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FUNDAMENTALS OF NURSING I. Nursing as a Profession Profession - It is defines as an occupation that requires extensive education or a calling that requires special knowledge, skill and preparation. Professionalism - It refers to professional character, spirit or methods. Professionalization - It is the process of becoming professional that is of acquiring characteristics considered to be professional. Criteria of a Profession 1. Specialized Education - It is imparted by the colleges and universities 2. Body of knowledge - It is a knowledge base of nursing that give direction to nursing practice, education and ongoing research. 3. Service orientation - Differentiate nursing from an occupation pursued primarily for profit - Nursing has a tradition of service to others that is guided by certain rules, policies, or codes of ethics 4. Ongoing research - Research in nursing is continuously increasing to contribute to the development of nursing practice 5. Code of Ethics - Integrity – a nurse is expected to do what is considered right regardless of the personal cost. - Preserved the high value on the worth and dignity of others 6. Autonomy - It regulates itself and sets standards for its members - Nursing is to have professional status therefore they must function autonomously in the formation of policy and in the control of its activity provided that it should be within the scope of practice. Scope of practice – particular functions and roles and determine its goals and responsibilities in delivery of its services. 7. Professional Organization
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Fundamentals of Nursing Lecture

Jul 20, 2016

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Page 1: Fundamentals of Nursing Lecture

FUNDAMENTALS OF NURSING

I. Nursing as a Profession

Profession- It is defines as an occupation that requires extensive education or a calling that requires special

knowledge, skill and preparation.

Professionalism- It refers to professional character, spirit or methods.

Professionalization- It is the process of becoming professional that is of acquiring characteristics considered to be

professional.

Criteria of a Profession1. Specialized Education

- It is imparted by the colleges and universities2. Body of knowledge

- It is a knowledge base of nursing that give direction to nursing practice, education and ongoing research.

3. Service orientation- Differentiate nursing from an occupation pursued primarily for profit- Nursing has a tradition of service to others that is guided by certain rules, policies, or codes of

ethics4. Ongoing research

- Research in nursing is continuously increasing to contribute to the development of nursing practice

5. Code of Ethics- Integrity – a nurse is expected to do what is considered right regardless of the personal cost.- Preserved the high value on the worth and dignity of others

6. Autonomy- It regulates itself and sets standards for its members- Nursing is to have professional status therefore they must function autonomously in the formation

of policy and in the control of its activity provided that it should be within the scope of practice.Scope of practice – particular functions and roles and determine its goals and responsibilities in delivery of its services.

7. Professional Organization- Governance is the establishment and maintenance of social, political, and economic arrangements

by which practitioners control their practice, their self-discipline, their working conditions, and their professional affairs.

Different definitions in accordance to different theorist:

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Focus of Theory Theory Emphasis of Nursing Theory Clinical Approach

Florence Nightingale“Environment Theory”

The proper environment for the patient “uses fresh air, light, warmth, cleanliness, quiet, and the proper election and administration of diet-all at the least expense of vital power to the patient”.

Nursing focuses on creating a positive environment through the manipulation of the patient’s surroundings in order to enhance the reparative process.

The nurse reviews the emergency room environment and finds that it is clean, warm, and well lighted. She places the woman in the quietest area to discuss her home environment with her.

The nurse, at the request of the woman, calls neighbor who is a close friend to watch the dog for her.

Thus, the woman can now utilize her energies to assist in her own care.

Hildegard Peplau“Nurse-Patient Relationship”

“Nursing is as significant, therapeutic interpersonal process.

Nursing is an educative instrument, a maturing force that aims to promote forward movement of personality in the direction of creative, constructive, productive personal and community living. The relationship had

Four phases: orientation, identification, exploration, and resolution, and it initiated the recognition of a felt need which is related to a health problem.

The nurse identifies the woman’s need to care for her pet at home and her need to become mobile. The nurse, acting as a counselor, identifies who can meet her need, contacts the neighbor, and resolves that concern. Both the nurse and the woman way either until the woman is mobile, or until she has matured in such a way as to accept her limitation.

The four phases are:1. Orientation is similar to the assessment phase of the nursing process. It also means being intellectually

and emotionally set and directed toward a nurse-patient relationship.2. Identification relates to feeling a close emotional association with others for gratification, emotional

support, or relief from stress. This is similar to establishing rapport and in the context of the nursing process, this phase fill fall under the assessment and planning stages.

3. Exploitation is similar to the implementation stage of the nursing process. In Hall‟ description, exploitation, means taking advantage of resources (nursing skills, empathy). The resolution phase corresponds to the evaluation phase of the nursing process.

