NCM 100- Lecture
NCM 100- Lecture (3 units) Fundamentals of NursingJacqueline M.
Calaycay, RN, MSNCourse Description: The course provides the
students with the overview of nursing as a profession, science,
& as an art. It shall include a discussion on the different
roles of a nurse emphasizing on health promotion, illness
prevention & utilizing the nursing process as a basis for
nursing practice.
Three Main Topics
Nursing as a ProfessionNursing as a ScienceNursing as an Art
Nursing as a Profession Definition of Nursing:It is a caring
profession. A unique profession, it is practiced with an earnest
concern for the art of care & the science of health.The
profession involves a humanistic blend of scientific knowledge,
& holistic nursing practice.
Definition of Nursing
The art & science by which people are assisted in learning
to care for themselves whenever possible & cared for by others
when they are unable to meet their own needs.Florence Nightingale
(1860).The act of utilizing the environment of the patients to
assist him in his recovery.
Definition of NursingVirginia Henderson (1960).The unique
function of the nurse is to assist the individual, sick or well, in
the performance of those activities contributing to health or its
recovery ( or to peaceful death) that he would perform unaided if
he had the necessary strength, will, or knowledge, & to do this
in such a way as to help him gain independence as rapidly as
possible.
Virginia Henderson (1960).The unique function of the nurse is to
assist the individual, sick or well, in the performance of those
activities contributing to health or its recovery ( or to peaceful
death) that he would perform unaided if he had the necessary
strength, will, or knowledge, & to do this in such a way as to
help him gain independence as rapidly as possible. OremA helping or
assisting service to persons who are wholly or partly dependent-
infants, children, & adults- when they, their parents &
guardians, or other adults responsible for their care are no longer
able to give or supervise their care. American Nurses Association
(ANA;1980) The diagnosis and treatment of human responses to actual
& potential health problems.Canadian Nurses Association
(CAN;1984)The identification & treatment of human responses to
actual & potential health problems & includes the practice
of & supervision of functions & services that directly or
indirectly in collaboration with client or providers of health care
other than nurses, have as their objectives the promotion of
health, prevention of illness, alleviation of suffering,
restoration of health & optimum development of health potential
& includes all aspects of the nursing process. NursingIs a
profession that serves the need of society, in the area of health.
The practice of nursing addresses a wide range of health problems,
both actual & potential, requiring of its practitioners a
special body of knowledge including skills to meet client needs
& a value system that recognizes the client as autonomous human
being with rights.
The Philippine Nursing ActProfessional Nursing as the
performance for a fee, salary or other reward or compensation of
professional nursing services to individuals, families, communities
in various stages of development toward the promotion of illness,
restoration of health, & alleviation of suffering through:
Professional Nursing as the performance for a fee, salary or other
reward or compensation of professional nursing services to
individuals, families, communities in various stages of development
toward the promotion of illness, restoration of health, &
alleviation of suffering through: communities & the like
settings: Undertaking consultation services & engaging in such
other activities that require the use of knowledge &
decision-making skill of a registered nurse.Utilization of the
nursing process.Establishment of connection with community
resources & coordination of the heath team.Motivation of
individuals, families, & communities & coordination of
services with other members of the health team.Participation in
teaching, guidance & supervision of students in nursing
education programs as well as administering of nursing services in
varied settings such as homes, hospitals,Undertaking nursing &
health manpower development training & research &
soliciting finances, therefore, in cooperation with the appropriate
government & private agencies.Concepts of ProfessionIs a
calling, an occupation that requires special knowledge, skill &
preparation.A profession is generally distinguished from other
kinds of occupation by: a) its requirement of prolonged,
especialized training to acquire a body of knowledge pertinent to
the role to be performed; b) an orientation of the individual
toward service, either to a community or team organization.
History of NursingFOUR GREAT PERIODS IN NURSING:
1.INTUITIVE:UNTAUGHT,INSTINCTIVE. It dated from prehistoric
times; was practiced among primitive tribes and lasted through the
Christian era. It was performed out of feeling of compassion for
others, out of desires to help and out of a wish to do
good.2.APPRENTICE: on-the-job training, without formal education.
It extends from the founding of religious nursing orders in the 6th
century, through the Crusades which means bean in the 11th century,
to 1836. 3.EDUCATED: June 1860 when Nightingale School of Nursing
opened in London. Forma education for nurses.4. CONTEMPORARY: Began
at the end of World War II.INTUITIVE:Reference to nursing was
mother role because pre-historic man was a nomad who had to search
for food and shelter.Philosophy then was self-preservationCause of
illness was invasion of victims body by an evil spiritTrephine is
drilling a hole in the skull with a rock or stone to remove the
evil spirit without the benefit of anesthesiaShaman or witch doctor
had the power to heal by using white magic, but he also had the
ability to inflict greater harm through black magic.Nurses role:
instinctive directed towards comforting, practicing midwifery and
being wet nurse to a child without training or direction.Near
East:A. Babylonia
King Hammurabi codified Babylonian LawsCode of Hammurabi medical
regulations established. Discouraged experimentation, designed
doctors for each diseases, and patients were given the choice
between the use of charms and medicine or surgery and cure of his
disease.
Ancient Civilization:The evolution dated back to 400 BC to
primitive societies in which mother nurse worked with the priest.In
200 BC , the use of wet nurses is recorded in Babylonia.During this
time, beliefs about the cause of disease were embedded in
superstitions & magic, caused by angry spirit(demons)Treatment
: exorcism, drugs obtained from plants, fruits, animals.
B. Egypt:Herodotus Time: 485 425 B.C., neurosurgery was
advanced.Imhotep Chief physician and advisor to Pharaoh,
contributions in architecture, care of the sick and formulated wise
proverbs.Greeks believed in life after deathDeveloped the ability
to make clinical observationHealthiest of all countries because of
Hygiene principlesExhibited careful planning to meet certain
community needs and avert public health problems.Art of Embalming
for human anatomy but since done on dead, they learn nothing in
physiology.C. Hebrew:
Leviticus: Laws controlling the spread of communicable
diseasesJudaic Covenant with God directing the ritual of
circumcision of the male child on the 8th day.Mosaic Code Physical
purity is equivalent to moral purityReference to nurses are
midwives and wet nursesMusic Therapy: David played the harp for
King Saul when depressedAaron The High Priest as physician of the
peopleMoses father of sanitation
Far EastA. China:Belief in spirits and demonsPractice of
ancestor worship prohibiting dissection of human bodyMateria Medica
(Pharmacology) 52 volumes of Chinese MedicineHuae To exponent of
acupunctureEmperor Shen Nung father of Chinese MedicineDiagnosis
was made on the basis of the Pulse TheoryYang and Yin Theory
established some scientific basis for diseaseYang (Male principle)
positive, active, fiery and full of lifeYin (Female Principle)
negative, cold, weak, dark, an lifelessB. India:
Built hospitals, practiced asepsisProficient in medicine and
surgeryFirst reference to nurses taking care of the sickWritings of
Sushurutu found a list of functions and qualifications of the
nursesMedical practice declined with the fall of BuddhismDiet was
according to patients conditionIndia Early hospitals were staffed
by male nurses who were required to meet 4 qualifications:Knowledge
of drugsClevernessDevotedness to patientPurity of mind &
body.
C. Greece:
Nursing was the task of untrained slave. Caduceus insignia of
the medical profession, associated with Aesculapius father of
Medicine in Greek MythHippocrates Father of MedicinePractices that
brought about cure were rest, wholesome food, physiotherapy fresh
air, sunshine
Greek medicine Two kinds of refuges for the sick:Secular-
directed by physicians. Which corresponds roughly to our spas or
health resorts of today.Religious institutions-governed by priests.
