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Providing Basic nursing care(BNC)

LO3. Identify clients need to

individualize nursing care
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By the end of the session the learner will be able to

• Describe basic concept of nursing care .

• Explain history of nursing and Nursing theories and
models.
• Identifying materials for basic nursing care.
• List Purpose of basic nursing care.
• Define therapeutic communication .
• Provide Care for the patient care unit.
• Perform Cleaning to the patient unit.
• Demonstrate ensuring ventilation and lighting of the
patient room.
• Perform Collecting patient specimen.
• Assist Feeding a helpless patient.
• Apply cold and heat for client in need.
• Follow appropriate aseptic techniques.
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Evolution of Nursing
 Nursing has evolved from an unstructured method of
caring for the ill to a scientific profession.

3
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Dark era in nursing

 Despite new discoveries and great scientific progress in
medicine ,the religious life of the community was shallow
 Only a few people were ready to join religious congregations
 Napoleon, the emperor of France closed all the monasteries
which catered for the sick and used them for non-religious
activities.
 prisoners, thieves, prostitutes and drunkards to give
nursing services to the sick in lieu of serving jail sen-
tences

4
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Development of modern nursing

(19th century)

5
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
Modern nursing…
Four types of organization developed gradually in order to improve the deteriorated care
for the sick:
1. The catholic religious congregations

2. Lutheran deaconesses

3. Civil orders (the Red Cross)

4. Civil nursing

 By the middle of 18th century and the beginning of 19th century, nursing
services started to be delivered by civil nurses - women who did not belong
to religious congregations.
 Florence nightingale, an English lady, instituted the reforms in the care of
the sick, which form the basis for the modern practice.

6
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Florence Nightingale
 Florence Nightingale
was born in Italy in
1820.
 She was a well-edu-
cated woman and be-
longed to a high social
position.

7
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History of Nursing in Ethiopia

• In ancient Ethiopia illness was considered to be

punishment from sins or magic.
• Most tribes and people had a medicine man or
women called "Hakims" or “wegesha" who
performed rituals, using various plants and herbs to
heal the sick.
• The religious people were also providing care for the
sick or injured in the monks' in Debrelibanos.
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History…
• Around 1866 missionaries came to Eritrea, and
started to provide medical care for very few members
of the society.
• school for midwives in Eritrea (the former province
of Ethiopia)
• In 1908 Minlik II hospital was established in the
capital of Ethiopia.
• The hospital was equipped and staffed by Russians.
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History…
• Princess Tsehai, the emperor youngest daughter was
the first graduated national nurse from Ormand street
hospital London.
• In 1948 the Ethiopian Red cross nursing school
established by his Imperial majesty in the private
Hospital Bet-Saida which later changed to Hales
lassie I Hospital.
• Then during the Derg regime, this hospital is changed
its name to Yekatit 12 hospital, which still exists
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History…
• In 1950, the school of nursing was established at
Empress Zewditu memorial hospital for male and
female nurses.
• The Princes Tsehai memorial Hospital was opened in
1951, as a tribute initially from the British now
known as Army Hospital.
• In March 1953, the first eight nurses from Ethiopian
Red Cross of nursing and nine from Empress Zewditu
memorial hospital were graduated.
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History…
• In 1951, two school of Nursing was stablished: one at
the princess Tsehai memorial only for female nurses
and the other one was in Nekemt at the Teferie
Mekonnen Hospital.
• In 1954 the Gonder Health College and training
center opened and gave training to community
nurses.
• An additional higher health professional training
institution was also established in 1983 In Jimma.
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History…
• After the overthrown of the Dergue, the transitional
government of Ethiopia developed a health policy
that emphasizes health promotion, diseases
prevention, and curative and rehabilitative health
service with priority to the rural societies.
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Definition of nursing
 Why Important to define?

 The word “nurse” originates from the latin

word “nutricius” which means something
that nourishes, fosters and protects.

14
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Defi…
1. “… what nursing has to do…...is to put the patient in
the best condition for nature to act upon him. (Florence
Nightingale).

2. “the unique function of the nurse is to assist the indi-

vidual sick or well, in the performance of those activi-
ties 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”.(Virginia Henderson).

15
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07/18/2023

Defi..
 Nursing is the protection, promotion and optimiza-

tion of health and abilities, prevention of illness

and injury, alleviations of suffering through the
diagnosis and treatment of human response, and
advocacy in the care of individuals, families, com-

munities, and populations (ANA, 2003).

16
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Defi…
 Nursing is The use of clinical judgment in the
provision of care to enable people to improve,
maintain, or recover health, to cope with health
problems, and to achieve the best possible quality
of life, whatever their disease or disability, until
death(Royal college of Nursing).

17
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Nursing is an art and science

 Nursing as an art:-
• The nurse must develop skilled techniques in the perfor-
mance of the various procedures required for giving adequate
care to the patient.

 Nursing as a science :-
• Underlying principles of nursing care depend on knowledge
of biological sciences such as anatomy, physiology, microbiol-
ogy and chemistry.
18
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Define Nursing as a profession

• Profession –is a vocation or occupation that require
advanced training in specialized field and that
involves academic preparation
• Nursing is an evolving discipline and profession ,we
will show this by presenting the evidence or rationale
in line with the established criteria for profession
 20

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Cont..
• A profession is generally distinguished from other
kinds of occupation by:
a) Its requirement of prolonged specialized training
acquiring a body of knowledge pertinent to the role to
be performed and
b) An orientation of the individual to ward service,
either to community or organization.
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OVERVIEW OF NURSING THEORY

• Nursing theory attempts to describe or explain the

phenomenon of nursing.
• Nursing theory differentiates nursing from other disciplines
and activities.
• Theories
▫ Are general concepts used to explain, predict, control, and
understand commonly occurring events.
▫ It provide a method of classifying and organizing data in a
logical, meaningful manner.
▫ Is a set of systematically interrelated concepts or hypothesis
that seeks to explain and predict phenomena.
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TYPES OF NURSING THEORIES

• General systems theory

• A system is a set of interacting elements, all serving the common
purpose of contributing to the overall goal of the system.
• If the system has permeable boundaries, it is called an ‘open system’.
If not, it is referred to as a closed system.
• In system theories, the patient is often referred to as an ‘open system
• The ‘human body’ system interacts with other systems and has
permeable boundaries because there are inputs into the system (e.g.
knowledge, food, water) and outputs (e.g. waste, speech, perspiration).
• The system theory helps nurses to view the individual client, the
family as well as the community holistically.
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General …
• These concepts may be applied to different kinds of
systems, for example, to molecules in chemistry,
cultures in sociology, organs in anatomy, and health
in nursing.
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Roy adaptation Theory

