ASSESSING  Record and reports, laboratory and diagnostic analyses

 Other health professionals

(First phase of nursing process)  Relevant literature
Data Collection Method:
INTERVIEWING: ORGANIZING DATA:
 Planning interview and setting arrangement  This is often referred to as a nursing health history, nursing assessment, or nursing database form
1. Time  Uses a format that organizes the assessment data systematically

2. Place FORMATS:

3. Distance 1. Conceptual models/Frameworks

4. Seating arrangement 2. Wellness Models

5. Language 3. Non nursing models

 Stages of an interview CONCEPTUAL MODEL AND FRAMEWORKS:

1. Opening (Establish rapport and orientation)  Gordon’s functional health pattern framework
 Orem’s self-care model.
2. Body  Roy’s adaptation model.
3. Closing WELLNESS MODELS:
EXAMINING: Such models generally include the following:
 The Physical examination or physical assessment is a systematic data collection method that uses  Health history
observation (i.e., the senses of sight, hearing, smell, and touch) to detect health problems  Physical fitness evaluation
 Techniques of Inspection, Auscultation, Palpation and Percussion  Nutritional assessment
 The cephalocaudal or head to toe approach  Life-stress analysis
 Body systems, screening examination, or also called review of systems approach.  Lifestyle and health habits
 Health beliefs
 Sexual health
TYPES OF DATA:  Spiritual health
 Relationships
SUBJECTIVE DATA
 Health risk appraisal
 Also referred to as symptoms or covert data NON-NURSING MODELS:
 Are apparent only to the person affected and can be described or verified only by that person
 Body System model
OBJECTIVE DATA
 Maslow’s hierarchy of need
 Also referred to as signs or overt data  Developmental theories
 Are detectable by, in observer or can be measured or tested again an accepted standard

VALIDATING DATA:
SOURCES OF DATA:
 Validation is the act of “double-checking” or verifying data to confirm that it is accurate and factual
PRIMARY SOURCE
Validating data helps the nurse complete these tasks:
 The client is the primary source of data
 Ensure that assessment information is complete.
SECONDARY SOURCE  Ensure that objective and related subjective data agree.
 Obtain additional information that may have been overlooked.
 Family members or other support persons
  Differentiate between cues and inferences
 Avoid jumping to conclusions and focusing in the wrong direction to identify problems. The Problem and its definition
DOCUMENTING DATA: The problem statement, or diagnostic label describes the client’s health problem or response
 It is the recording of all data collected in a factual manner for which nursing therapy is given
 To complete the assessment phase, the nurse record client data.
 Accurate documentation is essential and should include all data collected about the client’s health status. Qualifiers are words added/used to diagnostic statement
 Data are recorded in a factual manner and not interpreted by the nurse eg. Deficient, Impaired, Decreased, Ineffective compromised
 Documentation may be narrative form, a summary, detailed information as necessary, use of checklist and
others. The etiology
 Method of documentation depends on health condition of patient, resources available, and the like The etiology component of a nursing diagnosis identifies one or more probable causes of the
health problem, gives direction to the required nursing therapy, and enables the nurse to
individualize the client’s care.
DIANOSING
(Second phase of the nursing process) The defining characteristics
Defining characteristics are the cluster of signs and symptoms that indicate the presence of a
North American Nursing Diagnosis Association (NANDA) particular diagnostic label.
The members of NANDA include staff nurses, clinical specialists, faculty, directors of nursing, deans, theorists,
and researchers. FORMULATING DIANOSTIC STATEMENTS
The purpose of NANDA international is to define, refine, and promote a Taxonomy of nursing diagnostic Basic 2 Part Statement (PE) Basic 3 Part Statement (PES) One Part Statement
terminology of general use to professional nurses 1. Problem (P): statement of 1. Problem (P): statement of Statement comprises of
the client’s response the client’s response health promotion or risk
DEFINITONS AND CONCEPTS
(NANDA label) (NANDA label) diagnoses to desired higher
 Diagnosing refers to the reasoning process level of wellness
 Diagnosis is a statement or conclusion regarding the nature of a phenomenon. 2. Etiology (E): factors 2. Etiology (E): factors
contributing to or probable contributing to or probable
 Diagnostic labels are the standardized NANDA names for the diagnoses.
causes of the responses. causes of the response
 Nursing diagnosis is the client’s problem statement consisting of the diagnostic label plus 3. Signs and symptoms (S):
etiology (causal relationship between a problem and its related or risk factors). defining characteristics
manifested by the client
The official NANDA definition of a nursing diagnosis EXAMPLE:
“ a clinical judgement concerning a human response to health conditions/life processes, or a
vulnerability for that response, by an individual, family, group, or community” Basic 2 Part Statement (PE) Basic 3 Part Statement (PES) One Part Statement
P – Imbalanced nutrition, less P – ineffective breathing Risk for Activity Intolerance
KINDS OF NURSING DIAGNOSIS than body requirement pattern
 Risk nursing diagnosis is a clinical judgement that a problem does not exist, but the presence of risk LINK – related to LINK – related to Chronic pain syndrome
factors indicates that a problem is likely to develop unless nurses intervene. E- poor nutrition intake E- decreased lung expansion Risk for impaired Tissue
 Syndrome diagnosis is assigned by a nurse’s clinical judgement to describe a cluster of nursing diagnoses integrity
that have similar interventions S – as evidenced by dyspnea, Readiness for enhanced
coughing, and difficulty of parenting
THREE (3) COMPONENTS OF NURSING DIAGNOSIS breathing.
1. The problem and its definition
2. The etiology
3. The defining characteristics
  A Concept Map is another method of organizing and representing care plan information, a visual tool in
which ideas or data are enclosed in circles or boxes of some shape, and relationships between these are
PLANNING indicated by connecting lines or arrows
(Third Phase of Nursing Process) FORMAT OF A NURSING CARE-PLAN- FOUR COLUMNS
 Prioritize problems/diagnoses Example:
 Formulate goals/desired outcomes
 Select nursing interventions FORMAT OF A NURSING CARE PLAN- FIVE COLUMS
 Write nursing interventions Example:
Planning – is a deliberative, systematic phase of the nursing process that involves decision making and problem
solving
THE PLANNING PROCESS
The nurse refers to the client’s assessment data and diagnostic statements for direction in formulating client
goals and designing the nursing interventions, required to prevent, reduce, or eliminate the client’s health ACTIVITIES
problem.
 Setting priorities
 Establishing client goals/desire outcomes
 Selecting nursing interventions and activities
TYPES OF PLANNING
 Writing individualized nursing interventions on care plans.
Initial Planning
A. Setting priorities is the process of establishing a preferential sequence for addressing nursing diagnoses and
 Initial/admission assessment interventions.
 Observe client’s body language
Life-threatening problems Health-threatening problems Low priority problems
 Obtain Intuitive kinds of information
Ongoing Planning
B. Establishing Client Goals/Desired Outcomes the goals/desired outcomes describe, in terms of observable
 Obtain new information client responses, what hopes to achieve by implementing the nursing interventions.
 Evaluate the client’s responses to care
- Goal and desired outcome are used interchangeably
Discharge Planning
- Uses terms like expected outcome, predicted outcome, outcome criterion, and objective.
 Anticipating and planning for needs after discharge
 Coming up with a comprehensive health care plan - Defining goals as broad statements and desired outcomes as the more specific