Prietesses attended to patients who were housed in the temple.They
were known for their practice of gods & goddesses.Apollo- of
health; Aesculapius god of healingHygeia- goddes of health.D. Rome(
early Christian church & hospital)
Illness was a sign of weaknessSick was left to care of
slavesEvidence of specializationTranslation of Greek medical terms
to LatinCelsius his concept of cardinal signs of inflammation:
redness, swelling, heat, painChristianity value life and
equalityPhoebe first visiting nurseFabiola her home was the first
hospital in the Christian World
APPRENTICE:
Medicine in Europe was under two influences lay medicine and
ecclesiastical medicineDuring the middle ages, thousands of years
after the death of Christ, three organizations were developed
military orders, regular vows (with vows) and the secular orders
(without vows)Nursing care performed by people who are directed by
more experienced nursesEurope:
A. Crusades: (began before 1100-1300Military religious orders
founded during the Crusades. Established hospitals and staffed them
with men who served as nurses.B. Military Orders (Knight
Hospitaliers) Knights of St. John established organization of rank
and the principles of complete and unquestioned devotion of
dutyTeutonic Knights German equivalent of St. JohnKnight of St.
Lazarus for lepersAlexian Brothers one of the largest school of
nursing under religious auspices operated exclusively for men in
the US.C. Secular Orders the work of these nurses was complicated
by religious taboos and the social restrictions of their cultures
and educationAugustinian SistersThird Order of St. FrancisOrder of
St. Vincent de PaulLadies of CharityBenedictines
Order nuns prayed with and took care of patient; younger ones
washed soiled linens
D. Regular Orders: These religious orders gave rise to nursing
saints:1. St. Catherine of Siena Original Lady with a Lamp2. St.
Hildegarde prescribed cures and was supposed to have performed
miracles3. St. Elizabeth of Hungary Patroness of NursesCare of the
sick were performed mainly by volunteers who devoted themselves to
nursing.
Renaissance : 14-15-17th century the period of great revival of
learning.Forerunners of the great development during this period
were:Leonardo da Vinci- anatomical studies, described muscle &
arteries.Andreas Vesalius- described human anatomy.William Harvey-
discovered how blood circulates.Ambroise Pare- surgeon, developed
principles of surgery.During this period, nursing reached a high
level of organization & efficiency with religious &
military orders.Because of renewed interest in science,
universities were established, but no formal nursing schools were
founded.Women continued to fullfill the traditional role of
nurturer & caregiver in the home.Reformation (1600) religious
movement that aimed in reforming the Roman catholic church &
resulted in establishing the Protestant Churches.Religious upheaval
of the 16th century which destroyed the unity of Christian faith in
EuropeTransition from medieval to modern civilization which left
the world with the following:a. Economic changesb. political
changesc. cultural changes
Reformation: 17th to 19th century, nursing sank to its lowest
levels. This is the DARK Period of Nursing.
Crimean War: FLORENCE NIGHTINGALE took care of wounded soldiers,
believed that a clean environment played an important role in early
recovery.
Nursing during the Civil War:Early American NursingMiss Dorothy
Dix, though not a nurse, as appointed Superintendent of Female
Nurses, and got together the first Nurse Corps of US ArmyClara
Barton was president of the American Association of the Red Cross
in the District of Colombia
Period of Educated NursingThis period began on June15, 1860 when
the Florence Nightingale School of Nursing opened at St. Thomas
Hospital in London (St. Thomas School of Nursing).The development
of nursing during this period was strongly influenced by:Trends
resulting from warsFrom arousal of social consciousnessFrom the
emancipation of women From the increased educational opportunities
offered to women.
FLORENCE NIGHTINGALE:Recognized as the Mother of Modern Nursing;
known as the Lady with the Lamp.Born on May 12, 1820 in Florence
ItalyRaised in England in an atmosphere of culture &
affluence.Learned languages, literature, mathematics, & social
graces.Her education was rounded out by a continental tour.Not
contented with social custom imposed upon her as a Victorian Lady,
she develop her self-appointed goal: To change the profile of
Nursing.
Compiled notes of her visits to hospitals, her observation of
the sanitary facilities & social problems of the places she
visited.Noted the need for preventive medicine & good
nursing.Advocated for care of those afflicted with diseases caused
by lack of hygienic practices.At the age of 31, she overcame the
familys resistance.
She entered the Deaconess School at Kaiserwerth , Germany- where
she received training for three months.In 1853- studied in Paris
with the sister of Charity after which she returned to England,
& worked as a superintendent of a charity hospital for ill
governesses.Disapproved of the restrictions on admission of
patients & considered this as unchristian & incompatible
with health care.Upgraded the practice of nursing & made
nursing an honorable profession for gentlewomen.Led the nurses that
took care the wounded during the Crimean War.(1854-1856)She
implemented her principles in the areas of nursing practice &
environmental modification resulted in reduced morbidity &
mortality during the war.As a result of her experiences , she
forged the future of nursing education, she believed that nurses
should be formally educated & should function as client
advocates.1860 establishment of the Nightingale Training School of
Nurses. Put down her ideas in two published books: Notes in Nursing
and Notes on Hospitals.The Nightingale PledgeI solemnly pledge
myself before God,and in the presence of this assembly,to pass my
life in purity & to practice my profession faithfully.I will
abstain from whatever is deleterious and mischievous, and will not
take or knowingly administer any harmful drugs.
I will do all in my power to maintain and elevate the standard
of my profession, and will hold in confidence all personal matters
committed to my keeping and all family affairs, coming to my
knowledge in the practice of my profession,With loyalty, Will I
endeavor to work closely with the health team, and devote myself to
the welfare of those committed to my care.So help me GOD.
Nightingale Pledge was written in 1893 by: Canadian born Lystia
Grette- principal of the Farrand Training School for Nurses in
Detroit.It reflects Nightingales philosophy & styles.
EDUCATED: Established of the Nightingale System of Nursing for
improve nursing practice. First decade of the 20th century: age of
specialization. Standard curriculum for nursing was prepared by the
National League for Nursing Education between 1913 & 1937.Early
Schools:1. Bellevue Training School of Nurses in NY.2. Connecticut
Training School of New Haven, Conn3. John Hopkins in Baltimore,
MarylandLeaders:1. Linda Richards instituted the system of keeping
records and orders. The first graduate nurse in the US 2. Isabel
Hampton Robb standardized nursing education programs and prepared
teachers instruction in schools of nursing3. Mary Adelaide Nutting
had a unique collection of works on the history of nursing4. Lilian
Wald first President of the National Organization for Public Health
Nursing5. Isabel Maitland Stewart first nurse to receive an MA
degree6. Mary Elizabeth Mahoney first professional black nurse in
the US7. Florence Nightingale stated that environment played an
important role in mans health
Period of contemporary NursingThis period covers the period
after World War II to the present.Scientific & technological
developments as well as social changes mark this period.The United
Nations was created in 1945. Under this was the World Health
Organization, created to fight diseases by providing health
information and improving the living standards of all people
- WHO was formed to assist in fighting disease by providing
health information and improving the nutrition, living standards
and environmental conditions for all people.Use of atomic &
nuclear energy for medical diagnosis & treatment.Utilization of
computers for collecting data, teaching etc.The advent of space
medicine also brought about the development of aerospace
nursing.Health is perceived as a fundamental human right .Nursing
involvement in community is greatly intensified.Development of the
expanded role of nurses.
History of Nursing in the PhilippinesEarly Beliefs &
Practices1. ANCIENT TIMECare of the sick was based on mythical
superstitions and mythical background.Disease and death were said
to be god-given in a way of punishment.People found relief from
pain or illness from herbs, roots and tubers without knowing the
principlesPeople were graced with amulates to subdue the spirits
that caused illnessPersons with powers to expel demons can drive
away evil spirits (Herbolarios)
Early care of the sickThe early Filipinos subscribed to
superstitious beliefs & practices in relation to health &
sickness.Herbmen were called herbicheros meaning the one who
practiced witchcraft.Persons suffering from diseases without any
identified cause were believed to be bewitched by the mangkukulam
or mangagaway
Difficult childbirth & some diseases (called pamao) were
attributed to nonos.Midwife assisted in childbirth. During labor,
the mabuting hilot (good midwife) was called in.If the birth became
difficult witches were supposed to be the cause.Spanish RegimeThe
religious orders exerted effort to care for the sick by building
hospitals.Earliest Hospitals Established:Hospital Real de Manila
(1577)- to care for the Spanish Kings soldiers & Spanish
civilians.San Lazaro Hospital (1578)- was built exclusively for
patients with leprosy. Hospital de Indio (15 86)-established by the
Franciscan Order; service was supported by alms & contributions
from charitable institutions.Hospitals de Aguas Santas (1590)
estabished in Laguna, near a medicinal spring.San Juan de Dios
Hospital (1596). Founded by the brotherood of Misericordia ;
support was derived from alms & rents; rendered general
services to the public.Nursing began during the Revolution against
the Spanish Sovereignty in 1896.Filipino women volunteered to take
care of the sick & the wounded Filipino soldiers.Humanitarian
workConcept of Nursing-as the taking care of the sick & the
injured . Prominent Women involved in Nursing WorkJosephine
Bracken, wife of Jose Rizal, installed a field in an state house in
Tejeros: provided nursing care to the wounded,night & day.Rosa
Sevilla de Alvero. Converted their house into quarters for the
filipino soldiers, during the Philippine-American War that broke
out in 1899.
