CARING IN NURSING PRACTICE
 PROVIDING PRESENCE – establish reassuring
presence, eye contact, body language, voice tone,
listening and having a positive and encouraging attitude,
act together to create openness and attitude
 COMFORTING – involves the use of touch and the
skillful and gentle performance of nursing care
procedures
 Listening – involves paying attention to an individual's
words and tone of voice and entering into his/her frame
of reference.
 KNOWING THE CLIENT – is at the core of the process
by which nurses make clinical decisions. To know the
client means that the nurse considers the client as a
unique individual.
 SPIRITUAL CARING – offers a sense of
interconnectedness interpersonally (with oneself),
interpersonally (with others and the environment),
transpersonally (with the unseen God, or a higher power)
 FAMILY CARE – involves knowing of the family as
thoroughly as one knows the client. A nurse
demonstrates caring by helping family members become
active participants in the client care
CONCEPTS OF A PROFESSION BY MARIE JAHODA
 A profession is an organization of an occupational group
based on the application of special knowledge which
establishes its own rules and standards for the protection
of the public and the professionals
 A profession implies that the quality of work done by its
members is of greater importance in its own eyes and the
society than the economic rewards they earn
 A profession serves all of society and not the specific
interest of a group
 The aims of a profession are altruistic rather than
materialistic
THE CHARACTERISTICS AND ATTRIBUTES OF A
PROFESSIONAL PERSON:
 Is concerned with quality - should possess competence
to practice the profession in terms of scientific
knowledge, technological skills and desirable attitudes
and values
 Is self-directed, responsible and accountable for own
actions
 Is able to make independent and sound judgment
including high moral judgment
 Is dedicated to the improvement of human life
 Is committed to the spirit of inquiry - demonstrates zest
for continued studies including research, which will
steadily increase and improve knowledge, skills, attitudes
needed by the profession
CHARACTERISTICS OF NURSING AS A health
PROFESSION:
 EDUCATION – extended education of its members, as
well as basic liberal foundation
 THEORY – a theoretical body of knowledge leading to
defined skills, abilities and norms
 SERVICE – provides basic serve
 AUTONOMY – members of a profession have autonomy
in decision making and in practice
 CODE OF ETHICS – has code of ethics for practice. A
profession has sufficient self-impelling power to retain its
members throughout life. It must not be a mere
steppingstone to other occupations
 CARING – the most unique characteristic of nursing as a
profession
A PROFESSIONAL NURSE IS ONE WHO HAS
ACQUIRED THE ART AND SCIENCE OF NURSING
THROUGH HER BASIC EDUCATION, WHO INTERPRETS
HER ROLE IN USING IN TERMS OF THE SOCIAL ENDS
FOR WHICH IT EXISTS - THE HEALTH AND WELFARE OF
SOCIETY AND WHO CONTINUES TO ADD TO HER
KNOWLEDGE, SKILLS AND ATTITUDES THROUGH
CONTINUING EDUCATION AND SCIENTIFIC INQUIRY
(RESEARCH) OR THE USE OF THE RESULTS OF SUCH
INQUIRY
QUALIFICATIONS AND ABILITIES OF A impulses, habits and physical character into a
PROFESSIONAL NURSE
 Has faith in fundamental values. For example: respect for
human dignity, self-sacrifice for the common good, strong
sense of responsibility for sharing in the solution of the
problems of society
 Has sense of responsibility for understanding for those
with whom he works or associates with through the use
of the following skills:
 Utilizing relevant basic concepts of psychology
 Working effectively through therapeutic relationship
 Has faith in the reality of spiritual and aesthetic values
and awareness of the value and the pleasure of self-
development through the pursuit of some aesthetic
interests
QUALIFICATIONS AND ABILITIES CONTINUED
 Has the basic knowledge, skills and attitudes necessary
to address present day, social problems, realistic,
incisive, and well-organized thoughts through the use of
critical thinking.
 Critical thinking – the objective analysis and
evaluation of an issue in order to form a judgment. It
is securing, appraising and organizing evidence.
