FUNDAMENTALS OF NURSING

DEFINITION OF NURSING

 To assist clients (sick or well) in

the performance of activities
contributing to health, its
recovery or peaceful death that
clients will perform unaided, if
they had necessary will, strength
or knowledge (HENDERSON)
 OTHER DEFINITIONS

 Nursing is the diagnosis and treatment of human

responses to actual or potential health problems (ANA)
 4 essential features of contemporary nursing practice

1. Attention to the full range of human experience and

responses to health and illness without restrictions to
problem-orientation

2. Integration of objective data with knowledge gained

from an understanding of the client’s or group’s
subjective experience

3. Application of scientific knowledge to the process of

diagnosis and treatment

4. Provision of a caring relationship that facilitates health

and healing
 OTHER DEFINITIONS

 The act of utilizing the environment of

the patient o assist him in his recovery
(FRORENCE NIGHTINGALE)
 Nursing is an interpersonal process
whereby the professional nurse
practitioner assists an individual, family
or community to prevent or to cope with
the experience of illness and suffering
and if necessary, to find meaning in these
experiences (JOYCE TRAVELBEE)
 OTHER DEFINITIONS
NURSING is a/an…
 Caring
 Client-centered
 Art
 Holistic
 Science
 Adaptive
 Profession
 Helping profession
 Is concerned with HEALTH PROMOTION, MAINTENANCE &
RESTORATION
 PERIODS IN THE HISTORY OF
NURSING

 Intuitive Nursing
 From prehistoric times – early
Christian Era
 Nursing is performed out of
COMPASSION
 Nursing belong to women
 PERIODS IN THE HISTORY OF
NURSING

 Apprentice Nursing
 Founding of the religious order
 Establishment of KAISERWERTH INSTITUTE OF
DEACONESSES
 There is OJT
 Nursing performed without any formal education; just
by people who were directed by more experienced
nurses
 Dark period of nursing
 Nursing became the work of the least desirable women
 PERIODS IN THE HISTORY OF
NURSING

 Educated Nursing
 Florence Nightingale opened School of
Nursing
 Development of nursing was strongly
influenced by trends resulting from wars,
from an arousal of social consciousness,
from the emancipation of women and
from the increased educational
opportunities offered to women
 PERIODS IN THE HISTORY OF
NURSING

 Contemporary Nursing
 after world war 2 – present
 Marked by scientific and
technological developments
as well as social changes
 CARPER’S 4 PATTERNS OF
KNOWING

 Nursing science or scientific

knowledge
 The cognitive brain of nursing and includes
knowledge obtained through nursing
research done in other disciplines.
 It includes the facts and information
necessary for performing technical skills,
steps of the procedure, and knowledge of
the equipment.
CARPER’S 4 PATTERNS OF
KNOWING

 Nursing esthetics
 The way in which nursing knowledge is
expressed (affect)
 It is the art or heart of nursing.
 It involves feelings gained by subjective
experience
 It includes attitudes, beliefs and values
CARPER’S 4 PATTERNS OF
KNOWING

 Nursing ethics
 Refers to the knowledge of
accepted professional standards
of conduct
 It is concerned with matters of
obligation, ought to be done(basic
moral principles)
 CARPER’S 4 PATTERNS
OF KNOWING
 Personal knowledge
 Is concerned with knowing oneself
 Having conscious awareness of one’s
own values, belief, attitudes and
abilities
 Nurses with highly developed self-
awareness and self-knowledge
generally have a better self-concept and
are more attuned to their clients
LEVELS OF PROFICIENCY
ACCORDING TO BENNER

