NCM 103

Nursing as a Profession and Art

Communication and Nursing Practice
Basic Infection Control

__________
Margarita Salvador MAN RN
TRINITY UNIVERSITY OF ASIA
ST LUKE’S COLLEGE OF NURSING
 Learning Outcome
• 1. Discuss the historical development of
professional nursing roles.
• 2. Relate the global with the local history of
nursing and appreciate the progress of
TUA-SLCN as one of the pioneers in nursing in
the country.
• 3. Appreciate the role of nurses in the diverse
cultures in changing times.
1. NURSING AS A PROFESSION
 Introduction
✓Profession - a career requiring advanced
training involving mental rather than manual
work ex. teaching, engineering, especially
medicine and law.

✓So, nursing is a profession because it is based

on knowledge and training
 World Health Organization “WHO”

✓Nursing consists of autonomous and

collaborative care of individuals of all ages,
families, groups and communities, sick or
well and in all settings.
✓Includes promotion of health, prevention of
illness, and the care of ill, disabled and dying
people.
 Definition of Nursing
Protection, promotion, 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 of
individuals, families, communities, and
population. ANA (2010)
 Definition of Nurse

Nurse can be (male or female) who has

completed a program of basic nursing education
and authorized by appropriate authority to
practice nursing.
 Characteristics of Nursing
✓Involves close personal contact with the
recipient of care.
✓Committed to promoting individual, family,
community, and national health goals in its
best manner possible.
✓Is caring.
✓Committed to personalized services for all
persons without regard to color, creed, social
or economic status.
 Definition of Professional Nurse
A health worker identified by law as a
registered nurse whether graduated from
bachelor or diploma degree, and does not
include the assistant nurse.

Not just a collection of skills

RESPONSIBILITY AND ACCOUNTABILITY

Meet health promotion, illness

prevention and complex care needs
Characteristics of good professional nurse
✓Up to date knowledge
✓Clean, tidy and well groomed
✓Mature physically, emotionally and
intellectually
✓Self confidence
✓Punctual
✓Form a data base on information collected
about the client
 Characteristics of good professional nurse

✓ Have communication skills

✓Honest
✓Have the ability to teach
✓Have critical thinking skills
✓Form a data base on information collected
about the client
Science and Art of Nursing Practice
 Scope and Standard of Practice
✓Standard of Practice

✓Standards of Professional Performance

✓Code of Ethics
Standard of Practice
Standards of Professional Performance
 Code of Ethics
ANA Code of Ethics for Nurses

✓Establishes the ethical

standard for the profession.
✓Advocates for the protection of human rights
and social justice.
Historical Influences
 History of NURSING
Ancient History
During this time beliefs about the cause of
disease was embedded in superstition and
magic. Treatment often involved magical cues.
 Contributions of the Greeks
Hippocrates – the father of Medicine
✓ Made a major advance in
medicine by rejecting the belief
that diseases had supernatural
causes.
✓ Credited with developing
assessment standards for
clients, establishing overall
medical standards, and
recognizing a need for nurses.
 Early Christian Era
✓ Religion has a great role in the development of
nursing during this time.
✓ Many of the world’s religion encourage benevolence
“Love thy neighbor as thyself”.

✓ Deacons and Deaconess - designated to perform

services for the sick.
✓ Phoebe – most noted deaconess in nursing history.
✓ Fabiola – established the first general hospital in
Rome about 380 AD.
 The Middle Ages

✓Poverty was a critical problem.

✓Society faced epidemics of
leprosy, typhus and bubonic
plague.
✓Crusaders resulted in the
establishment of military
nursing and the recruitment of
men into nursing.
 The Renaissance

