Fundamentals of Nursing Practice

PRELIMS REVIEWER

LESSON 1: HEALTH CARE 2. SECONDARY PREVENTION

DELIVERY SYSTEMS > Consists of diagnosis and treatment.

HEALTH CARE SYSTEM > Early detection of disease.

> Totality of services offered by all health > Accomplished by routine screening
disciplines. of the population at risk for
developing certain conditions.
> A mechanism for providing services that
meet the health-related needs of > Includes:
individuals. bone density scan
dental exam
> The major purpose of a health care screening for cholesterol &
system was to provide care to people who blood pressure
were ill or injured. Early detection of cancer
HIV testing & counselling
TYPES OF HEALTH CARE
3. TERTIARY PREVENTION
SERVICES:
> Consists of rehabilitation, health
1. PRIMARY PREVENTION restoration and palliative care.
> Consists of health promotion and
illness prevention. > The goal of tertiary prevention is to
help people move to their previous
> > HEALTH PROMOTION emphasizes level of health.
the importance of clients role in
maintaining their own health & REHABILITATIVE CARE
encouraging them to maintain the > Emphasizes the importance of assisting
highest level of wellness they can clients to function adequately in the
achieve. physical, mental, social, economic, and
vocational areas of their lives.
> Primary prevention programs
address areas such as: TYPES OF HEALTH CARE AGENCIES
adequate and proper nutrition & SERVICES:
weight control and exercise
A. PUBLIC HEALTH/GOVERNMENT AGENCIES
stress reduction
> Established at the local, state, and
> Illness prevention programs may be federal levels to provide public health
directed at the client or the services.
community and involve such practices
as: > Their funds, usually generated from
providing immunizations taxes, are administered by elected or
identifying risk factors for appointed officials.
illnesses
helping people take measures
to prevent these illnesses
from occurring

> ENVIRONMENTAL PROTECTIVE

MEASURES are frequently legislated
by governments and lobbied for by
citizens group.
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LOCAL HEALTH DEPARTMENTS > More companies recognize the value

> Responsible for developing programs of healthy employees and encourage
to meet the health needs of the people, healthy lifestyles by providing
providing the necessary nursing. exercise facilities and coordinating
health promotion activities.
STATE HEALTH ORGANIZATIONS
> Responsible for assisting the local > Worker safety has always been a
health departments. concern of occupational nurses.

E. HOSPITALS
> Also provide direct services to
people. > Can be classified according to their
ownership or control as governmental
B. PHYSICIANS' OFFICE (public) or nongovernmental (private).
> Clients usually go to a physician’s GENERAL HOSPITALS
office for routine health screening, > Admit clients requiring a variety of
illness diagnosis, and treatment. services, such as medical, surgical,
obstetric, pediatric, and psychiatric
> People seek consultation from services.
physicians when they are
experiencing symptoms of illness or ACUTE CARE HOSPITAL
when a significant other considers > Provides assistance to clients whose
the person to be ill. illness and need for hospitalization are
relatively short term.
C. AMBULATORY CARE CENTERS
SAFETY-NET HOSPITALS
> The term ambulatory care center
has replaced the term clinic in many > Hospitals that provide a significant
places. level of care to low-income, uninsured,
and vulnerable populations.
> These centers offer two F. SUBACUTE CARE FACILITIES
advantages:
> A variation of inpatient care
they permit the client to live at
designed for someone who has an
home while obtaining necessary
acute illness, injury, or exacerbation
health care
of a disease process.
they free up costly hospital
beds for seriously ill clients
> The individual’s condition is such
that the care does not depend heavily
> Most ambulatory care centers have
on high-technology monitoring or
diagnostic and treatment facilities
complex diagnostic procedure.
that provide medical, nursing,
laboratory, and radiologic services.
> It is generally more intensive than
long-term care and less intensive than
> Some ambulatory care centers
acute care.
provide services to people who
require minor surgical procedures. G. EXTENDED/LONG TERM CARE FACILITIES
D. OCCUPATIONAL HEALTH CLINICS > Formerly called nursing homes.
> Gaining importance as a setting for
employee health care. > Multilevel campuses that include:
independent living quarters
for seniors
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assisted living facilities, > Nurses who are employed in day

skilled nursing facilities care centers may provide medications,
(intermediate care) treatments, and counseling.
extended care facilities that
L. RURAL CARE
provide levels of personal
care for those who are > To provide emergency care to
chronically ill or are unable clients in rural areas.
to care for themselves
without assistance > Nurses in rural settings must be
generalists who are able to manage a
> Traditionally, extended care wide variety of clients and health care
facilities only provided care for problems.
older adult clients, but they now M. HOSPICE SERVICES
provide care to clients of all ages
> A place for travelers to rests &
who require rehabilitation.
interprofessional health care service
H. RETIREMENT & ASSISSTED LIVING for the dying.
CENTERS
> The hospice movement subsumes a
> Consist of separate houses,
variety of services given to clients
condominiums, or apartments for
who are terminally ill, their families,
residents.
and support persons.

> It is intended to meet the needs of

> The central concept of the hospice
people who are unable to remain at
movement is not saving life but
home but do not require hospital or
improving or maintaining the quality of
nursing home care.
life until death.
I. REHABILITATION CENTERS
N. CRISIS CENTERS
> Usually are independent community > Provide emergency services to
centers or special units. clients experiencing life crises.

