NCM 103
MODULE 1: WELLNESS AND WELL BEING
• Wellness is well being. It involves
engaging in attitudes and behaviors that
enhance quality of life and maximize
personal potential.
• Well-being is a subjective perception of
balance, harmony and vitality.
• Wellness is a choice; way of life; the
integration of body, mind and spirit and
the loving acceptance of one’s self.
DIMENSIONS OF WELLNESS
- FINANCIAL
- INTELLECTUAL
- OCCUPATIONAL
- SOCIAL
- PHYSICAL
- ENVIRONMENTAL
- SPIRITUAL
- EMOTIONAL
Physical Dimension
 Genetic make-up, age, developmental level,
race and sex that strongly influence health
status and health practices.
 The ability to carry out daily tasks, achieve
fitness (e.g. pulmonary, cardiovascular,
gastrointestinal), maintain adequate nutrition
and proper body fat, avoid abusing drugs and
alcohol or using tobacco products, and generally
to practice positive lifestyle habits.
 Examples:
• The toddler just learning to walk is prone to
tall and injure himself.
• The young woman who has a family history of
breast cancer and diabetes is at a higher risk to
develop these conditions.
Emotional Dimension
 Ability to express feelings & develop/sustain
relationship; long term stress affects body
condition → health habits
 The ability to manage stress and to express
emotions appropriately, Emotional wellness
involves the ability to recognize, accept, and
express feelings.
Mental Dimension
 Positive sense of purpose & underlying belief
in one’s own worth
 Feeling Good
Socio-cultural Dimension
 Health practices & beliefs are strongly
influenced by a person’s economic level, life
style, family and culture.
 Family & culture to which the person belongs
determine patterns of living & values about
health & illness are often unalterable.
Intellectual Dimension
 Cognitive abilities, educational background
and past experiences.
 Influence a client’s responses to teaching
about health and reactions to health care during
illness & play a major role in health behaviors.
 The ability to learn and use information
effectively for personal, family, and career
development.
Environmental Dimension
 Housing, sanitation, climate and pollution of
air, food and water.
 The ability to promote health measures that
improve the standard of living and quality of life
in the community.
Spiritual Dimension
 Spiritual and religious beliefs and values are
important components of the way the person
behaves in health and illness.
 Recognition & ability to put into practice
moral & religious principles & beliefs
Occupational Dimension
 Ability to achieve a balance between work &
leisure time.
HEALTH – ILLNESS CONTINUUM
 The health illness continuum is a graphic
illustration of a well being ,concept first
proposed by John.W.Travis in 1972.
 It describes how wellbeing is more than
simply an absence of illness , but also
incorporates the individuals mental and
emotional health.
 Travis believed that the standard approach to
medicines , which assumes a person is well
when there are no signs or symptoms of disease
,was insufficient.
 Composed of two arrows pointing in opposite
direction and joined at a neutral point.
 Movement to the right to the arrows (toward
the high level of wellness) equals an increase in
level of health and wellbeing Achieved in three
steps: awareness, education & growth.
 Movement to the left to the arrows (towards
premature death) equates a progressively
decreasing state of health. Achieved in three
steps: signs, symptoms & disability.
Other Models of Health & Illness
 The Health & Illness Continuum (Dunn)
 Health Belief Model (HBM)
 Smith’s Models of Health
 Leavell & Clark’s Agent-Host- Environment
Model
 Health Promotion Model
ILLNESS
 Is a personal state in which the person feels
unhealthy.
 A state in which a person’s physical,
emotional, social, intellectual, developmental or
spiritual functioning is diminished or impaired
compared with previous experience.
 Classification of Illness:
a) Acute – severe symptoms, short duration
b) Chronic – lasts for 6 months or longer
 Stages of Illness:
1) Symptom experience
2) Assumption of sick role
3) Medical care contact
4) Dependent patient role
5) Recovery / rehabilitation
DISEASE
 An alteration in body functions resulting in
reduction of capacities or a shortening of the
normal life span.
 Common Causes of Disease:
1) Biologic agents 2) Inherited genetic defects 3)
Development defects 4) Physical agents 5) Chemical
agents 6) Tissue response to irritation / injury 7) Faulty
chemical / metabolic process 8) Emotional/ physical
reaction to stress.
Health Care System
 Totality of services offered by all health
disciplines.
 It is changing with increasing awareness in
health promotion, illness of prevention & level
of wellness, so with the roles of nurses.
TYPES OF HEALTH CARE SERVICES
1) Health Promotion and Illness Prevention
(Primary prevention)
2) Diagnosis and Treatment (Secondary
prevention)
3) Rehabilitation, Health Restoration & Palliative
Care (Tertiary prevention)
Health Promotion & Illness Prevention (Primary
Prevention)
 Primary prevention programs: adequate &
proper nutrition, weight control & exercise &
stress reduction.
 Health promotion activities emphasize the
