NCM 103 – Midterm Review Material

NURSING PROCESS
WHAT IS THE NURSING PROCESS IN SIMPLE WORDS?
 The nursing process is a series of steps nurses take to assess patients, plan for, and provide patient care, and
evaluate the patient’s response to care.
 It is considered the framework upon which all nursing care is based.
WHEN WAS THE NURSING PROCESS DEVELOPED?
 The earliest version of the nursing process was introduced in 1955 by Lydia Hall.
 Ms. Hall identified three steps of the nursing process:
o observation,
o administration of care, and
o validation.
 Dorothy Johnson, in 1959, described nursing as "fostering the behavioral functioning of the client.”
 Ms. Johnson’s version of the nursing process included the three steps:
o assessment,
o decision, and
o nursing action.
 in 1961, Ida Jean Orlando-Pelletier introduced the version of the nursing process known to nurses today.
WHO DEVELOPED THE NURSING PROCESS?
 The nursing process as we know it today is based upon the “Deliberative Nursing Process Theory” developed by Ida
Jean Orlando-Pelletier.
 Ms. Orlando-Pelletier's version of the nursing process includes five steps: Assessment, Diagnosis, Planning,
Implementation, and Evaluation.
WHAT IS THE PURPOSE OF THE NURSING PROCESS?
 The purpose of the nursing process is to establish a standard of care where nurses assess patients and create plans
of action to address individualized patient needs.
 To identify the client’s health status and actual or potential health care problems or needs (through assessment).
 The nursing process has other purposes, as well, including but not limited to the following.
o Establishes plans to meet patient needs.
o Guides nurses in the delivery of high-quality evidence-based care to meet those needs.
o To apply the best available caregiving evidence and promote human functions and responses to health and
illness (ANA, 2010).
o To protect nurses against legal problems related to nursing care when the standards of the nursing process
are followed correctly.
o Promotes a systematic approach to patient care that all members of the nursing team can follow.
o To establish a database about the client’s health status, health concerns, response to illness, and the ability
to manage health care needs.

WHAT ARE THE 7 MAIN CHARACTERISTICS OF THE NURSING PROCESS?

 There are several characteristics associated with providing nursing care.
 The following is a list of the seven main characteristics of the nursing process and an explanation for each one.
1. Within the legal Scope of Practice
 Perhaps the most essential characteristic of the nursing process is that it should be used within the nurse’s legal
Scope of Practice.
2. Based on sound knowledge
 Effective use of the nursing process requires the nurse to utilize nursing knowledge and skills to identify and
resolve problems.
  Nurses should develop and continuously strengthen critical thinking skills and the use of evidence-based nursing
interventions.
3. Planned
 A well-thought-out approach to patient care leads to organized, systemic patient care that is delivered efficiently
and in order.
4. Client-centered
 It is imperative that nurses understand the importance of client-centered nursing care.
 The nursing process characteristic of client-centered care helps nurses plan care that is individualized to the
patient.
 It also supports patient autonomy, which is every patient’s right.
5. Goal-directed
 As the title suggests, goal-directed care is a form of nursing care delivery based on achieving individualized goals
to achieve desired patient outcomes.
 Goals are created through the collaborative efforts of nurses, other members of the healthcare team, and
patients.
6. Prioritized
 When planning patient care, it is necessary to identify all health issues and risk factors and prioritize patient
care, focusing on the most serious issues first.
 the process is continuous, and nurses must repeat steps.
 As continued assessments and evaluations occur, and depending on the patient’s response to care, the order of
priorities in the care plan may change.
7. Dynamic and Cyclical
 The nursing process is a dynamic process as it is constantly affected by the patient's needs, circumstances
impacting their needs, and the environment in which care is applied.
 It encompasses emotional, physical, social, and medical aspects.
 Each phase of the nursing process interacts with and is influenced by other phases in a cycle of activity.
 From the time of admission until the patient is discharged from care, the dynamics of the cycle of nursing care
continues.
HOW MANY STEPS ARE THERE IN THE NURSING PROCESS?
 The nursing process consists of five steps which encompass the care provided. The five nursing process steps are:
1. Assessment
2. Diagnosis
3. Planning
4. Implementation
5. Evaluation
  The nursing process is defined as a systematic, rational method of planning that guides all nursing actions in
delivering holistic and patient-focused care.
 The nursing process is a form of scientific reasoning and requires the nurse’s critical thinking to provide the best care
possible to the client.
STEPS OF THE NURSING PROCESS

I. ASSESSMENT PHASE

What Is the Assessment Phase?

 The first phase of the nursing process is the assessment phase.
 In this phase, the nurse collects and organizes data related to the patient.
 Data includes information about the patient, family, caregivers, or the patient's community or environment as it is
relevant to his health and well-being.
What Is the Top 3 Reasons Why the Assessment Phase Is Important?
All phases of the nursing process are essential. The following are a few reasons why the assessment phase is important for
nurses to provide care.
1. In the assessment phase of the nursing process steps, the nurse gathers all pertinent information that will be used to
establish a care plan.
2. Every other step of the nursing process builds upon the previous. Without a thorough assessment, the other steps of
nursing care may be negatively impacted, resulting in unfavorable outcomes.
3. When assessments are performed correctly, they help reduce risks to patient safety which could occur when
symptoms or other factors are not considered.

What Are The 5 Main Objectives of The Assessment Phase?

 The assessment phase of the nursing process involves gathering information about the patient, which is used to
guide planning care, setting goals for recovery, and evaluating patient progress.
 Nurses can obtain information about the patient by implementing the following objectives.
1. Establish communication with the patient.
 The patient is the nurse’s main source of information. Therefore, it is essential to establish rapport with them as
soon as possible.
2. Establish communication.
 with the patient's family or caregivers when appropriate. Family members, friends, or other caregivers often
offer insight into what is going on with the patient.
 It is important for nurses to listen to the patient’s support people and gather any information available.
3. Conduct a patient interview.
 When the patient feels comfortable, it makes it easier to get the necessary information that will be used to
establish a plan of care. The patient interview is one of the main sources of information used to plan patient
care.
4. Collect objective data.
 Any information that is measurable or observable such as vital signs and test results is considered objective data.
5. Collect subjective data.
  Subjective data is information gathered from the patient.

What Skills Are Required for The Assessment Phase?

 Assessments are vital to the nursing process.
 The information gathered in the assessment phase impacts every component of patient care.
 Nurses must demonstrate excellent verbal and written communication skills, strong attention to detail, and
possess an in-depth understanding of body systems.
 The most frequently used clinical skills for patient assessment are inspection, percussion, palpation, and
auscultation.
What Exactly Does the Assessment Phase Involve?
 The assessment phase is a critical component of the nursing process.
 Information gathered in this phase is used to establish a foundation upon which all patient care moving forward is
established.
 Remember, it is normal for patients to feel nervous or fearful when they are sick and in an unfamiliar place, like a
hospital. Therefore, the nurse needs to establish an environment conducive to patient comfort.
 The assessment may include but is not limited to, the following aspects:
o environmental,
o physical,
o cultural,
o psychological,
o safety, and
o psychosocial assessments.
The following is a guideline of what should happen during the assessment phase.

