FUNDA LEC NOTES

• Nursing as a Profession
• Patient-centered care
• Professionalism
• Administer quality care
• Be responsible and accountable
• Health care advocacy groups
• Robert Wood Johnson Foundation (RWJF) Future of Nursing: Campaign for Action
• Institute of Medicine (IOM) publication on The Future of Nursing
• Science and Art of Nursing Practice
• Nursing requires
• Current knowledge and practice standards
• Insightful and compassionate approach
• Critical thinking
• Benner’s stages of nursing proficiency:
• Novice
• Advanced beginner
• Competent
• Proficient
• Expert
• Scope and Standards of Practice
• Nursing definitions
• American Nurses Association (ANA) definition of nursing: 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.
• The International Council of Nurses definition of nursing: Nursing encompasses
autonomous and collaborative care of individuals of all ages, families, groups, and
communities, sick or well, and in all settings. Nursing includes the promotion of health;
prevention of illness; and the care of ill, disabled, and dying people. Advocacy, promotion
of a safe environment, research, participation in shaping health policy and in patient and
health systems management, and education are also key nursing roles.
• Scope and Standards of Practice
• Nursing: Scope and Standards of Practice
• 1960: Documentation began
• Standards of Practice
• Standards of Professional Performance
• Goal
• To improve the health and well-being of all individuals, communities, and populations
through the significant and visible contributions of registered nursing using standards-
based practice
• Standards of Practice
• Six standards of practice:
• Assessment
 • Diagnosis
• Outcomes identification
• Planning
• Implementation
• Evaluation
• The nursing process is the foundation of clinical decision making
• Standards of Professional Performance
• Code of Ethics
• A code of ethics is the philosophical ideals of right and wrong that define principles used to
provide care.
• It is important for you to incorporate your own values and ethics into your practice.
• Ask yourself: How do your ethics, values, and practice compare with established standards?
• Professional Roles
• Quick Quiz!
1. Nursing is defined as a profession because nurses:
A. perform specific skills.
B. practice autonomy.
C. utilize knowledge from the medical discipline.
D. charge a fee for services rendered.
• Career Development
• Nursing provides an opportunity for you to commit to lifelong learning and career development.
• Case Study
• Ming graduated with an associate’s degree in nursing last year and received his RN credential. He
currently works in a long-term care facility. Although Ming enjoys his work and has been
promoted to shift supervisor on his unit, he finds that he’d like to pursue a nursing career that
offers a regular schedule and more autonomy.
• Ming considers returning to school for an advanced degree.
• Career Development (Cont.)
• Provider of care
• Advanced practice registered nurses
• Clinical nurse specialist
• Certified nurse practitioner
• Certified nurse midwife
• Certified registered nurse anesthetist
• Nurse educator
• Nurse administrator
• Nurse researcher
• Case Study (Cont.)
• Ming is particularly drawn to the idea of becoming an advanced practice registered nurse
(APRN).
• Ming’s career options for becoming an APRN include which of the following?
(Select all that apply.)
A. Physician assistant (PA)
B. Clinical nurse specialist (CNS)
C. Certified nurse midwife (CNM)
D. Certified RN anesthetist (CRNA)
• Case Study (Cont.)
If Ming decides to choose a career as a critical care CNS, then his specialty is identified by which means?
A. Population
B. Setting
C. Disease specialty
D. Type of care
E. Type of problem
• Nursing Shortage
• With fewer available nurses, it is important for you to learn to use your patient contact time
efficiently and professionally.
• Essential skills include:
• Time management
• Therapeutic communication
• Patient education
• Compassionate implementation of bedside skills
• Historical Influences
• Nurses:
• Respond to needs of patients
• Actively participate in determining best practices
• Knowledge of the history of the nursing profession increases your ability to understand the social
and intellectual origins of the discipline.
