FUNDA REVIEWER
PRELIM
Topic Outline:
● Concept of Nursing
● Fundamentals of Nursing Practice
● Nursing as an Art
CONCEPT OF NURSING
NURSING IS AN ART AND SCIENCE
● As a professional nurse, you will learn to
deliver care artfully with compassion, caring,
and respect for each patient’s dignity and
personhood.
● As a science, nursing practice is based on a
body of knowledge that is continually
changing with new discoveries and
innovations
● The Quality of Care is at level of excellence
that benefits patients and their families
SCIENCE AND ART OF NURSING PRACTICE
● Nursing practice requires a blend of the
most current knowledge and practice
standards with an insightful and
compassionate approach to patient care
● The nurse’s care will reflect the needs and
values of society and professional
standards of care and performance, meet
the needs of each patient, and integrate
evidence-based findings to provide highest
level of care
● Nursing has a specific body of knowledge
but it is also helpful to socialize within the
profession and practice to fully understand
and apply this knowledge to develop
professional expertise
NURSING AS A PROFESSION
PROFESSION
➢ 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.
PROFESSIONAL NURSING
● An art and science, dominated by an ideal
or service in which certain principles are
applied in the skillful care of the well and the
ill, and through relationship with the
client/patient, significant others, and other
members of the health team
PROFESSIONAL NURSE
● Is one who has acquired the art and science
of nursing through her basic education, who
interprets her role in nursing 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
BENNER: NOVICE TO EXPERT
NOVICE
● Beginning nurse or any nurse entering a
situation in which there is no previous level
of experience
ADVANCED BEGINNER
● A nurse who has had some level of
experience with the situation
● Experience may only be observational in
nature
COMPETENT
● Has been in same clinical position for 2-3
years
● Understands the organization and specific
care required by the type of patients
● Can anticipate nursing care and establish
long-range goal
PROFICIENT
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● With more than 2-3 years of experience in
the same clinical position
● Perceives a patient’s clinical situation as a
whole
● Can assess the entire situation and transfer
knowledge from previous experiences
EXPERT
● Has intuitive grasp of an existing or potential
clinical problem
● Is skilled at identifying both patient-centered
problems and problems related to the HCS
SCOPE AND STANDARDS OF PRACTICE
NURSING
● Is the protection, promotion, and
optimization of health and abilities;
prevention of illness and injury, alleviation of
suffering through the diagnosis and
treatment of human response, and
advocacy in the care individuals, families
and communities (ANA, 2010)
● Encompasses autonomous and
collaborative care of individuals of all ages,
families, groups and communities, sick or
well, and in all settings (ICN, 2014)
● It includes the promotion of health;
prevention of illness; and the care of ill,
disabled and dying people
ANA STANDARDS OF NURSING PRACTICE
STANDARD 1: ASSESSMENT
● The registered nurse collects
comprehensive data pertinent to the
patient’s health or situation
STANDARD 2: DIAGNOSIS
● The registered nurse analyzes the
assessment data to determine the diagnosis
or issues
STANDARD 3: OUTCOMES IDENTIFICATION
● The registered nurse identifies expected
outcomes for a plan individualized to the
patient or the situation
STANDARD 4: PLANNING
● The registered nurse develops a plan that
prescribes strategies and alternatives to
attain expected outcomes
STANDARD 5: IMPLEMENTATION
● Nurse implements the identified plan
● Nurse coordinates care delivery
● Nurse employs strategies to promote health
and safe environment
STANDARD 6: EVALUATION
● The registered nurse evaluates progress
toward attainment of outcomes
STANDARDS OF PROFESSIONAL PERFORMANCE
● It describes a competent level of behavior in
the professional role
● Provides method to assure that high-quality
care is rendered to patients
CODE OF ETHICS
● Is the philosophical ideals of right and
wrong; which defines the principles a
professional will use to provide care
PROFESSIONAL RESPONSIBILITIES AND ROLES
AUTONOMY AND ACCOUNTABILITY
● Autonomy –Involves initiation of
independent nursing interventions
● Accountability – Individual is responsible
professionally and legally for the type and
quality of nursing care provided
CAREGIVER
● Helps patient to maintain and regain health,
manage disease and symptoms, and attain
a maximal level of function and
independence through the healing process
ADVOCATE
● Protects your patient’s human and legal
rights and provide assistance in asserting
their rights
EDUCATOR
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● Explain concepts and facts about health,
describe the reason for routine care
activities
COMMUNICATOR
● Allows the nurse to know the patients as
well as their strengths, weaknesses and
needs
MANAGER
● Establish a collaborative patient-centered
care to provide safe, quality care with
positive patient outcomes
LEADER
● The nurse helps client make decisions in
establishing and achieving goals to improve
his well-being through the process of
interpersonal influences
COUNSELOR
● Helps the client to recognize and cope with
stressful psychological or social problems,
to develop improved personal relationships
and to promote personal growth. It also
include providing of emotional, intellectual
and psychological support
CHANGE AGENT
● Initiates changes and assist in the
modification of client’s lifestyle to promote
health
RESEARCHER
● Participates in scientific investigation and
uses research findings in practice
CASE MANAGER
● Coordinates the activities of the members of
the HC team in managing a group of client’s
care
COLLABORATOR
● Works together with all those involved in
care delivery, for mutually acceptable plan
in order to achieve common goal; thus the
nurse initiates nursing actions in the health
team
CRITERIA OF PROFESSION
EDUCATION
● Requires an extended education and basic
liberal foundation
THEORY
● Has theoretical body of knowledge
● Conceptual frameworks needed for nursing
practice, education & research
SERVICE ORIENTATION
● Altruism “hallmark of a profession (selfless
concern for others)
● Guided by rules, policies and COE
AUTONOMY
● Self-regulation and standards
● Needed in making decisions and in practice
CODE OF ETHICS
● Based on International Council of Nurses