1. Data Collection:
 During the assessment phase, the nurse collects objective and subjective data using proven methods to assess
the patient.
 The most common methods for collecting data are the patient interview, physical examination, and observation.
 The patient interview is a deliberate or intended communication or conversation with the patient. It is used to
obtain information, identify problems that concern the patient and/or the nurse, evaluate changes, provide
support, and educate the patient and family/caregivers.
 The nurse will also conduct a head-to-toe nursing assessment addressing each body system and noting any
abnormalities, complaints, or concerns. Observation requires the nurse to use all their senses (sight, touch,
smell, hearing) to learn about the patient.
2. Organize and Validate Data:
 After collecting data, the nurse must organize and validate data and document about the patient's health status.
 Validation is the process of verifying data to be sure it is factual and accurate. Nurses must be careful to not
come to conclusions without adequate data to support their conclusion.
 It is also necessary to understand the difference between inferences and cues.
o Cues are signals the patient uses to alert the nurse about a concern or question or objective data the
nurse can observe or measure.
o Inferences are the nurse's conclusion or interpretation based on cues.
o For example, the patient may complain about a painful incision two days post-operatively, and the nurse
may observe the incision site is red and feels hot. These are cues. The nurse then makes an inference
that the operative incision is infected.
3. Documenting Data:
 After data from the assessment is collected, organized, and validated, it must be recorded. One thing I always
tell nursing students and cannot stress enough to any nurse is, "If you didn't document it, you didn't do it."
  While that may seem harsh, from a legal standpoint, if a nurse is asked to verify care or treatment and there is
no supporting documentation, there is no way to prove the care occurred.
 Thorough documentation is one of the best ways for everyone involved in patient care to be aware of changes in
the patient's status, and it helps promote effective collaboration within the interdisciplinary team.

5 Common Challenges You Will Face During the Assessment Phase and How to Overcome
 While all the nursing process steps are essential, without a thorough assessment, the other steps of the nursing
process are not as easy to follow through.
 Nurses must recognize barriers that could impede the assessment phase and find ways to overcome them.
 The following are five common challenges you may face during the assessment phase and some suggestions on how
to overcome them.
 Challenge #1: Limited Time
o About the Challenge:
o There are days when nurses feel as though there aren’t enough hours to accomplish all the work that needs
to be done. When you are short-staffed or have several patients waiting for a nursing assessment before you
can initiate care, it can feel a bit overwhelming.
o How to Overcome:
o Even on the busiest of days, it is important for nurses to perform thorough nursing assessments for all
patients assigned to them. That means it is necessary to learn to manage time efficiently. The first step in
overcoming limited time is to be familiar with the format or forms your employer uses to record
assessments.
o For example, the Health Information Technology for Economic and Clinical Health Act of 2009 advanced the
adoption and use of electronic health records. Nearly one hundred percent of hospitals use some type of
EHR. Electronic health records have helped improve workflow by eliminating time spent pulling physical
charts or documenting in paper charts.
 Challenge #2: Interruptions
o About the Challenge:
o It is not uncommon for interruptions to occur when nurses are performing assessments. While some
interruptions may be necessary, all are not. Interruptions during patient assessments can delay care and
could result in errors or omissions.
o How to Overcome:
o The best way to overcome the challenge of interruptions during the assessment step of the nursing process
is to provide for privacy before you begin the assessment.
o Whether you are working in triage, assessing a patient newly admitted to your floor, or in a busy emergency
room, it is possible to reduce interruption. Pull the privacy curtain closed if you are in an area with more
than one patient or several staff close by. Some facilities use "Do Not Disturb" or "Room in Use" signs to
provide privacy for nurses and patients.
 Challenge #3: Inexperience
o About the Challenge:
o Every nurse knows the importance of a good nursing assessment. Newly graduated nurses are less
experienced than other nurses and may feel uneasy about performing a nursing assessment alone.
Additionally, if your facility changes its documentation format or implements a new program for charting,
and you've not yet used the program, your inexperience could pose a challenge when doing an assessment.
o How to Overcome:
o The only way to overcome inexperience is to become experienced. Nursing assessments are typically
classified as either a Complete Health Assessment or a Problem-Focused Assessment. Know which type of
assessment you need to perform.
 o Gather basic equipment: gloves, thermometer, blood pressure cuff, stethoscope, penlight, and watch.
Establish a sense of trust and respect between the patient and yourself.
o No matter which type of assessment you perform, it should be systematic, making sure you cover each body
system. If you assess each body system and make notes about what is normal/abnormal, you decrease the
chances of omissions in documentation. Remember, take your time, trust your instincts, and if you need
help, ask for it.
 Challenge #4: Patient Anxiety
o About the Challenge:
o Patient anxiety can create a significant challenge for nurses during a patient assessment. Anxiety can hinder
communication making it difficult to gather all the necessary data. If anxiety is bad enough, it can cause
changes in vital signs, which could be misinterpreted as something more than an anxious reaction.
o How to Overcome:
o Before beginning an assessment, take the time to make your patient comfortable. While you may not have
time for a long conversation or "get to know you" session, you can ease your patient's anxiety by being calm
and friendly.
o Some questions may make patients feel uncomfortable, especially teenagers. Allow them time to answer
your questions without feeling rushed. Verify their understanding by asking if they can explain what you've
discussed in their own words.
o Remember, everyone gets nervous or anxious at times, and when we are sick, it can be worse. It's nothing
personal against you or your skills. Make everything about the patient.
 Challenge #5: Patients Not Being Forthcoming About Symptoms
o About the Challenge:
o Whether it is fear of the unknown, embarrassment, or another reason, there are times when patients may
be apprehensive about sharing personal information.
o Lack of information or omission of details that the patient may think is irrelevant may negatively impact the
process of care planning. Therefore, while it is easy to understand a patient's apprehension, it is crucial for
nurses to gather as much information as possible when performing a nursing assessment.
o How to Overcome:
o It can be easy to feel frustrated if a patient is not forthcoming about symptoms during an assessment. Keep
in mind, being sick and needing medical care can be frightening.
o The best way to get patients to talk to you is to be accepting of them, no matter what. Be sure to tell your
patient you are there for them and will work with them to help them get better. When you say things like
you will "work with them," it lets your patient know you are going to do your part, but you expect them to
do theirs as well.
o If you feel like your patient is withholding information, instead of making an accusation, try to rephrase the
question. Make your questions clear so the patient knows what information you need.

