FUNDAMENTALS OF NURSING
Social
Health, Wellness and Illness
HEALTH
• The presence or absence of disease.
• A state of being well and using every power the
individual possesses to the fullest extent (F. Nightingale)
• A state of complete physical, mental and social well-
being and not merely an absence of disease or infirmity
(WORLD HEALTH ORGANIZATION)
PERSONAL DEFINITIONS OF HEALTH
• A 15-year-old with diabetes takes injectable insulin each
morning. He plays in the school soccer team and is editor
of the high school newspaper.
• A 32 year old is paralyzed from the waist down and
needs a wheelchair for mobility. He is taking accounting at
a nearby college and uses a specially designed automobile
for transportation.
Health is defined and described as:
• Being free from symptoms of disease
and pain as much as possible.
• Being able to be active and to do
what they want or must.
• Being good in spirits most of the time.
WELLNESS
• A state of well-being
BASIC ASPECTS OF WELLNESS
1. Self-responsibility
2. An ultimate goal
3. A dynamic, growing process
4. Daily decision making (nutrition, stress management,
physical fitness, preventive health care and emotional
health)
5. Whole being of the individual
7 Components of Wellness
(Anspaugh, Hamrick and Rosato)
1. Environmental
–The ability to promote health measures that improve the
standard of living and quality of life in the community.
–This includes influences such as food, water and air.
2.
–The ability to interact successfully with people and
within the environment of which person is a part, to
develop and maintain intimacy with significant others and
to develop respect and tolerance for those with different
opinions and beliefs.
3. Emotional
–The ability to manage stress and to express emotions
appropriately.
– It involves the ability to recognize, accept and express
feelings and to accept one’s limitations.
4. Physical
–The ability to carry out daily tasks,
achieve fitness, maintain adequate
nutrition and proper body fat, avoid
abusing drugs and alcohol or using
tobacco products and generally practice
positive lifestyle habits.
5. Spiritual
–The belief in some force (nature, science, religion or a
high power) that serves to unite human beings and
provide meaning and purpose to life.
– It includes a person’s own morals, values and ethics.
6. Intellectual
–The ability to learn and use information effectively for
personal, family and career development.
– Involves striving for continued growth and learning to
deal with new challenges effectively.
7. Occupational
–The ability to achieve a balance between work and
leisure time.
–A person’s belief about education, employment and
home influence personal satisfaction and relationships
with others.
WELL BEING
• A subjective perception of vitality and feeling well.
• Can be described objectively, experienced and
measured.
• Can be plotted on a continuum.
MODELS OF HEALTH AND WELLNESS
CLINICAL MODEL
• People are viewed as physiological systems with related
functions.
• Health is identified by the absence of signs and
symptoms of disease or injury.
• The state of not being “sick”. 3. Environment

• The opposite of health is disease or injury. – All factors external to the host that may or may not
predispose a person to the development of the disease.

– Physical environment includes climate, living conditions,

ROLE PERFORMANCE MODEL
sound (noise) levels and economic level.
• Health is defined in terms of an individual’s ability to
– Social environment includes interactions with others
fulfill societal roles, that is, to perform his or her work.
and life events, such as the death of a spouse.
• People who can fulfill their roles are healthy even if they
have clinical illness.
HEALTH-ILLNESS CONTINUA
• Example:
• Health and illness or disease can be viewed as the
–A man who works all day at his job as expected is healthy
opposite ends of a health continuum.
even though he is partially deaf.
• From a high level of health, a person’s condition can
• It is assumed in this model that sickness is the inability
move through good health, normal health, poor health
to perform one’s work role.
and extremely poor health, eventually to death.

ADAPTIVE MODEL
DUNN’S HIGH-LEVEL
• Health is a creative process; disease is a failure in
adaptation or maladaptation.
WELLNESS GRID
• The aim of the treatment is to restore the ability of the
person to adapt, that is, to cope.

• Dunn described a health grid in a health

EUDAIMONISTIC MODEL axis and an environmental axis interact.

• Health is seen as a condition of actualization or • The grid demonstrates the interaction of

realization of a person’s potential.
the environment with the illness-wellness
• Actualization is the apex of the fully developed
continuum.
personality.

• The highest aspiration of people is fulfillment and

complete development, which is actualization.
• Illness is a condition that prevents self-actualization.
AGENT-HOST- ENVIRONMENT MODEL
• Also called the ecologic model.
DUNN’S HIGH-LEVEL WELLNESS GRID
• The health axis extends from peak wellness to death,
and the environmental axis extends from very favorable
to very unfavorable.
• The intersection of the two axes forms four quadrants of
health and wellness:

• Used primarily in predicting illness rather in promoting
wellness, although identification of risk factors
that result from the interactions of agent, host and
environment are helpful in promoting and maintaining
health.
1. High-level wellness in a favorable environment
–Ex: A person who implements healthy lifestyle behaviors
and has the biopsychosocial, spiritual and economic
resources to support this lifestyle.
2. Emergent high-level wellness in an unfavorable
environment