● Worth dignity of others and integrity of
members
CARING
HISTORICAL INFLUENCES
FLORENCE NIGHTINGALE
● Established the first nursing philosophy
based on health maintenance and
restoration
● Identified the role of nursing as having
“charge of somebody’s health” based on the
knowledge of “how to put the body in such a
state to be free of disease or to recover
from disease
● Developed the first organized program for
training nurses, the Nightingale Training
School for Nurses (St. Thomas Hospital,
London)
● First practicing nurse epidemiologist
● She volunteered during the Crimean war
(1853)
THE CIVIL WAR TO THE BEGINNING OF THE 20TH
CENTURY
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 CLARA BARTON
● Founder of American Red Cross
● Tended soldiers on the battlefields, cleaning
their wounds, meeting their basic needs,
and comforting them in death
MOTHER MARY ANN BICKERDYKE
● Organized ambulance services and walked
abandoned battlefields at night, to look for
wounded soldiers
HARRIET TUBMAN
● Active in the Underground Railroad
Movement and helped to lead over 300
slaves to freedom
MARY MAHONEY
● The 1st professionally trained African-
American nurse
● Concerned with the effect culture had on
health care
● Brought awareness of cultural diversity and
respect for the individual, regardless of
background, race, color or religion
LATE 19TH CENTURY
● Expansion of hospitals
LILIAN WALD AND MARY BREWSTER
● Opened the Henry Street Settlement
● It focused on the health needs of poor
people who lived in tenements (NYC)
TWENTIETH CENTURY
● Early 20th century development of scientific,
research-based defined body of nursing
knowledge and practice
● Nurses began to assume expanded and
advanced practice roles
● Army and Navy Nurse Corps was
established
● 1920s specialization of nursing began
● Graduate Nurse-midwifery programs began
● Last half of century : creation of specialty-
nursing organization
MARY ADELAIDE NUTTING
● 1 st nursing professor (Columbia Teachers
College, 1906)
● Contributed in moving nursing education
into universities
TWENTY-FIRST CENTURY
● Nurse and nurse educators are revising
nursing practice and school curricula to
meet the ever-changing needs of society,
including aging population, bioterrorism,
emerging infections and disaster
management, the high acuity level care of
hospitalized patients, and early discharge
from health care institutions require nurses
in all settings to have a strong and current
knowledge base from which to practice
● Nursing organizations and the RWJF
involvement in supporting nursing scholars,
decreasing the nursing shortage, and
improve the health of the nation’s population
● Nursing takes a leadership role in
developing standards and policies to
address the needs of the population
CONTEMPORARY INFLUENCES
IMPORTANCE OF NURSES’ SELF-CARE
● A nurse cannot give fully engaged,
compassionate care to others when there’s
a feeling of depletion or does not feel cared
for herself. Nurses also experience grief and
loss
● Compassion fatigue: a state of burnout
and secondary traumatic stress. It occurs
without warning and often results from
giving high levels of energy and compassion
over a prolonged period to those who are
suffering, often without experiencing
improved patient outcomes
● Secondary traumatic stress: trauma that
HCP experience when witnessing and
caring for others suffering trauma
● Burnout: a state of physical and mental
exhaustion that often affects HCPs because
of the nature of their work environment, it
occurs when perceived demands outweigh
perceived resources
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THE AFFORDABLE CARE ACT AND RISING HEALTH
CARE COSTS
● ACA affects how health care is paid for and
delivered
● Greater emphasis on health promotion,
disease prevention and illness management
● More nurses will be in community-based
setting like community care centers, schools
and senior centers
DEMOGRAPHIC CHANGES
MEDICALLY UNDERSERVED
HISTORY OF NURSING IN THE PHILIPPINES
EARLY BELIEFS AND PRACTICES
● Diseases and causes and treatment were
shrouded with a mysticism and superstitions
● Beliefs about causation of disease (another
person like an enemy or witch; evil spirits)
● People believed that evil spirits could be
driven away by persons with powers to
expel demons
● People believe in special gods of healing,
with the priest physician (word doctors) as
intermediary. Herbolarios (herb doctors)
EARLY CARE OF THE SICK
● Superstitious beliefs and practices in
relation to health and sickness. Herb Men
(Herbicheros) , one who practices
witchcraft. Midwife assisted in childbirth.
During labor, the ‘mabuting hilot’ (good
midwife) was called in. If there’s difficulty in
labor, witches were supposed to be the
cause. To disperse this influence,
gunpowder was exploded from a bamboo
cane close to the head of the sufferer
HEALTH CARE DURING SPANISH REGIME
● The religious orders exerted their efforts to
care for the sick by building hospitals in the
various part of the Philippines
● Hospital real de Manila (1577) – Was
established mainly to care for Spanish
King’s soldiers, but also admitted Spanish
civilians
● San Lazaro Hospital (1578) – Built
exclusively for patients with leprosy,
founded by Brother Juan Clemenete and
was administered by Hospitalliers of San
Juan de Dios
● Hospital de Indio (1586) – Supported by
alms and contributions from charitable
persons and established by the Franciscan
Order
● Hospital de Aguas Santas (1590) –
Founded by Brother J. Bautista of the
Franciscan Order in Laguna
● San Juan de Dios Hospital (1596) –
Founded by Brotherhood of Misericordia
and supported by the Hospitallers of San
Juan de Dios
NURSING DURING THE PHILIPPINE REVOLUTION
● Prominent persons involved in nursing
works were:
● Josephine Bracken – Installed a field
hospital in an estate house in Tejeros;
provided care to the wounded night and day
● Rosa Sevilla de Alvero – Converted their
house into quarters for the Filipino soldiers
in 1899 during Philippine-American War
● Dona Hilaria de Aguinaldo – (Wife of
Emilio Aguinaldo), organized Filipino Red
Cross under the inspiration of Apolinario
Mabini
● Dona Maria Agoncillo de Aguinaldo –
(2nd wife of Emilio Aguinaldo) –
President of Filipino Red Cross Batangas
branch; provided nursing care to Filipino
soldiers during the revolution
● Melchora Aquino (Tandang Sora) –
Provided nursing care to the wounded
Filipino soldiers and gave them shelter and
food
● Capitan Salome – Revolutionary leader in
Nueva Ecija; provided nursing care to the
wounded when not in combat