Real-World Example of The Assessment Phase

The format for recording nursing assessment data may vary from one facility to another. However, the information gathered
for the assessment is relatively similar. The following are examples of content the nurse should include in the initial nursing
assessment phase of the nursing process.
Admission Notes
Date of Admission: 04/19/22 Time: 13.30
Transported By: J. Mock, LPN
Age: 54 yrs. 2 mos. Sex: M Height: 6’2” Weight: 268lbs 4oz
Attending Physician: Dr. Michael Coulvan
Date of Birth: 03/04/1968
Admitting Diagnosis: CHF, acute
Vital Signs on Admission: Temp 98.8, Resp. 20, Pulse 76, BP 136/80
Allergies: NKDA, no food allergies
Patient Demographics
Patient Name: Jerold R. Collie
Address: 123 Blakely Lane, Clayton, MO. 1234
Phone: (318) 555-1234

Physical Assessment
• Neurological: Alert & Oriented x3; PERRLA, Unaided hearing; Bilateral hand grips equal; Bilateral foot push equal; no
evidence of tremors; denies tingling, burning, loss of consciousness, hallucinations, disorientation, visual disturbances, or
hx/o brain injury or stroke.
• Cardiovascular: Pulses present, regular, and strong: x2 upper extremities (Radial); present X2 lower extremities (Pedal);
heart rate regular, strong; capillary refill <3 second upper and lower extremities
• Respiratory Status: Respirations even, labored; Dyspnea on exertion; Lungs: Bilateral rales in lung bases; Cough:
Nonproductive; Oxygen: 2L per NC
• Gastrointestinal: Reports 10 lb weight gain in last two weeks. Continent of bowel; Last BM 4/19/22; Laxatives: No, Enemas:
No; Hx of Constipation: No
• Genitourinary: Continent of bladder; Uses urinal prn; urinal emptied of approximately 200 cc clear, amber urine
• Integumentary: Skin is pink, warm, and dry; Mucous membranes pink and moist
• Musculoskeletal: Reports pain and stiffness in joints of hands mostly in the a.m.; denies history of gout, arthritis, bursitis,
or fractures; Negative paralysis; Negative contractures, No congenital anomalies; No prosthetic devices; Able to carry out
most ADLs with minimal assist but may require periods of rest r/t dyspnea with exertion; Uses walker for ambulation.
Pain Assessment
Location: Headache Intensity: Constant, throbbing Pain Scale: 5
Functional Status: Full weight-bearing; Ambulatory with 1 person assist; Client uses walker occasionally; No supportive
devices

Psychosocial: Client is alert, friendly, and answers questions readily; Comprehension: rapid.
Marital Status: Divorced; Client lives alone in his own home; Has two adult children who live nearby and visit frequently;
Client reports he has several close friends who call or visit often.
Prior Medical History: History of hypertension; Denies any other medical issues prior to this admission.
Substance Use: Client reports previous substance abuse, methamphetamine was his drug of choice. Client states he has
been substance and alcohol-free for three years.
Family Medical History: Paternal hx/o CHF, HTN, and Lung Ca. Maternal hx/o DM, and HTN.

*In addition to the information the nurse will gather during her assessment, the assessment phase of the nursing process
includes gathering objective data such as copies of laboratory or diagnostic testing. If the facility uses electronic health
records, as most do, this information will probably already be uploaded to the patient’s electronic chart. It is, however, the
nurse’s responsibility to gather and verify all data is available.

Frequently Asked Questions About the Assessment Phase

1. Why Is Assessment the First Step of The Nursing Process?
The assessment phase of the nursing process lays the foundation upon which all other nursing process steps build. The
information gathered during the nursing assessment tells the nurse about the patient’s history, current complaints,
medications, and any other pertinent information that may impact care planning. Without a thorough, proper patient
assessment, it is impossible to develop a patient-specific care plan.
2. How Is the Data for Assessment Obtained?
Nurses collect data during the assessment phase by communicating with the patient, spouse, and caregivers, reading patient
records, nursing observation, and collecting measurable data such as vital signs.
3. What Subjective Data Is Collected When Assessing a Patient?
Subjective data is any information the nurse collects through communication. A few examples of subjective data include the
reason for the patient’s visit to the doctor, patient or family medical history, medications the patient is taking, and any
symptoms such as chills, aches, or pain.
4. What Objective Data Is Collected When Assessing a Patient?
Objective data is any measurable information obtained from sources other than the patient. For example, the patient’s
height, weight, vital signs, and laboratory or diagnostic test results are objective data collected during a patient assessment.
5. How Do Nurses Collect Verbal Data?
Nurses collect verbal data by talking to patients, their family members (when appropriate), and other members of the
healthcare team. Subjective matter is usually often the result of verbal communication during the patient interview.
6. How Do Nurses Collect Nonverbal Data?
Nonverbal data is collected during the assessment phase of the nursing process by observing the patient's body language,
reading patient charts, or medical test results. For example, the patient may not offer a verbal report of pain, but the nurse
may observe him clutching or guarding his side, which could indicate pain.
The nurse can use the nonverbal data to form assessment questions as a way of following up with what she has observed or
read.

7. What Are the Sources from Where Data Is Collected?

The primary source of data collection during the nursing assessment is the patient. Other sources include family, friends,
caregivers, and other members of the healthcare team. Data are also collected from laboratory or diagnostic reports, the
patient’s medical records, and the nurse’s observations.
8. What Does Tertiary Source of Data Mean?
Tertiary data are data gathered from sources such as the patient's chart, lab, or x-ray reports. Nurses may also use tertiary
sources such as diagnostic manuals or textbooks to verify or compare information.
9. How Do Nurses Verify Whether the Collected Data Is Accurate or Not?
Nurses can use a few methods to verify the accuracy of data collected during the assessment phase of the nursing process.

A few ways to verify data is to clarify information with the patient by asking additional questions, compare objective and
subjective data to see if there are any discrepancies, recheck data by repeating the assessment, and verifying data with
another nurse or healthcare team member.

One example of verifying data is to perform repeat vital sign check. For instance, if Mr. Jones has a blood pressure reading of
220/100 but has no history of hypertension, the nurse should retake his blood pressure to validate its accuracy. If the nurse
feels it is necessary, they may use different equipment or ask someone else to perform the vital sign check to check for
accuracy.
10. What Methods Do Nurses Use to Collect Data?
The primary methods nurses use to collect data are observation, patient interviews, and head-to-toe assessments.
11. What Tools and Equipment Are Used To Collect Data?
Nurses use various tools and equipment to help gather data about patients. A few examples of tools and equipment nurses
use include a stethoscope, blood pressure cuff, thermometer, pulse oximeter, and scales. You may need a glucometer and
lancets to check blood sugar, as well.

Application of Nursing Process

 The nursing process is a systematic, rational method of planning and providing nursing care.
 A process is a series of steps or acts that lead to accomplishment of some goal or purpose.
 The purposes of the nursing process are to identify a client's healthcare status, and to actual or potential health
problems, to establish plans to meet the identified needs, and to deliver specific nursing interventions to address
those needs.
Characteristics of Nursing Process
  Nursing Process is client-centered.
 The Nursing Process is cyclic and dynamic (The steps of the nursing process build upon each other, but they are not
linear. There is an overlap of each step with the previous and subsequent steps).
 The Nursing Process is Universally applicable (designed to be used with clients throughout the life span and in any
setting where a nurse provides care for clients).