important role clients play in maintaining their
own health & encourage them to maintain the
highest level of wellness they can achieve.
 Illness prevention: immunizations, identifying
risk factors for illness, help in taking measures
to prevent illness (e.g stop smoking campaign);
environmental protective measures.
Diagnosis & Treatment (Secondary Prevention)
 Offered by hospitals & physicians offices.
 Hospitals – provides emergency, intensive &
around the clock acute care.
 Evolving freestanding diagnostic & treatment
facilities.
 Walk-in clinics
Goal of tertiary prevention: To help people move to
their previous level of health or to the highest they are
capable of.
Rehabilitative Care – assisting clients to function
adequately in the physical, mental, social,
economic, & vocational areas of their lives.
Palliative Care – people cannot return to health,
hence we provide comfort & treatment of
symptoms. End-of-life care
TYPES OF HEALTH CARE AGENCIES & SERVICES 1) Public
Health 2) Physician’s office 3) Ambulatory Care Centers –
diagnostics & treatments facilities 4) Occupational
Health Clinics 5) Hospitals 6) Sub-acute care facilities 7)
Extended (Long Term) Care facilities 8) Retirement &
Assisted Living Centers 9) Rehabilitation Centers 10)
Home Health Care Agencies 11) Day Care Centers 12)
Rural Care 13) Hospices Services 14) Crisis Centers 15)
Mutual Support & Self-Help Groups
Factors Affecting Health Care Delivery:
1) Increasing number of older adults
 Long-term illness will be prevalent
 Home management & nursing support
services are required to assist those
living in homes & communities
 Need to feel that they are still part of
the community – the feeling of being
useful, wanted & productive.
2) Advances in Technology
 Improved diagnostic procedures
 Sophisticated equipment
 New medications being manufactured
 Surgical procedures are more
common today
 Laser & microscopic procedures
 Computers, internet access
3) Economics
 Health care cost is becoming a greater
problem.
 Major reasons for cost increases: New
equipment costs more, inflation
increase, growing population especially
the older adults, hospital costs were
billed to medicare or healtcare aids,
more people seek medical assistance,
relative number of people who provide
health care services increased, number
of uninsured individuals are changing,
cost of drugs is increasing
4) Womens health
 Birthing centers, concerns for reproductive
aspects of health
5) Uneven distribution of services.
 Insufficient number of healthcare
professionals & services available to meet the
healthcare needs in remote & rural areas.
6) Access to health insurance.
 Problems of individuals to access to health
insurance: low income; receive less preventive
care, delay & avoid care & meds; eligibility for
government insurance programs
7) The homeless and the poor
 The conditions where homeless people live
their health problems increases & becomes
chronic.
8) Health insurance or portability and
Accountability Act.
 This is instituted to protect the privacy of
individuals by safeguarding individually
identifiable healthcare records
9) Demographic changes.
 Single-parent families & alternative family
structures.  Culture & ethnic diversity
Module 1 CONCEPT OF MAN, HEALTH & ILLNESS
• Referred to a person a patient. The mind and body of
the person as inseparable. Viewed as an holistic being .
PEPLAU, HENDERSON, TRAVELBEE
 MAN Defined as a human being. (PEPLAU
HENDERSON TRAVELBEE)
 A person is an Open System that works together with
other parts of its body as it interact with the
environment. (NEUMAN HENDERSON SR. CALLISTA ROY)
NURSING CONCEPT OF MAN
 Man is an integrated BIO-PSYCHOSOCIO-CULTURAL &
SPIRITUAL BEING:
- BIO
- SOCIAL
- PSYCHO
- CENTER: SPIRITUAL
Concept of Man …..
1. Biological being, man is like all other men.
 Because all men have the same basic
human needs.
2. Psychological being, man is like no other man.
 Because man is a unique,
irreplaceable, one-time being.
No two persons are exactly
alike.
  Capable of rational, logical Definitions of HEALTH
thinking but become irrational  (WHO) “A state of complete physical, mental,
and illogical when provoked. and social well being, not merely the absence of
3. Social being, man is like some other men. disease or infirmity”.
 Capable of relating with others  (Claude Bernard) Health is the ability to
 Has the capacity to cope with stressful maintain internal milieu, homeostasis or
stimuli. dynamic equilibrium.
 A group of people have common NIGHTINGALE
attributes that make them different  Health is being well and using one’s power to
from other groups. the fullest extent.
 Some factors that characterized a  Health is maintained through prevention of
particular groups of people are culture, disease via environmental health factors
age groups, social status, educational HENDERSON
status, etc…  Health is viewed in terms of the
4. Spiritual being, man is like all other men. individual’s ability to perform 14
 All men are spiritual in nature, components of nursing care unaided.
because they have intellect & will;
endowed with virtues of faith, hope &
charity.
 All men believe in the existence of a
Supreme Power who guides our fate &
