified in
midwifery  nurse midwife gives prenatal and postnatal care and manages deliveries in
normal pregnancies.
o NURSE RESEARCHER
Nurse researchers investigate nursing problems to improve nursing care 
and to refine and expand nursing knowledge. Expanded Career Roles for Nurses
o NURSE ADMINISTRATOR
The nurse administrator manages client care, including the delivery of 53
nursing services, a middle management position, such as head nurse or supervisor, or a
more senior management position, such as director of nursing services, functions of
nurse administrators include budgeting, staffing, and planning programs.
o NURSE EDUCATOR
Nurse educators are employed in nursing programs, at educational institutions,
and in hospital staff education. The nurse educator usually has a baccalaureate degree
or more advanced preparation and frequently has expertise in a particular area of
practice. The nurse educator is responsible for classroom and, often, clinical teaching.

o NURSE ENTREPRENEUR
A nurse entrepreneur usually has an advanced degree and manages a health-related
business

CHAPTER 2 NURSING AS A PROFESSION

A profession has been defined as an occupation that requires extensive education or a
calling that requires special knowledge, skill, and preparation.
    
CRITERIA OF A PROFESSION
1.Its requirement of prolonged, specialized training to acquire a body of knowledge pertinent to
the role to be performed
2. An orientation of the individual toward service, either to a community or to an organization
ongoing research
3.A code of ethics
4.Autonomy
5.A professional organization
o Professionalism refers to professional character, spirit, or methods. It is a set of
attributes, a way of life that implies responsibility and commitment
o Professionalization is the process of becoming professional, that is, of acquiring
characteristics considered to be professional.
Personal Qualifications of a Nurse
A.Philosophy of Life- every person must develop a personal philosophy of life and plan for
expanding his personal life
B.Good Personality – consists of the individual qualities that differentiate one person from the
other.
Components:
1. Personal Appearance
a. posture
b. grooming
c. dress and uniform- “the nurse uniform and cup”( wear it with respect and dignity)
2. Character- “The Nurse is Basically A Good Person”
3. Attitude- manner of acting, thinking or feeling that is indicated by ones response toward
another person, situation or experience
Eight ( 8 )Be-Attitudes of a Nurse
o Acceptance
o Helpfulness
o Friendliness
o Firmness
o Permissive
o Limit setting
o Sincerity
o Competence
4. Charm- to influence the senses or the mind by some quality or attraction.” to acquire
charm, one needs to cultivate the ff.”
a. Voice
b. Manner
c. Heart
d. Intelligence
 e. Poise
o Calmness & composure

- Face reality

- Avoid emotional flare-ups.

o Control of temper
-think before acting

- Avoid verbal & physical aggressiveness

Qualities and Abilities of a  Professional Nurse 

1. Has faith in the fundamental values that  underlie the democratic way of life:
o Respect for human dignity
o Self-sacrifice for the common good.
o Strong sense of responsibility for  sharing in the solution of the problems  of
the society.
2. Has a sense of responsibility for  understanding those with whom he works  or
associates with through the use of skills like working effectively through therapeutic relationship.
3 .Has the basic knowledge, skills and attitudes necessary  to address present day social
problems, realistic and  well organized thoughts through the use of critical  thinking
4. Has skills in using written and spoken language, both to  develop own thoughts and to
communicate them to  others.
5. Appreciates and understands importance of good health
6. Has emotional balance.
7. Accepts and tries to understand people of all sorts, regardless of race, religion and color.
8. Likes hard work and possesses a capacity for it
9. Appreciates high standard of workmanship
10. Knows nursing so thoroughly that every client will receive EXCELLENT CARE.
 
Benner’s Stages of Nursing Expertise
STAGE I: NOVICE
 No experience (e.g., nursing student). Performance is limited, inflexible, and governed
by context-free rules and regulations rather experience.

STAGE II: ADVANCED BEGINNER

Demonstrates marginally acceptable performance. Recognizes the meaningful “aspects”
of a real situation. Has experienced enough real situations to make judgments about them.
STAGE III: COMPETENT
Has 2 or 3 years of experience. Demonstrates organizational and planning abilities.
Differentiates important factors from less important aspects of care. Coordinates multiple
complex care demands.
STAGE IV: PROFICIENT
Has 3 to 5 years of experience. Perceives situations as wholes rather than in terms of
parts, as in Stage II. Uses maxims as guides for what to consider in a situation. Has holistic
understanding of the client, which improves decision making. Focuses on long-term goals.
Benner’s Stages of Nursing Expertise
STAGE V: EXPERT
Performance is fluid, flexible, and highly proficient; no longer requires rules, guidelines,
or maxims to connect an understanding of the situation to appropriate action. Demonstrates
highly skilled intuitive and analytic ability in new situations. Is inclined to take a certain 
action because “it felt right.”