> Play an important role in assisting > These centers may operate out of a
clients to restore their health and hospital or in the community, and most
recuperate. provide 24-hour telephone service.
J. HOME HEALTH CARE AGENCIES
> The primary purpose of the center is
> Offer education to clients and
to help people cope with an immediate
families.
crisis and then provide guidance and
support for long term therapy.
> Provide comprehensive care to
clients who are acutely, chronically, O. MUTUAL SUPPORT & SELF-HELP
or terminally ill. GROUPS
> Focus on nearly every major health
K. DAY CARE CENTERS
problem or life crisis people
> Provide care for infants and experience.
children while parents at work.
> These groups may be for the client
> Other centers provide care and or for the friends and family of the
nutrition for adults who cannot be client, who also need education,
left at home alone but do not need guidance, and support.
to be in an institution.
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PROVIDERS OF HEALTH CARE: INTRA-SECTORAL COLLABORATION

> Between sectors within health.

> EX. hospitals, community health centers,

home care agencies)

INTER-SECTORAL COLLABORATION
> Between health and non-health care
sectors.

> EX. social services, transportation,

housing, private sector, employment.

PHILIPPINE HEALTH CARE

DELIVERY SYSTEM:
1. PUBLIC - owned by the government
National
Local

FACTORS AFFECTING HEALTH 2. PRIVATE - owned by group of people or

religious people.
CARE DELIVERY:
Profit
1. Increasing Number of Adults Non Profit
2. Advances in Technology
3. Economics NONPROFIT HOSPITALS
4. Women's Health > exempt from paying federal income or
5. Uneven Distribution of Services state and local property taxes.
6. Access to Health Insurance
> they are owned and affiliated with
7. Homeless & The Poor
religious institutions, and the government
8. Health Insurance Portability & considers them charities.
Accountability Act
9. Demographic Changes DIFF. LAWS & PROGRAMS OF THE
PHILIPPINE GOVERNMENT FOR THE
FILIPINO PEOPLE REGARDING
HEALTH:
A. Department of Health

> Executive Order 102 series 1999.

> Executed by President JOSEPH

EJERCITO ESTRADA.

> Has been transformed from being

the sole provider of health services,
to being a provider of specific health
services and technical assistance
provider for health.
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> Seeks to serve as the national > Known as the National Health
technical authority on health. Insurance Act (NHI) of 1995.

> Will ensure the highest achievable > A major piece of social legislation,
standards of quality health care, the NHI Law promises to provide
health promotion and health financial access to quality health care
protection. services though a social health
insurance program.
> Leadership in Health
D. Universal Health Care in the Philippines
(RA 11223)
> Enabler and Capacity Builder
> Automatically covers all Filipinos
> Administrator of Specific Services under the National Health Insurance
Program of the Philippines or
B. Local Government Code (RA 7160) PhilHealth.
> The law mandated devolution of
basic services including health > Medical consultations and diagnostic
services to the local government testing, including lab tests, began to be
units and the establishment of a local covered.
health board in every province or
municipality. > Also referred to as Kalusugan
Pangkahalatan (KP)

> The provision to ever yFilipino of the

highest possible quality of health care
that is accessible, efficient, equitably
distributed, adequately funded, fairly
financed, and appropriately used by an
informed and empowered public.

FOURMULA
> Implementation framework for the
Health Sector Reform Agenda (HSRA).

> Directed at achieving goals of better

health outcomes, a more responsive
health system and equitable health care
financing.

> Specifies the objectives, strategies

and targets of the Department of Health.

C. National Health Insurance Act (RA 7875)

> Philippine Health Insurance
Corporation or PHILHEALTH.

> On February 14, 1995, President

Fidel V. Ramos signed this law.
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LESSON 2: CONCEPT OF A MAN HUMAN BEING

> Creatures of species of homo sapiens
meaning remains static.
WHY DO WE NEED TO STUDY
> Perspective can be explained in a
THE CONCEPT OF MAN?
scientific sense.
> Nurses are dealing with human being &
the way to serve them better is thru > Usually used as a noun phrase.
understanding man.
WHAT IS BEING HUMAN?
MAN > It means having feelings around you and
displaying all natural human qualities.
> A product of “discursive formations”
and of the “sociopolitical contingencies” > It can vary from one person to another,
of the various ethics of human history. used as a verbal phrase

> The concept of “man” is beyond > Varies acc. to different factors like one's
grammar and logic. religion, ethnicity and education.

> A biological, psychological, social & > Perspective can be explained in a

spiritual being who is in constant contact philosophical, religious sense.
with the environment.
MAJOR ATTRIBUTES OF BEING
> A unified whole composed of parts HUMAN:
which are interdependent & interrelated
with each other. 1. Capacity To Think or
Conceptualize On The Abstract
> It is composed of: Level
subsystem & supersystem.
parts which are greater than & > Before we act or do things we are
different from the sum of all his thinking.
parts.
> If we see something, our brains are
processing the things we see before
As a BIOLOGICAL BEING,
we can conclude something.
man is like other men.

> Do not do things out of the blue.
As a PSYCHOLOGICAL BEING,
> A result of our decision because we
man is like no other men.
have the capacity to think.