• Florence Nightingale
• First practicing epidemiologist
• Organized first school of nursing
• Improved sanitation in battlefield hospitals
• Practices remain a basic part of nursing today
• Civil War to the Beginning of the Twentieth Century
• Clara Barton
• Mother Bickerdyke
• Harriet Tubman
• Mary Mahoney
• Lillian Wald and Mary Brewster
• The Twentieth Century
• Movement toward scientific, research-based practice and defined body of knowledge
• Nurses assumed expanded and advanced practice roles
• 1906: Mary Adelaide Nutting, first nursing professor at Columbia Teacher’s College
• Army and Navy Nurse Corps established
• 1920s: Nursing specialization began
• Twenty-First Century
• Changes in curriculum
• Advances in technology and informatics
• New programs address current health concerns
 • Leadership role in developing standards and policies
• Contemporary Influences
• Importance of nurses’ self-care
• Changes in society lead to changes in nursing:
• Affordable Care Act (ACA)
• Rising health care costs
• Demographic changes
• Medically underserved
• Trends in Nursing
• Evidence-based practice
• Quality and Safety Education for Nurses (QSEN)
• Impact of emerging technologies
• Genomics
• Public perception of nursing
• Impact of nursing on politics and health policy
• Professional Registered Nurse Education
• Registered nurse education
• 2-year associate’s degree
• 4-year baccalaureate degree
• Graduate education
• Master’s degree, advanced practice RN
• Doctoral degrees
• Continuing and in-service education
• Nursing Practice
• Nurse Practice Acts (NPAs)
• Overseen by State Boards of Nursing
• Regulate scope of nursing practice
• Protect public health, safety, and welfare
• Licensure and certification
• Licensure: NCLEX-RN® examination
• Certification: requirements vary
• Professional Nursing Organizations
• Address member concerns
• Present educational programs
• Publish journals
• Student organizations
• National Student Nurses Association (NSNA)
• Canadian Student Nurses Association (CSNA)
• Quick Quiz!
2. Professional nursing specialty organizations seek to:
A. improve standards of practice.
B. expand nursing roles.
C. improve the welfare of nurses in specialty areas.
D. all of the above.
• Challenges to Health Care
• Uninsured patients
• Reducing health care costs while maintaining high-quality care for patients
• Improving access and coverage for more people
• Encouraging healthy behaviors
• Earlier hospital discharges result in more patients needing nursing homes or home care
• PHILIPPINE HEALTH CARE SYSTEM
• It is shared between the public and private sectors.
• Public hospitals focus their efforts on preventive and primary care while also taking the lead in
educating the public on health issues.
• private hospitals focus on specialized care for cardiovascular diseases, cancer, pulmonology, and
orthopedics.
• Republic Act 11223 or the Universal Health Care (UHC) Law in 2019
• allowing all Filipinos, including Overseas Filipino Workers (OFWs), access to healthcare services
under the Government’s health insurance program (PhilHealth).
• it aims to cover at least 50% of medical expenses to encourage Filipinos to visit specialty doctors
and undergo advanced medical procedures.
• Public Sector
• Executive Order 102
• Identifies DOH as the national authority on health providing technical and other
resource assistance to concerned groups
• Mandates DOH to perform the roles related to leadership in health, enabler and capacity
builder and administrator of specific services
• RA 7160 (Local Government Code)
• Transfers the responsibility for the delivery of basic services and facilities to the local
government including health services and facilities making them self-reliant and active
partners in the attainment of local goals through a more responsive and local
government structure
• National Priorities Partnership
• Promote best practices
• Promote prevention, treatment, and intervention practices for the leading causes of mortality
• Ensure person- and family-centered care
• Make care safer
• Promote communication and care coordination
• Make quality care affordable
• Health Care Regulation and Reform
• Regulatory and competitive approaches
• Professional standards review organizations (PSROs)
• Created to review the quality, quantity, and cost of hospital care provided
through Medicare and Medicaid
• Utilization review (UR) committees
• Review admissions, diagnostic testing, and treatments ordered by physicians
who cared for patients receiving Medicare
• Health Care Regulation and Reform (Cont.)
• Prospective payment system (PPS)
• Diagnosis-related groups (DRGs)
• Capitation
• RUGs
• Profitability
• Managed care
• “Never Events”
• Health Care Regulation and Reform (Cont.)
• Patient Protection and Affordable Care Act
• Access to health care for all
• Reducing costs
• Improving quality
• Provisions include
• Insurance industry reforms
• Increased funding for public programs
• Improved coverage for children
• Emphasis on Population Wellness
• Health Services Pyramid
• Managing health instead of illness
• Emphasis on wellness
• Injury-prevention programs
• Case Study
• Amy Sue Reilly is a 15-year-old white female of Irish descent. She is a freshman at a Catholic high
school. Although her parents are divorced, Amy Sue reports that her family (she has two
brothers and lives with her mother) is very close, and that her parents work together to meet all
their children’s needs.
• Amy Sue has had asthma since she was 5 years old. She controls her asthma by taking oral
medications and by using inhalers as needed.
• Health Care Settings and Services
• Preventive and Primary Health Care
• Preventive Care
• Reduces and controls risk factors for disease
• Primary care
• Focuses on improved health outcomes
• Requires collaboration
• Health promotion programs lower overall costs
• Reduces incidence of disease
• Minimizes complications
• Reduces the need for more expensive resources
• Secondary and Tertiary Care
• Focus: Diagnosis and treatment of disease
• Disease management is the most common and expensive service of the health care delivery
system
• Postponement of care by uninsured contributes to high costs
• Secondary and Tertiary Care (Cont.)