FIELDS OF NURSING
A. A. Nursing in Primary Care Setting
1.Primary- initial health care for general complaints
2.Usually the person’s 1st contact with the health care  delivery system
3.Managing current health care needs, and preventing  further problems.
o Public/community health nursing
o Occupational nursing/industrial nursing Clinic nursing
o Clinic nursing
B. Nursing in Primary Care Setting School nursing
o Private duty nursing
o Military nursing
o Ambulatory care nursing
 o Nursing in correctional facilities
C. Nursing in Secondary Care Setting 
         1.Institutional nursing: Hospital nursing
o Director of nursing
o Clinical coordinator
o Head nurse 
o Staff nurse (OB-Gyne nursing, Pediatric nursing, Orthopedic   nursing, OR
nursing, Med surgical nursing, Psychiatric nursing, ER nursing, Critical care
nursing)
o Flight nurse
o Infection-surveillance nurse
D. Nursing in Tertiary Care Setting
1. Skilled care setting
2. Rehabilitation setting
3. Advanced practice nursing  (APN)
o Clinical nurse specialist
o Nurse anesthetist
o Nurse educator
o Nurse administrator
o Nurse researcher

Types of Nursing Interventions

1.Independent or nurse-initiated interventions
These can solve the client’s problems without consultation & collaboration with
physicians or other health care professionals. (giving health-teachings on effect of smoking &
alcohol abuse).
2. Dependent or physician-initiated intervention
The nurse intervenes by carrying out physician’s  written orders, but requires nursing
judgment or  decision making. (administering antibiotics to the client)
3. Interdependent or collaborative intervention
Are therapies that require the knowledge, skill & expertise of multiple health care
professionals. E.g. assisting client in walking using crutches after conferring with the physical
therapist.
 HISTORY OF NURSING INTUITIVE PERIOD
❖ Prehistoric Early Christian Era
▪ More on intuition
▪ NOMADS – travel from one place to  another
✔Survival of the fittest

✔Best for the most” – motto

▪  Sickness is due to “voodoo”
▪ Performed out of feeling of compassion for others
▪ Performed out of desire to help
▪ Performed out of wish to do good
▪ Nursing is given by the women – plays  subservient or dependent role
▪ SHAMAN – uses white magic to  counteract the black magic
 
HISTORY OF NURSING
Intuitive Period
 Rise in Civilization
1 .From the mode of Nomadic life, agrarian  society, gradual development of urban
community life.  Start of scientific knowledge more  complex life, increase in health  problems
demand for more nurses.
2. Nursing as a duty of SLAVES and WIVES.  NURSING DID NOT CHANGE but there 
was  progress in the practice of Medicine.
3. Care of the sick was still closely allied with  superstitions, religion in Near East (Judaism,
Christianity, Islam) and magic. Near East culture was adopted by Greek & Romans combining
to Far East wonders , it was improved & carried to Europe resulted to greater knowledge  then
to the new world by the early settlers. The birth of Monotheism (believer of one God).