Assessment
 Assessment is the systematic and continuous collection, organization, validation, and documentation of data
(information).
 Assessment is a continuous process carried out during all phases of the nursing process.
 All phases of the nursing process depend on an accurate and complete collection of data.
Types of assessment
1. Initial Assessment.
2. Problem-focused assessment.
3. Emergency assessment.
4. Time –lapsed assessment.
1. Initial Assessment
 Performed within specified time after admission to a health care agency.
 To establish a complete database for problem identification, reference and future comparison.
 Example: Nursing admission assessment.
2. Problem – Focused Assessment
 Ongoing process integrated with nursing care.
 To determine the status of a specific problem identified in an earlier assessment, and to identify new or
overlooked problems.
 Example: Hourly assessment of client’s fluid intake and output.
3. Emergency Assessment
 Performed during any physiologic or psychological crisis of the client.
 Its purpose is to identify life-threatening problems.
 Example: Rapid assessment of airway, breathing, and circulation during a cardiac arrest.
4. Time- lapsed reassessment
 Performed several months after initial assessment.
 Its purpose is to compare the client’s current status to baseline data previously obtained.
 Example: Reassessment of the patients in outpatient setting after being discharged.
Components of Nursing Health History
 Biographic data:
 Name, Age, Gender, Marital status, Occupation, religion, Education, Income.
• Chief Complaint:
 Is the answer of the patient to question of: “ What brought you to the hospital or clinic.
 Should be recorded in patient’s own words.
 Example:
 Patient said: “I had severe pain in my chest, I was unable to breathe since last night”
• History of present illness:
 Onset: When the symptoms started?
 Pattern of onset: Gradual or sudden.
 Setting: Place where the patient was when the symptom started?
 Severity: Mild, Moderate, Severe.
 Location
 Quality: characteristics of problem.
 Radiation
 Duration
 Palliative and aggravating factors
  Associated symptoms
o Example of “History of present illness”:
1. Onset: pain started suddenly last night at 3.30 AM.
2. Setting: patient stated that he was in bed at home when pain started.
3. Location: pain is originated in the chest.
4. Quality: pain is like tightness on the chest.
5. Severity: patient said that pain was severe.
6. Duration: patient stated that the pain was continuous.
7. Radiation: patient stated that the pain is radiated to left arm and back.
8. Palliative factors: patient stated that the pain was slightly decreased with rest.
9. Aggravating factors: patient stated that pain was increasing with movement, and exposure to cold.
10. Associated symptoms: this pain was associated with Dyspnea, and nausea.
 Past History:
 Childhood illnesses: Chickenpox, Rubella, measles, rheumatic fever, …..etc.
 Childhood immunizations.
 Allergies to drugs, animals, food, insects.
 Accidents and injuries.
 Previous hospitalizations.
 Family History:

 Lifestyle:
 Personal habits: include amount, frequency, and duration of substance use (Coffee, Tea, cola, Tobacco).
 Diet.
 Sleep.
 Hobbies.
 Daily activities.

TYPES OF DATA
• Subjective data (Symptoms): data which is only can be described and verified by the client himself/herself.
• Objective data (Signs): data which can be detected by the observer or the nurse. They can be seen, heard, smelled,
felt, and they are obtained through observation or physical examination.

EXAMPLES OF SUBJECTIVE & OBJECTIVE DATA

 Subjective data
 “I feel pain in my chest”.
 “I drink 2 cups of tea daily”
 Objective Data
 Blood Pressure: 140/90 mmHg.
 Skin is pale.
 “I feel weak when I walk two steps forward”
 Client cried during interview.
 Vomited 100 mL green fluid.

SOURCES OF DATA
1. Primary source
 includes only the client.
2. Secondary Source
  All sources other than client such as family members, records and reports, laboratory and diagnostic
findings, and health care providers.

DATA COLLECTION METHODS

a. Observing.
b. Interviewing.
c. Examining

a. OBSERVING
 To observe is to gather data by using the senses.
 Sense
 Vision
 Example of client data
 Body size, posture, grooming, skin color
 Smell
 Hearing
 Touch
 Body or breath odors
 Lung and heart sounds, bowel sounds, orientation.
 Skin temperature, pulse rate, muscle strength.
b. INTERVIEWING
 Interview: is a planned communication or conversation with purpose to get or give information.
 Types of interviews:
o Directive interview: the nurse establishes the purpose of the interview and control the interview.
o Nondirective interview: the nurse allows the client to control purposes of the interview.
 It is better to use a combination of both directive and nondirective in interviewing clients.

TYPES OF INTERVIEW QUESTIONS

 Close questions: used in directive interviews, and generally requires only “yes” or “No” or short factual answers.
 Example:
 “What medication did you take?”
 “Are you having pain now?”
 “How old are you?”
 “When did you fall?”
 Open questions: used in nondirective interview, ad invites the client to elaborate, discover, discuss, explore feelings
and thoughts.
 Example:
 “What brought you to the hospital?”
 “Describe the pain you feel in more details?”
 “What would you like to talk about today?”

FACTORS AFFECTING NTERVIEW PLANNING

 Time: nurse need to plan interviews with hospitalized clients when the clients is physically comfortable, free of pain,
minimal interruptions by friends and family members.
 Place: a well lightened, well ventilated, moderate sized room, free of noises.
 Distance: must be neither too small nor too great. It is about inches in Arab countries.
 Language: The nurse must convert complicated medical terminology to simple language.

STAGES OF INTERVIEW
•The Opening.
•The Body.
•The Closing.
THE OPENING
 In this stage, the nurse introduces her/himself to the client, and explain the purpose of the interview.
 Through thus stage, the rapport between nurse and client is established.
 It can be begun with greeting (“Good morning, Mr. Salem), or a self-introduction (I am Ibrahim, I am a nursing
student”), accompanied by nonverbal gestures such as smile, handshake.
THE BODY
 In this stage the client communicates what he/she thinks, feels, knows, and perceives in responses to questions of
the nurse.
THE CLOSING
 The nurse terminates the interview when the needed information is obtained.
 The closing is important for maintaining rapport and trust and for facilitating future interactions.
Techniques for closing interview:
 offer to answer questions: do you have any questions?
 conclude by saying: “well, that’s all I need to know for now?”
 Thank the client: “thank you for your time and help”
 Express concern for person's welfare: “take care of yourself”
 Plan for next meeting.
 Provide a summary to verify accuracy and agreement.

