UNIT I: NURSING AS A PROFESSION

 REPUBLIC ACT 9173

o The Philippine Nursing Act of 2002
OUTLINE o An act providing for a more responsive nursing
I Introduction profession
II Who is a Professional Nurse? o The state guarantees the delivery of quality basic
A Professional Qualities of a Nurse
B Personal Qualities of a Nurse health services through an adequate nursing
personnel system throughout the country

INTRODUCTION WHO IS A PROFESSIONAL NURSE?

 PROFESSION  Professional Nurse
o An occupation or calling requiring advanced training  A person whose name and registration/professional license
and experience in some specific or specialized body of number is entered in the Commission’s registry book and
knowledge which provides service to society in that computerized database as legally authorized to practice the
special field nursing profession
o NURSING is an occupation requiring a unique body of
knowledge and skills and which serves society PROFESSIONAL QUALITIES OF A NURSE
o A calling that requires special knowledge, skill, and  Have a license to practice nursing in the country
preparation  Have a Bachelor of Science degree in Nursing; and
 Specialized education  Be physically and mentally fit
 Body of knowledge  Bachelor of Science in Nursing Graduate
 Code of ethics  Registered nurse with current PRC ID
 Autonomy  Must be physically, mentally, and psychologically fit to
CRITERIA OF A PROFESSION practice nursing
 Service Orientation  Must not be convicted of any moral turpitude
o Altruism – selfless concern for others  Must be a member of the Accredited Professional
o Service to others Organization (APO)
o However, must be guided by certain, rules, or code of
ethics; provide service or assistance with what’s in your PERSONAL QUALITIES OF A NURSE
capacity  Interest and willingness to work and learn with individual’s
o Good Samaritan Law – protects people in service; groups in a variety of settings
protected from liability in providing reasonable  A warm personality and concern for people
assistance in an emergency  Resourcefulness and creativity as well as a well-balanced
 Ongoing Research emotional condition
o Contributing to nursing practice  Capacity and ability to work cooperatively with others
o 1940s – early development of nursing research  Initiative to improve self and service
o 1950s – increased funding and professional support  Competence in performing work through the use of nursing
o 1960s – often related to the nature of the knowledge process
base underlying nursing practice  Skill in decision-making, communicating, and relating with
o 1970s – focuses on related issues on nursing practice others and being research oriented; and
o Evidence-base and outcome-based  Active participation in issues confronting nurses and
 Professional Organization nursing
o Philippine Nurses Association – accredited nursing
association
o Helps the maintenance of the political, economic, and
social arrangements under professional affairs
o Advances the nursing profession fostering advanced
REFERENCES
nursing practices
o Protects the rights of the nurse
Notes from the discussion by Ms. Restymay Manlongat
NURSING
 Science – knowledge University of Cebu - Banilad powerpoint presentation:
 Art – skills
 Nutrix – to nourish; vita – life Nursing as a Profession PPT
 Social science – well-being of the patient; primordial
concern is humanity
 Art - Treats human responses: physically, mentally,
emotionally, and spirituality
 An art that takes care of the sick and the well
 Science – treat patients in a systemic and scientific
methods

VILLAFLOR, KYLIE NICOLE | UNIVERCITY OF CEBU – BANILAD BSN 1H 1

 HISTORY OF NURSING

UNIT II: HISTORY OF NURSING

ROME
OUTLINE
III Primitive Historical Evolution of Nursing  Contribution is the development of hospitals.
A Ancient Greece  St. Jerome was responsible, through one of his disciplines,
i Asclepius Fabiola
ii Hippocrates  During the 3rd and 4th centuries several wealthy matrons
B Rome of the roman Empire such as, Fabiola converted to
C Early Christian Era Christianity and used their wealth to provide houses of care
D Period of Apprentice Nursing / Middle Ages
and healing (the forerunner of hospitals) for the poor, the
E Renaissance
F Industrial Revolution sick, and the homeless. Women, were not, however, the
G Foundations of Modern Nursing sole providers of nursing services.
i Elizabeth Fry  Hospitals were first established in the Eastern Roman
ii Florence Nightingale Empire.
H The Civil War to the Beginning of the Twentieth Century  St Jerome was responsible, through one of his disciples,
i Clarissa “Clara” Harlowe Barton Fabiola, for introducing hospitals in the West.
ii Mary Ann Biekerdyke
iii Harriet Tubman
iv Mary Mahoney EARLY CHRISTIAN ERA
v Lilian Wald  Christianity official religion of Rome
IV Philippine Nursing History  Great importance on the sanctity of life
A Early Beliefs and Practices
B Early Care of the Sick  Deaconesses function as visiting nurses
C Health Care During the Spanish Regime  PHOEBE
D Nursing During the Philippine Revolution o First deaconess identified in providing nursing care
E Hospitals and Nursing Schools o Referred to as the FOUNDER OF VISITING
F The Start of Nursing Practice NURSING
G Proliferation of Nurses as a Workforce  OLYMPIAS
H Nursing Profession Development
o Widowed at a young age
I Further Changes in Nursing Law
o Erected a convent
o Supervised 40 other deaconesses
 MARCELLA
PRIMITIVE HISTORICAL EVOLUTION OF NURSING
o Wealthy Roman woman
 The recorded evolution of nursing dates back to 4000 BC
o Converted her place into a monastery
 Primitive societies in which mother-nurses worked with  FABIOLA
priest o A Christian convert
 2000 BC, the use of wet nurses is recorded in Babylonia o Founded the first free hospital in Rome
and Assyria
 Bishops and deacons supervised early hospitals
 Bishops founded shelters, hospices and orphanages
ANCIENT GREECE  Early hospitals were supervised by bishops and managed
 Greeks built temples to honor Hygeia, the goddess of health by deacons to care for the poor, travelers, or others who
 Temples were more like health spas rather than hospitals could not be cared for at home.
governed by priests.  In addition, bishops founded shelters, hospices, and
 Priestesses attended to those housed in the temples orphanages where both men and women provided care
 ASCLEPIUS
o God of Medicine PERIOD OF APPRENTICE NURSING
o Patron Saint of Physicians  MIDDLE AGES
o Early physicians were known as Asclepiads or sons
 Political unrest, economic change and decline of
of Asclepius
deaconesses.
 They prescribed treatment such as
 Trade flourished
o Medications
 Famine and diseases were present
o Diets
o Exercise  Deaconesses became extinct
o Bathing in warm or cold water
o Fasting RENAISSANCE
o Various types  AD 1400 – 1550
 HIPPOCRATES  Interest in the arts and science emerged
o Practiced medicine during Greece’s Golden Age  Universities were established
(400 BC)  Women were not encouraged to leave their homes.
o Developed systems for patient assessment,  Protestant reformation dissolved Catholic hospitals
recording, established ethical standards.
o Advocated conservative treatment INDUSTRIAL REVOLUTION
o Concerned with physician – patient relationship
o Insisted upon respect for patient’s families and  Introduced technology that led to a proliferation of
defined ethical practice standard factories.
 Medical schools were founded
 The industrial revolution introduced technology that led to a
proliferation of factories. Conditions for the factory workers