destiny; the source of meaning &
purpose of life; to whom we seek
console in case of difficulties in life.
 Man is an OPEN SYSTEM ….
 It allows input & output to and from its boundaries;
one that allows exchange of, or is constantly affected by
matter, energy & information.
a) Matter – foods, medicines,
microorganisms
b) Energy – pain, fever, inflammation
c) Information – diagnosis of an illness,
pregnancy, undergoing surgery or other
treatments, death of a loved one
 Man is a UNIFIED WHOLE composed of parts which
are interdependent and interrelated with each other.
 The different organs and organ systems function
together to achieve a particular purpose. ROY
 Health is a state and a process of
 Man is composed of parts which are greater that and
different from the sum of all his parts. being and becoming an integrated and
whole person.
 “Greater than the sum of all his parts”…. because he is
OREM
not simply a composite of physiologic body parts but
 A state that is characterized by
also endowed with intellect, will, judgment, decision-
making abilities, talents, strengths & other numerous soundness or wholeness of developed
enabling powers. human structures and of bodily and
mental functioning.
 “ Different from the sum of all his parts” … because at
KING
times his responses are predictable, but at times
unpredictable. He is a creature with contradictions.  Health is a dynamic state in the life
cycle; illness is an interference in the life
cycle.
 Man is composed of subsystems and suprasystems.
NEUMAN
- Subsystems – cells, tissues, organs, organ
 Wellness are in harmony in which all
systems.
- Suprasystems – family, community and the parts and subparts of an individual are
society. in harmony with the whole system.
JOHNSON
 Man is an individual with vital reparative processes to
deal with disease & desirous of health but passive in  Health is an elusive, dynamic state influenced
terms of influencing the environment or nurse. by biologic, psychologic , and social factors.
 Man is a whole, complete and independent being  Health is reflected by the organization,
who has 14 fundamental needs to: interaction, interdependence and integration of
breath, eat & drink, eliminate, move & maintain the subsystems of the behavioral systems.
body posture, sleep & rest, dress & undress, ROGERS
maintain body temperature, keep clean, avoid  Positive health symbolizes wellness. It
danger, communicate, worship, work, play, and is a value term defined by the culture or
learn. individual.
 Man is a unity who can be viewed as functioning
biologically, symbolically & socially & who initiates &
performs self-care activities on own behalf in
maintaining life, health & well-being.
 HEALTH PROMOTION PROGRAMS
 Information dissemination
 Health Appraisal & Wellness
Assessment Programs
 Lifestyle & Behavior Change
Programs
 Worksite Wellness Programs
 Environmental Control
Programs
MULTIPLE FACTORS AFFECTING HEALTH & Illness
 Several models have been designed
to define health. One of these define
health as a multifactorial phenomenon.
According to this model, there are
several factors within and outside the
person that influence health. These
factors may or may not be under the
conscious control by the person or
others in the environment. However,
one thing is certain it is the interaction
of these factors that constitutes health.
(Leddy & Pepper 1993)
- POLITICAL FACTORS
o Political structure, leadership,
people’s empowerment & will,
policies & laws.
o The form of government, the style
of leadership, the extent &
consistency in implementing laws,
policies & ordinances.
- BEHAVIORAL FACTORS
o Behaviors are learned from parents,
members of extended family,
church, school, mass media &
others in the environment.
- BIOLOGICAL FACTORS
o Include genetic inheritance, sex,
age, developmental level, nutrition,
cognitive structures intelligence, &
race.
- SOCIO- ECONOMIC FACTORS
o Economic status, standard of living,
occupational roles & memberships
in social groups influence health
beliefs & practices.
- ENVIRONMENTAL FACTORS
o Rapidly accelerating changes in the
ecosystem.
o Increasing mobility of people
creates megacities.
o Psychosocial environment –
information technology which has
increased people’s access to
information.
MODULE 2:CONCEPT OF NURSING
Common themes in the definition of NURSING:
• Nursing is caring. • Nursing is an art. • Nursing is a
science. • Nursing is client centered. • Nursing is
holistic. • Nursing is adaptive. • Nursing is concerned
with health promotion, health maintenance and health
restoration. • Nursing is a helping profession
Recipients of Nursing
1. Consumer
– individual, group of people or community
that uses a service or commodity.
2. Patient - Latin word
– to suffer /to bear) person waiting for or
undergoing medical treatment & care.
3. Client
– person who engages the advice or services of
another who’s qualified to provide this service.
They are collaborators in their care.
ROLES & FUNCTIONS OF THE NURSE
1. Caregiver 2. Communicator 3.
Teacher 4. Client Advocate 5. Counselor
6. Change Agent 7. Leader 8. Manager
9. Case Manager 10. Research
Consumer
PROFESSION
 An occupation that requires extensive /
advanced knowledge & skills & is an outgrowth