✓ Revival of learning spurred the advance of

Medicine
✓ Revival contributed to recognition of the need
for sound education preparation in nursing
and to the profession’s further advancement.
✓ Lack of effective sanitation and increasing
poverty resulted in serious healthcare
problems, further delayed the move towards
improving the nursing education.
 The Reformation
✓Dispersion of religious orders had been the
primary source of healthcare, resulted in a
serious deterioration in hospital conditions
and nursing care.
✓Women viewed as subordinate to men,
expected to remain at home caring for
children; this decreased the number of
women practicing nursing.
 Historical Perspectives in Nursing
Role of Women
• Care and nurturing role
• Cared for infants and children
• Roots in the home
• Subservient and dependent role (woman)
• Role has always been humanistic caring,
nurturing, comforting ad supporting
 Religion
• Christian value
• Love thy neighbor as thyself
• Christ parable of Good Samaritan
• Wealthy matrons (Fabiola)
• Converted to Christianity and used their
wealth to provide houses of care and
healing for the poor, the sick and the
homeless.
 The Crusades
• Form several orders of knights
• Provided nursing care t o their sick and
injured comrades
• Also built hospitals
• Knight s of Saint Lazarus
• Dedicated themselves to the care of people
with leprosy, syphilis and chronic skin
conditions.
CRIMEAN War (1854)
• Inadequacy of care given to soldiers that led
to public outcry in Great Britain.
• Florence Nightingale (role was well-known).
• Asked by Sir Sidney Herbert of the British War
Department to recruit a contingent of female
nurses to provide care to the sick and injured
in the Crimea.
• American Civil War (1861-1865)
Harriet Tubman - Moses of Her People
Nursed the sick and suffering of her own race
• Sojourner Truth
• Women’s right advocate
WAR (Cont.)
• World War II
• Acute shortage of caregivers
• Cadet Nurse Corps was established (1943)
• To address the shortage
• Practical nurses, aides and technicians under
the supervision of better prepared nurses
• Vietnam war - 90% of the 11,000 American
military women were NURSES
 Societal Attitudes
Before Mid-1800s
• Nursing was without organization, education or social status
• Prevailing attitude
• Women’s place at home; no respectable woman should have a career
• Role: WIFE AND MOTHER
Latter part of the 19th century
-Nightingale
• Brought respect
• Noble, compassionate, moral, religious, dedicated and self-sacrificing
Early 19th century
• Doctor ’s handmaiden image
• Medicine was viewed as a male domain (paternalistic)
• Past decades, nursing profession has taken steps to improve its image
• ANA and INC
 Visionary Nursing Leaders
NURSING LEADERS CONTRIBUTIONS
Florence Nightingale (1820- 1910) Lady with the lamp (Crimean War); standards of
care

Clara Barton (1812 - 912) American Red Cross (linked with IRC)

Linda Richards (1841 - 1930) US 1st trained nurse; nurse’s notes and doctor’s
orders; practice of wearing uniforms

Mary Mahoney (1845 - 1926) 1st African-American professional Nurse (equality)

Lilian Wald (1867 - 1940) Founder of Public Health Nursing (N. Y. slums)

Lavinia Dock (1858 - 1956) Campaigned for legislation; allowing nurses rather
than physician to control their profession