● Agueda Kahabagan – Provided nursing
services to her troops and she was a
revolutionary leader in Laguna
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● Trinidad Tecson – “Ina ng Biak na Bato’
cared for the wounded soldiers in the
hospital at Biak na Bato
HOSPITALS AND SCHOOLS OF NURSING
● Iloilo Mission Hospital School of Nursing
(Iloilo City, 1906) - It was ran by Baptist
Foreign Mission Society of America; Miss
Rose Nicolet (first superintendent). Miss
Flora Ernst an American nurse took charge
in 1942; in March 1944, 22 nurses
graduated and in April 1944 the graduated
nurses took the first Nurses Board
Examination in Iloilo Mission Hospital
● St. Paul’s Hospital School of Nursing
(Manila, 1907) - The hospital was
established by the Archbishop of Manila, the
Most Reverend Jeremiah Harty under the
supervision of the Sisters of St. Paul de
Chartres. It provided general services and
had a free dispensary and dental clinic. In
1908, it opened its training school for nurses
with rev. Mother Melanie (superintendent)
and Miss E. Chambers (Principal)
● Philippine General Hospital School of
Nursing (1907) - Began in 1901 as a small
dispensary mainly for Civil Officers and
Employees in Manila City, then became a
Civil Hospital
● St. Luke’s Hospital School of Nursing
(Quezon City, 1907) - The hospital is an
Episcopalian Institution which began as a
small dispensary (1903) and the school
opened with three Filipino girls admitted
(1907)
● Mary Johnston Hospital and School of
Nursing (Manila, 1907) - It was called
Bethany Dispensary and was funded by the
Methodist Mission for the relief of suffering
among women and children
● Philippines Christian Mission Institute
Schools of Nursing
● San Juan de Dios Hospital School of
Nursing (Manila, 1913)
● Emmanuel Hospital School of Nursing
(Capiz, 1913)
● Southern Islands Hospital School of
Nursing (Cebu, 1918)
THE FIRST COLLEGES OF NURSING IN THE
PHILIPPINES
● University of Santo Tomas College of
Nursing (1946)
● Manila Central University College of Nursing
(1947)
● University of the Philippines College of
Nursing (1948)
NURSING LEADERS IN THE PHILIPPINES
● Anastacia Giron-Tupas – Founder of PNA;
1st Filipino to hold the Chief Nurse
Superintendent position
● Cesaria Tan – 1st Filipino to receive
Masters degree in Nursing abroad
● Socorro Sirilan – Chiefnurse and
Pioneered in Hospital Social Services in
San Lazaro Hospital
● Rosa Militar – Pioneer in school health
education
● Ser Ricardo Mendoza – Pioneer in nursing
education
● Socorro Diaz – 1st editor of the PNA
magazine “the Message”
● Conchita Ruiz – 1st fulltime editor of PNA
magazine named “The Filipino Nurse”
● Loreto Tupaz – Dean of the Philippine
Nursing ; Florence Nightingale of Iloilo
PERSONAL QUALIFICATIONS OF A NURSE
PHILOSOPHY OF LIFE
● Concerned with those basic truths that
contribute to personal growth in a
systematic fashion and with those principles
that relate to the moral values that shape
the facets of the character
GOOD PERSONALITY
● Personality consists of the distinctive
individual qualities that differentiate one
person from another
● It is the impression one makes on others
which will include more than that which
meets the eye
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 ● Components:
1. Personal appearance
2. Character
3. Attitude
4. Charm
PERSONALITY CAN BE DEVELOP THROUGH:
● Warmth of manner, a ready smile, sincere
laugh, genuine interest in others
● Complete sincerity
● Sympathetic grooming
PROFESSIONAL REGISTERED NURSE EDUCATION
ASSOCIATE DEGREE PROGRAM
● 2-year program usually offered by a
university or community college
● The program focuses on the basic sciences
and theoretical and clinical courses related
to the practice of nursing
BACCALAUREATE DEGREE PROGRAM
● 4 years of study in a college or university
● It focuses on the basic sciences; theoretical
and clinical courses; and courses in the
social sciences, arts, and humanities to
support nursing theory
GRADUATE EDUCATION
● Provides the advanced clinician with strong
skills in nursing science and theory
● Emphasizes advance knowledge in the
basic sciences and research-based clinical
practice
● Master’s degree in nursing
● Doctoral degree
DOCTORAL PREPARATION
● Professional doctoral programs in nursing
(DSN or DSNc) prepare graduates to apply
research findings to clinical nursing
● Doctor of Philosophy (PhD) in Nursing is a
research and theory development
● Doctor of Nursing Practice (DNP) is a
practice-focused doctorate; terminal
practice degree and required preparation for
all APRNs
CONTINUING AND IN-SERVICE EDUCATION
CONTINUING EDUCATION
● Involves formal, organized educational
programs offered by universities, hospitals,
state nurses associations, professional
nursing organizations and educational and
health care institutions
● Updates your knowledge about the latest
research and practice developments, helps
in specializing in a particular area of
practice developments, and teaches new
skills and techniques (Hale et.al, 2010)
CONTINUING EDUCATION PROGRAMS
● Help nurses maintain current nursing skills,
gain new knowledge and theory, and obtain
new skills reflecting the changes in the
healthcare delivery system
IN-SERVICE EDUCATION PROGRAM
● Are instruction or training provided by a HC
agency or institution
● Designed to increase knowledge, skills, and
competencies of nurses and other health
care professionals employed by the
institution
● Often it focuses on new technologies
NURSING PRACTICE ACTS
● Regulate the scope of nursing practice and
protect public health, safety and welfare
LICENSURE
● Provides standardized minimum knowledge
base for nurses
● License: legal credential awarded by an
individual state that grants permission to
that individual to practice a given profession
CERTIFICATION
● Granted on completion of an education
program and the passing of a standardized
examination
● Certified or registered
CAREER DEVELOPMENT
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ADVANCED PRACTICE REGISTERED NURSE (APRN)
● Is the considered as the most independently
functioning nurse
● Has advanced education in
pathophysiology, pharmacology and
physical assessment and certification and
expertise in specialized area of practice
● CORE ROLES OF APRN;
1. Clinical Nurse Specialist - Is an
expert clinician in a specialized area
of practice. The specialty may be
identified by a population, setting,
disease specialty, type of care or
type of problem
2. Nurse Practitioner (NP) - Provides
health care to a group of patients
usually in an outpatient ambulatory
care or community-based setting.