1. Agent –Ex: A woman who has the knowledge to implement a

healthy lifestyle practice but does not implement
–Any environmental factor or stressor that by its presence
adequate self- care practices because of family
or absence can lead to illness or disease.
responsibilities, job demands or other factors.
2. Host
3. Protected poor health in a favorable environment
–Person (s) who may or may not be at risk of acquiring a
– Ex: An ill person whose needs are met by health care
disease
system and who has access to appropriate medications,
–Family history, age, and lifestyle habits influence the diet and health care instruction.
host’s reaction.
4. Poor health in an unfavorable environment
– Ex: A young child who is starving in a
drought-stricken country.
ILLNESS-WELLNESS CONTINUUM
• Developed by Anspaugh, Hamrick and Rosato ranges
from optimal health to premature death.
• The model illustrates arrows pointing in opposite
directions and joined at a neutral point.
VARIABLES INFLUENCING HEALTH STATUS, BELIEFS AND
PRACTICES
• HEALTH STATUS
– State of health of an individual at a given time.
• HEALTH BELIEFS
– Concepts about health that an individual believes are
true.
• HEALTH BEHAVIOR
– The actions people take to understand their health
state, maintain an optimal state of health, prevent illness
and injury, and reach their maximum physical and mental
potential.
Internal Variables
• Non-modifiable variables
• Include: biologic, psychological and cognitive
dimensions.
• Genetic makeup – influences biologic characteristics,
innate temperament, activity level and intellectual
potential
• Sex – certain acquired and genetic diseases are more
common in one sex than in the other.
–Females – Osteoporosis, Autoimmune disease (RA)
– Males – stomach ulcers, abdominal hernia and
respiratory diseases.
• Age – The distribution of disease varies for age.
– Arteriosclerotic heart disease is common in middle-
aged males but occurs infrequently in younger people.
– Communicable diseases as whooping cough and
measles are common in children but rare in older adults.
• Developmental level – has major impact on health
status
– Infants lack physiological and psychological maturity
so their defenses against disease are lower during the first
years of life..
– Adolescents who strive to conform to peers are more
prone to risk taking behavior and subsequent injury than
adults are.
PSYCHOLOGICAL DIMENSION
• Mind-body interactions
– Ex: A student who is extremely anxious before a test
may experience urinary frequency and diarrhea.
• Self-concept
– How a person feels about self (self-esteem), and
perceives the physical body (self-image), needs, roles and
abilities.
COGNITIVE DIMENSION
• Lifestyle
– Refers to a person’s general way of living, including
living conditions and individual patterns of behavior that
are influenced by socio-cultural factors and personal
characteristics.
• Spiritual and religious beliefs
– Ex: Jehovah’s Witnesses oppose blood transfusions
– Some fundamentalists believe that a serious illness is a
punishment from God
– Some religious groups are strict vegetarians
– Religious Jews perform circumcision on the eighth day
of a male baby’s life.
External Variables
• Include the physical environment,
standards of living, family and cultural
beliefs and social support networks.
• Environment
–Geographic location determines climate and climate
affects health.
–Pollution (water, air and soil)
–Radiation
–Pesticides/insecticides
• Standards of Living
– An individual’s standard of living is related to health,
morbidity and mortality.
– Hygiene, food habits and ability to seek health care
advice and follow health regimens vary among high-
income and low income groups.
– Environmental conditions of impoverished areas
– Occupational roles
• Family and Cultural Beliefs
–The family passes on patterns of daily living and lifestyles
to offspring.
–Culture and social interactions
• Social Support Networks
–Having a support network and job satisfaction helps
people avoid illness.
–Support persons also help the individual confirm that
illness exist.
HEALTH BELIEF MODELS
Health Locus of Control Model
• Locus of control is a concept from social learning theory
that nurses can use to determine whether clients are
likely to take action regarding health, that is, whether
clients believe that their health status is under their own
or other’s control.
• People who believe that they have a major influence on
their own health status – that health is largely self-
determined – are called internals.
• People who believe that their health is largely controlled
by outside forces are referred to as externals.
Rosenstock and Becker’s Health Belief Models
• Based on the assumption that health related action
depends on the simultaneous occurrence of three factors:
– Sufficient motivation to make health issues be viewed
as important
– Belief that one is vulnerable to a serious health
problem or its consequences.
– Belief that following a particular health
recommendation would be beneficial.
Individual Perceptions
• Perceived susceptibility
–A family history of a certain disorder, such as diabetes or
heart disease, may make the individual feel at increased
risk.
–Awareness of personal high-risk lifestyle behaviors also
increases perceived susceptibility.
• Perceived seriousness
– In the perception of the individual, does the illness
cause death or have serious consequences?
–Example: concern about the spread of AIDS reflects the
general public’s
perception of the seriousness of the
illness.
• Perceived threat
–Perceive susceptibility and seriousness combine to
determine the total perceived threat of an illness to a
specific individual.
–Example: A person who perceives that many individuals
in the community have AIDS may not necessarily perceive
a personal threat of the disease; if the person is a drug
addict or a homosexual, however, the perceived threat is
likely to increase because the susceptibility is combined
with seriousness.
MODIFYING FACTORS
• Demographic Variables
– Include age, sex, race and ethnicity
– Example: An infant does not perceive the importance of
a healthy diet
An adolescent may perceive peer approval as more
important than family approval and as a consequence
may participate in hazardous activities or adopt unhealthy
eating and sleeping patterns.
• Sociopsychological variables
–Social pressure or influence from peers or other
reference groups.
• Structural variables
–Knowledge about the target disease and prior contact
with it are structural variables that are presumed to
influence preventive behavior.
• Cues to action
– Cues can either be internal or external.
– Internal cues include feelings of fatigue, uncomfortable
symptoms or thoughts about the condition of an ill person
who is close.
Likelihood of an Action
• Perceived benefits of the action
– In order to prevent lung cancer one refrains from
smoking and to maintain weight, one eats nutritious
foods and avoids snacking.
• Perceived barriers to action
– Include cost, inconvenience, unpleasantness and
lifestyle changes
HEALTHCARE ADHERENCE
• It is the extent to which an individual’s behavior
coincides with medical or health advice.
• When a nurse identifies nonadherence, it is important
to take the following steps:
• Establish why the client is not following the regimen.
• Demonstrate caring.
• Encourage healthy behaviors through positive
reinforcement.
• Use aids to reinforce teaching
• Establish a therapeutic relationship of freedom, mutual
understanding and mutual responsibility with the client
and support persons.
ILLNESS
• A highly personal state in which the person’s physical.
Emotional, intellectual, social, development or spiritual
functioning is thought to be diminished.
DISEASE
• Alteration in body functions resulting in a reduction of
capacities or a shortening of the normal lifespan.
• Etiology
– Causation of a disease or condition
Classification of Illness and Disease
• Acute Illness
–Characterized by symptoms of relatively short duration.
• Chronic Illness
– One that lasts for an extended period, usually 6 months
or longer and often for the person’s life.
– Usually have a slow onset and often have periods of
remission, when the symptoms disappear and
exacerbation, when the symptoms reappear.
Illness Behaviors
• A coping mechanism, involves ways individuals describe,
monitor and interpret their symptoms, take remedial
actions and use the health care system.
Four Aspects of the Sick Role
• Rights
–Clients are not held responsible for their condition.
–Clients are excused from certain social roles and tasks.
• Obligations
–Clients are obliged to try to get well as quickly as
possible.
–Clients or their families are obliged to seek competent
help.
Five Stages
• Stage 1: Symptom Experiences
–At this stage, the person comes to believe something is
wrong.
– 3 aspects
• The physical experience of symptoms
• The cognitive aspect
• The emotional response
• Stage 2: Assumption of the Sick Role
–The individual now accepts the sick role and seeks
confirmation from family and friends
• Stage 3: Medical Care Contact
– Sick people seek the advice of a health professional
either on their own initiative or at the urging of significant
others
– Three types of information
• Validation of real illness
• Explanation of the symptoms in understandable terms
• Reassurance that they will be all right or prediction of
what the outcome will be
• Stage 4: Dependent Client Role
– After accepting the illness and seeking treatment, the
client becomes dependent on the professional for help.
• Stage 5: Recovery or Rehabilitation
– During this stage, the client is expected to relinquish
dependent role and assume former roles and
responsibilities.
HEALTH CARE DELIVERY SYSTEMS
HEALTH CARE SYSTEM
• The totality of services offered by all health
disciplines.
Types of Health Care Services
–Primary Prevention (Health Promotion and Illness
Prevention)
–Secondary Prevention (Diagnosis and Treatment)
–Tertiary Prevention (Rehabilitation, Health Restoration
and Palliative Care)
Primary Prevention