• According to this theory nursing is the practice of

facilitating the adaptation of an individual’s four
subsystems (physiologic, self-concept, role function,
interdependence).
• The nurse attempts to modify or maintain stimuli
affecting adaptation within the nursing process.
• Nursing assessment focuses on two units of analysis:
the person's system and environmental interaction,
while intervention is concerned with manipulation of
parts of the system or environment.
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Adaptation…
• Adaptation is a continuously occurring process that
effects change and involves interaction and response.
• Human adaptation occurs on three levels: the internal
(self), the social (others), and the physical
(biochemical reactions).
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Developmental theory

• It outlines the process of growth and development of

humans as orderly and predictable, beginning with
conception and ending with death.
• Although the pattern has definite stages, the progress
and behaviors of an individual within each stage are
unique.
• Heredity, temperament, emotional and physical
environment, life experiences, and health status
influence the growth and development of an individual.
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Orem's self-care nursing Theory

• The model revolves around the concept of self-care.
• Orem describes nursing as a creative effort of one
human being to help another human being.
• Helping system which can be wholly compensatory;
that is, the client is unable to achieve self-care,
therefore has health deviation self-care requisites;
partly compensatory where both nurse and client
work to achieve self –care.
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Johnson Behavioral Systems Model

• Johnson believes that nursing care is directed toward

caring for the whole patient to facilitate effective and
efficient behaviors necessary to prevent illness.
• Johnson views nursing as being separate from medicine.
• This model emphasizes that both the internal and
external environments of the system need to be orderly
and predictable to maintain homeostasis.
• If the subsystems are out of balance, tension and
disequilibrium result.
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Purpose of basic nursing care.

• First, it’s important to review the broader aims

of nursing care, such as
• Helping the patient cope with restricted
mobility,
• Making his environment comfortable,
• Promoting safety,
• Preventing complications, and
• Helping him return to a normal life.
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Care of Patient Unit

• Definition: Patient: A Latin word meaning to suffer or to bear.

• Is a person who is waiting for or undergoing medical treatment and care.
• Patient Care Unit: is the space where the patient is accommodated in
hospital and consists of the bed, an over bed table, a bedside table, and
possibly a chair.
The patient unit is of three types:
1. Private room – is a room in which only one patient be admitted
2. Semi private room – is a patient unit which can accommodate two
patients
3. Ward- is a room, which can receive three or more patients.
 Consists of a hospital bed, bed side stand, chair, overhead light,
suction and oxygen, electrical outlets, sphygmomanometer, a nurses
call light, waste container and bed side table.
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Pcu…
Hospital Bed
• Gatch bed: a manual bed which requires the use of
hand racks or foot pedals to manipulate the bed into
desired positions i.e. to elevate the head or the foot of
the bed.
• Most commonly found in Ethiopia hospitals and are
less expensive
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Side rails
it prevent client falls.
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Pcu…
Bed Side Stand
• Is a small cabinet that generally consists of a drawer and a cupboard area
with shelves.
• Used to store the utensils needed for clients care and storage of personnel
utensils that will be used frequently. E.g. soap, shampoo, lotion etc.
The Chair
• Most basic care units have at least one chair located near the bedside.
• For the use of the client, a visitor, or a care provider
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Over Bed Table

• The height is adjustable
• Can be positioned and consists of a rectangular, flat
surface supported by a side bar attached to a wide
base on wheels
• Along side or over the bed or over a chair
• Used for holding the tray during meals, or care items
when completing personal hygiene
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Ward…
Overhead Light (examination light)
• Is usually placed at the head of the bed, attached to either the wall or the
ceiling.
Suction and Oxygen Outlets
• Suction is a tube that is used to pull (evacuate) fluids from the body. E.g.
to clear respiratory mucus or fluids.
• Oxygen is an essential gas used for treatment purpose.
Electrical Outlets
• Almost always available at the head of the bed.
Sphygmomanometer
• The blood pressure assessment tool, has two types:
1. An aneroid
2. Mercury
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Cleaning of patient's Care unit

• Definition - is keeping of the patients’ room neat &
orderly.
• There are two types of cleaning that are concurrent and
terminal cleaning
1. Concurrent Cleaning- is a daily cleaning of the
patients room. It consists cleaning the room by damp
mopping the floor and dusting with damp cloth.
2. Terminal cleaning - is cleaning the room that is done
after the patient is discharged or transferred to another
room.
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Methods of cleaning
• MANUAL METHODS • MECHANICAL METHODS
a. Sweeping A. Suction cleaning
b. Dusting B. Buffing
c. Damp Dusting C. Polishing
d. Moping D. Burnishing
e. Scrubbing E. stripping
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CLEANING PROCEDURES
1. Decontaminate hands prior to and following procedure.
2. Put on aprons and disposable gloves
3. Strip bed
4. Using the appropriate detergent / disinfectant to
decontaminate bed frame, mattress and base.
5. Check integrity of mattress
6. Decontaminate pillows and duvet
7. Remake bed with fresh laundry.
8. Attach and date green assurance label to bed after the
procedure is done.
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General Rules for Cleaning

• Dry dusting of the room is not advisable.
• Dusting should be done by sweeping only
• Use a damp duster for collecting dust
• Dust with clear duster
• Collect dust at one place to avoid flying from place to
place
• Dusting should be done without disturbing or
removing the patients from bed
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Cont..
• Dusting should be done from top to bottom i.e. from
upward to downward direction
• While dusting, take care not to spoil the beds or walls
or other fixtures in the room or hospital ward
• While dusting, wounds or dressing should not be
opened by other staff
• There should be a different time for dusting daily
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Definition of terms
• Dust -fine, dry powder consisting of tiny particles of
earth or waste matter
• Mop - wipe or soak up liquid away from a surface
• Scrub- use water to remove impurities from the hand
or surface
• Asepsis – is the process of reducing or elimination the
number of micro organisms on both animate (living)
surfaces (skin and mucous membranes) and inanimate
objects (surgical instruments and other items).
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Cont..
• Antisepsis – is the process of reducing the number of
micro – organisms on skin, mucous membranes or
other body tissue by applying an antimicrobial
(antiseptic) agent.
• Decontamination – is the process that makes
inanimate objects safer to handle by staff before
cleaning (i.e. inactivates HBV, HCV & HIV and
reduces the number of other microorganisms but does
not eliminate them) E.g. soaking soiled items for 10
minutes in 0.5% chlorine solution
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Ensuring ventilation and lighting of the patient

room
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Cont..
• Ventilation is the intentional introduction of outside
air into a building or room
• Ventilation is mainly used to control indoor air
quality by diluting and displacing indoor pollutants;
it can also be used for purposes of thermal comfort or
dehumidification when the introduction of outside air
will help to achieve desired indoor psychometric
conditions.
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Cont..
• Lighting or illumination is the deliberate use of light
to achieve a practical or aesthetic effect.
• Lighting includes the use of both artificial light
sources like lamps and light fixtures, as well as
natural illumination by capturing daylight.
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Principles of ventilation and lighting