Provides comprehensive care,
directly managing the nursing and
medical care of patients with
complex problems and a more
holistic approach than physicians
3. Certified Nurse-Midwife (CNM) -
Also educated in midwifery and is
certified. Provides independent care
for women during normal pregnancy,
labor and delivery and care of the
newborn. It also includes some
gynecological services (ex: Pap
smear, FP and treatment of minor
vaginal infections)
4. Certified Registered Nurse
Anesthetist (CRNA) - Had
advanced education from a nurse
anesthesia-accredited program.
Must have at least 1 year of critical
care or emergency experience.
Provide anesthesia under the
supervision and guidance of the
anesthesiologist (physician with
advanced knowledge of surgical
anesthesia
NURSE EDUCATOR
● Has master’s degree in nursing or earned
doctorate in nursing or related field
● Works primarily in nursing schools, staff
development departments of HC agencies
and patient education department
● Needs clinical practice in order to provide
the students with practical skills and
theoretical knowledge
● Faculty member in nursing program
educates students to become professional
nurse
● Nursing faculty member is responsible in
teaching current nursing practice; trends;
theory and necessary skills in classroom,
laboratories and clinical settings
● Primary focus of nurse educator in a patient
education: to teach and coach patients and
their families how to self-manage their
illness or disability and make positive
choices or change their behaviors to
promote health. Usually specialized or has
certification like a certified diabetes
educator (CDE) or ostomy care nurse
NURSE ADMINISTRATOR
● Manages patient care and the delivery of
specific nursing services within a health
care agency
● Has master’s degree in nursing
administration, hospital administration
(MHA), public health (MPH) or an MBA
● Functions includes:
1. Budgeting
2. Staffing
3. Strategic planning of programs and
services
4. Employee evaluation
5. Employee development
NURSE RESEARCHER
● Conducts evidenced-based practice and
research
● Works in and academic setting, hospital or
independent professional or community
service agency
● Requires a doctoral degree with at least a
master’s degree in nursing
MANAGEMENT
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 ENTREPRENEURSHIP
FIELDS OF NURSING
1. Hospital or Institutional Nursing
2. Public Health Nursing or Community Health
Nursing
3. Private Duty or Special Duty Nursing
4. Industrial or Occupational Health Nursing
5. Nursing Education
6. Military Nursing
7. School Nursing
8. Clinic Nursing
9. Independent Nursing Practice
TRENDS IN NURSING
EVIDENCE-BASED PRACTICE
● In the practice of nursing, it should be based
FACTORS AND ISSUES AFFECTING HEALTH AND
on current evidence, not just according to
your education or experiences and the
policies and procedures of health care
facilities
● The general public has knowledge on health
care needs, the cost of health care, and the
incidence of medical errors within health
care institution
QUALITY AND SAFETY EDUCATION FOR NURSES
(QSEN)
● Addresses the challenge to prepare nurses
with the competencies needed to
continuously improve the quality of care in
their environment
● Competencies of patient-centered care,
teamwork and collaboration, EBP, quality
improvement (QI), safety and informatics
IMPACT OF EMERGING TECHNOLOGIES
● This helps nurses use noninvasive, more
accurate assessment tools, implement EBP,
collect and trend patient outcome data and
use clinical decision support system
● Electronic Health Record (HER) offers
efficient method to record and manage
patient health care information
GENOMICS
● Is a newer term that describes the study of
all genes in a person and interactions of
these genes with one another and with that
person’s environment (CDC, 2015)
● Genetics is the study of inheritance, or the
way traits are passed down from one
generation to another
FUNDAMENTALS OF
NURSING PRACTICE
CONCEPT OF MAN, HEALTH AND ILLNESS
● Health is a fundamental right of every
human being. It is a state of integration of
the body and mind
ILLNESS
HEALTH
● A state of physical, mental, and social well-
being, not merely the absence of disease or
infirmity. (WHO, 1947)
● The actualization of inherent and acquired
human potential through goal-oriented
behavior, competent self-care, and
satisfying relationships with others while
adjustments are made as needed to
maintain structural integrity and harmony
with the environment (Pender, 2015)
MODELS OF HEALTH AND ILLNESS
MODEL
● Is a theoretical way of understanding a
concept or idea
● Represent different ways of approaching
complex issues
HEALTH BELIEFS
● Person’s ideas, convictions and attitudes
about health and illness
● Positive health behaviors- activities related
to maintaining, attaining or regaining good
health and preventing illness
● Negative health behaviors- practices
actually or potentially harmful to health
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 HEALTH-ILLNESS CONTINUUM (DUNN) 1. Individual characteristics and
experiences
2. Behavior specific knowledge and
affect
3. Behavioral outcomes, in which the
patient commits to or changes a
behavior

MASLOW’S HIERARCHY OF NEEDS

● Nurses use this model to understand the
interrelationships of basic human needs
● It provide basis for nurses to render care to
patients across lifespan in different settings

HEALTH BELIEF MODEL

● Developed in effort to understand why
people do not engage in certain health
behaviors
● Argues that our belief in the threat of an
illness/diseases (ex. Obesity) plus our belief
in the effectiveness in a proposed behavior
(ex. Physical activity) determines whether
we will engage in that behavior
● Had several theoretical constructs
1. Perceived susceptibility, perceived
severity, perceived benefits,
perceived barriers
2. Modifying variables, cues to action,
self efficacy (1980s)
● Addresses the relationship between a HOLISTIC HEALTH MODEL
person’s beliefs and behaviors ● Attempts to create conditions that promote a
1. 1st component: individual’s patient’s optimal level of health
perception of susceptibility to an ● Involvement of patient in their healing
illness process; assumes responsibilities on health
2. 2nd component: individual’s maintenance
perception of the seriousness of the
illness VARIABLES INFLUENCING HEALTH
3. 3rd component: likelihood that a
INTERNAL VARIABLES
person will take preventive action
● Developmental stage
HEALTH PROMOTION MODEL (PENDER) ● Intellectual background
● Health is a positive dynamic state not ● Perception of functioning
merely the absence of disease ● Emotional factors
● Designed to be a complementary ● Spiritual factors
counterpart to models of health protection
EXTERNAL VARIABLES
● Focuses on:

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● Family practices – the way the patient’s ● Any situation, habit, or other variable such