14History is the study of trends of human thought & actions
as they influenced the patterns of our lives.Jacqueline M.
Calaycay, RN, MSN 05212015Filipino Red CrossMalolos, Bulacan was
the location of the National head quarters.Established branches in
the provinces.Functions:Collection of war funds & materials
through concerts, charity bazzars, & voluntary
contributions.Provision of nursing care to wounded fil.
soldiers
Requirements for membership:At least 14 y/o, age requirement for
officer was 25y/o.Of sound reputation.
INTUITIVE:Reference to nursing was mother role because
pre-historic man was a nomad who had to search for food and
shelter.Philosophy then was self-preservationCause of illness was
invasion of victims body by an evil spiritTrephine is drilling a
hole in the skull with a rock or stone to remove the evil spirit
without the benefit of anesthesiaShaman or witch doctor had the
power to heal by using white magic, but he also had the ability to
inflict greater harm through black magic.Nurses role: instinctive
directed towards comforting, practicing midwifery and being wet
nurse to a child without training or direction.Dona Hilaria de
Aguinaldo. Wife of Emilio Aguinaldo; organized Filipino Red Cross
under the inspiration of Apolinario Mabini.Dona Maria Agoncillo de
Aguinaldo. Second wife of Emilio Aguinaldo; provided nursing care
to Filipino soldiers during the revolution. President of the Phil.
Red Cross in Batangas.Melchora Aquino (Tandang Sora). Nursed the
wounded soldiers, gave them shelter & food.August, 1898- there
was a great need for doctors & nurses to help prevent the
recurring epidemic of communicable diseases.1906- strong agitation
for establishment of nursing schools began.Capitan Salome. A
revolutionary leader in Nueva Ecija, provided nursing care t the
wounded, when not in combat.Agueda Kahabagan. Revolutionary leader
in Laguna, also provided nursing services to her troops.Trinidad
Tecson.Ina ng Biac Bato, stays in the hospital at Biac na Bato to
care for the wounded solders.
Hospitals & Schools of NursingIloilo Mission hospital School
of Nursing (Iloilo City, Aug. 19060)- ran by the Baptist Foreign
mission Society of America.Established when the American system of
education was just introduced in the country. Miss rose Nicolet-
waa the first superintendent- who was a graduate of
New England Hospital for Women & Children in Boston,
Massachusetts.Miss Flora Ernst -American nurse, took charge in
1942. 1909-graduated the ist class of trained nurses.1944- 22
nurses graduated & took the first board exam held in Iloilo
Mission Hospital.St. Pauls Hospital School of Nursing
(Manila,1907)Established by the Archbishop of Manila, located in
Intramuros & provided general hospital services.It had a free
dispensary & dental clinic.Training School for nurses opened in
1908, with Rev. Mother Melanie as superintendent & Miss E
chambers as Principal.The Philippine General Hospital School of
Nursing (1907)Began in 1901 as a small dispensary- mainly for civil
officers & employees in Manila & later grew into Civil
Hospital.1906, Mrs Mary Coleman Masters, an educator advocated for
idea of training Filipino girls for the profession of Nursing.1907,
with the support of Governor General Forbes & the Director of
Health among others, opened classes in nursing under the auspices
of the Bureau of EducationAdmission was based on entrance
examination.The applicant must have completed elementary education
to seventh grade.Julia Nichols & Charlotte Clayton taught
nursing subjects & American physicians served as lecturers.
19010,Act No. 1976 modified the organization of the school, placing
it under the supervision of the Director of Health.The civil
hospital was abolished, & became the Philippine General
Hospital.The school became known as the Philippine General Hospital
school of Nursing.Elsie McCloskey Gaches became the chief nurse,
& introduced several improvements, that made nursing attractive
& more practical.Anastacia Geron Tupas- the first Filipino
nurse to occupy the position of chief nurse & superintendent in
the country.
17Jacqueline M. Calaycay, RN, MSN 05212015St. Lukes Hospital
School of Nursing (Quezon City,1907)It began as a small dispensary
in 1903.1907, the school was opened with three Filipino girls
admitted. These girls had their first year in combined classes with
PGHSN & SPHSNHelen Hicks was the first principal.Vitallana
Beltran was the first Filipino superintendent.Dr. Jose Fores was
the first Filipino medical director1907-1910- the period of
reorganization, the first year nursing students of PGHSN, SLHSN,
SPHSN had a common first year course-known as the Central School
idea in nursing education. They were later own fused in one class,
lived in a dormitory, & received the same instruction in
anatomy & physiology, massage, practical nursing, materia
medica, bacteriology & English.The three schools agreed on how
students were selected.Educational preparation, at least completion
of seventh grade.Sound physical & mental health.Good moral
character.Good family & social standing.Recommendations from
three different persons well known in the community.Mary Johnston
Hospital & School of Nursing (Manila, 1907)Funded by Methodist
missionThe nurses training course began with three fil. young girls
from elementary grade, which was organized by Sr. Rebecca Parrish
together with the registered nurses Rose Dudely & Gertrude
Dreisback.It was burned down in 1945 & was reconstructed in
1947.Mis Librada Javalera was the first fil. Director of the
school.
Sorcerers-practice witchcraft, black magic; priests; practiced
trephening.18Jacqueline M. Calaycay, RN, MSN 05212015Philippine
Christian Institute Schools of NursingThe United Christian
Missionary Society of Indianapolis, Indiana, a Protestant
organization of the Disciples of Christ, operated three schools of
nursing:Salle Long Road Memorial Hospital School of Nursing (Laog,
Ilocos Norte, 1903)Mary Chiles Hospital School of Nursing
(1911)Frank Dunn Memorial Hospital (Vigan, Ilocos Sur,1912San Juan
de Dios hospital School of Nursing ( Manila, 1913)The school was
opened through the initiative of Dr. Benito Valdez.The school is
run by the Daughters of Charity since thenSister Taciana Trinanes
was the first directress of the school. Emmanuel Hospital School of
Nursing (Capiz,1913)The school offered a three year training course
for an annual fee of P100.00.Miss Ciara Pedrosa was the first
filipino principal.Southern Islands School of Nursing
(cebu,1918)Anastacia Giron-Tupas organized the school.Visitacion
Perez was the first principal. Other schools of Nursing
established:Zamboanga General Hospital school of Nursing
(1921)Chinese General Hospital school of Nursing (1921)Baguio
General Hospital school of Nursing (1923)Manila Sanitarium &
Hospital school of Nursing (1930)St. Pauls school of Nursing in
Iloilo city(1945)The first Colleges f Nursing in the
PhilippinesUniversity of Santo Thomas college of Nursing (1945)The
college began as the UST School of Nursing Education on feb.
11,1941Manila central University college of Nursing
(1947)University of the Philippines College of Nursing (1948)
Julita Sotejo was the first dean
The custom of embalming enabled them to become acquainted with
organs of the body. From clinical observation they learned to
recognize diff.diseases,developed drugs, inc. surgery.19Jacqueline
M. Calaycay, RN, MSN 05212015Nursing Leaders in the
PhilippinesAnastacia Giron-Tupas- the first fil. Nurse to hold the
position of Chief Nurse Suprintendent; founder of PNA.Cesaria Tan.
