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PERIODS OF NURSING HISTORY Intuitive Period Apprentice Period Educative Period Contemporary Period INTUITIVE PERIOD Prehistoric Early

Early Christian Era More on intuition NOMADS travel from one place to another Survival of the fittest Best for the most motto Sickness is due to voodoo Performed out of feeling of compassion for others Performed out of desire to help Performed out of wish to do good Nursing is given by the WOMEN INTUITIVE PERIOD SHAMAN uses white magic to counteract the black magic They are the doctors during those time. TREPHINING drilling the skull Used to treat Psychotic patients Psychotic patients are believed to be possessed by evil spirits. Growth of religion most important thing that happened Growth of civilization Law of self preservation inspire man in search of knowledge

RISE IN CIVILIZATION From the mode of Nomadic life agrarian society gradual development of urban community life Existence of means of communication Start of scientific knowledge more complex life increase in health problems demand for more nurses Nursing as a duty of SLAVES and WIVES. NURSING DID NOT CHANGE but there was progress in the practice of Medicine. Care of the sick was still closely allied with superstitions, religion and magic RISE IN CIVILIZATION Near East birth place of 3 religious ideologies: Judaism Christianity Mohammedism or Islam - Near East culture was adopted by the Greeks and Romans combine with the wonders of the Far East by returning crusaders and explorers improved and was carried to Europe during the Renaissance Period that resulted to greater knowledge then to the New World by the Early settlers. RISE IN CIVILIZATION New World a tiny area known as birth of monotheism that lies between Tigris and Euphrates River in the Nile River arose the cultures of Babylonia, Egypt and Hebrew. MONOTHEISM believer of one God BABYLONIANS CODE OF HAMMURABI 1st recording on the medical practice Established the medical fees Discouraged experimentation Specific doctor for each disease

Right of patient to choose treatment between the use of charms, medicine, or surgical procedure EGYPTIANS ART OF EMBALMING Mummification Removing the internal organs of the dead body Instillation of herbs and salt to the dead Used to enhance their knowledge of the human anatomy. Since work was done and performed on the dead, they learned nothing of Philosophy THE 250 DISEASES Documentation about 250 diseases and treatments HEBREW Teachings of MOSES Created Leviticus Father of sanitation Practice the values of Hospitality to strangers and the Act of Charity contained in the book of Genesis LEVITICUS 3rd book of the Old Testament Laws controlling the spread of communicable diseases Laws governing cleanliness Laws on preparation of food Purification of man and his food The ritual of CIRCUMCISION on the 8th day after birth MOSAIC LAW Meant to keep Hebrews pure so that they may enter the sanctuary without affronting God Meant as a survival for health and hygienic reason only

CHINA Use of pharmacologic drugs MATERIA MEDICA Book that indicates the pharmacologic drug used for treatment No knowledge on anatomy Use of wax to preserve the body of the dead Method of paper making FACTORS THAT HAMPERED THE ADVANCEMENT OF MEDICINE: Baby boys given girls name Prohibits dissecting of human body thus thwarting scientific study INDIA SUSHURUTO 1st recording on the nursing practice Hampered by Taboos due to social structures and practices of animal worship Medicine men built hospitals Intuitive form of asepsis There was proficient practice of Medicine and Surgery NURSES QUALIFICATIONS: Lay Brothers, Priest Nurses, combination of Pharmacist, Masseurs, PT, cooks There was also decline in Medical practice due to fall of Buddhism state religion of India GREECE AESCULAPUS Father of medicine in Greek mythology HIPPOCRATES Father of modern medicine 1st to reject the idea that diseases are caused by evil spirits

1st to apply assessment Practice medical ethics CADUCEUS Insignia of medicine Composed of staff of travellers intertwined with 2 serpent (the symbol of Aesculapus and his healing power). At the apex of the staff are two wings of Hermes (Mercury) for speed. NURSES function of untrained slaves ROMANS Proper turnover for the sick people If youre strong, youre healthy motto Transition from Pagan to Christianity FABIOLA Was converted to Christian and later she converted her home to a hospital and used her wealth for the sick. 1st hospital in the Christian world APPRENTICE PERIOD 11th century 1836 On-the-job training period Refers to a beginner (on-the-job training). It means care performed by people who are directed by more experienced nurses Starts from the founding of Religious Orders in the 6th century through the Crusades in the 11th century (1836 when the deaconesses School of Nursing was established in Kaiserswerth, Germany by Pastor THEODORE FLEIDNER) APPRENTICE PERIOD There was a struggle for religious, political, and economic power Crusades took place in order to gain religious, political, and economic power or for adventure