Margaret Sanger (1879 - 1966) Public Health Nurse in NY Planned Parenthood

 Historical Perspective
A. 1860 to 1959
1. 1860 - Environment theory, F. Nightingale
2. 1952- Journal Nursing Research
3. H. Peplau - Interpersonal
4. 1955 - V. Henderson, definition
of nursing
5. 1950 - master’s and doctoral,
opened in New York
B. 1960 to 1969
1. 1960, Faye Abdellah, 21 Nursing Problems
2. 1961, Ida Orlando, The Dynamic Nurse Patient
Relationship
3. 1962, Lydia Hall Core, Care, and Cure model
4. 1964, Emestine Wiedenbach, Clinical Nursing A
Helping Art
5. 1965, ANA, theory development important goal for
nursing.
6. 1966, Myra Levine , 4 conservation principles
7. 1969, Dorothy Johnson, Behavioral Systems Models
C. 1970 to 1979
1. 1970, Martha Rogers, An Introduction to
Theoretical Basis of Nursing
2. 1971, Dorethea Orem, Self Care Deficit
Imogene King, J Travelbee
3. 1972, B. Neuman, Health Care Systems
Model
4. 1976, Sr C. Roy , adaptation Theory
J.G Patterson & L.T. Zderad
5. 1978, M Leninger , Transcultural Nursing
6. 1979, J. Watson, Human Services and
Human Care
D. 1980 to present
1. 1982,J Fitzpatrick, Life Perspective
Model
2. 1983, K Barnard, Parent-Child
Interaction Model
3. 1984, P. Benner, Novice to Expert
4. 1985, R. Mercer Maternal Role
Attainment
5. 1986, Margarett Newman, Model of
Health
6. 1990, Kolcaba, Theory of Comfort
7. 1994, M. Rogers , Occupational
Health Nursing Model
8. 1997, Barbara Artinian & Margaret
Conger, Intersystem Model
 Nursing in the 18th Century
✓Revolutions and epidemics resulted in the
expansion of nursing roles.
✓Continuing problems related to healthcare
needs (poor sanitation and low standards of
living).
✓By the end of the century, nursing was present
in hospitals but working conditions were poor,
resulting in a loss of social status for members
of the profession.
 Nursing in the 19th Century
✓ The Industrial Revolution initiated political,
economic, and social expansion throughout North
America and Europe.
✓ Poverty, long work days for men, prevalence of
disease increased the need for nurses to addressed
community health problems.
✓ Religion once again was influential; the caring image
of the nurse was believed to be based on Spiritual
calling to the profession.
 Florence Nightingale
Founder of Modern Nursing
 Florence Nightingale
✓ Founder of Modern Nursing - born May 12, 1820 in
Florence, Italy
✓ Educated in languages, philosophy and liberal arts.
✓ Her hope was to replace “Sarah Gamp” image with
one of education, intelligence and kindness.
✓ Improved health laws, reformed hospitals,
reorganized military medical services.
✓ Nightingale viewed “Sick Nursing”- as helping clients
use their own reparative process to get well and
“Health Nursing” – as preventing illness.
 Florence Nightingale
• “Trained” for 3 mos. in Kaiserswerth, Germany
• Studied in Paris Sisters of Charity for further nursing
training.
• Then returned to England and became the nurse
superintendent at King’s College Hospital.
• During the British war - she took cared of the injured
and sick soldiers. Her efforts were credited with
decreasing the mortality rate by half, and soon
became known as the “Lady with the Lamp”.
 Nursing During the American Civil War

• More hospitals and better prepared nurses

were needed.
• Dorothea Dix - established the Nurse Corps of
the US Army.
Clara Barton – Founder of the American Red
Cross.
 Nursing Education in the 19th Century

• 1869 – the American Medical Association

developed the Committee on the Training of
Nurses; as a result of this committee’s
recommendations, hospital based School of
Nursing under medical supervision emerged.
• Lillian Wald (1867-1940) - founder of the
Henry Street Settlement and Visiting
Nurses Service (circa 1893), provided
nursing and social services and organized
educational and cultural activities.
Considered the founder of public health
nursing.
• Lillian Wald and Mary Brewster -
established the first public Health Nursing
service for the sick and the poor.
 Lillian Wald
Founder of Public Health Nursing
 Nursing in the 20th Century

• Spanish American War

- Volunteer Nurse Corps( 1898)
• Nurses were transported to war areas in Europe and
the Far East to care for the sick and wounded.
• Esther Lucille Brown - wrote that nursing education
belonged in colleges and universities and the need
for university based education programs.

**Black Nurses were admitted to the nursing Service.

 National Commission on Nursing and
Nursing Education
• Addressed several issues including supply
and demand for nurses, clarification of
nursing roles and functions, nursing
education, and available career
opportunities.
• The report was called “Lysaught report, it
helped clarify the role of professional
nursing practice.
 Professional Development
• Curriculum era
• Research emphasis era
• Graduate education era
• Theory era
• Pre paradigm to paradigm - metaparadigm
 Professional Development in the
20th Century
Professional organizations were created:
• American Nurses Association(ANA)
• National League of Nursing (NLN)
• American Association of Colleges of Nursing
(AACN)
• American Journal of Nursing (AJN)
 Evolution of Nursing Education
1. Practical/Vocational Nursing Programs
- 1 year program that prepares nurses to
perform technical skills under the provision of
registered nurses.