First fil. to receive a Mastrs degree in Nursing Abroad.Socorro
Sirilan. Pioneered in Hospital Social Service in San Lazaro
Hospital where she was the Chief Nurse.Rosa Militar. A pioneer in
school health Education.Sor Ricarda Mendoza. A pioneer in nursing
educationSocorro diaz. First editor of the PNA magazine called the
Message.Conchita Ruiz. First full- time editor of the newly named
PNA magazine the filipino NurseLoreto Tupaz. Dean of the Philippine
Nursing; Florence Nightingale of Iliolo
Far EastA. China:Belief in spirits and demonsPractice of
ancestor worship prohibiting dissection of human bodyMateria Medica
(Pharmacology) 52 volumes of Chinese MedicineHuae To exponent of
acupunctureEmperor Shen Nung father of Chinese MedicineDiagnosis
was made on the basis of the Pulse TheoryYang and Yin Theory
established some scientific basis for diseaseYang (Male principle)
positive, active, fiery and full of lifeYin (Female Principle)
negative, cold, weak, dark, an lifelessNURSING LEADERS:Annie Sand-
Chief Nurse of the San Lazaro Hospital in ManilaLoreta Tupaz- Dean
of Philippine Nursing, Florence Nightingale of IloiloJovita Sotejo-
Graduate of PGH 1929, elevated nursing education to its
professional levelMaria Tinawin- Chairman, Board of Examiner for
NursesAnastacia Giron- Tupas- Superintendent and Chief Nurse of
PGH, founder of PNALeah Samaco- Paquiz- Present PNA PresidentDean
Carmelita Divinagracia- President ADPCNFirst BON that gave the
first nurse exam- Dr Juan Cabarrus, Belen del Rosario, Anastacia
Giron- TupasThe first Nursing Law Act No. 2808 .An act Regulating
the Practice of Nursing Profession in the Philippines Islands.June
1919 nurses were registered without taking the examination.June
1920. the first Nursing Board Examination. Definition:
Profession is an occupation or calling requiring advanced
training and experience in some specific or specialized body or
knowledge which provides service to society in that special
field.
Characteristics & Attributes of a Professional Person
Profession
A calling in which members profess to have acquired special
knowledge, by training or experience or both, so that they may
guide, serve or advice others in that special fieldIs concerned
with quality. He/she possesses competence to practice the
profession in terms of scientific knowledge, technological skills
& desirable attitudes & values.Is self-directed,
responsible & accountable for his/her actions.Is able to make
independent & sound judgment including high moral judgment.Is
dedicated to improvement of life.Is committed to the spirit of
inquiry. Demonstrates zest for continued studies including research
which will steadily increase & improve knowledge, skills &
attitude needed by the profession.Nursing as a ProfessionEducation.
A profession requires an extended education of its members, as well
as basic liberal foundation.Theory. A profession has theoretical
body of knowledge leading to defined skills, abilities &
norms.Service. A profession provides basic service.Autonomy.
Members of a profession have autonomy in decision making & in
Practice.Code of Ethics. The profession as whole has a code of
ethics for practice.Caring. The most unique characteristic of
nursing as a profession is that, it is a CARING profession.
Flexners Criteria for a Profession compared with
Nursing.Patterns of Developing ProfessionNursing Profession
Profession are basically intellectualNurses are educated
institution of higher learning & function in a responsible
& accountable manner. Critical thinking is being emphasized to
a great extent at all levels of nursing function.Profession are
based on a specific body of knowledge that can be learned.Nursing
has identified and continues to develop its own specific body of
knowledge from which nursing practice emerges. Application of
theory derived from research provides the rationale for
action.Professions are practical as well as theoretical.Nursing
professionals accept great responsibility for providing for peoples
healthcare needs. The profession evolved in response to needs
identified by society and is guided by an ethical code.Professional
work can be taught through professional educationNurses are
educated primarily in different types of degree programs
baccalaureate degree and advanced nursing degree programs (Masters
degree and Doctorate degree).Professions have strong internal
organization.Practitioners are guided by altruism.The Philippines
Nurses Association (PNA) and other bodies provide internal
organizationMany nurses enter the profession out of a desire to
help others.Benners Stages of Nursing ExpertiseStage I NoviceNo
experiencePerformance is limited, inflexible, governed by
context-free rules & regulations, rather than experience.Stage
II Advanced BeginnerDemonstrates marginally acceptable
performance.Recognizes the meaningful aspects of real situation.Has
experienced enough real situation to make judgements about
them.Stage III-CompetentHas 2-3 years experienceDemonstrates
organizational & planning abilities.Differentiates important
factors from less important aspects of care.Stage IV-ProficientHas
3-5 years experiencePerceives situation as whole rather than as
parts.Uses maxims as guides for what to consider in a situation.Has
holistic understanding of the client, which improves decision
making.Focuses on long term goals.Stage V- ExpertPerformance is
flexible & highly proficientNo longer requires rules,
guidelines or maxims to connect an understanding of the situation
to appropriate action.Demonstrates highly skilled intuitive &
analytic activity in new situations.Is inclined to take certain
action because it felt right.
Professional NurseIs one who has acquired the art and science of
nursing through her basic education, who interprets her role in
nursing in terms of the social ends for it exists - the health and
welfare of society and who continues to add to her knowledge,
skills, and attitudes through continuing education and scientific
inquiry (research) or the use of the results of such
inquiry.Professional Nurse is a person who has completed a basic
nursing education program and is licensed in his / her country or
state to practice professional nursing.
Qualifications and Abilities of a Professional Nurse
Professional preparation:Have a license to practice nursing in the
countryA Bachelor of Science degree in NursingBe physically and
mentally fitPersonal Qualities and Professional Nurse
Professional proficiencies:1. Interest and willingness to work
and learn with individuals/groups in a variety of setting.2. A warm
personality and concern for people.3. Resourcefulness and
creativity as well as well-balanced emotional condition4. Capacity
and ability to work cooperatively with others.5. Initiative to
improve self and service.6. Competence in performing work through
the use of nursing process.7. Skill in decision-making,
communicating, and relating with others and being research
oriented.8. Active participation in issues confronting nurses and
nursing.
Basic Educational Program in NursingBefore 1983, Basic
three-year hospital-based program leading to the title Graduate in
NursingUntil 1983, Only basic educational program in nursing ~ the
four-year collegiate degree leading to the Bachelor of Science in
Nursing (BSN).Council of DeansPhilippine Colleges of
NursingDepartment of EducationNursing Practitioners1998-1999:
Effective Enforcement of the common two- year Associate in Health
Science Education (AHSE).The BSN intends to produce a professional
nurse who demonstrates the ff. behaviours:Caring behaviours (
compassionate, committed, competent, & confident).Ability to
practice legal, ethico-moral, social responsibilities &
accountabilities.Critical & creative thinkingSkills in
practicing KSA for the promotion of health, prevention of illness,
restoration of health, alleviation of sufferings & assisting
client to face death with dignity & in peace. Professional
NursingIs an art and a science, dominated by an ideal of service in
which certain principles are applies in the skillful care of the
well and the ill, and through relationship with the client/patient,
significant others, and other members of the health team.The
performance for salary or remuneration, of professional nursing
service, particularly that of diagnosing and treating human
responses and potential health problems. Types of Educational
ProgramLPN/LVN ProgramLasts 9 or 12 months ( classroom &
clinical practice.A graduate takes the NCLEX-PN to obtain
license.Practice is under the supervision of an RN.Provide basic
technical care to client.
Registered Nursing ProgramDiploma Program patterned after
Florence Nightingale.Associate Degree ProgramFirst & only
program for nursing that were systematically developed from planned
research & controlled experimentation.Baccalaureate
ProgramFirst school of nursing in a university setting.2 years of
liberal arts & basic 3 year diploma prog.Graduate Nursing
ProgramMasters Program-(1.5-2years) provides specialized knowledge
& skills that enable nurses to assume advanced roles in
practice, education administration & research.Doctoral Program
(PhD, DNS) emphasis is on theory development; research.Nursing
PracticeNurses practice in an ever- increasing variety of ways
& setting.The focus of all nursing practice is the client, who
may be an individual, family. Group or community.RA No. 9173-
Philippine Nursing Act- an act providing for a more responsive
nursing profession, repealing for the purpose RA No.7164, otherwise
known as the the Philippine Nursing Act of 1991. The Recepients of
nursingConsumer- people who use health care products or services
are consumer of health.Patient- a person who is waiting for or
undergoing medical treatment & care; traditionally we call them
patients when they seek assistance because of illness or for
surgery.Client- a person who engages the advice or services of
another who is qualified to provide care or to provide this
services.Refers as the receivers of health care less as passive
recepients & more as collaborators in the care, that is a
person who are responsible for their health.