families use HC services as social, environmental, physiological,
● Psychosocial and Socioeconomic factors psychological, developmental, intellectual,
1. Socioeconomic variables or spiritual that increases the vulnerability of
2. Economic variables an individual or group to an illness or
● Cultural background- influences beliefs, accidents
values and customs ● Categories:
1. Genetic and physiological factors
HEALTH PROMOTION 2. Age
● Activities that help patients maintain or 3. Environment
enhance their present health level 4. Lifestyle
● Ex: routine exercise and good nutrition
ILLNESS
WELLNESS ● Is a state in which a person’s physical,
● Strategies that help people to achieve new emotional, intellectual, social,
understanding and control of their lives developmental, or spiritual functioning is
● Ex: health education diminished or impaired
● Acute illness: usually has a short duration,
ILLNESS PREVENTION reversible and is often severe
● Activities that motivate people to avoid a ● Chronic illness: usually longer than 6
decline in health or functional levels months, is irreversible, and affects the
functioning in one or more systems
LEVELS OF PREVENTIVE CARE
● Illness behavior:
1. Are acts exhibited by people who
PRIMARY PREVENTION
are ill
● Aimed at health promotion
2. Includes how monitoring of bodies,
● Precedes disease or any dysfunction for
define and interpret the symptoms,
patients who are considered physically and
take remedial actions and use of the
emotionally healthy
resources in the HCS
SECONDARY PREVENTION
VARIABLES INFLUENCING ILLNESS AND ILLNESS
● It focuses on people who are experiencing
BEHAVIOR
health problems or illnesses, and who are at
risk for developing complications INTERNAL VARIABLES
● The activities are directed at diagnosis and ● Patient perception of symptoms
prompt intervention, which reduces severity ● The nature of the illness
and enable patient to return to normal level
of health EXTERNAL VARIABLES
● Visibility of symptoms
TERTIARY PREVENTION ● Social group
● Involves minimizing the effect of long-term ● Cultural background
disease or disability by interventions in ● Economic variable
order to prevent complications ● Accessibility of health care system
● It occurs when a defect or disability is ● Social support
irreversible
STAGES OF ILLNESS
RISK FACTOR
SYMPTOM EXPERIENCE

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 ● Transition stage when a person believes
something is wrong and experiences some
symptoms
● Aspects: physical, cognitive, emotional
ASSUMPTION OF THE SICK ROLE
● Acceptance of the illness and seeks advice
or support to give up some activities
MEDICAL CARE CONTACT
● Confirmation of real illness, explanation of
symptoms and reassurance of outcome
DEPENDENT PATIENT ROLE
● A person becomes more passive and
accepting while becoming dependent on
health professional
RECOVERY/REHABILITATION
● Returns to former roles and function by
giving up the sick role
ECOLOGIC MODEL (LEAVELL AND CLARK’S AGENT-
HOST-ENVIRONMENT MODEL)
AGENT
● Any factor or stressor that can lead to
illness or disease
HOST
● Person who may or may not be affected by
a disease
ENVIRONMENT
● Any external factor that may or may not
predispose the person to certain disease
HEALTH CARE DELIVERY SYSTEM
● Nursing is a caring discipline
● Values of the nursing profession are rooted
in helping people to regain, maintain, or
improve health; prevent illness; and find
comfort and dignity
INSTITUTE OF MEDICINE (2011)
● Has a vision for transformed HCDS which
makes quality care accessible to all
populations, focuses on wellness and
disease prevention, improve health
outcomes, and provides compassionate
care across the life span
● Encourages a safe, effective, patient
centered, timely efficient, and equitable
health care delivery system
● Nurses faces challenges to provide
evidence-based, compassionate care and
as a patient advocate
INSTITUTE OF MEDICINE REPORT
● Practicing to the full extent of their
education and training
● Achieving higher levels of education and
training through an improved education
system that provides seamless progression
● Becoming full partners with physicians and
other health care providers in redesigning
the healthcare system
● Improving data collection and information
infrastructure for effective workforce
planning and policy making
HEALTH CARE SETTINGS AND SERVICES
LEVELS OF HEALTH CARE
● Disease prevention
● Health promotion
● Primary level
● Secondary level
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 ● Tertiary level
HEALTH CARE SETTINGS
● Preventive
● Primary
● Secondary
● Tertiary
● Restorative
● Continuing care
● Integrated Delivery Networks – has
network of facilities, providers, and services
which deliver continuum of care to a
population of patients at particular setting
PREVENTIVE AND PRIMARY HEALTH CARE (HEALTH
PROMOTION)
● Primary health care: focuses on improved
health outcomes for an entire population
● Health promotion programs: reduces
incidence of disease, minimizing
complications
● Preventive care: is more disease oriented
and focused on reducing and controlling risk
factors for disease
● Ex: primary care and health education
proper nutrition maternal/child health care,
family planning immunizations, control of
diseases
● Settings: schools, physician’s offices,
occupational health clinics, community
health centers, nursing centers
SECONDARY AND TERTIARY CARE (ACUTE CARE)
● Diagnosis and treatment of illnesses
● Disease management most common and
most expensive service of HCDS
● Chronic illness causing disability, decreased
quality of life and increased health care
costs
HOSPITALS
● Provides comprehensive and specialized
tertiary care to seriously ill patients
● Focus: quality, safe care
● Ex: hospital emergency departments,
urgent care centers, critical care units, in-
patient MS units
● Discharge planning: is a centralized,
coordinated, interdisciplinary process that
ensuring that a patient has a plan for
continuing begins the moment a patient is
admitted to a health care facility
INTENSIVE CARE
● An ICU or critical care unit provides close
monitoring and intensive medical care to
patients
● Has advanced technologies
● Medical and nursing staff have specialized
knowledge on critical care principles and
techniques
PSYCHIATRIC FACILITIES
● It cater services to patients who are
suffering from emotional and behavioral
problems
● This require special counseling and
treatment
● Offers inpatient and outpatient services,
depending on the severity of mental health
problem
● The health care team (medical, nursing,
social work and activity therapy) work
together to develop a plan of care that
enable patients to return to functional states
within the community
● Located in hospitals, independent outpatient
clinics or private mental health hospitals,