• Hospitals
• Work redesign
• Discharge planning
• Intensive care
• Psychiatric facilities
• Rural hospitals
• Restorative Care
• Serves patients recovering from an acute or chronic illness/disability
• Helps individuals regain maximal function and enhance quality of life
• Restorative Care: Home Health Care
• Provision of medically related services and equipment to patients and families in their homes for
health maintenance, education, illness prevention, diagnosis and treatment of disease,
palliation, and rehabilitation.
• Involves coordination of services.
• Focuses on patient and family independence.
• Usually reimbursed by government (such as Medicare and Medicaid in the United States),
private insurance, and private pay.
• Restorative Care: Rehabilitation
• Includes physical, occupational, and speech therapy, and social services
• Begins on admission
• Focuses on preventing complications
• Maximizes patient function and independence
• Restorative Care: Extended Care
• Extended care facility
• Provides intermediate medical, nursing, or custodial care for patients recovering from
acute illness or disabilities
• Intermediate care/skilled nursing facility
• Provides care for patients until they can return to their community or residential care
location
• Continuing Care
• For people who are disabled, functionally dependent, or suffering a terminal disease
• Available within institutional settings or in the home:
• Nursing centers or facilities
• Assisted living
• Respite care
• Adult day care centers
• Hospice
• Continuing Care: Nursing Centers or Facilities
• Provide 24-hour intermediate and custodial care
• Nursing, rehabilitation, diet, social, recreational, and religious services
• Residents of any age with chronic or debilitating illness
• Regulated by standards: Omnibus Budget Reconciliation Act of 1987
 • Interdisciplinary functional assessment is the focus of clinical practice: MDS, RAIs
• Continuing Care: Assisted Living
• Long-term care setting
• Home environment
• Greater resident autonomy
• No fee caps
• Continuing Care: Respite Care
• Respite care provides short-term relief or “time off” for people providing home care to an
individual who is ill, disabled, or frail.
• Settings include home, day care, or health care institution with overnight care.
• Trained volunteers enable family caregivers to leave the home for errands or social time.
• Quick Quiz!
1. A patient who needs nursing and rehabilitation following a stroke would most benefit from
receiving care at a:
A. primary care center.
B. restorative care setting.
C. assisted-living center.
D. respite center.
• Continuing 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
• May be associated with a hospital or nursing home or may operate independently
• Continuing Care: Hospice
• Family centered care that allows patients to live with comfort, independence, and dignity while
easing the pains of terminal illness.
• Focuses on palliative (not curative) care
• Many hospice programs provide respite care, which is important in maintaining the health of the
primary caregiver and family.
• Care Coordination
• Accountable care organizations (ACOs)
• Developed to coordinate medical care
• Nurses act as leaders and care coordinators
• Patient-centered medical home (PCMH)
• Coordinates care, gathers clinical data, monitors patient outcomes
• Primary care providers function as the hub of the PCMH
• Case Study (Cont.)
• Recently, Amy Sue has had some difficulty breathing, especially during gym class.
• Corrine is a 45-year-old African-American nurse, who recently accepted a job as a school nurse
for the four Catholic schools in the area. Three of the schools are grade schools, and one is Amy
Sue’s high school. Before she took this job, Corrine worked at a pediatrician’s office.
• Case Study (Cont.)
• Issues in Health Care Delivery
• Nursing shortage
• Competency
 • Quality and safety in health care
• Pay for performance
• Patient satisfaction
• Issues in Health Care Delivery (Cont.)
• Magnet Recognition Program
• Nursing-sensitive outcomes
• Nursing informatics and technological advancements
• Globalization of health care
• Vulnerable populations
• Quick Quiz!
2. Technological advances in health care:
A. make the nurse’s job easier.
B. depersonalize bedside patient care.
C. threaten the integrity of the health care industry.
D. do not replace sound personal judgment.
• Quality and Performance Improvement
• Quality data
• Quality improvement (QI)
• Performance improvement (PI)
• Quality improvement programs
• Models
• Patient Self-Determination Act (PSDA)
• Six Sigma or Lean
• Rapid-cycle improvement or rapid-improvement event (RIE)
• The Future of Health Care
• Change opens up opportunities for improvement.
• Health care delivery systems need to address the needs of the uninsured and the underserved.
• Health care organizations are striving to become better prepared to deal with these and other
challenges in health care.
• The solutions necessary to improve the quality of health care depend largely on the active
participation of nurses.

• New Stimulus for Community-Based Nursing Practice

• Because patients spend less time in acute care settings, there is a growing need to have
organized health care services where the population lives, works, and learns.