ORGANIZING DATA
 We use nursing and non-nursing models.
 Non-nursing models such as Maslow hierarchy of needs, and body system models

 BODY SYSTEMS MODEL

 Integumentary system.
 Respiratory system.
 Cardiovascular system.
 Nervous system.
 Musculoskeletal system.
 Gastrointestinal system
 Genitourinary system.
 Reproductive system
 Immune system.
 DO NOT FORGET TO DOCUMENT EVERY THING YOU ASSESS
DIAGNOSING
 Is the pivotal second phase of the nursing process, in which the nurse interprets assessment data, identifies clients’
strengths and health problems, and formulates diagnostic statements.
 According to NANDA: “Diagnosis is a clinical judgment about individual, family, and community response to actual or
potential health problem /life processes”

TYPES OF NURSING DIAGNOSES

 Actual diagnosis: is a client problem that is present at the time of assessment.
 Example: Anxiety, Ineffective breathing pattern
 Risk Diagnosis: is a clinical judgment that a problem doesn’t exist, but the presence of risk factors indicates that the
problem is likely to develop.
 Example: Risk for infection
 Wellness diagnosis: it describes the human responses to level of wellness in an individual, family, and community
that have a readiness for enhancement.
 Example: Readiness for enhanced family coping
 Possible diagnosis: is one in which evidence about a health problem is incomplete or unclear.
COMPONENTS OF NANDA NURSING DIAGNOSIS
1. Problem: describe the client health problem or response for which nursing therapy is given
 Examples:
o Anxiety.
(Problem)
o Fluid Volume Deficit.
o Ineffective breathing pattern.
o Knowledge deficit.
o Risk for infection.
2. Etiology: identifies one or more probable causes of the health problem.
Example:
Constipation related to inactivity and insufficient fluid intake.
(Problem) (Etiology)
3. Defining characteristics: are the cluster of signs and symptoms that indicate the presence of a particular problem
Example:
Anxiety related to breathlessness and medication’s side effects as manifested by patient verbalization and facial expressions
(Problem) (Etiology) (Defining characteristics)

EXAMPLES OF NURSING DIAGNOSIS

Chest pain related to increased oxygen demand and decreased oxygen supply as manifested by patient
verbalizations, facial expression (furrow eyebrows).
o Problem: Chest pain.
o Etiology: Increased oxygen demand and decreased oxygen supply.
o Defining characteristics: patient verbalizations, facial expression
Risk for Infection related to presence of open surgical wound in chest and left leg.
o Problem: Risk for infection.
o Etiology: Presence of open surgical wound in chest and leg.
EXAMPLE
 Patient said:" I feel chest pain radiated to my back and left arm lasted for about 20 minutes".
 Patient stated that pain severity is about 8 on scale.
 Patient stated that pain was slightly decreased but not relieved by rest.
 Facial expressions: furrow eyebrows, no smile.
 Patient’s heart rate was 123 b/m.
Nursing Diagnosis:
Severe chest pain related to increased oxygen demand and decreased oxygen supply as manifested by the patient
verbalizations, facial expression (furrow eyebrows, absence of smile), tachycardia, patient is anxious.
PLANNING
 Planning is the third phase in which the nurse and the client develop goal, desired outcomes, and nursing
interventions to prevent, reduce, or alleviate a client health problem.
 Nursing Intervention: is any treatment, based upon clinical judgment and knowledge, that the nurse performs to
enhance patient or client outcomes.

TYPES OF PLANNING
 Initial Planning: is planning which performed by the nurse after admission assessment.
 Ongoing Planning: is performed by all nurses who work with the client. Also, ongoing planning may perform before
each shift as the nurse plans the care given at that day.
 Discharge Planning: is the process of anticipating and planning for needs after discharge.

CARE PLANS
 Informal nursing care plan: is a strategy of action that existsin the nurse’s mind.
 Formal nursing care plan: is a written or computerized guide that organizes information about the client’s care.
 Standardized care plan: a formal plan that specifies the nursing care for groups of clients with common needs.
 Individualized care plan: a formal plan that specifies the nursing care for individual with unique needs.
THE PLANNING PROCESS
 Setting priorities.
 Establishing client goal / desired outcomes.
 Selecting nursing interventions.
 Writing nursing orders.

SETTING PRIORITIES
 Setting priority: is the process of establishing a preferential sequence for addressing nursing diagnoses and nursing
interventions.
 Nurses frequently use Maslow hierarchy of needs when setting priorities.
 For example: “Ineffective airway clearance” take higher priority over “Anxiety”

ESTABLISHING CLIENT GOALS/DESIRED OUTCOMES

 On care plan, “Goal/Desired Outcomes” describes what the nurse hopes to achieve by implementing the nursing
interventions.
 Goal: is a broad statement about the client’s status.
 Desired outcomes: specific statements used to evaluate whether goal have been met or not.

EXAMPLE OF GOAL AND DESIRED OUTCOMES

 Nursing diagnosis: Altered nutrition: less than body requirements.
 Goal: To improve nutritional status of the client.
 Desired outcome: Patient will gain 10 kg within 1 month.

TYPES OF GOALS
 Short term goal is the goal that needs shorter time to be achieved (usually lesser than 6 weeks).
 Example: Client will reports decrease in anxiety level within 6 hours.
 Long term goal: is the goal that needs longer time to be achieved (usually more than 6 weeks).
 Example: Client will regain full use of right arm within 6 weeks.

COMPONENTS OF GOAL/DESIRED OUTCOMES

 Subject: is the noun, or any part of client’s name, or some attribute of the client.
 Verb: specifies the action that the client is to perform.
 Condition: added to verb to explain circumstances under which the behavior is to be performed. They explain what,
where, when, and how.
  Criterion of desired performance: specifies the time or speed, accuracy, distance, and quality.

HOW TO WRITE DESIRED OUTCOME

Client will drink 100 mL of water per hour

Subject Verb Condition Criterion

EXAMPLES OF DESIRED OUTCOME

Client will perform leg range of motion exercises as taught every 8 hours.
Subject Verb Condition Criterion

Client will list three signs and symptoms of diabetes before discharge
Subject Verb Condition Criterion

EXAMPLES OF ACTION VERBS

Apply Drink Select

Breathe Explain Share
Choose Identify Sit
Compare Inject Sleep
Define List State
Demonstrate Move Talk
Describe Name Transfer
Discuss Report Verbalize

SELECTING NURSING INTERVENTIONS

 Nursing interventions: are the activities that the nurse perform to achieve client goals.

Types of nursing interventions:

 Independent nursing intervention: are those activities that nurses are licensed to initiate on the basis of their
knowledge and skills.
 Dependent nursing intervention: are those activities that carried out by the nurses under the physician's order or
supervision.