VILLAFLOR, KYLIE NICOLE | UNIVERCITY OF CEBU – BANILAD BSN 1H 2

 HISTORY OF NURSING
were deplorable. Long hours, grueling work, and unsafe
conditions prevailed in the workplace.
 The health status of laborers received little, if any, attention
FOUNDATIONS OF MODERN NURSING
 ELIZABETH FRY
o Prison and Mental Asylum Reformer
o Founded the Protestant Sisters of Charity in 1840.
Members of this sisterhood received a rudimentary
education in nursing and observed patients at two
London hospitals.
o In 1848, the English Protestant sisterhood St.
John’s House was founded. These sisters lived
together as a community and participated in a two-
year long nursing education program
o They were required to work for St. John’s House for
five years in return for room and board plus a small
salary.
o They nursed for a few hours each day and spent the
rest of the time in prayer and religious instruction.
o Impressed with the work of Elizabeth Fry, the
German Lutheran pastor Theodor Fliedner
established a Deaconess Home and Hospital in
Kaiserswerth,
 FLORENCE NIGTHINGALE
o Lady with the Lamp
o Was a philanthropist from a wealthy English family
o Studied nursing under the direction of Pastor
Fliedner in Germany
o Was appointed superintendent of the Upper
Harley Street Hospital in London, a small hospital
for sick and elderly women of the upper class who
were experiencing financial difficulties.
o Observed the hospital work of the Catholic
Sisters of Charity in Paris and volunteered at the
Middlesex Hospital during the cholera epidemic
o In 1854 she received permission for herself and a
group of upper-class women to travel to Crimea to
care for sick and injured troops.
o Documented the results of her care and used
these records as the basis for further
interventions. Her work was the foundation for
today’s evidence-based nursing practice.
o Established the Nightingale School of Nursing at
St. Thomas’s Hospital in London, offering
education for professional nurses.
o Nightingale’s school combined classes in nursing
theory with clinical experiences at hospital
THE CIVIL WAR TO THE BEGINNING OF THE
TWENTIETH CENTURY
 CLARISSA “CLARA” HARLOWE BARTON
o Pioneering nurse who founded the American
Red Cross
o She was a hospital nurse in the American Civil War,
a teacher, and patent clerk. Barton is noteworthy for
doing humanitarian work at a time when relatively
few women worked outside the home
o Her father convinced her that it was her duty as a
Christian to help the soldiers. In the April following
his death, Barton returned to Washington to gather
medical supplies. Ladies' Aid societies helped in
sending bandages, food, and clothing that would
later be distributed during the Civil War.
o She worked to distribute stores, clean field
hospitals, apply dressings, and serve food to
wounded soldiers in close proximity to several
VILLAFLOR, KYLIE NICOLE | UNIVERCITY OF CEBU – BANILAD BSN 1H
battles, including Cedar Mountain, Second Bull Run,
Antietam, and Fredericksburg
o In 1864 she was appointed by Union General
Benjamin Butler as the "lady in charge" of the
hospitals at the front of the Army of the James.
Among her more harrowing experiences was an
incident in which a bullet tore through the sleeve of
her dress without striking her and killed a man to
whom she was tending.
o She was known as the "Angel of the Battlefield”
 MARY ANN BIEKERDYKE
o Volunteered her considerable medical skills to help
the hundreds of men who were dying, not from battle,
but from typhoid, dysentery and other diseases.
 HARRIET TUBMAN
o Was an American abolitionist, humanitarian, and an
armed scout and spy for the United States Army
during the American Civil War.
o Traveling by night and in extreme secrecy, Tubman
(or "Moses", as she was called) never lost a
passenger
 MARY MAHONEY
o Was the first African American to study and work as
a professionally trained nurse in the United States,
graduating in 1879
o One of the first African Americans to graduate
from a nursing school, and she prospered in a
predominantly white society. She also challenged
discrimination against African Americans in nursing
 LILIAN WARD
o Considered the founder of public health nursing.
o Together with Mary Brewster were the first to
offer trained nursing services to the poor in the
New York slums.
o Their home among the poor on the upper floor of a
tenement, called the Henry Settlement and Visiting
Nurse Service, provided nursing services, social
services, and organized educational and cultural
activities.
o Soon after the founding of the Henry Street
Settlement school nursing was established as an
adjunct to visiting nursing
PHILIPPINE NURSING HISTORY
EARLY BELIEFS AND PRACTICES
 MYSTICISM AND SUPERSTITIONS
 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 OF THE SICK
 Herb men were called “herbicheros” meaning one who
practiced witchcraft
 Persons suffering from diseases without any identified
cause were believed bewitched by “mangkukulam
 Difficult childbirth and some diseases (called “pamao”) were
attributed to “nunos”
HEALTH CARE DURING THE SPANISH REGIME
 Certain practices when taking care of a sick individuals
entails interventions from babaylan (priest physicians) or
albularyo (herb doctor).
 1578, male nurses were acknowledged as ‘Spanish Friars’
assistants for caring sick individuals in the hospital. These
male nurses were referred as practicante or enfermero.
3
 HISTORY OF NURSING
EARLY HOSPITALS DURING THE SPANISH REGIME
 Religious orders exerted efforts to care for the sick by
building hospitals in different parts of the Philippines
 HOSPITAL REAL DE MANILA (1577)
o 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)
o Founded by Brother Juan Clemente and was
administered for many years by the Hospitalliers of
San Juan de Dios
o Built exclusively for patients with leprosy
 HOSPITAL DE INDIOS (1586)
o Established by the Franciscan Order
o service was in general supported by alms and
contributions from charitable persons
 HOSPITAL DE AGUAS SANTAS (1590)
o Established in Laguna; near a medicinal spring,
o Founded by Brother J. Bautista of the Franciscan
Order
 SAN JUAN DE DIOS HOSPITAL (1596)
o Founded by the Brotherhood of Misericordia and
administered by the Hospitaliers of San Juan de Dios
o Support was delivered from alms and rents
o Rendered general health service to the public
NURSING DURING THE PHILIPPINE REVOLUTION
 In the late 1890’s, the war between Philippines and Spain
emerges which resulted to significant amount of casualties.
 With this, many women have assumed the role of nurses in
order to assist the wounded soldiers.
 The emergence of Filipina nurses brought about the
development of Philippines Red Cross
JOSEPHINE BRACKEN
 Wife of Jose Rizal
 Installed a field hospital in an estate house in Tejeros.
 She provided nursing care to the wounded night and day
ROSA SEVILLA DE ALVERO
 At the age of 18 volunteered to the nurse the sick and
injured soldiers of the Philippine revolution.
 Converted their house into quarters for the Filipino soldiers;
during the Philippine- American War that broke out in 1899
 She also became the first Dean of Women at the
University of Santo Tomas
DONA HILARIA DE AGUINALDO
 Wife of Emilio Aguinaldo
 Organized the Filipino Red Cross under the inspiration
of Mabini.
 She established the Hijas de la Revolución (Daughters
of the Revolution) that later became Asociación de la
Cruz Roja (Red Cross Association).
o The organization is considered a precursor of the
present Philippine National Red Cross, and for this
she raised funds for medicines and other medical
supplies.
 Del Rosario died on March 6, 1921 after suffering from
leprosy
DONA MARIA AGONCILLO DE AGUINALDO
 Second wife of Emilio Aguinaldo
 Provided nursing care to Filipino soldiers during the
revolution,
VILLAFLOR, KYLIE NICOLE | UNIVERCITY OF CEBU – BANILAD BSN 1H
 President of the Filipino Red Cross branch in Batangas.
MELCHORA AQUINO A.K.A “TANDANG SORA”
 Nursed the wounded Filipino soldiers and gave them
shelter and food.
 Operated a store, which became a refuge for the sick and
wounded revolutionaries.
 "Woman of Revolution"
 "Mother of Balintawak"
 "Mother of the Philippine Revolution"
 Died on March 2, 1919, at the age of 107
CAPITAN SALOME
 A revolutionary leader in Nueva Ecija
 Provided nursing care to the wounded when not in combat
AGUEDA KAHABAGAN
 Revolutionary leader in Laguna, also provided nursing
services to her troops
 Agueda Kahabagan y Iniquinto is referred to in the few
sources that mention her as "Henerala Agueda"
 It was most probably General Pío del Pilar who
recommended that she be granted the honorary title of
Henerala. In March 1899, she was listed as the only
woman in the roster of generals of the Army of the
Philippine Republic. She was appointed on January 4,
1899
TRINIDAD TECSON
 INA NG BIAK – NA BATO
 Stayed in the hospital of Biak - na - Bato
 Cared for the wounded revolutionary soldiers
HOSPITALS AND NURSING SCHOOLS
 HOSPITAL SCHOOL OF NURSING’S FORMAL
TRAINING
o The first hospital in the Philippines
o Trained Filipino nurses in 1906 was Iloilo Mission
Hospital
o Established by the Baptist Missionaries
o It was ran by the Baptist Foreign Mission Society of
America.
 Miss Rose Nicolet, a graduate of New England
Hospital for Women and Children in Boston,
Massachusetts was the first superintendent for
nurses.
 Miss Flora Ernst, an American nurse, took
charge of the school in 1942. In April 1944
graduate nurses took the first Nurses Board
Examination at the Iloilo Mission Hospital
 SAINT PAUL’S HOSPITAL SCHOOL OF NURISNG
MANILA (1907)
o Established by the Archbishop of Manila, Jeremiah
Harty under the supervision of the Sisters of St. Paul
de Chartres located in Intramuros.
o It opened its training school for nurses in 1908, with
Mother Melanie as superintendent and Miss
Chambers as Principal
 PHILIPPINE GENERAL HOSPITAL SCHOOL OF
NURISNG (MANILA, 1907)
o In 1906, Mary Coleman Masters, 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
4
 HISTORY OF NURSING
for Girls enrolled at the Philippine Normal Hall and
the University of the Philippines.
o In 1907, with the support of Governor General
Forbes and the Director of Health, she opened
classes in nursing under the Auspices of the Bureau
of Education.
o Admission was based on an entrance examination.
The applicant must have completed elementary
education to the seventh grade. Julia Nichols and
Charlotte Clayton taught the students nursing
subjects. American physician also served as
lecturers
 ST LUKE’S HOSPITAL SCHOOL OF NURSING
(QUEZON CITY, 1907)
o Episcopalian Institution
o Began as a small dispensary 1903
o In 1907, the school opened with three girls admitted
 MARY JOHNSTON HOSPITAL AND SCHOOL OF
NURSING (MANILA, 1907)
o Started as a small dispensary on Calle Cervantes
(now Avenida)
o Was called the Bethany Dispensary and funded by
the Methodist Mission
o Rebacca Parrish together with Rose Dudley and
Gertude Dreisbach organized the Mary Johnston
School of Nursing
 MARY CHILES HOSPITAL OF NURISNG (MANILA, 1911)
o Established by Dr. WN Lemon
o Azcarraga, Sampaloc, Manila
o In 1913, Miss Mary Chiles of Montana donated a
large sum of money with which the preset building at
Gastambide was bought
o The Tuason Annex was donated by Miss Esperanza
Tuason, a Filipino philanthropist
 SAN JUAN DE DIOS HOSPITAL SCHOOL OF NURSING
(MANILA, 1913)
o Was founded on the ideals of nursing and health
care, which were pioneered in the Philippines by the
Franciscans in 1578
o In 1913, Hospital de San Juan de Dios opened the
first nursing school in the country
 EMMANUEL HOSPITAL SCHOOL OF NURISNG (CAPIZ,
1913)
o In 1913, the American Baptist Foreign Mission
Society sent Dr. PH Lerrigo
o Offered a 3-year training course for an annual fee of
Php 100.00
o Miss Clara Pedroso was the first principal
 SOUTHER ISLANDS HOSPITAL SCHOOL OF NURSING
(CEBU, 1918)
o Established in 1911 as Hospital Del Sur
o Opened in 1918
o Anastacia Giron-Tupas as the organizer.
o Miss Visitacion Perez was the first principal
o In 1992, it was renamed to honor Senator Vicente
Sotto. As of 1998, it is authorized to have 800 beds
 OTHER SCHOOLS OF NURSING
o Zamboanga General Hospital School of Nursing
(1921)
o Chinese General Hospital School of Nursing (1921)
o Baguio General Hospital School of Nursing (1923)
o Manila Sanitarium Hospital and School of Nursing
(1930)
o St. Paul School of Nursing in Iloilo City (1946)
o North General Hospital and School of Nursing (1946)
o Siliman University School of Nursing (1947)
VILLAFLOR, KYLIE NICOLE | UNIVERCITY OF CEBU – BANILAD BSN 1H
THE START OF THE NURSING PRACTICE
(1911-1921)
 Promulgation of Act No. 2493 allowing the regulation of
nursing practice
 Act 2808 First True Nursing Law
 Board Examiners for Nursing was also created.
 The first nursing board examination was given on 1920
 Philippine Nurses Association (PNA)
o Filipino Nurses Association was established (now
PNA) as the National Organization of Filipino Nurses
o PNA: 1st President – Rosario Delgado
o Founder – Anastacia Giro-Tupas
FIRST COLLEGES OF NURSING IN THE PHILIPPINES
 UNIVERSITY OF SANTO TOMAS – COLLEGE OF
NURSING (1946)
o Grant the title Graduate Nurse to 21 students
o Sor Taciana Trinanes was its first directress
 MANILA CATHEDRAL UNIVERSITY – COLLEGE OF
NURSING (1947)
o First offered BSN and Doctor of Medicine degress in
1947
o Miss Consuelo Gimeno was its first principal
 UNIVERSITY OF THE PHILIPPINES MANILA –
COLLEGE OF NURSING (1948)
o The idea of opening the college began in a
conference between Miss Julita Sotejo and UP
President
o In April 1948, the University Council approved the
curriculum, and the Board of Regents recognized the
profession as having an equal standing as Medicine,
Engineering, etc.
o Miss Julita Sotejo was its first dean
PROLIFERATION OF NURSES AS A WORKFORCE
(1951-1971)
 The Philippine Nursing Law was approved under the
Republic Act No. 877 on June 19 1953.
 Celebration of Nurses’ Week was proclaimed by President
Carlos P. Garcia under the Proclamation No. 539.
 Between 1966 and 1985 about 25,000 Filipino nurses have
migrated to United States
NURSING PROFESSION DEVELOPMENT
(1971-2001)
 Presidential Decree No. 223, was mandated which brought
about the establishment of the agency, Professional
Regulation Commission.
 Philippine Nursing Act of 1991 was also amended
under Republic Act No. 7164 which expanded nursing
practice to other roles such as management, teaching,
decision making, and leadership.
 The qualification of nurses or faculty’s in the academe was
also updated to Master’s Degree in Nursing or equivalent
FURTHER CHANGES IN NURSING LAW
(2001 TO PRESENT)
 During this period, the Philippine Nursing Act of 2002
was enacted under the Republic Act No. 9173 which
entails changes on existing policies under Republic Act No.
7164. These changes underscore on the requirements
for faculty and Dean of the Colleges of Nursing, as well
as the conduct for Nursing Licensure Exam.
5
 CARPER’S FOUR PATTERNS OF KNOWING
REFERENCES
Notes from the discussion by Ms. Restymay Manlongat
University of Cebu - Banilad powerpoint presentation:
History of Nursing PPT
UNIT III: CARPER’S FOUR PATTERNS OF KNOWING
OUTLINE
V Carper’s Fundamental Ways of Knowing
A Empirical
B Evidence-Based Practice
C Aesthetic Knowing
D Ethical Knowing
E Personal Knowing
CARPER’S FUNDAMENTAL WAYS OF KNOWING
 Is a typology that attempts to classify the different
sources from which knowledge and beliefs in
professional practice (originally specifically nursing) can
or have been derived
EMPIRICAL
 Factual knowledge from science, or other external
sources, that can be empirically verified
 Relating factual and descriptive knowing
 Aimed at the expansion of abstract and theoretical
explanations
 Knowledge obtained from textbooks, lectures, journals and
online resources.
 First primary model of knowing (Kenney, 1996.)
 Information source
 Emphasizes scientific research
 Focuses on evidence-based research
 Most theory and research development is concentrated
 EXAMPLES:
o The student nurse performs the proper technique in
handwashing based on what he learned in NCM.
o The nurse explained to the patient the action of the
medication based on what she learned from the Drug
Handbook.
EVIDENCE-BASED PRACTICE
 Uses a form of evidence in making clinical judgment
 Stem from tradition, authority, experience, trial, error, logic
and reason
 Involves accurate and thoughtful decision making about
the health care delivery for clients
 Based on the result of the most relevant and supported
evidence derived from research
AESTHETIC KNOWING
 Is related to understanding what is of significance to
particular patients such as feelings, attitudes, points of
view (Carper,1978)
 Manifestation of the creative and expressive styles of the
nurse (Kenney, 1996)
VILLAFLOR, KYLIE NICOLE | UNIVERCITY OF CEBU – BANILAD BSN 1H
 Used in the process of giving appropriate nursing care
through understanding the uniqueness of every patient
 Emphasizing creative and practical styles of care
 Focuses: empathy – understandings another’s feelings
 Includes nurse’s ability in changing ways and manner of
rendering care based on the client’s individual needs and
perceptions.
 EXAMPLES:
o The nurse uses layman terms in explaining the
needs of the patient with breast cancer.
o The student nurse uses toys in explaining to a 5-year
old patient the purpose of taking the temperature
ETHICAL KNOWING
 Attitudes and knowledge derived from an ethical
framework, including an awareness of moral questions
and choices.
 Requires knowledge of different philosophical positions
regarding what is good and right in making moral
actions and decisions
 Code of Ethics – leads the conduct of nurses
 Deeply rooted in the concepts of human dignity, service and
respect for life.
 Lessening suffering, upholding and preserving health is one
of the key elements why nursing is a core service in society.
 EXAMPLES:
o The nurse explains the concept behind organ
donation to a terminally ill patient.
o The clinical instructor reprimands a student who
cheated on an examination and explains the
consequences
PERSONAL KNOWING
 Encompasses knowledge of the self in relation to others
and to self
 Involves the entirety of the nurse-patient relationship
 Focused on realizing, meeting and defining the real, true
self (self-awareness)
 Most difficult to master and to teach
 Involves therapeutic use of self
 Takes a lot of time to fully know the nature of oneself in
relation to the world around
 Stresses that human beings are not in a fixed state but are
constantly engaged in a dynamic state of changes.
(Kenney, 1996)
 EXAMPLES:
o The student nurse tries to develop rapport with his
patient and the significant others.
o The nurse joins self-awareness seminar in
preparation in preparation for his psychiatric rotation.
6
 BENNER’S LEVEL OF PROFICIENCY

REFERENCES

Notes from the discussion by Ms. Restymay Manlongat

University of Cebu - Banilad powerpoint presentation:

Carper’s Four Patterns of Knowing PPT

UNIT IV: BENNER’S NOVICE TO EXPERT THEORY

 Has gained prior experience in actual nursing situations

OUTLINE  Formulation of guidelines or principles from prior
VI Benner’s Novice to Expert Theory experiences provide guidance in future experiences
A Novice
B Advanced Beginner
C Competent THE COMPTENT NURSE
D Proficient  Has been on the job in similar situations for 2-3 years
E Expert  Aware of long term goals—gain perspective from planning
their actions
 Become more efficient and organized
THE NOVICE
 Begins with no prior experience THE PROFICIENT NURSE
 Taught rules to perform tasks  Perceives and understands situations as whole parts
 Rule governed behavior is limited and inflexible  Views patient holistically
 Being a novice is not exclusive to students—any nurse  Has learned what to expect in certain situations and how to
entering a setting without prior experience with that modify plans as needed
particular patient population may be limited to the novice
level THE EXPERT NURSE
 No longer relies on principles, rules, or guidelines to
THE ADVANCED BEGINNER connect situations and determine actions
 Can demonstrate marginally acceptable performance  Performances are fluid, flexible, and highly proficient
 Expertise comes naturally

REFERENCES

Notes from the discussion by Ms. Restymay Manlongat

University of Cebu - Banilad powerpoint presentation:

Benner’s Novice to Expert Theory PPT

UNIT V: ROLES AND RESPONSIBILITIES OF A PROFESSIONAL NURSE

OUTLINE WHAT ARE THE ROLES OF THE NURSE?