During the Crusade in this period, it happened as an attempt to recapture the Holy Land from the Turk who obtained and gain control of the region as a result of power struggle. Christians were divided due to several religious war and Christians were denied visit to The Holy Sepulcher. MILITARY RELIGIOUS ORDERS AND THEIR WORKS KNIGHTS OF ST. JOHN OF JERUSALEM (ITALIAN) Also called as Knights of the Hospitalers Established to give care TEUTONIC KNIGHTS (GERMAN) Took subsequent wars in the Holy Land Cared for the injured and established hospitals in the military camps KNIGHTS OF ST.LAZARUS Care for those who suffered Leprosy, syphilis, and chronic skin diseases ALEXIAN BROTHERS A monasteric order founded in 1348. They established the Alexian Brothers School of Nursing, the largest School under religious auspices exclusively for men in US and it closed down in 1969 ST. VINCENT DE PAUL He organized the charity group called the La Charite and the Community of Sisters of Charity composed of women dedicated in caring for the sick, the poor, orphaned, and the widowed. He founded the Sisters of Charity School of Nursing in Paris, France where Florence Nightingale had her 2nd formal education in Nursing. LOUISE de GRAS Was the 1st Superior and co-founder of the Community of Sisters of Charity NURSING SAINTS ST. CLAIRE OF ASSISI Took vows of poverty, obedience to service and chastity Founded the 2nd order of St. Francis of Assisi the poor Claire

ST. ELIZABETH OF HUNGARY The patroness of Nursing A princess Sees her calling to give care for the sick Fed thousands of hungry people St. CATHERINE OF SIENA Little Saint took care of the sick as early as 7y/o 1st Lady with a Lamp RISE OF RELIGIOUS NURSING ORDER Orders of St. Francis of Assisi 1st order founded by St. Francis 2nd order the poor Claire founded by St. Claire 3rd the tertiary order Beguines Lambert Le Begue Oblates (12th Century) Benedictines Ursulites Augustinians DARK PERIOD OF NURSING From 17th century 19th century Also called the Period of Reformation until the American Civil War Hospitals were closed Nursing were the works of the least desirable people (criminals, prostitutes, drunkards, slaves, and opportunists) Nurses were uneducated, filthy, harsh, ill-fed, overworked Mass exodus for nurses

The American Civil War was led by Martin Luther, the war was a religious upheaval that resulted to the destruction in the unity of Christians. The conflict swept everything connected to Roman Catholicism in schools, orphanages, and hospitals DARK PERIOD OF NURSING THEODORE FLIEDNER (a pastor) reconstituted the Deaconesses and later be established the School of Nursing at Kaiserswerth, Germany where Florence Nightingale had her 1st formal training for 3 months as nurse FLORENCE NIGHTINGALE Practiced her profession during the Crimean War Lady with a Lamp From a well-known family Went to Germany to study EDUCATIVE PERIOD Florence Nightingale era Began in June 15, 1860 when Florence Nightingale School of Nursing opened at St. Thomas Hospital in London England, where 1st program for formal education of Nurses began and contributed growth of Nursing in the US FACTORS THAT INFLUENCED DEVELOPMENT OF NURSING EDUCATION: Social forces Trends resulting from war Emancipation of women Increased educational opportunities EDUCATIVE PERIOD FLORENCE NIGHTINGALE Mother of Modern Nursing Lady with the Lamp

Born on May 12, 1820 in Florence, Italy Her SELF-APPOINTED GOAL to change the profile of Nursing She compiled notes of her visits to hospitals, her observations of sanitation practices and entered Deaconesses School of Nursing at Kaiserswerth, Germany for 3 months. EDUCATIVE PERIOD Became the Superintendent of the Establishment for Gentle Women during the Illness (refers to the ill governess or instructors of Nursing She disapproved restriction on admission of patient and considered this unchristian and contrary to health care. Upgraded the practice of Nursing and made Nursing a honorable profession Led other nurses in taking care of the wounded and sick soldiers during the Crimean War She was designated as Superintendent of the Female Establishment of English General Hospital in Turkey during the Crimean War She reduced the casualties of war by 42%-2% thru her effort by improving the practice of sanitation techniques and procedure in the military barracks EDUCATIVE PERIOD THE CONCEPTS OF FLORENCE NIGHTINGALE ON NURSING SCHOOL: School of Nursing should be self-supporting not subject to the whimps of the Hospital. Have decent living quarters for students and pay Nurse instructors Correlate theories to practice Support Nursing research and promote continuing education for nurses Introduce teaching knowledge that disease could be eliminated by cleanliness and sanitation and Florence Nightingale likewise did not believed in the Germ Theory of Bacteriology. Opposed central registry of nurses Wrote Notes on Nursing, What it is and what it is not. Wrote notes on hospitals EDUCATIVE PERIOD

OTHER SCHOOLS OF NURSING Bellevue Training School for Nurses New York City Alexian Brothers Hospital School of Nursing in US exclusively for men. It opened in 1348 and it closed down in 1969. LINDA RICHARDS the first graduate nurse in US. Graduated in September 1, 1873. 2 NURSING ASSOCIATION / ORGANIZATIONS THAT UPGRADED NURSING PRACTICE IN US: American Nurses Association National League for Nursing Education CONTEMPORARY PERIOD World War II present This refers to the period after World War I and the changes and development in the trends and practice of Nursing occurring since 1945 after World War II. Includes scientific and technological development, social changes occurring after the war. Nursing is offered in College and Universities CONTEMPORARY PERIOD DEVELOPMENT AND TRENDS: W.H.O established by U.N to fight diseases by providing health information, proper nutrition, living standard, environmental conditions. The use of Atomic energy for diagnosis and treatment. Space Medicine and Aerospace Nursing Medical equipment and machines for diagnosis and treatment Health related laws Primary Health Care Nurses involvement in CHN Utilization of computers Technology advances such as development of disposable equipment and supplies that relieved the tedious task of Nurses. Development of the expanded role of Nurses