(Health Promotion and Illness Prevention) Types of Health Care Agencies and Services

• Healthy People 2020 goals • Public health

– Increase quality and years of healthy life – Local health departments develop programs to meet
the health needs of the people, providing necessary
– Achieve health equity and eliminate health disparities
nursing and staff to carry out these programs, continue
– Create healthy environment for everyone evaluating the effectiveness of the program, and
monitoring changing needs.
– Promote health and quality life across the life span
• Public health
• Adequate and proper nutrition
– Public Health Service (PHS) of the U.S. Department of
• Weight control and exercise Health and Human Services
• Stress reduction – National Institutes of Health (NIH)
• Immunizations – Centers for Disease Control and Prevention (CDC)
• Smoking cessation campaigns • Physicians’ offices
• Environmental programs – Family practice physicians, specialists

– Routine health screening, illness diagnosis, and

Secondary Prevention treatment

(Diagnosis and Treatment) – NPs more common than RNs in this setting

• Freestanding diagnostic and treatment facilities • Ambulatory care centers

• Early detection of disease (routine screening-dental – Diagnostic treatment facilities

exams, bone density studies) – Minor surgery
• HIV testing and counseling • Occupational health clinics

– Run by companies for employees

Tertiary Prevention – Health promotion activities
(Rehabilitation, Health Restoration and Palliative Care) • Hospitals
• Goal: help people move to their previous level of health – Acute inpatient services
or to the highest level they are capable of given their
current health status. – Outpatient and ambulatory care

– Emergency department

Types of Health Care Agencies and Services – Hospice care

• Public Health • Subacute care facilities

• Physician’s Offices – Variation of inpatient care

• Ambulatory Care Centers – Technically complex treatments

• Occupational Health Clinics • Extended (long-term) care facilities

• Hospitals – Formerly called nursing homes

• Subacute Care Facilities – Independent living

• Extended (Long Term) Care Facilities – Assisted, skilled, extended care facilities

• Retirement and Assisted Living Centers – Rehabilitation

• Rehabilitation Centers – Custodial care

• Home Health Care Agencies – Insurance criteria, treatment needs, and nursing care
requirements must all be assessed before admittance
• Day Care Centers
• Retirement and assisted living centers
• Rural Care
– For clients unable to stay at home, but do not require
• Hospice Services hospital or nursing home
• Crisis Centers – Relative independence
• Mutual Support and Self-Help Groups
• Rehabilitation centers

– Restore or recuperate health Providers of Health Car

– Drug and alcohol • Nurse

• Home health care agencies – RN

– Education to clients and families – Licensed vocational nurse (LVN)

• Day care centers – Licensed practical nurse (LPN)

– Infants or children • Alternative (complementary) care provider

– Adults who cannot be left at home – Practices not commonly part of Western medicine

• Rural care -Although all members of the health care team

individualize care for the client based on the expertise of
– Federal funding
their own discipline, there are areas of overlap facilitated
– Services for rural residents through teamwork.

– Office of Rural Health Programs in each state • Case manager

• Hospice services – Ensures fiscally sound, appropriate care in the best

– Care for dying in home or facility
– Improve or maintain quality of life until death
– Ongoing assessment of needs of client and family
– Help in finding resources and services
• Crisis centers
– Emergency services for life crises
– Counseling and support
• Mutual support and self-help groups
– Health problems
– Life crises
setting
• Dentist
– Mouth, jaw, and dental problems
• Dietitian or nutritionist
– Dietitian has knowledge about diets required to
maintain health, treat disease.
• Dietitian or nutritionist
– Nutritionist has knowledge about nutrition and
food; works in community.
• Emergency medical personnel
– Several categories of first-responder care, such as fire
departments

Providers of Health Care • Occupational therapist

• Nurse – Assists clients with impaired functions to gain skills to

perform ADLs
• Alternative (Complementary) Care Provider
• Paramedical technologist
• Case Manager
– Laboratory
• Dentist
– Radiologic
• Dietitian or Nutritionist
– Nuclear medicine
• Emergency Medical Personnel
• Pharmacist
• Occupational Therapist
– Prepares, dispenses pharmaceuticals in hospital and
• Paramedical Technologist community settings
• Pharmacist • Physical therapist
• Physical Therapist – Assists clients with musculoskeletal problems
• Physician • Physician
• Physician Assistant – Responsible for medical diagnosis, determining therapy
• Podiatrist – Primary care or specialists
• Respiratory Therapist – Allopathic, osteopathic
• Social Worker • Physician assistant
• Spiritual Support Personnel – Performs certain tasks under direction of physician
• Unlicensed Assistive Personnel
– May have similar job description to NP
• Podiatrist
– Diagnoses, treats foot and ankle conditions
• Respiratory therapist
– Knowledgeable about oxygen therapy devices,
accessory devices
– Administers pulmonary function tests
• Social worker
– Counsels clients and support persons regarding
finances, marital difficulties, adoption of children
• Spiritual support personnel
– Chaplains, pastors, rabbis, priests, and other religious or
spiritual advisers
– Most volunteer
• Unlicensed assistive personnel (UAP)
– Assumes delegated aspects of basic client care
• Bathing, assisting with feeding, collecting
Specimens
NURSING AS A PROFESSION
• Nursing is a caring profession. As a unique profession, it
is practiced with an earnest concern for the art of care
and the science of health.
• The profession involves humanistic blend of scientific
knowledge, and holistic nursing practice.
• Is a group that requires specialized education and
intellectual knowledge.
• An organization of an occupational group based on the
application of special knowledge which stabilizes its own
rules and standards for the protection of the public and
the professionals.
• It implies that the quality of work done by its members
is of great importance in its own eyes and the society
than the economic rewards they earn.
NURSING AS A PROFESSION
• Nursing is not simply a collection of specific skills,
and the nurse is not simply a person trained to perform
specific tasks.
• Nursing is a profession, no one factor absolutely
differentiates a job from a profession, but the difference is
important in terms of how nurses practice.
• When we say a person acts “professionally”, we imply
that the person is conscientious in action, knowledgeable
in the subject, and responsible to self and others.
• Nurses were viewed as noble, compassionate, moral,
religious, and well sacrificing.
A profession possesses the following primary
characteristics:
1. Education.
Requires an extended education of its members, as well
as basic liberal foundation.
2. Theory.
Has a theoretical body of knowledge leading to defined
skills, abilities and norms.
3. Service.
A profession provides basic service.
4. Autonomy.
Members of a profession have autonomy in decision
making and in practice.
5. Code of Ethics.
A profession has sufficient self- impelling power to retain
its members throughout life.
6. Caring.
The most unique characteristic of nursing as a profession
is that, it is a CARING profession.
PROFESSIONAL NURSE
• Is a person who has completed a basic nursing
education program and is licensed in his/her country or
state to practice professional nursing.
• A 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 the society
and who continues to add her knowledge, skills, and
attitudes through continuing education and scientific
inquiry (research) or the use of the results of such inquiry.
What is 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 population.
(ANA, 2003)
Certain themes are common to many definitions of
nursing.
• Nursing is caring • Nursing is an art
• Nursing is a science • Nursing is client centered
• Nursing is holistic • Nursing is adaptive
• Nursing is a helping profession
• Nursing is concerned with health promotion, and health IN THE PHILIPPINES
restoration
• EARLY BELIEFS AND PRACTICES