• Keep the air within the room as pure as the air
without chilling him
• Consider the source of air in the patients room.
• Provide as much natural daylight as possible for
occupants while avoiding excessive heat loss, heat
gain, and glare/ very bright or unpleasant light.
• Provide views and access to the outdoor environment
for all occupants.
• The patient should not be too warm or too cold.
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Cont..
• The temperature could be controlled by appropriate
balance ventilation from windows.
• Provide connections to indoor and outdoor nature
where possible.
• Integrate natural and electric lighting strategies, and
provide controls that optimize day lighting/electric
lighting interaction.
• Light vertical surfaces/walls to increase the perceived
brightness of the space.
 50

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Cont..
• Balance the quantity and quality of light in all work
areas and design for "uniformity with flexibility."
• Consider individually controlled task lighting for
each workstation that properly illuminates the task.
• Control or eliminate glare from ceiling lighting and
windows.
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Cont..
• Provide individual control of task lighting and, where
possible, adjustment of ceiling light using advanced
lighting systems technologies.
• Assure a visually appealing environment through the
appropriate and well-balanced use of scale, colors,
textures, patterns, artwork, and plants.
• Avoid both uniformity and visual chaos.
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Techniques of room ventilation and lighting

• Opening the windows
• Many windows are often provided ventilative cooling
and the reduction of solar radiation during the day by
efficient external solar shading should prevent
overheating.
• Every room to have a window for natural light to
come into and help create a healing environment for
the patient
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THERAPEUTIC COMMUNICATION

• Therapeutic communication is the use of

communication for the purpose of creating a
beneficial outcome for the client.
• Therapeutic communication:
• Is purposeful and goal-directed
• Has well-defined boundaries
• Is client-focused
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Principles of Therapeutic Interaction

• Plan to interview at an appropriate time. The time frame

within which an interaction occurs influences the outcome.
• For example, it is unwise to plan to talk with a client during
visiting hours, during change of shift, or when the client is
distracted by environmental stimuli (e.g., the homebound
client is watching a favorite television show).
• Ensure privacy. No one wants to discuss private matters when
or where other people are listening.
• Provide for comfort during the interaction. Discomfort can be
distracting. Pain
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Therapeutic…
• Accept the client exactly as is. Being judgmental blocks
communication.
• Encourage spontaneity. The nurse gathers more data when
the client is talking freely
• Focus on the leads and cues presented by the client. Asking
questions just for the sake of talking or for the satisfaction of
one’s own curiosity does not contribute to effective
interviewing.
• Therefore, allow the client to initiate the topic to be
discussed; then, use techniques to focus on that topic.
• Encourage the expression of feelings.
• The nurse must make a conscious effort to prevent personal
feelings from getting in the way of the client’s progress.
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The Elements of Therapeutic

Communication
• Empathy: An emotional linkage between two or more people
through which feelings are communicated; involves trying to
imagine what it must be like to be in another person’s situation.
• Behaviors of the nurse to be exhibited by Verbal comments:
like ‘‘This must make you feel sad.’’ or Nonverbal actions: by
Nodding the head to indicate understanding shows the nurse is
emphatic
• Truth ; client’s belief that the nurse will behave predictably
and competently while responding to the client’s needs
• Being consistent, doing exactly what you say you will do for
the client, being consistently open and honest.
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Elements…
Active listening: Hearing and interpreting language,
noticing nonverbal and Para verbal enhancements, and
identifying underlying feelings.
Caring
• Spending quality time with the client
• Paying attention to the client’s needs
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ASSISTING FEEDING A HELPLESS PATIENT

• It is a process of feeding patient unable to bring food
from receptacle to mouth.
• Patient with illness ,trauma or compromise oral
integrity, the client may be physically unable to eat
without assistance .
• Physical impairment that limit self-feeding includes:
compromised dentition,
improper fitting dentures,
oral lesion or infection, or
disease with resulting impaired digestion may limit the
types and consistence of food tolerated.
 59
Cont’d…
07/18/2023

Purpose
To be sure that the patient receive adequate nutrition

To promote the patient well-being

To promote the immunity and its function
To facilitate feeding with independently
Factors limiting self-feeding
 Fracture arm
 Hemiplegic
 Quadriplegia
 Dressing and bandage
 Debilitating illness
 Generalized weakness
 Presence of IV catheter or tubing
 60
Cont’d… 07/18/2023

Feeding helpless patient at meal time –general instruction

Check the diet order.
Make surrounding neat and clean.
Prepare patient and over –bed table .
The tray should be completed and should be attractive
and appetizing.
Hot food should be served hot and cold food cold.
Keep patient in a cheerful mood.
Do not hurry the patient feed, patient at his own speed.
Use the request of the patient rather than force in trying to
get a patient to take his food.
Encourage the patient to chew his food well.
In caring liquids to the patient in a cup or glass, carry
 61

Meeting the clients feeding needs 07/18/2023

• Check chart, or diet to list to determine whether the

client has limitation on eating e.g. fasting for lab or
procedure
• Check each tray for the clients name and the type of
diet.
• If pain is factor limiting food intake or self-feeding
ability, give analgesia to permit pain relief at meal
time.
• If fatigue is the problem, schedule a rest period
before eating to enhance appetite and increase
independence.
• Help the client urinate or defecate prior to meal if
needed to enhance meal time comfort.
 62

Cont’d… 07/18/2023

• Enhance the setting: Turn on the lights if needed,

Provide good ventilation, Remove room odors and
disturbing sights, such as soiled dressings.
• Prepare the clients for meal time by finding dentures
and eyeglass, brushing teeth ,rinsing mouth and
washing hands.
• Help the clients to a comfortable position for eating,
usually sitting in high fowler’s position bed or a chair
• Clear the overhead table of extraneous items.
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Specimen collection
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 65