HISTORY OF NURSING
 BABYLONIANS - CODE OF HAMMURABI
  1st recording on the medical practice. Established the medical fees, discouraged
experimentation. Right of patient to choose treatment between the use of charms,
medicine, or surgical  procedure.
 EGYPTIANS - ART OF EMBALMING
 Mummification by removing the internal organs of the dead body through instillation of
herbs and salt to the dead. Used to enhance their knowledge of the human  anatomy.
 HEBREW – MOSES Teachings: 
 Father of sanitation. Practice the values of “Hospitality to  strangers” and the “Act of
Charity”. Laws controlling the spread of communicable  diseases
 CHINA - Use of pharmacologic drugs “MATERIA MEDICA”. Use of wax to preserve
the body of  the dead.
 INDIA–SUSHURUTO. 1st recording on the nursing practice. There was proficient
practice of  Medicine and Surgery, but also decline in medical  practice due to fall of
Buddhism religion.
 GREECE – AESCULAPUS. Father of medicine in Greek mythology
 HIPPOCRATES - Father of modern medicine
 CADUCEUS - Insignia of medicine. Composed of staff of travelers intertwined with  2
serpent (the symbol of Aesculapius and his  healing power). At the apex of the staff are
two  wings of Hermes (Mercury) for speed. NURSES – untrained slaves
 ROMANS – FABIOLA. A Matrons converted to Christianity and used her wealth (the
forerunner of hospitals) for the sick, poor. and the homeless. The 1st hospital in the
Christian world.
 APPRENTICE PERIOD
•11th century 1836. when the deaconesses School of Nursing was established in 
Kaiserswerth, Germany by Pastor  Theodore Fleidner
•An On-the-job training period. Refers to a beginner were care performed  by people
who are directed by more  experienced nurses. During the Crusade in this period, it  happened
as an attempt to recapture the  Holy Land from the Turk who obtained and  gain control of the
region as a result of  power struggle. Christians were divided  due to several religious war and
Christians  were denied visit to The Holy Sepulcher.
 Military Religious Orders  and Their Works
▪ Knights of St. John of  Jerusalem (Italian) - Also called as “Knights of the
Hospitalers”established to give care.
▪ Teutonic Knights (German) - Took subsequent wars in the Holy Land. Cared for the injured
and established  hospitals in the military camps.
▪ Knights of St. Lazarus - Care for those who suffered Leprosy,  syphilis, and chronic diseases
▪ ALEXIAN BROTHERS - A monasteric order founded in 1348. They established the Alexian
Brothers School of Nursing, the largest School under  religious auspices exclusively in US and it
closed down in 1969.
 
HISTORY OF NURSING THE DARK PERIOD OF NURSING
 From 17th century – 19th century,. Also called the Period Of Reformation until the
American Civil War Hospitals were closed. Nursing were the works of the least
desirable  people (criminals, prostitutes, drunkards, slaves,  and opportunists) Nurses
were uneducated, filthy, harsh, ill-fed,  overworked. They worked seven days a week,
slept in cubbyhole near hospital ward or patient. These women personified in a Charles
Dickens novel as Sairy Gamp, a negative image of nurses.
 The American Civil War was led by Martin Luther,  the war was a religious upheaval
that resulted to  the destruction in the unity of Christians.

Nursing in America
 The Nurse’s Society of Philadelphia - organized a school of nursing under the
direction of Dr. Joseph Warrington in 1839. 
Nurses were trained on the job and attended some preparatory courses.
 Women’s Hospital in Philadelphia – established six-month course in nursing.
 Dorothea Lynde Dix – established the Nurse Corps of the 
United States Army. She directed the nursing of the injured.
 Clara Barton – founded the American Red Cross

EDUCATIVE PERIOD
 Began on June 15, 1860 when the Florence Nightingale School of Nursing opened at
St. Thomas Hospital in London England, where 1st program for formal education of
nurses began and contributed growth of nursing in the U.S.
•About FLORENCE NIGHTINGALE
•Recognized as “Mother of Modern Nursing”; she was also known as  the “Lady with the
Lamp”
 •Born on May 12, 1820 in Florence, Italy. Raised in England in an atmosphere of culture
& affluence. Her education was rounded out by a continental tour.
•She developed her self-appointed goal: “To change the      profile of nursing”.
Advocated for care of those afflicted      with diseases cause by hygienic practices. 
•At the age of 31, she entered the Deaconess School at   Kaiserworth..
•Led the nurses  took  care the wounded during the Crimean war. And, reduced the
casualties of war by 42% to 2% by improving the sanitation techniques in the military barracks.

Other important persons, groups during this period

 Linda Richards – the first graduate  nurse in US. Graduated in September 1,  1873.
 Dr. William Halstead – designed the first rubber gloves
 Caroline Hampton Robb – the first nurse to wear the rubber  gloves working as an
operating nurse.
American Nurses Association & National League for Nursing
     Education – a nursing organization that contributes to the uplift of nursing profession.