VII What are the Roles of the Nurse?
A Caregiver/Care Provider
B Client Advocate CAREGIVER / CARE PROVIDER
C Teacher  Has traditionally included those activities that assist the
D Counselor client physically and psychologically while preserving
E Change Agent the client’s dignity.
F Manager
o Provide privacy; expose only the parts you’re going
G Leader
H Communicator to work on
I Case Manager o Always ask permission
 Provide direct care and comfort of client
 Holistic approach; accept the client as a person
 Maintain and regain health; manages symptoms
 The required nursing actions may involve:
o Full care for the completely dependent client

VILLAFLOR, KYLIE NICOLE | UNIVERCITY OF CEBU – BANILAD BSN 1H 7

 ROLES AND RESPONSIBILITIES OF A NURSE

 E.g. newborn babies, comatose patients, MANAGER

patients suffering from Alzheimer’s disease and  Makes decisions, coordinates activities of others, allocate
Dementia
resources, evaluate care and personnel
o Partial care for the partially dependent client
 Plans, give direction, develop staff, monitors operations,
 Can perform certain activities but with limitations
give the rewards fairly and represents both staff and
 E.g. feeding (threatened abortion) – patient can
administrations as needed
feed themselves but can’t get out of bed
 Coordinate with other healthcare staff
o Supportive – educative care to assist clients in
attaining their possible level of health and wellness.
 E.g. awareness breastfeeding LEADER
 Influences others to work together to accomplish a specific
CLIENT ADVOCATE goal.
 A learned process requiring an understanding of the needs
 Involves concern for and actions in behalf of the client to
and goals that motivate people, the knowledge to apply the
bring about a change
leadership skills, and the interpersonal skills to influence
 Promotes what is best for the client, ensuring that the others.
client’s needs are met and protecting the client’s right.
 Improvement of the well-being of the patient
 Provides explanation in client’s language and support
 Influences the behavior of the patient
clients decisions.
 Protect your patient’s human and legal rights and
COMMUNICATOR
provide assistance in asserting these rights if the need
arises  Nurses identify client problems and then communicate
o Nurse’s responsibility to follow what the client wants these verbally or in writing to other members of the
o Support the client’s decisions health care team.
o Responsibility to act in behalf of your patient  The nurse must be able to communicate clearly and
accurately in order for a client’s health care needs to be
TEACHER met.
 The nurse helps clients learn about their health and the
health care procedures they need to perform to restore or
CASE MANAGER
maintain their health.  Work with the multidisciplinary health care team to measure
 Assesses the client’s learning needs and readiness to the effectiveness of the case management plan and to
learn. monitor outcomes.
 Encourages compliance with prescribed therapy.  Works with primary or staff nurses to oversee the care
 Promotes healthy lifestyle of a specific caseload.
 Interprets information to the client  In other agencies, the primary nurse or provides some level
 Some of your teaching is unplanned and informal of direct care to the client and family.
o Explain concepts about health; explain the
procedure to the patient; gives information to the
patient REFERENCES
o Give information with the learning needs of your
patient, capacity of the patient, and their readiness Notes from the discussion by Ms. Restymay Manlongat
to learn
o Goal of a teacher is to have intellectual growth
University of Cebu - Banilad powerpoint presentation:
COUNSELOR
Roles and Responsibilities of a Nurse PPT
 Helps client to recognize and cope with stressful
psychologic or social problems; to develop an improve
interpersonal relationships and to promote personal growth
 Provides emotional, intellectual to and psychologic
support
 Focuses on helping a client to develop new attitudes,
feelings and behaviors rather than promoting intellectual
growth.
 Encourages the client to look at alternative behaviors
recognize the choices and develop a sense of control.
o E.g. present facts of contraceptive methods
o Responsibility is to help and guide the patient of what
is their choice
 ADVISOR – give your own opinion or idea

CHANGE AGENT
 Initiate changes or assist clients to make modifications in
themselves or in the system of care
 Combination of client advocate, caregiver, and change
agent

VILLAFLOR, KYLIE NICOLE | UNIVERCITY OF CEBU – BANILAD BSN 1H 8

 UNIT I: COMMUNICATION PROCESS

 DECODER – understanding the information

OUTLINE o Receiver interprets message based on personal,
I Communication cultural and professional biases
A Steps in Communication o May not have the same meaning
i Ideation
ii Encoding o Interpretation is based on one’s understanding
iii Transmission o Facial expression, nonverbal gestures
iv Receiving o Receiver decodes message according to sender’s
v Decoding intent
vi Response o Through decoding would know if communication is
II Modes of Communication successful or not;
III Factors that Affect Communication o Effective communication – decoded messages
IV Communication Skills matches with the intent of the sender
V Methods of Communication
VI Issues in Communication
o Ineffective communication – decoder
VII Communication Systems misinterprets the message
A Barriers to Communication
B Other Barriers to Communication  RESPONSE
o receiving and accurately interpreting the message
(i.e. feedback)
COMMUNICATION
 Giving and receiving of information MODES OF COMMUNICATION
 The complex exchange of thoughts, ideas, or information  Most accurately interpreted when using more than one
on at least two levels: verbal and nonverbal mode
 Purpose:
o Perform VERBAL COMMUNICATION
o Acquire  Is largely communication
o Entertain  Spoken words or written words (written communication)
 Words vary among individuals according to culture,
STEPS IN COMMUNICATION socioeconomic background, age, and education
 IDEATION  Countless possibilities exist for the way ideas are
o sharing the content of the message with someone exchanged, as well as feelings convey when individuals talk
(ideation begins) to one another
o need to communicate
o develops an idea PACE AND INTONATION
o selects information to share
 The manner of speech
 ENCODING
 Pace or rhythm and intonation will modify the feeling and
o putting meaning into symbolic forms
impact of the message
o process or method on how to send the message
o use clearly understood symbols  E.g. speaking slowly and softly to an excited client may help
calm the client
 Spoken
 Written  Enthusiasm, anger, sadness, anger, or amusement
 Nonverbal  Interest, anxiety, boredom, fear
 TRANSMISSION
o Overcoming interference with the message sent SIMPLICITY
such as:  Includes the use of commonly understood words
 Use of unintelligible words  Brevity and completeness—nurses need to learn to select
 Complex sentences appropriate understandable term based:
 Distortion o Age
 Noise o Knowledge
 Illegible handwriting o Culture
 RECEIVING o Education
o activating the senses of seeing and hearing  Use layman’s term
o Selective Attention  Avoid medical terminologies
 Hears the messages of interest
o Selective Perception CLARITY AND BREVITY
 Hears the part of the message that conforms to
what they would want to hear  Direct and simple will be more effective
 e.g. selective listening or selective reading  Clarity is saying precisely what is meant, and brevity is
o Preoccupation using the fewest words necessary
o Poor Listening  The goal is to communicate clearly

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 COMMUNICATION PROCESS

 DON’T: mumbling the words and not facing the patient
properly
 DO: informing the patient with direct eye contact while
enunciating the message appropriately
 Brief and concise
 Speak slowly and enunciate clearly
 Patient record: use few words which best describe the
situation
TIMING AND RELEVANCE
 Timing needs to be appropriate to ensure words are heard
 DON’T: ask several questions at once
 DO: allow the client to respond to the social talk or chat; the
nurse develops rapport with the client that can help facilitate
effective therapeutic communication
 Sensitivity to the client’s needs and concerns
 Slouched posture and a slow, shuffling gait suggest
depression or physical discomfort
FACIAL EXPRESSION
 The face is the most expressive part of the human body
 Although the face may express the person’s genuine
emotions, it is also possible to control these muscles so the
emotion expressed does not reflect what the person is
feeling
GESTURES
 Hand and body gestures may emphasize and clarify the
spoken word, or they may occur without words to indicate a
particular feeling or to give a sign
 Patients who are anxious is shown through their gestures
 Can give the actual information or feelings of the patient

ADAPTIBILITY TELEPHONE COMMUNICATION

 Alteration of spoken words in accordance with behavioral o Rapid.
cues from the client o Allows receiver to clarify message at time it is
 Astute assessment and sensitivity are required by the nurse received
for effective adaptability o Does not, however, allow the receipt of nonverbal
messages for either the sender or the receiver.
 Assessment and sensitivity
ELECTRONIC COMMUNICATION
CREDIBILITY o Common form is e - mail
 Most important criterion for effective communication o Individual can send a message by computer, to
 Nurse needs to be knowledgeable about what is being another person or group of people.
discussed and to have accurate information Nurses need to know when it is and when it is not
 Acknowledgement of limitations of the nurse appropriate to use e–mail for communicating
with clients
HUMOR o Common in the health care system
o Document nursing care and assessment
 The use of humor can be a positive and powerful tool in
nurse-client relationship, but it must be used with care
 When using humor, it is important to consider the client’s
Table No. 1 Advantages and Disadvantages of Electronic
perception of what is considered humorous
Communication
 Helps client adjust to painful situations
ADVANTAGE DISADVANTAGE
 Reduces tension by a different perspective
Fast, efficient, and legible Privacy confidentiality, and
 However, timing should be considered
misuse of information
Provides a record of the Socioeconomic problems i.e.
NONVERBAL COMMUNICATION time and date of the not everyone has computer
 Sometimes called body language message that was sent or or cellphone
 Body movements, gestures, use of touch, and physical received
appearance Provide clients ways on Clients may have limited
 Often tells more about what the person is feeling how they can reach abilities speaking, writing, or
 It also reinforces or contradicts what is said verbally specified staff members understanding English
 To observe and interpret the client’s nonverbal behavior is Improves communication
and essential skill for nurses and continuity of client
 Verify and validate what your observing is true care as well as access
between client and the
PERSONAL APPERANCE healthcare provider
 Clothing and adornments can be sources of information
about a person
 Choice of apparel is highly personal, it may convey social FACTORS THAT AFFECT COMMUNICATION
and financial status, culture, religion, group association,
and self-concept CULTURE
 It can also denote respect  A set of shared values that a group of people holds; it is
constantly EVOLVING
POSTURE AND GAIT  Every culture has rules, principles, morals and beliefs that
 Posture – how the person stands and sit; Gait – how the each member should follow
person walks  Some values that affect how you think and act and, more
 The way an individual walks and carries themselves are importantly, the kind of criteria by which you judge others.
often reliable indicators of self-concept, current, mood, and  Cultural meanings render some behaviors as normal and
health right and others strange or wrong
 Erect posture and an active, purposeful stride suggest a  HOW CULTURE INFLUENCES HEALTH
feeling of well-being o The influence of culture on health is vast. It affects
perceptions of health, illness and death, beliefs

VILLAFLOR, KYLIE NICOLE A. | BSN 1H UNIVERSITY OF CEBU - BANILAD 2

 COMMUNICATION PROCESS

about causes of disease, approaches to health o Social: 4 to 12 feet

promotion, how illness and pain are experienced and  Characterized by a cl ear visual perception of the
expressed, where patients seek help, and the types whole person. Communication is therefore more
of treatment patients prefer. formal an d is limited to seeing and hearing.
o Both health professionals and patients are  E.g. when nurses make rounds
influenced by their respective cultures. Canada’s o Public: 12 feet and beyond
health system has been shaped by the mainstream  This requires loud, clear vocalizations with
beliefs of historically dominant cultures. careful enunciation. The faces and forms of
o Cultural bias may result in very different health- people are seen at public distance, individuality
related preferences and perceptions. Being aware is lost.
of and negotiating such differences are skills known  E.g. public speaking
as ‘cultural competence’. This perspective allows
care providers to ask about various beliefs or TERRITORIALITY – REGIONAL AFFILIATION
sources of care specifically, and to incorporate new  A concept of the space and things that an individual
awareness into diagnosis and treatment planning. considers as belonging to the self
 TERRETORIES – marked off by people; may be visible to
DEVELOPMENTAL LEVEL – EDUCATION AT LEVEL others
OR INTELLIGENCE  Health care workers must recognize this human tendency
 Language, psychosocial, and intellectual development to claim territory. Clients often feel the need to defend their
move through stages across the lifespan territory when it is invaded by other people
o LANGUAGE – the way a patient talk  Nurses need to obtain permission from clients to remove,
o PSYCHOSOCIAL - The interrelation of social factors rearrange or borrow certain objects in their hospital area
and patient thought and behavior  E.g. Clients in a hospital often consider their territory as
o VALUES AND BELIEFS – the things the patient bounded by the curtains and around the bed unit or by the
believes walls of a private room
o INTELLECTUAL – the way a patient possesses a
highly develop intellect ROLES AND RELATIONSHIPS
 Between sender and receiver affect the communication
GENDER process
 Females and males communicate differently  Roles such as nursing student and instructor, client and
 FEMALE primary care provider, or parent and child affect the content
o Use language to seek confirmation, minimize and responses in the communication process
differences and establish intimacy.
o Uses communication to discover how she is feeling ENVIRONMENT – ROOM
and what it is she wants to say
 Environmental distraction can impair and distort
 MALE
communication
o Use language to establish independence and
 People communicate effectively in a comfortable
negotiate status within a group
environment
o Believes communication should have a clear
purpose.  ENVIRONMENTAL FACTORS THAT INTERFERE WITH
COMMUNICATION
o Temperature extremes
VALUES AND PERCEPTIONS
o Excessive noise
 VALUES – the standards that influence behavior o Poorly ventilated environment
 PERCEPTIONS – the personal view of an event o Lack of privacy
 EACH PERSON IS UNIQUE – each one of us have unique
personality traits, values, and experiences that makes us OTHER FACTORS THAT MAY INFLUENCE
different COMMUNCIATION PROCESS
 Level of self-esteem
PERSONAL SPACE (PROXEMICS)
 Physical and psychological barriers – illness
 PROXEMICS – The study of distance between people in
their interactions. CONGRUENCE
 The distance people prefer in interactions with other people  Verbal and nonverbal aspects of the message match
 The physical space immediately surrounding someone, into  Will help prevent miscommunication when both actions and
which any encroachment feels threatening to or words are congruent
uncomfortable for them.  Body language or nonverbal communication is usually the
 FOUR DISTANCES IN COMMUNICATION one with the true meaning
o Intimate: 0 to 1 ½ feet  E.g. nurses are taught to assess clients, but clients are
 Characterized by body contact, heightened often adept at reading nurse’s expressions or body
sensations of body heat and smell, and language
vocalizations that are low
 E.g. cuddling a baby
INTERPERSONAL ATTITUDES
o Personal: 1 ½ to 4 feet
 Less overwhelming than the intimate distance.  Attitudes convey beliefs, thoughts, feelings about people
Voice tones are moderate and body heat and and events.
smell are noticed less. Mostly use between  CARING AND WARMTH
nurses and clients occurs at this distance o Caring is more enduring
 E.g. nurse giving medications to the client o Requires psychological energy