• As community health care partnerships develop, nurses are in a strategic position to play an
important role in health care delivery and to improve the health of the community.
• Focus of Community-Based Nursing
• Community-Based Health Care
• A model of care to reach all in a community
• Focuses on helping individuals and communities to create a healthy living environment
• Occurs outside of traditional health care facilities
• Provides services for acute and chronic conditions
• Community-Based Health Care (Cont.)
• Public health problems influenced by:
• Political policy and the Affordable Care Act (ACA)
• Social determinants of health
• Increases in health disparities
• Economics
• Achieving Healthy Populations and Communities
• Healthy People Initiative (by USDHHS)
• Establishes ongoing health care goals
• Healthy People 2020
• Goals are to increase life expectancy and quality of life, and to eliminate health
disparities through improved delivery of health care services
• Improved Delivery of Health Care
• Improved delivery of health care occurs through
• Assessment of health care needs of individuals, families, and communities
• Development and implementation of public health policies
• Improved access to care
• Case Study
• Kim Callahan is a student in a community health nursing course. She is working in a community
nursing service within a large city. Most of the patients in this agency are Bosnian immigrants.
• A major care initiative in this agency is to provide well-child examinations and immunizations to
get children ready to enter the public school system.
• Social Determinants of Health
• Health Disparities
• Negatively affect groups of people who have systematically experienced social or economic
obstacles to health
• Preventable differences in the burden of disease, injury, violence, or opportunities to achieve
optimal health that are experienced by socially disadvantaged populations
• Result from poverty, environmental threats, inadequate access to health care, individual and
behavioral factors, and educational inequalities
• Community Health Nursing
• Public health nursing requires an understanding of
• Needs of a population
• Factors that influence health promotion and health maintenance
• Trends and patterns influencing disease within populations
• Environmental factors contributing to health and illness
• Political processes used to affect public policy
• Community Health Nursing (Cont.)
• Community health nursing
• Nursing practice in the community
• Primary focus: health care of individuals, families, and groups within the community
• Goal: preserve, protect, promote, or maintain health
• Nursing Practice in Community Health
• Expert community health nurses:
• Understand the needs of a population or community
 • Use critical thinking skills to apply knowledge
• Understand resources
• Build relationships within the community
• Are responsive to changes in the community
• Community-Based Nursing
• Involves acute and chronic care
• Enhances individuals’ capacity for self-care
• Promotes autonomy
• Uses critical thinking
• Reduces costs
• Provides direct access to nurses
• Vulnerable Populations
• Individuals living in poverty
• Older adults
• People who are homeless
• Immigrant populations
• Individuals in abusive relationships
• Substance abusers
• People with severe mental illnesses
• Case Study (Cont.)
• Kim and her classmates conducted an assessment of the community’s health care needs and
practices.
• This is a close community that is facing many challenges, although chronic disease is absent in
this population.
• General preventive health care practices, including well examinations and basic screenings, are
lacking.
• Competency in Community-Based Nursing
• Nurses utilize a variety of skills and talents:
• Quick Quiz!
1. Vulnerable populations of patients are those who are more likely to develop health problems as
a result of:
A. living at home.
B. abusive habits.
C. citizenship.
D. middle age.
• Case Study (Cont.)
• Many members of the Bosnian community are suspicious of free/low-cost care.
• Kim attends community meetings with her community nurse preceptor to assess the beliefs and
concerns of the community.
• Misunderstandings and fears about health care services in this country are identified.
• Kim uses beneficence—wanting to do the most good for the most people.
• Kim respects the community’s beliefs.
• Community Assessment
• Components of community assessment
 • Systematic data collection on the population
• Monitoring the health status of the population
• Making information available about the community’s health
• Components of the community
• Structure or locale
• People
• Social systems
• Assess individuals in the context of a community
• Case Study (Cont.)
• One single-parent family in the community is 30-year-old Katrina Dudek and her two children
(ages 3 years and 6 months).
• Kim and the community health nurse work with Ms. Dudek to determine the health care needs
of her children and herself.
• So far, Ms. Dudek and her children have not received any care. Kim and Ms. Dudek discuss the
need for immunizations of the children and set that as a goal.
• Quick Quiz!
2. In identifying needs for health policy and health program development and services, a community
assessment focuses on which of the following elements?
A. Structure
B. People
C. Social systems
D. Environments
E. All of the above
• Changing Patients’ Health
• Establish strong, caring relationships with patients and their families
• Understand day-to-day activities of family life
• Design interventions to promote health and prevent disease
• Case Study (Cont.)
• Kim identifies community leaders to serve as key persons in educational programs.
• Kim spends 12 weeks working with the community agency and leaders to explain how the clinic
provides services and the confidentiality of these services.