4. Resolution involves findings an answer to, or reaching a firm decision about something. The resolution phase corresponds to the evaluation phase of the nursing process.

Virginia Henderson“Unique function of nursing”

“Nursing is primarily assisting the individual (sick or well) in the performance of those activities contributing to health or its recovery (or a peaceful death) that he would perform unaided if he had the necessary strength, will or knowledge”.

This can be done by identifying the needs of the patient in terms of fourteen components.

The nurse allows the woman to express her fears and opinions, and assists her in caring for the dog by contacting the neighbor.

The focus of the care will be to aid the woman to become independent,

Especially in the area of bodily movement.

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Fourteen human needs1. Breath normally2. Eat and drink adequately.3. Eliminate body wastes.4. Move and maintain desirable posture.5. Sleep and rest.6. Select suitable clothing.7. Maintain body temperature.8. Keep body clean and well-groomed and protect the integument.9. Avoid environmental dangers and avoid injuring others.10. Communicate with others in expressing emotions, needs, fears, or opinions.11. Worship according to faith.12. Play or participate in various forms of recreation.13. Work at something providing a sense of accomplishment.14. Learn, discover, or satisfy curiosity that leads to normal development and health and use of the available

health facilities.Faye Abdellah“Twenty-one nursing problem”

Patient needs can be classified into four categories:

1. sustenal care related to survival needs

2. remedial care directed toward restoring the patient’s self-help ability by reducing or correcting the impaired state

3. restorative care helping the patient to live with impairment

4. preventive care making the patients better able to help themselves

After the nurse calls the neighbor, she will identify, under sustenal care, whether her needs for physical comfort, rest and activity, safety, oxygen, nutrition, fluids, and excretion are being met. She will focus on preventing complications from the patient’s immobility and helping her live with her impairment. This will be done by focusing on the identification of feelings and encouraging communication and the use of community resources.

Twenty-one nursing problem1. To maintain good hygiene and physical comfort.2. To promote optimal activity: exercise, rest, and sleep.3. To promote safety through prevention of accident, injury, or other trauma and through the prevention of

the spread of infection.4. To maintain good body mechanics and prevent and correct deformity.5. To facilitate the maintenance of a supply of oxygen to all body cells.6. To facilitate the maintenance of nutrition of all body cells.7. To facilitate the maintenance of elimination.8. To facilitate the maintenance of fluid and electrolyte balance.9. To recognize the physiological responses of the body to disease conditions-pathological, physiological,

and compensatory.10. To facilitate the maintenance of regulatory mechanisms and functions.11. To facilitate the maintenance of sensory function.12. To identify and accept positive and negative expressions, feelings, and reactions.13. To identify and accept interrelatedness of emotions and organic illness.14. To facilitate the maintenance of effective verbal and nonverbal communication.15. To promote the development of productive interpersonal relationships.16. To facilitate awareness of self as an individual with varying physical, emotional, and developmental

needs.

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17. To create and / or maintain a therapeutic environment.18. To facilitate awareness of self as individual with varying physical, emotional, and developmental needs.19. To accept the optimum possible goals in the light of limitations, physical, and emotional.20. To use community resources as an aid in resolving problems arising from illness.21. To understand the role of social problems as influencing factors in the cause of illness.

Martha Roger Sever“Science of Unitary Man”

Nursing’s Central focus is the study of the unity of man and the process of life, which is expressed in assumptions.

Such assumptions include those that man is a unified whole, an open system exchanging energy with the environment, unidirectional with change, having pattern and organization.

Nursing is concerned with human health and welfare.

Since the patient’s energy and environment have an effect on her health and welfare, the nurse will first call the neighbor about the dog. The nurse will them identify the patient’s total patterns of behaving, especially in terms of her moving ahead toward health and mobility. Change in the patient’s ability to move and become independent will guide care.

Dorothea Orem1. Theory of Self-Care – Relates to regulating structural integrity, human functioning, and development, which is continuous throughout life.2. Theory of Self-Care Deficits - Self-care deficits are predictive of a nursing requirement.3. Theory of Nursing Systems - Nursing systems refer to the approach to practice by which the nurse acts in relation to the patient’s self-care deficits.

Nursing is human service which focuses on the need for self-care provided by the individual or the nurse in order to sustain life or recover from disease.

Self-care basic needs are: 1. Universal - need for air, water, food2. Related to health deviation - changes in extremities or healing3. Developmental - related to children and their needs.

The nurse identifies the universal self-care requests of maintaining bonds of affection, love, and friendship and allows the patient to call her neighbor and arrange for the dog’s care.

The nurse will analyze her patient’s ability to care for herself in relation to her health deviation needs.