WRITING NURSING ORDERS

4/4/2011: Administer prescribed analgesics every12 hours / I.R.A
Date Action Verb Content Area Time element Signature

DEFINITION OF INDIVIDUAL
 is a single, distinct, and unique person, organism, or entity referring to a single member of a species, particularly a
human being, considered as a separate and independent entity with its own characteristics, identity, and agency
CONCEPTS & CHARACTERISTICS
 Uniqueness: Every individual is unique, possessing a distinct combination of physical traits, personality, thoughts,
and experiences. This uniqueness is a fundamental aspect of the concept of an individual.
 Autonomy: Individuals have the capacity to make independent choices and decisions. Autonomy implies that
individuals have the freedom to act according to their own will, within the boundaries of societal norms and laws.
 Rights and Responsibilities: Individuals have legal and moral rights, such as the right to life, liberty, and the pursuit
of happiness. With these rights come responsibilities, including respecting the rights of others and abiding by
societal rules.
  Identity: Each individual has a sense of self, shaped by personal experiences, cultural background, values, beliefs,
and social interactions. This self-identity plays a crucial role in how individuals perceive themselves and relate to
others.
 Development: Individuals go through stages of development across the lifespan, including physical, cognitive,
emotional, and social development. These developmental processes contribute to an individual's growth and
maturation.
 Society and Community: While individuals are unique, they also exist within a broader social context. They interact
with others in families, communities, and societies, influencing and being influenced by these social structures.
 Psychology and Behavior: Understanding the individual involves exploring psychological aspects such as personality,
motivations, emotions, and behaviors. Psychologists and researchers often study these aspects to gain insights into
human nature.
 Health and Well-being: Individual health and well-being are essential aspects of personal and societal concern.
Health professionals focus on the physical and mental well-being of individuals, aiming to improve their quality of
life.
 Legal Status: In legal contexts, individuals are recognized as legal entities with rights and responsibilities. This
recognition allows individuals to enter into contracts, own property, and engage in legal processes.
 Cultural Variability: The concept of an individual can vary across cultures. Some cultures prioritize collectivism,
emphasizing group identity and interdependence, while others emphasize individualism, valuing personal
autonomy and achievement.
 Ethical Considerations: Ethical discussions often revolve around the treatment of individuals, including issues
related to human rights, justice, and fairness.

STRUCTURES OF AN INDIVIDUAL
 Physical Structure: This includes the individual's body, organs, and systems. Community health nurses assess an
individual's physical health, vital signs, and any physical conditions or illnesses.
 Psychological Structure: This encompasses the individual's mental and emotional well-being. Nurses consider an
individual's mental health status, emotional state, and cognitive abilities when providing care.
 Social Structure: The social structure includes an individual's relationships, family dynamics, living conditions, and
social support networks. Community health nurses assess the social determinants of health, such as housing,
employment, and access to social services.
 Cultural and Ethnic Identity: Understanding an individual's cultural background and ethnic identity is essential for
providing culturally competent care. This includes recognizing cultural beliefs, values, and practices that may
influence health behaviors.

FUNCTIONS OF AN INDIVIDUAL
 Autonomy and Decision-Making: Individuals have the right to make decisions about their own health and
healthcare. Community health nurses respect an individual's autonomy and involve them in decision-making
regarding their care.
 Self-Care: Promoting self-care is a key function of community health nursing. Nurses educate individuals about
healthy behaviors, self-monitoring, and self-management of chronic conditions.
 Health Promotion: Community health nurses work with individuals to promote health and prevent illness. This
includes providing information on healthy lifestyles, nutrition, exercise, and immunizations.
 Disease Prevention: Nurses help individuals identify risk factors for diseases and take preventive measures. This can
involve vaccinations, screenings, and lifestyle changes to reduce disease risk.
 Illness Management: When individuals are already experiencing health issues, nurses assist with illness
management. This includes, medication management, symptom management, and adherence to treatment plans.
 Advocacy: Nurses may advocate for individuals within the healthcare system, ensuring they receive appropriate care
and have access to necessary services.
 Education: Community health nurses provide health education to individuals and their families. This includes
explaining medical conditions, treatment options, and the importance of adhering to prescribed therapies.
 Assessment: Nurses continually assess an individual's health status, identifying changes or potential issues that
require attention. Regular assessments help in early detection and intervention.
  Referral: If an individual's healthcare needs extend beyond the scope of community health nursing, nurses may
refer them to specialized healthcare providers or services.
 Support: Providing emotional and social support is a critical function. Nurses offer empathy, active listening, and
counseling to help individuals cope with health challenges.
 Community Integration: Nurses help individuals connect with community resources and support networks that can
enhance their well-being and social integration.
 Health Equity: Promoting health equity is a fundamental function. Nurses advocate for equal access to healthcare
and work to address disparities in health outcomes among individuals and communities.

FAMILY
 The family is the unit of service in community and public health nursing
 The family is the basic unit of society and the social institution that has the most marked effect on its members
(Friedman, 1986).
 the family is a group of persons usually living together and composed of the head and other persons related to the
head by blood, marriage, or adoption (NSCB in 2008), (NCSB = National Statistical Coordination Board)
 A group of persons united by ties of marriage, blood or adoption, constituting a single household, interacting and
communicating with each other, in their respective social roles, of husband and wife, mother and father, son and
daughter, brother, and sister, creating and maintaining a common culture is two or more persons who are joined
together by bonds of sharing and emotional closeness and who identify themselves as being part of a family
(Friedman, 1998).
 is an open and developing system of interacting personalities with a structure and process enacted in relationships
among the individual members, regulated by resources and stressors, and existing within the larger community.

FAMILY
 WHO characterizes the family as A primary social agent in the promotion of health and well-being
HOUSEHOLD
 A group of persons living under one roof and sharing the same kitchen, and housekeeping arrangements.
 Not related by marriage, blood or adoption
 Not engaged in the performance of familial roles

I N COMMUNITY AND PUBLIC HEALTH NURSING, THE FAMILY IS CONSIDERED AS A UNIT OF SERVICE
 considered as the “natural” and fundamental unit of the society.
 It is an institution that involves the majority of the population group that generates, prevents, tolerates and corrects
health problems within its membership.
 acts as the basic care provider. It is the family that works to achieve certain health goals.
 The health problems of the family are interlocking. Illness in one member affects the entire family and its
functioning, is the most frequent focus of health decisions and actions in personal care is an effective and available
channel for much of the community health nursing efforts.
 Improved community health is realized only through improved health families

Factors & issues affecting Health & Illness

• Definition of Health and Wellness
• Dimensions of Wellness
• Different Models of Health
- Judith Smith's Model
- Leavell and Clark's Agent- Host - Environment Model
• The Health-Illness Continua
- Dunn's Health Grid
- Travis' Illness-Wellness Continuum
• Illness and Disease
• Definition
 • Classification of Illness
• 4 aspects of the sick role (Parsons)
• Five stages of Illness Behavior
• Effects of Illness on Client & Family

CONCEPT OF MAN
Bio-psycho-socio-spiritual human being
 Man is a BIOPSYCHOSOCIAL and SPIRITUAL being who is in constant contact with the environment.
 As a biologic being, man is like other men.
 As a psychologic being, man is like no other man.
 As a social being, man is like some other man.
 As a spiritual being, man is like all other men.
 Man is composed of subsystems and suprasystems.
 Man is a unified whole composed of parts which are interdependent and interrelated with each other.
 Man is composed of parts which are greater than and different from the sum of all his parts.