DEVELOPING A CARE PLAN

 The end product of the planning phase of the nursing process is a formal or informal plan of care Purposes of Goal and/Desired Outcome
 A standardized care plan is a formal plan that specifies the nursing care for groups of client’s with Provide direction for planning nursing interventions Enable the client and nurse to determine when the
common needs problem has been resolved
 An individualized care plan is tailored to meet the unique needs of a specific client-needs that are not
addressed by the standardized plan. Serve as criteria for evaluating client progress Help motivate the client and nurse by providing a sense

FORMAT OF A NURSING CARE PLAN Of achievement

 The care plan is often organized into four sections LONG-TERM GOAL AND SHORT-TERM GOAL
1. Problem/nursing diagnoses Long-Term Goal are set to guide planning for client’s discharge home or in a managed care environment
2. Goals/desired outcomes
3. Nursing interventions Short-Term Goal are set for clients who require health care for a short time or address immediate needs
4. Evaluation
 Assessment data preceding problem/nursing diagnosis for a five-section nursing care plans
 Adding “Rationale” after the nursing interventions, as it is the evidence-based principle given as the
reason for selecting a particular nursing intervention
COMPONENT OF GOAL AND/ DESIRED OUTCOME  Client’s overall care must be implemented according to the care plan and the nurse is responsible in
supervising the delegated care done by other health care personnel or caregivers, validates and
*SUBJECT *CONDITIONS AND MODIFIERS
responds to adverse findings and client’s responses
*VERB *CRITERION OF DESIRED PERFORMANCE  Documenting the nursing activities after carrying it out, completes the implementing phase by recording
the interventions and client nursing progress notes.

C. Selecting Nursing Interventions and Activities Evaluating

 These are nursing actions chosen with focus on eliminating or reducing the etiology of the nursing (Fifth Phase of the Nursing Process)
diagnosis Definition and Concepts
 Choosing interventions to treat the signs ans symptoms, the defining characteristics in NANDA
International terminology, or focusing on measure to reduce client’s risk factors To evaluate is to judge or to appraise
EVALUATING is a planned, ongoing, purposeful activity in which clients and health care professionals
determine;
TYPES OF NURSING INTERVENTIONS
(a) the client’s progress toward achievement of goals/outcomes and
Nursing intervention include both direct and indirect care, as well as nurse-initiated, physician initiated and other
provider-initiated treatments. (b) the effectiveness of the nursing care plan.

 Dependent Interventions EVALUATION IS CONTINUOUS and done while or immediately after implementing a nursing order that will
 Independent Interventions enables nurse to do on the spot modifications in an intervention and continues until health goals are archived
 Collaborative or Interdependent Interventions Successful evaluation depends on the effectiveness of the steps that precede it;
a) Accurate and complete assessment data
IMPLEMENTING b) Appropriate nursing diagnosis

is the action phase in which the nurse performs the nursing interventions c) Desired outcomes stated concretely using behavioral terms

The nurse performs or delegates the nursing activities for the interventions and then concludes the d) Plan is put into action
implementing step by recording nursing activities and the resulting client responses.
THE EVALUATING PROCESS
Implementing Skills
The evaluation phase o=has five components:
1. Cognitive skills (intellectual skills) include problem solving, decision making, critical thinking, clinical reason,
 Collecting data related to desired outcomes
and creativity
 Comparing data with desired outcomes
2. Interpersonal Skills are all of the activities, verbal and nonverbal, people use when interacting directly with  Relating nursing activities to outcomes
one another  Drawing conclusions about problem status
3. Technical Skills require knowledge and frequently, manual dexterity  Continuing, modifying, or terminating the nursing care plan