Differs than RN in two areas:

a. Educational preparation
b. Scope of practice
2. Diploma Nursing Program
• Used to be hospital sponsored, once the
primary source of nurses.
• First type of educational preparation for
RNs, usually require 3 years of study.
• Can work as beginning practitioner in
acute, intermediate, long term, and
ambulatory care.
• Must demonstrate competency in the
Nursing process.
3. Associate Degree Nursing Program
• Initially developed in response to nursing
shortage.
• Students pursuing this degree attend junior
college for 2 years, receiving college credit for
all courses and clinical experience.
• Goal of the program is to prepare technical
nurses-who are capable of functioning as
quality practitioners under the supervision of
professional nurses.
4. Baccalaureate Degree Nursing Program
• Offers students full college or university
education with background on liberal arts.
• Programs provide students with credits for
nursing courses and clinical experience in all
areas of nursing practice.
• Emphasizes community, health, leadership,
and management.
 Advance Nursing Education Opportunities

Master’s Degree Nursing Program

- Graduate education prepares nurses for advanced,
independent practice with continued emphasis on
research.
Doctoral Degree Program
- Must have finished their master’s Degree.
- Advanced preparation for clinical research is a
major component.
- Doctoral Degree Program
Professional Responsibilities and Role
• Autonomy and accountability
• Caregiver
• Advocate
• Educator
• Communicator
• Manager
 Career Development
• Provider of care
• Advance Practice Registered Nurses
– Clinical nurse specialist
– Nurse practitioner
– Certified nurse-midwife
– Certified registered nurse anesthetist
• Nurse Educator
• Nurse Administrator
• Nurse Researcher
 Roles of the Professional Nurse
a. Care Provider
The nurse supports the clients by attitudes and
actions that show concern for client welfare and
acceptance of the client as a person.
b. Communication/Helper
The nurse communicates with clients, supports
persons and colleagues to facilitate all nursing
actions.
c. Teacher
Nurse provides health teaching to effect behavior
change, which focus on acquiring new knowledge or
technical skills. Role gives emphasis on health
promotion and health maintenance.

d. Counselor
Nurse helps the client to recognize and cope with
stressful psychologic or social problems to develop
improved personal relationships and to promote
personal growth. Role includes providing emotional,
intellectual and psychologic support.
e. Client Advocate
Nurse promotes what is best for the client, ensures
that the client’s needs are met, and protects the
client’s rights.

f. Leader
Nurse through the process of interpersonal
influence, helps the client make decisions in
establishing and achieving goals to improve his well
being.
g. Change Agent

Nurse initiates changes and assists the client

make modifications in the lifestyle to promote
health.
h. Manager
plans, give directions, develops staff,
monitors operations, gives rewards fairly, and
represents both staff members and
administration as needed.
i. Researcher
participates in scientific investigation and
uses research findings in practice.
General Classification of 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
 Overview
Professional nursing practice - commitment to
compassion, caring and strong ethical values;
continuous development of self and others;
accountability and responsibility for
insightful practice; demonstrating a
spirit of collaboration and flexibility

Professional Practice in Nursing: A Framework ::

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 Definition of 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 of individuals,
families, communities, and populations.
ANA (2010)
A Model of Professional Nursing Practice
 History of TCQC-SLCN
1903 - St. Luke’s hospital opened its doors for
service as a small dispensary.

1907 - The school of Nursing opened at the same time

St. Luke’s Hospital known then as University Hospital.

The first 3 Students of St. Luke’s were:

1. Quintana Beley
2. Veneranda Sulit
3. Candida Goco
1st Graduates
Nurses Dormitory at Calle Magdalena Tondo
St. Luke’s Hospital formerly named University Hospital
✓ October 1911 - ELLEN T. HICKS - The
Superintendent of nurses when the school of
nursing opened.

✓ 1911 - the first graduates of the St. Luke’s Hospital

School of Nursing had their commencement
exercises in the Columbia Club in Ermita

✓ The first graduates were sent to the United States

and took a post graduate course in the Protestant
Episcopal Hospital in Philadelphia, Pennsylvania.
This was made possible by their benefactor Mrs.
Elizabeth Whitelaw Reid.
• June 1912 – The three graduates returned to the
Philippines armed with the degree that they have
earned. And they were assigned as members of
the school faculty.
Degrees Earned:
• 1. Quintana Beley - General care of medical cases
• 2. Veneranda Sulit - OR and Surgical technique
• 3. Candida Goco - Children’s Disease