of society’s needs for special services.
 An occupation that requires extensive
education or calling that requires special
knowledge, skills & preparation.
 Professional – a person who is conscientious
in actions, knowledgeable about the subject, &
responsible to self & others.
CRITERIA OF A PROFESSION
1. Specialized Education 2. Body of
Knowledge 3. Service Orientation 4.
Ongoing Research 5. Code Ethics 6.
Autonomy 7. Professional Organization
Personal Qualities of a Nurse
1) Philosophy of Life
 It is concerned with those basic truths that
contribute to personal growth in a systematic
fashion & with those principles that relate to the
moral values that shape the facets of the character.
 Theories of nursing can be taught, but not a
philosophy of life or a philosophy of service.
2) Good personality
 It consists of the distinctive individual qualities
that differentiates one person from the another.
 It refers to the impression one makes on others
which will include more than that which meets the
eye.
Components of Good Personality
1) Personal appearance – includes
posture, grooming, dress and uniform.
2) Character – the moral values and
beliefs that are used as guide to
personal behavior and actions. 3)
Attitude – a manner of acting, thinking
or feeling that is indicated by one’s
response toward another person,
situation or experience. 4) Charm –
influence the senses or the mind by
some quality or attraction.
Qualities of a Professional Nurse
 Has faith in the fundamental values:  Respect for
human dignity  Self-sacrifice for common good  Strong
sense of responsibility for sharing in the solution of the
problems of society
 Has sense of responsibility for understanding those
with whom he/she works with.
 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.
Qualities of a Professional Nurse
 Has the basic knowledge, skills and attitudes
necessary to address the present problem through the
use of critical thinking
 Has skill in using written and spoken language, both
to develop own thoughts and to communicate them to
others
 Appreciates and understands the importance of good
health
 Has emotional balance
Likes hard work and possesses a capacity for it.
Appreciates high standards of workmanship.
 Accepts and tries to understand people of all sorts,
regardless of race, color and religion.
 Knows nursing so thoroughly that every client will
receive excellent care.
Module 3 NURSING AS AN ART
Caring
 People, relationship and things matter
 It is central to all & enables people to create meaning
in their lives
 Sharing deep & genuine concern about the welfare of
another person. Caring Practice
 Involves connection, mutual recognition and
involvement between the nurse & client.
Nursing Theories on Caring
Leininger
 Caring as a nurturing behavior has been present
throughout history and is one of the most critical factors
in helping people maintain or regain health.
- Caring is the essence of nursing and the
distinct, dominant and unifying focus of
nursing.
- Nurses must understand different cultures
in order to function effectively. They utilize
nursing actions which are culturally
congruent – preservation, accommodation
& repatterning.
Theory of Bureaucratic Caring (Ray)
 Caring in organizations as cultures. Caring in nursing is
contextual and is influenced by the organizational
structure.
Caring, the Human Mode of Being (Roach)
 Caring as a philosophical concept and proposes that
caring is the human mode of being, of the “most
common, authentic criterion of humanness. ” All
persons are caring, and develop their caring abilities by
being true to self, being real and being who they truly
are.
Nursing as Caring ( Boykin and Schoenhofer)
 The purpose of the discipline and profession of
nursing is to know persons and nurture them as persons
living and caring and growing in caring. Respect for
persons as caring individuals and respect for what
matters to them. Caring is a lifetime process, lived
moment to moment by the nurse and constantly
unfolding.
WATSON
 Caring as the essence and moral ideal of nursing.
 Human care is the basis nursing’s role in society.
 There is transpersonal human caring, a human
connection wherein the nurse enters into the
experience of the client and vice versa. It gains self-
knowledge & keeps alive his or her common humanity &
avoids reducing the other to an object.
SWANSON
 Caring as nurturing way of relating to a valued other,
toward whom one feels a personal sense of
commitment and responsibility.
 Described the caring processes which provided
guidance for nurses when caring for pregnant &
postpartum women. These are knowing, being with,
doing for, enabling & maintaining belief.
 3. CONFIDENCE
o The quality that fosters trusting
relationships. Comfort with self,
client and family
4. CONSCIENCE
o Morals, ethics, and an informed
sense of right and wrong.
Awareness of personal
responsibility.
5. COMMITMENT
o Convergence between one’s desires
and obligations and the deliberate
choice to act in accordance with
them.
6. COMPORTMENT
o Appropriate bearing, demeanor,
dress and language, that are in
harmony with a caring presence.
Presenting oneself as someone who
respects others and demands
respect.