–Diseases and their causes and treatment were shrouded

Personal and Professional Qualities of a Nurse
with mysticism and superstitions.

• Beliefs about causation of disease

Professional Preparation
–Another person (an enemy or witch)
– Have a license to practice nursing in the country
–Evil spirits
– Have a Bachelor of Science degree in Nursing; and
• Belief that evil spirits are driven away by
– Be physically and mentally fit
persons with powers to expel demons

• Belief in special gods of healing, with

Personal Qualities and Professional Proficiencies
Preparation
– Interest and willingness to work and learn with
individuals/groups in a variety of setting
– A warm personality and concern for people
– Resourcefulness and creativity as well as a well-
balanced emotional condition
– Capacity and ability to work cooperatively with others
– Initiative to improve self and service
– Competence in performing through the use of nursing
process
– Skill in decision-making, communicating, and relating
with others and being research oriented
– Active participation in issues confronting nurses and
nursing
Personal Qualifications of a Nurse
Philosophy of Life
• Theories of Nursing can be taught, but not a
the priest-physician (called word
doctors) as intermediary. If they used
leaves or roots, they were called herb
doctors
Early Care of the Sick
• The early Filipinos subscribed to superstitious belief and
practices in relation to health and sickness
• Herbmen were called “herbicheros” meaning one who
practiced witchcraft. Persons suffering from diseases
without any identified cause were believed bewitched by
“mangkukulam” or “mangangaway”.
• Difficult childbirth and some diseases (called “pamao”)
were attributed to “nonos”
• Midwives assisted in childbirth. During labor, “mabuting
hilot” (good midwife) was called in. If birth became
difficult, witches were supposed to be the cause. To
disperse their influence, gunpowder was exploded from a
bamboo cane close to the head of the sufferer.

philosophy of life or a philosophy of service.

Health Care During the Spanish Regime

• The religious orders exerted their efforts to care for the

Good personality sick by building hospitals in the different parts of the
Philippines.
1. Personal Appearance

a.) Posture b.) Grooming c.) Dress and uniform

Earliest Hospitals
2. Character
• Hospital Real de Manila (1577)
3. Attitude
• San Lazaro Hospital (1578)
4. Charm
• Hospital de Indios (1586)

• Hospital de Aguas Santas (1590)

HISTORICAL DEVELOPMENT IN NURSING
• San Juan de Dios Hospital (1596)
• HISTORY OF NURSING IN THE