CONTEMPORARY PERIOD FACTORS AFFECTING NURSING TODAY: Economics Consumers Demand Family Structure Information and Telecommunications Legislation HISTORICAL PERSPECTIVE Womens Roles Religion War Societal Attitudes HISTORICAL PERSPECTIVE WOMENS ROLES The role as a wife, mother, daughter, sister has always been included in the care of their family They cared for their infants, members of the family and members of the community (It could be said that Nursing have its roots in the home) Has the will to serve for others (subservient) The care provided were related to physical maintenance and comfort They care given were humanistic, nurturing comforting and supporting HISTORICAL PERSPECTIVE RELIGION Played a significant role in the development of Nursing The Christian values of LOVE THY NEIGHBOR AS THY SELF, PARABLE OF THE GOOD SAMARITAN had a significant impact on Nursing CHRISTIANITY the greatest impact in the influence of religion in the development

The religious values of self-denial, Spiritual Calling, Devotion to Duty, and Hard Work dominated Nursing throughout the history and led to the development. Knights contributions, Fabiolas contributions, the saints and other personalities Deaconesses Theodore Fliedner HISTORICAL PERSPECTIVE WAR Crimean War (Arm conflict between England and allies Turkey, Sardinia vs. Russia); 1854-1856 Florence Nightingale emerged and became well-known (Crimean War) She was asked by Sir Sidney Herbert of the British war department to recruit contingent of female nurses to provide care to the sick and injured in Crimea. She transformed military camps into hospitals by setting up sanitation process: hand washing and washing clothes regularly HISTORICAL PERSPECTIVE WAR American Civil War (1861-1865) Harriet Tubman and Sojourner Truth provided care and safety to slaves fleeing to the North on the Underground Railroad Mother Biekerdyke and Clara Barton searched the battlefield and gave care to injured and dying soldiers Walt Whitman And Loiusa May Alcott volunteered as nurses to give care to injured soldiers in military hospitals World War II Created acute shortage of care Cadet Nurse Corps established in response to shortage of nurses Auxiliary health care workers became prominent Practical Nurses, aides, and technicians provided much of the actual nursing care under the instruction and supervision of better prepared nurse Medical specialties arose to meet the needs of hospitalized clients

HISORICAL PERSPECTIVE SOCIETAL ATTITUDES Nursing was without organization, no education, and social status Womens role was in the home and no respectable woman should have a career Victorian Middle Class Women were just wives to their husbands and children Nurses were poorly educated, some were incarcerated criminals This was reflected in the book written by Charles Dickens through the character of Sairy Gamp who cared for the patients by stealing from them, physically abused them. This literary works has greatly affected social attitudes about nursing, the negative impression and image of nurses up to the contemporary period. Guardian Angel or Angel of Mercy image arose in the latter part of 19th century because of work of Florence Nightingale in the Crimean War. She brought respectability to the nursing profession, nurses were viewed as noble, compassionate, moral, religious, dedicated, and self-sacrificing HISORICAL PERSPECTIVE SOCIETAL ATTITUDES Doctors handmaiden image arising in the early 19th century ; this image evolved when women had yet to obtain the right to vote; the family structures were highly paternalistic, and when the medical profession portrayed increasing use of scientific knowledge that was viewed as male domain. Heroine evolved from nurses acts of bravery during World War II and their contributions in fighting poliomyelitis in the work of Australian nurse, Elizabeth Kenney NURSING LEADERS Florence Nightingale Clara Barton Lillian Wald Lavinia L. Dock Margaret Higgins Sanger Mary Breckinridge

NURSING LEADERS FLORENCE NIGHTINGALE Contributions are well documented Lady with the Lamp She was the 1st nurse to exert political pressure on government Notes on Nursing: What It is and What It Is Not her greatest achievement ; made her be recognized as nursings 1st scientist-theorist Born on a wealthy and intellectual family She was given an honorarium of 4500 and used it to develop Nightingale Training School for Nurses, which was opened in 1860. NURSING LEADERS CLARA BARTON A school teacher who volunteered as nurse during the American Civil War Her responsibility was to organize the nursing services Established the American Red Cross LILIAN WALD Founder of Public Health Nursing Wald and Mary Brewster were the 1st one to offer trained nursing services to the poor in the New York slums NURSING LEADERS LAVINIA L. DOCK Feminist, prolific writer, political activist Friend of Wald She participated in protest movements for womens rights which granted women to vote. Campaigned for legislation to allow nurses rather than physicians to control their professions

