FUNDAMENTALS OF

PROFESSIONAL NURSING
By
Dr. Mrs. Rita Opoku-Danso
 INTRODUCTION
• An understanding of contemporary nursing
practice includes a look at
• definitions of nursing,
• recipients of nursing,
• scope of nursing,
• settings for nursing practice,
• nurse practice acts, and current standards of
clinical nursing practice.
 DEFINITIONS OF NURSING
• Florence Nightingale defined nursing nearly 150 years
ago as:
• "the act of utilizing the environment of the patient to
assist him in his recovery" (Nightingale, 1860-1969).
• Nightingale considered a clean, well-ventilated, and
quiet environment essential for recovery.
• Often considered the first nurse theorist, Nightingale
raised the status of nursing through education.
• Nurses were no longer untrained housekeepers but
 DEFINITIONS OF NURSING
• Virginia Henderson was one of the first modern nurses to
define nursing.

• She wrote,

• "The unique function of the nurse is to assist the individual,

sick or well, in the performance of those activities contributing
to health or its recovery (or to 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“ (Henderson, 1966, p. 3).
 DEFINITIONS OF NURSING
• Like Nightingale, Henderson described nursing in relation to the
client and the client's environment.

• Unlike Nightingale, Henderson saw the nurse as concerned with both

healthy and ill individuals, acknowledged that nurses interact with
clients even when recovery may not be feasible, and mentioned the
teaching and advocacy roles of the nurse.
•
In the latter half of the 20th century, a number of nurse theorists
developed their own theoretical definitions of nursing.
 DEFINITIONS OF NURSING
•Theoretical definitions are important because they go beyond simplistic
common definitions.
•They describe what nursing is and the interrelationship among nurses,
nursing, the client, the environment, and the intended client outcome:
health.

•Certain themes are common to many of these definitions:

Nursing is caring.
•Nursing is an art.
•Nursing is a science.
•Nursing is client centered.
•
 DEFINITIONS OF NURSING

• Nursing is adaptive.

• Nursing is holistic.
• Nursing is concerned with health promotion, health
maintenance, and health restoration.

• Nursing is a helping profession

 DEFINITIONS OF NURSING
• Professional nursing associations have also examined
nursing and developed their definitions of it.
• In 1973, the American Nurses Association (ANA) described
nursing practice as
• "direct, goal oriented, and adaptable to the needs of the
individual, the family, and community during health and
illness“ (ANA, 1973, p. 2).
• In 1980, the ANA changed this definition of nursing to this:
• "Nursing is the diagnosis and treatment of human responses
to actual or potential health problems“ (ANA, 1980, p. 9).
 DEFINITIONS OF NURSING
• In 1995, the ANA recognized the influence and
contribution of the science of caring to nursing
philosophy and practice.
• Their most recent definition of professional nursing is
much broader and states: "Nursing is the:
• protection,
• promotion,
• and optimization of health and abilities,
 DEFINITIONS OF NURSING

• preventions of illness and injury,

• alleviation of suffering through the diagnosis and
treatment of human response,
• and advocacy in the care of individuals, families,
communities, and populations"
(ANA, 2003, p. 6).
 RECIPIENTS OF NURSING
Sometimes called:
consumers
• patients,
• clients.

• A consumer is an individual, a group of people, or a community

that uses a service or commodity.

• People who use health care products or services are consumers

of health care.
 RECIPIENTS OF NURSING
• A patient is a person who is waiting for or
undergoing medical treatment and care. The word
patient comes from a Latin word meaning "to
suffer" or "to bear.“

• Traditionally, the person receiving health care has

been called a patient.
• Usually, people become patients when they seek
assistance because of illness or for surgery
 RECIPIENTS OF NURSING
• Some nurses believe that the word patient implies passive
acceptance of the decisions and care of health professionals.
• With the emphasis on health promotion and prevention of
illness, many recipients of nursing care are not ill.
• Nurses interact with family members and significant others
to provide support, information, and comfort in addition to
caring for the patient.
• Recipients of health care as clients.
• A client is a person who engages the advice or services of
another who is qualified to provide this service.
 RECIPIENTS OF NURSING
• Client are also collaborators in the care, that is, as
people who are also responsible for their own health.