THE IMPLENMENTING PROCESS

Salient Points

 Do reassessment on the client just before implementing an intervention because the client’s condition
may have changed.
 The Nurse may also require assistance when implementing nursing intervention for reasons such as;
unable to implement activity safety or efficiently alone, it would reduce stress on the client if with
assistance, and the nurse lacks the knowledge and skills to implement a particular nursing activity
 Explain to client what the interventions to be done, what sensations to expect, what the client is expected
to do, and what the expected outcome is when implementing interventions
COMMUNICATION- central to successful caring relationships. Listening is important for effective understanding
and communication

 Is the interchange information between two or more people; in other words, the exchange of ideas or Indicated the patient has been
thoughts. Accepting understood. It does not indicate Uh-hmm. Yes, I’m following you,
agreement and is nodding.
METHODS: talking and listening or writing and reading, painting, dancing, and storytelling, gestures and body non-judgemental.
actions
INTENT of communication is to obtain a response. Thus, communication is a process. Giving Indicated awareness of change in Good morning, Mr. Jones I see you have
recognition personal efforts. Does not Imply put in your jewelry today.
TWO MAIN PURPOSES: to influence others and to gain information. good or bad, right or wrong.
Offering self Offers presence, interest, and a I’ll sit with you her for a while, I would
SEVEN C’S OF COMMUNICATION desire to listen to the patient. like to spend sometime with you. I’m
available if you need to talk.
CONTENT
Making Calls attention to the patient’s You appear intense. I noticed that you
CONTUINITY AND CONSISTENCE Observations physical behavior or emotional are biting you lip.
state. Verbalizing what the nurse
CLARITY perceives.
Acknowledgin To help patient know that feelings Patient: “I hate it here. I wish I could go
CONTEXT
g feelings are understood and accepted. home.
CHANNELS (empathy) Nurse: It must be difficult to stay in a
place you hate.
CREDIBILITY Reflecting Directing questions, feelings and Patient: what do you think I should do
ideas back to the patient. about telling my employer about my
CAPABILITY Acknowledges the patient’s right illness?
CONTENT to have opinions and make Nurse: What have you been thinking
decisions about this situation?
MODES OF COMMUNICATION Patient: “Everyone ignores me”
Nurse: Ignores you?
VERBAL- uses the spoken or written word Proving Makes facts available in order to This medication is for you high blood
NON-VERBAL – uses other forms, such as gestures or facial expressions, and touch. information assist in decision-making or pressure. This test will determine your
drawing conclusions. treatment options.
ELECTRONIC – uses technological means such as email, others My purpose for being here is….
Clarifying To make clear what which is vague I am not sure I follow you. What would
THERAPEUTIC COMMUNICATION TECHNIQUES or maximize understanding you say the main point of what you said
between the nurse and patient. was?
TECHNIQUE DESCRIPTION EXAMPLE
Can you give me an example?
Broad opening To allow the patient to pick the Where would you like to begin? What is
Seeking Searching for mutual Tell me whether my understanding of it
statements topic, take the initiative to express on your mind today?
consensual understanding especially when agrees with yours. Are you using this
self, and set the direction of the
validation slang term have been used. word to convey that…?
conversation
Offering Encourages the client to continue Go on. And then? Tell me about it.
general leads and that the nurse is interested in
what comes next.
Exploring Examines certain ideas, Tell me more about that. What kind of Verbalizing To voice what the patient has Patient: I can’t talk to you or anyone else
experiences, or relationships more relationship do u have with your implied implied. To verify impressions to because it’s a waste of time
fully. children? Could you talk about how you thoughts and help the patient more fully aware Nurse: Do you feel that no one
felt when you learned you had cancer? feelings of feelings expressed. understand?
Focusing Helps the patient focus on a certain Let’s stop and look more closely at your Sharing Humor Discharge of energy through comic This gives a whole new meaning to “just
point when they are jumping from feelings about managing your enjoyment of the imperfect. Can relax”
topic to topic. medications. reduce the tension and promote
Silence Provides time for the patient to put Maintain an interested expectant silence. mental well-being. Must be used
thoughts or feelings into words, carefully and sparingly
regain composure or continue Encouraging Brings out recurrent themes by Was it something like….? Have you had
talking.
comparison looking at similarities or
differences
Encouraging Assists the patient In considering
evaluation things from their own set of values
or perspective.
Encouraging of Asking the patient to verbalize
description of things from their own perspective.
perception
Placing the To help the patient see cause and
event in time or effect or identify patterns of events
in sequence and actions.
Presenting Indicated what is real without
reality arguing. Presenting facts of a
situation
Voicing Doubt Expressing uncertainty about the
reality of the patient’s perceptions.
The patient can become aware that
others do not necessarily perceive
things in the same way. This is not
an attempt to get the patient to
change their point of view.
Attempting to Seeking to verbalize the patient’s
translate into feelings that are expressed only
feelings indirectly.
TECHNIQUE DESCRIPTION
Sharing hope Communication a sense of
possibility to achieve their
potential. Commenting on the
positive aspects of the patients
behavior, performance, and
response
Encouraging Asking patient to consider kinds of
formulation of behavior likely to be appropriate in
an action plan future situations
Summarizing Concise review of the key aspects
of the interaction to bring a sense
of satisfaction and closure.
Self-disclosure Generalized sharing of personal
experiences about the self to
benefit the patient.
Confrontation Helping the patient become aware
of inconsistencies in feelings,
attitudes, beliefs or behaviors
Recommend or Allows patient to consider options
suggest options they may not have previously
(do not advise) considered
a similar experience? Has this ever PROBLEM SOLVING
happened before?
What did it mean to you when he said PROBLEM SOLVING – is a mental activity in which a problem is identified that represents an unsteady state.
her couldn’t stay? How do you feel  It requires the nurse to obtain information that clarifies the nature of the problem and suggests possible
about your recovery this time in the
solutions.
hospital?
APPROACHES TO PROBLEM SOLVING
Tell me what is happening right now?
Tell me what you are thinking when you 1. TRIAL AND ERROR – a number of approaches are tried until a solution is found.
feel anxious
2. INTUITION- Relies on a nurse’s inner sense
When did this happen? What seemed to
lead up to..? Was it before or after? 3. RESEARCH PROCESS- a formalized, logical, systematic approach to problem solving.
Your mother is not here, I am the nurse, I PROBLEM SOLVING PROCESS
see no else in this room.
 Identify the issues
Really? That’s hard to believe, isn’t that  Understand everyone’s concern
unusual.  List possible solutions
 Evaluate the options
 Select an option or options
 Document the agreements
 Agree on contingencies, monitoring, and evaluation
Patient: I’m dead inside.
Nurse: Are you saying you feel lifeless?
THE NURSING PROCESS
EXAMPLE
I believe you will find a way to face your - Is a systematic, rational method of planning and providing individualized nursing care.
situation because I have seen your PURPOSES ARE:
courage and creativity.
1. identify a client’s health status and actual or potential health care problems or needs
2. To establish plans to meet the identifies needs
What could you do to let your anger our DISTINCTIVE CHARACTERISTICS OF THE NURSING PROCESS
harmlessly? Next time this comes up,
how might you handle it? what are other  Client Centeredness
ways you could approach your boss?  Focus on problem solving and decision making
During the past hour, you and I have  Its cyclic and dynamic nature
discussed…. We have discussed many
ways to deal with your anger toward  Universal applicability
your mother. You have agreed to try a  Interpersonal and collaborative style
few and let me know how it works out  The use of critical thinking and clinical reasoning
That happened to me once, it was
devastating, and I had to face some
things about myself that I didn’t like.
You say you have already decided what
to do, yet you are still talking a lot about
your options.
Have you thought about…? Here are
some things other people in your
situation have considered..?
MODULE 4
FRAMEWORKS AND PRINCIPLES BEHIND OUR MORAL DISPOSITION FRAMEWORKS ■ ARETE- Greek word of virtue which means excellence. The Greeks thought of how a thing fulfills its function
(ergon) in accordance with its nature.
■ VIRTUE ETHICS is a philosophy developed by Aristotle and other ancient Greeks. It is the quest to understand
and live a life of moral character. ■ To be virtuous is to exhibit one’s capacity to fulfill one’s essence or purpose in such a way that one’s potentiality as a
particular being may be said to be actualized in the most excellent way
■ This character-based approach to morality assumes that we acquire virtue through practice. By practicing being
honest, brave, just, generous, and so on, a person develops an honorable and moral character. According to Aristotle,
by honing virtuous habits, people will likely make the right choice when faced with ethical challenges.
KINDS OF VIRTUES:

■ Moral
ARISTOTLE
■ Intellectual
■ Born in Greek colony of Stagira in Macedonia.
■ It is in practice that we come to know what we truly know that we truly know to do something. We become morally
■ He served the royal family as tutor to Alexander the great. virtuous by doing morally virtuous acts.

■ studied at Plato’s University and is considered as Plato’s greatest student ■ To be morally virtuous, one must be able to respond to situations not just with the correct feelings or action but in
proper degree, at the right time, towards the right people and for the right reasons.
■ (Ignorance is solely responsible for committing moral acts, thinking that once truly knows the good one will
inevitably do the good.) ■ According to Aristotle, virtue is a state of one’s character that is the result of choice that is governed by prudence or
practical wisdom (phronesis) .
NICOMACHEAN ETHICS
■ PHRONESIS is the human person’s instrument in dealing with moral choices.
■ NICOMACHEAN ETHICS (son Nichomachus), a guide for living well, a handbook for those who seek to build
and cultivate one’s character in the hope of achieving life ultimate goal (telos), which he says is happiness or
flourishing (eudaimonia)
ST. THOMAS AQUINAS: NATURAL LAW
VIRTUE AS HABIT
■ An Italian Catholic priest who belongs to the Religious Order of Preachers or Dominicans.
■ Aristotle considers that morality is not merely a matter of knowing the good but actually doing or practicing the
■ An influencial philosopher, theologian, and jurist in the tradition of scholasticism
good habitually.
■ A poet, he wrote some of the most gravely beautiful eucharistic hymns in the church’s liturgy.
■ His ethics is grounded in the formation of one’s character- a way of being and living in harmony with the human
person’s proper end. THE NATURAL LAW
■ We become what we are by what we do and not merely by what we know. ■ Believed that human morality comes from nature.
HAPPINESS AS VIRTUE ■ Everything in nature has a purpose including humans.
■ EUDAIMONIA ■ Any law that is good is moral and any moral law is good.
■ the chief good for human person. ■ Starts from the principle good is to be done and evil is to be avoided.
■ Is the self-sufficient, final and attainable goal of human life. ■ Conscience evaluates and judges the motives and moral qualities of actions.
■ Is an activity of the soul in accordance with virtue. CONSCIENCE
■ SOUL ■ Different kinds of conscience that may lead us to wrong doing?
■ the part of human being that animates the body. ■ Perplexed-confused
■ composed of rational and irrational elements ■ Callous-insensitive or emotionally hardened
■ RATIONAL ■ Scrupulous – diligent or attentive to details
■ Speculative (responsible for knowledge) ■ Ignorant-lack of knowledge
■ Practical (responsible for choice and action)