Later she will either provides care to meet the deficits or educate the patient to meet her own needs.

Imogene King“Systems Framework”

Nursing is a process involving perceptions, judgment, actions, reactions, interactions, and transactions that lead to a goal attainment. The focus of nursing is related to human beings interacting with their environment in order to achieve health. Health involves human growth and development, adjustment to stresses, and the use of resources within a culture.

Personal, interpersonal, and social systems show the relationship among the concepts identified within the theory.

The nurse and patient perceive the initial goal as that of meeting the needs of the patient’s dog, and the nurse calls the neighbor directly.

The interaction between the patient and nurse becomes the focus in terms of the patient’s immobility and her ability to further develop and adjust to stresses and use resources available to her.

The individual’s perception of her body image, her ability to communicate with others, and her fears of loneliness will influence her ability to regain health.

Betty Neuman“System Model”

Assist psychiatric/mental health nursing students in their early

The nurse realizes that the patient has experienced several stressors and

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encounters with clients in community mental health centers.

Nursing is a total person approach in which we view the individual in relationship to stress.

The aim is to reduce stress factors and adverse conditions that interfere with wellness by increasing the amount of energy that is stored.

Humans have to stressors.Nursing identifies the patient’s

ability to defend or resist such stressors and develops the means to prevent further stress.

Stressors occur within, between, and outside the individual.

has reduced energy with which to deal with her situation. In order to reduce her stress/concern for her dog, she contacts the neighbor and arranges for the pet’s care.

Emphasis will be placed on preventing further stress in the patient and minimizing her loss of energy due to immobility. The latter concern can be accomplished by improving her lines of defense, such as through exercise and / or rest, and by assisting her in resisting other stressors, such as the feeling of helplessness.

Sr. Callista Roy“Adaptation Model”

Nursing views the person as an adaptive system which reacts to stimuli in four modes.

These adaptive modes are related to physiological needs, such as the need for fluids and oxygen, the self-concept, role functioning, and interdependence.

Persons experience adaptation problems which need to be minimizing in order to allow them to cope with other stimuli and to maintain health.

The major initial stimulus that is interfering with the patient’s ability to adapt to her condition and the environment of the emergency room is her concern for her dog. This relates to her self-concept, role, and interdependence.

Calling her neighbor and reducing the major stimuli will allow the nurse to focus on other stimuli, such as her physiological need for movement and her ability to adapt to immobility.

Lucille Kinlein“Independent Nurse Practitioner”

The formal objective of nursing is caring for the body, mind, and soul of a person.

The focus is the person’s health state in relation to his self-care practices and the nurse as a self-care agent. It is through knowledge and experience and the continuous contact with the client that the outcome of care will be more predictable.

The nurse recognizes that the patient is immobile and cannot care for herself and her dog. She contacts the neighbor and those proceeds to focus continuously on the patient’s ability to care for her based on her strength (such as her ability to move her left side) and her deficits (such as her inability to walk).

She will view the patient as becoming increasingly healthy as she becomes more independent and has greater self-care assets.

Jean Watson“Interpersonal Caring Theory”

Its major concepts caring, interpersonal relations, needs, growth.

The science of caring involves the interpersonal process in relation to meeting certain human needs to promote health and growth of individuals and families through a

The nurse, after realizing that the patient’s immediate need is to have her dog cared for, calls the neighbor.

This assists the nurse is establishing a supportive-trusting relationship, which includes faith and hope with the patient in relation to her potential, in order to facilitate her health, growth,

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humanistic altruistic system of values.

Faith, hope, and the development of a helping-trust relationship within a supportive, protective, and corrective environment are essential.

and development.

Ida Jean Orlando“Immediate needs”

Nursing focuses on meeting patient’s immediate needs, this relieves or diminishes their distress or improve their immediate sense of adequacy of well being.

Patients generally require help when there are physical limitations, when there are adverse reactions to the setting, and when they cannot communicate their needs.

The nurse’s practice centers around observation, reporting, recording and those actions performed with or for the patient.

The immediate need for the patient is having the nurse contact the neighbor.

The nurse will then focus on the woman’s physical limitations, observe the effect of the emergency room on her reaction, and assist her to communicate her needs.

Lydia Hall“Core, Care, Cure Model”

Nursing involves the care or nurturing of patients, the core or therapeutic use of self, and the cure of disease with the help of other health care professionals.

These interrelated aspects differ in their emphasis depending on the patient’s present situation and their ability to cope.

Recognizing the woman’s feelings about her dog (core), the nurse will contact the neighbor immediately. The nurse, in providing nurturance (care), will also facilitate and carry out the physician’s prescription (cure), and assist the woman in coping with her inability to move and face the future.