HISTORY OF NURSING CONTEMPORARY PERIOD

• The period after World War II to the present.
• World health Organization (WHO) was established by the U.N. to assist in fighting
disease by providing health promotion and improving nutrition, living standards, and
environmental conditions of all people.
• Use of sophisticated equipment for diagnosis
• Utilization of computers for collecting data
• Colonel Pearl Tucker developed a comprehensive
• One-year course to prepare nurses for aero • Space at Cape Kennedy.
• Nursing Is offered in colleges & Universities

HISTORY OF NURSING FACTORS AFFECTING NURSING  TODAY

a.Health Care Reforms – health care delivery system
b.Consumer’s Demand – people believe that health is a right of all 
people, not just a privilege of the rich. Everyone is responsible for their own health. (physical
examination)
c.Family Structure – increasing number of family members influencing 
the need for nursing services.
d.Information and Telecommunications – nurses will need to expand 
their knowledge base and technical skills as they adapt to meet the needs of clients.
e.Legislation – emphasizes clients right to accept or refuse medical 78 care.
 
History of Nursing in the PHILIPPINE
EARLY CARE OF THE SICK
•HERBICHEROS – herbmen who  practice witchcraft
•MANGKUKULAM / MANGANGAWAY –  a person suffering from disease without  any identified
cause and were believed  bewitched by such
•Difficult child birth and some diseases  attributed to (NONO) midwives
•Difficult birth, witches were supposed to  be the cause, gunpowder exploded  from a bamboo
pole close to the 
head  of the mother to drive evil spirits

EARLY HOSPITALS:
Hospital Real de Manila – 1577 1st hospital established Gov. Francisco de Sande To give
service to the king’s Spaniard  soldiers
History of Nursing in the PHILIPPINE 

San Lazaro Hospital – 1578 Fray Juan Clemente Named after the Knights of St. Lazarus
Hospital for the lepers
Hospital de Indios – 1586
 Franciscan Orders
 Hospital for the poor Filipino people
Hospital de Aguas Santas – 1590
 Fray Juan Bautista
 Named after its location (near spring)  because people    believed that spring has a 
healing power.
San Juan de Dios Hospital – 1596
 For poor people
 Located at Roxas Boulevard
 History of Nursing in the PHILIPPINE Nursing During the Philippine Revolution 

Dona Hilaria de Aguinaldo

❖ 1st wife of Emilio Aguinaldo
❖ Established Philippine Red Cross –  February 17, 1899
               
Dona Maria Agoncillo de Aguinaldo
❖2nd wife of Emilio Aguinaldo
❖1st president of Philippine Red Cross  (Batangas Chapt)
              
 Josephine Bracken     Melchora Aquino
❖Helped Rizal in treating sick people
❖Took care of the wounded Katipuneros

History of Nursing in the PHILIPPINE Nursing During the Philippine Revolution  

Anastacia Giron Tupaz
❖Founder of Filipino Nurses Association –  established on October 15, 1922

❖1st Filipino chief nurse of PGH

❖1st Filipino Superintendent of Nurses in the  Philippines
Francisco Delgado
❖1st president of Filipino Nurses Association
Loreto Tupaz
❖Florence Nightingale of Iloilo
Cesaria Tan
❖1st Filipino to receive Masteral Degree in Nursing abroad

History of Nursing in the PHILIPPINE Nursing During the Philippine Revolution              

Anastacia Giron Tupaz

❖Founder of Filipino Nurses Association –  established on October 15, 1922
❖1st Filipino chief nurse of PGH

❖1st Filipino Superintendent of Nurses in the  Philippines

Francisco Delgado
❖1st president of Filipino Nurses Association
Loreto Tupaz
❖Florence Nightingale of Iloilo
Cesaria Tan
❖1st Filipino to receive Masteral Degree in Nursing abroad

EARLY NURSING SCHOOLS

❖ Iloilo Mission Hospital and School of Nursing
Established in 1906 under the supervision of Rose  Nicolet (American) Nursing course – 3yrs.
Produced 1st batch of Nursing graduates in 1909 –  22 nurses 1st TRAINED NURSES:
Nicasia Cada, Felipa Dela Pena & Dorotea Caldito
April 1944 – 1st Nursing Board Exam at Iloilo  Mission Hospital
❖ PGH School of Nursing – 1907

❖ St. Paul School of Nursing – 1907

❖ St. Luke’s School of Nursing – 1907 ❖ Fatima – 1947

❖ UST – 1946

NURSING AN ART 
A.Caring-   is sharing deep and genuine concern about the welfare of another person. Caring
for self means taking the time to nurture oneself. This involves initiating and maintaining
behaviors that promote healthy living and well-being

PROFESSIONALIZATION OF CARING
Caring practice- involves connection, mutual recognition, and involvement between nurse &
client. Milton Mayeroff (1990)
                          - defines major ingredients of caring as follows:
a. Knowing – understanding other’s needs & how to respond to these needs.
b. Alternating rhythms – signifies immediate & long term meanings 88 of behavior,
considering the past. 
c. Patience – enables the other to outgrow in his own way & time.
d. Honesty – awareness and openness to one’s feelings & a genuineness in caring for the
other.
e. Trust – to allow other to grow in his own way & own time
f. Humility – acknowledging that there is more to learn, and learning may come from any
source.
g. Hope – belief in the possibilities of the other’s growth
h. Courage – sense of going into unknown, informed from insight of past experiences.