As a SOCIAL BEING, RENE DESCARTES

man is like some other men. > He agreed with the great thinkers before

him that the human ability to reason
As a SPIRITUAL BEING, constitutes the extraordinary instrument we
have to achieve truth and knowledge.
man is like all other men.
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2. Family Formation SOVEREIGNTY

> FAMILIES are the core unit of > Entails hierarchy within the state, as
society in which people are well as external autonomy for states.
supported and cared for and social
values are developed. > The exercise of power by a state.

> FAMILY is a socially recognized > The concept of sovereignty has

group usually joined by blood, multiple conflicting components, varying
marriage, cohabitation, or adoption definitions, and diverse and inconsistent
that forms an emotional connection applications throughout history.
and serves as an economic unit of DE JURE SOVEREIGNTY
society. > Refers to the legal right to do so.
TYPES OF FAMILY: DE FACTO SOVEREIGNTY
Family Of Orientation > Refers to the factual ability to do so.
> Refers to the family into which a
person is born. 4. Ability To Use Verbal Symbols As
Language, A Means Of Developing
> Sociologists identify different & Maintaining Culture
types of families based on how
one enters into them. > HUMAN LANGUAGE is unique on the
planet because it has the qualities of
Family Of Procreation generativity, recursion, and
> Describes one that is formed displacement.
through marriage.
> HUMAN COMMUNICATION consists of
> These distinctions have cultural both signals and symbols such as
significance related to issues of sounds, gestures, material objects, or
lineage. written words.
HUMAN LANGUANGE IS
3. Tendency To Seek & Maintain A
GENERATIVE
Territory
> It can communicate an infinite number of
> A social behavior to maintain a ideas from a finite number of parts.
territory.
> It is combinatorial words can be
> POSSESSION OF A TERRITORY combined in different orders to create
involves aggressive behavior and thus different larger meanings of a sentence.
contrasts with the home range.
HUMAN LANGUANGE IS
> The type of territory varies with the RECURSIVE
social behavior and environmental > It can build upon itself without limits.
and resource requirements of the
particular species. > We can put words, phrases, and
sentences inside of themselves without
> Acts as a spacing mechanism and a limits.
means of allocating resources among
a segment of the population and > Have the ability to be self-containing,
denying it to others. we could have an infinite sentence.
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HUMAN LANGUANGE > People who have anorexia try to keep

USES DISPLACEMENT their weight as low as possible by not
eating enough food or exercising too
> Means that through the power of
much, or both
language, we can refer to things that
aren’t present spatially or temporally. PHYSICAL SIGNS & SYMPTOMS OF
ANOREXIA:
> Allows us to talk about things and
places whose existence we cannot even Extreme weight loss
be sure of. Thin appearance
Abnormal blood counts
> Refer to things that are not physically Fatigue
present. Insomnia
HUMAN LANGUANGE IS Dizziness or fainting
Bluish discoloration of the fingers
MODALITY-INDEPENDENT
Hair that thins, breaks or falls out easily
> It is possible to use the features of
displacement, generativity, and recursion Usually the signs & symptoms of a patient
across multiple modes. is an example of ATOMISTIC APPROACH.

> SPEAKING is the auditory form of

The HOLISITIC APPROACH supplements the
language, but WRITING & SIGN
data collected by means of atomistic
LANGUAGE are visual forms.
study.

APPROACHES IN STUDYING MAN

MAN AS A BIOLOGICAL BEING
A. ATOMISTIC APPROACH
> Man responds to environmental stimuli as
> The atomistic study of man views a particular unit.
him as an organism composed of
different organ systems, each > Man is a living organism, he has to
system composed of organ made up contend continually with forces in his
of tissue cells-body structures only. environment.

B. HOLISTIC APPROACH
WHY IS MAN A BIOLOGICAL BEING?
> Traces pattern of man's
relationship with other being in the because man has life, and like all living
supra system of society. organisms, he grows and matures
man is composed of cells which makes
> Viewing man as an organism with him function as a human being
iterrelated parts functioning to he is driven by his instincts to survive, to
produce a behavior which is reproduce and thrive in the world he
acceptable or unaaceptable to him lives in
or to the society. he has basic needs
he is born to live and is ultimately
ANOREXIA destined to die.
> An eating disorder and serious mental
health condition.
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2 SYSTEMS OF A MAN: ORGANISMIC BEHAVIOR

1. SUBORDINATE SYSTEM > Man, normally responds as a unified
> includes cells, organs & systems whole rather than a set of integrated parts.
within the individual.
> Man as a whole is different from & more
> important in carrying out daily than the sum of his component factors.
activities which are vital to survival.
> Refers to those observable features &
2. SUPERORDINATE SYSTEM actions that reflect man's functioning as a
> consists of bigger units of man like unified whole.
family, community and society.
> Reflects the dynamic changes that occur
> provides man with the necessary in him.
framework of relationships which
links him to the family, community MAN AS A SYSTEM
and society.
> Function as a whole by virtue of the
interdependence of its parts.
LIST OF PEOPLE WHO HELP MAN
UNDERSTAND HIMSELF BETTER: > A system has common of unifying
A. MICROBIOLOGIST boundaries with interrelated and
interdependent parts.
> studies the cellular behavior of a
man.
> Composed of subsystem designed to
B. PHYSIOLOGIST carry out activities necessary for achieving
> studies the organ and organ system the general purpose of a system.
behavior.
TYPES OF SYSTEMS:
C. PSYCHOLOGIST & SOCIOLOGIST
CLOSED SYSTEM
> for his relationship with family,
> It is self-sufficient and totally
community or society.
isolated from other systems.
D. SOCIAL SCIENTISTS
> studies the behavior at the societal > Does not allow outside stimuli to
level. penetrate its boundaries.