The nurse will focus on the woman’s messages about how she feels about her present state and encourage her to make conscious decisions on her own behalf.

Ernestine Wiedenbach“A helping Art”

Nursing integrates thoughts, feelings, and overt actions in order to meet a patient’s need for help which is set by a behavioral stimulus, affected by a set of values and beliefs in order to fulfill a specific purpose.

The major components of practice, and art.

Practice includes knowledge, judgment, and procedural and communication skills.

The patient’s behavior is affected by her beliefs and values relating to her dog and its care. In order to facilitate this care, the nurse calls the neighbor and assures the patient the dog is receiving attention.

The patient’s reaction to the nurse and to her immobility will assist the nurse in exploring the patient’s ability to resolve her problems.

The nurse will administer care to the patient if the plan of care is accepted by the patient.

Four phases/components:1. Identification includes assessing patient’s needs.2. Ministration involves providing help.

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3. Validation is evidence that help resulted in patient’s ability to function.4. Coordination of resources is integrating the nurses’ service with the service of others in the health team.

Levine“Conservation Model”

Human respond to the environment holistically.

Nursing is based on four conservation:

a. principles of energyb. structural integrityc. personal integrityd. social integrity

Observation, the scientific approach, and communications affect patient-centered nursing interventions.

In order to preserve the patient’s social and personal integrity and to facilitate her ability to participate in her care, the nurse will call the neighbor to care for the dog. She will then assess her energy level, her feelings about her wholeness and being immobile, her relationships with others, and her own body’s ability to heal structurally.

Dorothy E. Johnson“Behavioral System Model”

a. A behavioral system includes all the patterned repetitive and purposeful ways of having a highly complex system contains parts or subsystems which can be described and analyzed. Each sub-system has drives and goals, a predisposition to act, a scope of action, and a behavior. b. They include attachment or affiliative, sexual, eliminative, aggressive/protective, achievement, ingestive, restorative, and dependency subsystems.c. Nurturance, protection, and stimulation of the subsystems.d. Nurturance, protection, and stimulation of the subsystem are the basis of nursing practice.

The nurse, being aware of the patient’s attachment to her dog, will call the neighbor. She will protect and stimulate the mobility of the patient during her care in order to facilitate purposeful ways of having and to restore her sense of independence.

Nursing Characteristic1. The science underlying the discipline of nursing is a human science. In other words, nursing

focuses on the human being: the person and his/her totality. This includes health, illness, experiences, responses, interactions, behaviors, concerns, problems, his environment, all the other things that shape the actions and reactions of the human being. The goal of nursing is to assist individuals to adapt to their illness and to the environment.

2. Nursing is a practice-oriented discipline. Its primary mission is related to practice, which is the practice of providing nursing care. To provide a theory based nursing practice, members of the nursing profession seek knowledge, engage in research and develop theories, not for the sake of knowledge alone, but primarily to improve nursing practice. Nursing as a discipline requires knowledge content and process.

3. Nursing is a caring discipline. Caring is a central concept of nursing and its considered the profession’s essence. The art of nursing has been historically considered synonymous for caring, more often with caring women, mothers, the religious.

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4. Nursing is a health-oriented discipline. Health is integral to nursing. It is through their perspectives of health that nurse makes their assessment of patient’s condition, plan for interventions evaluate interventions, make changes in interventions.

Personal and Professional Qualities of a Nurse1. Caregiver

Assist the client physically and psychologically while preserving the client’s dignity.Encompasses the physical psychosocial, developmental, cultural, and spiritual levels.

2. CommunicatorNurses 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.

3. TeacherThe nurse helps clients learn about their health and health care procedures they need to perform to restore or maintain their health.Nurses also teach unlicensed assistive personnel to whom they delegate care and they share their expertise with other nurses and health professionals.

4. Client advocateActs to protect the clientThe nurses represent the client’s needs and wishes to their health professionals, such as relaying the client’s wishes for information to the physician.They also assist clients in exercising their rights and help them speak up for themselves.

5. CounselorHelping a client to recognize and cope with stressful psychological or social problems, to develop improved interpersonal relationships, and to promote personal growth.

6. Change agentNurses act to make changes in a systemNurses act when assisting others to make modifications in their own behavior.

7. LeaderInfluences others to work together to accomplish a specific goal.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.

8. ManagerA nurse manages the nursing care of individuals, families and communities.Nurse-manager also delegates nursing activities to ancillary workers and other nurses, and supervises and evaluates their performance.Managing requires knowledge about organizational structure and dynamics, authority and accountability, leadership, change theory, advocacy, delegation, and supervision and evaluation.