Different Fields of NursingInstitutional Nursing- nursing in
hospitals & related health facilities.The nurse provides direct
nursing care, using the nursing process & critical thinking
skills.The nurse participates in all phases of patient care of the
acutely ill, the convalescing & the ambulatory
patient.Community Health Nursing/Public Health Nursing.Public
Health Nursing- focus requires understanding the needs of a
population, or a collection of individuals who have in common one
or more personal or environmental characteristics.Community Health
Nursing- is a nursing approach that merges knowledge from the
public health sciences with professional nursing theories to
safeguard & improve the health of population in the
community.School Health Nursing.they are responsible for the
schools activities in the areas of health service, health education
& environmental health & safety.Occupational health
Nursing/Industrial Nursing.Provides & delivers health care
services to workers. The practice focus on promotion, protection
& supervision of workers health within the context of safety
& healthy work environment.Private Duty Nursing.Nurses in
private practice, who undertakes to give a comprehensive nursing
care to a client on one-to-one ratio. She/he is an independent
contractor.General Private Duty NursePrivate Duty
EspecialistNursing Education.Role can be developed in many settings
including schools of nursing & hospital staff development
departments.Military Nursing (The Nurse Corps)Provides
comprehensive & quality nursing care to all military personnel,
dependents & authorized relative.Flight Nursing or Aero- Space
Nursing. Responsible for patients, military or otherwise, who have
been evacuated from battle areas to the nearest installation for
treatment.
Clinic Nursing.Requires that a nurse possesses general skills.
The nurse acts as a receptionist, answers phone, does the billing,
takes x-rays, ECG, changes dressing & assist in physical
examination.Advanced Nursing Practice.The field of nursing
synonymous with specialization. For example clinical nurse
specialist or a nurse specialist, nurse clinician or clinical
specialist. Expanded Nursing RolesNurse Practitioner (NP)- has
advanced education (at least MA) & is a graduate of nurse
practitioner program.Nurse practitioner function with more
independence & autonomy than other nurses.They are highly
skilled in performing nursing assessment, PE, counseling, teaching,
& treating minor health problems.Clinical Nurse Specialist
(CNS). Has MA & may have advanced experience in specialized
area of practice (e.g.,Gerontology, Pediatric, Critical Care,
Oncology0.Clinical nurse specialists work in various settings,
depending on their specialty.Roles of clinical nurse specialists
include clinician, educator,, manager, consultant &
researcher.Nurse Midwife. Is educated in Nursing & midwifery
& is licensed.Nurse Anaesthetist. Provides general anaesthesia
for clients undergoing surgery, under the supervision of a
physician prepared in anaesthesiology.Nurse anaesthetist are the
RNs with advanced education in anaesthesiology.Nurse Researcher. Is
responsible for the continued development & refinement of
nursing knowledge & practice through investigation of nursing
problems. Other OpportunitiesImmigration (USA, Canada )Short Term
Employment.Nurses who work in Germany, Vienna, Saudi Arabia, &
other middle East countries are not required to take the board
exam.Entrepreneurship.Day CareSpecial school Geriatric Care
Roles & Functions of a Professional NurseCare Provider.
Referred as the mothering actions in nursing.The nurse supports the
client by attitudes & actions that show concern for client
welfare & acceptance of the client as a person.The nurse s
primarily concerned with the clients needs.Communicator. Effective
communication is an essential element of all helping
profession.Communication shapes relationships between nurses &
clients.The nurse communicates with clients, supports person &
colleagues to facilitate all nursing actions.Teacher. The nurse
provides health teaching to effect behaviour change which focuses
on acquiring new knowledge or technical
skills.Counselor.Counselling is the process of helping a client to
recognize & cope with stressful psychologic or social problems,
to develop improve interpersonal relationships & to promote
personal growth.This role includes providing emotional,
intellectual & psychologic support.Counselling is done to help
client increase their coping skills. Client Advocate- the nurse
promotes what is best for the client, ensures that clients needs
are met, protects the clients right.Change agent. The nurse
initiates changes & assists the client make modifications in
the lifestyle to promote health. This involves the use of nursing
process, & will help the client to propose, implement &
maintain change that promote the clients change. Leader. The nurse
through the process of interpersonal influence helps the client
make decision in establishing & achieving goals to improve his
well being.Manager. The nurse plans, gives direction, develop,
staff, monitors operations, gives rewards fairly, & represents
both staff members & administration as needed.Team
member/collaborator. A vital role of a nurse. The nurse works in a
combined effort with all those involved in care delivery.
Researcher. The nurse participates in scientific investigation
& uses research findings in practice.Case Manager. The nurse
coordinates the activities of other members of the health team,
such as nutritionists & physical therapist, when managing a
group of client.Resource Person. The nurse function as a resource
person by providing skilled intervention, &
information.Ethico-Moral-Legal Responsibilities in NursingSafe
& compassionate nursing practice includes an understanding of
the ethico-moral & legal boundaries within which nurses must
function.To be able to determine what is good or valuable for all
people & to judge what is right & wrong.The nurse must
understand the law to protect themselves from liability & to
protect their clients right.Ethics a branch of philosophy that
examines differences between right & wrong. (study of
morality).Refers to expected standards of behaviour of a particular
group.(professional ethics).It came from the Greek word ethos which
means moral duty.Morals- are specific ways of behaviour or of
accomplishing ethical practices.Morality derived from the Greek
word moralis which refers to social consensus about moral conduct
for human beings & society.Ethical problems are created as a
result of;Changes in the societyAdvances in technologyConflicts
within the nurses role itselfNurses conflicting loyalties &
obligation.As technology, has expanded the role of the nurse, the
ethical dilemmas associated with the client care have increased
& often become legal issues as well.Nurses familiarity with
ethico-moral-legal implications of nursing enhances their ability
to be client advocate.
Nurses Ethical Decision are influenced by:Role perception &
responsibilities. Nurses are responsible for determining their own
action & for supporting clients who are making ethical
decision.What is a good decision?Moral theories.Teleology- looks to
the consequences of an action in judging whether the action is
right or wrong.Deontology or duty oriented theory.Ethical theory
that considers the intrinsic significance of the act itself as
criterion for determination of right or wrong.The morality of a
decision is not determine by its consequences.Moral Principles. can
be used as guidelines in analyzing dilemmas, they can also serve as
justification for the resolution of ethical problems.Nursing Code
of Ethics. A formal statement of a groups ideals &
values.Provide direction for nurses to act morally.Cognitive Moral
Development- ethics problems requires nurses to think & reason
in making decisions, judgment & choices.Values, Beliefs, &
Attitudes. Nurses should be aware of their values. Moral
PrinciplesWhen a nurse is confronted with situations where moral
judgment is necessary, the nurse may be guided by the following
principles or rules:
The Golden Rule - Do unto others what you would like others do
unto you. Since nurses like others to treat them kindly and with
respect, they should be willing to do same to others too.
A good decision is the one that is in the clients best interest
& at the same time preserves the integrity of all
involved.32Jacqueline M. Calaycay, RN, MSN 052120152. The Two-fold
Effect when a nurse is faced with situation which may have both
good and bad effects, The basis of action may be the following:That
the action must be morally goodThat the good effect must be willed
and the bad effect merely allowedThat the good effect must not come
from an evil action but from the initial action itself directlyThat
the good effect must be greater than the bad effect.Examples:It is
not morally good if a boy steals in order to alleviate his hunger
because the action itself is already bad. If the patient who has a
cancer of the uterus submits to hysterectomy she will not be able
to bear a child. If she does not have the operation, she will die.
It is the gynecologists intention to help the mother and not to
harm her. The surgeons action is morally good since saving the
mothers life is of primary importance. Also the doctor himself did
not will that the patient lose her child-bearing function.