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Specimen Collection

Specimen collection refers to collecting various

specimens (samples), such as, stool, urine, blood and
other body fluids or tissues, from the patient for
diagnostic or therapeutic purposes.
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Cont..
• Because only medical history can’t lead to the
accurate diagnosis .
• Laboratory examinations of specimens such as; urine,
blood, sputum, stool, throat swab, vaginal swab,
wound drainage etc provide important adjunct
information for diagnosing health care problems and
• provide a measure of the response to therapy.
 67

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Cont..
• Laboratory test contribute vital information about the
clients health.
• Correct diagnosis and therapeutic decision rely, in
part, on the accuracy of the test result.
• Adequate patient preparation, specimen collection,
and specimen handling are essential prerequisites for
accurate test results.
 68

Common mistakes affecting specimen 07/18/2023

• Failure to label specimen correctly and to provide all

pertinent information required on the test request form.
• Insufficient quantity of specimen to run the test
• Failure to use the correct container /tube for appropriate
specimen preservation
• Inaccurate and incomplete patient instruction prior to
collection
• Failure to tighten specimen container, resulting in leakage
and/or contamination of the specimen.
• failure to maintain the specimen at appropriate temperature
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The specimen should be labeled with:

▫ Patient’s full name

▫ Medical record no
▫ Date and time of specimen collection
▫ Specimen source (it indicated)
▫ Sign of the person who conducted the
procedure
▫ Unless it is labeled with this information the
specimen will be rejected.
 70

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Cont’d..
 71

General considerations for specimen collection

07/18/2023

wear gloves to protect self from contact

Get request for specimen collection and identify the types of
specimen
Give adequate explanation to the patient.
Assemble and organize all the necessary materials
Get the appropriate specimen container and it should be
clearly labeled.
specimen container and it should be clearly labeled
The patient's identification (name, age, card number, the
ward
The types of specimen and method used (if needed).
The time and date.
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Cont.…
Put the collected specimen into its container without
contaminating outer parts of the container and its
cover.
 All the specimens should be sent promptly to the
laboratory
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Collecting Stool Specimen

• Analysis of stool specimen can provide information about a

client’s health condition.
reasons for testing stool /feces
To determine the presence of occult (hidden) blood.
To analyze for dietary products and digestive secretions
• To detect the presence of ova and parasite
• To detect the presence of bacteria or virus, by culture
• For laboratory diagnosis, such as microscopic examination,
culture and sensitivity tests
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Equipment

Clean bedpan or commode

Wooden spatula or applicator
Specimen container
Tissue paper
Laboratory requests
Disposable glove, for patients confined in bed
Bed protecting materials
Screen
 75

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Obtain stool sample

Take the sample using spatula or applicator without
contaminating the container.
 The amount of stool specimen to be taken depends on the
purpose, but usually takes.
3.5 gm. sample from formed stool, 15.30 ml
sample from liquid stool
Visible mucus, pus or blood should be included into sample
stool specimen taken.
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Care of equipment and the specimen collected.

Handle and label the specimen correctly

Send the specimen to the laboratory immediately
give proper care of all equipments used.

Documentation and report

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Collecting Urine Specimen

Purpose
To identity components of urine
To determine the presence of legal or illegal
drugs
To determine pregnancy
To diagnose disorder
 Routine laboratory analysis &
culture and sensitivity tests
 78

07/18/2023

Types of urine specimen collection

• The type of testing determines the method of
collection.
• The different methods of urine collection are:
▫ Random collection (routine analysis)
▫ Timed collection
▫ Collection from a closed urinary drainage system
▫ Clean-voided specimen
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07/18/2023

Types of urine specimen collection

Clean voided urine specimen

• Clean catch or midstream specimen: - is used when
specimen relatively free of MOs is required.
• The client’s urinary meatus is cleaned and the patient is told
to void into the toilet, stop the urinary flow and then void
midstream urine into a clean container and finish voiding on
the toilet.
• The specimen is taken immediately to the lab.
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 Collection from a Closed Drainage System

• sterile specimen can be collected from a client with

an indwelling Foley catheter with a closed drainage
system.
• A sterile specimen is used to culture the urine.
• Specimen from catheter: - may be necessary when
the client is unable to void or already has a catheter in
place.
• Urine should not be collected from the collection bag;
it should be directly obtained from the catheter.
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Timed urine specimen

• Timed collection is done over a 24-hour period.
• The urine is collected in a plastic gallon container that
contains preservative.
• It is two types
Short period  1-2 hours
Long period  24 hours
 82

07/18/2023

Cont..
• 24hrs urine specimen: - is used to measure
accurately renal (kidney) function for certain
substances such as creatinine, urine urea nitrogen,
glucose, sodium, potassium etc.
• often started early in the morning after the client’s
first void, the first void is discarded and the time is
noted as the beginning of the 24hrs period during
which all urine is saved /collected
 83

07/18/2023

Random urine specimen: -

• As the name implies the specimen is collected at any time

using a clean cup.
• This is the specimen most commonly sent to the laboratory
for analysis, because it is easier to obtain and readily
available.
• This specimen is usually submitted for urinalysis and
microscopic analysis, although it is not a specimen of
choice for either of these tests.
 84

07/18/2023

Equipment

• Disposable gloves
• Specimen container
• Laboratory requisition form
• Water and soap or cotton balls and antiseptic
solutions (swabs).
• Urine receptacles (i.e. bedpan or urinals)
• Bed protecting materials
• Screen (if required)
 85

07/18/2023

Obtain urine specimen

Ask patient to void

Let the initial part of the voiding passed into the receptacle
(bed pan or urinal) then pass the next part (the midstream) into
the specimen container.
Hold the vulva or penis apart from the specimen container
Don't allow the container to touch body parts
Collect about 30-60 ml midstream urine
Handle the outside parts of the container
Remove the glove
 86

07/18/2023

Cont’d…
Care of the specimen and the equipment
Handle and label the container correctly
Send the urine specimen to the laboratory immediately
together with the completed laboratory requested forms
Empty the receptacles content properly
Give appropriate care for the used equipments
 87

07/18/2023

Cont.…
Document pertinent data and report, such as
▫ Specimen collected, amount, time and
date.
▫ Consistency of the urine
▫ Patients experience during voiding
 88