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9. Case managerNurse case managers word with the multidisciplinary health care team to measure the effectiveness of the case management plan and to monitor outcomes.

10. Research consumerNurses often use research to improve client care

11. Expanded career rolesNurses are fulfilling expanded career rolesa. Nurse practitionerb. Clinical nurse specialistc. Nurse midwifed. Nurse educatore. Nurse researcherf. Nurse anesthetistg.

Different Fields in Nursing1. Institutional nursing (hospital staff nursing)2. Community health nursing (school nursing /industrial nursing/public health nursing)3. Independent nursing practice4. Nursing in education5. Nursing in other fields

Overview of the Professional Nursing Practice

Level of Proficiency according to Benner

Stage I NoviceNo experience (eg nursing student)Performance is limited, in flexible, and governed by context-free and regulations rather than experience.

Stage II Advanced BeginnerDemonstrates marginally acceptable performanceRecognizes the meaningful “aspects” of a real situationHas experienced enough real situations to make judgments about them

Stage III CompetentHave 2 or 3 years of experience. Demonstrates organizations and planning abilitiesDifferentiates important factors from less important aspects of careCoordinates multiple complex care demands

Stage IV ProficientHas 3 to 5 years of experiencePerceives situations as wholes rather than in terms of parts, as in Stage IIUses maxims as guides for what to consider in a situationHas holistic understanding of the client, which improves decision makingFocuses on long term goals

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Stage V ExpertPerformance is fluid, flexible, and highly proficient no longer requires rules, guidelines, or maxims to connect an understanding of the situation to appropriate actionDemonstrates highly skilled intuitive and analytic ability in new situationsIs inclined to take a certain action because “it felt right”

ARTICLE VI : Nursing PracticeSection 28. Scope of Nursing.

A person shall be deemed to be practicing nursing within the meaning of this Act when he/she singly or in collaboration with another, initiates and performs nursing services to individuals, families and communities in any health care setting. It includes, but not limited to, nursing care during conception, labor, delivery, infancy, childhood, toddler, preschool, school age, adolescence, adulthood, and old age. As independent practitioners, nurses are primarily responsible for the promotion of health and prevention of illness. A members of the health team, nurses shall collaborate with other health care providers for the curative, preventive, and rehabilitative aspects of care, restoration of health, alleviation of suffering, and when recovery is not possible, towards a peaceful death. It shall be the duty of the nurse to:

a. Provide nursing care through the utilization of the nursing process. Nursing care includes, but not limited to, traditional and innovative approaches, therapeutic use of self, executing health care techniques and procedures, essential primary health care, comfort measures, health teachings, and administration of written prescription for treatment, therapies, oral topical and parenteral medications, internal examination during labor in the absence of antenatal bleeding and delivery. In case of suturing of perineal laceration, special training shall be provided according to protocol established;

b. establish linkages with community resources and coordination with the health team;c. Provide health education to individuals, families and communities;d. Teach, guide and supervise students in nursing education programs including the administration of

nursing services in varied settings such as hospitals and clinics; undertake consultation services; engage in such activities that require the utilization of knowledge and decision-making skills of a registered nurse; and

e. Undertake nursing and health human resource development training and research, which shall include, but not limited to, the development of advance nursing practice;

Provided, That this section shall not apply to nursing students who perform nursing functions under the direct supervision of a qualified faculty: Provided, further, That in the practice of nursing in all settings, the nurse is duty-bound to observe the Code of Ethics for nurses and uphold the standards of safe nursing practice. The nurse is required to maintain competence by continual learning through continuing professional education to be provided by the accredited professional organization or any recognized professional nursing organization: Provided, finally, that the program and activity for the continuing professional education shall be submitted to and approved by the Board.

Board Resolution No. 220Series of 2004Code of Ethics for Registered Nurses

1. Values, customs, and spiritual beliefs held by individuals shall be respected.2. Individual freedom to make rational and unconstrained decisions shall be respected. 3. Personal information acquired in the process of giving nursing care shall be held in strict confidence.4. Human life is inviolable.

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5. Quality and excellence in the care of the patients are the goals of nursing practice.6. Accurate documentation of actions and outcomes of delivered care is the hallmark of nursing

accountability.7. Registered Nurses are the advocates of the patients: they shall take appropriate steps to safeguard

their rights and privileges.8. Registered Nurses are aware that their actions have professional, ethical, moral, and legal dimensions.9. They strive to perform their work in the best interest of all concerned. 10. The Registered Nurse is in solidarity with other members of the healthcare team in working for the

patient’s best interest.11. The Registered Nurse maintains collegial and collaborative working relationship with colleagues and

other health care providers.12. The preservation of life, respect for human rights, and promotion of healthy environment shall be a

commitment of a Registered Nurse.13. The establishment of linkages with the public in promoting local, national, and international efforts to

meet health and social needs of the people as a contributing member of society is a noble concern of a Registered Nurse.