Examples:It is not morally good if a boy steals in order to
alleviate his hunger because the action itself is already bad. If
the patient who has a cancer of the uterus submits to hysterectomy
she will not be able to bear a child. If she does not have the
operation, she will die. It is the gynecologists intention to help
the mother and not to harm her. The surgeons action is morally good
since saving the mothers life is of primary importance. Also the
doctor himself did not will that the patient lose her child-bearing
function. One who acts through an agent is himself responsible
Example: A patient wants to have an abortion and asks a nurse if
she can do it. The nurse refuses, but recommends a doctor who is
capable of performing. The nurse is liable to such crime, since he
/ she is an accomplice of the said doctor.5. No one is obliged to
betray himself / herself. In testifying before the court, no one
can force any person to answer a question if such will incriminate
him / her.6. The end does not justify the means. Example: Giving
sleeping tablet to a chronically ill person so she / he can die in
peace is morally wrong.
7. Defects of nature may be corrected.- Example: Patient with a
Harelip or cleft palate may have their defects corrected by plastic
surgery.8. If one is willing to cooperate in the act, no injustice
is done to him / her. - Example: A patient subjects himself /
herself willingly to an experimental drug and she / he has been
told of the possible effects of the same, is of right age, and is
sane, there is no violation of human rights.9. A little more or
less does not change the substance of an act. Example: If a nurse
gets medicine from the hospital stock without permission or without
prescription, he / she will be guilty of theft even if he / she got
only one tablet of the same.10. The greatest good for the greatest
number. Example: During an epidemic, immunization against
communicable diseases is administered to the people. If there may
be some who may have slight reactions to the vaccine, the greater
majority of the population shall be considered rather than the
isolated few.
11. No one is held to the impossible. Example: To promise that a
patient with heart transplant will live may be impossible. Yet,
such procedures are done in the hope of saving or prolonging a
patients life. The doctor or the nurse cannot be held to the
impossible if they have done their best to take care of the patient
and the latter dies.12. The morality of cooperation. Formal
cooperation in an evil act is never allowed. Immoral operations
such as abortion shall not be participated upon by a nurse even if
the doctor commands it.
13. Principle relating to the origin and destruction of life.
One of GODs commandments is Thou shall not kill.
1. AutonomySelf- governingAn individual has the right to make
decisions and take independent actions without external
control.Based on the belief that a person has unconditional value
and has the capacity to determine own destinyEthical
PrinciplesExamplesConsent on all treatmentsKnowing policies on
advance directives like DNRPrivileged CommunicationPhysical
privacy
Persons who lack capacity to be autonomousInfantsIrrationally
suicidal individualsDrug-dependent individuals
2. BeneficenceDo good. The duty to do good to others and
maintain balance between benefits and harmsOne person takes action
for the good of another person.Act in ways that benefit
othersExamplesProviding ALL patients including terminally ill
patients with EQUAL CARING attentionOrgan donationsTreating every
patient with respect and courtesy Obligation to help others further
their legitimate and important interestsContribute to the well
being of another
3. NonmaleficenceDo no harmDo not commit acts that cause
deliberate harm Ex. Experimental researchAvoid harm as a
consequence of doing good Ex. Immunization of
infantsExamplesWorking within the scope of nursing
practiceObserving safety rules and precautionsPerform procedures
according to protocols. Never do shortcuts!Ask appropriate person
if in doubt or unsureContinuing Professional Update4.
Veracity*Obligation to tell the truth*Not to lie or deceive others
essential to the integrity of the client-provider
relationship.ExamplesAdmit mistakes promptly. Offer to do whatever
is necessary to correct themRefusal to participate in any fraudGive
an honest day work every day5. ConfidentialityNon- disclosure of
private or secret information with which one is entrusted.Requires
that information about client be kept private unless client
consented.6. JusticeFair, equitable and appropriate treatmentTo
each equallyTo each according to needTo each according to meritTo
each according to social contributionTo each according to the
persons rightsTo each according to individual effortTo each as you
would be done byTo each according to the greatest good to the
greatest number7. FidelityConcept of faithfulness and the practice
of keeping promisesUpholding the professions code of ethicsPractice
within the scope of nursingExamples:a. Contractsb. loyalty within
the nurse- patient relationshipThe patient has the right to
considerate and respectful care.Except in emergencies when the
patient lacks decision-making capacity and the need for treatment
is urgent, the patient is entitled to the opportunity to discuss
and request information related to the specific procedures and / or
treatments, the crisis involved, the possible length of
recuperation, and the medically reasonable alternatives and their
accompanying risks and benefits.Patients Bill of Rights:3. The
patient has the right to make decisions about the plan of care
prior to and during the course of treatment and to refuse a
recommended treatment or plan of care to the extent permitted by
law and hospital policy and to be informed of the medical
consequences of this action.
4.The patient has the right to have an advance directive (such
as a living will, health care) concerning treatment or designating
a surrogate decision maker with the expectation that the hospital
will honor the intent of that directive to the extent permitted by
law and hospital policy.4. The patient has the right to every
consideration of his privacy.
5. The patient has the right to expect that all communications
and records pertaining to his / her care should be treated as
confidential by the hospital.
6. The patient has the right to review the records pertaining to
his / her medical care and to have the information explained or
interpreted as necessary except when restricted by law.7. The
patient has the right to expect that, within its capacity and
policies, a hospital will make reasonable response to the request
of a patient for appropriate and medically indicated care and
services.
8. The patient has the right to ask and be informed existence of
business relationships among the hospital, educational
institutions, other health care providers, or players that may
influence the patients treatment and care.9. The patient has the
right to consent to or decline to participate in proposed research
studies or human experimentation affecting his care and treatment
or requiring direct patient involvement, and to have those studies
fully explained prior to consent.
10. The patient has the right to expect reasonable continuity of
care when appropriate and to be informed by physicians and
caregivers of available and realistic patient care options when
hospital care is no longer appropriate.11. The patient has the
right to be informed of hospital policies and practices that relate
to patient care, treatment, and responsibilities. Scope of Nursing
PracticeThe Phil. Nursing Act of 1991 (R.A. 7164) has been repealed
by the Phil. Nursing Act of 2002 (R.A. 9173) Section 28. scope of
Nursing PracticeA person shall be deemed to be practicing nursing
within the meaning of this act, when he/she singly or in
collaboration with another, initiates & performs nursing
services to individuals, families, communities in any health care
setting.It includes but not limited to, nursing care during
conception, labour, delivery, infancy, childhood, toddler,
pre-school, school age, adolescence, adulthood and old age.
As independent practitioners, nurses are primarily responsible
for the promotion of health and prevention of illness.As 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:Provide nursing care through the utilization
of the nursing process. Nursing care includes, but is not limited
to, traditional and innovative approaches, therapeutic of 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 labour in the absence of antenatal bleeding and delivery, In
case of suturing of perineal laceration, special training shall be
provided according to protocol established;Establish linkages with
community resources and coordination with the health team;Provide
health education to individuals, families and communities;Teach,
guide and supervise students in nursing education programs
including the administration of nursing services in varies 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;Undertake nursing
and health human resource development training and research, which
shall include, but not limited to, the development of advanced
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 practice of nursing in all setting,
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.Legal Roles of NursesProvider of Service. The
rights & responsibilities of the nurse in the role of a citizen
are the same as those individual under the legal system.Liability.
Is the quality or state of being legally responsible for ones
obligations & actions & to make financial restitution for
wrongful acts.Standards of Care. It is by which a nurse acts or
fails to act are legally defined by
nurse practice acts & by rule & reasonable prudent
professional with similar preparation & experience would do in
similar circumstances.Employee or Contractor for Service. A nurse
who is employed by a hospital work as an agent of the hospital
& the nurses contract with the clients is an implied
one.Contractual Relationships.Independent Nurse PractitionerNurse
Employed by a HospitalThe nurse represents & acts for hospital
& therefore must function within the policies of the
agency.Citizen. The rights & responsibilities of the nurse in
the role of a citizen are the same as those individual under the
legal system.