psychiatric facilities
RURAL HOSPITALS
RESTORATIVE CARE
● Provide care to patients recovering from an
acute or chronic illness or disability which
requires additional services in order to
return to previous level of function or reach
the new level of function limited by their
illness or disability
● Goal: to help individuals regain maximal
functional status and enhance quality of life
through promotion of independence and self
care
HOME CARE
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● Provides medically related professional and
paraprofessional services and equipment to
patient and families in their homes for health
maintenance, education, illness prevention,
diagnosis and treatment of disease,
palliation, and rehabilitation
● It also includes medical and social services:
physical, occupational, speech and
respiratory therapy and nutritional therapy
● Coordinates the access and delivery of
home health equipment, or medical
equipment
● Primary objective: health promotion and
education
REHABILITATION
● Restores a person to the fullest physical,
mental, social, vocational, and economic
potential
● It begins from the moment the patient enters
a health care setting for treatment
● Patients who had physical or mental illness,
injury, or chemical addiction require
rehabilitation
● Focuses on :
1. Preventing complications related to
illness or injury
2. Helps to maximize a patient’s
functioning and level of
independence
● Rehabilitation services include:
1. Physical
2. Occupational
3. Speech therapy
4. Social services
EXTENDED CARE FACILITIES
● Provides intermediate medical, nursing, or
custodial care for patients recovering from
acute illness or those with chronic illnesses
or disabilities
● It includes:
1. Intermediate care and skilled nursing
facility- caters skilled care from
licensed nursing staff
2. Long-term care and assisted-living
facilities
● Primarily, provides care for older adults
CONTINUING CARE
● Refers to a variety of health, personal, and
social services provided over a prolonged
period
● It cater services for people who are:
1. Disabled
2. Never functionally independent
3. Suffering from terminal disease
NURSING CENTERS OR fACILITIES
● It provides a 24-hour intermediate and
custodial care like nursing, rehabilitation,
dietary, recreational, social and religious
services
● It includes:
1. Nursing centers or facilities
2. Assisted living
● Interdisciplinary functional assessment of
residents is the cornerstone of clinical
practice within nursing centers
ASSISTED LIVING
● Offers an attractive long-term care setting
with an environment more like home and
greater resident autonomy
● Promote physical and psychosocial health
● Activities include:
1. Assistance in the ADL
2. Medication administration (for some
assisted living facilities)
RESPITE CARE
● Provides short-term relief or “time-off” for
people providing home care to individual
who is ill, disabled, or frail
● It can be offered in the home, a day care
setting, or a health care institution that
provides overnight care
ADULT DAY CARE CENTERS
● Provide a variety of health and social
services to specific patient populations who
live alone or with family in the community
● It is associated with a hospital or nursing
home or independent centers
HOSPICE
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 ● A system of family- centered care that
allows patients to live with comfort,
independence, and dignity while easing the
pains of terminal illness
● Focus:
1. Is palliative care
ISSUES AND CHANGES IN HEALTH CARE DELIVERY
● Nursing shortage
● Competency
1. Emphasize the importance public
service, caring for the health of
communities, and developing
ethically responsible behaviors
2. IOM Competencies for the 21st
century
3. Provide patient-centered care
4. Work in interdisciplinary team
5. Use evidence-based practice
6. Apply quality improvement
7. Use informatics
QUALITY AND SAFETY IN HEALTH CARE DELIVERY
● Is the degree to which health services for
individuals and populations increase the
likelihood of desired health outcomes and
are consistent with current professional
knowledge
● Globalization in Health Care
● Nursing informatics and Technological
Advancements
1. Nursing informatics: uses
information and technology to
communicate, manage knowledge,
and mitigate error. And support
decision-making
2. Ex: Telemedicine, telehealth
THE FUTURE OF HEALTHCARE
● Change is often threatening, but it also
opens up opportunities for improvement.
The ultimate issue is designing and
delivering health care in ensuring the health
and welfare of the population
NURSING AS AN ART
CARING
● A universal phenomenon influencing the
ways in which people think, feel and behave
in relation to one another
● Personal concern for another person, an
event, or a thing provides motivation and
direction for people to care
● People, events, projects, and things matter
to people (Benner et.al. 2010)
● A word for being connected
● Facilitates a nurse’s ability to know a
patient, allowing the nurse to recognize a
patient’s problems and find and implement
individualized solutions on the basis of the
patient’s unique needs
● If patient sense that HC providers are
sensitive, sympathetic, compassionate, and
interested in them as people, they usually
become active partners in the plan of care
CARING IN NURSING PRACTICE
PROVIDING PRESENCE
● Person-to-person encounter conveying a
closeness and sense of caring
● Presence involves “being there” and “being
with”
● Presence is an interpersonal process
characterized by sensitivity, wholism,
intimacy, vulnerability, and adaptation to
unique circumstances
● Nursing presence is the connectedness
between the nurse and the patient
COMFORTING
● The use of touch is relational and leads to a
connection between nurse and patient
● It is a comforting approach that reaches out
to patients to communicate concern and
support
1. Contact touch
2. Non Contact touch
● Caring touch is a form of nonverbal
communication which influences a patient’s
comfort and security, enhances self-esteem,
increases confidence and improves mental
well-being (like holding patient’s hand, back
massage)
LISTENING
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● Is a planned and deliberate act in which the
listener is present and engages the patient
in a nonjudgmental and accepting manner
● Needs silence and listen with openness
● Involves paying attention to the individual’s
words, and tone of voice and entering
his/her frame of reference; observe
expressions and body language
KNOWING THE PATIENT
● Is a complex process with a temporal nature
that occurs within the context of the nurse-
patient relationship
● Comprises both as nurse’s understanding of
a specific patient and his/her subsequent
selection of interventions (Swanson, 1991)
● Elements that facilitates knowing:
1. Continuity of care
2. Clinical expertise