Four Major Attributes of a Human Being

1. The capacity to think or conceptualize on the abstract level.
2. Family formation
3. The tendency to seek and maintain territory
4. The ability to use verbal symbols as language, a means of developing and maintaining culture

Basic Human Needs

 Each individual has a unique characteristic, but certain needs are common to all people.
 Human needs are physiologic and psychologic conditions that an individual must meet to achieve a state
of well-being.

Human Needs
 Necessary, useful, or desirable to maintain well- being & life; motivation for behavior.
 May be met consciously or unconsciously

Characteristics of Basic Human Needs

 Needs are universal.
 Needs may be met in different ways.
 Needs may be deferred.
 Needs may be interrelated.
 An unmet human need results in disruption of normal body activities and frequently leads to eventual illness.
CONCEPTS OF HEALTH, WELLNESS, AND WELL-BEING
 Health was defined in terms of the presence or absence of disease.
 Health as a state of being well and using every power the individual possesses to the fullest extent.
Florence Nightingale (1860/1969)
 Health has also been defined in terms of role and performance. Talcott Parsons (1951)
 "Health is not a condition; it is an adjustment. It is not a state but a process. The process adapts the
individual not only to our physical but also our social environments" U.S. President's Commission on
Health Needs of the Nation (1953)
 "Health as a state of complete physical, mental, and social well-being, and not merely the absence of
disease or infirmity." (WHO) (1948)
 "Health and illness are human experiences. The presence of illness does not preclude health, nor does
optimal health preclude illness" ANA (2010)
PERSONAL DEFINITIONS OF HEALTH
• 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 in good spirits most of the time.
1. Definitions vary according to an individual's previous experiences, expectations of self, age, and
sociocultural influences.
2. A person's definition of health influences behavior related to health and illness.

 There is no consensus about any definition of health. There is knowledge of how to attain a certain level of
health, but health itself cannot be measured.

 Reflects concern for the individual asa total person functioning physically, psychologically, and socially.
Mental processes determine people’s relationship with their physical and social surroundings, their
attitudes about life, and their interaction with others.
o Places health in the context of environment. People’s lives, and therefore their health, are affected
by everything they interact with-not only environment influences such as climate and the availability
of nutritious food, comfortable shelter, clean air to breathe, a pure water to drink, but also other
people, including family, lovers, employers, coworkers, friends, and associates of various kinds.
o Equates health with productive and creative living. It focuses on the living state rather than on
categories of disease that may cause illness or death.

 Health has also been defined in terms of role and performance. Talcott Parsons (1951), an eminent
American sociologist and creator of the “sick role”, conceptualized health as the ability to maintain roles.

WELLNESS
 Wellness is a state of well-being. Basic concepts of wellness including self- responsibility; an
ultimate goal; a dynamic, growing process; daily decision making in the areas of nutrition, stress
management, physical fitness, preventive health care, emotional health, and other aspects of
health; and, most importantly, the whole being of the individual.
 Anspaugh, Hamrick, and Rosato (2003, pp. 3-7) propose seven components of wellness. To realize
optimal health and wellness, people must deal with the factors within each component:
 Physical. The ability to carry out daily tasks, achieve fitness (e.g., pulmonary,
cardiovascular, gastrointestinal), maintain adequate nutrition and proper body
fat, avoid abusing drugs and alcohol or using tobacco products, and generally
to practice positive lifestyle habits.
 Social. The ability to interact successfully with people and within the
environment of which each 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.
 Emotional. The ability to manage stress and to express emotions
appropriately. Emotional wellness involves the ability to recognize, accept, and
express feelings and to accept one’s limitations.
 Intellectual. The ability to learn and use information effectively for personal,
family, and career development. Intellectual wellness involves striving for
continued growth and learning to deal with new challenges effectively.
 Spiritual. The belief in some force (nature, science, religion, or a higher power)
that serves to unite human beings and provide meaning and purpose to life. It
includes a person’s own morals, values, and ethics.
 Occupational. The ability to achieve a balance between work and leisure time.
A person’s beliefs about education, employment, and home influence personal
satisfaction and relationships with others.
 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.
 Models of Health and Wellness
 Because health is such a complex concept, various researchers have developed
models or paradigms to explain health and in some instance its relationship to
illness or injury. Models can be helpful in assisting health professionals to meet
the health and wellness needs of individuals. Nurses need to clarify their
understanding of health, wellness, and illness for the following reasons:
 A nurse’s definition of health largely determines the scope and nature of nursing
practice. For example, when health is defined narrowly as a physiologic
phenomenon, nurses confine themselves to assisting clients to regain normal
physiologic functioning. When health is defined more broadly, the scope of
nursing practice increases correspondingly.
 People’s health beliefs influence their health practices. Thus, a nurse health
values and practices may differ from those of a client. Nurses need to ensure
that a plan of care developed for an individual relates to the client’s conception
of health. Otherwise, the client may fail to respond to a health care regimen.

Models of Health and Wellness

 clinical model
 the role performance model
 the adaptive model
 the eudaimonistic model
 the agent-host-environment model
 Health-illness continua

Clinical Model
 The narrowest interpretation of health occurs in this model.
 People are viewed as physiological systems
 It is considered the state of not being "sick."

Role Performance Model

• Health is defined in terms of an individual's ability to fulfill societal roles.
• According to this model, people who can fulfill their roles are healthy even if they
have clinical illness.
• It is assumed in this model that sickness is the inability to perform one's work role.

Adaptive Model
 In the adaptive model, health is a creative process; disease is a failure in adaptation, or
maladaptation.
 According to this model, extreme good health is flexible adaptation to the environment and
interaction with the environment to maximum advantage.

Eudaimonistic Model
 The eudaimonistic model incorporates a comprehensive view of health.
 Health is seen as a condition of actualization or realization of a person's potential.
 In this model the highest aspiration of people is fulfillment and complete development,
which is actualization.
  Illness, in this model, is a condition that prevents self-actualization.

Agent-Host-Environment Model
• The agent-host-environment model of health and illness, also called the ecologic model.
• The model is used primarily in predicting illness rather than in promoting wellness.
• The model has three dynamic interactive elements:
1. Agent
2. Host
3. Environment

Health-Illness Continua

• Health-illness continua (grids or graduated scales) can be used to measure a

person's perceived level of wellness.
• Health and illness or disease can be viewed as the opposite ends of a health
continuum .

Dunn's High-Level Wellness Grid

ILLNESS-WELLNESS CONTINUUM
 ranges from optimal health to premature death
 The model illustrates arrows pointing in opposite directions and joined at a neutral point.
Movement to the right of the neutral point indicates increasing levels of health and
wellness for an individual.
 In contrast, movement to the left of the neutral point indicates progressively decreasing
levels of health.

• Health-illness continua (grids or graduated scales) can be used to measure a person’s

perceived level of wellness.
• Health and illness or disease can be viewed as the opposite ends of a health continuum.
• From a high level of health person’s condition can move through good health, normal
health, poor health, and extremely poor health, eventually to death.
• People move back and forth within this continuum day by day.
• There is no distinct boundary across which people move from health to illness or from
illness back to health.
• How people perceive themselves and how others see them in terms of health and illness
will also affect their placement on the continuum.
• The ranges in which people can be thought of as healthy or ill are considerable.