■ IRRATIONAL

■ Vegetative

■ Appetitive HAPPINESS AS CONSTITUTIVE OF MORAL AND CARDINAL VIRTUES

 ■ The morality of happiness should be connected to our virtues in doing what is right and good. The cardinal virtues
are the 4 principal moral virtues
■ Prudence - concerned with intellect, guides the judgement of our conscience in discerning our true good and
applying moral principles to particular circumstances. “Right reason in an action”. It is the guide and measure for all
the moral virtues.
■ Justice – concerned with the will, the virtue that consists in giving to god and neighbor what is due to each. “Giving
them what is rightfully belong to them” to establish the peace and harmony that bring together people and allow
them to prosper while living in community.
■ Fortitude - prudence and justice are the virtues through which decided to be done “Fortitude gives us strength to do
it.” When we are confronted with moral choices fortitude allows us to remain strong and constant in our pursuit of
what is good and gives us strength to resist temptation that would pull us in the wrong decision.
■ Temperance – while fortitude is concerned with the restraint of fear so that we can act, restraint of our desires or
passions … Temperance is “Moderation in all things”. It involves the balanced use of the many goods given to us so
that their use remains ordered and at service of development of a good well-rounded and complete person.
THEORIES OF RIGHTS:
■ There are compelling theories of rights offered by several theorists.
■ IMMANUEL KANT
■ Influential Prussian German philosopher
■ Born 22 April 1724 to a religious and lower middle class family.
■ His interest in philosophy started when he continued his studies at the University of Konigsberg.
■ He was an effective teacher and was awarded full professorship in 1770.
■ Main interest is on epistemology, ethics, cosmogony and aesthetics
DEONTOLOGY
■ One of the distinctive features of Kant’s ethics is that it focuses on duties, defined by right and wrong. Right and
wrong (which are the primary deontic categories, along with obligatory, optional, supererogatory, and others) are
distinct from good and bad (which are value categories) in that they directly prescribe actions: right actions are ones
we ought to do (are morally required to do) and wrong actions we ought not to do (are morally forbidden from
doing). This style of ethics is referred to as deontology.
■ The name comes from the Greek word deon, meaning duty or obligation. In deontology, the deontic categories are
primary, while value determinations are derived from them. As we’ll see, Kant believes all our duties can be derived
from the categorical imperative
GOODWILL
■ For Kant, just doing the right thing is not sufficient for making an action have full moral worth. It’s also necessary to
act with good will, by which Kant means something like the inclination to do good or what is also known as a good
character.
■ He believes that a good will is essential for morality.
■ This is intuitively plausible because it seems that if an otherwise good action is done with bad or selfish intentions,
that can rob the action of its moral goodness.
THREE TYPES OF LEGAL RIGHTS
CATEGORICAL IMPERATIVE
■ A hypothetical imperative is a moral obligation applicable only in pursuit of a predetermined goal. For example, a
student studies to get good grades. Hypothetical imperatives are independent of morality. Kant holds that our
moral duties are driven by categorical imperatives. The rules are categorical as they are universally applicable, to
every person, in every situation, regardless of their personal goals and inhibitions. They are imperative because a
human being may be inclined to not adhere to a moral code of conduct, as it is only human to seek pleasure and
reduce pain.
■ Kant derives a test to determine a categorical imperative. He says, “Act only in accordance with that maxim through
which you can at the same time will that it become a universal law.” It means that an idea can be only be exposed
when applied to everyone.
■ According to Kantian ethics, categorical imperatives are counterintuitive in the sense that even though human
beings may be inclined to act in self-interest, their actions must be driven by their duty to humanity. Kant
considered self-improvement and preservation to be an undebatable obligation that is placed on everyone.
Therefore, unproductivity, suicide, or any form of self-destruction is inherently immoral.
TYPES OF RIGHTS:
■ Natural Rights
■ In classical political philosophy “natural right” denotes to the objective rightness of the right things, whether the
virtue of a soul, the correctness of an action, or the excellence of a regime.
■ Aristotle stated in Politics that no one would call a man happy who was completely lacking in courage, temperance,
justice, or wisdom. A man who was easily terrified, unable to restrain any impulse toward food or drink, willing to
ruin his friends for a trifle, and generally senseless could not possibly lead a good life. Even though chance may
occasionally prevent good actions from having their normal consequences, so that sometimes cowards fare better
than brave men, courage is still objectively better than cowardice. The virtues and actions that contribute to the
good life, and the activities intrinsic to the good life, are naturally right.
■ Moral Rights
■ Moral Rights are based on human consciousness. They are supported by moral force of human mind. These are
based on human sense of goodness and justice. These are not assisted by the force of law. Sense of goodness and
public opinion are the sanctions behind moral rights.
■ Legal Rights
■ Legal rights are those rights which are accepted and enforced by the state. Any defilement of any legal right is
punished by law. Law courts of the state enforce legal rights. These rights can be enforced against individuals and
also against the government. In this way, legal rights are different from moral rights. Legal rights are equally
available to all the citizens. All citizens follow legal rights without any discrimination. They can go to the courts for
getting their legal rights enforced.
 ■ Civil Rights:
■ Civil rights are those rights which provide opportunity to each person to lead a civilized social life. These fulfil basic