VILLAFLOR, KYLIE NICOLE A. | BSN 1H UNIVERSITY OF CEBU - BANILAD 3

 COMMUNICATION PROCESS

o By caring, people reap the benefits of greater  Cultural differences

communication and understanding
o Warmth conveys friendliness and consideration OTHER BARRIERS TO COMMUNICATION
o Shown by acts of smiling and attention to physical
 Physical barriers (e.g., hearing impairment, noisy
comforts
environment, speech difficulties, poor eyesight, poor
 RESPECT cognitive abilities)
o An attitude that emphasizes the other person’s worth
 Emotional barriers (e.g., aggression, fear perceptions,
and individuality
prejudices, threats)
o It conveys people’s hopes and feelings are special
 Faulty reasoning
and unique even though similar to others in many
ways  Poorly expressed messages
o Elderspeak – speech style similar to baby talk that  Filtering of what is communicated
gives the message of dependence and  Time pressures
incompetence and is seen as patronizing by older
adults (morrow, 2013). It does not communicate
respect
 ACCEPTANCE REFERENCES
o Emphasizes neither approval nor disapproval
o E.g. An accepting attitude allows clients to express Notes from the discussion by Ms. Restymay Manlongat
personal feelings and to be themselves
University of Cebu – Banilad College of Nursing powerpoint
BOUNDARIES
presentation:
 The need for nurses to behave professionally is constant

COMMUNICATION SKILLS Communication Process PPT

 Ensure understanding by: Modes of Communication PPT
o Clarification by asking questions
 Ex: “I don’t understand what you mean”
o Confirmation by stating one’s understanding of what
was heard or repeating what was said
 Ex: “I understand what you said”
 Enhance value by:
o Refraining from criticizing may be more effective to
enhance value
o Identifying the merits of the suggestion
 Support by:
o Giving feedback about the positive aspects of
another person’s ideas or efforts
o Expressing appreciation
o Acknowledging the value of the other’s contributions

METHOD’S OF COMMUNICATION
 Five S’s for effective oral and written presentations
o Strategy - purpose (why)
o Structure - to capture the audience (how)
 Ex: use of a PowerPoint presentation
o Support - use of evidences for credibility
o Style - eye contact, physical arrangement
o Supplement – preparedness to answer questions

ISSUES IN COMMUNCATION
 Two major ethical issues when using information
technology
o Ensuring confidentiality by disseminating information
only to authorized individuals or organizations
o Issues of confidentiality and reimbursement for
health services across state lines and provision of
quality care (i.e., Telehealth)

COMMUNICATION SYSTEMS

BARRIERS TO COMMUNICATION
 Misperception
 Misinterpretations
 Faulty Reasoning
 Selective Perception
 False Assumption
 Status
 Gender differences

VILLAFLOR, KYLIE NICOLE A. | BSN 1H UNIVERSITY OF CEBU - BANILAD 4

 NURSING PROCESS AND CRITICAL THINKING

UNIT II: NURSING PROCESS AND CRITICAL THINKING

o EXTERNAL
 Environment conditions and time
OUTLINE  Unpredictable events and uncertainty in clinical
VIII Nursing Roles settings
A Critical Thinking  Agency policies – dictates a standard format that
i Characteristics of Critical Thinkers
blocks creative thinking
ii Barriers to Creative Thinking
iii Skills in Critical Thinking  GROUPTHINK
· Critical Analysis o Going along with the majority opinion while
· Inductive and Deductive Reasoning personally having another viewpoint
· Differentiating Types of Statements  UNRESOLVED CONFLICTS AMONG TEAM MEMBERS
B Attitudes that Foster Critical Thinking
C Standards of Critical Thinking
IX Nursing Process
SKILLS IN CRITICAL THINKING
A Requirement for Nursing Process  CRITICAL ANALYSIS
B Historical Perspective o The application of a set of questions to a particular
C Benefits of the Nursing Process situation or idea to determine essential information
D ANA Nursing Scope and Standards of Practice and ideas and discard superfluous information and
E Components of the Nursing Process
ideas
i Assessing
ii Diagnosing o Socratic Questioning – the technique one can use
iii Outcome Identification and Planning to:
iv Implementing  Look beneath the surface
v Evaluating  Recognize and examine assumptions
 Search for inconsistencies
 Examine multiple points of view
NURSING ROLES  Differentiate what one knows from what one
 Whatever role nurses take: The most important merely believes
responsibilities are TO MAKE CORRECT and SAFE o Activities which needs Socratic Questioning:
DECISIONS in a variety of client care situations.  An end-of-shift report
o DIRECT CARE PROVIDERS  Reviewing a history of progress notes
o COORDINATORS OF CARE  Planning care
o MANAGERS  Discussing a client’s care with colleagues
o EDUCATORS  INDUCTIVE AND DEDUCTIVE REASONING
o CLIENT ADVOCATES o Inductive Reasoning
 SKILLS REQUIRED TO FULFIL THESE ROLES:  Generalizations are formed from a set of specific
o Critical-thinking = “decide and solve problems” facts or observations
o Problem-solving = “the ONLY solution of the  E.g. premise or specifics observed from one (1)
problem” patient
o Decision-Making = “the BEST solution for the - Dry skin
problem” - Poor turgor
s/s of dehydration
- Sunken eyes
CRITICAL THINKING - Dark amber urine
- GENERALIZATION: All clients with same
 An intellectual skill based on theories and principles guided
symptoms are dehydrated
by:
o Deductive Reasoning
o Logic – forces a decision apart from or in opposition
 Reasoning from general premise to the specific
to reason
conclusion
o Intuition – a power to attaining to direct knowledge
 Example:
without evident rational thought and inference
- GENERALIZATION: All children eat only
o Creativity – quality of something created not
one (1) kind of food at the time
imitated
- SPECIFICS: If the client is a child, she eats
one (1) kind of food at a time
CHARACTERISTICS OF CRITICAL THINKERS o Helps analyze situations and establish which
 Know how to think – they THINK like a nurse premises are valid
 Possess intellectual autonomy – they refuse to accept  DIFFRENTIATING TYPES OF STATEMENTS
conclusions without evaluating evidence (facts and o Can help nurses:
reasons)  Evaluate the credibility of information sources
 Think beyond the obvious and make connections between  Comprehend a client situation early
ideas
ATTITUDES THAT FOSTER CRITICAL THINKING
BARRIERS TO CREATIVE THINKING  INDEPENDENCE
 INTERNAL AND EXTERNAL FACTORS o Not easily swayed by the opinions but take
o INTERNAL responsibility for their own views from acquired
 Individual’s perception influenced by physical knowledge and experience
and emotional states and by personal  FAIR-MINDEDNESS
characteristics o Listening to opinions of all the members of the health
 E.g. values, past experiences, interest, and team
knowledge

VILLAFLOR, KYLIE NICOLE A. | BSN 1H UNIVERSITY OF CEBU - BANILAD 5

 NURSING PROCESS AND CRITICAL THINKING

o Assessing all viewpoints with the same standards NURSING PROCESS

and not basing their judgements on personal or  The systematic framework for providing professional,
group bias or prejudice quality Nursing Care
 INSIGHT INTO EGOCENTRICITY  GOAL: HELP INDIVIDUALIZED PATIENT CARE
o Actively trying to examine their own biases and bring  All nursing activities are directed to:
them to awareness each time they make a decision o Promote Health - e.g. exercise
o Example: Nurses believe that all patients are willing o Protect Health - e.g. immunization
to listen to discharge instructions but mystified when o Restore Health – e.g. medication
the client appears uninterested. o Provide Peaceful Death – e.g. spiritual vision
 Best thing to do:  Characteristics of Nursing Process
- I identify client’s priorities before initiating o Problem-oriented = determine its problem
health teachings o Goal-oriented = there is a specific aim to solve the
 INTELLECTUAL HUMILITY problem
o Awareness of the limits of one’s own knowledge o Orderly-planned step by step = there is a series of
o Nurses must be willing to: steps or components needed to achieve the goal
 Admit what they do not know o Open to accepting information during application
 Seek new information o Feedback
 Rethink their conclusion in light of new o Phase are interrelated
knowledge o Can be viewed from a system and humanistic
 INTELLECTUAL COURAGE TO CHALLENGE THE perspective
STATUS QUO AND RITUALS o Creativity = the continual development of the
o Considering and examining fairly one’s own ideas or process
views especially those to which one may have a  System – sets the interrelated parts that form a unified
strong negative reaction whole
o Values and beliefs – are not always acquired  Process – a continuous progression from one point to
rationally another to achieve a specific goal
o Rational belief – are those that have been examined
and found to be supported by solid reasons and data REQUIREMENT FOR NURSING PROCESS
 INTEGRITY
o Applying same rigorous standards of proof to their  CRITICAL THINKING
own knowledge and beliefs as they apply to the o a logical pattern of thoughts based on knowledge,
knowledge and beliefs of others experience, problem solving ability and reasoning.
 PERSEVERANCE o It is widening of information and selection of relevant
o Determination to finding effective solutions to client information, thus enables the individual to make
and nursing problem decisions in an efficient and effective manner, to
analyze relationships, to conceptualize and to make
 CONFIDENCE
reasoned judgement.
o The faith of belief that one will act in a right, proper,
o TO THINK CRITICALLY IS A SKILL which is
or effective way which is the result of both inductive
developed and refined throughout life. So, young
and deductive reasoning
children as well as lack of knowledge and experience
 CURIOSITY
have much to do with it.
o Being interested in what is not one’s personal or
o Approaches:
proper concern by asking relevant questions
 Systems Approach – the process is viewed as
the primary system
STANDARDS OF CRITICAL THINKING - Subsystems
o Patient
Table No. 2 Standards of Critical Thinking o Nurse
STANDARD SAMPLE QUESTION o Component of the Process
Clarity What is an example of this?  Humanistic Approach – take into account all that
Accuracy How can I find out if that is is known about thoughts, feelings, values,
true? experiences, likes, desires, behaviors, and body
Relevance How does that help me with (Lamonica, 1979)
the issue?
Logicalness Does that follow from the Table No. 3 Historical Perspective of the Nursing Process
evidence? YEAR
Divided the Nursing Process into
Breadth Do I need to consider another CATHOLIC these phases:
point of view? 1967 UNIVERSITY OF 1. Assessment
AMERICA 2. Planning
Precision Can I be more specific? (Yurn and Walsh) 3. Intervention
Significance Which of these facts is most 4. Evaluation
Used four-step process in the
important? DOLORES LITTLE development of written NCP, combing
Completeness Have I missed any important 1969 AND DORIS health, health assessment,
CARNEVALI designation of the problem into the
aspects? first step.
Fairness Am I considering the thinking KRISTINE GEBBIE Initiated national conferences on the
AND MARY ANN classification of nursing diagnosis
of others? 1973 LAVIN
Depth What makes this a difficult (St. Louis University
School of Nursing)
problem? RUTH FREEMAN AND Introduced Six-Step process for CHN
1981 JANET HEINRICH
Introduced a typology of functional
1982 MARJORY GORDON
health patterns