 Has skill using written and spoken language, both to
develop own thoughts and to communicate them to
others
 Appreciates and understands the importance of good
 Has emotional balance. Is able to maintain poise and
composure in trying situations
 Likes hard work and possesses capacity for it
 Appreciates high standards of workmanship
 Accepts and tries to understand people of all sorts,
regardless of race, religion and color
 Knows nursing so thoroughly that every client will receive
excellent care
PERSONAL QUALIFICATIONS OF A NURSE
 Philosophy of life – concerned with the basic truths that
contribute to personal growth
 include things like how you decide what is good and
bad, what success means, what your purpose in life
is
 Theories of nursing can be taught but not a
philosophy of life or a philosophy of service
 Good personality – consists of the distinctive individual
qualities that differentiate one person from another
 It refers to the impression one makes on others
which will include more than that which meets the
eye
 Consists of deeper traits which come from the heart
and which infiltrate the real person if one wishes to
exert a magnetic influence on others
 It is a result of integrating one's abilities, desires,
harmonious whole
COMPONENTS OF GOOD PERSONALITY:
 Personal Appearance – often reveals more about the
real you than any words you may say
 Character – what a person is inside
 Attitude – a manner of acting, thinking or feeling that is
indicated by one's response toward another person,
situation or experience
 Charm – quality of giving delight
COMPONENTS OF PERSONAL APPEARANCE
 Posture
 Refers to the habitual or assumed positions of your
body in standing, sitting or moving about
 Presents some clues about your personality
 As a nurse, practice physical regimen that help to
develop and maintain good posture and physical
fitness
 Grooming
 Hair should be neat, clean and well arranged
 Hair should truly crown the features of your face in
an attractive manner
 It also includes personal hygiene and cleanliness
 Dress and uniform
 Self respect is reflected in the care you exercise with
regards to dressing
BASIC GUIDES FOR PERSONAL DRESS
 Undergarments must be clean and properly fitted for
body support
 All articles of clothing should be neat, presentable and
trim, especially the "give away"
 Street attire is expected to be appropriate and to give you
a sense of security in official or social situations
 Your wardrobe may be limited but planning it in basic
colors and using contrasting or blending hues can add
greatly to its extensiveness
 Accessories should match the attire and should be
suitable to the occasion and to your personality
 Current fads and styles may have to be disregarded to
accommodate your budget or your body structure
THE NURSE'S UNIFORM
 Come in different colors but irrespective of color the
nurse's distinctive uniform identifies you as a nurse to
your patient and his family as well as your co-workers
 You must respect the uniform. It is part of the nurse's
public image
 Wear the uniform only during working hours
 It should not be worn with jewelry except a school pin or
name plate
THE NURSE'S CAP
 The style of the cap remains usually the same for a
particular school
 Like the uniform, wear it with respect and dignity
POINTS TO REMEMBER IN WEARING THE
NURSE'S UNIFORM
 Spotlessly clean, well fitting, and in good repair
 Shoes, socks, stockings and tights worn should provide
maximum comfort
 Uniform designated for use in a given hospital area is
worn only in the line of duty and not to be worn outside
the specified department
 Modification of any authorized uniform to suit your
individual preference is not permitted by the dictates of
both good taste and integrity
CHARACTER
 Refers to the moral values and beliefs that are used as
guides to personal behavior and actions
 It is a what a person is inside
 It is the development in proportion to emotional and
intellectual growth and involves the degree to which you
understand, direct and channel your feelings
 The practice of nursing utilizes one's love for fellowmen.
Charity is the greatest virtue and serves as the
foundation for a sense of values and the development of
human character
 THE NURSE IS BASICALLY A GOOD PERSON.
FOUR VIRTUES EMANATING FROM THE
PRACTICE OF CHARITY:
 JUSTICE – the quality of being righteous, correct, fair
and impartial
 PRUDENCE – the ability to govern and discipline oneself
by the use of reason in the management of affairs.
Permits us to live with good sense and perspective.
Guides one's choice of action here and now. Skill and
good judgment in the use of resources. Exercise wisdom
and caution.
 FORTITUDE – Assists in the control of feelings, thoughts
and emotions in the face of difficulty
 TEMPERANCE – Encourages constructive use of the
pleasure of the senses. Moderation in action, thought or
feeling restraint
ATTRIBUTES OF CHARACTER
 Honesty
 Loyalty
 Tolerance
 Judgment
 Reliability
 Motivation
 Resourcefulness
 Moderation
ATTRIBUTES OF CHARACTER
 HONESTY – being truthful, trustworthy and upright in
one's dealings with others as well as refraining from lying,
cheating and stealing
It is demonstrated in terms of :
 Truthfulness – the quality of being in agreement with
facts, reality and experience
 Honor – making good commitments
 Integrity – adhering to one's set of moral values
 Evidences of honesty can be observed in the following:
 Care of materials
 Recognition of authority
 Obedience to rules, regulations, and authority
 Use of time in terms of punctuality in performing
activities
 LOYALTY
 The feeling of confidence, trust and affection you
have towards your family and friends and towards
those who have helped, guided and stood by you as
you proceeded toward your goals
 Example: Speaking well about co workers and the
institution where you work
 TOLERANCE
 It manifests itself in your recognition of the rights of
others
 It allows you to respect and accept others as fellow
human beings entitled to enjoy the same basic rights
and privileges that you claim for yourself
 It is demonstrated in the practice of patience, a
sense of humor, sympathy, understanding, and
unselfishness
 Ex. Allowing an angry relative to verbalize feelings
 JUDGMENT
 Sometimes referred to as "good sense"
 It indicates one's ability to use one's intellectual
capacity to form sound opinions
 Qualities involved in the use of judgment are:
 Wisdom
 Discretion
 Tact – sensitivity in dealing with others or with
difficult issues
 Example: questioning an unclear Doctor's order
before acting
 RELIABILITY
 It is dependability and involves one's use of sound
judgment based upon careful observation and an
understanding ofany given situation in which one is
required to act
 Ex: performing one's responsibilities thoroughly even
beyond time of duty, as necessary; reporting on duty
even during holidays, floods, typhoons, snow,
bushfires etc
 MOTIVATION
 Something that moves one to plan and accomplish
specific things, it is a positive force that directs one's
personal actions to the fulfillment of desires or drives
that are referred to as basic human needs
 Ex. Aiming to give the best quality of patient care at
all times
 RESOURCEFULNESS
 Involves a person's ability to recognize and deal
promptly and effectively with difficulties or problems
that arise.