• September 1917- Miss Hicks left for the US. There

were 22 student nurses and 5 Filipina head nurses
at St. Luke’s Hospital.
 Deaconess Charlotte Massey
• Took charge as school superintendent in
1918- 1921.
• Through her effort one of the graduates
was sent to America to take her post
graduate course in dietetics.
• She was sponsored by the scholarship of
the Daughters of the American Revolution
in 1921. And was sent to St. Luke’s Hospital
in San Francisco.
 FELIZA DAVIS
• Was assigned as superintendent when
Deaconess Massey was assigned to a
mission in the mountain province.
• But due to ill health she stayed at St. Luke’s
Hospital for a brief time only.
 LILIAN J. WEISER
• Superintendent of nurses in the early part
of 1923
• Always concerned with nurses welfare and
raising the standards of instruction
• Training was shortened to 3 years
 VITALIANA G. BELTRAN

• 1926, was given a full time teaching job and

was later assigned to assist in the
management of the school of Nursing which
position she held until 1941.
• Later appointed superintendent of nurses
when Mrs. Weiser resigned.
 World War II
• Accommodated hundreds of sick American,
British Interns who were allowed to leave the
concentration camp.
• Doctors and nurses stayed to render services
to the sick, including Filipino and Chinese
patients.
• After the Liberation, The school of Nursing
faculty focused attention to the improvement
of the school facilities and the standard of
instruction.
Japanese Occupation
 MARY VITA BELTRAN

• Given a scholarship grand in 1946 by the

women's auxiliary of New York and Pittsburg.
• Obtained an M.A Degree at Teachers’ College
Columbia University.
• Appointed Principal of the School of Nursing.
Important Dates in the History of St.
Luke’s Hospital School of Nursing
1911 - Graduated its 1st batch of nurses
1941 - (December) World War II broke out and
schools were closed.
1943 - Schools were resumed after the Japanese
doctors and nurses took over.
1907 - St. Luke’s Hospital then called University
Hospital opened training school for nurses.
1945 - Japanese team left the country, Filipino
staff continue the work.
1946 - Graduation of the post War class
1954 - Incorporation of the St. Luke’s Hospital
School of Nursing. It began to have a
separate Board of trustees and operated
its own budget.
During this year when Mrs. Ester A. Santos -
Principal of the School at that time, proposed that
the school look into the possibility of offering a BSN
Program for its nurses.
• 1956 BSN proposal was shelved by the
Board of Trustees because of
requirements for a collegiate
program.
• 1963 Purchase of Capitol City College
by the Episcopal Church thru
Prime Bishop Ret. Rev. Lyman C.
Ogilby. It was renamed Trinity
College of Quezon City
• 1965 The 1st class was admitted to take
courses under the BSN program of
TCQC SLCN.
• 1970 The 1st BSN class who graduated
under a 5 year curriculum.
• 1975 School granted special permission
to offer a 2 year program.
Graduated later on took a 3 year
Diploma Program. Took licensure
examination and became
Registered Nurses.
• 1975 Accredited by the Philippine
Accrediting Association for Schools,
Colleges, and Universities.(PAASCU)
• 1984 New Curriculum with RLE
implemented
• 1988 1st graduates of the New BSN
curriculum with RLE.
History of Nursing in the Philippines
• Earliest Hospitals in the Philippines
1. Hospital Real De Manila ( 1577 )
2. San Lazaro Hospital ( 1578 )
3. Hospital de Indios (1586 )
4. Hospital de Aguas Santas ( 1590 )
5. San Juan de Dios Hospital ( 1596 )
1st Hospitals with School of Nursing
1. Iloilo School of Nursing ( 1906 )
2. St. Paul’s Hospital School of Nursing ( 1907 )
3. Philippine General Hospital School of
Nursing ( 1907 )
4. St. Luke’s Hospital School of Nursing ( 1907 )
5. Mary Johnston Hospital and School of
Nursing ( 1907 )
2. NURSING AS AN ART
 Caring in Nursing Practice

✓Caring is central to nursing practice.

✓Caring is the heart of a nurse’s ability to
work with people in a respectful and
therapeutic way.