• Kim presented information in three homes as well.
• A gradual increase was noted in the use of services, including fewer “missed” appointments.

• The Need for Evidence-Based Practice

• Evidence-based care
• Improves quality, safety, and patient outcomes
• Increases nurse satisfaction
• Reduces costs
• The Need for Evidence-Based Practice (Cont.)
• The Need for Evidence-Based Practice (Cont.)
• Sources of evidence
• Textbooks
 • Articles from nursing and health care literature
• Quality Improvement and risk management data
• Standards of care
• Infection control data
• Benchmarking, retrospective, or concurrent chart reviews
• Clinicians’ expertise
• Steps of Evidence-Based Practice
1. Cultivate a spirit of inquiry.
2. Ask a clinical question in PICOT format.
3. Search for the most relevant evidence.
4. Critically appraise the evidence you gather.
5. Integrate all evidence with your clinical expertise and patient preferences and values.
6. Evaluate the outcomes of practice decisions or changes using evidence.
7. Share the outcomes with others.
• 1. Cultivate a Spirit of Inquiry
• Question what does not make sense to you and what needs to be clarified
• Gain evidence-based practice (EBP) knowledge and skills
• Be committed to providing the best care possible
• Use problem- and knowledge-focused triggers
• Consider data gathered from a health care setting to examine clinical trends
• 2. Ask a Clinical Question
• Developing a PICOT question:
• P = Patient population of interest
• I = Intervention of interest
• C = Comparison of interest
• O = Outcome
• T = Time
• 3. Collect the Best Evidence
• Ask experts for help
• Nursing faculty
• Advanced practice nurses
• Staff educators
• Risk managers
• Librarians
• A medical librarian can
• Identify the databases that are available to you
• Identify key words that will provide the best answer to your PICOT question
• Collect the Best Evidence (Cont.)
• 4. Critically Appraise the Evidence
• After critiquing all articles for a PICOT question:
• Synthesize or combine the findings
• Consider the scientific rigor of the evidence and whether it has application in practice
• Critically Appraise the Evidence (Cont.)
• Elements of an article
 • Abstract
• Introduction
• Literature review or background
• Manuscript narrative
• Purpose statement
• Methods or design
• Results or conclusions
• Clinical implications
• 5. Integrate the Evidence
• Integrating evidence: teaching, assessment or documentation tools, clinical practice guidelines,
policies and procedures
• Applying evidence: consider setting, staff support, scope of practice, resources
• A pilot study may be conducted when evidence is not strong enough to apply in practice
• 6. Evaluate the Practice Decision or Change
• After applying evidence, evaluate the outcome.
• When evaluating an EBP change determine:
• Was the change effective?
• Are modifications needed?
• Should the change be discontinued?
• Unexpected events or results may occur.
• Never implement a practice change without evaluating its effects.
• 7. Share the Outcomes with Others
• After implementing an EBP change, it is important to communicate the results
• Clinical staff on the unit
• Nursing practice council or the research council
• Clinicians
• Professional conferences and meeting
• Nursing Research
• A way to identify new knowledge, improve professional education and practice, and use
resources effectively
• Many professional and specialty nursing organizations support the conduct of research for
advancing nursing science.
• Case Study
• Shana and Eric are nurses who work in the surgical intensive care unit (ICU). They belong to their
unit practice committee, which meets monthly to discuss practice issues. They have received a
copy of the monthly report on quality indicators.
• Case Study (Cont.)
• Shana notes that the incidence of catheter-related bloodstream infections (CR-BSIs) has steadily
increased during the last 3 months.
• Patients with central venous catheters, used to deliver fluids and medications over extended
periods of time, are becoming infected, but why?
• Is there a problem with the type of dressing placed over the catheter or the way the site is
cleansed before insertion?
• Outcomes Research
 • Helps patients, health care providers, and those in health care policy make informed decisions
on the basis of current evidence.
• Typically focuses on the benefits, risks, costs, and holistic effects of a treatment on patients.
• Outcomes must be observable or measurable.
• Scientific Method
• The foundation of research
• The most reliable and objective means of acquiring and conducting research and gaining
knowledge.
• A step-by-step process to ensure that findings from a study are valid, reliable, and generalizable
to a similar group of subjects
• Quick Quiz!
1. Which of the following is the first step of the research process?
A. Analyze data
B. Identify problem
C. Conduct study
D. Use the findings
• Nursing and the Scientific Approach
• Research allows you to study nursing questions and problems in greater depth within the
context of nursing.
• Quantitative
• Experimental research
• Nonexperimental research
• Surveys
• Evaluation research
• Qualitative
• Ethnography
• Phenomenology
• Grounded theory
• Research Process
• Research Process (Cont.)