PROFESSIONALIZATION OF CARING
Caring, the Human Mode of Being(Roach) – believed that individuals are caring, and develop
their caring abilities by being true to self, being real, and being who truly they are.

The Six C’s of Caring:

1.Compassion – awareness of one’s relationship to others, sharing their joy, sorrows & pains.
2.Competence – knowledge, skills & experiences
3.Confidence – comfort with self, clients, & others that allows one to build trusting relationship.
4.Conscience - awareness of personal responsibility
5.Commitment – choice to act in accordance to one's desires  as well as obligation, resulting in
investment of self in a task or cause.
6.Comportment – presenting oneself as someone who respects others  and demands respect
Caring for self
-Mayroff, describes as helping oneself grow and actualize one’s possibilities. Self-care
means taking the time to nurture oneself, it is the opposite of the self-complacency that often
accompanies egocentricity. 
Example: 
-healthy lifestyle (nutrition, activity & exercise, recreation)
- Mind-body therapies (meditation, music, yoga) bring
                  balance to thoughts and emotions.
Self-care- defined as responding to one’s own needs to grow, is the opposite of the self-
complacency that often accompanies egocentricity. Caring for self means taking the time to
nurture oneself.

Caring as “Helping the Other Grow”

Milton Mayeroff (1990), a noted philosopher, has proposed that to care for another
person is to help him grow and actualize himself. Caring is a process that develops over time,
resulting in a deepening and transformation of the relationship.
 A HEALTHY LIFESTYLE
 NUTRITION- Healthy eating is important for everyone. A nutritionally balanced eating
plan provides energy, builds endurance to carry out daily activities, and reduces the risk
for certain health.
 ACTIVITY AND EXERCISE- Exercise is recognized as a lifetime endeavor that is
essential for energetic, active, and healthy living. The benefits of exercise have been
linked to many physiological and psychological responses, from a reduced feeling of
stress to an increased sense of well-being. Exercise strengthens the heart, lungs, and
blood vessels to prevent heart disease, keeps the joints flexible, 
and helps many people deal with sad or unhappy feelings.
 RECREATION- Self-care also includes taking time to do the things that bring joy and
stimulate creativity. Nurses need to reward themselves, to experience spontaneity, and
even to take downtime or time to do nothing.
 AVOIDING UNHEALTHY PATTERNS- Part of staying healthy is avoiding unhealthy life
patterns. This means avoiding activities or thought patterns that contribute to negative
health outcomes.
 MIND–BODY THERAPIES- The interconnectedness of the mind and body is the basis
for the complementary therapies. Imagery, meditation, storytelling, music therapy, and
yoga are examples of complementary therapies that bring balance to thoughts and
emotions.
Positive Affirmations
Begin the day with positive statement. Saying to yourself:
✔ I am a person of worth and goodness
✔ I am happy to be alive

✔ I am in the right place at the right time

✔ I am prepared to do a good job today

✔ I am surrounded by people that I love, who love me

✔ I am doing what brings me joy

✔ This is an opportunity to grow

B. Communicating
Communication- is a critical skill for nursing. It is the process by which humans meet their
survival needs, build relationships, and experience emotions. In nursing, communication is a
dynamic process used to gather assessment data, to teach and persuade, and
 to express caring and comfort. It is an integral part of the 
helping relationship.
- is any means of exchanging information or feelings between two or more people. It is a basic
component of human relationships, including nursing.
                      