When rendering care, technology is being

used to diagnose and treat patients.
AONE Guiding Principles for
Future Care Delivery
 Theoretical Views on Caring

✓A universal phenomenon that influences the

way we think, feel, and behave.
✓Florence Nightingale studied caring.
✓In the 1980s, Patricia Benner with Judith
Wrubel offered another definition of
caring.
 The Essence of Nursing and Health

Madeleine Leininger - studied caring

from a transcultural perspective.
✓Caring is an essential human need.
✓Caring helps an individual or group improve a
human condition.
✓Caring helps to protect, develop, nurture, and
sustain people.
 Cultural Aspects of Care

Implications for nursing practice:

• Know the patient’s cultural norms for caring
practices.
• Know the patient’s cultural practices
regarding end-of-life care.
 Cultural Aspects of Care (cont’d)
Implications for nursing practice:
• Determine whether a member of the patient’s
family or cultural group is the best resource to
use for caring practices such as providing
presence or touching.

• Know the patient’s cultural practices regarding

removal of life support.
 Transpersonal Caring Jean Watson’s
Theory of Caring (1988, 1979)

• Promotes healing and wholeness

• Rejects the disease orientation to health care
• Places care before cure
• Emphasizes the nurse-patient relationship
Jean Watson’s Theory of Caring
 Swanson’s Theory of Caring

Kristen Swanson (1991)

• Caring as a nurturing way of relating to a
valued other, toward whom one feels a
personal sense of commitment and
responsibility.
 Patient’s Perspective of Caring
Patients value the affective
dimension of nursing care.
✓Reassuring presence
✓Recognizing an individual as
unique
✓Keeping a close and
attentive eye on the
situation
 Ethics of Care
✓Concerned with the relationship between the
patient and the nurse and the attitude of each
toward the other
✓Places the nurse as the patient’s advocate who
solves ethical dilemmas by creating a
relationship
✓Gives priority to each patient as a unique being
 Caring in Nursing Practice

✓ Providing Presence
✓ Being with
✓ Eye contact
✓ Body language
✓ Tone of voice
Touch Provides Comfort Creates a Connection

✓Contact touch
Non contact touch
✓Protective touch
✓Task - oriented touch
 Listening Creates Trust Opens Lines of
Communication
• Creates a mutual relationship
✓ Listening is not only “taking in” what a patient
says; it also includes interpreting and
understanding what the patient is saying and
giving back that understanding
✓ Listening is an art form that must be developed.
✓ Indicates that you have your patient’s full
attention.
✓ Listening leads to knowing and responding to
what really matters to the patient and family.
Knowing the Patient Develops Over Time

The core process of clinical decision making

aspects of knowing include:
- Responses to therapy, routines, and habits
- Coping resources
- Physical capacities and endurance
 Spiritual Care
Spirituality offers a sense of
interpersonal and transpersonal
connectedness.
✓An intrapersonal relationship is when persons
are connected to themselves.
✓An interpersonal relationship exists when one
is connected with others and the environment.
✓A transpersonal relationship exists when one is
connected with God, an unseen force or a
higher power.
 Family Care
A nurse discusses a patient’s health
care needs with his family.
•People experience life through
relationships with others.
•Caring does not occur in isolation
from a patient’s family. Family is an
integral resource.
•When you care for patients, you will
also care for their families.
•Families will seek and require
information so they feel a part of
the care, treatment, and decisions.
 The Challenge of Caring

•
Communication and Nursing Practice

Communication

Is simply the act of transferring

information from one place, person or
group to another.
Communication - key to nurse patient relationships
and the ability to deliver patient centered care.
✓Patient safety
✓Reduce risk errors
✓Improved patient satisfaction
✓Effective relationships
✓Meets legal, ethical and clinical standards of care
Communication and interpersonal relationship

Nurse express caring by:

✓ Becoming sensitive to others
✓ Promoting and accepting the
expression of positive and negative feelings
✓ Developing caring relationships
✓ Instilling faith and hope
✓ Promoting interpersonal teaching and learning
✓ Providing a supportive environment
✓ Assisting with gratification of human needs
✓ Allowing for spiritual expression
Therapeutic Communicaation

Healing Relationship
Basic elements of the communication process
• Referent – motivates one to communicate with another
• Sender/Receiver – one who encodes and one who
decodes the message
• Message – content of the message
• Channels – conveying and receiving messages
• Feedback – message the receiver returns
• Interpersonal variable – factors that influence
communication
• Environment – setting for sender-receiver interaction
 Levels of communication