Documentation -as written evidence of:The interaction between
& among health professionals, clients, their families &
health care organization.The administration of tests procedures,
treatments & client education.The result or clients response to
these diagnostic tests & interventions.Documentation provides a
written records that reflect client care provided on thebasis of
assessment data & the clients response to
interventions.Reporting & recording are the major communication
techniques used by health care provider.The medical record serve as
a legal document for recording all clients activities assessed
& initiated by health care provider.Purposes of documentation
or Client RecordCommunication- the record serve as the vehicle by
which health professionals who interact with a client communicate
with each other.Legal documentation. In the cases of law suit the
record serve as the description of what exactly happen to a
client.Research. The information contained in a record can be
valuable source of data for research.Education. Students In health
disciplines often use client records as educational tools, a record
can frequently provide a comprehensive view of the client, illness
& treatments.Quality assurance Monitoring. Use to monitor the
care the client is receiving & the competence of the people
giving the care Statistics- Statistical information from client
records can help an agency anticipate & plan for future
needs.Accrediting & licensing. JCAHO, Phil.
HealthReimbursement. Helps facility receives reimbursement or
received or obtained payment from Phil. Health.Incident ReportAn
agency record of any accident or incident.The report should be
completed as soon as possible always within 24 hours.The IR is not
part of the clients record, but the facts of the incident should be
noted in the medical record.When an accident occurs the nurse
should assist first the client.Information to include in an
IR:Identify client with the hospital number.Date, time, & place
of the incident.Describe the facts of the incident. Avoid any
conclusion or blame.Identify all the witnesses to the
incident.Identify any equipment or medication.Document any
circumstances surrounding the incident. II. Nursing as a
ScienceDefinition of termsConcept- the building blocks of
theory.Abstract ideas or mental images of phenomena or
reality.(abstract or concrete ideas)Concepts helps us to name
things & occurrences in the world around us & assist us in
communicating with each other about the world.Conceptual framework-
is a group of related concepts. It provides overall view or
orientation to focus our thoughts.Can be visualized as an umbrella
under which many theories can exist.Is a structure that links
global concepts together & represents a unified whole of a
larger reality.The concepts in a conceptual framework are linked
together to form proposition.
Proposition- is a statement that expresses the relationship
between concepts & is capable of being tested, believed or
denied.E.g., People & their Environment are open System.Theory-
is a set of concepts & propositions that provide an orderly way
to view phenomena. a supposition or system of ideas that is
proposed to explain a given phenomenon.Purpose of a Theory: is to
guide research to enhance the science by supporting existing
knowledge or generating new knowledge.Nursing Theory (purposes)To
provide direction & guidelines for structuring, a) professional
nursing practice b) education c) research.Differentiating the focus
of nursing from other professions. In PracticeAssist nurses to
describe, explain & predict everyday experiences.Serve to guide
assessment, intervention, evaluation of nursing care.Provide a
rationale for collecting reliable & valid data about the health
status of clients, which are essential for effective decision
making & implementation.Help to establish criteria to measure
the quality of nursing care.Help build a common nursing terminology
to use in communicating with other health professionals. Ideas are
developed & words defined.Enhance autonomy of nursing through
defining its own independent function.In EducationProvide a general
focus for curriculum design.Guide curricular decision making.In
ResearchOffer a framework for generating knowledge & new
ideas.Assist in discovering knowledge gaps in the specific field of
study.Offer a systematic approach to identify questions for study,
select variables, interpret findings, & validate nursing
intervention.General Nursing TheoriesFlorence Nightingales
Environmental Theory (1859)The first theory of Nursing. Notes on
Nursing: What it is, what it is not.She focused on changing, &
manipulating the environment in order to put patient in the best
possible conditions for nature to act.She believed that nurturing
the environment, the body could repair itself.
She linked health with 5 environmental factors; 1) Pure fresh
air 2) pure water 3) efficient drainage 4) cleanliness 5) light
especially direct sunlight. Deficiency in these five factors
produce lack of illness or illness.Her general concept about
ventilation, cleanliness, quiet, warmth, & diet remain integral
parts of nursing & health care today.
Virginia Henderson: Definition of Nursing (1955) She postulated
that the unique function of the nurse is to assist the client sick
or well, in the performance of those activities contributing to
health or its recovery, that client will perform unaided if they
have the necessary strength, will or knowledge,She further believed
that nursing involves assisting the client, in gaining independence
as rapidly as possible, or assisting him achieve peaceful death if
recovery is no longer possible.Martha Rogers: Science of Unitary
Human Beings. ( 1970)Rogers views the person as an irreducible
whole, the whole being greater than the parts. The distinctive
properties of the whole are significantly different from its
partUnitary man is an energy field in constant interaction with the
environment
She believed that human being is characterized by the capacity
for abstraction & imagery language & thought, sensation
& emotion.E.g., Therapeutic touch- process by which energy is
transmitted or transferred from one person to another with the
intent of potentiating the feeling of healing process of who is ill
or injured.85Jacqueline M. Calaycay, RN, MSN 05212015Dorothea Orem:
Self care and Self care Deficit Theory (1971)She defined self care
as the practice of activities that individuals initiate &
perform on their own behalf in maintaining life, health & well
being.According to this theory self care is a learned behaviour
& a deliberate action in response to a needShe identified 3
kinds of self care requisites:Universal requisites- common to all
people, include the maintenance of air, water, food, elimination,
activity & rest, solitude & social interaction,& the
promotion of human functioning both physiological & social
interaction needs.Developmental requisites -are the needs that
arise as the individual grows & develop.Health deviation
requisites- results from
the needs produced by disease or illness states. It impairs the
individual to perform self care.Theory of Self Care deficit.This
theory purports (claims) that nursing care is needed when people
are affected by the limitation that do not allow them to met their
self care needs.The relationship between the nurse & client is
established when a self care deficit is present.It also determines
the need for nursing care.Nursing System TheoryAttempts to answer
the question What do nurses do?Three types of Nursing SystemsWholly
compensatory system: when the nurse is expected to accomplish all
the patients self care or to compensate for the clients inability
to care for self or when the client needs continuous guidance in
self care.Partially compensatory: are designed for individuals who
are unable to perform some ( but not all) self care activities.Both
nurse & client engage in meeting self care needs.Supportive
Educative (developmental): the that requires assistance in decision
making behaviour control & acquisition of knowledge &
skills.
System TheoriesSister Callista Roy: Adaptation Model
(1979,1984)Widely used by nurse educator, researchers, &
practitioners.She viewed each person as a unified biopsychosocial
adaptive system in constant interaction with the changing
environment.She viewed that the nurse must first assess how the
client behaves in each adaptive mode & then determine what can
be altered in that mode to produce more efficient & effective
responses.Four adaptive Modes:Physiologic mode- involves the bodys
basic physiologic needs & ways of adapting in regard to fluid
& electrolytes, activity & rest, circulation & oxygen
etc. e.g., caring for a patient with fever.Self Concept Mode-
includes two components; the physical self,( sensation & body
image) & the personal self ( whish involves of self ideal, self
consistency & moral ethical self. E.g., patient who will
undergo surgery & caring for an obese client.The role function
mode- is determine by the need for social integrity & refers to
the performance of duties based on given positions within society.
The interdependence mode- involves ones relation with significant
others & support system that provide help, affection &
attention. E.g., a grieving widow.Imogene King: theory of goal
Attainment (1971)Derived from a conceptual framework of 3 dynamic
interacting systems:Personal system- perception, self, body image,,
growth & development, space & time.
Interpersonal system- interaction, communication, transaction,
roles & stress.Social system- organization, authority power,
status, & decision making.To identify problems & establish
goals the nurse & client perceive one another, act & react,
interact & transact.