 Utilizes resources available about a given situation
and using it courageously, sensibly and
constructively in dealing with the situation
 Ex. Using indigenous materials/articles in the
absence of sophisticated ones
 MODERATION
 Allows one to maintain harmony and balance among
all the elements of one's character and in one's
relationships with other's by encouraging one to
develop perspective and a sense of objectivity.
 Ex. Indulging in food, material, goods, and other
factors that provide pleasure or enjoyment to the
senses in controlled manner
ATTITUDE
 A manner of acting, thinking, or feeling that is indicated
by one's response toward another person, situation or
experience
 Personality is shaped by one's attitudes
 It is a part of a pattern of personal behavior
 It is based on opinions, viewpoints or feelings
 It is a result of responses to specific experiences
 It changes from time to time as additional knowledge
is gained and one's understanding is broadened
 A change in attitude results to a change in behavior
  It develops from awareness of oneself in relation to  Can solve client's problems without consultation or  This model involves the delivery of nursing care by
individuals and situations collaboration with physicians or other health care staff of various educational preparations
CHARM professionals  An RN leads the time composed of other RN'stand
 TO ACQUIRE CHARM, ONE NEEDS TO CULTIVATE  Example: The nurse gives health teachings on the ill assistive personnel (ex. Nurse assistants, health
THE FOLLOWING: effects of cigarette smoking, alcohol abuse and drug aides)
 Voice – well modulated with clear enunciation abuse  The team members provide direct client care to
 Manner – Courteous, attentive, patient and receptive  Dependent or physician- initiated interventions group of clients under the direction and coordination
 Heart - attempt never to show indifference or a  Based on physician's response to medical diagnosis of the RN team leader.
callused manner. Be empathetic, understanding and  Nurse intervenes by carrying out physician's written  This model emphasizes collaboration that
tolerant. Remember to say "Thank you as this works orders, but requires nursing judgment or decision encourages each member of the team to help others
miracles in social harmony making  The team leader coordinates care of the team by
 Intelligence – keep an active mind, recognize  Ex. The nurse administers antibiotics to the client communicating with the physicians and other health
beauty, accept new ideas from others, read and with infection care personnel and resolving the problems met by
exchange opinions with others  Interdependent or collaborative interventions the team members
 Poise – equanimity, calmness, composure,  Therapies that require knowledge, skill and expertise  The team leader is responsible for coordinating each
evenness of temper, self-control of multiple healthcare professionals client's nursing care plan
 THE REQUIREMENTS FOR DEVELOPMENT OF  Example: The nurse assists the client in walking  PRIMARY NURSING
POISE ARE AS FOLLOWS: using crutches after conferring with the physical  This model was developed with the aim of placing
 Calmness and composure: therapists RN's at the bedside and improving the professional
 Face reality NURSING CARE DELIVERY MODELS relationships between staff
 Avoid emotional flare ups  Total Patient Care  An RN assumes responsibility for a caseload of
 Control of temper  Functional Nursing clients over time
 Think before acting  Team Nursing  The RN selects the clients of his caseload and care
 Avoid verbal and physical aggressiveness  Primary Nursing for the same clients during their hospitalization or
EIGHT BE-ATTITUDE OF A NURSE  Case Management stay in a health care setting
 Acceptance NURSING CARE DELIVERY MODELS  A care delivery model assigned to maintain
 Helpfulness  Total Patient Care continuity of care across shifts, days or visits
 Friendliness  A care delivery model where the RN is responsible  CASE MANAGEMENT
 Firmness for all aspects of one or more client's care  A care delivery approach that coordinates and links
 Permissiveness  The nurse works directly with the client, family, health care services to clients and their families
 Limit Setting physician, health team members  This involves a professional nurse assuming
 Sincerity  This model has a shift - based focus responsibility for client care from admission through
 Competence  The same nurse does not necessarily care of the following discharge
1987 CANADIAN NURSES ASSOCIATION: same client over time  Clinicians either as individuals or as a part of
Described nursing practice as dynamic, caring, helping  For continuity of care, the staff needs to collaborative groups oversee the management of
relationship in which the nurse assists the client to achieve communicate clearly the client's needs to one case-type-based care
and obtain optimal health. another from shift to shift  Ex. Nurse care of clients with specific diagnosis
ROLES OF A PROFESSIONAL NURSE  Functional Nursing 20th CENTURY
 Care Provider  This care delivery model involves the division of Nurse theorists developed their own theoretical
 Communicator/Helper tasks, with one nurse assuming responsibility for definitions: go beyond simplistic common definitions,
 Teacher certain tasks describing what nursing is and the interrelationship among
 Counselor  Example: administration of medications while nurses, nursing, the client, the environment and the intended
 Client Advocate another nurse assumes client outcome which is health
 Change Agent  responsibility of others like hygiene and nursing COMMON NURSING DEFINITIONS:
 Leader therapies  Nursing is caring
 Manager  Nurses tend to become highly competent with the  Nursing is an art
 Researcher tasks that are repeatedly assigned to them  Nursing is a science
 Case Manager  Nursing is client centered
 However, it is task focused, not client-focused
 Collaborator  Nursing is holistic
 Absence of holistic view of clients, great possibility
TYPES OF NURSING INTERVENTIONS: that care becomes mechanical  Nursing is adaptive
 Independent or Nurse-initiated interventions  Nursing is concerned with health promotion, health
 Communication is not always clear since no one