14. Maintenance of loyalty to the nursing profession and preservation of its integrity are ideal.15. Compliance with the by-laws of the accredited professional organization (PNA), and other

professional organizations of which the Registered Nurse is a member is a lofty duty.16. Commitment to continual learning and active participation in the development and growth of the

profession are commendable obligations.17. Contribution to the improvement of the socio-economic conditions and general welfare of nurses

through appropriate legislation is a practice and a visionary mission.

Legal aspect of Nursing Practice

Types of Laws1. Public law

Refers to the body of law that deals with relationships between individuals and the government and governmental agencies.Criminal law – deals with actions against the safety and welfare of the public. Eg homicide, manslaughter and theft.Classification:a. Felonies – a crime of a serious nature such as murder, punishable by a term in prison.b. Misdemeanor – an offense of a less serious nature and is usually punishable by a fine

or short term jail sentence or both. Eg slapping a client’s face

2. Private lawBody of law that deals with relationship among private individuals.Also known as Civil lawClassification:a. Contract law – involves the enforcement of agreements among private individuals or

the payments of compensation for failure to fulfill the agreements.b. Tort law – enforces duties and rights among private individuals that are not based on

contractual agreements. Eg negligence and malpractice

Classification of Tort Law1. Unintentional Torts

a. Negligence

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Misconduct or practice that is below the standard expected of an ordinary, reasonable, and prudent person.

b. Gross negligenceInvolves extreme lack of knowledge, skill, or decision making that the person clearly should have known would put others at risk for harm.

c. Malpractice“Professional negligence” – negligence that occurred while the person was performing as a professional such as physicians, dentists, lawyers, and generally includes nurses.

Six elements must be present for a case to be proven:a. Duty – nurse is involve in providing care and following an acceptable standard of careb. Breach of duty – there must be a standard of care that is expected in the specific situation but that

the nurse did not observe.c. Foreseeability – a link must exist between the nurse’s act and the injury sufferedd. Causation – it must be proved that the harm occurred as a direct result of the nurse’s failure to

follow the standard of care and the nurse could have known that failure to follow the standard of care could result n such harm.

e. Harm or Injuryf. Damages

2. Intentional Tortsa. Assault – an attempt or threat to touch another person unjustifiably. Eg close fistb. Battery – willful touching of a person or the person’s clothes or even something the person is

carrying that may or may not cause harm. Touching without permissionc. False imprisonment – “unjustifiable detention of a person without legal warrant to confine the

person”. Eg restrain without doctor’s orderd. Invasion of privacy – is a direct wrong of a personal nature

Four types of invasion: Use of the client’s name or likeness for profit, without consent Unreasonable intrusion Public disclosure of private facts Putting the person in a false light

Points to observe in order to avoid legal problems1. Be familiar with the Philippine Nursing Law2. Be aware of the laws that affect nursing practice3. At the start of employment get a copy of the agency’s rules, regulations and policies4. Upgrade your skills and competence5. Accept only such responsibility that is in the scope of your employment and your job description6. Do not delegate your responsibility to others7. Determine whether your subordinates are competent in the work you are assigning them8. Develop good interpersonal relationship with your co-workers, whether they are your superiors,

peers or subordinates9. Consult your superiors for problem that may be too big for you to handle10. Verify orders that are not clear to you or those that seem to be erroneous11. The doctors should be informed about the patients’ conditions, the effects of medication and

treatments or the patients lack of progress12. The nurse should be aware of the value necessity of keeping accurate and adequate records13. Patients are entitled to informed consent

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14. Be familiar with Article 19 of the Revised Penal Code; Every person must, in the exercise of his/her right and in the performance of his/her duties, act and justice, give everyone his/her due and observe honesty and good faith and follow the golden rule

Bill of Rights of the Patients:1. The patient has the right to consider and respect care.2. The patient has the right to obtain from his physician complete current information concerning his

diagnosis, treatment and prognosis which he/she is reasonably expected to understand.3. The patient has the right to know what hospital rules and regulations apply to his conduct as

patient.4. The patient has the right to examine and receive an explanation of his bill regardless of source of

payment.5. The patient has the right to refuse treatment to the extent permitted by law and to be informed of

the medical consequences of his action.6. The patient has the right to expect communications and records pertaining to his care which should

be treated as confidential.7. The patient has the right to every consideration of his privacy concerning his own medical care

program.8. The patient has the right to expect that the hospital must make reasonable response to the request

for patient service. The hospital must provide evaluation service and/or referral as indicated by the urgency of the case.