The Communication Process
 SENDER
The sender, a person or group who wishes to communicate a 
message to another, can be considered the source-encoder. This term suggests that the person
or group sending the message must have an idea or reason for communicating (source) and
must put the idea or feeling into a form that can be transmitted. Encoding involves the selection
of specific signs or symbols (codes) to transmit the message, such as which language and
words to use, how to arrange the words, and what tone of voice and gestures to use.
 MESSAGE
The second component of the communication process is the message itself—what is actually
said or written, the body language that accompanies the words, and how the message is
transmitted. The method used to convey the message can target any of the receiver’s senses. It
is important for the method to be appropriate for the message, and it should help make the
intent of the message clearer
 RECEIVER
The receiver, the third component of the communication process, is the listener, who must
listen, observe, and attend. This person is the decoder, who must perceive what the sender
intended 
(interpretation). Perception uses all the senses to receive verbal and nonverbal messages. To
decode means to relate the message perceived to the receiver’s storehouse of knowledge and
experience and to sort out the meaning of the message
 RESPONSE
The fourth component of the communication process, the response, is the message that the
receiver returns to the sender. It is also called feedback. Feedback can be either verbal,
nonverbal, or both. Nonverbal examples are a nod of the head or a yawn. Either way, feedback
allows the sender to correct or reword a message.
Modes of Communication
1.Verbal communication
uses the spoken or written words     is largely conscious because people choose the
words they use. The words used vary among individuals according to culture, socioeconomic
background, age, and education.  As a result, countless possibilities exist for the way ideas are
exchanged. Nurses need to consider the following when choosing words to say or write: 96
pace and intonation, simplicity, clarity and brevity, timing and relevance, adaptability, credibility,
and humor
2.Nonverbal communication
uses other forms, such as gestures or facial expressions, and touch, sometimes called
body language, includes gestures, body movements, use of touch, and physical appearance,
including adornment. Nonverbal communication often tells others more about what a person is
feeling than what is actually being said, because nonverbal behavior is controlled less
consciously than verbal behavior. Nonverbal communication either reinforces or contradicts
what is said verbally.
Modes of Communication
3.Electronic communication
a common form of electronic communication is e-mail, in which an individual can send a
message, by computer, to another person or group of people

ADVANTAGES E-mail has many positive advantages. It is a fast, efficient way to communicate
and it is
legible. It provides a record of the date and time of the message 97
that was sent or received.
DISADVANTAGES  of e-mail is concern by both clients and primary care providers regarding
privacy, confidentiality, and potential misuse of information

Factors Influencing the Communication Process

❖ DEVELOPMENT- Knowledge of a client’s developmental stage will allow the nurse to
modify the message accordingly.
❖ GENDER- From an early age, females and males communicate differently. Girls tend to
use language to seek confirmation, minimize differences, and establish intimacy.
❖ VALUES AND PERCEPTIONS- Values are the standards that influence behavior, and
perceptions are the personal view of an event. 98 Because each person has unique
personality traits, values, and life experiences, each will perceive and interpret messages and 
     experiences differently.
❖ PERSONAL SPACE- Personal space is the distance people prefer in interactions with
others. 

Proxemics is the study of distance between people in their interactions.

1.Intimate: 0 to 11⁄2 feet
Intimate distance communication is characterized by body contact, heightened
sensations of body heat and smell, and vocalizations that are low. Vision is intense, is restricted
to a small body part, and may be distorted. Nurses frequently use intimate distance
2.Personal: 11⁄2 to 4 feet
Personal distance is less overwhelming than intimate distance. Voice tones are
moderate, and body heat and smell are noticed less. 
Physical contact such as a handshake or touching a shoulder is 99 possible
3.Social: 4 to 12 feet
Social distance is characterized by a clear visual perception of the whole person. Body
heat and odor are imperceptible, eye contact is increased, and vocalizations are loud enough to
be overheard by others. Communication is therefore more formal and is limited to seeing and
hearing.
4. Public: 12 feet and beyond.
Public distance requires loud, clear vocalizations with careful enunciation. Although the
faces and forms of people are seen at 
public distance, individuality is lost. Instead, the perception is of the group of people or the
community
 TERRITORIALITY
Territoriality is a concept of the space and things that an individual considers as
belonging to the self. Territories marked off by people may be visible to others.