Founded the American Society of Superintendents of Training Schools for Nurses on the United States and Canada precursor to the current National League for Nursing NURSING LEADERS MARGARET HIGGINS SANGER Public health nurse in New York Had a lasting impact on womens health care Imprisoned for opening the 1st birth control information clinic in America Considered to be the founder of Planned Parenthood NURSING LEADERS MARY BRECKINRIDGE Notable pioneer nurse Established Frontier Nursing Service (FNS) She worked with the American Committee for Devastated France, distributed food, clothing, and supplies to rural villages and taking care of the sick children. HISTORY OF NURSING (PHILIPPINE SETTING) EARLY BELIEFS AND PRACTICES Beliefs About Causation of Diseases: Caused or inflicted by other person (enemy or witch) Evil spirits Beliefs That Evil Spirits Could Be Driven Off By Person With Powers To Expel Bad Spirits: Believed in Gods of healing Word doctors priest physicians Herbolarios herb doctors HISTORY OF NURSING (PHILIPPINE SETTING) EARLY CARE OF THE SICK

HERBICHEROS herbmen who practice witchcraft MANGKUKULAM / MANGANGAWAY a person suffers from disease without any identified cause and were believed bewitched by such Difficult child birth and some diseases (PAMAO) attributed to (NONO) midwives Difficult birth, witches were supposed to be the cause, gunpowder exploded from a bamboo pole close to the head of the mother to drive evil spirits HISTORY OF NURSING (PHILIPPINE SETTING) EARLY HOSPITALS: Hospital Real de Manila 1577 1st hospital established Gov. Francisco de Sande To give service to kings Spaniard soldiers San Lazaro Hospital 1578 Fray Juan Clemente Named after the Knights of St. Lazarus Hospital for the lepers HISTORY OF NURSING (PHILIPPINE SETTING) EARLY HOSPITALS: Hospital de Indios 1586 Franciscan Orders Hospital for the poor Filipino people Hospital de Aguas Santas 1590 Fray Juan Bautista Named after its location (near spring) because people believed that spring has a healing power.

San Juan de Dios Hospital 1596 For poor people Located at Roxas Boulevard HISTORY OF NURSING (PHILIPPINE SETTING) PERSONAGES: Dona Hilaria de Aguinaldo 1st wife of Emilio Aguinaldo Established Philippine Red Cross February 17, 1899 Dona Maria Agoncillo de Aguinaldo 2nd wife of Emilio Aguinaldo 1st president of Philippine Red Cross (Batangas Chapter) Josephine Bracken Helped Rizal in treating sick people HISTORY OF NURSING (PHILIPPINE SETTING) PERSONAGES: Melchora Aquino Took care of the wounded Katipuneros Anastacia Giron Tupaz Founder of Filipino Nurses Association established on October 15, 1922 1st Filipino chief nurse of PGH 1st Filipino Superintendent of Nurses in the Philippines Francisco Delgado 1st president of Filipino Nurses Association HISTORY OF NURSING (PHILIPPINE SETTING)

PERSONAGES: Cesaria Tan 1st Filipino to receive Masteral Degree in Nursing abroad

Socorro Sirilan Pioneer in Social Service at San Lazaro Hospital Also the chief nurse Rosa Militar Pioneer in nursing education Socorro Diaz 1st editor of PNA magazine called, The Message Conchita Ruiz Full time editor of the PNA newly named magazine, The Filipino Nurse HISTORY OF NURSING (PHILIPPINE SETTING) EARLY NURSING SCHOOLS Iloilo Mission Hospital and School of Nursing Established in 1906 under the supervision of Rose Nicolet (American) Nursing course 3yrs. Produced 1st batch of Nursing graduates in 1909 22 nurses 1st TRAINED NURSES: Nicasia Cada Felipa Dela Pena Dorotea Caldito April 1944 1st Nursing Board Exam at Iloilo Mission Hospital HISTORY OF NURSING (PHILIPPINE SETTING)

EARLY NURSING SCHOOLS PGH School of Nursing 1907 St. Paul School of Nursing 1907 St. Lukes School of Nursing 1907 UST 1946 MCU 1947 Fatima 1947 NURSING: DEFINITIONS NURSING (as an art) Is the art of caring sick and well individual. It refers to the dynamic skills and methods in assisting sick and well individual in their recovery and in the promotion and maintenance of health NURSING (as a science) Is the scientific knowledge and skills in assisting individual to achieve optimal health. It is the diagnosis and treatment of human responses to actual or potential problem NURSING: DEFINITIONS FLORENCE NIGHTINGALE Nursing is the act of utilizing the environment of the patient to assist him in his recovery. VIRGINIA HENDERSON Nursing is the act of assisting the individual, sick or well, in the performance of those activities contributing to health or its recovery (or to a peaceful death) that he would perform unaided if he had the necessary strength, will, or knowledge, and to do this in such a way as to help him gain independence as rapidly as possible. NURSING: DEFINITIONS CANADIAN NURSES ASSOCIATION (CNA) Nursing is a dynamic, caring, helping relationship in which the nurse assist the client to achieve and obtain optimal health. 1987 THEMES THAT ARE COMMON TO THESE DEFINITION:

Nursing is caring Nursing is an art Nursing is a science Nursing is client-centered Nursing is holistic Nursing is adaptive Nursing is concerned with health promotion, health maintenance, and health restoration Nursing is a helping profession NURSING: DEFINITIONS AMERICAN NURSES ASSOCIATION (ANA) 1973 Nursing is direct, goal oriented, and adaptable to the needs of the individual, the family, and community during health and illness. 1980 Nursing is the diagnosis and treatment of human responses to actual or potential health problems. Provision of caring relationship that facilitates health and healing. NURSING: DEFINITIONS 1995 ANA acknowledges FOUR ESSENTIAL FEATURES OF CONTEMPORARY NURSING PRACTICE: Attention to the full range of human experiences and responses to health and illness without restriction to a problem-focused orientation. Integration of objective data with knowledge gained from understanding of the client or groups subjective experience. Application of scientific knowledge to the processes of diagnosis and treatment.

Provision of caring relationship that facilitates health and healing. NURSE: DEFINITION NURSE Comes from a Latin word to nourish or to cherish One who cares for the sick, the injured, and the physically, mentally, and emotionally disabled One who advise and instruct individuals, families, groups and communities in the prevention, treatment of illness and diseases and in the promotion of health. An essential member of a health team who cares for individuals, families and communities in disease and illness prevention and in the promotion of health and healthy environment. PATIENT: DEFINITION PATIENT Comes from a Latin word, to Suffer or to Bear An individual who is in the state of physical, mental, and emotional imbalance An individual who seeks for nursing assistance, medical assistance, or for surgery due to illness or a disease. Is an individual who is waiting or undergoing medical or surgical care. One who is physically or mentally disabled. NURSING PROGRAMS Licensed Vocational Nursing Program / Licensed Practical Nursing Program (LVN,LPN) REGISTERED NURSING PROGRAMS: Community College / Associate Degree Diploma Program Baccalaureate Degree Program GRADUATE NURSING EDUCATION: Masters Degree Doctoral Degree

External Degree LVN / LPN Licensed Vocational Nursing Program / Licensed Practical Nursing Program (LVN,LPN) Last for 9 12 months Provide both classroom and clinical experiences Provided by the community colleges, vocational schools, hospitals, or other independent health agencies. Under supervision of RN Prepares students how to give basic direct technical care Graduate takes NCLEX PN to obtain license as a practical or vocational course. REGISTERED NURSING PROGRAMS Community College / Associate Degree Arose in early 1950s 2-year program Technical nurse or bedside nurse ADN (AA or AS) Diploma Program 3-year program Hospital-based Provide rich clinical experience for nurses Associated with colleges and universities REGISTERED NURSING PROGRAMS Baccalaureate Degree Program Early Baccalaureate Program 5-year program (3-year diploma program in addition to 2 years of liberal arts) Todays Baccalaureate Degree Program 4-5-year program

Offer courses in the liberal arts, sciences, humanities, and nursing REGISTERED NURSING PROGRAMS Graduates must fulfill both the degree requirements of the college or university and the nursing program before being awarded a baccalaureate degree. BSN Also admit RN who have diplomas or associate degrees. Much background More theories GRADUATE NURSING EDUCATION Masters Degree 1.5 2-year program Encourage the development of graduate study in nursing Major emphasis was to be research and specialization for teaching and administration Provide specialized knowledge and skills that enable nurses to assume advanced roles in practice, education, administration, and research. MAN / MSN GRADUATE NURSING EDUCATION Doctoral Program PhD, DNS, ND Further prepares the nurse for advanced clinical practice, administration, education, and research. Content and approach vary among doctoral programs. All emphasized research No specific time EXTERNAL DEGREE External Degree Offers credit for expertise gained outside formal classroom setting

Seminars post- grad courses No specific time Short courses ROLES OF A NURSE Caregiver Communicator Teacher Client Advocate Counselor Change Agent Leader Manager Case Manager Research Consumer Role Model Administrator Expanded Career Roles ROLES OF A NURSE Caregiver Primary goal TYPES OF CARE: Full Care for completely dependent patient Partial Care for partially dependent patient Supportive-Educative care to assist clients in attaining their highest possible level of health and wellness; for learnings