• Thus, the health status of a client is the responsibility of

the individual in collaboration with health
professionals.
 SCOPE OF NURSING
Nurses provide care for three types of clients:
• individuals,
• families,
• communities.
• Nursing practice involves four areas:
• promoting health and wellness,
• preventing illness, restoring health, and caring for
the dying. (Discuss class)
 PROMOTING HEALTH AND WELLNESS
Wellness: Activities and behaviors that enhance quality
of life and maximize personal potential (Anspaugh,
Hamrick, & Rosata, 2003, p. 490).
Nurses promote wellness in clients who are both healthy
and ill.
Involve individual and community activities to enhance
healthy
lifestyles:
• improving nutrition and physical fitness,
• preventing drug and alcohol misuse,
 PROMOTING HEALTH AND WELLNESS

• restricting smoking,
• preventing accidents and injury in the home and
workplace
 PREVENTING ILLNESS
Nursing activities include:
• immunizations,
• prenatal and infant care,
• and prevention of sexually transmitted disease (All to
maintain optimal
health by preventing disease).
 RESTORING HEALTH
• Focuses on the ill client, and it extends from early
detection of disease through helping the client
during the recovery period.
• Nursing activities include:
• Providing direct care to the ill person, such as
administering medications, baths, and specific
procedures and treatments
• Performing diagnostic and assessment
procedures, such as measuring blood pressure and
 RESTORING HEALTH
• Consulting with other health care professionals
about client problems
• Teaching clients about recovery activities, such as
exercises that will accelerate recovery after a
stroke
• Rehabilitating clients to their optimal functional
level following physical or mental illness, injury,
or chemical addiction
 CARING FOR THE DYING

Involves comforting and caring for people of all

ages who are dying.
It includes helping clients live as comfortably as
possible until death and helping support persons
cope with death.

Nurses carrying out these activities work in homes,

hospitals, and extended care facilities.
 SETTINGS FOR NURSING

• Acute care hospitals,

• clients' homes,
• community agencies,
• ambulatory clinics (CHIP Centres)
• long-term care facilities or health maintenance
organizations (HMOs) eg. Rehabilitation centres
 NURSE PRACTICE ACTS

• Nurse practice acts, or legal acts for professional

nursing practice, regulate the practice of nursing.

• Although nurse practice acts differ in various

jurisdictions, they all have a common purpose: to
protect the public.

• (Read on nurse practice art for Ghana)

 STANDARDS OF NURSING PRACTICE

• Establishing and implementing standards of practice are

major functions of a professional organization.

• The purpose of the ANA Standards of Practice is to

describe the responsibilities for which nurses are
accountable
 STANDARDS OF NURSING PRACTICE
• Describe a competent level of behavior in that the nurses
must know exactly what is necessary to provide nursing care.
• The standards provide a method to assure patients that they
are receiving high-quality care and to ensure that the nurses
must know exactly what is necessary to provide nursing care.

• The standards also are in place to determine whether nursing

care meets the standards.
 STANDARDS OF PRACTICE FOR ANA
• Assessment
Collects comprehensive data pertinent to the patient's health or the
situation.
• Diagnosis
Analyzes the assessment data to determine the diagnoses or issues.
• Outcomes Identification
Identifies expected outcomes for a plan individualized to the patient
or the situation.
• Planning
Develops a plan that prescribes strategies and alternatives to attain
expected outcomes.
• Implementation
Implements the identified plan (Coordination of Care & Health Teaching and Health
Promotion: The registered nurse employs strategies to promote health and a safe environment)

• Evaluation
Evaluates progress towards attainment of outcomes.

• Culturally Congruent Care: The registered nurse practices in a manner that is congruent with
cultural diversity and inclusion principles.
•
Communication: The registered nurse communicates effectively in
all areas of practice.
• Collaboration
• Leadership
• Education
• Evidence-Based Practice and Research
• Quality of Practice: The registered nurse contributes to quality
nursing practice.
• Professional Practice Evaluation: The registered nurse evaluates
one’s own and others’ nursing practice.
• Resources Utilization
• Environmental Health
• Ethics
Integrates ethical provisions in all areas of
practice.
•Assignment: Read on Standards of Practice
for NMC, Ghana/ for nurses in Ghana
•END
•The roles of a professional nurse within the
health care team
 INTRODUCTION
•Nurses assume a number of roles when-they provide
care to clients.
•Nurses often carry out these roles concurrently, not
exclusively of one another. For example, the nurse
may act as a counselor while providing physical care
and teaching aspects of that care.
•The roles required at a specific time depend on the
needs of the client and aspects of the particular
environment.
• Caregiver
Assist the client physically and psychologically while preserving the
client's dignity.
Involve full care for the:
• completely dependent client,
• partial care for the partially dependent client,
• and supportive-educative care to assist clients in attaining their
highest possible level of health and wellness.
• It encompasses the physical, psychosocial, developmental, cultural,
and spiritual levels. The nursing process provides nurses with a
framework for providing care
A nurse may provide care directly or delegate it to other
caregivers
• Communicator
• Integral to all nursing roles.
• Nurses:
• Communicate with the client, support persons, other
health professionals, and people in the community.
• Identify client problems and then communicate these
verbally or in writing to other members of the health
team.
• Must be able to communicate clearly and accurately in
order for a client's health care needs to be met
• NOTE: The quality of a nurse's communication is an
important factor in nursing care.