needs of human life in society. Right to life, liberty and equality are civil rights. Civil rights are protected by the
state.
■ Political Rights:
■ Political rights are those rights by virtue of which inhabitants get a share in the political process. These allow them
to take an active part in the political process. These rights include right to vote, right to get elected, right to hold
public office and right to criticize and oppose the government. Political rights are really available to the people in a
democratic state.
■ Economic Rights:
■ Economic rights are those rights which provide economic security to the people. These empower all citizens to
make proper use of their civil and political rights. The basic needs of every person are related to his food, clothing,
shelter, and medical treatment. Without the fulfilment of these no person can really enjoy his civil and political
rights. It is therefore essential, that every person must get the right to work, right to adequate wages, right to
leisure and rest, and right to social security in case of illness, physical disability and old age.
UTILITARIANISM
■ Utilitarianism is an ethical theory that determines right from wrong by focusing on outcomes. It is a form of
consequentialism.
■ Utilitarianism holds that the most ethical choice is the one that will produce the greatest good for the greatest
number. It is the only moral framework that can be used to justify military force or war. It is also the most common
approach to moral reasoning used in business because of the way in which it accounts for costs and benefits.
■ However, because we cannot predict the future, it’s difficult to know with certainty whether the consequences of
our actions will be good or bad. This is one of the limitations of utilitarianism.
ORIGINS AND NATURE
■ Quantitative Utilitarianism or Benthamite utilitarianism - is a branch of utilitarianism that was developed out of
the work of Jeremy Bentham (1747-1832) – an English philosopher, economist, political scientist, legal scholar, and
social reformer. Quantitative utilitarianism is concerned with aggregate utility maximization (i.e., maximizing the
overall happiness of everyone) and uses a hedonic calculus to determine the rightness or wrongness of actions.
■ Bentham’s fundamental axiom states that, “It is the greatest happiness of the greatest number that is the measure
of right and wrong.” The concept of hedonic calculus (also known as felicific calculus) was developed by Bentham in
his 1789 text, “Introduction to the Principles of Morals and Legislation.”
■ According to quantitative utilitarianism, every action results in some amount of “pleasure” and some amount of
“pain” for an individual. Hedonic calculus aggregates the individual “pleasures” and “pains” on the basis of their
intensity, duration, certainty, propinquity, fecundity, purity, and extent.
BENTHAM’S THEORY OF UTILITY
■ three central features:
■ 1. The greatest happiness principle (or utility principle)
■ 2. Egoism
■ 3. Artificial identification of one’s own interests with those of others
■ Qualitative utilitarianism is a branch of utilitarianism that arose from the work of John Stuart Mill (1806-1873) – an
English philosopher, civil servant, and politician. Qualitative utilitarianism rejected hedonic calculus and categorized
“pleasures” and “pains” in a more qualitative manner.
■ Mill argued that certain “pleasures” and “pains” were of greater consequence than others, even if there was no
quantifiable proof of their increased importance. He argued that “higher pleasures” could only be recognized by
those who have experienced them.
■ We should act always so as to produce the greatest good for the greatest number.” {principle of utility}
ACT AND RULE UTILITARIANISM
■ 1. ACT UTILITARIANISM - is one of the simpler and more straight-forward types. Act utilitarianism advises us to
judge each individual action on its outcome/results alone. If it is a choice between two courses of action, we are
morally obliged to take the one which yields the most happiness for the most people.
■ 2. RULE UTILITARIANISM - The principle of rule-utilitarianism is to follow those rules which will result in the
greatest good for the greatest number of people.
BUSINESS FASCINATION WITH UNITARIANISM
■ The core idea of utilitarianism is that an action is right if it results in the happiness of the greatest number of people
in a society or a group. In the workplace, the idea of this concept is if you conduct yourself properly at work, then
you will be able to achieve professional happiness. By making morally correct decisions, your happiness will
increase. However, if you choose to do something morally wrong, even though it may be legal, your happiness will
decrease.
JUSTICE AND FAIRNESS: PROMOTING THE COMMON GOOD
■ JUSTICE
■ According to Aristotle the principle is “equals should be treated equally and unequal’s unequally." In its
contemporary form, this principle is sometimes expressed as follows: "Individuals should be treated the same,
unless they differ in ways that are relevant to the situation in which they are involved.
■ FAIRNESS – freedom from prejudice and quality of treating people equally, it is usually dictated by our moral system
THE NATURE OF THE THEORY
■ JOHN RAWLS
■ A political philosopher during the 20th century
■ Main work “A theory of justice” published in 1971
■ Proposes justice as fairness as an ethical framework
■ Social order – the organized set of social institution and patterns of institutionalized relationship that together
composes society.
■ Anonymity condition – one knows nothing about a particular individual each represents such as their gender, race,
skin color temperament interest taste and preferences.
■ TYPES OF JUSTICE
■ Distributive justice – refers to a fair distribution of goods in a society
■ Corrective justice – for punishment of criminal cases
■ Compensatory justice – refers to hen people are properly compensated for their injuries.
■ EGALITARIAN DISTRIBUTIVE JUSTICE
■ Relating to or believing in principle that all people are equal and deserve equal rights and opportunities thus people MODULE 5
should get the same or be treated the same. ETHICS THROUGH THICK AND THIN AND ETHICS AND RELIGION.