 Autonomous actions related to nursing diagnosis maintenance and health restoration
nurse is responsible for the overall care of the client
and client centered goals  Nursing is a helping profession
 TEAM NURSING
PERSONAL AND PROFESSIONAL QUALITIES OF A  A spiritual being – all men are spiritual in nature
NURSE because we all have intellect and will, we are all
 Caring endowed with virtues of faith, hope and charity. We
 Strong communication skills believe in existence of super power whom we seek
 Emphatic console in case of difficulties in life like in illness or
 Attention to detail hospitalization
 Problem solving skills  Man is an open system in constant interaction with a
 Stamina changing environment (Roy) – constantly affected by
 Sense of humor matter, energy and information
 Commitment to patient advocacy  Ex of matter - food, medicine, microorganism
 Willingness to learn  Ex of energy - pain, fever, inflammation
 Critical thinking  Ex of information - diagnosis of an illness,
 Time management pregnancy, the need to undergo surgery or other
 Leadership treatment
 Experience  Man is a unified whole composed of parts which are PHYSIOLOGIC NEEDS
NURSING FIELDS: interdependent and interrelated with each other’s  Oxygen
 Nurse Anesthetist – administer anesthesia in variety of (Rogers)  Fluids
possible settings including inpatient, outpatient and  the different organs and organ systems function  Nutrition
emergency facilities. Trained as Certified Registered together to achieve a particular purpose  Body temperature
Nurse Anesthetist (CRNA)  Man is composed of parts which are greater than and  Elimination
 Nurse Researcher – work in universities, medical labs, different from the sum of all his parts (Rogers)  Rest
non-profits and other healthcare centric industries. For  Greater than the sum of his parts – not only a  Sleep
nurses who love to write and love pursuing knowledge composite of physiologic body parts but endowed  Sex (it is not necessary for individual survival but it is
 Mental Health Nurse Practitioner – aka psychiatric with intellect necessary for survival of mankind)
nurse practitioners – work with patients suffering  different from the sum of all – a man is a creature of SAFETY AND SECURITY
psychiatric disorders contradictions  Physical safety
 Certified Nurse Midwife – assist in births in hospital,  responses may be favorable to some factors like  Psychological safety
clinic and home settings as well as providing care for food, medications and treatment  The need for shelter and freedom from harm and danger
newborn babies. Also involved in patient care and LOVE AND BELONGINGNESS NEEDS
education in the area of reproductive health Responses may be unfavorable to factors like developing  The need to love and be loved
4 MAJOR ATTRIBUTES OF HUMAN BEING diarrhea after eating a certain food, developing allergies to  The need to care and be cared for
 CAPACITY TO THINK OR CONCEPTUALIZE ON THE certain medications, developing adverse reactions to  The need for affection; to associate or to belong
ABSTRACT LEVEL treatments like surgery and anesthesia  The need to establish fruitful and meaningful
 FAMILY FORMATION  Man is composed of subsystems and supra systems relationships with people, institution, or organization
 TENDENCY TO SEEK AND MAINTAIN TERRITORY (Roy) SELF ESTEEM
 ABILITY TO USE VERBAL SYMBOLS AS LANGUAGE,  subsystems – cells, tissues, organs, organ systems  Self-worth
A MEANS OF DEVELOPING AND MAINTAINING  suprasystem – family, community and the society  Self-identity
CULTURE  Man is an individual with vital reparative processes to  Self-respect
NURSING CONCEPTS OF MAN deal  Body image
 BIOPSYCHOSOCIAL AND SPIRITUAL BEING (ROY)  with disease and desirous of health but passive in terms SELF ACTUALIZATION
 BIOLOGIC – MEN HAVE ALL THE SAME BASIC of influencing the environment or nurse (Nightingale)  The need to learn, create, and understand or
HUMAN NEEDS  Man is a whole, complete and independent being who comprehend
 PSYCHOLOGIC – MAN HAS THE FF has 14 fundamental needs to: (Henderson)  The need for harmonious relationships
CHARACTERISTICS:  The need for beauty or aesthetics
A. Rational but at times irrational Breathe, eat and drink, eliminate, move and maintain  The need to be self-fulfilled
B. Mature with a core of immaturity posture, sleep and rest, dress and undress, maintain body  The need for spiritual fulfillment
C. With limited and unlimited nature temperature, keep clean, avoid danger, communicate, CHARACTERISTICS OF BASIC HUMAN NEEDS
D. A being of contradictions worship, work, play, learn  Needs are universal
E. A being who is usually at the crossroads of  Needs may be met in different ways
indecisiveness  Man is a unity who can be viewed as functioning  Needs may be stimulated by external and internal factors
 A social being – like some other men biologically, symbolically and socially and who initiates  Priorities may be altered
- Ex. Culture, ethnicity, age groups, social status, and performs self-care activities on own behalf in  Needs may be deferred
educational status (beliefs, language, practices, maintaining life, health, and well-being (Orem)  Needs are interrelated
norms, taboos, religions)
MASLOW’S CHARACTERISTIC OF A SELF-
ACTUALIZED PERSON
 Realistic, sees life clearly and is objective about
observations
 Judges correctly
 More decisive
 Has clear notion to what is right or wrong
 Accurate in predicting future events
 Understands art, music, politics and philosophy
 Possesses humility, listens to others carefully
 Dedicated to work, task, duty or vocation
 Highly creative, flexible, spontaneous, courageous and
willing to make mistakes
 Is open to new ideas
 Is self-confident and has self-respect
 Has low degree of self-conflict, personality integrated
 Respects self, does not need fame, possesses a feeling
of self-control
 Is highly independent, desires privacy
 Can appear remote and detached
 Is friendly, loving and governed more by inner directives
than by society
 Can make decisions contrary to popular opinion
 Is problem centered rather than self-centered
 Accepts the world for what it is
BASIC HUMAN NEEDS
A SELF-ACTUALIZED PERSON IS BASICALLY A
MENTALLY HEALTHY PERSON. ON THE WHOLE, SELF
ACTUALIZATION IS THE ESSENCE OF MENTAL HEALTH.