• Institutional Review Board (IRB)
• Human Research Terminology
• Informed consent means
• Participants receive full and complete information
• They can understand the information
• They have free choice to participate
• They understand how their confidentiality will be kept
• Confidentiality
• Case Study (Cont.)
• Shana and Eric volunteer as part of their committee responsibilities to implement an EBP
project.
• Their first step will be to develop a clinical question and then search the scientific literature.
• Their aim is to determine what evidence is available so that they can make an informed decision
about the best approaches for reducing CR-BSIs among their patients.
 • The Relationship between EBP, Research, and QI
• Although EBP, research, and QI are closely related, they are separate processes.
• EBP: Use of information from research and other sources to determine safe and effective
nursing care with the goal of improving patient care and outcomes
• Research: Systematic inquiry answers questions, solves problems, and contributes to the
generalizable knowledge base of nursing; may or may not improve patient care
• QI: Improves local work processes to improve patient outcomes and health system
efficiency; results usually not generalizable
• The Relationship between EBP, Research, and QI (Cont.)
• Quick Quiz!
2. Every health care organization gathers data on health outcomes. Examples of key quality-of-care or
performance indicators include:
A. discharges.
B. medications administered.
C. healthy births.
D. infection rates.

• Healthy People Documents

• Healthy People: The Surgeon General’s Report on Health Promotion and Disease Prevention,
1979
• Healthy People 2000: National Health Promotion and Disease Prevention Objectives
• Healthy People 2010
• Healthy People 2020
• Healthy People Documents (Cont.)
• Healthy People 2020 Goals
• Attain high-quality, longer lives free of preventable disease, disability, injury, and
premature death
• Achieve health equity, eliminate disparities, and improve the health of all groups
• Create social and physical environments that promote good health for all
• Promote quality of life, healthy development, and healthy behaviors across all life stages
• Case Study
• Jack is a 59-year-old man with a history of type 2 diabetes, hypertension, and obesity. He is
married and works 50 to 60 hours per week in a computer technology position.
• His wife works the same number of hours, although she tends to travel more with her job and
sometimes works the night shift.
• As a result, both Jack and his wife have a hard time fitting exercise into their daily routine, and
they often eat in restaurants.
• Definition of Health
• A state of complete physical, mental, and social well-being, not merely the absence of disease or
infirmity (WHO, 1947)
• A state of being that people define in relation to their own values, personality, and lifestyle
• Models of Health and Illness
• A model is a theoretical way of understanding a concept or idea
 • Health beliefs
• Health behaviors
• Positive
• Negative
• Health Belief Model
• Health Promotion Model
• Models of Health and Illness (Cont.)
• Maslow’s Hierarchy of Needs
• Used to understand the interrelationships of basic human needs
• Holistic Health Model
• Attempts to create conditions that promote optimal health
• Case Study (Cont.)
• Jack comes to the clinic today for routine follow-up for his diabetes. Jack’s laboratory data reveal
that his blood glucose level is consistently running high. His blood pressure is on the high side of
normal.
• Sally, the diabetes nurse educator, is working with Jack for the second time. Sally knows she
wants to find a way to get Jack’s blood glucose levels down to avoid the long-term complications
of diabetes.
• Variables Influencing Health
and Health Beliefs and Practices
• Variables influence how a person thinks and acts.
• Health beliefs can negatively or positively influence health behavior or health practices.
• Quick Quiz!
1. According to Maslow’s hierarchy of needs, which of these needs would the patient seek to meet first?
A. Self-actualization
B. Self-esteem
C. Shelter
D. Love and belonging
• Internal Variables
• External Variables
• Case Study (Cont.)
• Because Jack occasionally exercises, Sally decides to focus her teaching on the importance of
routine exercise to improve Jack’s health and help with the management of diabetes.
• Sally finds out that 6 months ago, Jack was using his treadmill for 20 minutes on most mornings.
Since then, he has gotten out of the habit because he now tries to arrive at work 30 minutes
earlier.
• Quick Quiz!
2. After evaluating a patient’s external variables, the nurse concludes that health beliefs and practices
can be influenced by
A. emotional factors.
B. intellectual background.
C. developmental stage.
D. socioeconomic factors.
 • Health Promotion, Wellness,
and Illness Prevention
• Levels of Preventive Care
• Primary Prevention
• True prevention that lowers the chances that a disease will develop
• Secondary Prevention
• Focuses on those who have health problems or illnesses and are at risk for developing
complications or worsening conditions
• Tertiary Prevention
• Occurs when a defect or disability is permanent or irreversible
• Quick Quiz!