EXPERT
PROFICIENT
COMPETENT
ADVANCE BEGINNER
NOVICE
 LEVELS OF PROFICIENCY
ACCORDING TO BENNER

 NOVICE- no experience; governed by rules,

limited and in flexible
 ADVANCE BEGINNER- demonstrate acceptable
performance
 COMPENTENT- has 2-3 years of experience;
consciously plans nursing care
 PROFICIENT- greater that 3-5 years of
experience; perceives situations
 EXPERT- has intuitive grasp of nursing situation
ROLES & RESPONSIBILITIES OF
A PROFESSIONAL NURSE
 CARE GIVER- helping clients promote, restore and maintain
dignity, health and wellness, assisting in the physiologic,
spiritual, emotional, developmental, cultural and social
needs of a holistic person
 COMMUNICATOR- is the central role of the nurse. As she
identifies needs and problems of a client or a group, the
same is communicated to other members of the health
team.
 EDUCATOR/TEACHER- is the role, which involved in all
nursing activities; especially when health promotion is the
primary nursing concern; part of her function is the
assessment of client’s learning needs and readiness to learn,
setting learning goals, implementing planned activities and
evaluating teaching strategies
ROLES & RESPONSIBILITIES OF
A PROFESSIONAL NURSE
 COUNSELOR- is a role that helps clients recognize and cope
with stressful psychological and social problems, develop
interpersonal relationships and promote growth
 MANAGER/COORDINATOR- nurse directly, manages and
coordinates care, delegates nursing activities, supervises
and evaluates performance of other nurses and support
workers.
 CHANGE AGENT- the nurse assists clients to modify
behavior and cope with highly dynamic (changing)
healthcare system, health technology, and the human
system itself.
 LEADER- nurse influences others to work together towards
a mutually envisioned goal.
 ROLES & RESPONSIBILITIES OF
A PROFESSIONAL NURSE
 CLINICIAN- use of technical expertise to administer nursing
care and initiate and modify it based on client’s needs
 ADVOCATE- nurse intercedes for or work on behalf of the
patient, explains, interprets, and defends the patient’s right
 RESEARCHER- continuing education as part of the advance
practice role.

EXPANDED NURSING ROLES

 NURSE GENERALIST

 NURSE CLINICIAN

 NURSE PRACTITIONER

 NURSE SPECIALIST
 RIGHTS OF THE PATIENTS

 P - privacy
 A - autonomy
 T – treatment refusal
 I - information
 E - education
 N – not to be restrained
 T – to be treated with confidentiality
 S - services
SCOPE OF NURSING PRACTICE (R.A.
9173 PHILIPPINE NURSING ACT 2002

 As 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, toddlerhood, pre-school,
school age, adolescence, adulthood and school age.
 As independent practitioners, nurses are primarily
responsible for the promotion of health and prevention
of illness. As a member of the health team, nurses
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.
SCOPE OF NURSING PRACTICE (R.A.
9173 PHILIPPINE NURSING ACT 2002

 IT SHALL BE THE DUTY OF THE NURSE TO:

1. Provide nursing 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, & administration of written
prescription for treatment, therapies, oral, topical &
parenteral medication & internal examination during
labor in the absence of antenatal bleeding and delivery.
In cases of suturing of perineal laceration, special
training shall be provided according to protocol
established.
SCOPE OF NURSING PRACTICE
(R.A. 9173 PHILIPPINE NURSING ACT 2002

2. Establish linkages with community resources and

coordination with health team
3. Provide health education to individuals , families and
communities
4. Teach, guide and supervise students in nursing program
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
5. Undertake nursing and health human resource
development training and research, which include but
not limited to the development of advance nursing
practice
SCOPE OF NURSING PRACTICE
(R.A. 9173 PHILIPPINE NURSING ACT 2002

 The nurse is duty-bound

to observe the CODE OF
ETHICS for nurses and
uphold the standards of
safe nursing practice.
 NURSING PRACTICE

 Patient- recipient of nursing

 Latin word meaning to suffer or to
bear
 Client- receiver of health care less as passive
recipients and more as collaborators in the care,
that is, as persons who are also responsible of
their health
 FOCUS OF NURSING

 HEALTH PROMOTION
 HEALTH MAINTENANCE
 HEALTH RESTORATION
 CARE OF THE DYING
COMMUNICATION
 THERAPEUTIC COMMUNICATION
TECHNIQUES

1. Using silence – utilizing absence of communication

2. Accepting – giving indication of reception; indicating that
the nurse has hear and is willing to hear what the client
says.
“Yes”
“Uh hmm”
“I follow what you said”
3. Giving recognition – acknowledging indicating awareness.
“Good morning, Mr S.”
“ I notice that you combed your hair”
4. Offering self – making oneself available; introducing self
and identifying relationship.
“I’ll sit with you awhile”
I’ll stay here with you”
 THERAPEUTIC COMMUNICATION
TECHNIQUES