VILLAFLOR, KYLIE NICOLE A. | BSN 1H UNIVERSITY OF CEBU - BANILAD 6

 NURSING PROCESS AND CRITICAL THINKING
BENEFITS OF NURSING PROCESS
 NURSE
o Self-confidence
o Job satisfaction
o Professional growth
 CLIENT
o Potential for greater participation in their own career
o Continuity of quality care
ANA NURSING SCOPE AND STANDARDS OF
PRACTICE
 STANDARD 1. ASSESSMENT
o The registered nurse collects comprehensive data
pertinent to the client’s health or situation
 STANDARD 2. DIAGNOSIS
o The registered nurse analyzes the assessment data
to determine the diagnosis or issues.
 STANDARD 3. OUTCOME IDENTIFICATION
o The registered nurse identifies expected outcomes
for a plan individualized to the client or situation.
 STANDARD 4. PLANNING
o The registered nurse develops a plan that describes
strategies and alternatives to attain expected
outcomes.
 STANDARD 5. IMPLEMENTATION
o The registered nurse implements the identified plan.
o Standard 5A: Coordination of Care
 The registered nurse coordinates care delivery.
o Standard 5B: Health Teaching and Health
Promotion
 The registered nurse employs strategies to
promote health and a safe environment.
o Standard 5C: Consultation
 The advanced practice registered nurse and the
nursing role specialist provide consultation to
influence the identified plan, enhance the abilities
of others, and effect change.
o Standard 5D: Prescriptive Authority and
Treatment The advanced practice registered nurse
uses prescriptive authority, procedures, referrals,
treatments, and therapies in accordance with state
and federal laws and regulations.
 STANDARD 6. EVALUATION
o The registered nurse evaluates progress towards
attainment of outcomes.
COMPONENTS OF THE NURSING PROCESS
ASSESSING
 The vital phase of the Nursing Process with the following
steps:
o Collection of data from different sources
o Validating the data
o Organizing the data
o Categorizing / identifying patterns in the data
o Making initial inferences or impressions
o Recording or reporting data
 Purposes:
o A way to communicate patient information to other
caregivers
o Method to document initial baseline data
o Foundation on which to build an effective care plan
o A way to prove—in court or to a quality assurance
committee that you gave quality patient care
 Collection:
o Data collected should be descriptive, concise,
complete, and should NOT include interpretative
statements
VILLAFLOR, KYLIE NICOLE A. | BSN 1H UNIVERSITY OF CEBU - BANILAD
o The nurse records only what is OBSERVED and
DOES NOT INTERPRET the client’s behavior
o Descriptive:
 E.g. Situation: Pain is described to be sharp,
throbbing on the abdomen.
- Record what you observed: the client lies on
his side holding his abdomen. Facial
grimacing present throughout assessment
- Do not interpret: “the client tolerates pain
poorly”
o Concise:
 Information is summarized in a short format using
correct medical terms
TYPES OF DATA
 OBJECTIVE DATA
o Are observations on measurements made by the
data collector (SIGN)
o E.g. rash observed 6x4 along posterior thigh
 SUBJECTIVE DATA
o Are not directly observable as measurable by any
person other than the patient
o The patient will tell another as perceived by himself
(SYMPTOM)
o E.g. patient complained of itching at the back of his
thigh
 SOURCES OF DATA
o Client – best source because it can be the most
accurate
o Family or significant others – as primary sources
of information about infants or children, critically ill,
mentally handicapped, disoriented or unconscious
clients; can also give additional data about the
client’s health status
o Health Team Members – physicians, nurses, allied
health professionals and non-professionals,
employees working in a health care setting
o Medical Records – present and past medical
records of the patient can verify information
o Other Records – as educational, military, and
employment records may contain pertinent health
care information
 Note: any information about the patient’s medical
records is CONFIDENTIAL and is treated as part
of the client’s legal medical records
o Literature Review – reviewing nursing and medical
literature about the client’s illness helps to complete
the database; the review increases the nurse’s
knowledge about the symptoms, treatment, and
prognosis of specific illness
METHODS OF DATA COLLECTION
 Interviewing
 Doing Physical Assessment
 Collecting Supplemental Data
INTERVIEW
o A pattern of communication initiated for a specific
purpose and focused on a specific content area
o The first step toward establishing a therapeutic
relationship between the nurse and client so health
interventions occur
o Purpose in Nursing:
 Obtain a NURSING HEALTH HISTORY
 Identify health needs and risk factors
 Determine specific changes in the level of
wellness and pattern of living
o Objectives of Nursing Interview:
 Initiates nurse-client relationship
7
 NURSING PROCESS AND CRITICAL THINKING

 Obtains information from the client in all  Paraphrase – to validate information without
dimensions changing the meaning of the client’s statement
 Provides the nurse with an opportunity to observe  Clarify – facilitate correct communication
the client  Focusing – eliminates vagueness in
 Provides the client with an opportunity to obtain communication
information  State Observation –provides the client with
 Provides the first step towards establishing a feedback
therapeutic relationship between the nurse and  Offer Information –to clarify tx, initiate health
client teachings, and identify correct misconception
o INITIATING THE NURSE-CLIENT RELATIONSHIP  Summarize Data Gathered – because it will help
 Initial Relationship validate date and clients can confirm that the data
- Introduce yourself as the interviewer: (a) are correct
State your name and position, (b) Purpose of  TERMINATION PHASE
the interview o Give a clue that the interview is about to end
 Communicate trust and confidentiality to the  E.g. there are just 2 more questions..
client o The interview should be terminated in a friendly
- Assure the client that the interview is manner and specifically indicate when will be your
confidential next contact
 Convey professionalism and competence  E.g. thank you for answering these questions
- Show professional attitude and manner,  OBSERVATION
appearance o The basic tool of assessing information behavior with
 TYPES OF INTERVIEW TECHNIQUES: the use of all senses: touch, sight, hearing, taste,
o Emergency room – centers the: common sense
 Present illness or trauma o General Survey
 Precipitating factors  Initially view the patient from the foot of the bed
 Medications the client is taking to allow face to face contact
 Allergies  The opportunity of the nurse to make pertinent
o Extension Rehabilitation – focus on past and observations
present illnesses and coping strategies, family and - Observe patient’s general appearance
community resources and the client’s present - Shake hands with them
limitation and goals for rehabilitation - Take VS
 APPROACHES IN INTERVIEW - Take note of the following:
o Directive o Apparent state of health
 Used to obtain factual information o Signs of distress
 Sets of questions are prepared in mind or even o Skin color
written form used o Stature and habitus
o Non-directive o Weight
 Usually opens with some general discussion and o Posture
gradually moves to the focus point o Dress grooming
 Facilitates expression of thoughts and feelings o Facial expression
since it is non-threatening and allows the o Manner
individual to control the flow of discussion o Speech
o “Combined” Technique o State of awareness
 The combination of the two approaches which is o Vital Signs
the most effective o Any pertinent observations
o Immediate environment
PHASES OF INTERVIEW - *Detailed notes in health assessment
transes
 Orientation Phase
o Review the following:
 NURSING HEALTH HISTORY
 Purpose of the Interview
o Obtained during interview
 Types of data to be obtained
o Usually taken in admission that represents a
 Most appropriate method of interview to be used
baseline of information used by the nurse in
(5 to 10 minutes is needed to be acquainted with
developing an assessment of the individual’s health
the client
state
 WORKING PHASE
o Difference between Nursing Hx and Medical Hx:
o As the interview progresses, consider the 10
 Nursing Hx – deals with the individual responses
STRATEGIES FOR EFFECTIVE
to changes in health status and patterns of living
COMMUNICATION:
 Medical Hx – focuses on the sequences of
 Silence – helpful for making observations and
events of the individual’s present illness,
provides the client time to organize thoughts and
contributing factors, and his illness and wellness
to present complete information to the interviewer
hx
 Attentive Listening – demonstrates interest in
 Together, give a complete picture of the
client’s needs, concerns, and problems; EYE
individual’s health care needs
CONTACT IS IMPORTANT
 Conveying Acceptance – do not be judgmental
especially to the client’s beliefs, values, and
PHYSICAL ASSESSMENT (EXAMINATION)
practices  Is the taking of Vital Signs and other measurement and the
 Plan related Questions –the nurse uses words examination of all body parts using the techniques of
and word pattern in the client’s normal socio- Inspection, Palpation, Percussion, and Auscultation
cultural context  Conducted after Nursing Health History data gathered
VILLAFLOR, KYLIE NICOLE A. | BSN 1H UNIVERSITY OF CEBU - BANILAD 8
 NURSING PROCESS AND CRITICAL THINKING

 APPROACHES - Texture
o Cephalo-caudal - Vibration
o System by system - Pulsations
o Need Approach - Masses
 FOUR GENERAL PRINCIPLES IN DOING PE  Basic principles in doing palpation:
o Gain general impression first then focus on a specific - Short fingernails – to avoid hurting the
area patient and yourself
o Follow planned order of IPPA - Dry hands prior touching the patients – cold
o The body is symmetrical, compare one side with the hands can make muscles tense distorting
other side findings
o Use all senses - Encourage patient to breathe normally
 PREPARE PATIENT FOR HEALTH ASSESSMENT throughout
o Explain procedure - Inform patient where, when, and how the
o Measure patient’s height and weight done your touch will occur especially when the patient
admission cannot see what you’re doing
 Attire patient in gown  Tools in palpation
 Place clean paper towel on the scale and ask - Light palpation – indenting the skin about ½
patient to remove shoes or slipper to check temperature, moisture, and to
 Help patient to stand with his back towards the detect large tumors and tender or painful
scale bar areas
 Read height - Deep palpation – indenting patient’s skin
 Weight should be taken after height more than ½ to locate organs and determine
o Take vital signs their size, to detect crepitus and tumors,
o Empty bladder – abdominal organ can be distorted spasticity, rigidity to feel palpation
by a distended bladder  Methods:
o Provide privacy – draping appropriately - By one hand
o Provide adequate lighting - Bimanual
o Proper positioning - Grasping
 PHYSICAL EXAMINATION TECHNIQUES - Ballottement
o Inspection
 The use of one’s sense of vision and smell to o Percussion
consciously observe body parts to ascertain  Act of tapping or striking surfaces of body parts
quality or state health to learn its condition beneath by result to sound
 Qualities elicited:  The sound indicates the density of the underlying
- Mental status or level of consciousness tissue and thus detect the location of any body
- State of nutrition and development organs or structure
- Behavior and emotional rxn  Example:
- Abnormal anatomic structure - Stomach – produces a high-pitched, drum-
- Body movement like sound called TYMPANY because it is
- Posture and stature hollow
- Color, size, shape, location - Liver – dullness (low-pitched, thud-like)
- Order and sound because it is a dense organ
 How to analyze Percussion sound:
o Palpation - Intensity – (amplitude) relative loudness or
 The act of touching a patient in a therapeutic softness of sound
manner by pressure of the hand and fingers to - Duration – time period over which the sound
the surface of the body specially to determine is heard
conditions of underlying parts or organ - Pitch – (frequency) caused by vibration of
 Used to detect: highness and lowness of a sound
- Tenderness - Quality – (Timbre) how one perceives it
- Temperature musically
- Distinct sound produced

Table No. 4 Characteristics of a Percussion Sound

SOUND INTENSITY DURATION PITCH QUALITY NORMAL ABNORMAL DENSITY
LOCATION LOCATION
Flatness Soft Short High Flat Muscle (thigh) or Lungs MOST
bone (severe DENSE
pneumonia)
Dullness Moderate Moderate High Thud Organs (liver) Lungs
(atelectasis)
Resonance Loud Moderate- Low Hollow Normal lungs No abnormal
long location
Hyper Very Loud Long Very Low Boom No normal location Lungs
resonance in adults; normal (emphysema)
lungs in children
Tympani Loud Long High Drum Gastric air bubble Lungs (large
pneumothorax) LEAST
DENSE