• Intrapersonal – occurs within an individual

• Interpersonal – one-on-one interaction
between two people
• Transpersonal – interaction within a person’s
spiritual domain
• Small Group - interaction with a small
number of people
• Public – interaction with an audience
Developing Communication Skills
✓Critical thinking
✓Perseverance and creativity
✓Self-confidence
✓Fairness and integrity
✓Humility
✓Thinking is influenced by perception
✓Five senses
✓Culture
✓Education
✓Perceptual bias
 Elements of Communication
Four main types of communication
1. Verbal - Communicating by way of a spoken
language.
2. Non verbal - Communicating by way of body
language, facial expressions.
3. Written - Communicating by way of written
language, symbols and numbers.
4. Visual - Communication by way of photography,
art, drawings, sketches, charts and graphs.
 Forms of Communication
Verbal aspects of
communication:
Vocabulary
✓Intonation
✓Pacing
✓Denotative and connotative
meaning
✓Clarity and brevity
✓Timing and relevance
 Forms of Communication (cont’d)

Non verbal
✓Personal appearance
✓Posture and gait
✓Facial expressions
✓Eye contact
✓Gestures
✓Sounds
✓Territoriality and personal space
 Forms of Communication (cont’d)

Symbolic - The verbal and nonverbal symbolism

used by others to convey meaning.
Metacommunication - A broad term that refers
to all factors that influence communication
Art and music
Metacommunications - send messages that
oftentimes present incongruence between the
word and body language.
 Nurse-Patient Relationship
Phases
1. Pre- interaction phase - occurs before meeting the
patient
2. Orientation phase - when the nurse and the
patient meet and get to know each other
3. Working phase - when the nurse and the
patient work together to solve problems and
accomplish goals
4. Termination phase - occurs at the end of a
relationship
Professional Nursing Relationships

✓ Nurse-patient helping relationships

✓ Nurse-family relationships
✓ Nurse-health team relationships
✓ Nurse-community relationships
Elements of Professional Communication
➢Appearance, demeanor, and behavior
➢Courtesy
➢Use of names
➢Trustworthiness
➢Autonomy and responsibility
➢Assertiveness
 Nursing Process: Assessment
✓Through the patient’s eyes
✓Gather information, synthesize, apply critical
thinking
✓Physical and emotional factors
✓Developmental factors
✓Sociocultural factors
✓Gender
 Nursing Process: Diagnosis
Many patients experience difficulty with
communication:
✓ Lacking skills in attending, listening,
responding, or self-expression
✓ Inability to articulate, inappropriate
verbalization
✓ Difficulty forming words
✓ Difficulty with comprehension
 Nursing Process: Planning

❖Goals and outcomes

❖Specific and measurable
❖Setting of priorities
❖Teamwork and collaboration
Possible outcomes include:
✓Patient initiates conversation about diagnosis or health
care problem.
✓Patient is able to attend to appropriate stimuli.
✓Patient conveys clear and understandable messages to
health care team.
✓Patient expresses increased satisfaction with the
communication process.
✓Setting priorities: Always maintain an open line of
communication; ensure the patient is comfortable and
that all physical needs have been met.
✓Teamwork: If patients have problems with communication,
you may need to seek the services of a speech therapist or
an interpreter.
 Nursing Process: Implementation
✓ Therapeutic communication techniques are specific
responses that encourage the expression of feelings
and ideas and convey acceptance and respect.
✓ Active listening means being attentive to what a
patient is saying both verbally and nonverbally.
✓ Use “SOALER”:
✓ Communication techniques need to be used to
prevent barriers when rendering care to patients.
✓ Effective communication techniques are facilitative
and tend to encourage the other person to openly
express ideas, feelings, or concerns.
 Barrier to Communication
• Stereotyping • Changing topics &
• Agreeing & subjects
disagreeing • Unwarranted
• Being defensive reassurance
• Challenging • Passing judgement
• Probing • Giving common
• Testing advice
• Rejecting
Active listening mnemonic means:
S- Sitting
O- Open posture
(i.e., keep arms and legs uncrossed).