9. The patient has the right to expect reasonable continuity of care. He has the right to know in advance what time physicians are available and where.

10. The patient has the right to be advised if the hospital proposes to engage in or perform human experimentation affecting his care or treatment. The patient has the right to refuse to participate in such a research project.

Communication SkillsInterchange of information between two or more peopleExchange of ideas or thoughts

Mode of Communication1. Verbal communication - way of communicating that uses written or spoken language

a. Face and intonationb. Simplicityc. Clarity and Brevityd. Timing and Relevancee. Adaptabilityf. Credibilityg. Humor

2. Nonverbal communication - way of communicating that uses facial expressions, gestures, and body language.a. Personal appearanceb. Posture and Gaitc. Facial expressiond. Gesture

Communication Process1. Sender – the person with information to share2. Message – form of information deliver to the receiver3. Receiver – the person for whom the information is intended.

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4. Response – the receiver lets the sender know whether the message was received and understood.

How to be a good communicator1. When you are the sender, make sure your message is clear

a. Think about what you want to say. Present the information in a logical, organized way.b. If your message is written, make sure your handwriting is neat and your spelling is

accurate.c. Speak clearly at a normal pace, and avoid mumbling. Unless the person is hearing

impaired, there is no reason to raise your voice.d. Use words that the person you are speaking to understands. When appropriate, use simple,

common words in place of more technical words, if necessary, use an interpreter.e. Face the person you are speaking to.f. Make sure that the person you are speaking to is able to physically receive the message.

2. When you are the receiver, be good listenera. Focus your attention on the speakerb. Sit down and do not appear rushed or in a hurryc. Make eye contact with the speakerd. Do not interrupt or try finish the speaker’s sentences

3. Learn techniques for encouraging people to talka. Ask open ended question instead of “yes/no” question.b. Seek feedbackc. Observe for nonverbal cues

4. Avoid behaviors that block effective communicationa.Avoid being judgmentalb.Avoid assuming that another person knows what you are thinkingc.Avoid “turning out” otherd.Avoid negative body language

5. When caring for a person who speaks a foreign languagea. Use hand gestures or picture board to communicate very basic ideasb. You may need to use an interpreter to avoid misunderstanding

6. When communicating with a person who has a hearing loss:a. Face the person when you are speaking to him or herb. Use a note pad to write down important questions or directions so that the person can

read them.c. Consider learning sign language or using a sign language interpreter.d. Make sure the hearing aid is turn on and that the volume is turned up high enough.

7. When caring for a person who has trouble speaking:a. Ask “yes/no” question when all you need is basic information.b. If you cannot understand what the person is saying, please tell the person that you did not

understand and look for other ways to help the person communicate.

Therapeutic Communication1. Using silence

Accepting pauses or silences that may extend for several seconds or minutes without interjecting any verbal response.

2. Providing general leadsUsing statements or questions that encourage the client to verbalize, choose a topic of conversation, and facilitate continued verbalization.Can you tell me how it is for you?

3. Being specific and tentativeMaking statements that are specific rather than general, and tentative rather than absolute

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Rate your pain in the scale of 0 - 104. Using open ended questions

Asking broad questions that lead or invite the client to explore9 elaborate, clarify, describe, compare or illustrate0 thoughts or feelings.I’d like to hear more of that…

5. Using touchProviding appropriate forms of touch to reinforce caring feelings.Putting an arm over the clients’ shoulder.

6. Restating or paraphrasingActively listening for the client’s basic message and then repeating those thoughts and feelings in similar words.This conveys that the nurse has listened and understood the client’s basic message and also offers clients a clearer idea of what they have said.You had difficult eating yesterday…

7. Seeking clarificationA method of making the client’s broad overall meaning of the message more understandable. It is used when paraphrasing is difficult of when the communication is rambling or garbled. I’m not sure I understand that

8. Perception checking or seeking consensual validationA method similar to clarifying that verifies the meaning of specific words rather than the overall meaning of message.You mean….

9. Offering selfSuggesting one’s presence, interest, or wish to understand the client wiout making any demands or attaching conditions that the client must comply with to receive the nurse’s attention.I’ll stay with you until your daughter arrives

10. Giving informationProviding in a simple and direct manner, specific factual information the client may or may not request.Your surgery is scheduled for 11 AM tomorrow

11. AcknowledgingGiving recognitions, in a nonjudgmental way, of a change in behavior, an effort the client has made, or a contribution to a communication.You trimmed your beard and mustache and washed your hair

12. Clarifying time or sequenceHelping the client clarify an event, situation or happening in relationship to time.Client: I vomited this morningNurse: was that after breakfast?