• Caring for Self – helping oneself grow and

actualize one’s possibilities.
• Self Care – responding to one’s own needs to
grow, is the opposite of self-complacency that
often accompanies egocentricity.

Self Care Activities

1. A balanced diet
2. Regular exercise
3. Adequate rest and sleep
4. Recreational activities
5. Meditation and prayer

The Primacy of Caring (Benner and Wrubel)

 Caring is the essence of excellence in nursing.
- Caring practice requires attending to the
particular client over time, determining
what matter to the person and using this
knowledge in clinical judgement
NURSING PRACTICE CARING INVOLE: MIND AND BODY THERAPHY:
1. PROVIDING PRESENCE 1. GUIDED IMAGERY
2. COMFORTING 2. MEDITATION
3. KNOWING THE CLIENT 3. STORYTELLING
4. SPIRITUAL CARING 4. MUSIC THERAPHY
5. FAMILY CARE 5. YOGA

6 C’s Reflection – is thinking from a critical point of view,

1. COMPASSION analyzing why one acted in a certain way, and assessing
the results of one’s actions. To develop oneself as a
o Awareness of one’s relationship to caring practitioner, reflection on practice must be
others, sharing their joys, sorrows, personal and meaningful.
pain and accomplishments.
Participation in the experience of
another.
2. COMPETENECE
o Having the knowledge, judgment,
skills, energy, experience and
motivation to respond adequately
to others within the demands of
professional responsibilities.
 ( ANG SUGPON SA PDF ANG MODULE
3: CONTINUE)

TEACHING
 A system of activities intended to
produce learning. The teaching-learning
process involves dynamic interaction
between teacher and learner.
 Nurses teach a variety of learners in
various settings – clients & their
families, community, health personnel
AREAS OF CLIENT EDUCATION
1) Promotion of Health 2) Prevention of
Illness / Injury 3) Restoration of Health
4) Adapting to altered health & function

LEARNING NEED – is a desire or a requirement to know

something that is presently unknown to the learner . It
could include a new knowledge or information or a new
or different skill or physical ability or a new behavior or
a need to change an old behavior.

1) COGNITIVE DOMAIN (“thinking”) – includes 6

intellectual abilities & thinking processes - knowing,
comprehending, applying, analysis, synthesis &
evaluation.
2) PSYCHOMOTOR DOMAIN (“skill) – includes fine &
gross motor abilities such giving an injection.
3) AFFECTIVE DOMAIN (“feeling”) – deals with personal
issues such as “attitudes, beliefs, behaviors & emotions”