E. ANTHROPOLOGISTS > Uses up its reserves for energy,

> studies the light of more value ENERGY-ENERGY.
systems taboos and social
OPEN SYSTEM
intercourse.
> Exchanges matter, energy, or
F. PUBLIC HEALTH WORKER information with environment
> studies the characteristic surrounding it.
behavioral patterns toward current
and potential health crises. > Directly affected by events or
changes in other systems.
G. LAW ENFORCING AGENCIES
> studies the deviant or antisocial
> Views person as a living behavioral
behavior.
systems.
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> Exchanges matter, energy, or RATIONAL SIDE

information with environment > Also called as rational state of mind
surrounding it. or rational thinker.

> Directly affected by events or > Makes mankind, merciful &

changes in other systems. compassionate.

> Views person as a living behavioral > Can make choices and be responsible
systems. with those choices.

EXTERNAL INTERACTIONS:
> Can cope on stressful stimuli & relate
INPUT with others .
> A stimulus that acts on and is IRRATIONAL SIDE
integrated into our system.
> It can make him make mistakes or
make him commit criminal acts.
> ENERGY is our emotions or feelings.

> Makes mankind, merciful &

> MATTER/MATERIALS are anything that
compassionate.
occupies space & has weight.

OUTPUT > Everyone is ruled by their emotions,

> Given out by the system as a result not their minds.
of the input.
MAN AS A SPIRITUAL BEING
ENERGY-MATTER EXCHANGE > Believes that there’s someone greater
OF MAN than him and his universe.
> As an energy unit, man's energy is not
limitless but must be continuously > Believes in the 3 great virtues such as
replenished as soon as it is utilized. faith, hope & charity.

> When this energy supply is exhausted, THE UNITY OF MAN IN BODY, MIND
man dies. AND SPIRIT
> The mind and body form as one.
> The input matter results in output matter
and man exchage matter with environment,
> Man, the spiritual being, needs the
utilizing energy in the process.
essential freedom of the human spirit.
MAN AS A PSYCHOSOCIAL
> This ability to overcome the physical and
BEING
social needs through TRANSCENDENCE ~ is
> Unique, irreplaceable individual, a one descriptive of man's spiritual nature.
time being in this world.
> Man has intellect and will that assist him
> Capable of relating to others. in the power of transcendence.

SIDES OF MAN:
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INTELLECT
> Allows man to look for the truth.

WILL
> Expresses man's own wishes, desire or
longing to do what he has set his mind to
do.

BELIEF IN SUPREME FORCE

> Man, no matter what his religion is,
believes that his life is governed by a
power greater than he is.

> RELIGIOUS BELIEFS are one of the few

"human universals" that appear in all
cultures,

> The brain is built in such a way as to

facilitate spiritual kinds of experiences.

> The explanation for religious beliefs and

behaviors is to be found in the way all
human minds work.

MOTIVATION TO OVERCOME
HARDSHIPS
> Motivation may come either from natural
or supernatural forces.

NATURAL MOTIVATION
> When there is suffering, it is natural to
man to be motivated for those whom he
loves and wishes to protect from pain and
suffering.

SUPERNATURAL MOTIVATION
> Happens when one transcends pain and
suffering to a higher place in the hope of
non-material rewards.
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LESSON 3: HISTORY OF CONTRIBUTIONS OF ANCIENT

NURSING CIVILIZATION TO MEDICINE AND
NURSING
INTUITIVE/MEDIEVAL PERIOD A. BABYLONIA
> Nursing was untaught and instinctive > They contributed the "Code of
meaning there is no formal education. Hammurabi".

> It was performed of compassion for > CODE OF HAMMURABI ~ provided

others, out of the wish to help others. laws that covered-every facet of
Babylonian life including medical
> No caregiving training is evident, it was practice.
based on experience and observation.
> There was no mention of nurse or
> Nursing was a function that belonged to nursing during this time.
women before.
B. EGYPT
> Primitive men believed that illness was > The Egyptian Introduced “the art of
caused by the invasion of the victim's embalming".
body of evil spirits.
> THE ART OF EMBALMING ~ enhanced
SHAMAN their knowledge of human anatomy.

> The medicine or witch doctor had the

> They developed the ability to make
power to heal.
keen observation and left a record of
250 recognized diseases.
TREPHINING
> Drilling a hole in the skull with a rock or C. ISRAEL
stone. > Promulgated laws of control on the
spread of communicable disease and
ANCIENT GREECE the ritual of circumcision of the male
> In ancient Greece, they built temples to child.
honor HYGIEA, the Goddess of Health.
> Referred nurses as midwives, wet
> Priestesses attended to those housed in nurses or children whose acts where
the temples. compassionate and tender.