Betty Neuman: Health care system Model. (1972) Based on the
individuals relationship to stress, the reaction to it &
reconstitution (state of adaptation to stressors) .She viewed the
client as an open system consisting of a basic structure or central
core of energy resources ( physiologic, psychologic,
socio-cultural, developmental & spiritual) surrounded by two
cocentric boundaries or rings referred as lines of resistance.The
two lines of resistance represent internal factors that help the
client depend against on stressors.The inner or normal lines of
defense represents the persons state of equilibrium, or the state
of adaptation developed & maintained overtime & considered
normal for that person.The flexible lines of defense is dynamic
& can be rapidly altered over a short period of time. It is a
protective buffer that prevents stressors from penetrating the
normal lines of defence.The concern of nursing is to prevent stress
invasion, to protect the clients basic structure & to obtain or
maintain a maximum level of wellness.Nursing actions are carried
out on the three preventive levels:Primary prevention- identify
risk factors, attempt to eliminate the stressors & focuses on
protecting the first line of defense strengthening the first line
of
defense.Secondary prevention- relate to intervention or active
treatment initiated after symptoms have occurred.The focus is to
strengthen the internal lines of resistance, reduce the reaction
& increase resistance factors.Tertiary prevention- refers to
interventions following that in the secondary level.It focuses on
readaptation & stability & protects reconstitution or
return to wellness following treatment.The nurse emphasizes
educating the client in strengthening resistance to stressors &
ways to help prevent recurrence of reaction or regression.Dorothy
Johnson: Behavioural System Model (1960)She used her observation of
behaviour over many years to formulate this theory.Described the
individual as a behavioural system composed of seven
sub-systems:Attachment- Affiliative subsystem security seeking
behaviour, provides survival & security.Its consequences are
social inclusion, intimacy, & the formation & maintenance
of a strong social bond.Dependency subsystem- promotes helping
behaviour that calls for a nurturing response.
Its consequences are approval, attention or recognition &
physical assistance.The Ingestive subsystem- satisfies appetite. It
governed by social & psychologic consideration as well as
biologic.The Eliminative subsystem- ridding the body waste in
socially & culturally acceptable ways.The Sexual subsystem-
dually for procreation & gratificationThe Achievement
subsystem-attempts to manipulate the environment.It controls or
masters an aspect of the self or environment to some standard of
excellence.The Aggressive subsystem- protects & preserves the
self & society & within the limits imposed by society.
Each of the above subsystem has the same functional
requirements; protection, nurturance, & stimulation.The
subsystem responses are developed through motivation, experience
& learning & are influenced by biopsychosocial
factors.Interpersonal/Caring TheoriesHildegard Peplau:
Interpersonal Model / Psychodynamic Nursing Theory (1952
)Psychodynamic Nursing- is defined as understanding ones own
behaviour to help others identify felt difficulties & applying
principles of human relations to problem arising during the
experience.She defined nursing as an interpersonal process of
therapeutic interaction between an individual who is sick & in
need of health services & a nurse especially educated to
recognize & respond to the need for help.She identified four
phases of nurse-patient relationship namely:Orientation: The nurse
& client initially do not know each other. The patient seeks
help, & the nurse assists the patient to understand the problem
& the extent of need for help. Identification: during this
phase, the patient assumes a posture of dependence, interdependence
in relation to the nurse.The nurses focus to assure the person that
the nurse understands, the interpersonal meaning of the patient
situation.3.Exploitation: in this phase the patient derives full
value from what the nurse offers through the relationship.The
patient utilizes all available resources
to move toward a goal of maximum health or
functionality.Resolution: refers to the termination phase of the
nurse-patient relationship. It occurs when the patients needs are
met, & client can move toward new goal.Peplau further assumed
that that the nurse-patient relationship fosters growth for both
the nurse & client.Jean Watson: Philosophy & Science of
Caring (1979 ).She believes that the practice of caring is central
to nursing & it is the unifying focus for practice.Her theory
is composed of ten (10) carative factors which are classified as
nursing actions or caring process.Forming a humanistic-altruistic
system of values.This factor relates to satisfaction through giving
& extending of the sense of self.Although the values are
learned early in life, but they can greatly influenced by
education.Instilling Faith & Hope. Feeling of faith & hope
promote wellness by helping client adopt health seeking
behaviours.
Cultivating sensitivity to ones self & others.Nurses who are
able to recognize & express their feelings are better able to
allow others to express theirs.Developing a helping trust (human
care) relationship.This kind of relationship involves effective
communication, empathy & non possesive warmth.It promotes &
accepts the expression of positive, & negative feelings.
Expressing positive & negative feelings.Sharing feelings of
sorrow, love & pain is risk taking experience. The nurse must
be prepared for negative feeling.Using a creative problem-solving
approach or caring process.Promoting transpersonal teaching
learning.This factor separate caring from curing & shifts
responsibility for wellness to the client.
Providing a supportive, protective or corrective mental,
physical, socio-cultural, & spiritual environment.The nurse
must asses & facilitate the clients abilities to cope with
mental, emotional & physical changes.Assisting with
gratification of human needs.Recognizing & attending to the
physical, emotional, social, & spiritual needs of the
client.Being sensitive to existential phenomenologic- spiritual
forces.Existential psychology is a science of human existence that
employs the method of phenomenologic analysis.Person possesses
three spheres of being: mind , body, & soul.Allowing for
expression of these forces leads to better understanding of self
& others.Madeleine Leininger: Transcultural Care Theory
(1978)The goal of transcultural nursing is to develop a scientific
& humanistic body of knowledge in order to provide- culture
specific & culture-universal nursing practices.She believes
culture is the broadest & the most holistic means to
conceptualize, understand & be effective with people.there can
be no cure without caring but there may be caring without
curing.Faye Abdellah (1960): Patient- Centered Approaches to
Nursing Model.She defined nursing as service to individuals &
families; therefore to society.She conceptualized nursing as an art
& a science that molds the attitudes, intellectual competencies
& technical skills of the individual nurse into the desire
& ability to help people, sick or well, & cope with their
health needs.
III.Nursing as an ArtCaring TheoriesPeplaus Interpersonal
Nursing TheoryWatsons Philosophy & science of CaringLeinnengers
Transcultural Nursing TheoryTherapeutic Use of SelfA process in
which nurses deliberately plan their actions & approach the
relationship with a specific goal in mind before interacting with
the client.The most effective tool for demonstrating caring is not
some technologically sophisticated machines with lights &
alarms but rather oneself.Therapeutic use of self makes the art of
nursing as different from science of nursing.This is an oppurtunity
of the nurse to be with the person at a human to human
level.Characteristics of therapeutic RelationshipWarmth- exhibiting
positive behaviour toward a client. Respect, genuine interest,
caring are all expression of warmth.Hope- means anticipating the
future by helping clients look realistically at their
potentials.Hope is the energy source that allows individuals to
plan, act & achieve.Rapport- is a bond or connection between
people that is based on mutual trust.Trust- must be present for
help to be given & received. ( consistency, respect, honesty
are essential in the development of trust.)Empathy understanding
another perception of the situation.Acceptance- accepting client as
a person & working with clients even those clients who exhibit
undesirable behaviours.Active Listening- is required in every
nurse-client relationship.Humor- can assist in establishing a
relationship because it helps break the ice, decreases fear, &
establish trust, & can help strengthen relationship.compassion-
you care what happen to another person.Kindness & genuine
concern are demonstrated through compassionate acts.Self Awareness-
necessary to be therapeutic.Being aware of ones feeling is the
first step in developing therapeutic behaviour.Self-awareness allow
the nurse to remain objective, that is separate enough to
distinguish ones own feelings.Non-judgmental approach- acting
without biases, pre conceptions or stereotypes.Flexibility- a
flexible nurse is one who is ready for the unexpected.Risk taking-
the nurse must give themselves permission to try something new, to
step outside the ordinary & not to be bound by tradition or
fear.Phases of Nurse- Client RelationshipOrientation
phase:Introductory phase, it sets the tone for the rest of the
relationship.Getting to know each other & developing a degree
of trust.Client may display some resistance behaviour- inhibit
involvement.Assessment of client is the most important goal
.Working Phase:The nurse & client begin to view each other as
unique individuals.They begin to appreciate this uniqueness &
begin to care about each other.Behaviours that indicate the client
is in the working phase; asking questions about own problem,
seeking clarification from the nurse, being attentive to
instructions, asking for more information about his role in
recovery.Termination Phase- is often difficult & filled with
ambivalence.It focuses in evaluation of goal achievement &
effectiveness of treatment.Many methods can be used to terminate
relationships;Summarizing or reviewing the process can produce a
sense of accomplishment.Planning for termination is actually
initiated during the beginning of the relationship. Thank You