PHILIPPINES
Nursing During the Philippine Revolution
• HISTORY OF NURSING IN THE
• Prominent Persons involved in nursing work:
WORLD
– Josephine Bracken
– Mrs. Rosa Sevilla de Alvero
– Doña Hilaria de Aguinaldo
– Doña Maria Agoncillo de Aguinaldo
– Melchora Aquino
– Capitan Salome
– Agueda Kahabagan
– Trinidad Tecson
Filipino Red Cross
• Malolos – location of the national head quarters
• Established branches in the provinces
• Functions:
– Collection of war funds and materials through concerts,
charity bazaars and voluntary contributions
–Provision of nursing care to wounded Filipino soldiers
• Requirements for membership:
–At least 14 years old, age requirement for officers was 25
years
–Of sound reputation
Hospitals and Schools of Nursing
• Iloilo Mission Hospital School of Nursing
(Iloilo City, 1906)
• St. Paul’s Hospital School of Nursing (Manila, 1907)
• Philippine General Hospital School of Nursing (1907)
• St. Luke’s Hospital School of Nursing (Quezon City, 1907)
• Mary Johnston Hospital and School of Nursing
(Manila, 1907)
• Philippine Christian Mission Institute Schools of Nursing
• San Juan de Dios Hospital School of Nursing (Manila,
1913)
• Emmanuel Hospital School of Nursing
• Southern Islands Hospital School of Nursing
The First Colleges of Nursing in the Philippines
• University of Sto. Tomas College of Nursing (1946)
• University of the Philippines College of Nursing (1948)
• Manila Central University College of Nursing (1947)
Nursing Leaders in the Philippines
• Anastacia Giron-Tupas
• Cesaria Tan
• Socorro Sirilan
• Rosa Militar
• Sor Ricarda Mendoza
• Socorro Diaz
• Conchita Ruiz
• Loreto Tupaz
HISTORY OF NURSING IN OTHER LANDS
• Period of Intuitive Nursing
– Intuitive Nursing was practiced since prehistoric times
among primitive tribes and lasted through the early
Christian era. Nursing was ‘untaught’ and instinctive. It
was performed out of compassion for others, out of the
wish of to help others.
Beliefs and Practices of Prehistoric Man
• He was a nomad. His philosophy of life was ‘the best for
the most’ and he was ruled by the law of self
preservation.
• Nursing was a function that belonged to women. She
took good care of the children, sick and the aged.
• He believed that the illness was caused by the invasion
of the victim’s body and evil spirit through the use of
black magic or voodoo.
• He believed that the medicine man called ‘shaman’ or
witch doctor had the power to heal by using white magic.
Among others, the shaman used hypnosis, charms,
dances, incantations, purgatives, massage, fire, water and
herbs as a means of driving illness from the victim.
• Trephining was practiced as a last resort to drive evil
spirits from the body of the afflicted.
Nursing in the Near East
• Beliefs and Practices
– Man’s mode of living changed from a nomadic style to
an agrarian society to an urban community life.
– Man developed a means of communication and the
beginnings of a body of scientific knowledge.
– Nursing remained the duty of slaves, wives, sisters or
mothers.
• The care of the sick was still closely related to religion,
superstition and magic. Astrology and numerology were
also used in medical practice.
• The place saw the birth of three great religious
ideologies: Judaism, Christianity and Islam.
Contributions to Medicine and Nursing
• Babylonia
• Code of Hammurabi – provided laws that covered
every facet of Babylonian life including medical
practice.
• Egypt
• Introduced the art of embalming which enhanced their
knowledge of human anatomy.
• They developed the ability to make keen observation
and left a record of 250 recognized diseases.
• Israel
• Moses is recognized as the “Father of Sanitation”
Nursing in the Far East
• China
–The people strongly believed in spirits and demons as
seen in the practices such as giving male babies girl’s
clothes to keep them from befalling evils.
–Materia Medica
• India
– Men of medicine built hospitals, practiced an intuitive
form of asepsis and were proficient in the practice of
medicine and surgery.
–Sushurutu made a list of function and qualifications of
nurses. For the first time in recorded history, there was
reference to the nurse’s taking care of patients. These
nurses were described as combination of physical
therapist and cook.
Nursing in Ancient Greece
• Nursing was the task of untrained slave
• The Greeks introduced the caduceus, the insignia of the
medical profession today.
• Hippocrates – born in Greece, was given the title
“Father of Scientific Medicine”
• Rome
– The transition from pagan to Christian philosophy took
place. There was contrast between the materialism of
pagan society and the spirituality of the
converted Christians.
– The Romans attempted to maintain vigorous health,
because illness was a sin of weakness.
– Care of the ill was left to the slaves or Greek