D. CHINA
> Nursing that was done by women was
> Matera Medica was introduced.
performed in the home.

> MATERA MEDICA ~ methods of

NEAR EAST
treating wounds, infection and muscle
> Nursing remained the duty of slaves, pain.
wives, sisters, or mother.
> Using herbs, minerals and
> The care of the sick was still closely acupuncture to treat the sick.
related to religion, superstition & magic.
> Also using massaged, hydrotherapy
> Astrology and numerology were also and exercise as preventive health
used in medical practice. measures.
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E. INDIA PARABOLANI
> “Sushurutu” was introduced. > provided an opportunity for male nurses in
the early church period.
> SUSHRUTU ~ a list of functions and
qualifications of male nurse some of >they took care of the sick and burrythe
the qualifications are: dead.
knowledge of drugs
administrations APPRENTICE NURSING
he should be clever, devoted
> also called as the period of "on the job
to patients
training".
have the purity of mind and
body
> nursing performed without any formal
F. AFRICA education and being done by people who
> The nurturing functions of a nurse were directed by more experienced nurses
included roles as midwifes, herbalist, .
wet nurse and carer of child and > hospitals were first established in the
elderly. Eastern Roman Empire.

G. ROME > caregivers had no formal training in

> The transition from pagan to therapeutic modalities and volunteered their
Christian philosophy took place. time to nurse the sick.

> The Romans attempted to maintain

MILITARY RELIGIOUS ORDERS
vigorous health because illness was a TEUTONIC KNIGHTS
sign of weakness.
> they are from Germany.

> Care of the ill was left to the slaves

> established tent hospitals for the
or Greek physician.
wounded and injured comrades.
HUMORAL THEORY KNIGHTS OF SAINT LAZARUS
> states that good health comes from a > dedicated themselves to the care of
perfect balance of the four humors: people with leprosy, syphilis, and
blood, chronic skin conditions.
phlegm,
yellow bile, ALEXIAN BROTHERS
black bile > monastic order founded in 1348.

FABIOLA > established Alexian Brother Hospital

> a worldly, beautiful Roman matron who School of Nursing.
was converted to Christianity by her ALEXIAN BROTHER HOSPITAL
friends Marcella and Paula. SCHOOL OF NURSING
> largest school of nursing under a
> thru her effort the first public hospital
religious orders exclusively for men.
was built NOSOCOMIUM - a place for the
sick.
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THEODOR FLIEDNER PEOPLE WHO HELP IN REFORMING

> reinstituted the Order of DURING DARK PERIOD
Deaconesses.
JOHN HOWARD
> opened a small hospital & training > a prison reformer helped improved
school in Kaiserswerth, Germany. the living condition in prison & gave
prisoners renewed hope.
RENAISSANCE APPRENTICE
MOTHER MARY AIKENHAND
NURSING > Irish Sister of Charity.
> During AD 1400-1550, interests in the
arts and sciences emerges & world NURSING IN AMERICA
literally expanded. A. PRE-CIVIL WAR NURSING

> Universities were established, but no > in the USA and Canada, religious
formal nursing schools were founded. nursing orders, both Catholic and
Protestant carried out nursing.
RISE OF SECULAR ORDERS MADAME JEANNE MANCE
> Religious nursing orders for women. > first laywoman who worked as a nurse
in North America.
IMPORTANT PERSONALITIES IN
THIS PERIOD > founded the Hotel Dieu of Montreal.
MRS. ELIZABETH SETON
ST. CLARE
> an American, founded the Sisters of
> gave nursing care to the sick & the Charity of Emmitsberg, Maryland in 1809.
afflicted.
B. AMERICAN REFORMS IN NURSING
ST. ELIZABETH OF HUNGARY
> The Nurse’s Society of Philadelphia
> patrones of nurses.
organized a school of nursing under
ST. CATHERINE OF SIENA the direction of Dr. Joseph
Warrington.
> first lady with a lamp.
> Women’s Hospital in Philadelphia
DARK PERIOD OF NURSING established 6mos course in nursing.
> No provisions for the sick, no one cared
for the sick. > They were taught a minimum amount
of medical and surgical nursing,
> Extends from the 17th-19th century. Materia medica and dietetics.

> Properties of hospitals, schools were C. NURSING DURING CIVIL WAR

confiscated and nurses fled for their lives. > The American Medical Association
created the Committee on Training
> Nursing became the work of the least Nurses.
desirable of women.
> Doctors realized the need for
qualified nurses.
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DOROTHEA DIX FLORENCE NIGHTINGALE

> An American advocate on behalf of the > Mother of Modern Nursing.
indigent mentally ill.

> Created the first generation of American EARLY RELIGIOUS VALUES AND
mental asylums. NURSES COMMITMENT
SELF-DENIAL
SOCIETAL ATTITUDES
> Refers to the social mind setup. > The habit of refusing to do or have
things that you would like.
> Consists of the social beliefs, feelings
and actions of an individual or group. > Also called as self-sacrifice.

SPIRITUAL CALLING
BEFORE MID 1800S
> A gift from God that uses your
> Nursing was without education,
skills, talents, abilities, and values to
organization and social status.
serve the world around you.

> Nurses in hospitals were poorly

> A life's mission.
educated.
DEVOTION TO DUTY
> Attitude towards nurses was not that
> The commitment a person shows to
good.
his/her duty.
MARTIN CHUZZLEWIT HARD WORK
> A novel written by Charles Dickens. > Generally involves physical, mental
or emotional effort, high levels of
> Main character is Sairey Gamp. focus and greater purpose.

SAIREY GAMP > Also called as diligent.