● Factors that contribute to knowing the
patient:
1. Time
2. Continuity of care
3. Teamwork of nursing staff
4. Trust
5. Experience
● Barriers to knowing the patient:
1. Organizational structure of the
organization
2. Economic constraints
SPIRITUAL CARE
● Offers a sense of interconnectedness
● Include nurses who are able to identify
methods to incorporate the spiritual caring
practices into routine care and do not
perceive variables e.g. (lack of sufficient
time, patient census)
● Spirituality offers a sense of connectedness:
1. Intrapersonally (connected with
oneself)
2. Interpersonally (connected with
others and the environment)
3. Transpersonally (connected with
the unseen, God, or a higher power)
RELIEVING SYMPTOMS AND SUFFERING
● Involves caring nursing actions that gives
patient comfort, dignity, respect, and peace
and provide necessary comfort and support
to the family or significant others
● Through skillful and accurate assessment of
patient’s condition, (like pain) the nurse can
design a patient-centered care to improve
the level of comfort
● Human suffering is multifaceted, affecting a
patient physically, emotionally, socially, and
spiritually
FAMILY CARE
● Nurse caring behaviors as perceived by
families
1. Provide honest, clear, and accurate
information
2. Listening to patient and family
concerns, complaints, fears
3. Advocating for patient’s care
preferences and end-of-life
decisions
4. Asking permission before doing
something to the patient
5. Providing comfort
6. Reading patient passages from
religious texts, favorite books, cards
or mail
7. Providing for and maintaining patient
privacy
8. Informing the patient about the types
of nursing services and the people
who may enter the personal acre
area
9. Assuring the patient that nursing
services will be available
10. Teaching the family how to keep the
relative physically comfortable
THEORETICAL VIEWS ON CARING
(CARING PRACTICE MODELS)
LEININGER’S TRANSCULTURAL CARING
● Madeleine Leininger (1991) describes care
as essence and central, unifying and
dominant domain that distinguishes nursing
from other health disciplines
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● Care is an essential human need,
necessary for the health and survival of all
individuals
● Stresses how important it is for nurses to
understand cultural caring behaviors
● Caring includes knowing a patient’s cultural
values and beliefs
● “Transcultural nursing”
WATSON’S TRANSPERSONAL CARING
● Caring is a central focus of nursing and it is
integral to maintain the ethical and
philosophical roots of the profession
● Suggest that a conscious intention to care
promotes healing and wholeness
● 10 Carative factors:
1. Forming a human-altruistic value
system
2. Instilling faith-hope
3. Cultivating a sensitivity to one’s self
and to others
4. Developing a helping, trusting,
human caring relationship
5. Promoting and expressing positive
and negative feelings
6. Using creative problem-solving,
caring processes
7. Promoting transpersonal teaching-
learning
8. Providing for a supportive,
protective, and/or corrective mental,
physical, societal, and spiritual
environment
9. Meeting human needs
10. Allowing for existential-
phenomenological-spiritual forces
SWANSON’S THEORY OF CARING
● Caring is nurturing way of relating to an
individual (when one feels commitment and
responsibility)
● The theory provides direction for how to
develop useful and effective caring
strategies appropriate for multiple age-
group and health care settings
● Objective: deliver care that promotes
dignity, respect and empowerment
● Components of caring:
1. Knowing
2. Being with
3. Doing for
4. Enabling
5. Maintaining belief
CHALLENGE OF CARING
● Today’s health care system presents many
challenges for the nurse to provide a caring
patient-centered plan of care. Nurses are
often torn between the human caring model
and the task-oriented biomedical model and
institutional demands that consume their
practice.
● As a nursing student, share your view
regarding this approaches in the care of a
patient with end-stage renal disease
THE 6 C’S
● Care, Compassion, Competence,
Communication, Courage and Commitment
1. Care: Helping people to stay
independent, maximize wellbeing
and improving health outcomes
2. Compassion: Working with people
to provide a positive experience of
care.
3. Competence: Delivering high quality
care and measuring the impact
4. Communication: Building and
strengthening leadership
5. Courage: Ensuring we have the
right staff, with the right skills in the
right place
6. Commitment: Supporting positive
staff experience
CARING FOR SELF AND OTHERS
● Family: biologically, legally, or as a social
network with personally constructed ties and
ideologies
● Includes people related by marriage, birth,
or adoption
● The family is the central institution in society
● It faces many challenges which includes
health and illness, childbearing and
childrearing, changes in family structure and
dynamics, and caring for older parents.
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● Attributes or characteristics of a family:
1. Durability: system of support and
structure within a family that extends
beyond the walls of the household
2. Resiliency: ability of a family to
cope with expected and unexpected
stressors
3. Diversity: the uniqueness of each
family unit
● Effective interprofessional communication is
important to provide safe transitions in care
● Team communication and collaboration
skills are necessary to ensure safe patient
care
● Therapeutic communication occurs within a
healing relationship between a nurse and
patient
COMMUNICATION AND INTERPERSONAL
RELATIONSHIPS
● Caring relationships formed among a nurse
and those affected by the nurse’s practice
are at the core of nursing
● Caring through communication can be
expressed by:

● Family dynamics:
1. Family make-up (configuration)
2. Structure
3. Function
4. Problem-solving
5. Coping capacity
● Goal of family-centered nursing care: to
address the comprehensive health care
needs of the family as a unit; and to
advocate, promote, support, and provide for
the well-being and health of the patient and
individual family members ● Referent: motivates a person to
● Threats or concerns facing families: communicate with another
1. Changing economic status ● Sender: the person who encodes and
2. Homelessness delivers the message
3. Domestic violence ● Receiver: the person who receives and
4. The presence of acute or chronic decodes the message
illnesses or trauma ● Message: is the content of the
5. End-of-life care communication which includes verbal or
nonverbal expressions of thoughts and
COMMUNICATION feelings
● Is a powerful therapeutic tool and an ● Channels: are means of sending and
essential nursing skill that influences others receiving messages through visual,
and achieves positive health outcomes. auditory, and tactile senses.