07/18/2023

Cont..
Collecting a Sterile Urine Specimen
Sterile urine specimen collected using a catheter in
aseptic techniques
 89

07/18/2023

Collecting a Timed Urine Specimen

Purpose
For some tests of renal functions and urine
compositions, such as:- measuring the level of
hormones, such as adrenocortico steroid hormone,
creatinine clearance or protein quantization tests.
 90

07/18/2023

Collecting sputum specimen

Sputum is the mucus secretion from the lungs,

bronchi and trachea, but it is different from saliva.
The best time for sputum specimen collection is in
the mornings up on the patient’s awaking (that have
been accumulated during the night).
If the patient fails to cough out, the nurse can obtain
sputum specimen by aspirating pharyngeal secretion
using suction.
 91

07/18/2023

Purpose
Sputum specimen usually collected for:
Culture and sensitivity test (i.e. to identify the
microorganisms and sensitive drugs for it)
Cytological examination
Acid fast bacillus (AFB) tests
Assess the effectiveness of the therapy
 92

07/18/2023

Equipment
Disposable gloves
Specimen container
Laboratory requisition form
Mouth care (wash) tray
 93

07/18/2023

Procedure

Patient preparation
teach pt about the difference between sputum and
saliva, how to cough deeply to raise sputum.
Position the patient, usually sitting up position. Also
postural drainage can be used.
Give oral care, to avoid sputum contamination with
microorganisms of the mouth. Avoid using tooth pest
because it alters the result.
 94

07/18/2023

Cont…
Obtain sputum specimen
Put on gloves
Ask pt to cough deeply to raise up sputum
Take usually about 15-30 ml sputum
Ask pt to spit out the sputum into the specimen
container
Make sure it doesn't contaminate the outer part of the
container.
Cover the cape tightly on the container
 95

07/18/2023

Care of the specimen & equipment

Document the amount, color, consistency of

sputum, (thick, watery, tenacious) and presence of
blood in the sputum.
 96

07/18/2023

Throat swab
(posterior pharyngeal swab)

WHO/CDS/EPR/ARO/2006.1
 97

Collecting Blood Specimen 07/18/2023

Venous blood is drawn for most tests, but

arterial blood is drawn for blood gas
measurements.
 98

07/18/2023

Cont..blood
Arterial
▫ Difficult to identify
▫ Blood flows with pumping pressure
▫ Control of blood collection is difficult
▫ Difficult to stop the bleeding
Venous blood
▫ Easy to identify
▫ Better control on flow of blood
▫ Bleeding can be easily stopped
 99

07/18/2023

Cont..

Venous blood
infants: 0.5 – 2 ml
children: 2 – 5 ml
adults: 5 – 10 ml
 100

07/18/2023

Purpose
• To assess the bloods normal cells & other
components
• To determine the presence of abnormalities or disease
causing organisms
• Specimen of venous blood are taken for complete
blood count(CBC), which includes
including Hgb
and Hct,
 WBC with differential count etc.
 101

07/18/2023

Cont..
• To measure serum electrolyte and acid-base balance
• To evaluate renal function test by measuring blood urea
and creatinine
• To evaluate serum osmolarity (fluid balance)
• For monitoring serum drug levels. e.g. digoxin,
• For blood chemistry e.g. to evaluate serum enzyme level
• To evaluate blood glucose level
• To measure arterial blood gases
• To know blood group etc
 102

07/18/2023

Equipment

Sterile gloves
Tourniquet
Antiseptic swabs
Dry cotton (gauze)
Needle and syringe
Identification/ labeling: name, age address, etc.
Laboratory requisition forms
Specimen container with the required diluting or
preservative agents (: anticoagulant).
 103

07/18/2023

Cont..
• Vain puncture – is the procedure of using a needle to with
draw blood from a vein. It is often done from the inside
surface of the forearm near the elbow, called antecubital
space. Here the veins are near the surface and are easy to
secure or feel.
 104

07/18/2023

Cont..
• Venipuncture is one of the most routinely performed
invasive procedures and is carried out for any of five
reasons:
▫ to obtain blood for diagnostic purposes;
▫ to monitor levels of blood components
▫ to administer therapeutic treatments including medications,
nutrition or chemotherapy;
▫ To collect blood for later use in patients requiring transfusions.
▫ Is the procedure of using a needle to withdraw blood from a
vein.
Vaginal or Urethral Discharge Specimens
• Normally thin, nonpurulent, whitish or clear, small in
amount
• S&S STD’s, UTI
• Assess external genitalia
• If STD record sexual history
• Physician’s order- vaginal/urethral
 106

Dessalegn D.(BSc N) 07/18/2023

Taking other body discharge

Body discharges collected as sample;
• Gastric content
• Cerebrospinal fluid
• Peritoneal
• Pleural
• Biopsy Bone marrow, Kidney tissue, Liver tissue
• Swabs and smears
 107

Taking other body discharge cont… Dessalegn D.(BSc N) 07/18/2023

Gastric content sampling

Samples of gastric and duodenal juices are obtained for
biochemical, microbiological and cytological
examination. The sample is sent to the laboratory in a wide
neck sterile tube.
The sample is collected by:
• Syringe aspiration through a gastric tube
• Removal of a sample from a kidney bowl when vomiting
• Endoscope aspiration during endoscopic examination
 108

Taking other body discharge cont… Dessalegn D.(BSc N) 07/18/2023

Cerebrospinal fluid sample

• Cerebrospinal fluid is collected strictly aseptically
from the spinal canal, i.e. the lumbar puncture,
performed by a doctor and assisting nurse.
• The patient signs their consent to the
examination
 109

Dessalegn D.(BSc N) 07/18/2023

Taking other body discharge cont…

Sampling fluid from the peritoneal cavity
Abdominal paracentesis involves drawing fluid from
the peritoneal cavity in the event of accumulation -
ascites (e.g. liver cirrhosis).
The aim is to obtain a sample of fluid for laboratory
examination and to relive the pressure on the abdominal
organs
 110

Dessalegn D.(BSc N) 07/18/2023

Taking other body discharge cont…

Sampling fluid from the pleural cavity
Thoracentesisis a collection of fluid or air from the
pleural cavity.
The accumulated fluid is extracted for diagnostic or
therapeutic reasons
The procedure is carried out by a doctor and assisting
nurse with a puncture needle which has a three-way
valve attached to prevent air penetrating into the pleural
cavity
WHEN TO USE HEAT

07/18/2023
 With chronic injuries - two weeks or more and have
persisted for a length of time
 Osteoarthritis
 Tension headaches
 For relaxation (baths)
 Before deep stretching
 Before exercise to warm the muscles

111
 PURPOSE

07/18/2023
 To relieve stasis of blood
 To increase absorption of inflammatory products

 To relieve stiffness of muscle and muscle pain

 To relieve pain and swelling of a localized inflammation boil

or carbuncle
 To increase blood circulation

 To promote suppuration

 To relieve distention and congestion

 To provide warmth to the body

112
 POINTS TO BE REMEMBERED:
 Heat only applied when specific ordered by physician and with
outmost caution

07/18/2023
 Specific body part such as the eye lid, neck, and inside the arm
are specially sensitive area to heat

 Each person has his or her own sensitivity to heat. Test each
person for sensitivity before applying heat.