MARIE JAHODA’S CRITERIA OF A MENTALLY
HEALTHY PERSON
 Attitude towards himself is positive
 Aware of the meaning of his actions
 Self-concept is similar to that which others have of the
person
 Accepts himself
 Have sense of identity
 Person changes and grows throughout life
 Person acts in a unified manner
2 NEEDS THAT MUST BE FULFILLED BY A
MENTALLY HEALTHY PERSON (WILLIAM
GLASSER)
 The need to be loved
 The need to feel that one is worthwhile to self and to
others
To be able to fulfill the above:
 A person fulfills this need by doing that which is realistic,
responsible and right
 Realistic behavior – chooses reasoning and considering
the immediate consequences to self and others
 Responsibility – being able to fulfill personal needs and at
the same time not deprive others of being able to fulfill
their needs
COMMUNICATION IN NURSING
 COMMUNICATION – a process in which people affect
one another through exchange of information, ideas and
feelings.
 Nurses need to communicate in an accurate, timely and
effective manner
 Documentation and recording
 Discussion, reports (verbal and written) and records
MODES OF COMMUNICATION
 Verbal – use spoken or written words
 Nonverbal communication – uses gestures, facial
expression, posture, gait, body movements, physical
appearance (also body language), eye contact, tone of
voice
 Kinetics – gestures
 Proxemics – physical distance
A. Intimate space – up to 18 inches
B. Personal space – 18 inches up to 4 feet
C. Social-consultative space – 9 to 12 feet
D. Public space – more than 12 feet
 Touch
 Silence
 Paralanguage
CHARACTERISTICS OF COMMUNICATION:
 Simplicity – includes use of commonly understood
words, brevity and completeness
 Clarity – involves saying exactly what is meant. The
nurse also needs to speak slowly and enunciate words
well. Repeat the message as needed. Reduce
distractions.
 Timing and Relevance – require choice of appropriate
time and consideration of the client’s interests and
concerns. Ask one question at a time. Wait for an
answer before making another comment.
 Adaptability – involves adjustment on what the nurse
says and how it is said depending on moods and
behavior of the client
 Credibility – means worthiness of belief. To become
credible, the nurse requires adequate knowledge about
the topic being discussed. The nurse should be able to
provide accurate information, to convey confidence and
certainly in what she says. Most importantly, she should
be a good role model for what she teaches
COMPONENTS OF A COMMUNICATION:
 Sender (Encoder)
 Message
 Receiver (Decoder)
 Response (Feedback)
COMMUNICATION
 Communication is a basic component of human
relationships and nurse client relationships
 Non-verbal communication is a more accurate
expression of a person’s thoughts and feelings than
verbal communication
 When assessing nonverbal behaviors, consider cultural
influences. Variety of feelings can be expressed by a
single non-verbal expression. Ex. Head nodding does not
always mean agreement
 Effective communication is reciprocal interaction (two-
way process) based on trust and aimed at identifying
client needs and developing mutual goals.
 Trust is the foundation of a positive nurse-client
relationship. It develops gradually as the client perceives
an attitude of acceptance, understanding and empathy
from the nurse. The client initially may test the nurse’s
confidence such as sharing that he expects remains
confidential.
 Covert communication represents inner feelings that a
person may be uncomfortable talking about. Such
communication may be revealed through nonverbal
modes. Validation is required for overt communication. It
is an attempt to confirm the observer’s perception
through feedback, interpretation and classification.
 Therapeutic Communication is a fundamental component
in all phases of the nursing process, and for establishing
effective nurse- client relationship
 Effective nurse client relationship is a helping relationship
which is growth facilitating and provides support, comfort
and hope
THE CHARACTERISTICS OF AN EFFECTIVE
NURSE-CLIENT RELATIONSHIP
 An intellectual and emotional bond between the nurse
and the patient and is focused on the patient
 Respects the client as an individual who has ability to
participate in his care, ethnic and cultural factors, family,
relationships and values
 Respects client’s confidentiality
 Focuses on client’s well-being Based on mutual trust,
respect and acceptance
DOCUMENTING AND REPORTING
 Documentation - serves as a permanent record of client’s
information and care
 Reporting - takes place when two or more people share
information about client care, either face to face or by
telephone
PURPOSES OF CLIENT’S RECORD/CHART
1. Communication – provides efficient and effective
method of sharing information. It allows to convey
meaningful data about the client.