ROLES OF A NURSE Communicator Integral to all nursing roles Nurses communicate with the client, support persons, other health professionals, and people in the community Nurses identify client problems and then communicate these verbally or in writing to other members of the health team ROLES OF A NURSE Teacher Nurses help clients learn about their health and the health care procedure they need to perform to restore or maintain their health. Nurses assesses the clients learning needs and readiness to learn, sets specific learning goals in conjunction with the client, enacts teaching strategies, and measures learning. Nurses also teaches unlicensed assistive personnel to whom they delegate care, and they share their expertise with other nurses and health professionals. ROLES OF A NURSE Client Advocate Acts to protect the client Nurse may represent the clients needs and wishes to other health professionals, such as relaying the clients wishes for information to the physician. Nurses assist clients in exercising their rights and help them speak up for themselves ROLES OF A NURSE Counselor Helping a client recognize and cope with stressful psychologic or social problems, to develop improved interpersonal relationships, and to promote personal growth. Involves providing emotional, intellectual and psychologic support. Nurses counsel primarily healthy individuals with normal adjustment difficulties and focuses on helping the person develop new attitudes, feelings, behaviors by

encouraging the client to look at alternative behaviors, recognizing the choices, and develop sense of control. ROLES OF A NURSE Change Agent Assisting others to make modifications in their own behavior. Nurses also often act to make changes in a system if it is not helping client return to health. ROLES OF A NURSE Leader Influences others to work together to accomplish a specific goal. Can be employed at different levels: individual client, family, groups of clients, colleagues, or the community ROLES OF A NURSE Case Manager Work with the multidisciplinary health care team to measure the effectiveness of the case management plan and to monitor outcomes. Works with primary or staff nurses to oversee the care of a specific caseload. Primary nurse or provides some level of direct care to the client and family Helps ensure that care is oriented to the client, while controlling costs. ROLES OF A NURSE Research Consumer Often use research to improve client care Have some awareness of the process and language of research Be sensitive to issues related to protecting the rights of human subjects Participate in the identification of significant researchable problems Be a discriminating consumer of research findings ROLES OF A NURSE

Role Model Has good physical appearance Practices proper hygiene Practices healthy lifestyle ROLES OF A NURSE Administrator Assumes middle management position Connects the patient to other services of the hospital Expanded Career Roles Nurse practitioner, clinical nurse specialist, nurse midwife, nurse educator, nurse researcher, and nurse anesthetist All of which allow greater independence and autonomy. SCOPE OF NURSING PRACTICE FOUR AREAS: Promoting Health and Wellness Preventing Illness Restoring Health Care of the Dying SCOPE OF NURSING PRACTICE PROMOTING HEALTH AND WELLNESS Wellness state of well-being. Engaging in attitudes and behavior that enhance the quality of life and maximize personal potential For both healthy and ill. Involve individual and community activities to enhance healthy lifestyle, such as improving nutrition and physical fitness, preventing drug and alcohol misuse, restricting smoking, and preventing accidents and injury in the home and workplace. SCOPE OF NURSING PRACTICE

PREVENTING ILLNESS The goal is to maintain optimal health by preventing diseases Nursing activities includes immunizations, prenatal and infant care, and prevention of sexually transmitted disease. SCOPE OF NURSING PRACTICE RESTORING HEALTH Focuses on the ill client Extends from early detection of disease to helping the client during the recovery period SCOPE OF NURSING PRACTICE NURSING ACTIVITIES: Providing direct care to the ill person: administering medications, baths, and specific procedures and treatments Providing diagnostic and assessment procedures: measuring BP and examining feces for occult blood Consulting with other health care professionals about clients problems Teaching clients about recovery activities: exercise that will accelerate recovery after a stroke Rehabilitating clients to their optimal functional level following physical or mental illness, injury, or chemical addiction SCOPE OF NURSING PRACTICE CARE OF THE DYING Involves comforting and caring for people of all ages who are dying Includes helping clients live as comfortable as possible until death and helping support persons cope with death. Work in homes, hospitals, and extended care facilities Hospices are specifically designed for this purpose.

HEALTH: A MULTIFACTORIAL PHENOMENON HEALTH State of complete physical, mental and social well-being, not merely the absence of disease or infirmity (WHO) Major contributor to the over arching goal of poverty reduction CLAUDE BERNARD Ability to maintain internal milieu. Illness is the result of failure to maintain internal environment. WALTER CANON Health is the ability to maintain homeostasis or dynamic equilibrium. Homeostasis is regulated by the negative feedback mechanisms. FLORENCE NIGHTINGALE Health is being well and using ones full potential/power to the fullest extent. Maintained through prevention of diseases through ENVIRONMENTAL FACTORS. VIRGINIA HENDERSON Health is viewed in terms of the ability to perform 14 components of nursing care unaided. MARTHA ROGERS POSITIVE health symbolizes WELLNESS. It is a value term defined by the culture or individual. ROY Health is a STATE and a PROCESS of being and becoming an integrated and WHOLE PERSON. OREM Health is a state that is characterized by soundness or wholeness of developed human structures and of bodily and mental functioning. KING Health is a dynamic state in the life cycle; illness is the interference in the life cycle.