RELIGION

TWO KINDS OF DISTRIBUTIVE EGALITARIANISM  RELIGION - definition is controversial and complicated subject with scholars failing to agree on any definition.
Generally religion is a “System of beliefs and practices.”
■ Political egalitarianism – where legal rights of every citizen are equally observed
 Comes to the Latin word “Religare” which means to bind, it promotes proper social behavior based on the teaching
■ Economic egalitarianism – where the distribution of socioeconomic goods is equally observed of a deity or a supreme being.
■ CAPITALIST DISTRIBUTIVE JUSTICE ETHICS AND LAW
■ Capitalist – a wealthy person who utilizes cash to put resources into exchange and industry for benefit as per the  Law is an ordinance of reason
standards of capitalism. They distribute according to distribution.
 Law can be eternal, divine , natural or human.
■ Proportion – is based around the idea that equal work produces equal outcomes
 Standards of Christian morality is law.
■ According to capitalist view of justice , people engage in economic exchange with each other what a person gets
out of the exchange should be at least equal in value to what the person has distributed. TYPES OF LAWS

■ SOCIALIST DISTRIBUTIVE JUSTICE  Eternal Law – the expression of god’s providence, it is an ordinance of god based on his divine intelligence.

■ Is a concept that addresses the ownership of the goods in a society.  Divine Law – the law of god as expressed in revelation and such are expressed in the holy scriptures.

■ It assumes that there is a large amount of fairness in the distribution of goods. Ethical work should provide  Natural law – the law of god as understood by human reason.
individuals with an equal outcome in terms of goods acquired or the ability to acquire goods
 Human law – is the ordinance of man which could either be legal – the law of civil authority or ecclesiastical/canon
– the law of the church.

FIVE PRINCIPLES CHALLENGES OF PLURALISM AND FUNDAMENTALISM: THE SEARCH FOR UNIVERSAL VALUES

■ Right to meaningful employment and to a living wage and right to union and association.  PLURALISM VERSUS FUNDAMENTALISM

■ Dignity of works and rights of workers.  Pluralism –it is the holding of two or more beliefs or concepts in a single society.

■ Goods of the world are gifts to be shared with others donating excess and volunteering.  This is the prevailing idea that is introduced in the modern world to make this a better place to live in.

■ Primacy of common goods over private property  The Pluralist ideology fell on the following premises:

■ Jesus stands on the sin of the poor and so must we.  1) Pluralism is engagement with diversity. This means that the walls that divide people due to religious
beliefs shall be removed, at present religious diversity is present but devoid of religious pluralism. That is in
certain countries religious ghettoes allow religious minorities to exist in their fold but is still alienated due
to their biases by the adherents of the dominant religion.

 2) Pluralism is understanding that transcends lines of differences. Many are mistaken that we have to
learn the entire religious doctrine of another only a portion is enough to at least build a bridge to connect them.
Absence of knowledge of another culture led to bias and alienation.

 3) Pluralism is encounter of commitments, this is simply to empathize to people of another religion.

We should not isolate ourselves from what we know but break borders.

 4) Pluralism is based on dialogue –talking is the most basic way of communicating, silence will bring us
nowhere.

 FUNDAMENTALISM is defined as a strict belief in the literal interpretation of the religious tenet.
Fundamentalists view of other religious beliefs are biased and contrary to their fundamental beliefs are considered
“heretic”. Their religious tenets adhere to the idea that morality is ebbing due to modernization.
GLOBALIZATION AND PLURALISM

 In our ever-changing world, pluralism are political responses to different historical challenges that they
shape history that build bridges than Fundamentalism that create walls. Policies geared religious pluralism
center on religious toleration, rights for denominations, or individual religious freedom. They believed that
even if they subscribe to religious beliefs they belong to One Faith and are unified by the philosophy of being
one.

 Globalization since we are now in the Digital Age, play a major role in achieving common understanding that
Ecumenical Services accepted people of “alien” religions to be at one thanks to the internet. With the continuing
development in telecommunications that will prove brighter in the years to come, will lead to peaceful co-
existence and even to ideological convergence.

CHALLENGES OF FILINNIALS

 Another trait that unified most of them is their narcissistic attitude, making them known as the “Me, Me, Me
Generation.”

 They are so conscious of what and how they look that selfies are a common thing. It must be noted though that there
are also good attitudes which millennials possess among them are their politically and social astuteness.

 The social media opened their eyes that traditional media such as TV, movies, radio and print are no longer
the source of information. Compared to other generations, millennials have their say about issues and are
more involved with politics and are not squeamish about revealing their opinions.