> Cared for the sick by neglecting
them ,stealing from them & AMERICAN CIVIL WAR
physically abusing them.
> Women played a significant role in the
Civil War.
CRIMEAN WAR
> Inadequacy of care given to soldiers. > Women served in a variety of capacities,
as trained professional nurses giving
SIDNEY HERBERT direct medical care, as hospital
> From British War Department. administrators, or as attendants offering
comfort.
> recruited a contingent of female nurses
to provide care to the sick and injured in HARRIET TURBAN
the Crimea > Provided care & safety to slaves fleeing
to the north on the underground railroad.
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DURING 19TH CENTURY CONTEMPORARY NURSING

> Nurse viewed as: (20TH CENTURY)
doctor's handmaiden
sex object > Covers the period after the world war II
surrogate mother to the present.
tyrannical mother
body expert/body minder > Licensure of nurses started.

EARLY 1900S > Specialization of Hospital and diagnosis.

> Nurses had a distinct stereotype:
> Training of Nurses in diploma program.
feminine, middle class, Christian and
white.
> Development of baccalaureate and
advance degree programs
> This image evolved when women had yet
to obtain the right to vote, when family
LIST OF THE DEVELOPMENTS THAT
structures were largely paternalistic.
TOOK PLACE IN 20TH CENTURY
BY THE 1980S > Marked by scientific and technological
> Nurses were actively trying to upend developments as well as social changes.
such imagery, and they’ve been Health is perceived as a fundamental
successful for the most part. human right
Nursing involvement in community
> The few modern recruitment postcards health
in the exhibit feature nurses of all Techological advances – disposable
genders, races and classes. supplies and equipments
Expanded roles of nurses was
PERIOD OF EDUCATED developed
NURSING WHO was established by the United
Nations
> Also called as Nightingale Era (19th- Aerospace Nursing was developed
20th century). Use of atomic energies for medical
diagnosis, treatment
> Began on June 15, 1860 when Florence Use of sophisticated equipment for
Nightingale School of nursing opened St. diagnosis and therapy
Thomas Hospital in London. I. Computers were utilized-data
collection, teaching, diagnosis,
> DEVELOPMENT OF NURSING was inventory, payrolls, record keeping,
strongly influenced by trends resulting billing.
from wars.
EARLY 1960S
> Nursing evolved as an art and science.
Technological advances increased the
scope of practice of Medicine and
Nursing
Access to health care services
enhanced by Medicare, Mediaid
Physician and nurses shortage
Feminist movement, inception of nurse
practitioners
Heath maintenance
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EARLY 1970S BLUE SHIELD

Health care costs escalating with > provide reimbursement for medical
unemployement services provided to subscriber.
Professional autonomy was being
debated NURSING LEADERS:
Nursing theories were being developed
Nursing education was being integrated A. FLORENCE NIGHTINGALE
in the university setting > Mother of Modern Nursing.
Nurses were becoming more politically
astute B. CLARA BARTON
> A school teacher & volunteered
EARLY 1980S during American Civil War.
Nursing became more specialized and
autonomous > Noted for her role in establishing
Rapid technological advances required American Red Cross.
more specialization in Nursing
C. LILLIAN WALD
Expanded roles of nurses were
developing in response to greater > Founder of Public Health Nursing.
demand for nursing services
> Founded Henry Street Settlement.
EARLY 1990S
D. LAVINIA DOCK
Nurses are actively assuming more
responsibilities for the delivery of > Feminist & a friend of Wald.
health care
Aging of the population calls for more > Participated in protest movements
involvement with the elderly • = passage of 19th amendment to the
Nursing is becoming a stronger US constitution.
advocate for elderly, those living in
poverty, homeless, those with HIV and > Founded the American Society of
AIDS Superintendents of Training Schools
American Association of Colleges of for Nurses of the US and Canada
Nursing (National League for Nursing).
American Nurses Association
E. MARGARET SANGER
American Organization of Nursing
Executives > Public health nurse in New York.
National League for Nurses
“Nurses of America”- to improve images > Founder of Planned Parenthood.
of nurses
F. MARY BRECKINRIDGE
BLUE CROSS > Established Frontier Nursing
> joint venture that pioneered the Service (FNS).
development of insurance company .
> Started first Midwifery training
schools.
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NURSING HISTORY IN E. CAPTAIN SALOMEN