3. You will use the concept of primary prevention when instructing a patient to:
A. get a flu shot every year.
B. take a blood pressure reading every day.
C. explore hiring a patient with a known disability.
D. undergo physical therapy following a cerebrovascular accident.
• Risk Factors
• Variables that increase the vulnerability of an individual or a group to an illness or accident
• Risk factors include:
• Genetic and physiological factors
• Age
• Environment
• Lifestyle
• Risk Factor Modification and Changing Health Behaviors
• Case Study (Cont.)
• Sally wants to apply the stages of behavior change with Jack. By using this model, she will work
with Jack regarding what he is ready to do rather than simply telling Jack to be more active.
• To do this, she first asks Jack how he feels about exercise and what his plans are. Jack states, “I
know that exercise would be good for me and I should probably work on it.”
• This tells Sally that Jack is at the contemplation stage.
• Risk Factor Modification and Changing Health Behaviors (Cont.)
• Patient Teaching: Lifestyle Changes
• Objective
• Patient will reduce health risks related to poor lifestyle habits through behavior
change.
• Teaching strategies
• Provide active listening, ask about perceived barriers, assist the patient in
establishing goals, and reinforce the process of change.
• Evaluation
• Have the patient track adherence, and provide positive reinforcement.
• Illness
• A state in which a person’s physical, emotional, intellectual, social, developmental, or spiritual
functioning is diminished or impaired
• Acute Illness
 • Short duration and severe
• Chronic Illness
• Persists longer than 6 months
• Quick Quiz!
4. Sally has decided to set aside 30 minutes a day to walk after work next week. Sally is in what stage of
risk factor modification?
A. Precontemplation
B. Contemplation
C. Preparation
D. Action
E. Maintenance
• Illness Behavior
• Involves how people monitor their bodies and define and interpret their symptoms
• Variables influencing illness and illness behavior
• Internal variables: Perception of illness and nature of illness
• External variables: Visibility of symptoms, social group, cultural background, economics,
and accessibility to health care
• Impact of Illness on the Patient and Family
• Behavioral and emotional changes
• Impact on body image
• Impact on self-concept
• Impact on family roles
• Impact on family dynamics
• Case Study (Cont.)
• Teaching strategies:
• Practice active listening and determine what Jack understands regarding health risks
related to poor lifestyle.
• Ask Jack what barriers and benefits he perceives with the planned lifestyle change of
consistently exercising.
• Help Jack set achievable goals for change.
• Work with Jack to establish realistic time lines for modification of exercise habits.
• Case Study (Cont.)
• At the next appointment, Jack says, “I saw there was a sale on walking shoes. If I’m going to start
walking, do you think I need to get new shoes? Next week, I am taking a week of vacation, just
doing things around the house, and I thought this would be a good time to start.”
• Case Study (Cont.)
• Evaluation strategies
• Have Jack maintain an exercise log to track adherence, and provide positive
reinforcement.
• Ask Jack to discuss his success with lifestyle changes, such as minutes spent in activity.
• Have Jack identify community resources used in making a change.
• Caring for Yourself
• Eat a nutritious diet
• Get adequate sleep
• Engage in exercise and relaxation activities
• Establish a good work-family balance
• Engage in regular nonwork activities.
• Develop coping skills
• Allowing personal time for grieving
• Focus on spiritual health
• Find a mentor

• AONE Guiding Principles for Future Care Delivery

• Theoretical Views on Caring
• Caring: a universal phenomenon that influences the way we think, feel, and behave.
• Since Florence Nightingale, nurses have studied caring.
• Caring is at the heart of a nurse’s ability to work with all patients in a respectful and therapeutic
way.
• Theoretical Views on Caring (Cont.)
• Caring is primary
• Caring determines what matters to a person.
• Caring helps you provide patient-centered care.
• Leininger’s Transcultural Caring
• 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.
• Case Study
• Mrs. Levine is an 82-year-old patient diagnosed 2 months ago with lymphoma, a cancer of the
lymph tissue. She has been experiencing weakness and fatigue. Over the past 4 weeks, she has
lost 8 pounds.
• Mrs. Levine had been relatively independent before her diagnosis, playing bridge each week
with friends and going to lunch with fellow church members. But now she has much less energy
to do the things she enjoys.
• Theoretical Views on Caring (Cont.)
• Watson’s Transpersonal Caring
• Promotes healing and wholeness
• Rejects the disease orientation to health care
• Places care before cure
• Emphasizes the nurse-patient relationship
• Swanson’s Theory of Caring
• Defines caring as a nurturing way of relating to an individual
• States that caring is a central nursing phenomenon but is not necessarily unique to
nursing practice
• Summary of Theoretical Views
• Nursing caring theories have common themes.