 Infants, older people, and those with fair, thin skin have less
heat resistance.
 Lowered body resistance due to illness also makes body tissue
less resistance to heat.
113
 Points to be remembered:
 Clients who are unresponsive and anesthetized and those
suffering from neurologic disorders or dementia are at

07/18/2023
increased risk for injury from heat applications
 Clients receiving radiation therapy or chemotherapy for
cancer and those with any degree of paralysis are particularly
susceptible to burns
 Listen to the clients. If he or she complains of pain or
discomfort, stop the treatment and consult the team leader or
primary care provider.

114
 DO NOT USE HEAT IF:

07/18/2023
1. An acute injury is present – heat increases bleeding and swelling;
2. Hypertension or other circulatory issues are present;
3. Decreases skin sensitivity to temperature change is present;
4. With inflamed joints or skin burns;
5. In the presence of infections, hives or rashes;
6. Person is hypersensitive to heat;
7. Caution with MS (multiple sclerosis);
8. Avoid over cancerous areas or areas containing malignant tumors.

115
METHODS FOR APPLYING DRY AND
MOIST HEAT

07/18/2023
Dry heat Moist heat
 Hot water bottle  Compress
 Aquathermia pad(waterproof  Hot pack
water filled heating pad
 Soak
 Disposable heat pack
 Sitz bath
 Electric pad

116
PERFORMING A WARM SOAK

07/18/2023
 Assemble equipment:
1. Bath thermometer
2. Soak basin
3. Pitcher
4. Large plastic sheet
5. Bath towel
6. Bath blanket

117
TECHNIQUE

07/18/2023
 A,B,C
 Bring equipment to the bedside.

 Cover the patient with a bath blanket.

 Fanfold bedding to the foot of the bed.

 Expose the limb to be soaked.

118
TECHNIQUE…

07/18/2023
 Position the patient for comfort on the far side of the bed
(opposite the part to be soaked). Be sure the side rail is
up and secure.
 Cover the bed with a plastic sheet and towel.

 Fill the soak basin half full with water at the prescribed
temperature (usually 105°F).
 Check the temperature with a bath thermometer.

119
TECHNIQUE…

07/18/2023
 Take the soak basin from the over bed table and
position it on the bed protector.
 Assist the patient to gradually place the limb in
the basin (figure). Cover the basin with a towel
to help maintain temperature.

120
TECHNIQUE…

07/18/2023
 Check the temperature every 5 minutes.
 Use a pitcher to get additional water and
add to the soak basin to maintain
temperature.
 Remember to remove the patient’s limb
before adding water to the container.

121
TECHNIQUE…

07/18/2023
 Discontinue the procedure at the end of the prescribed
time.
 Lift the patient’s limb out of the basin.

 Slip the basin forward and allow the limb to rest on the
bath towel.
 Place the basin on the over bed table. Gently pat the limb
dry with a towel.
 Remove the plastic sheet and towel.

122
TECHNIQUE…

07/18/2023
 Adjust bedding and remove the bath blanket.
If the treatment is to be repeated, fold the bath blanket
and place it in the bedside stand.
 Leave the unit tidy and the call bell within reach.

 Lower the head of the bed and make the patient

comfortable.
 Take equipment to the utility room. Clean and store it
according to facility policy.
 Carry out ending procedure actions.

123
APPLYING A WARM MOIST COMPRESS

07/18/2023
Equipment:
Disposable gloves
Syringe

Bed protector

Compresses

Bath thermometer

Binder or towel

Pins or bandage

124
TECHNIQUE

07/18/2023
 A,B,C
 Basin with prescribed solution at temperature ordered

 Bring equipment to the bedside.

 Expose only the area to be treated.

 Protect the bed and the patient’s clothing with a bed

protector.
 Put on disposable gloves.

 Check the temperature of the solution.

 Moisten the compresses; remove excess liquid.

125
TECHNIQUE…

07/18/2023
 Apply to treatment area.
 Secure the compresses with a bandage or binder.

 The compress must be in contact with the patient’s skin.

 Help the patient to maintain a comfortable position

throughout the treatment.
 Unscreen the unit. Leave the unit neat and tidy, with the
signal cord within easy reach.

126
TECHNIQUE…

07/18/2023
 Maintain proper temperature and moisture.
 If the compresses are to be kept warm, a K-Pad may be
applied.
 If the compresses are to be kept cool, an ice bag may be
applied.
 A syringe may be used to apply more solution to keep
the compresses wet.
 Remove the compresses when ordered. Change as
ordered or once in 24 hours. Check skin several times
each day.
127
TECHNIQUE…

07/18/2023
 Discard the compresses.
 Remove and dispose of gloves according to facility
policy.
 Carry out ending procedure actions.

128
WHEN TO USE HEAT

07/18/2023
 With chronic injuries - two weeks or more and have
persisted for a length of time
 Osteoarthritis
 Tension headaches
 For relaxation (baths)
 Before deep stretching
 Before exercise to warm the muscles

129
 PURPOSE

07/18/2023
 To relieve stasis of blood
 To increase absorption of inflammatory products

 To relieve stiffness of muscle and muscle pain

 To relieve pain and swelling of a localized inflammation boil

or carbuncle
 To increase blood circulation

 To promote suppuration

 To relieve distention and congestion

 To provide warmth to the body

130
 POINTS TO BE REMEMBERED:
 Heat only applied when specific ordered by physician and with
outmost caution

07/18/2023
 Specific body part such as the eye lid, neck, and inside the arm
are specially sensitive area to heat

 Each person has his or her own sensitivity to heat. Test each
person for sensitivity before applying heat.