VILLAFLOR, KYLIE NICOLE A. | BSN 1H UNIVERSITY OF CEBU - BANILAD 9

 NURSING PROCESS AND CRITICAL THINKING

o Auscultation IMPLEMENTING
 Is the act of active listening to body organs to  Execution of nursing plan of care to meet goals set with the
gather information on a patient’s clinical status client
 Types of Auscultation:  Skills needed:
- Direct or Immediate – listening with the o Psychomotor – nursing procedures
unaided ear o Interpersonal – therapeutic command
- Indirect or Mediate – listening with some o Critical Thinking – decision about what needs to be
amplification or mechanical device done
 Implementation
DIAGNOSING o A category of nursing behavior in which the actions
 The outcome formulated after analysis (breaking the whole necessary for achieving the expected outcomes of
into parts) and synthesis (putting data together in a new the nursing care plan are initiated and completed
way) o It includes the nursing:
 According to NANDA-I (North American Nursing Diagnosis  Performing or assisting in the performance of the
Association-International): client’s activities of daily living
o Nursing Diagnosis is a clinical judgement about the  Counselling and teaching the clients or families,
individual, family, or community responses to actual giving care to achieve client-centered goals
or potential health problems / life processes  Supervising and evaluating the work of staff
 COMPONENTS OF NURSING DIAGNOSIS members
o Problem (P)  Recording and exchanging information relevant
o Etiology (E) to the client’s continued health care
o Signs (S)
TYPES OF NURSING INTERVENTION
TYPES OF NURSING DIAGNOSIS  DEPENDENT INTERVENTION
o A nursing action that is completed with a physician’s
Table No. 5 Types of Nursing Diagnosis order that requires nursing judgement or decision-
NURSING DIAGNOSIS EXAMPLE making.
(P) Deficient Fluid Volume  INDEPENDENT INTERVENTION
related to (E) nausea and o Can solve the client’s problems without consultation
Actual Diagnosis
vomiting as (S) manifested by or collaboration with physicians or other non-nursing
P + E + S
dry skin and mucous health professionals
yes yes yes
membranes and decrease o E.g. Medication
oral intake of fluids  INTERDEPENDENT INTERVENTIONS
Risk Diagnosis Risk for infection related to o Is completed with or without physician’s order or is
(Potential Problem) the presence of invasive lines written at a nurse’s suggestion.
P + E + S (intravenous lines and o Client’s problem is solved through a collaborative
no yes no indwelling bladder catheter) manner, through judgement with recommendation of
Possible Imbalanced Nutrition the health team.
Possible Diagnosis
Less than Body o E.g., referrals; carrying a protocol or standing orders
P + E + S
Requirements, related to  Protocol and Standing Orders
? yes yes
insufficient oral intake - Protocol – is a written plan specifying the
Wellness Diagnosis procedure to be followed during an
Readiness for enhanced
P + E + S assessment or in providing treatment.
spiritual well-being o E.g., admitting a patient.
no yes no
Syndrome Diagnosis Risk for Disuse Syndrome - Standing Order – is a written document
P + E + S related to complications and containing rules, policies, procedures,
no yes yes immobility regulations, and orders for the conduct of
client care in various clinical settings.
o E.g., ICU setting
Table No. 6 Difference between Medical and Nursing o Specific Drug for irregular rhythm is
Diagnosis ordered as a standing order. With or
MEDICAL DIAGNOSIS NURSING DIAGNOSIS without doctor’s order – the nurse will
Focuses on illness, injury, Focuses on the responses to give the medication after assessing
or disease process actual or potential health such unique rhythm.
problems or life processes  Protocols and standing Orders – give the nurse
Remains constant until a Changes as the client the large protection to intervene appropriately in
cure is effected responds and/or the health the client’s best interest.
problems changes
Identifies conditions the Identifies situation in which DECISION-MAKING STRATEGIES FOR CHOOSING
healthcare practitioner is the nurse is licensed and NURSING INTERVENTIONS
licensed and qualified to qualified of intervene  Select the interventions designed to achieve expected
treat outcomes and know the difference between dependent,
independent and interdependent interventions.
 Consultation
OUTCOME IDENTIFICATION AND PLANNING o How?
 Planning – formulation of guidelines what nursing action to  Identify the general problem area
take, to resolve nursing diagnoses and develop client’s care  Direct consultation to appropriate professional
plan  Provide the consultant pertinent information
includes:
VILLAFLOR, KYLIE NICOLE A. | BSN 1H UNIVERSITY OF CEBU - BANILAD 10
 NURSING PROCESS AND CRITICAL THINKING
- Brief summary of the problems
- Methods used to resolve the problem
- Outcome of those methods
 Avoid biases by not overloading consultants with
subjective and emotional conclusions about the
client and the problem.
 Be available to discuss the findings and
recommendation
- Provide a private comfortable atmosphere
for which the consultant and client can meet
with the nurse.
 Incorporate the consultant’s recommendation
into the NCP.
IMPLEMENTATION METHODS
 Assisting with Activities of Daily Living (ADL)
o E.g. eating, dressing, etc.
o Conditions resulting in the need for assistance with
ADL’s can be acute, chronic, temporary, permanent,
or rehabilitative
 Counselling
o Helps the client use a problem-solving process to
recognize and manage stress
o Emotional, intellectual, spiritual, and psychological
support
 Teaching
o Is closely aligned to counselling
o Used to present correct principles, procedures, and
techniques of health care
o Both uses communication skills to effect change
 In counselling – the change results in the
development of new attitudes and feelings
 In teaching – the focus of change is intellectual
growth of the acquisition of new knowledge or
psychomotor skills
 Giving care to achieve the client’s goal
o Nursing interventions
 Compensations for Adverse Reactions
o Adverse Reaction – is a harmful or unintended effect
of a medication, diagnostic, test, or therapeutic
intervention
o How to avoid?
 The nurse must have knowledge about the
potential individual effect
 E.g. know the side effects of the drug first before
taking
 Preventive Measures
o Promotion of the client’s health potential
o Application of prescribed measures
immunizations, health teaching, early diagnosis, and
treatment and rehabilitation
 Correct Techniques in administering care and
preparing a client for procedure
o Experience is needed
 Lifesaving Measures
o Emergency needs
o CPR
o Restraining a confused patient
o Counselling for a severely anxious client
o Experience is needed
 Reporting and documentation are part of implementing
(discussion after evaluating concept)
EVALUATING
 Evaluation - – measures the client’s response to nursing
actions, progress towards achieving goals, the quality of
nursing care provided and the level of nursing care for a
client.
VILLAFLOR, KYLIE NICOLE A. | BSN 1H UNIVERSITY OF CEBU - BANILAD
EVALUATION PROCESS
 Establishment of outcome criteria
o e.g., expected outcome: client able to cough
productively
 Comparison of client response to outcome criteria
 Analysis of variables affecting outcomes and conclusions.
o determine the reason for failed plan: REASSESS.
 Modification – in the NCP.
o Modification is based on conclusions.
 Re-evaluate – continue to assess plan, implement and
evaluate for as long as you care for the patient.
BENEFITS OF EVALUATION
 Quality Assurance – an ongoing, systematic,
comprehensive evaluation of health care services and the
import of those services on the health care consumer.
 Goal: TO ENSURE EXCELLENT HEALTH CARE
 SEVEN COMPONENTS OF QUALITY ASSURANCE
PROGRESS:
o Identification of problem
o Setting priorities
o Establishment of criteria
o Selection of assessment methodology
o Identification of etiology.
o Implementation of connective action
o Evaluation
 During the evaluation process, ask yourself these
questions:
o Has the patient’s condition improved, deteriorated,
or stayed the same?
o Was the Nursing Diagnosis accurate?
o Have the patient’s nursing needs been met?
o Did the patient meet the care plan’s outcome
criteria?
o Which nursing intervention should I revise or
discontinue?
o Why did the patient fail to meet some goals?
o Should I reorder priorities, revise goals and outcome
criteria?
 Nursing Audit
o Is part of quality assurance
o A thorough investigation designed to identify,
examine or verify the performance of certain
specified aspects of nursing care using established
professional standards.
 Concurrent Nursing Audit
o An evaluation of nursing care while the patient is still
in the hospital
as
HOW TO RECORD EVALUATION
 Continue – the problem still exist and the plan will continue
as is.
 Revised – the problem still exist, but the nursing orders
required revision (write the revision)
 Ruled out – a problem that had been designated as possible
has been ruled out.
 Resolved – portion of the Nursing Care Plan (NCP)is
discontinued.
REFERENCES
Notes from the discussion by Ms. Restymay Manlongat
University of Cebu – Banilad College of Nursing powerpoint presentation:
Nursing Process PPT
11
 UNIT I: DOCUMENTATION
 RESEARCH
o Information in the record can be a valuable source of
OUTLINE data for research
I Overview  EDUCATION
II Purpose of Documentation
o Students in health disciplines often use client
III Types of Records
A Source-oriented Client Records records as educational tools
B Problem-oriented Clinical Records 
C Four Basic Components of POMR
i Database  QUALITY ASSURANCE MONITORING
ii Problem List o The record is used to monitor the care the client is
iii Plan of Care receiving and the competence of the people giving
iv Progress Notes
D Computer Records
that care.
IV Formats for Nursing Documentation  Nursing Audit
A SOAP - Quality assurance monitoring of nursing
B Focus Charting - Peer Review
V Guidelines for Good Reporting and Recording  STATISTICS
VI Do’s and Don’ts of Intershift Report o Statistical information from client records can help an
VII Charting Techniques agency anticipate and plan for people’s future needs.
 ACCREDITING AND LICENSING
o Organization as Joint Commission on Accreditation
DOCUMENTATION of Healthcare Organization
 Florence Nightingale  REIMBURSEMENT
o Founder of Nursing Documentation o Clinical record must contain the correct DRG codes
o She stressed the importance of gathering patient and reveal that the appropriate care has been given
information in a: and facilitate reimbursement from Medicare or other
 Clear health insurances.
 Concise
 Organized manner TYPES OF RECORDS
 Health Personnel Communicate through:
o Discussions SOURCE-ORIENTED CLIENT RECORDS
o Reports
 Each person or department makes notations in a separate
o Records
section or sections of the client’s chat
 The legal responsibility of nurses to patients is to provide
 In this type of record, information about a particular problem
quality nursing care utilizing the nursing process
is distributed throughout the record
o “All nursing data related to assess, nursing
 E.g. Admission Department – admission sheet
diagnosis, nursing interventions, and client outcome
must be permanently filled in a client information
system” PROBLEM-ORIENTED CLINICAL RECORD (POR) OR
 ETHICAL AND LEGAL CONSIDERATIONS: PROBLEM-ORIENTED MEDICAL RECORD (POMR)
o REPUBLIC ACT 10173 – Data Privacy Act  The record INTEGRATES all about a problem whether
 The American Nurses Association Code of Ethics gathered by physicians, nurses, or other healthcare
states “The nurse has a duty to maintain personnel involved in the client’s care.
confidentiality of all patient information”  Coordinates the care given by all healthcare team members
and focuses on the client and the client’s health problems
PURPOSES OF DOCUMENTATION
 PLANNING CLIENT CARE 4 BASIC COMPONENTS OF POMR
o Each health care professional uses data from the  Database
client’s record to plan for the client  Problem List
 COMMUNICATION o A need that the client is unable to meet without
o A vehicle of interaction for all health care assistance from a health professional
professionals o Problem list should include:
o This prevents fragmentation, repetition, and delays  Socio-economic
in client care  Demographic
 LEGAL DOCUMENTATION  Psychologic
o Client’s record  Physiological Data
 Is a legal document and is admissible in court as  Plan of Care
evidence  Progress Notes
o Record o Methods:
 Is usually considered the property of the agency  Narrative Charting
 PIE
 Flowsheets

VILLAFLOR, KYLIE NICOLE A. | BSN 1H UNIVERSITY OF CEBU - BANILAD 1

 DOCUMENTATION

 Charting by Exception (CBE) ADVANTAGES OF SOAPIE

 SOAPIE  Makes it easier to track particular problems for quality
 Focus Charting assurance monitoring
 Computer Records  Provides evidence that the plan of care was implemented.
o Documentation is entered to the computer (installed
in the patient’s room) after giving the nursing care DISADVANTAGES OF SOAPIE
FORMATS OF NURSING DOCUMENTATION  Nurses have difficulty determining the most appropriate
place for certain information
 Nursing Care Plans
o Traditional-written for each client  Seldom implemented in its pure form because of
o Standardized Care Plan modification
 Critical Pathways  There is considerable redundancy because there are
flowsheets where the same info is found.
 KARDEX
o Often recorded in pencil so they can be changed and  Not the most efficient method of documentations.
kept up to date
 Organized Information FOCUS CHARTING
o Pertinent Information  A method of identifying patients concerns and organizing
o Medications the narrative documentation to include: DATA, ACTION,
o IVF RESPONSES for each identified concern.
o Tx and procedures  This was developed by a committee of staff nurses at Eitel
o Diagnostic procedures Hospital in Minneapolis.
o Allergies  Before adopting FOCUS charting, the hospital used the
o Specific data on how the client’s physical needs are SOAP format. The committee examined the Nursing
to be met, diet, etc. Process and specific hospital policies and collaborated with
o Problem list, goals, and nursing approaches physicians and hospital department heads to discuss
interdisciplinary requirements for documentations.
SOAP o The committee determined the following to be
 SOAPIE; SOAPIER; APIE essential information for nursing documentation:
 Was introduced in late 1960’s by Dr. Lawrence Weed  Nursing Assessment
 Nursing Care Plan for each concern
 Nursing care provided
  Evaluation of the patient’s response to
S 
What the patient tells you (Subjective Data)
What the family/significant other tells you intervention
o Patient’s concerns are identified from data collected
 Objective data related to subjective data during admission assessment or reassessment
O  Can include VS, lab, and dx results and other
observations
during hospitalization.
 The identified concern is not called a problem but a focus
 that eliminates the negative connotation of the word
A Assessment / interpretation or conclusion from
the subjective and objective data

problem.
Patient’s concern or focus is generally phrased as a Nursing

P  What the nurse will do to resolve the problem

Diagnosis but a focus can also be any of the following:
o Current behavior or concern
 Specific nursing interventions implemented  Ex. anxiety, discharge needs
o A sign of symptom
I  Do not include ROUTINE ACTIVITIES which
are recorded in other flow sheets
 Fever, nausea
o Acute change in the status
 Client’s response
 Cardiac arrest, seizures
 It answers the question “what is the client’s
E behavior which indicates that the plan was
o Significant patient care event
 Chemotherapy, surgery
successful o Nursing diagnosis
  ineffective breathing pattern R/T decrease
R Revision; change that must be made in the
initial or original plan energy.