2. Legal Documentation – it is admissible as evidence in a
court of law
3. Research – provides valuable health related data for  Provides a concise method of organizing and recording  Describe behaviors rather than feelings to allow
research data about a client, making information readily accessible other health team members to determine the actual
4. Statistics – provides statistical information that can be to all members of the health team problems of the client
utilized for planning people’s future needs  It is a series of flip cards usually kept in portable file  Refusal of medications and treatments must be
5. Education – serves as an educational tool for students in  It is a way to ensure continuity of care from one shift to documented
health discipline another and from one day to the next 4. Appropriateness
6. Audit and quality assurance – monitors the quality of  It is a tool for a change – off shift report. But  Only information that pertain to the client’s health
care received by the client and the competence of health endorsement is not simply reciting content of Kardex. problems and care are recorded
care givers The health care needs of the client is still primary basis  Any other personal info that is conveyed to the nurse
7. Planning client care – provides data which the entire for endorsement is inappropriate for the record
health team uses to plan care for the client  Kardex usually includes the following data: 5. Completeness and chronology/organization/sequence/
8. Reimbursement – provides the basis for decisions  Personal data (demographic data) timing
regarding care to be provided and subsequent  Basic needs  Notes should appear on each succeeding line
reimbursement to the agency, to cover health -related  Allergies  Continuous charting is done for each entry unless a
expenses  Diagnostic tests time change occurs. No need for a new line for each
TYPES OF RECORDS  Daily nursing procedures new idea or entry
A. Source Oriented Medical Record (Traditional Client  Medications and intravenous (IV) therapy, BT  Date is entered in the date column on the first line of
Record)  Treatments like oxygen therapy, steam inhalation, every page of nurse’s notes and whenever the date
 Each person or department makes notations in a suctioning, change of dressings, mechanical changes
separate section/s of the client’s chart ventilation  Time is entered in the time column whenever a new
FIVE BASIC COMPONENTS OF THE TRADITIONAL  Entries are usually in pencil so that they can be changed time entry occurs
CLIENT RECORD as client’s condition changes. This implies the Kardex is  Avoid time changes in the text of the nurse’s notes
 Admission Sheet for planning and communication purposes only.  Avoid double chart. If something appears on a
 Physician’s order sheet CHARACTERISTICS OF GOOD RECORDING particular sheet, it does not need to appear on the
 Medical History 1. Brevity nurse’s notes, unless there is an alteration from the
 Nurse’s notes  entries are concise normal ex. Body temperature, blood pressure
 Special records and reports (referrals, X-ray reports,  Complete sentences are not required  Avoid squeezing information into a space because
laboratory findings, report of surgery, anesthesia
 Start each entry with a capital letter and end the you forgot to chart it earlier. Add the information on
record, flow sheets, vital signs, I&O, medications)
entry with a period even if the entry is a single word the first available line. Write the time the event
B. PROBLEM ORIENTED MEDICAL RECORD
or phrase occurred, not the time you entered the information
(POMR/POR)
2. Use of ink/ permanence 6. Use of standard terminology
 Data about the client are recorded and arranged
 Avoid felt pen or pencil for permanence of data,  Use only those abbreviations and symbols approved
according to the source of the information
because the client’s chart can be used as an by the institution; spell correctly; use proper
 The record integrates all data about the problem,
evidence in a legal court grammar
gathered by the members of the health team
3. Accuracy 7. Signed
FOUR BASIC COMPONENTS OF POMR/POR
1. Database – contains all the initial information about  Chart objective facts, not your interpretations or  Affix signature, place at the end of the charting, at
the client opinions the right-hand margin of the nurse’s notes
2. Problem list – contains all the aspects of the  Ex.  Sign each entry with your full name and status
person’s life requiring health care CORRECT INCORRECT  Script, not printing is for the signature
3. Initial list of orders or care plans Ate 50% of the food Ate with poor appetite. 8. In case of ERROR
4. Progress notes: served.  Correct errors by drawing a single (horizontal) line
 Nurse’s or narrative notes (SOAPIE format) Refused medications Uncooperative through the error
S – subjective data Seen crying Depressed  Write the word error above the line, then your
O – objective data  Place complaint of the client in quotation marks to signature
A – assessment indicate that it is his statement.  No ink eradication, erasures or use of occlusive
P – planning  Ex. Complained of “chest pain radiating down the left materials
I – intervention arm.” 9. Confidentiality – only the health personnel who
E – evaluation  Objective data are also to be charted participate in the care of the client are allowed to read the
 Flow sheets (data that are monitored)  Ex. Skin cold and clammy. Diaphoretic. Prefers to sit chart
 Discharge notes or referral summaries up. Vital signs taken as follows: Temp=37.6 °C, 10. Legal Awareness
KARDEX PR=110/min, RR=26/min, BP=146/90 mmHg  Chart only what you personally have done,
observed, heard, smelled or felt
 Do not discard any part of the client record
11. Legible rate 8. The goal of the nurse client relationship is to assist the
 Writing must be clear and easily read by the others BP Blood pressure client to develop problem solving abilities and coping
 If writing is not legible, then print mechanisms
12. Do not use the word “patient” or “pt” in the chart; the c.c. cum With
chart belongs to the patient. All information in the chart Cap capsula Capsule The nurse needs to consider the religious and spiritual
pertain to the patient Gtt gutta Drop practices of the client and whether these practices may give
13. A horizontal line drawn to fill up a partial line. This is to the client hope, comfort and support while healing
h.s. hora somni Hours of sleep
prevent other persons from adding information in the
nurse’s notes. IM Intramascular Distance Zones:
Ex. ——————————— Cheryl Mina E. Uy, RN Mcgtt microdrop  Intimate Zone (0 to 18 inches between people) –
THE FOLLOWING INFO SHOULD BE CHARTED comfortable for parents with young children, people who
NPO Non per orem Nothing by mouth mutually desire personal contact or people whispering.