physicians. Both groups were looked upon as inferior
by Roman society.
– Fabiola was a worldly beautiful Roman matron who
was converted to Christianity by her friends Marcella
and Paula. With their help, she made her home the
first hospital in the Christian world.
Period of Apprentice Nursing
• This period extends from the founding of religious
nursing orders in the Crusades, which began in the 11th
century and ended in 1836, when Pastor Fliedner and his
wife established the Kaiserswerth Institute for the training
of Deaconesses in Germany.
• It is called the period of ‘on-the-job’ training.
• Nursing care was performed without any formal
education and by people who were directed by more
experienced nurses.
Important Nursing Personages During this Period.
• St. Clare
• St. Elizabeth of Hungary
• St. Catherine of Siena
The Dark Period of Nursing
• This extends from the 17th to the 19th century from the
period of reformation until the US Civil War.
• The religious upheaval led by Martin Luther destroyed
the unity of Christian faith.
• Protestantism swept everything connected with Roman
Catholicism in schools, orphanages and hospitals.
• Nursing became the work of theleast desirable of
women – women who took bribes from patient’s food
and used alcohol as a tranquilizer.
• They worked seven days a week, slept in cubbyhole near
the hospital ward or patient and ate scraps of food when
they could find them.
Period of Educated Nursing
• This period began on June 15, 1860 when the Florence
Nightingale School of Nursing opened at St. Thomas
Hospital in London.
• The development of nursing during this period was
strongly influenced by tends resulting from wars, from an
arousal of social consciousness, from the emancipation of
women and from the increased educational opportunities
offered to women.
Period of Contemporary Nursing
• This covers the period after World War II to the present.
Scientific and technological developments as well as social
changes mark this period.
Overview of the Professional Nursing Practice
Level of Proficiency (Benner )
STAGE I – NOVICE
• No experience (e.g. nursing student)
• Performance is limited, inflexible,
and governed by context-free rules
and regulations rather than
experience.
STAGE II – ADVANCED BEGINNERS
• Demonstrates marginally acceptable
performance.
• Recognizes the meaningful “aspects” of
a real situation.
• Has experienced enough real situations
to make judgments about them.
STAGE III – COMPETENT
• Has 2 or 3 years of experience.
• Demonstrates organizational and
planning abilities.
• Differentiates important factors from less
important aspects of care.
• Coordinates multiple complex care
demands.
STAGE IV – PROFICIENT
• Has 3 or 5 years of experience.
• Perceives situations as wholes rather than
in terms of parts, as in Stage II.
• Uses maxims as guides for what to
consider in a situation.
• Has holistic understanding of the client,
which improves decision making.
• Focuses on long term goals.
STAGE V – EXPERT
• Performance is fluid, flexible and highly
proficient.
• No longer requires rules, guidelines, or
maxims to connect an understanding of
the situation to appropriate action.
• Demonstrates highly skilled intuitive and
analytic ability in new situations.
• Is inclined to take a certain action because
“it felt right”
Roles & Responsibilities of a Nurse
1. Caregiver/ Care provider – the traditional and most
essential role functions as nurturer, comforter, provider
• “mothering actions” of the nurse
• provides direct care and promotes comfort of client
• activities involves knowledge and sensitivity to what
matters and what is important to clients
• shows concern for client welfare and acceptance of the
client as a person
2. Teacher – provides information and helps the client to
learn or acquire new knowledge and technical skills
• encourages compliance with prescribed therapy.
• promotes healthy lifestyle
• interprets information to the client
3. Counselor - helps client to recognize and cope with
stressful psychologic or social problems; to develop an
improve interpersonal relationships and to promote
personal growth
• provides emotional, intellectual to and psychologic
support
• focuses on helping a client to develop new attitudes,
feelings and behaviors rather than promoting intellectual
growth.
• encourages the client to look at alternative behaviors
recognize the choices and develop a sense of control.
4. Change agent - initiate changes or assist clients to make
modifications in themselves or in the system of care.
5. Client advocate - involves concern for and actions in
behalf of the client to bring about a change.
• promotes what is best for the client, ensuring that the
client’s needs are met and protecting the client’s right.
• provides explanation in clients language and support
clients decisions.
 How to become an RN?