Table No. 1 Significant Weight Loss Problem CATEGORIES OF FOCUS CHARTING

01-12-2015 7-3 shift  DATA (D) Category – reflects the assessment phase of the
 “Di ko ganahan mo inum ug sustagen” or nursing process
S  “Di siya ganahan mo inum ug sustagen” as claimed  ACTION (A) Category – reflects planning and
by the mother implementation and includes immediate and future nursing
O wt = 110 lbs with ht of 5’9”
actions
A Still for further assessment
 RESPONSE (R) Category – reflects the evaluation phase
 Request order for dietary consult
P
 Speak with wife during visiting hours
of the nursing process and describes the client’s response
 Obtained order from doctors for dietary consult
to any nursing and medical care
I  Coordinated w/ dietician to visit pt at 2pm today
 Talked with wife re: request for pospas
 Visited by Ms. Joy, the dietician who will change
E menu sections
 Mrs. Roger (wife) will bring pospas tomorrow

VILLAFLOR, KYLIE NICOLE A. | BSN 1H UNIVERSITY OF CEBU - BANILAD 2

 DOCUMENTATION

Table No. 2 FDAR Charting Sample Table No. 3 Examples of Criteria for Reporting and Recording
Date/Time Focus Progress Note TOPIC WHAT TO REPORT OR RECORD
D – Patient requested pain Description of episode, location of
medication for incisional pain Symptom symptom, onset, precipitating factor (s),
(pain, nausea,
in right groin. Patient is 1 day headache,
frequency, duration, aggravating
status post right heart cath. dizziness) factor(s), relieving factor(s), associated
Rates pain 8 on 1-10 pain symptom(s)
10/30/2015
scale Sign Location of sign, description or quality
0800 Pain (rash, tenderness on of finding, aggravating or relieving
0900 palpation o body
A – Administered Lortab 5/325 factor(s)
mg PD. part, diminished
breath sounds)
Nursing Care Time administered, equipment used if
R – Patient now rates pain 2 Measures appropriate, client’s response positive
on 1 – 10 pain scale (enema, bath, or negative, nurse’s observation
dressing)
ADVANTAGES OF FOCUS CHARTING Time of occurrence, behaviors
Client Behavior
 Provide structure for the progress notes by organizing the exhibited, precipitating factor(s),
(anxiety, confusion,
content into data, action, response. hostility) nursing response or action, client
 Promotes documentation of the Nursing Process. response to nursing action
 Increase the ease with which information can be located in Time administered, any required
the progress notes. Simply by scanning the N-focus column Medication preliminary observations (pulse, blood
Administration pressure), client response (positive) or
the nurse can locate specific information.
(analgesic) nursing measures taken if negative
 Nurses are encouraged to identify patient concerns not just
response occurs
problems.
Information or topic presented,
 Promotes analytical thinking by requiring the nurse to
methods or instructions (discussion,
analyze data and draw conclusions regarding patient’s
role playing, demonstration), resources
status Patient Teaching
used (videotape, booklet), and
evidence that client understand
DISADVANTAGES OF FOCUS CHARTING instructions
 If not monitored regularly, the focus charting can become a
narrative note with no evidence of patient response to
interventions. DO’S AND DON’T’S OF INTERSHIFT REPORT
 Focus, like SOAP, requires a change in thinking. The nurse
must be able to identify the focus accurately and sort the Table No. 4 Do’s and Don’ts of Intershift Report
data into the appropriate categories of date, action and DO’S DON’T’S
response.  Provide only essential background  Don’t review all routine care
 Nurses have varying degrees of difficulty constructing information about client (name, procedures or tasks (bathing or I
accurate and logical focus notes. They leave discrepancies sex, age, physicians diagnosis, & O)
medical history).  Don’t review all biographical
between the focus and the content of the notes.  Identify client’s nursing diagnosis information already available on
or health care problems and their Kardex.
GUIDELINES FOR GOOD REPORTING AND related causes.  Don’t use critical comments
 Describe objective measurements about the client’s behavior.
RECORDING or observations about the client’s  Don’t make assumptions about
 ACCURACY conditions and response to health relationships between family
o Correct information. problem. Stress any recent members.
changes.
o Do not make assumptions when data are not  Share significant information about
complete. family members as it relates to
o Use precise measurements to ensure accuracy. client’s problems
o Use correct spelling.
o Accurate signature includes the following: CHARTING TECHNIQUES
 First name initial  Write neatly and legibly.
 Complete surname  Use proper spelling and grammar.
 Status e.g. R. Diputado, R.N. o Keep a dictionary in charting areas.
 CONCISENESS o Post a list of frequently misspelled words.
 THOROUGHNESS o Write a clear and concise sentences.
 CURRENTNESS  Document in blue or black ink and use military time.
o Activities that must be communicated at the time  Use authorized abbreviations
they occur:  Make sure the patient’s name is on every sheet.
 adm. of meds or other tx  Transcribe orders carefully.
 prep. of clients for dx test or surgery  Document complete information about medications:
 change in a client’s status o time, date
 admission, transfer, or discharge of a client o site of injections
 tx initiated for sudden changes in a client’s o reasons why meds are omitted
condition  Chart promptly.
 ORGANIZATION  Chart after the delivery of nursing care, not before.
 CONFIDENTIALITY  Identify late Entries correctly.
o Procedure:
 Add the entry to the first available line

VILLAFLOR, KYLIE NICOLE A. | BSN 1H UNIVERSITY OF CEBU - BANILAD 3

 DOCUMENTATION

 label the entry “late entry” to indicate it is out of

sequence.
 Record the time and date of entry.
 In the body of entry, record the time and date
 Correct mistaken entries PROPERLY.
o Procedure:
 Draw a single line through the entry so that it is
still readable.
 “mistaken entry” – above the or beside the
original records. “error” is no longer advisable
because juries tend to associate it with a clinical
error.
 Place the date and your initials next to the words
“mistaken entry” or M.E.
 Do not tamper with medical records. Tampering with
records involves:
o Adding to the existing record at a late date without
indicating the addition is late entry.
o Placing inaccurate information into the record.
o Omitting significant tasks.
o Dating a record to make it appear as if it were written
at an earlier time.
o Rewriting or altering the record.
o Destroying records.
o Adding to someone else’s notes.
 Chart only care you provided or supervised.
 Avoid using the medical record to criticize other healthcare
professionals.
 Fill in the blanks on chart forms.
 Document any comments the patient makes about a
potential lawsuit against a health care provider or institution
 Eliminate bias from written description of the patient. 18. Be
precise in documenting the information you report to the
physician.
 Document potentially contributing patient acts.
o A patient’s referral or inability to provide accurate
and complete info.
o Non-compliance with medical and nursing care.
 staying in bed
 dietary restrictions
 return appointment
 Leaving against medical advice
 abuse or refusal of medical intervention
o Presence of unauthorized personal items at the
bedside.
o Tampering with medical equipment

REFERENCES

Notes from the discussion by Ms. Restymay Manlongat

University of Cebu – Banilad College of Nursing powerpoint

presentation:

Documentation PPT

VILLAFLOR, KYLIE NICOLE A. | BSN 1H UNIVERSITY OF CEBU - BANILAD 4

 ILLNESS, WELLNESS AND HEALTH

UNIT II: ILLNESS, WELLNESS, AND HEALTH

 RECOVERY OR REHABILITATION
OUTLINE o Client is expected to relinquish the dependent role
VIII Health and resume former roles and responsibilities
A Disease
i Acute
ii Chronic WELLNESS
IX Illness  An integrated method of functioning which is oriented
A Five Stages of Illness and Health – Seeking Behavior by toward maximizing the potential of which the individual
Suchman is capable.
X Wellness  It requires that the individual maintains a continuum of
A Dimensions of Wellness
balance and purposeful direction within the environment
XI Health – Illness Continuum
A Characteristics of Health – Illness Continuum Model where he is functioning (Halbert Dunn).
B Nurse Responsibilities  WELL-BEING – A subjective perception of balance,
C Models of Health and Illness harmony, and vitality
i Dunn’s High-Level Wellness and Grid Model
ii Travis’ Illness-Wellness Continuum DIMENSIONS OF WELLNESS
iii Health Belief Model by Rosenstock  PHYSICAL/ BIOLOGIC DIMENSION
o Genetic makeup, age, developmental level, race and
sex are all part of individual’s physical dimension and
HEALTH strongly influence health status and health practice
 According to the World Health Organization, Health is the  EMOTIONAL DIMENSIONS
state of physical, mental, social well-being and not o Self-concept is how a person feels about self and
merely the absence of disease or infirmity perceives the physical self, needs, roles, and
 Health is individually defined by each person abilities.
o On a personal level, individuals define health  INTELLECTUAL DIMENSION
according to: o Cognitive abilities, educational background and past
 How they feel experiences; positive sense of purpose.
 Absence or presence of symptoms of illness  ENVIRONMENTAL DIMENSION
 And ability to carry out activities o The ability to promote health measure
o Awareness of their environment and how it affects
DISEASE their health and level of wellness
 Objective pathologic process  SOCIO-CULTURAL DIMENSIONS
 Pathologic change in the structure or function of the mind o Concerns having support network and job
and body satisfaction help people avoid illness.
 ACUTE o Culture and social interactions also influence how a
o Rapid onset of symptoms person perceives, experiences, and copes with
o Some are life threatening health and illness.
o Many do not require medical treatment  SPIRITUAL DIMENSIONS
 CHRONIC o Refers to the recognition and ability to practice moral
o Broad term that encompasses many different or religious principles or beliefs and maintenance of
physical and mental alterations in health a harmonious relationships with a supreme being.
o It is a permanent change
o Requires special patient education for rehabilitation HEALTH-ILLNESS CONTINUUM
o Requires long term of care and support  Health and illness can be viewed as the opposite ends of a
health continuum.
ILLNESS  From high level of health, a person’s condition can move
 A highly personal state in which the person feels unhealthy, through good health – normal health– poor health-
may or may not related to disease. extremely poor health – to death
 Highly subjective- feeling of being sick or ill  People move back and forth within this continuum day by
o How the person feels towards sickness day.
 Concerns the nurse  How people perceive themselves and how others see them
in terms of health and illness will also affect their placement
FIVE STAGES OF ILLNESS AND HEALTH – SEEKING on the continuum
BEHAVIOR BY SUCHMAN
 SYMPTOM EXPERIENCE CHARACTERISTICS OF HEALTH-ILLNESS
o Client realizes there is a problem CONTINUUM MODEL
o Client responds emotionally  At any time any person’s health status holds a place on
 SICK ROLE ASSUMPTION certain point between two ends of health –illness
o Self-medication continuum.
o Communication to others  Any point on the health – illness continuum is asynthetically
 MEDICAL CARE CONTACT representation of various aspects of individual in
o Seek advice of health professional physiology, psychology and society
o May accept or deny diagnosis
 DEPENDENT CLIENT ROLE NURSE RESPONSIBILITIES
o Accepting the illness and seeking treatment
 To help the client to identify their place on the health–
continuum

VILLAFLOR, KYLIE NICOLE A. | BSN 1H UNIVERSITY OF CEBU - BANILAD 5

 ILLNESS, WELLNESS AND HEALTH

 To assist the clients to adopt some measures in order to  Movement to the left on the arrows (towards premature
reach a well state of health death) equates a progressively decreasing state of health
o Achieved in 3 steps:
MODELS OF HEALTH AND ILLNESS  Signs
 Symptoms
DUNN’S HIGH-LEVEL WELLNESS AND GRID MODEL  Disability
 Most important is the direction the individual is facing on the
 X – axis is health
pathway
o Ranges from peak wellness to death
o If towards high – level health, a person has a
 Y – Axis is environment
genuinely optimistic or positive outlook despite
o Ranges from very favorable to very unfavorable
health status
o If towards premature death, a person has a
genuinely pessimistic or negative outlook about
health status
 Compares a treatment model with a wellness model
o If a treatment model is used, an individual can move
right only to the neutral point
o If wellness model is used, an individual can move
right past the neutral point

HEALTH BELIEF MODEL BY ROSENSTOCK

 Concerned with what people perceive about themselves in
relation to their health
 Consider perceptions (influences individual’s motivation
toward results)
o Perceived susceptibility
o Perceived seriousness
o Perceived benefit out of action

REFERENCES
Figure 1. Dunn’s High-Level Wellness and Grid Model
Notes from the discussion by Ms. Restymay Manlongat
 Quadrant 1 – high-level Wellness in a favorable
environment University of Cebu – Banilad College of Nursing powerpoint
 Quadrant 2 – Protected Poor Health in a favorable presentation:
environment
 Quadrant 3 – Poor health in an unfavorable environment Illness, Wellness And Health PPT
 Quadrant 4 – Emergent High level Wellness in an
unfavorable environment

TRAVIS’ ILLNESS-WELLNESS CONTINUUM

 Composed of two arrows pointing in opposite directions and
joined at a neutral point

Figure 2. Travis’ Illness-Wellness Continuum

 Movement to the right on the arrows (towards high level

wellness) equals an increasing level of health and well –
being.
o Achieved in 3 things:
 Awareness
 Education
 Growth

VILLAFLOR, KYLIE NICOLE A. | BSN 1H UNIVERSITY OF CEBU - BANILAD 6

 UNIT I: DEATH, DYING, AND POST-MORTEM CARE

OUTLINE TYPES OF COMPLICATED GRIEF

I Overview
II Sources of Loss  Unresolved or chronic grief -di ka move on
III Types of Grief Response  Inhibited grief -murag manhid
A Types of Complicated Grief  Delayed grief -late reaction
IV Development Concept of Death  Exaggerated grief -oa ra kaayo
V Five Stages of Grief
A Denial
B Anger DEVELOPMENT CONCEPT OF DEATH
C Bargaining
D Depression Table No. 2 Development Age Concept of Death
E Acceptance Age Concept
VI Martocchio’s Five Clusters of Grief - Does not understand the concept
VII Engel’s Stages of Grieving of death
VIII Symptoms of Grief Infancy to 5 yrs.
IX Assisting Clients with their Grief
- Believes death is reversible; a
A Interventions for Fears temporary departure or sleep
X Physiology of Dying - Understands that death is final
A Basic Body Changes Result in Death - Believes own death can be
B Indications of Death 5 to 9 yrs. avoided
XI Post-Mortem Care - Associated death with aggression
A Nursing Interventions for the Body after Death or violence
- Fears of lingering death
- May fantasize that can be defied,
OVERVIEW acting out of defiance through
12 to 18 yrs.
reckless behavior
Table No. 1 Emotional and Physiological Elements of Death - Views death in religious and
and Dying philosophic terms
Definition of Terms - Has the attitude towards death that
An illness or condition which recovery 18 to 45 yrs. is influenced by religious or cultural
is not expected beliefs
Terminal Illness
E.g. AIDS, emphysema, dementia, and - Accepts own mortality
-Ilness nga wa nay cure
some types of cancers - Encounters death of parents and
Is an actual or potential situation that in 45 to 65 yrs.
some peers
which a valued object, person, or the - Experiences peak of death anxiety
Loss
like is inaccessible or changed so that - Fears prolonged illness
it is no longer perceived as valuable - Encounters death of family
when loss= in grief
Mental anguish specifically associated members and pears
with loss - Sees death as having multiple
It is the total response to the emotional 65 yrs. And above
Grief meanings
experience of the loss and is - E.g. freedom from pain, reunion
manifested in thoughts, feelings, and with already deceased family
behaviors members
Is the behavioral process through
which grief is eventually resolved or FIVE STAGES OF GRIEF
Mourning altered
Ex: 40 days of the dead It is often influenced by culture, custom, DENIAL
and spiritual beliefs
 Refuses to believe that loss is happening.
SOURCES OF LOSS  Is unready to deal with practical problems, such as
prosthesis after the loss of a leg
 Aspect of oneself
 May assume artificial cheerfulness to prolong denial
 Loss of an object external to oneself
 Nurse Implications:
 Separation from an accustomed environment o Verbally support client but do not reinforce denial.
 Loss of a loved or valued person o Examine your own behavior to ensure that you do
not share in client’s denial.
TYPES OF GRIEF RESPONSE  Effects on the Person’s Behavior
 Abbreviated -shortened grief o The person may ask for second opinion
 Anticipatory -expected or prepared grief o The person may act as if nothing is wrong
 Disenfranchised -a grief that is not accepted in the society o The person may refuse medications or treatment.
 Pathologic or complicated grief -hard to cope up or lisod i-accept nga grief