 Infants, older people, and those with fair, thin skin have less
heat resistance.
 Lowered body resistance due to illness also makes body tissue
less resistance to heat.
131
 Points to be remembered:
 Clients who are unresponsive and anesthetized and those
suffering from neurologic disorders or dementia are at

07/18/2023
increased risk for injury from heat applications
 Clients receiving radiation therapy or chemotherapy for
cancer and those with any degree of paralysis are particularly
susceptible to burns
 Listen to the clients. If he or she complains of pain or
discomfort, stop the treatment and consult the team leader or
primary care provider.

132
 DO NOT USE HEAT IF:

07/18/2023
1. An acute injury is present – heat increases bleeding and swelling;
2. Hypertension or other circulatory issues are present;
3. Decreases skin sensitivity to temperature change is present;
4. With inflamed joints or skin burns;
5. In the presence of infections, hives or rashes;
6. Person is hypersensitive to heat;
7. Caution with MS (multiple sclerosis);
8. Avoid over cancerous areas or areas containing malignant tumors.

133
METHODS FOR APPLYING DRY AND
MOIST HEAT

07/18/2023
Dry heat Moist heat
 Hot water bottle  Compress
 Aquathermia pad(waterproof  Hot pack
water filled heating pad
 Soak
 Disposable heat pack
 Sitz bath
 Electric pad

134
PERFORMING A WARM SOAK

07/18/2023
 Assemble equipment:
1. Bath thermometer
2. Soak basin
3. Pitcher
4. Large plastic sheet
5. Bath towel
6. Bath blanket

135
TECHNIQUE

07/18/2023
 A,B,C
 Bring equipment to the bedside.

 Cover the patient with a bath blanket.

 Fanfold bedding to the foot of the bed.

 Expose the limb to be soaked.

136
TECHNIQUE…

07/18/2023
 Position the patient for comfort on the far side of the bed
(opposite the part to be soaked). Be sure the side rail is
up and secure.
 Cover the bed with a plastic sheet and towel.

 Fill the soak basin half full with water at the prescribed
temperature (usually 105°F).
 Check the temperature with a bath thermometer.

137
TECHNIQUE…

07/18/2023
 Take the soak basin from the over bed table and
position it on the bed protector.
 Assist the patient to gradually place the limb in
the basin (figure). Cover the basin with a towel
to help maintain temperature.

138
TECHNIQUE…

07/18/2023
 Check the temperature every 5 minutes.
 Use a pitcher to get additional water and
add to the soak basin to maintain
temperature.
 Remember to remove the patient’s limb
before adding water to the container.

139
TECHNIQUE…

07/18/2023
 Discontinue the procedure at the end of the prescribed
time.
 Lift the patient’s limb out of the basin.

 Slip the basin forward and allow the limb to rest on the
bath towel.
 Place the basin on the over bed table. Gently pat the limb
dry with a towel.
 Remove the plastic sheet and towel.

140
TECHNIQUE…

07/18/2023
 Adjust bedding and remove the bath blanket.
If the treatment is to be repeated, fold the bath blanket
and place it in the bedside stand.
 Leave the unit tidy and the call bell within reach.

 Lower the head of the bed and make the patient

comfortable.
 Take equipment to the utility room. Clean and store it
according to facility policy.
 Carry out ending procedure actions.

141
APPLYING A WARM MOIST COMPRESS

07/18/2023
Equipment:
Disposable gloves
Syringe

Bed protector

Compresses

Bath thermometer

Binder or towel

Pins or bandage

142
TECHNIQUE

07/18/2023
 A,B,C
 Basin with prescribed solution at temperature ordered

 Bring equipment to the bedside.

 Expose only the area to be treated.

 Protect the bed and the patient’s clothing with a bed

protector.
 Put on disposable gloves.

 Check the temperature of the solution.

 Moisten the compresses; remove excess liquid.

143
TECHNIQUE…

07/18/2023
 Apply to treatment area.
 Secure the compresses with a bandage or binder.

 The compress must be in contact with the patient’s skin.

 Help the patient to maintain a comfortable position

throughout the treatment.
 Unscreen the unit. Leave the unit neat and tidy, with the
signal cord within easy reach.

144
TECHNIQUE…

07/18/2023
 Maintain proper temperature and moisture.
 If the compresses are to be kept warm, a K-Pad may be
applied.
 If the compresses are to be kept cool, an ice bag may be
applied.
 A syringe may be used to apply more solution to keep
the compresses wet.
 Remove the compresses when ordered. Change as
ordered or once in 24 hours. Check skin several times
each day.
145
TECHNIQUE…

07/18/2023
 Discard the compresses.
 Remove and dispose of gloves according to facility
policy.
 Carry out ending procedure actions.

146
PROVIDING SITZ BATH

07/18/2023
 Definition: A sitz bath can refer to a bath where the
pelvic region is immersed in warm water, or to a type of
tub, which makes taking the sitz bath easier.
Sitz derives from the German word sitzen,
which means to sit.
It is possible to take a sitz bath in a

regular tub, but you either keep the feet

over the side of the tub or put the feet in
the water, keeping the knees bent.
This may not be quite as hygienic as a sitz
147
bath taken in a sitz bath tub.
 PURPOSE AND RISKY PEOPLE

Purpose
 To cleanse perineal area  People at risk of developing

07/18/2023
 To soothe perineal area perineal infection
 To reduce sign of inflammation of 1. Client with indwelling catheters
2. Perineal ,rectal or lower urinary
perineal
tract surgery
,vaginal area after child birth 3. Incontinent clients
Cleanse and soothe and 4. Women after child birth
reduce inflammation after vaginal or
rectal surgery
 Hemorrhoids or fissures

148
PRECAUTION

07/18/2023
lasts 10-20 minutes (or upon doctor’s
recommendations)
If it is going to be given in the tub – fill ½
the tube with water and add the ordered
medication

149
 PRECAUTION
 Temperature :- as to preference but it is usually 1050-
1130F(40.5-45oC)

07/18/2023
 You can often get away with using a large dish tub, but a
person carrying extra weight may need a larger sized sitz
bath.
 The basin or tub should be thoroughly cleaned after each
use.
 Don’t add soap to the water as this can be irritating if you
have any type of anal infection or irritation.
 After the sits bath gentle dry the affected area with a soft
towel.
150
COLD APPLICATION

07/18/2023
 Cold Temperature is between 0 to 12 deg celsius;
 cool is considered between 13 to 18 deg.celsius,

 Cold application prevents escape of heat from the body by

slowing circulations, which also relieves congestions and
often relieves muscle pain.