NEUMAN Parts and subparts of an individual are in harmony with the whole system. JOHNSON Health is an elusive, dynamic state influenced by biologic, psychologic, and social factors. Health is reflected by the organization, interaction, interdependence and integration of subsystems of the behavioral systems. WELLNESS AND WELL-BEING Wellness is well-being. It involves engaging in attitudes and behaviors and enhance the quality of life and maximize personal potential. Well-being is a subjective perception of balance, harmony, and vitality. Wellness is a choice. Wellness is a way of life. Wellness is the integration of body, mind, and spirit. Wellness is the loving acceptance of ones self. MODELS OF HEALTH AND ILLNESS THE HEALTH-ILLNESS CONTINUUM (DUNN) Describes the interaction of the environment will well-being and illness. HIGH LEVEL OF WELLNESS (HLW) is an integrated of functioning that is oriented towards maximizing ones potentialities within the limitations of the environment. Concepts connotes ability to perform ADL or to function independently. THE HEALTH-ILLNESS CONTINUUM (DUNN) THE HEALTH-ILLNESS CONTINUUM (DUNN) PRECURSORS OF ILLNESS

1. HEREDITY: family history of DM, HPN, CA 2. BEHAVIORAL FACTORS: cigarette smoking, alcohol abuse, high cholesterol diet 3. ENVIRONMENTAL FACTORS: overcrowding, poor sanitation, poor supply of potable water HEALTH BELIEF MODEL (BECKER, 1975)

Describes the relationship between a persons belief and behavior. Individual perceptions and modifying factors may influence health beliefs and preventive health behaviors. HEALTH BELIEF MODEL (BECKER, 1975)

1. INDIVIDUAL PERCEPTIONS: 1. PERCEIVED SUSCEPTIBILITY TO AN ILLNESS: family hx of DM increases risk to develop the disease 2. PERCEIVED SERIOUSNESS OF ILLNESS: DM lifelong disease 3. PERCEIVED THREAT OF ILLNESS: DM causes damage to brain, heart, eyes, kidneys, blood vessels HEALTH BELIEF MODEL (BECKER, 1975)

2. MODIFYING FACTORS 1.DEMOGRAPHIC VARIABLES: age, sex, race 2. SOCIOPSYCHOLOGIC VARIABLES: social pressure or influence from peer 3. STRUCTURAL VARIABLES: knowledge about the disease and prior contact with it 4. CUES TO ACTION: internal (fatigue, uncomfortable symptoms) external (mass media advice from others) HEALTH BELIEF MODEL (BECKER, 1975)

3. LIKELIHOOD OF TAKING RECCOMMENDED PREVENTIVE HEALTH ACTION 1. Perceived benefits of preventive action 2. Perceived Barriers to preventive action Preventive health behavior may include lifestyle changes, increased adherence to medical therapies, search medical advice or treatment. Perceived barriers to preventive action may be due difficulty to lifestyle changes, social pressures, physical symptoms such as fatigue, joints pains, economic factors, accessibility of healthcare facilities. HEALTH BELIEF MODEL (BECKER, 1975) SMITHS MODEL OF HEALTH

1. CLINICAL MODEL: views people as physiologic system with related functions and identifies health as absence of signs and symptoms of disease or injury. 2. ROLE PERFORMANCE MODEL: defines health in terms of individuals ability to fulfill societal roles such as performing work. SMITHS MODEL OF HEALTH

3. ADAPTIVE MODEL: adaptation is the focus; views health as a creative processes and diseases as a failure in adaptation or mal-adaptation. Aim of treatment is to restore the ability of the person to adapt; COPE 4. EUDAEMONISTIC MODEL: HEALTH is a condition of actualization or realization of a persons potential; avers the highest aspiration of people is fulfilment and complement development actualization LEAVELL AND CLARKS Avers that there are three interactive fact be affected ors that affect health and illness.

1. AGENT: any factor or stressor that can lead to illness 2. HOST: persons who may or may not be susceptible to disease 3. ENVIRONMENT: any factor external to the host that may or may not predispose the person to a certain disease. LEAVELL AND CLARKS DETERMINANTS OF HEALTH Affected by a combination of many factors Determined his circumstances and environment It is inappropriate therefore to blame or credit the persons state of health to himself alone because he is unlikely able to directly control many of these factors Knowledge of these factors is important in order to effectively promote health and prevent illnesses FACTORS AFFECTING HEALTH AND ILLNESS PHYSICAL DIMENSION Genetic make-up, age, developmental level, race and sex are all part of an individuals physical dimension and strongly influence health status and health practices.

Examples: a. The toddler just learning to walk is prone to fail and injure himself. b. The young woman who has a family history of breast cancer and diabetes and therefore is at a higher risk to develop these conditions. EMOTIONAL DIMENSION How the mind and body interact to affect body function and to respond to body conditions also influences health. Long term stress affects the body systems and anxiety affects health habits; conversely, calm acceptance and relaxation can actually change body responses to illness.

Examples: a. Prior to a test, a student always has diarrhea. b. Extremely nervous about a surgery, a man experiences severe pain following his operation. c. Using relaxation techniques, a young woman reduces her pain during the delivery of her baby. INTELLECTUAL DIMENSION The intellectual dimension encompasses cognitive abilities, educational background and past experiences. These influence a clients responses to teaching about health and reactions to health care during illness. They also play a major role in health behaviors.