VILLAFLOR, KYLIE NICOLE A. | BSN 1H UNIVERSITY OF CEBU - BANILAD 1

 DEATH, DYING, AND POST-MORTEM CARE
ANGER
 Client or family may direct anger at nurse or staff about
matters that normally would not bother them.
 Effects on the Person’s Behavior:
o The person may become moody and withdrawn
o The person may become uncooperative and hostile
o The person may lose religious faith.
 Nursing Implications:
o Help client understand that anger is a normal
response to feelings of loss and powerlessness
o Avoid withdrawal or retaliation; do not take anger
personally.
o Deal with needs underlying any angry reaction
o Provide structure and continuity to promote feelings
of security.
o Allow clients as much control as possible over their
lives.
BARGAINING
 Seeks to bargain to avoid loss -negotiating
 E.g. “let me just live until and then I will be ready to die”
 Effects on a Person’s Behavior:
o - The person may speak for wanting to live long
enough to accomplish a goal or to witness a specific
event (wedding or a child’s birth)
 Nursing Implications:
o Listen attentively, and encourage client to talk to
relieve guilt and irrational fear
o If appropriate, offer spiritual support
DEPRESSION
 Grieves over what has happened and what cannot be.
 May talk freely, or may withdraw
 Nursing Implications:
o Allow client to express sadness
o Communicate nonverbally by sitting quietly without
expecting conversation
o Convey caring by touch
 Effects on the Person’s Behavior:
o The person may be sad or cry a lot
o The person may withdraw and say little
o The person may refuse food or have trouble falling
asleep.
ACCEPTANCE
 Comes to terms with loss.
 May have decreased interest in surroundings and support
people
 May wish to begin making plans
 Effects on the Person’s Behavior:
o May want to complete unfinished business
o May want to say goodbye to friends and loved ones
o May plan his own funeral service
o May want to talk about his death with others.
 Nursing Implications:
o Help family and friends understand client’s
decreased need to socialize
o Encourage client to participate as much as possible
in the treatment program.
MARTOCCHIO’S FIVE CLUSTERS OF GRIEF
 SHOCK AND DISBELIEF
o Feeling of numbness following the death of a loved
one.
 YEARNING AND PROTEST
o The anger that the bereaved feel may be directed at
the deceased for having died, at GOD, at others
whose love ones are still alive or at the caregivers.
VILLAFLOR, KYLIE NICOLE A. | BSN 1H UNIVERSITY OF CEBU - BANILAD
 ANGUISH, DISORIENTATION, AND DESPAIR
o When the reality of the loss is genuinely admitted,
depression can set in.
o Weeping is common.
o The bereaved lose interest and motivation in
pursuing the future and lack of confidence and
purpose
 IDENTIFICATION IN BEREAVEMENT
o The bereaved may take on the behavior, personal
traits, habits and ambitions of the deceased.
o Sometimes they may also experience the same
symptoms of physical illness
 REORGANIZATION AND RESTITUTION
o Achieving stability and sense of reintegration can
take a period of time that ranges widely, from less
than a year to several years.
ENGEL’S STAGES OF GRIEVING
 SHOCK AND DISBELIEF
o Refusal to accept loss, stunned feelings and
intellectual acceptance but emotional denial
 DEVELOPING AWARENESS
o Reality of loss begins to penetrate awareness; anger
may be directed at hospital, nurses, etc. and crying
and self – blame.
 RESTITUTION
o Rituals of mourning
 RESOLVINGTHE LOSS
o Attempts to deal with painful void; still unable to
accept new love object to replace the loss person
o May accept more dependent relationship with
support
o Thinks over and talks about memories of the dead
person.
 IDEALIZATION
o Produces image of dead persons that is almost
devoid of undesirable features;
o Represses all negative and hostile feelings toward
the deceased;
o Unconsciously internalizes admired qualities of the
deceased
o Reinvest feelings in others
 OUTCOME
o Behavior influenced by several others:
 Importance of the lost object as source of support
 Degree of ambivalence toward deceased
 Number and nature of other relationship
 Number and nature of previous grief experiences
SYMPTOMS OF GRIEF
 Repeated somatic distress
 Tightness in chest
 Choking or shortness of breath
 Sighing
 Empty feeling in the abdomen
 Loss of muscular power
 Intensive subjective distress
ASSISTING CLIENTS WITH THEIR GRIEF
 Provide opportunity for the person to tell their story.
 Recognize and accept the varied emotions that people
express in relation to a significant loss.
 Provide support for the expression of difficult feelings such
as anger and sadness
 Include children in their grieving process
 Encourage the bereaved to maintain established
relationships.
 Acknowledge the usefulness of mutual – help group.
2
 DEATH, DYING, AND POST-MORTEM CARE
 Encourage self-care by family members particularly, the
primary caregivers
 Acknowledge the usefulness of counseling for specially
difficult problems.
 DEATH CAN INVOLVE FEARS THAT ARE PHYSICAL,
SOCIAL, AND EMOTIONAL
o PHYSICAL - Helplessness, dependence, loss of
physical faculties, mutilation, pain
o SOCIAL - Separation from family, leaving behind
unfinished business
o EMOTIONAL - Being unprepared for death and what
happens after death
INTERVENTIONS FOR FEARS
 Talk as needed
 Avoid superficial answers
o I.e. “It’s God’s will
 Provide religious support as appropriate
 Stay with the patient as needed
 Work with families to strengthen and support
PHYSIOLOGY OF DYING
 Somatic death or death of the body
 Series of irreversible events leading to cell death
 Causes of death varies
 However, there are basic body changes leading to all
deaths
BASIC BODY CHANGES RESULT IN THE DEATH OF
ALL VITAL BODY SYSTMES
 PULMONARY
o Unable to oxygenate the body
o Assess for poor oxygenation—skin pale, cyanotic,
mottled, cool
o In dark skinned—assess mucous membranes,
palms of hands, soles of feet
 CARDIOVASCULAR
o Large load on heart when lungs fail
o Heart not getting needed oxygen
o Pumping heart not strong enough to circulate blood
o Blood backs up causing failure
o Leads to pulmonary and liver congestion
 BLOOD CIRCULATION
o Decreased, as heart less able to pump
o May have a “drenching sweat” as death approaches
o Pulse becomes weak and irregular
o If pulse relatively strong, death is hours away
o If pulse is weak and irregular, death is imminent
 Combination of these events leads to cell death, and death
of the organism (human)
 As pulmonary and cardiovascular systems fail, other
body systems begin to fail as well
FAILING METABOLISM
 PHYSICAL CHANGE
o Metabolic rate decreases, almost stopping
o Feces might be retained or incontinence might be
present
 CARE MEASURES
o Offer ice chips and provide frequent oral care to keep
the mouth moist and promote comfort.
o Enemas may be necessary to assist with bowel
elimination
FAILING URINARY SYSTEM
 PHYSICAL CHANGE
o Urinary output decreases
o Blood pressure too low for kidney filtration
VILLAFLOR, KYLIE NICOLE A. | BSN 1H UNIVERSITY OF CEBU - BANILAD
o Further load on cardiovascular system due to
increase circulating volume
 CARE MEASURES
o Check person regularly for incontinence.
o Clean the skin gently and change soiled or wet
clothing and bedlinens.
o Bed protectors or in dwelling urinary catheters
maybe needed
FAILING NERVOUS SYSTEM
 PHYSICAL CHANGE
o Some people lose the ability to speak
o Vision may become blurred
o Pain is usually diminished
o Hearing usually remains sharp
o Consciousness may be altered
 CARE MEASURES
o Ask questions that can be answered by a nod or a
shake of the head
o Keep the room well lit and make sure you introduce
yourself when entering the room.
o Observe the person for pain and report findings to
the nurse so that the person can receive medication
to remain comfortable
o Always talk to the personas if he or she is able to
hear you, even if he or she cannot respond.
o Encourage family members to talk to the dying
person also.
SPECIFIC SENSORY DECLINE
 Dying person turns toward light—sees only what is near
 Can only hear what is distinctly spoken
 Touch is diminished—response to pressure last to leave
 Dying person might turn toward or speak to someone not
visible to anyone else
 Eyes may remain open even if unconscious
 Person might rally just before dying
FURTHER NEUROLOGIC DECLINE AT DEATH
 Pupils might react sluggishly or not at all to light
 Pain might be significant
 Assess for pain if person unable to talk: restlessness, tight
muscles, facial expressions, frowns
 Provide pain medication as needed
INDICATIONS OF DEATH
 Total lack of response to external stimuli.
 No muscular movement
 No reflexes
 Flat ECG. This is the most accurate indicator of death
POST-MORTEM CARE
 The care of a person’s body after the person’s death
 Body Changes:
o RIGOR MORTIS
 The stiffening of the muscles that usually
develops within 2 to 4 hours of death
 Results from lack of adenosine triphosphate
(ATP) which is not synthesized due to lack of
oxygen in the body
 Position the body, place dentures in the mouth
and close the eyes and mouth before rigor mortis
sets in
o ALGOR MORTIS
 Is the gradual decrease of the body’s
temperature after death
 When blood circulation terminates and the
hypothalamus ceases to function, body
3
 DEATH, DYING, AND POST-MORTEM CARE

temperature falls about 1°C (1.8°F) per hour

until it reaches room temperature REFERENCES
o LIVOR MORTIS
 Discoloration of the skin death after circulation
Notes from the discussion by Ms. Restymay Manlongat
has ceased.
 The RBC cells break down, releasing hemoglobin
which discolors the surrounding tissues. University of Cebu – Banilad College of Nursing powerpoint
 AUTOPSY – examination of a person’s organs and tissues presentation:
after the person has died, done to confirm or identify the
cause of the person’s death Death and Dying PPT
 Postmortem care is necessary to keep the body in proper Post-Mortem Care PPT
alignment and to prevent skin damage and discoloration.
 During postmortem care:
o The skin is cleaned of any mucus, urine feces, or
other fluids.
 Standard precautions are followed when
performing postmortem care because body fluids
are still potentially infectious, even after death.
o The body is placed in proper alignment before rigor
mortis occurs.
 Be aware that during repositioning, trapped air
may escape from the lungs or digestive tract,
making a sound like a sigh or a moan.
 Although these sounds may startle you, they are
normal.

o A shroud may be applied.
 SHROUD – a covering used to wrap the body of
a person who has died.
o The person’s personal belongings are collected and
packed up to send with the family.
o
HOW TO PREPARE THE BODY FOR VIEWING BY THE
FAMILY
 Straighten the bed linens.
 Wash the person’s body and dress the person in a clean
gown or pajamas.
 Position the person in a natural position on the bed, draw
the top sheet up to the person’s shoulders and cuff it neatly.
Do not cover the person’s face with the sheet.
 Make sure that the room is neat and adjust the lights so that
they are not too bright. As always, provide for privacy.

NURSING INTERVENTIONS FOR THE BODY AFTER

DEATH
 Make the environment as clean and as pleasant as possible
 Make the body appear natural and comfortable
 Remove all equipment and supplies from the bedside
 Remove soiled linens, so the room is free from odors
 Place the body in supine position, the arms at the sides,
palms down
 Place one pillow under the head and shoulders to prevent
blood from discoloring the face
 Close the eyelids, insert dentures and close the mouth
 Wash soiled areas of the body.
 Place absorbent pads under the buttocks to take up any
feces and urine released because of relaxation of the
sphincter muscles
 Provide clean gown, brush/comb the hair
 Remove all jewelries. All the client’s valuables are listed and
placed in a safe storage area for the family to take away
 Allow the family to view the patient’s body
 Apply identification tags, one to the ankle and one to the
wrist
 Wrap the body in shroud. Apply another identification tag to
the outside of the shroud
 Bring the body to the morgue for cooling(cyanosis)

VILLAFLOR, KYLIE NICOLE A. | BSN 1H UNIVERSITY OF CEBU - BANILAD 4