151
WHAT DOES COLD DO?

07/18/2023
 When applied locally (to affected area) it reduces the
temperature of the skin, then the muscles and joint
 Slowing body metabolism and its demand for oxygen

 Effect may last up to 45 minutes after cold source is

removed
 Restricts blood flow to the area by narrowing the blood
vessels (vasoconstriction)
 Decrease inflammation, swelling and muscle spasm

152
 Can be applied to the body in two ways

Moist
 Dry

07/18/2023
Do Not Use Cold If:
 Raynaud’s Disease or decreased skin sensitivity to temperature is
present ,circulatory insufficiency is present. Do not use over new
wounds.

153
PURPOSE

07/18/2023
 To relieve pain: cold decrease prostaglandin's, which
intensify the sensitivity of pain receptors, and other
substances at the site of injury by inhibiting the
inflammatory processes
 To reduce swelling and inflammation: by decreasing the
blood flow to the area (vasoconstriction effect)
 Reduce raised body temperature due to fever Cold can be
applied in moist (cold compress 18-27 c) and dry form (ice
pack (bag) <15 oc) Systemic effects of cold – extensive
cold application can increase blood pressure Systemic
effects of Hot – produce a drop in blood pressure –
excessive peripheral vasodilatation 154
 To relieve headache
METHODS FOR APPLYING DRY
AND MOIST COLD

07/18/2023
 Dry cold
 Cold pack
 Ice bag
 Ice glove
 Ice collar
 Hypothermic blanket
 Moist cold
 Compress
 Cooling sponge bath
155
COLD, MOIST COMPRESSES

07/18/2023
 Apply cold moist compresses to reduce swelling and
inflammation in soft tissue injury or after tooth
extractions.
 Gauze 4X4’s are frequently used as cold moist
compresses for tooth pain.

156
 Appling cold compresses

07/18/2023
1. Explain the treatment to patient as it reduce pain and relieve
discomfort
2. Wear gloves in patient has open wound or has had surgery
3. Put the compresses in a basin containing pieces of ice and
small amount of water.
4. Wring the compresses thoroughly and apply
5. Change the compresses frequently
6. Continue the treatment as ordered, usually for 15-20 minutes.
Repeat the treatment 2-4 hrs as ordered
7. Properly dispose of gloves if used and wash hands and157them
document the procedure.
 GIVING TEPID SPONGE BATH
 A,B,C and D as necessary
 Give opportunity to use bed pans or urinals before bath

07/18/2023
 Take temperature and record

 Note whether patient has antipyretic to reduce fever

 Add tepid water to the bath basin (21.1oC to 29.4 oC) use
thermometer to measure
 Place moist, cool cloths wrung out just enough to prevent
dripping in the client axillae and the groin
 Be aware that the client’s first reaction to a tepid sponge bath is
a sensation of chilliness, which disappears as the body adjusts to
the water’s temperature .therefore continue the bath long enough
t allow for this adjustment(at least 25-30minute).
158
PROCEDURE…TEPID SPONGE

07/18/2023
 Monitor the client’s body temperature throughout the
procedure to determine the treatment effects.
 Sponge each limb for at least 5 minute and the back and
buttocks for at least 10-15minute.
 Stop the procedure if the client become very chilled or
begins to shiver.
 Stop sponging as soon as the client’s temperature
approaches the normal range (38.7 oC).give the patient bath
blanket
 Wash hand .document the procedure with patient reaction
temperature pre and post
 Take the temperature 30minute after you complete the bath. 159
TEPID SPONGING WITH ALCOHOL

07/18/2023
 Tepid (Lukewarm) water + alcohol3 parts water: 1 part alcohol
 The temperature of the water is 32 oC (below body temperature) 27 oC for alcohol evaporates
at a low temperature and therefore removes body heat rapidly
 Less frequently used – because alcohol causes skin drying

 Heat loss is by conduction and vaporization

 Determine the patients’ temperature, PR and RR frequently every (Q) 15 min

 Sponge each area (part) for 2-3 min changing the washcloth

 The sponge bath should take about 30 minutes

Reassess v/s at the end

Discontinue the bath if the clients becomes pale or cyanotic or

shivers, or if the PR becomes rapid or irregular

The application is repeated Q2 – 3 hrs to relieve swelling

compress– a moist gauze or cloth immersed in (hot or cold)

water and applied over an area. 160
DRY COLD (ICE BAG)

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 Ice kept in a bag
 Covered with cloth and applied on an area

 Temperature <150 C

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CONTRAST - HEAT THEN COLD

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CONTRAST - HEAT THEN COLD

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 Alternating heat then cold causes a flushing effect –
blood vessels dilate then constrict, causing an overall
increase of circulation to the area, tissue healing and
reduces swelling.
 It is also thought that the brain is momentarily distracted
away from sending or receiving pain messages through
the use of contrasting temperatures.
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CONTRAST - HEAT THEN COLD

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 Applied in a ratio of 3:1, 3 minutes of heat to 1 minute of
cold and repeat 3 times for maximum effect
 The greater the difference in temperature of the
application, the greater the effect on the local circulation
 Always end with cold application to prevent congestion

 When to use Contrast

Approximately 2 days to 2 weeks after

an injury
The presence of inflammation, swelling

and heat should be diminishing 164

SUMMARY POINTS

07/18/2023
 Heat dilates blood vessels while cold constrict it.
 Warm, moist applications heat the skin more quickly than
dry heat applications
 Water temperature for soak should be no higher than 105oF
 Cold moist compresses applied to small body parts
 A tepid sponge bath may be used to reduce a clients body
temperature
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  
SUMMARY
Description Temperature Application

07/18/2023
Very cold Below 15C Ice bag
Cold C 15-18 Cold packs
Cool C 27 – 18 Cold compresses
Tepid C 37 – 27 Alcohol sponge bath
Warm C 40 – 37 Warm bath
Hot C 46 – 40 Hot soak, hot compresses
Very Hot Above 46 C Hot water bag for adult

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Characteristics of profession
1. A profession requires an extended education of its mem-
bers, as well as a basic liberal foundations
2. Has a theoretical body of knowledge leading to defined
skill, abilities, and norms
3. Profession provides a specific service
4. Member of the profession autonomous in decision making
and practice
5. The profession as a whole has a code of ethics for practice.

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