 Physician’s visits
 Times the patient leaves and returns to the unit, mode of Od Omni die Once a day Invasion of this zone by anyone else is threatening and
transportation and destination OD Oculus Dexter Right eye produces anxiety
 Medications should be charted immediately after given o.m. Omni mane Every morning  Personal Zone (18 – 36 inches) – the distance is
 Treatments should be charted immediately after given comfortable between family and friends who are talking
OS Oculus sinister Left eye  Social Zone (4 – 12 feet) – acceptable for
REPORTING
OU Oculus uterque Both eyes communication in social, work and business settings
Types of Reporting
1. Change of Shift reports or endorsement p.c. Post cebum After meals  Public Zone (12 – 25 feet) – acceptable distance
 For continuity of care p.o. Per orem By mouth between a speaker and an audience, small groups, and
other informal functions
 It is based on health care needs of the client p.r.n. Pro re nata As necessary
 It is not mere reciting the content of the Kardex q.h. Quaque hora Every hour  Hispanic, Mediterranean, East Indian, Asian, Middle
2. Telephone Reports
q.i.d Quater in die Four times a day Eastern more comfortable with less than 4-12 feet space
 Provide clear, accurate and concise information
s.s. Sine Without while talking
 The nurse documents telephone report by including
s.c. Sub cutem subcutaneously  Nurse of European American or African American -
the following info:
uncomfortable if clients of these cultures stand close
A. When the call was made ss. semis One-half when talking
B. Who made the call/report Stat Statim Immediately/at  Clients from these backgrounds may perceive the nurse
C. Who was called once as remote or indifferent
D. To whom info was given
E. What info was given Tid Ter in die Three times a
day – ALWAYS ASK CLIENT’S PERMISSION
F. What info was received
3. Telephone Orders Principles Of Nurse Client Relationship:
1. Genuineness, respect and empathic understanding are THE THERAPEUTIC COMMUNICATION INTERACTION
 Only RN’s may receive telephone orders
characteristics important to the development of a IS MOST COMFORTABLE WHEN THE NURSE AND
 The order needs to be verified by reporting it clearly CLIENT ARE 3-6 FEET APART
and precisely therapeutic nurse – client relationship
 The order should be countersigned by the physician 2. The client should be cared for in a holistic manner
3. The nurse considers clients cultural beliefs and values in – Client invades nurse intimate space (0 – 18 inches) = set
who made the order within prescribed period of time limits gradually on how often the client invaded the nurse’s
(within 24 hours) assessing the clients response to the nurse-client
relationship and his adaptation to stressors space and safety of the situation
4. Transfer Reports
4. Appropriate limits and boundaries define and facilitate a CONCEPT OF TIME:
 This is done when transferring a client from one unit  ASIAN – respect for the past but includes emphasis on
to another therapeutic nurse client relationship
 Set time framed relationship during orientation phase the present and future
COMMONLY USED ABBREVIATIONS  HISPANIC AND LATINO – oriented more to the present,
 In African Americans personal questions asked on
Abbreviations Latin English may be late for appointment because relationships and
initial contact with a person may be viewed as
a.c. Ante cebum Before meals intrusive events that are occurring are valued more than being on
ad.lib Ad libitum As desired 5. Honest and open communication are important for the time
development of trust  NATIVE AMERICANS – oriented to present
ADL Activities of daily  WHITE AMERICANS – future oriented, time is valued, on
living 6. The nurse uses therapeutic communication techniques to
encourage the client to express thoughts and feelings as time and impatient with people who are not on time
Ax. Axillary  AFRICAN AMERICANS – varies according to age,
they address identified problem areas
Bid Bis In die Twice a day 7. The nurse respects the client’s confidentiality and limits socioeconomic and subcultures. May include past,
discussion of the client to members of the treatment team present or future orientation. May be late for appointment
BMR Basal metabolic
 AMISH - members generally remain separate from other
communities, physically and socially
THERAPEUTIC RELATIONSHIP
It is a nurse-client relationship that is directed toward
enhancing client’s wellbeing.