> a revolutionary leader in Nueva Ecija
THE PHILIPPINES provided nursing care to the wounded
when not in combat.
EARLY BELIEFS & CARE OF THE
SICK F. AGUEDA KAHABAGAN
> revolutionary leader in Laguna also
Early Filipinos subscribed to
provided nursing services to her
superstitious belief and practices in
troops.
relation to health and sickness.
Diseases, their causes and treatment G. TRINIDAD TECSON
were associated with mysticism and
> stayed in the hospital at Biak na
superstitions,
Bato to care for the wounded soldiers.
Cause of disease was caused by
another person (an enemy of witch) or
> Ina ng Biak na Bato.
evil spirits.
Persons suffering from diseases without SCHOOLS OF NURSING:
any identified cause were believed
bewitched by “mangkukulam”. 1900 - St. Paul’s Hospital School of
Evil spirits could be driven away by Nursing, Intramuros Manila
persons with powers to expel demons. 1906 - Iloilo Mission Hospital Training
Belief in special Gods of healing: School of Nursing
priest-physician, word doctors, 1909 - Distinction of graduating the 1st
herbolarios/herb doctors. trained nurses in the Phils. With no
standard requirements for admission of
PROMINENT PEOPLE INVOLVED applicants.
DURING THE PHILIPPINE April 1946 - A board exam was held
outside of Manila. It was held in the
REVOLUTION
Iloilo Mission Hospital.
A. JOSEPHINE BRACKEN 1907 - St. Luke’s Hospital School of
Nursing
> wife of Jose Rizal installed a field
1907 - Mary Johnston Hospital School of
hospital in an estate in Tejeros that
Nursing
provided nursing care to the
1910 - Philippines General Hospital
wounded night and day.
school of Nursing
B. ROSE SEVILLA DE ALVARO
COLLEGE OF NURSING:
> converted their house into quarters
1946 - UST College of Nursing, 1st
for Filipino soldiers during the Phil-
college of nursing in the PH.
American War in 1899.
JUNE 1947 - MCU College of Nursing, 1st
C. HILARIA DE AGUINALDO College who offered BSN – 4 year
program
> wife of Emilio Aguinaldo organized
1947 - Siliman University College of
the Filipino Red Cross.
Nursing
D. MELCHORA AQUINO JUNE 1948 - UP College of Nursing
JUNE 1955 - FEU Institute of Nursing
> nursed the wounded Filipino
OCT 1958 - UE College of Nursing
soldiers, gave them shelter and food.
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1909
> 3 female graduated as “qualified
medical-surgical nurses”.

1919
> The 1st Nurses Law (Act#2808) was
enacted regulating the practice of the
nursing profession in the Philippines
Islands.

> Provided the holding of exam for the

practice of nursing on the 2nd Monday of
June and December of each year.

1920
> 1st board examination for nurses was
conducted by the Board of Examiners, 93
candidates took the exam.

1921
> Filipino Nurses Association was
established (now PNA) as the National
Organization Of Filipino Nurses

> PNA: 1st President – Rosario Delgado

> PNA Founder – Anastacia Giron-Tupas

1953
> Republic Act 877, known as the “Nursing
Practice Law” was approved.
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LESSON 4: NURSING PROCESS COMMONLY USED APPROACHES TO

PROBLEM SOLVING
CRITICAL THINKING 1. TRIAL AND ERROR
> The process of intentional higher-level > A number of approaches are tried
thinking to define a client’s problem, until a solution is found.
examine the evidence-based practice in
caring for the client, and make choices in > The use of trial-and-error methods in
the delivery of care. nursing care can be dangerous because
the client might suffer harm if an
> Requires the nurse to think creatively, approach is inappropriate.
use reflection, and engage in analytical
thinking. > Nurses often use trial and error in the
home setting due to logistics,
> Essential skill needed for the equipment, and client lifestyle.
identification of client problems and the
implementation of interventions to 2. INTUITION
promote effective care outcomes. > A problem-solving approach that
relies on a nurse’s inner sense.
CRITICAL REASONING
> The cognitive process that uses thinking > Legitimate aspect of a nursing
strategies to gather and analyze client judgment in the implementation of care.
information, evaluate the relevance of the
information, and decide on possible > Understanding or learning of things
nursing actions to improve the client’s without the conscious use of reasoning.
physiological and psychosocial outcomes.
> Also known as sixth sense, hunch,
> Guides nurses in assessing, assimilating, instinct, feeling, or suspicion.
retrieving, and/or discarding components CLINICAL JUDGMENT
of information that affect patient care.
> A decision-making process to
ascertain the right nursing action to be
> Application of critical thinking to the
implemented at the appropriate time in
clinical situation.
the client’s care.

SOCRATIC QUESTIONING CLINICAL EXPERIENCE

> A technique one can use to look beneath > Allows the nurse to recognize cues and
the surface. patterns and begin to reach correct
conclusions.
PROBLEM SOLVING
> EXPERIENCE is important in improving
> A mental activity in which a problem is
intuition because the rapidity of the
identified that represents an unsteady
judgment depends on the nurse having
state.
seen similar client situations many times
.
before.
> Requires the nurse to obtain information
that clarifies the nature of the problem
and suggests possible solutions.
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3. RESEARCH PROCESS 3. ADAPTATION OF PROBLEM SOLVING

> Formalized, logical, systematic > Can be viewed as parallel to but
approach to problem solving. separate from the process used by
physicians (the medical model).
> The classic quantitative research
4. INVOLVES DECISION MAKING
process is most useful when the
researcher is working in a controlled > This facilitates the individualization
situation. of the nurse’s plan of care.

NURSING PROCESS > Involved in every phase of the

nursing process.
> The systematic, rational method of
planning and providing nursing care. 5. INTERPESIONAL & COLLABORATIVE
> It requires the nurse to communicate
> Begins with assessment of the client
directly and consistently with clients
and use of clinical reasoning to identify
and families to meet their needs.
client problems.
6. UNIVERSALLY APPLICABLE
PURPOSE OF THE NURSING > Used as a framework for nursing
PROCESS care in all types of health care
to identify a client’s health status and settings, with clients of all age
actual or potential health care groups.
problems or needs 7. USES CRITICAL THINKING
to establish plans to meet the
> To carry out the nursing process.
identified need
to deliver specific nursing interventions PHASES OF THE NURSING
to meet those needs
PROCESS
THE USE OF THE NURSING PROCESS IN CLINICAL A. ASSESSMENT
PRACTICE GAINED ADDITIONAL LEGITIMACY IN 1973
WHEN THE PHASES WERE INCLUDED IN THE
> Systematic and continuous
AMERICAN NURSES ASSOCIATION (ANA) STANDARDS collection, organization, validation,
OF NURSING PRACTICE. and documentation of data.