Examples: a. An elderly woman who has only a third-grade education who needs teaching about a complicated diagnostic test. b. A young college student with diabetes who follows a diabetic diet but continues to drink beer and eat pizza with friends several times a week. ENVIRONMENTAL DIMENSION The environment has many influences on health and illness. Housing, sanitation, climate and pollution of air, food and water are aspects of environmental dimension.

Example: a. Increased incidence of asthma and respiratory problems in large cities with smog. SOCIO-CULTURAL DIMENSION Health practices and beliefs are strongly influenced by a persons economic level, lifestyle, family and culture.

Low-income groups are less likely to seek health care to prevent or treat illness; high-income groups are more prone to stress-related habits and illness. SOCIO-CULTURAL DIMENSION The family and the culture to which the person belongs determine patterns of livings and values, about health and illness that are often unalterable.

Examples: a. The adolescent who sees nothing wrong with smoking or drinking because his parents smoke and drink. b. The person of Asian descent who uses herbal remedies and acupuncture to treat an illness. SPIRITUAL DIMENSION Spiritual and religious beliefs are important components of the way the person behaves in health and illness.

Examples: a. Roman Catholics require baptism for both live births and stillborn babies. b. Jehovah Witnesses are opposed to blood transfusions. ILLNESS Personal state in which the person feels unhealthy. State in which a persons physical, emotional, intellectual, social development or spiritual functioning is diminished or impaired with previous experience. ILLNESS AND DISEASE ILLNESS AND DISEASE


Illness is not synonymous with disease ; although nurses must be familiar with different kinds of diseases and their treatments thay are concerned more with illness which may include disease but also the effects on functioning and well-being in all dimensions. DISEASE Alteration in body functions resulting in reduction of capacities shortening of the normal life span.


1. Biologic agents (microorganisms) 2. Inherited genetic defects (cleft palate) 3. Developmental defects (imperforate anus) 4. Physical agents (radiation, UV rays, hot & cold substances) 5. Chemical agents (lead) 6. Tissue response to irritation (fever, inflammation) 7. Faulty chemical/metabolic processes (inadequate insulin in diabetes mellitus, inadequate iodine causing goiter) 8. Emotional/physical reaction to stress (anxiety. Fear) STAGES OF ILLNESS

1. Symptom experience Transition stage WRONG Experiences some symptom

3 ASPECTS: PHYSICAL (muscle aches, headache) COGNITIVE (perception of having flu) EMOTIONAL (worry on consequence of illness) STAGES OF ILLNESS

2. Assumption of Sick Role Acceptance of the illness Seeks medical advice, support for decision to give up some activities

3. Medical Care Contact Seeks advice to medical professionals for several reasons:

1. validation of real illness 2. explanation of symptoms

3. reassurance or prediction of outcome STAGES OF ILLNESS

4. Dependent Patient Role The person becomes a client dependent on health professional for help Accepts/rejects health professionas suggestions Become more passive and accepting May regress to an earlier behavioral stage. STAGES OF ILLNESS

5. Recovery and Rehabilitation Gives up the sick role and returns to former roles and functions. ASPECTS OF SICK ROLE One is not held responsible for his condition and person did not cause his illness Excused from social roles and person is allowed to rest by seeking sick leave or LOA. Obliged to get well as soon as possible and expected to cooperate and comply with recommended therapies. Obliged to seek for competent help and expected to seek help from health professionals. RISK FACTORS Any situation, habit, social or environmental condition, physiological, or psychological condition, developmental, intellectual condition or spiritual or other variable that increases the vulnerability of an individual or group to an illness or accident. It s presence doesnt necessarily mean that a disease will develop but risks factors increases the chances that the individual will experience a particular dysfunction. RISK FACTORS OF A DISEASE


GOAL OF RISK FACTOR IDENTIFICATION: merely assist clients in visualizing those areas in their life that can be modified or even eliminated to promote wellness and prevent illness. CLASSIFICATION OF DISEASE: ETIOLOGIC FACTORS

1. Hereditary 2. Congenital 3. Metabolic 4. Deficiency 5. Traumatic 6. Allergic 7. Neoplastic 8. Idiopathic 9. Degenerative 10. Iatrogenic CLASSIFICATION OF DISEASE: DURATION OR ONSET

1. ACUTE ILLNESS: short duration; severe; symptoms are abrupt; intense and subside after relatively short periodaffects functioning in any dimension 2. CHRONIC ILLNESS: persists usually longer than 6 months and can also affect functioning in any dimension. Client may fluctuate between maximal functioning and serious relapses that may be life threatening. Characterized by REMISSION AND EXACERBATION CLASSIFICATION OF DISEASE: DURATION OR ONSET

REMISSION: period during which the disease is controlled and symptoms are not obvious EXACERBATION: disease becomes more active again at a future time, with reccurence of pronounced symptoms. CLASSIFICATION OF DISEASE: OTHER CLASSIFICATION

1. Organic 2. Functional 3. Occupational

4. Familial 5. Venereal 6. Epidemic 7. Endemic 8. Pandemic 9. Sporadic LEAVELL AND CLARKS THREE LEVELS OF PREVENTION