6. Manager – makes decisions, coordinates activities of Finish BSN Program

others, allocate resources, evaluate care and personnel
Licensure Examination
• plans, give direction, develop staff, monitors operations,
Ratings
give the rewards fairly and represents both staff and
administrations as needed. Oath

Issuance of Certificate of Registration/Professional License

and Professional Identification Card
7. Researcher – participates in identifying significant
researchable problems

• participates in scientific investigation and must be a
consumer of research findings
• must be aware of the research process, language of
research, a sensitive to issues related to protecting the
rights of human subjects.
Article VI Sec. 28. Scope of Nursing
• A person shall deemed to be
practicing nursing within the meaning
of this ACT when he/she singly or in

collaboration with another, initiates

Expanded Role of the Nurse: and performs nursing services to
1. Clinical Specialists - is a nurse who has completed a individuals, families and communities
master’s degree in specialty and has considerable clinical
expertise in that specialty. She provides expert care to in any healthcare setting.
individuals, participates in educating health care
professionals and ancillary, acts as a clinical consultant
and participates in research. This includes, but not limited to:

2. Nurse Practitioner - is a nurse who has completed • Nursing care during conception • Labor and delivery
either as certificate program or a master’s
• Infancy, Childhood, Toddler • Adulthood and old age
degree in a specialty and is also certified by the
• Pre-school, School Age, Adolescence
appropriate specialty organization. She is skilled at making
nursing assessments, performing P. E., counseling,
teaching and treating minor and self- limiting illness.

3. Nurse-midwife - a nurse who has completed a program

As independent practitioner: Primary Responsibilities:
in midwifery; provides prenatal and postnatal care and
delivers babies to woman with uncomplicated a.Promotion of health b.Prevention of illness
pregnancies.

4. Nurse anesthetist - a nurse who completed the course

As health team member:
of study in an anesthesia school and carries out pre-
operative status of clients. • Collaborate with other health care providers for the:
5. Nurse Educator - A nurse usually with advanced a. Curative
degree, who teaches in clinical or educational settings,
teaches theoretical knowledge, clinical skills and conduct b. Preventive
research. c. Rehabilitative
6. Nurse Entrepreneur - a nurse who has an advanced d. Restoration of health
degree, and manages health-related business.
e. Alleviation of suffering
7. Nurse administrator – a nurse who functions at various
f. When recovery is not possible towards peaceful death
levels of management in health settings; responsible for

the management and administration of resources and

personnel involved in giving patient care. It shall be duty of the nurse to:

1. Provide nursing care through utilization of the nursing

process.
SCOPE OF NURSING PRACTICE
This includes but not limited to:
• RA 9173 - "Philippine Nursing Act of 2002."
a. Traditional and innovative approaches
– AN ACT PROVIDING FOR A MORE RESPONSIVE NURSING
PROFESSION, REPEALING FOR THE PURPOSE REPUBLIC b. Therapeutic use of self
ACT NO. 7164, OTHERWISE KNOWN AS "THE PHILIPPINE c. Executing healthcare techniques and procedures
NURSING ACT OF 1991" AND FOR OTHER PURPOSES

d. Essential primary healthcare
e. Comfort measures
f. Health teachings
g. Administration of written presentation for:
-treatment
-therapies
-oral, topical and parenteral medications
-internal examination during labor in the absence of
antenatal bleeding and delivery; in case of suturing of
perineal laceration, special training shall be provided
according to protocol established.
2. Establish linkages with community resources and
coordination with the health team;
3. Provide health education to individuals, families and
communities;
4. Teach, guide and supervise students in nursing
education programs including:
a. The administration of nursing services in varied settings
such as hospitals and clinics;
b. Undertake consultation services;
c. Engage in such activities that require the utilization of
knowledge and decision-making skills of a registered
nurse
5. Undertake nursing and health human resource
development training and research, which shall include,
but not limited to, the development of advance
nursing practice.
FIELDS OF OPPORTUNITIES IN NURSING
• HOSPITAL/INSTITUTIONAL NURSING
–The nurse cares for the patient in the hospital and plans
for the nursing care needs of the patient.
–The nurse participates as a member of the health care
team in all phases of patient care; the care of the acutely
ill, the convalescing and the ambulatory patient.
–The nurse performs nursing measures that will meet the
patient’s physical, emotional, social and spiritual needs
while in the hospital and helps him and his family plan for
his further health care needs when he returns home.
–The National Health Program of the Philippines gives as
much emphasis on the promotion of health and
prevention of diseases rather than care of the sick.
–Community nursing deals with the care of the families in
a community.
• PRIVATE DUTY NURSING
• Nursing in private practice are expected to be expert
clinicians as well as expert generalist in nursing.
• PDN – is a registered nurse who undertakes to give
comprehensive care to a client on a one to one ratio.
S/He is an independent contractor. The patient maybe
provided care in the hospital or in home.
• OCCUPATIONAL HEALTH NURSING/ INDUSTRIAL HEALTH
NURSING
• This field of nursing requires special skills including
ability to take and read ECG, eye screening, audiometer ,
lab. Test and x-ray.
• The occupational nurse works alone in situations where
she may have to give immediate care to patients with
serious injuries.
–Industrial nurses must know company policies on
personal insurance benefits, health programs medical
matters.
–Since the industrial nurse works alone with only part
time or on-call doctor, she may find herself custodian of
employee’s health records , counselor and adviser of
workers, health and safety teacher as well as first aider to
the injured.
• NURSING EDUCATION
–Nurses who would like to consider teaching as their field
of choice should consider the following
factors:
•They must be clinically inclined
•They must have a Master’s Degree in Nursing
•Teachers often work 40 hours a week. Much time is
spent in planning lessons, preparing and correcting
examinations, attending faculty meetings and counseling
students.
•They must have at least 3 years of clinical practice.
• MILITARY NURSING
• The Nurse’s Corps, AFP provides the nursing care and
services essential to the accomplishment of the mission of
the medical service, which is conserve the fighting
strength of the AFP.
• Nursing service in the military seeks to provide the
highest quality of nursing care to patients, in-patients in
the hospitals and out-patients in the dispensaries.

–Nurses are being trained locally or abroad.

–Flight nursing – is responsible for patients, military who

are being evacuated from battle areas to the nearest
installation for treatment.

• SCHOOL NURSING

– School nurses should like children

– The primary function of the school nurse is education.

– Each school health program is geared to having the

students and faculty gain in the understanding of the
health programs which emphasizes the health
promotions, the prevention of disease and the ability to

follow through of any findings that indicate a need for

medical care and treatment.

• OFFICE NURSING

– Requires a nurse with general skills. Usually a doctor has

been in general practice for a number of years. It is within
him that the nurse acts as a receptionist, answers the
phone, does the billing of patient, takes x- rays and ECG,
does dressing changes,

• injections (immunization) and assist in physical

examination.

– Teaching client and their family has become an

important function of the clinic nurse.

• INDEPENDENT NURSING PRACTICE

– Here in the Philippines, there are already a few nursing

clinics, a group of nursing specialist wherein nurses do
independent nursing practice.

– While some independent nursing practitioners set up

their clinic near a hospital (Psychiatric Nursing Specialist)

most of them are community based.

– These nurse reach out and offer their services rather

than expect client to seek their help.

–They perform both independent and collaborative roles.

–They make referrals and collaborate with physicians and

other disciplines as needed by client or family.

– Health care assessment, formulating plans for health

maintenance, prevention strategies, continuation of
supportive activities in critical and complex health
problems are all within the scope on nursing practice.