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 behaviors - 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
o Biologic dimension
o Psychological dimension
o Cognitive dimension
  External variables
• Environment
• Standards of living
• Family and cultural beliefs
• Social support networks

Health Belief Models

• Health Locus of Control Model
• 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 others' control.
• Rosenstock and Becker's Health Belief Models
- Individual perceptions
- Modifying factors
- Likelihood of action
HEALTH CARE ADHERENCE
• Adherence is the extent to which an individual's behavior (for example, taking
medications, following diets, or making lifestyle changes) coincides with medical or
health advice

Factors Influencing Adherence

• motivation
• lifestyle change
• perceived severity
• beliefs
• cost of therapy

HEALTH CARE ADHERENCE

• 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 AND DISEASE

• Illness is a highly personal state in which the person's physical, emotional, intellectual,
social, developmental, or spiritual functioning is thought to be diminished.
• It is not synonymous with disease and may not be related to disease. An individual could
have a disease, for example, a growth in the stomach, and feel ill. Similarly, a person
can feel ill, that is, feel uncomfortable, yet have no discernible disease. Illness is highly
subjective; only the individual person can say he or she is ill.
• Disease can be described as an alteration in body functions resulting in a reduction of
capacities or a shortening of the normal life span.
• Etiology - the causation of a disease or condition
• Remission - when the symptoms disappear Exacerbation - when the symptoms
reappear.
 ✓ Nurses are involved in caring for chronically ill individuals of all ages in all types of
settings.
✓ Care needs to be focused on promoting the highest level possible of independence, sense
of control, and wellness.
✓ Clients often need to modify their activities of daily living, social relationships, and
perception of self and body image.
✓ In addition, many must learn how to live with increasing physical limitations and
discomfort.

• There are many ways to classify illness and disease; one of the most common is as
acute and chronic.
• Acute illness is typically characterized by severe symptoms of relatively short duration.
The symptoms often appear abruptly and subside quickly and depending on the cause,
may or may not require intervention by health care professionals. Some acute illnesses
are serious (for example, appendicitis may require surgical intervention), but many acute
illnesses, such as colds, subside without intervention or with the help of over-the-counter
medications. Following an acute illness, most people return to their normal level of
wellness.
• A chronic illness is one that lasts for an extended period, usually 6 months or longer, and
often for the person’s life. Chronic illnesses usually have a slow onset and often have
periods of remission, when the symptoms disappear, and exacerbation when the
symptoms reappear.

• Examples of chronic illnesses are arthritis and diabetes mellitus. Nurses are involved in
caring for chronically ill individuals of all ages in all types of settings-homes, nursing
homes, hospitals, clinics, and other institutions. Care needs to be focused on promoting
the highest level possible of independence, sense of control, and wellness. Clients often
need to modify their activities of daily living, social relationship, and perception of self
and body image. In addition, many may learn how to live with increasing physical
limitations and discomfort.

Illness Behaviors
• A coping mechanism involves ways individuals describe, monitor, and interpret their
symptoms, take remedial actions, and use the health care system.
Talcott Parsons' Sick Role Theory (1951)
Rights:
1. Clients are not held responsible for their condition. Even if the illness was partially
caused by an individual's behavior.
2. Clients are excused from certain social roles and tasks.
3. Clients has right to be taken care of Obligations:
4. Clients are obliged to try to get well as quickly as possible.
5. Clients or their families are obliged to seek competent help.

Edward A. Suchman's 5 stages of illness Stages of Illness

Stage-1 Symptom experience
Stage-2 Assumption of sick role
Stage-3 Medical care contact
Stage-4 Dependent client care
Stage-5 Recovery or rehabilitation
Effects of Illness

• Impact on the client.

o body image or physical appearance
o self-esteem and self-concept
o dependence on others
o unemployment, financial problems
o inability to participate in social functions
• impact on the family
o Role changes
o Increased stress
o Financial problems
o Loneliness as a result of separation and pending loss
o Change in social customs.
 Nurses need to help clients express their thoughts and feelings, and to provide
care that helps the client effectively cope with change.

 Nurses need to support clients' right to self- determination and autonomy as

much as possible by providing them with sufficient information to participate in
decision-making processes and to maintain a feeling of being in control.

 Nurses can help clients adjust their lifestyles.

Levels of Care
Health Promotion
• Activities that develop human attitudes and behaviors to maintain or enhance well-being.
Nurse’s Role in Health Promotion
• Model healthy lifestyle behaviors and attitudes
• Facilitate client involvement in the assessment, implementation, and evaluation of
health goals
• Teach clients self-care strategies to enhance fitness, improve nutrition, manage stress,
and enhance relationships.
• Assist individuals, families, and communities to increase their levels of health. Educate
clients to be effective health care consumers
• Assist clients, families, and communities to develop and choose health-promoting
options.
• Guide clients’ development in effective problem solving and decision making Reinforce
clients’ personal and family health-promoting behaviors
• Advocate in the community for changes that promote a healthy environment

Disease Prevention
• Activities that protect people from becoming ill because of actual or potential health
threats.
The Three Levels of Prevention
1. Primary prevention health - promoting behaviors or activities that reduce the occurrence of
an illness.
2. Secondary prevention early diagnosis and treatment of illness (e.g., screening for
hypertension).
3. Tertiary prevention care that prevents further progression of disease.
Health Maintenance
• A systematic program or procedure planned to prevent illness, maintain maximum
function, and promote health. It is central to health care, especially to nursing care at all
levels (primary, secondary, and tertiary) and in all patterns (preventive, episodic, acute,
chronic, and catastrophic).
Curative
• Curative care involves treatment intended to alleviate the symptoms or cure a current
medical condition. It strives to reduce pain, improve function, and help improve the
quality of life for patients. Examples of treatment options include medications, casts and
splints for broken bones, dialysis for kidney conditions, and chemotherapy for cancer.
Nurses provide and coordinate curative care for patients in various environments. They
set up plans for the care of patients, carry out medical treatments, observe patients, and
discuss conditions with doctors and other medical staff. They also assist with diagnostic
testing and evaluating results. Nurses perform an important role in instructing patients
and families on how to manage their medical condition and explain home care and follow
up treatments.
Rehabilitative
• In rehabilitative care, nurses assist patients with temporary and long-term disabilities or
chronic illnesses. They assist in adapting to their conditions, meeting their highest
potential, and living more independent lives. They commonly use holistic approaches to
medical treatment to meet all needs of patients. They work with patients and family
members to establish a treatment plan and establish short and long-term goals. They
also prepare patients and caregivers for changes that occur in rehabilitative treatment.
Many rehabilitative nurses join the Association of Rehabilitation Nurses to access
continuing education options and various other resources.