• Caring is highly relational.
• Caring theories are valuable when assessing patient perceptions of being cared for in a
multicultural environment.
• Enabling is an aspect of caring.
• Knowing the context of a patient’s illness helps you choose and individualize interventions that
will actually help the patient.
• Case Study (Cont.)
• Mrs. Levine’s son, Jim, lives only a few miles away and is a consistent resource when she needs
transportation to the physician or trips to the grocery store.
• She will begin a research protocol for chemotherapy treatments this week at the oncology clinic.
• Patient’s Perspective of Caring
• Patients value the affective dimension of nursing care
• Connecting with patients and their families
• Being present
• Respecting values, beliefs, and health care choices
• Ethic of Care
• In any patient encounter a nurse needs to know what behavior is ethically appropriate.
• An ethic of care is unique so professional nurses do not make professional decisions based solely
on intellectual or analytical principles.
• Instead, an ethic of care places caring at the center of decision making.
• Case Study (Cont.)
• Sue is a nurse who has worked in the oncology clinic for more than 10 years. She enters the
examination room where Mrs. Levine is waiting, introduces herself, and sits down next to her
patient.
• Sue states, “Mrs. Levine, I am here to understand your story. I want to listen and learn how I can
best help you.” Sue uses eye contact while talking and leans toward Mrs. Levine to establish a
physical presence. Mrs. Levine nods, smiles, and begins her story.
• Caring in Nursing Practice
• As you deal with health and illness in your practice, you grow in your ability to care and develop
caring behaviors.
• Caring is one of those human behaviors that we can give and receive.
• Recognize the importance of self-care.
• Use caring behaviors to reach out to your colleagues and care for them as well.
• Providing Presence
• Case Study (Cont.)
• Mrs. Levine explains, “I have had a good life. I just don't know what is going to happen. The
doctor tells me the cancer is serious. I worry about what is going to happen to me and how it will
affect my son, Jim. I do not want to become a burden to him.”
• Sue responds in a calm, soothing tone, “Mrs. Levine, your concerns are very normal. It is
important for you to remain as independent as possible. Let’s talk about how we can do that.”
• Touch
• Provides comfort
• Creates a connection
• Noncontact touch
• Contact touch
 • Task-oriented touch
• Caring touch
• Protective touch
• Quick Quiz!
1. A female patient has just found a large lump in her breast. The physician needs to perform a breast
biopsy. The nurse helps the patient into the proper position and offers support during the biopsy. The
nurse is demonstrating:
A. enabling.
B. comforting.
C. a sense of presence.
D. maintaining belief.
• Case Study (Cont.)
• Mrs. Levine has consistently relied on her son, Jim, to provide caregiving support by assisting
with transportation and being a day-to-day resource. Jim brings his mother to the outpatient
oncology clinic for her first chemotherapy infusion.
• The total treatment will last for approximately 5 hours. Sue invites Jim to sit in the treatment
area with his mother.
• Listening
• 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
• Case Study (Cont.)
• Outside of the treatment room, Jim asks, “How will my mother respond to this chemotherapy?
What should we be expecting?”
• Based on Swanson's theory of caring, what might be an appropriate response on Sue's
part in “maintaining belief”?
• Spiritual Caring
• Spiritual health is achieved when a person can find a balance between his life values, goals, and
belief symptoms and those of others.
• Spirituality offers a sense of intrapersonal, interpersonal, and transpersonal connectedness.
• Relieving Symptoms and Suffering
• Performing caring nursing actions that give a patient comfort, dignity, respect, and peace
• Providing necessary comfort and support measures to the family or significant others
• Creating a physical patient care environment that soothes and heals the mind, body, and spirit
• Comforting through a listening, nonjudgmental, caring presence
• Family Care
• Case Study (Cont.)
• Three hours into the infusion, Mrs. Levine asks Sue for a glass of water and begins to talk about
her pet cat and her desire to return home and be able to visit with one of her bridge partners
 tomorrow. Sue has another patient down the hall who has an infusion that has been under way
for about an hour.
• What should Sue do to show her caring for Mrs. Levine?
• Quick Quiz!
2. When a nurse enters a patient’s room and says “Good morning” before starting care, the nurse
combines nursing tasks and conversation. An important aspect of care for the nurse to remember is the
need to:
A. establish a relationship.
B. gather assessment data.
C. treat discomforts quickly.
D. assess the patient’s emotional needs.
• The Challenge of Caring
• Challenges
• Task-oriented biomedical model
• Institutional demands
• Time constraints
• Reliance on technology, cost-effective strategies, and standardized work processes
• If health care is to make a positive difference in patients’ lives, health care must become more
holistic and humanistic.