5. Giving Broad Openings- allowing the patient to take

the initiative in introducing the topic; using open-
ended questions that provide opportunity for the
client to introduce topic.
“Is there something you would like to talk
about?”
“What are you thinking about?”
“Where would you like to begin?”
6. Offering General Leads…giving encouragement to
continue.
“Go on.”
“And then?”
“Tell me about it.”
 THERAPEUTIC COMMUNICATION
TECHNIQUES

7. Placing the Event in Time or in Sequence…

clarifying the relationship of events in time.;
assessing time frame and sequence of an event
over time.
“Was this before or after…?”
“When did this happen?”
8. Making Observations…verbalizing what is
perceived; verbalizing what nurses sees in client’s
appearance and behaviors
“You appear tense.”
“I notice that you’re biting your lips.”
“It makes me uncomfortable when you…
 THERAPEUTIC COMMUNICATION
TECHNIQUES

9. Encouraging Description of Perceptions – asking the

patient to verbalize what he perceives; having the client
describe his/her view of an event or experience.
“Tell me when you feel anxious”
“What is happening”
“ What does the voice seem to be saying”
10. Encouraging Comparison – asking that similarities and
differences be noted.
“Was this something like…?
“Have you had similar experience?”
11. Restating – repeating the main idea expressed.
Patient: “I cant sleep. I stay awake all night”
Nurse: “You have difficulty sleeping?”
 THERAPEUTIC COMMUNICATION
TECHNIQUES

12. Reflecting – directing back to the patient questions,

feelings and ideas.

Patient: “Do you think I should tell the doctor?”

Nurse: “Do you think you should?”

13. Focusing – concentrating on single point

“This point seems worth looking at more closely.”

14. Exploring – delving further into a subject or idea

“Tell me more about that..”

“Would you describe it more fully?”

 THERAPEUTIC COMMUNICATION
TECHNIQUES

15. Giving Information- making available the facts that the

patient needs.
“My name is….”
“Visiting hours are…”
16. “Seeking Clarification” – seeking to make clear that which is
not meaningful or that which is vague; trying to clear up
confusion about events or people.
“I’m not sure that I follow.’
“What would you say is the main point of what you
said?”
17. Presenting Reality – offering for consideration that which is
real; giving a realistic explanation of what the client says or
hears.
“I see no one else in the room”
“ Your mother is not here, I’m a nurse”
 THERAPEUTIC COMMUNICATION
TECHNIQUES

18. Voicing Doubt – expressing uncertainty as to the reality of the

patients perception; gently questioning the reality of the
clients perception.
“Isn’t that unusual?”
“Really?”
19. Seeking Consensual Validation – searching for mutual
understanding for accord in the meaning of the words; two or
more people achieving agreement of interpretation of
an event, behavior or issue.
“Tell me whether my understanding of it agrees with
yours..”
20. Verbalizing the Implied – voicing what the patient has hinted
at or suggested.
Patient: “ I can’t talk to you or to anyone. It’s a waste of
time.”
Nurse : “Is it your feeling that no understand you?”
 THERAPEUTIC COMMUNICATION
TECHNIQUES

21. Encouraging Evaluation – asking the patient to appraise

the quality of his experience.
“ What are your feelings in regard to”
22. Attempting to translate into feelings- seeking to
verbalize the feelings that are being expressed only
indirectly.
Patient: “I’m dead”
Nurse: Are suggesting that you feel lifeless? Or is it
that life seems without meaning?”
23. Suggesting Collaboration – offering to share, to strive,
to work together with the patient for his benefit.
“Perhaps you and I can discuss and discover what
produces your anxiety”
 THERAPEUTIC COMMUNICATION
TECHNIQUES

24. Summarizing – organizing and summing up that

which has gone before.

“Have I got this straight?”

“You’ve said that..”

25. Encouraging Formulation of Plan of Action- asking

the patient to consider kinds of behavior likely to be
appropriate in further situations; planning
appropriate resolution of a problem in graded steps.