A- “closed”
L- Lean toward the patient
E- Eye contact
R- Relax
Nursing Process: Implementation (cont’d)

✓Therapeutic communication techniques

✓Nontherapeutic communication techniques
✓Adapting communication techniques
[See Box 24-9 on page 324 Communicating with Patients Who Have Special Needs for
further discussion.]
 Adapting Communication Techniques
✓ Patients who cannot speak clearly
✓ Cognitive impairment
✓ Hearing impairment
✓ Visual impairment
✓ Unresponsive
✓ Patients who do not speak English (or your language)
✓ Older adults with sensory, motor, or cognitive
impairments require adaptation of communication
techniques to compensate for their loss of function
and special needs
✓ Patients with impaired verbal communication require
special consideration and alterations in
communication techniques to facilitate sending,
receiving, and interpreting messages
 Nursing Process: Evaluation
✓ Through the patient’s eyes
✓ Patient outcomes
✓ Nurses and patients need to determine whether
the plan of care has been successful.
✓ Nursing interventions are evaluated to
determine which strategies or interventions
were effective.

❖ If expected outcomes are not met, the plan of

care needs to be modified.
 Guide Questions
✓ Does the patient perceive having difficulty
communicating?
✓ Have the patient’s needs been met?
✓ Videotaping practice sessions with peer or process
recording can help students assess their
communication style.
✓ Desired outcomes for patients with impaired verbal
communication include increased satisfaction with
interpersonal interactions, the ability to send and
receive clear messages, and attention to and accurate
interpretation of verbal and nonverbal cues.
Basic Infection Control
 Hand Hygiene

• Procedures include the use of alcohol-based

hand rubs (containing 60%–95% alcohol) and
hand washing with soap and water.
• Considered widely as the most effective
means of spreading infection.
Five Moments of Hand Hygiene
Personal Protective Equipment (PPE)
 Personal Protective
Equipment (PPE)

• Barrier between infectious

agent and the HCP
• HICPAC and CDC issued
recommendation on how PPE
be worn and discarded.
 Precaution
• Standard Precaution - minimum infection
prevention practices that apply to all
patient care.

• TRANSMISSION BASED PRECAUTION

– Contact Precaution
– Droplet Precaution
– Airborne Precaution
 Standard Precaution
1. Use of personal protective equipment (e.g.,
gloves, masks, eyewear).
2. Respiratory hygiene / cough etiquette.
3. Sharps safety (engineering and work practice
controls).
4. Safe injection practices (i.e., aseptic technique
for parenteral medications).
5. Sterile instruments and devices.
6. Clean and disinfected environmental surfaces.
 Transmission Based Precaution
• Contact Precaution
– Used for clients with known or suspected
infections and would likely be spread by
direct contact to client’s environment.
Ex. Wound drainage, urine, feces.

– Recommendations: private room, use of

gloves and gown ( usage limited to client’s
room)
 Transmission Based Precaution
• Droplet Precaution
– Used on client with infectious agents that
spread through close respiratory contact. This
secretions do not remain infectious over long
distances
Ex. PTB, Mumps, Colds, Influenza

– Recommendations: private room, use of mask.

 Transmission Based Precaution

• Airborne Precaution
– Infectious agent remain suspended in air
and over long distances
Ex. Measles, Chickenpox, Covid – 19,
Meningitis
– Recommendations
• Negative pressure room
• N95 mask
 Protective Environment
• Intended for client with hematopoetic
stem cell transplants.

• Highly susceptible to fungal infections

• Intended to reduce fungal spore counts

in the air.
 Isolation
• Reverse Isolation
– Intended to protect immunocompromised
and suppressed clients.
• Quarantine
– Intended to limit spread of infectious agent
and maybe applied to those exposed
ENVIRONMENTAL WASTE
MANAGEMENT
• According to WHO, about 85% of the total
amount of waste generated by health care
activities is general, non-hazardous waste.

• The remaining 15% is considered hazardous

material that could be infectious, toxic or
radioactive.
 Types of Waste

✓Infectious waste
✓Pathological waste
✓Chemical waste
✓Pharmaceutical waste
✓Cytotoxic waste
✓Radioactive waste
✓Non-hazardous or general waste
Key element in improving health-care
waste management
• promoting practices that reduce the
volume of wastes generated and
ensure proposer waste segregation
 Health-care facility recommendations for standard
precautions

1. Hand hygiene
2. Gloves
3. Facial protection
4. Gown
5. Prevention of needle stick injuries
6. Respiratory hygiene and cough etiquette
7. Environmental cleaning
8. Linens
9. Waste disposal
10. Patient care equipment

Source: WHO
Thank You!