ELEMENTS OF THERAPEUTIC RELATIONSHIP
1. A CONTRACT – establishes the time, place and purpose
of meetings between the nurse and client as well as
conditions for termination
2. BOUNDARIES establish the relationship as therapeutic
as supposed to a social relationship
a. The roles of participants are clearly defined
b. The nurse is defined as professional helper
c. The client’s needs and problems are the focus of the
interaction
3. CONFIDENTIALITY – helps build trust and must be
maintained by the nurse throughout the relationship
a. Share client info with professional staff only on a
need-to-know basis
b. Obtain client’s written permission to share info with
any others outside the treatment plan
4. Therapeutic behaviors and practices involve the
demonstration of the ff consistent practices by the nurse
when interacting with the client:
a. Self-awareness
b. Genuinely warm, respectful behavior
c. Empathy
d. Cultural sensitivity
e. Collaborative goal setting
f. Responsible, ethical practice
EMPATHIC BEHAVIORS
 Verbal behaviors:
 Asking open ended questions
 Focusing on client’s feelings
 Paraphrasing client’s comments to check
perceptions
 Seeking clarification
 Communicating an understanding of the client’s
feelings and perceptions
 Non-Verbal Behaviors:
 Fully attending to the client
 Using a warm vocal tone
 Maintaining a relaxed, unhurried manner
 Leaning slightly forward in an open body posture
 Nodding head and smiling periodically
 Synchronizing movements with those of the client
 Maintaining eye contact (note in some cultures,
direct eye contact is inappropriate, the nurse should
be respectful of cultural differences)
PHASES OF THERAPEUTIC NURSE – CLIENT
RELATIONSHIP
 Preinteraction Phase
 Orientation Phase
 Working Phase B. Assess the client
 Termination or Separation Phase C. Nursing diagnosis is formed
PREINTERACTION PHASE D. Prioritize client’s problems
 Learn as much as possible about your client, including E. Nurse and client establish mutually agreed on goals
reasons for seeking care WORKING PHASE
 To begin assessment:  Begin to:
 Review clients medical record and nursing notes 1. Assess the person’s concerns, strengths and
 Note the client history of previous hospitalizations as weaknesses
well as any procedures that he had undergone in the 2. Establish a contract with the client regarding
past expectations and responsibilities
 Note the symptoms that brought the client to hospital 3. Decide on mutually agreed upon goals
or clinic 4. Establish a plan of action that satisfies you and the
 Speak with other HCP who may have cared for the client
client, inquire about client’s cultural background and 5. Set limits
emotional state and the client’s ability to 6. Discuss the time frame for your relationship. During
comprehend his disorder and its treatment this phase, continue to establish rapport and build
In relation to learning about your client, examine your trust. In doing so, encourage the client to speak
own culturally based beliefs. Uncovering these feelings is only openly about feelings, fears and regrets
the first step in building transcultural relationship. Then put  Working phase involves planning outcomes and related
the feelings aside when providing care. interventions to help the client achieve goals
SELF AWARENESS A. Help client to express problems, thoughts and
 The process by which the nurse gains recognition of his feelings
or her own feelings, beliefs, and attitudes. B. Collaborates with the client using a problem-solving
 Ex. A nurse who believes that abortion is wrong may be approach to resolve problems
assigned to care for a client who has had an abortion C. The nurse teaches and encourages the use of
POINTS TO CONSIDER WHEN WORKING ON SELF coping measures
D. Encourages the client to practice adaptive behaviors
AWARENESS
and evaluates their effectiveness
 Keep a diary or journal, focus on experiences and
feelings. Review and look for patterns or changes TERMINATION PHASE
 Talk with someone you trust about your experiences and  Reasons:
feelings. Discuss how he may feel in similar situation or  Client may be discharged
how he deal with uncomfortable situations or feelings  The nurse or nursing student may change services
 Engage in formal clinical supervision to gain insights and or
new approaches  Client’s goal may be met
 Seek alternative points of view. Put yourself in client’s TERMINATION (EVALUATION) – MARKS THE
situation and think about his feelings, thoughts and ENDING OF NURSE CLIENT RELATIONSHIP
actions  Evaluate outcomes, reassessing the problems, goals and
 Do not be critical of yourself or others for having certain interventions if necessary
beliefs. Accept them or work to change those you wish to  Nurse and client express feelings about termination
be different  Nurse observes client for regressive behaviors
ORIENTATION PHASE  Nurse evaluates the entire nurse client relationship
 Nurses need to continue gathering information about TASKS IN THE TERMINATION PHASE
client’s history and current problems  Outline client’s strengths and discuss the progress the
 Perform physical, psychosocial and cultural assessment person has made while you care
 Formulate patient outcomes  Review areas in need of improvement
 Plan interventions  Discuss the client’s goals and develop plan of self-care
 Through this phase, it is important to show the client following discharge
respect and to establish trust and rapport  Discuss any feelings (positive or negative) that the client
 SET TIMED FRAMED RELATIONSHIP and make certain might have regarding the termination of relationship
client will understand the relationship will end NON-THERAPEUTIC TECHNIQUES OF
ORIENTATION, THE INITIAL PHASE, INVOLVES COMMUNICATION
ASSESSMENT AND ANALYSIS
A. Establish trust with the client
 Reassuring  Defending
 Give approval  Requesting an explanation
 Rejecting  Indicating the existence of an
 Disapproving external source
 Agreeing  Belittling feeling expressed
 Disagree  Making stereotyped comments
 Advising  Give literal responses
 Probing  Using denial
 Challenging  Interpreting
 Testing  Introducing an unrelated topic