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● Feedback: is the message a receiver INTRAPERSONAL COMMUNICATION
receives from the sender which indicate if ● also called as ‘self-talk’
the receiver understood the meaning of the ● It is used to develop self-awareness and a
sender’s message positive self-esteem that enhances
● Interpersonal variables: factors within both appropriate self-expression
the sender and receiver that influence ● Ex
communication
: transforming statement: “I’m scared to work with thi
● Environment: the setting for sender-
receiver interaction

FORMS OF COMMUNICATION INTERPERSONAL COMMUNICATION

● Is one-on-one interaction between a nurse
VERBAL COMMUNICATION and another person that often occurs face to
● Vocabulary – communication is effective if face
the receiver and sender translate one ● Results in an exchange of ideas, problem
another’s words and phrases solving, expression of feelings, decision
● Denotative and Connotative Meaning – making, goal accomplishment, team
1. Denotative: individuals who use a building and personal growth
common language ● Ex: Use interaction to assess understanding
2. Connotative: is the shade or and clarify misinterpretation when teaching
interpretation of the meaning of the a patient about a health concern
word influenced by the thoughts,
feelings, or ideas that people have SMALL-GROUP COMMUNICATION
about the word ● Is the interaction that occurs when a small
● Pacing – appropriate speed or pace by number of people meet
speaking slowly and clearly d. Intonation – ● Usually goal directed which requires an
tone of voice understanding of group dynamics and
● Clarity and Brevity – effective feedback from participants
communication is simple, brief and direct ● Should be organized, concise and complete
● Timing and Relevance
PUBLIC COMMUNICATION
NONVERBAL COMMUNICATION ● An interaction with an audience to increase
● Includes the five senses and does not their knowledge about health-related topics,
involve the spoken or written word health issues and other issues important to
● Personal appearance the nursing profession
● Posture and gait ● It requires special adaptations in eye
● Facial expression contact, gestures, voice inflection, and use
● Eye contact of media materials to communicate
● Gestures messages effectively
● Sounds
● Territoriality and Personal Space ELECTRONIC COMMUNICATION
● Use of technology to create ongoing
METACOMMUNICATION relationships with patients and their HC
● Refers to all factors that influence team
communication
PROFESSIONAL NURSING RELATIONSHIPS
LEVELS OF COMMUNICATION
PHASES OF THE HELPING RELATIONSHIPS

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● Pre Interaction phase: Before meeting a
patient
● Orientation phase: When the nurse and
patient meet and get to know one another
● Working phase: When the nurse and
patient work together to solve problems and
accomplish goals
● Termination phase: During the ending of
the relationship
COMMUNICATION AND THE NURSING PROCESS
ASSESSMENT
● Through the Patient’s eyes: Assess
patient's values, preferences, and cultural,
ethnic, and social backgrounds
● Physical and Emotional factors
● Developmental factors
● Sociocultural factors
● Gender
NURSING DIAGNOSIS
● Impaired Verbal Communication – Used
to describe a patient with limited or no ability
to communicate verbally. A state in which
an individual experiences a decreased,
delayed or absent ability to receive,
process, transmit and use symbols for a
variety of reasons
● Defining characteristics:
1. Inability to articulate words,
inappropriate verbalization, difficulty
forming words, and difficulty
comprehending
2. Anxiety, social isolation, ineffective
coping, compromised family coping,
powerlessness, impaired social
interaction
PLANNING
● Goals and Outcomes:
1. Goal: At the end of 8 hours of
nursing intervention, the patient will
be able to; Express needs and
achieve understanding of physical
condition
2. Outcomes: Patient initiates
conversation about diagnosis or
health care problem. Patient is able
to attend to appropriate stimuli.
Patient conveys clear and
understandable messages with the
health care team. Patient expresses
increased satisfaction with the
communication process
IMPLEMENTATION
● Use communication techniques
● Therapeutic communication techniques (are
specific responses that encourage the
expression of feelings and ideas and
convey acceptance and respect
● Active listening (being attentive wo what a
patient is saying both verbally and
nonverbally) S-sit facing the patient O-
Open position
● Sharing empathy (ability to understand and
accept another person’s reality, accurately
perceive feelings and communicate the
understanding to the other
● Sharing hope
● Sharing humor
● Sharing feelings
● Using touch
● Using silence
● Providing information
● Clarifying
● Focusing
● Paraphrasing
● Validation
● Asking relevant questions
● Summarizing
● Self-disclosure
● Confrontation
● Non-therapeutic communication: Asking
personal questions Giving personal options
Changing the subject Automatic responses
False reassurance Sympathy Asking for
explanations Approval or disapproval
Defensive and aggressive responses
EVALUATION
● Evaluate the effectiveness of your own
communication by conducting practice
sessions with peers or by making process
recording with patients
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● Ex: ● Disease prevention
1. Determine whether you encouraged ● Health restoration and maintenance
openness and allowed the patient to ● Rehabilitation
“tell his story’ expressing both
thoughts and feelings
2. Identify any missed verbal or
nonverbal cues
3. Determine whether nursing
responses were positive and
supportive

RELATED FACTORS
● Altered perceptions
● Biochemical alterations in the brain of
certain neurotransmitters
● Brain injury or tumor
● Cultural difference (e.g., speaks a different
language)
● Dyspnea
● Fatigue
● Psychological barriers (lack of stimuli)
● Sensory challenge involving hearing or
vision
● Side effects of medication
● Structural problem (e.g., cleft palate,
laryngectomy, tracheostomy, intubation,
wired jaws)

DEFINING CHARACTERISTICS
● Difficulty vocalizing words
● Difficulty discerning and maintaining the
usual communication pattern
● Disturbances in cognitive associations (e.g.,
perseveration, derailment, poverty of
speech, illogicality, neologism, and thought
blocking)
● Inability to find, recognize, or understand
words
● Inability to recall familiar words, phrases, or
names of known people, objects, and
places
● Inappropriate verbalization
● Problems in receiving the type of sensory
input being sent or sending the type of input
necessary for understanding

TEACHING
● Health promotion
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