13. Presenting realityHelping the client to differentiate the real from the unreal

14. FocusingHelping the client expand on and develop a topic o importance

15. ReflectingDirecting ideas, feelings, questions or content back to client to enable them to explore their own ideas and feelings about a situation.

16. Summarizing and planningStating the main points of discussion to clarify the relevant points discussed.

Barriers to Communication1. Stereotyping

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Offering generalized and oversimpliried beliefs about groups of people that are base on experiences too limited to be valid.Two year-olds are brats

2. Agreeing and disagreeingAkin to judgmental responses, agreeing and disagreeing imply that the client is either right or wrong and that the nurse is in a position to judge this.Client: I don’t think Dr. Broad is a very good doctor. He doesn’t seem interested in his patientsNurse: dr. broad is head of the Department of Surgery and is an excellent surgeon

3. Being defensiveAttempting to protect a person of health care services form negative comments.These responses prevent the client from expressing true concerns.

4. ChallengingGiving a response that makes clients prove their statement or point of view.Client: I feel as if I am dyingNurse: how can you feel that way when your pulse is 60?

5. ProbingAsking for information chiefly out of curiosity rather than with the intent to assist the clientClient: I didn’t ask the doctor when he was ereNurse: why didn’t you?

6. TestingAsking questions that make the client admit to something. These response permit the client only limited answers and often meet the nurse’s need rather than the client’s.Who do you think you are?

7. RejectingRefusing to discuss certain topics with the client

8. Changing topics and subjectsDirecting the communication into areas of self interest rather than considering the client’s concerns is often a self protective response to a topic that causes anxiety.

9. Unwarranted reassuranceUsing clichés or comforting statement of advice as a means to reassure the client. These responses block the fears, feelings, and other thoughts of the client.

10. Passing judgmentGiving opinions and approving or disapproving responses, moralizing, or implying one’s own values.

11. Giving common adviceTelling the client what to do

Nursing ProcessIdentify a client’s health status and actual or potential health care problems or needs, to establish

plans to meet the identified need, and to deliver specific nursing interventions to meet those need.

Characteristic of Nursing Process1. It is a regularly repeated event or sequence of events that are continuously changing rather than

staying the same.2. Client centered3. Adaptation of problem solving and systems theory.4. Decision making is involved in every phase of the nursing process.5. SMART

Nursing Process

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Phase and Description Purpose Activities1. Assessing

Collecting, organizing, validating and documenting client data

To establish a database about the client’s response to health concerns or illness and the ability to manage health care needs.

Establish a database:a. Obtain a nursing health

historyb. Conduct a physical

assessmentc. Review client recordsd. Review nursing literaturee. Consult support personsf. Consult health

professionals Update data as needed Organize data Validate data Communicate/document data

2. DiagnosingAnalyzing and

synthesizing data

To identify client strengths and health problems that can be prevented or resolved by collaborative and independent nursing interventions. To develop a list of nursing and collaborative problems

Interpret and analyze dataa. Compare data against

standardsb. Cluster or group data

Generate tentative hypotheses

c. Identify gaps and inconsistencies

Determine client’s strengths, risks, diagnoses, and problems.

Formulate nursing diagnoses and collaborative problem statements.

Document nursing diagnoses on the care plan.

3. PlanningDetermining how to

prevent, reduce or resolve the identified client problems, how to support client strengths and how to implement nursing interventions in an organized, individualized, and goal-directed manner.

To develop an individualized care plan that specifies client goals/desired outcomes, and related nursing interventions.

Set priorities and goals/outcomes in collaboration with client.

Write goal. Desired outcomes. Select nursing strategies

interventions. Consult other health

professionals Write nursing orders and

nursing care plan Communicate care plan to

relevant health care providers.4. Implementing

Carrying out the planned nursing interventions.

To assist the client to meet desired goals/outcomes Promote wellness Prevent illness and disease Restore health And facilitate coping with altered functioning

Reassess the client to update the database

Determine need for nursing assistance

Perform planned nursing interventions

Communicate what nursing

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actions were implementeda. Document care and client

responses to careb. Give verbal reports as

necessary5. Evaluating

Measuring the degree to which goals/outcomes have been achieved and identifying factors that positively or negatively influence goal achievement.

To determine whether to continue, modify, or terminate the plan of care

Collaborate with client and collect data related to desired outcomes

Judge whether goals/outcomes have been achieved

Relate nursing actions to client outcomes

Make decisions about problem status

Review and modify the care plan as indicated or terminate nursing care.

Document achievement f outcomes and modification of the care plan.