THE RELIGIOUS RESPONSE: THE ROLE OF RELIGION IN ETHICS.

 Even in the current situation, many are still arguing about the role of religion in Ethics. Will this age-old institution
be the primary agent for the right ethics for they propagate the Word of God? Most religions have an
ethical component because ethics is yardstick for right conduct and good life.

 A necessary component of making this a guide to temporal happiness. Is this the most reliable conception of
analyzing what is right from what is wrong? The central theme of ethics is "the good life”, the very reason we aspire
for in this temporal world we live in that ancient Greeks regarded as eudaimonia or happiness.

 The ancient Greeks believed happiness was brought about by living one’s life in accordance with virtue–positive
traits of character. Virtue is the source of good character, that us integrated by good personal habits such as
courage and temperance, but also friendship and justice and intellectual virtue.
PROXEMICS - is the study of how space is used in human interactions.
PLANNING SOME LOGISTICS
Health professionals perform many diagnostic or treatment procedures within the personal and intimate distance
zones. You may have to invade the patient’s culturally derived boundaries of interaction, sometimes with little ✦ Plan examination sequence
warning. Consider, for instance, the weak or debilitated patient who comes for treatment and must be helped to a
✦ Avoid frequent position changes
treatment table. To get the patient on the treatment table, you might have to “embrace” the patient and, in some
cases, lift the patient to the table, deeply invading his or her intimate zone. ✦ Move from "head to toe"

✦ Stand on the patient's right side for better assessment of jugular vein distention, apical pulse, and right kidney
The four distance zones are as follows:
SUGGESTED PHYSICAL EXAMINATION SEQUENCE
INTIMATE DISTANCE involving direct contact, such as that of lovemaking, comforting, protecting, and In the sitting position:
playing football or wrestling.
✦General survey
PERSONAL DISTANCE ranging from 1 to 4 feet. At arm’s length, subjects of personal interest can be discussed ✦Vital signs
while physical contact, such as holding hands or hitting the other person in the nose, is still possible. ✦Skin of upper torso (anterior and posterior)
✦Head and neck, including thyroid and lymph nodes
SOCIAL DISTANCE ranging from 4 to 12 feet. At this distance, more formal business and social discourse takes
✦Mental status, cranial nerves, upper extremity
place.
strength and tone, cerebellar function
PUBLIC DISTANCE ranging from 12 to 25 feet or more. No physical contact and very little direct eye contact ✦Thorax and lungs
are possible. Shopping centers, airports, and city sidewalks are designed to maintain this type of distance ✦Breasts
✦Musculoskeletal assessment of upper extremities
In the supine position, turned to the left side, with Sitting, leaning forward:
PHYSICAL EXAMINATION the head of the bed raised 30 degrees: ✦Cardiovascular assessment (for murmur of aortic
✦Cardiovascular assessment insufficiency)
APPROACHING THE PATIENT

✦ Act calm, competent, and organized Lying supine: Standing:

✦Thorax and lungs ✦Gait
✦ Assess patient in a certain order
✦Breasts and axillae ✦Musculoskeletal examination
✦ Assure patient there isn't necessarily anything wrong if you take extra time ✦Abdomen
✦Peripheral vascular and skin of the lower extremities
✦ Be selective of what you share and lower torso
✦Lower extremity strength and tone, reflexes
✦ Finish assessment before making any conclusions
Lithotomy position: Supine, turned to left side:
SCOPE OF THE EXAMINATION ✦Pelvic and rectal examinations of women ✦Prostate and rectal examinations of men

✦ Determined by patient's symptoms, age, and health history

✦ Based on your knowledge of disease patterns
✓ COMPREHENSIVE EXAMINATION
✦ Provides a source of knowledge about your
patient
✦ Helps identify or rule out physical cause
✦ Serves as a baseline for future comparisons
✦ Provides opportunity for health promotion
✦ Increases your credibility
ADJUSTING THE ENVIRONMENT
✦ Position patient for mutual comfort
✓ PERIODIC PHYSICAL ASSESSMENT
✦ Adjust height of bed or table as needed
✦ Helps with screening and prevention
✦ Adjust lighting level as needed for inspection
✦ Arrange a quiet environment to facilitate auscultation
PROMOTING PATIENT COMFORT
Privacy
✦ Remain professional and show concern 7-9 Very severe

✦ Close doors and curtains 10 Worst pain possible

Modesty  Oxygen saturation

✦ Drape patient with a gown or sheet Normal 95-100 % spo2

Mild hypoxia 90-94% spo2
✦ Visualize one area at a time
Moderate hypoxia 86-89% spo2
Communication
Severe hypoxia <86% spo2
✦ Explain each step of the examination

✦ Tell patient what to expect when you're finished

VITAL SIGNS
 Temperature
Oral: 35.5-37.5 °c
Rectal: 36.6-38.0 °c
Axillary: 34.7-37.3 °c

 Heart rate
Bradycardia < 60 bpm
Normal 60-100 bpm
Tachycardia > 100 bpm

 Respiration
Normal: 12-20 breaths per min
Tachypneic >20
Bradypneic <12

 Blood pressure
Hypertension >140 >90
Pre-Hypertension >120.139 >80.89
Normal 100-120 / 60-79
Hypotension < 100 <60

 Pain
1 TO 10
1-3 mild
4-6 moderate – severe