• Teacher
The nurse:
• helps clients learn about their health and the health care
procedures they need to perform to restore or maintain their
health.
• Assesses the client's learning needs and readiness to
learn, sets specific learning goals in conjunction with the
client, enacts teaching strategies, and measures learning.

• Teach unlicensed assistive personnel (UAP) to whom

they delegate care
• Share their expertise with other nurses and health
professionals.
 TEACHER/EDUCATOR
• Explain concepts and facts about health
• Describe the reason for routine care activities,
• Demonstrate procedures such as self-care activities,
• Reinforce learning or patient behavior
• Evaluate the patient’s progress in learning.
• Some of your patient teaching is unplanned and informal.
• For example, during a casual conversation you respond to
questions about the reason for an intravenous infusion, a
health issue such as smoking cessation, or necessary lifestyle
changes.
• Other teaching activities are planned and more formal
such as when you teach your patient how to self-
administer insulin injections.

• Assess your patient’s and family caregiver’s learning

styles and needs and develop a teaching plan that
includes teaching methods that match your patient’s and
family’s needs
• Client Advocate
• Acts to protect the client
• Present the client's needs and wishes to other
health professionals, such as relaying the client's
wishes for information to the physician.
• Assist clients in exercising their rights and help
them speak up for themselves
• As a patient advocate you protect your patient’s human
and legal rights and provide assistance in asserting these
rights if the need arises.
• As an advocate you act on behalf of your patient and
secure your patient’s health care rights (Kowalski,
2016).

• For example, you provide additional information to

help a patient decide whether to accept a treatment, or
• Defend patients’ rights to make health care decisions in a general way
by speaking out against policies or actions that put patients in danger or
conflict with their rights.
• Ensure that patients’ autonomy and self-determination are respected
(Gerber, 2018).
• Patient advocacy is hard and often provides unique emotional
challenges to health care providers, especially when caring for patients
with terminal or debilitating chronic illnesses (O’Mahoney et al, 2017).
• Be mindful of personal stressors and to identify ways to cope with
these stressors
• Counselor
Counseling is the process of helping a client to
recognize and
cope with stressful psychologic or social problems, to
develop
improved interpersonal relationships, and to promote
personal
growth.
• It involves providing:
• emotional,
• The nurse counsels primarily healthy individuals with
normal adjustment difficulties and focuses on helping the
person develop new attitudes, feelings, and behaviors by
encouraging the client to look at alternative behaviors,
recognize the choices, and develop a sense of control.
•Change Agent
Assist clients to make modifications in their
behavior.
•Make changes in a system, such as clinical care, if
it is not helping a client return to health.
•Changes in medications are just a few of the
changes nurses deal with daily
• Leader
A leader influences others to work together to accomplish a
specific goal.
• The leader role can be employed at different levels:
individual client, family, groups of clients, colleagues, or the
community.
• Effective leadership is a learned process requiring an
understanding of the needs and goals that motivate people, the
knowledge to apply the leadership skills, and the interpersonal
skills to influence others.
• Manager
• Manages the nursing care of individuals, families,
and communities.
• Delegates nursing activities to ancillary workers
and other nurses and supervises and evaluates
their performance.
• Managing requires knowledge about
organizational structure and dynamics, authority
 AUTONOMY AND ACCOUNTABILITY
• Autonomy is an essential element of professional nursing that
involves the initiation of independent nursing interventions
without medical orders.
•
Although the nursing profession regulates accountability through
nursing audits and standards of practice, you also need to develop
a commitment to personal professional accountability.
• For example, you independently
implement coughing and deep-breathing exercises to clear the
lungs and promote oxygenation for a patient who recently had
major surgery.
 AUTONOMY AND ACCOUNTABILITY
• As you continue to care for this patient, a complication arises.
• You note that the patient has a fever, and the surgical wound has a yellow-green
discharge.
• You collaborate with other health care professionals to develop the best
treatment plan for this patient’s surgical wound infection.

• With increased autonomy comes greater responsibility and accountability.

Accountability means that you are responsible professionally and legally for the
type and quality of nursing care provided.

• You must remain current and competent in nursing and scientific knowledge
and in technical skills.
• Expanded Career Roles
Nurses are fulfilling expanded carer roles such as:
• nurse practitioner,
• clinical nurse specialist,
• nurse midwife,
• nurse educator,
• nurse researcher,
• and nurse anesthetist, all of which allow greater
independence and autonomy.