 ROLES AND RELATIONSHIPS

The roles and the relationships between sender and receiver affect the
communication process. Roles such as nursing student and instructor, client and
 primary care provider, or parent and child affect the content and responses in the
communication process.
 ENVIRONMENT
People usually communicate most effectively in a comfortable
environment.Temperature extremes, excessive noise, and a poorly ventilated
environment can all interfere with communication
 CONGRUENCE
In congruent communication, the verbal and nonverbal aspects of the message
match. Clients more readily trust the nurse when they perceive the nurse’s
communication as congruent. This will also help to prevent miscommunication
 INTERPERSONAL ATTITUDES
Attitudes convey beliefs, thoughts, and feelings about people and events.
Attitudes are communicated convincingly and rapidly to others. Attitudes such as caring,
warmth, respect, and acceptance facilitate communication, whereas condescension,
lack of interest, and coldness inhibit communication
 Caring and warmth convey a feeling of emotional closeness, in contrast to an
impersonal approach. Caring is more enduring and intense than warmth. It conveys
deep and genuine concern for the person, whereas warmth conveys friendliness and
consideration, shown by acts of smiling and attention to physical comforts. Caring
involves giving feelings, thoughts, skill, and knowledge. It requires psychological energy
and poses the risk of gaining little in return; yet by caring, people usually reap the
benefits of greater communication and understanding.
 Respect is an attitude that emphasizes the other person’s worth and individuality. It
conveys that the person’s hopes and feelings are special and unique even though
similar to others in many ways

 
 
 
 
Phases of the Helping Relationship

PREINTERACTION PHASE
 The preinteraction phase is similar to the planning stage before an interview.

INTRODUCTORY PHASE
The introductory phase, also referred to as the orientation phase or the prehelping
phase, is important because it sets the tone for the rest of the relationship. During this initial
encounter, the client and the nurse closely observe each other and form judgments about the
other’s behavior rest of the relationship. During this initial encounter, the client and the nurse
closely observe each other and form judgments about the other’s behavior. The goal of the
nurse in this phase is to develop trust and security within the nurse–client relationship

WORKING PHASE
During the working phase of a helping relationship, the nurse and the client begin to view
each other as unique individuals. They begin to appreciate this uniqueness and care about each
other. Caring is sharing deep and genuine concern about the welfare of another 110 person.
Once caring develops, the potential for empathy increases. The working phase has two major
stages:
1.exploring and understanding thoughts and feelings, and 
2. facilitating and taking action

TERMINATION PHASE
The termination phase of the relationship is often expected to be difficult and filled with
ambivalence.
 
COMMUNICATION AND THE NURSING PROCESS
Assessing
To assess the client’s communication abilities, the nurse determines communication
impairments or barriers and communication style
Impairments to Communication
Various barriers may alter a client’s ability to send, receive, or comprehend messages.
These include language deficits, sensory deficits, cognitive impairments, structural deficits, and
paralysis. The nurse must assess each to determine their presence.
1.Language Deficits-Determine the client’s primary language for communicating and
whether a fluent interpreter is required COMMUNICATION AND THE NURSING PROCESS
 2.Sensory Deficits-The ability to hear, see, feel, and smell are important adjuncts to
communication. Deafness can significantly alter the message the client receives; impaired
vision alters the ability to observe nonverbal behavior, such as a smile or a gesture; inability to
feel and smell can impair the client’s abilities to report injuries or detect the smoke from a fire
3.Cognitive Impairments-Any disorder that impairs cognitive functioning (e.g.,
cerebrovascular disease, Alzheimer’s disease, and brain tumors or injuries) may affect a client’s
ability to use and understand language.
4.Structural Deficits-Structural deficits of the oral and nasal cavities and respiratory
system can alter a person’s ability to speak clearly and spontaneously .E.g., include cleft palate,
artificial  airways such as an endotracheal tube or tracheostomy, and laryngectomy (removal of
the larynx).

COMMUNICATION AND THE NURSING PROCESS

Evaluating
Evaluation is useful for both client and nurse communication
C.Teaching
     Teaching is a system of activities intended to produce learning. The teaching process is 
intentionally designed to produce specific learning.
✔   HEALTH PROMOTION
• Increasing a person’s level of wellness
• Growth and development topics
• Fertility control
• Hygiene
• Nutrition
• Exercise
• Stress management
• Lifestyle modification
• Resources within the community

COMMUNICATION AND THE NURSING PROCESS

✔   DISEASE PREVENTION 
• 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 117   
condoms, use of sunscreen use of medication, umbilical cord care
• First aid
Safety (e.g., using seat belts, helmets, walkers)

✔ RESTORATION OF HEALTH/ MAINTENANCE

• Information about tests, diagnosis, treatment, medications
• Self-care skills or skills needed to care for family member
• Resources within health care setting and community

COMMUNICATION AND THE NURSING PROCESS ✔   REHABLILITATION/ADAPTING TO

ALTERED HEALTH AND FUNCTION
• 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