CHARACTERISTICS OF THE > Continuous process carried out

during all phases of the nursing
NURSING PROCESS
process.
1. CYCLIC & DYNAMIC IN NATURE
> The nursing process is a regularly > Obtain a nursing health history,
repeated event or sequence of conduct a physical assessment.
events (a cycle) that is continuously
changing (dynamic) rather than > Review client records and nursing
staying the same (static). literature.

2. CLIENT CENTERED > Consult support persons & health

> The nurse organizes the plan of professionals.
care according to client problems
rather than nursing goals. > Update data as needed.

> Organize, validate & communicate or

document data.
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TYPES OF ASSESSMENT: History of Present Illness

1. Initial Assessment > When the symptoms started

> To establish a complete database
for problem identification. > Whether the onset of symptoms was
sudden or gradual
> Performed within specified time
after admission to health care > How often the problem occurs
agency. Past History
2. Problem-focused Assessment > Illnesses, such as chickenpox,
> To determine the status of a mumps, measles, rubella
specific problem identified in an
earlier assessment. > Immunizations and the date of the
last tetanus shot
> Ongoing process integrated with
nursing care. > Allergies to drugs, animals, insects,
or other environmental agents
3. Emergency Assessment
> To identify life-threatening and > Accidents and injuries
new/overlooked problems.
> Hospitalization for serious illnesses
> During any physiologic or
psychological crisis of the client. > Medications
3. Time-lapsed Assessment Family History of Illness
> To compare the client's current
> To ascertain risk factors for certain
status to baseline data previously
diseases, the ages of siblings,
obtained.
parents, and grandparents and their
current state of health.
> Several months after initial
assessment. Lifestyle

ACTIVITIES DURING ASSESSMENT: > Personal habits, sleeping patterns

Data Collection > Diet, recreation or hobbies

Validation of Data
Organization of Data > Activities of daily living and
Documentation of data instrumental ADLs
COMPONENTS OF A NURSING Social Data
HISTORY: > Family relationships/friendships &
Biographic Data ethnic affiliation
> Client’s name, address, age, sex,
> Educational & occupational history
marital status, occupation, religious
preference, health care financing, and
> Economic status and home &
usual source of medical care.
neighborhood conditions
Chief Complaint or Reason For Visit
> The answer given to the question
“What is troubling you?” or “Describe
the reason you came to the hospital
or clinic today.
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Psychological Data APPROACHES TO INTERVIEWING:

> Major stressors & usual coping Directive Interview
pattern for a serious problem > Highly structured and elicits
specific information.
> Communication style
Patterns of Health Care > The nurse establishes the purpose
of the interview and controls the
> All health care resources the client
interview, at least at the outset.
is currently using and has used in the
past. Nondirective Interview
> Rapport building interview.
TYPES OF DATA
SUBJECTIVE DATA > The nurse allows the client to
> Also referred to as symptoms or control the purpose, subject matter,
covert data. and pacing.

> Felt & experienced by the patient. TYPES OF INTERVIEW QUESTIONS

OBJECTIVE DATA Closed Questions

> Also referred to as signs or overt > Used in the directive interview.
data.
> Restrictive and generally require
> Observed/detected by an observer. only “yes” or “no” or short factual
answers that provide specific
> They can be seen, heard, felt, or information.
smelled, and they are obtained by
observation or physical examination. > Often begin with “when,” “where,”
“who,” “what,” “do (did, does),” or “is
METHODS OF DATA COLLECTION (are, was).
A. OBSERVATION
Open Questions
> To observe is to gather data by > Associated with the nondirective
using the senses. interview.

> A conscious, deliberate skill that is > Invite clients to discover and
developed through effort and with an explore, elaborate, clarify, or
organized approach. illustrate their thoughts or feelings.

> Has two aspects: (a) noticing the > Specifies only the broad topic to be
data and (b) selecting, organizing, discussed and invites answers longer
and interpreting the data. than one or two words.
B. INTERVIEWING
> Planned communication or a > May begin with “what” or “how.”
conversation with a purpose.

> In a FOCUSED INTERVIEW, the

nurse asks the client specific
questions to collect information
related to the client’s problem.

> RAPPORT is an understanding

between two or more people.
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C. PHYSICAL EXAMINATION STAGES OF THE INTERVIEW

> Systematic data collection method
Opening
that uses observation to detect
health problems. > The most important part of the
interview because what is said and
> The nurse uses techniques of done at that time sets the tone for the
inspection, auscultation, palpation, remainder of the interview.
and percussion.
> To establish rapport and orient the
> May be organized according to the interviewee.
examiner’s preference, in a head-to- Body
toe approach or a body systems > The client communicates what he or
approach. she thinks, feels, knows, and
CEPHALOCAUDAL perceives in response to questions
> Also called as head-to-toe from the nurse.
approach. Closing
> The nurse terminates the interview
> Begins the examination at the head
when the needed information has
been obtained.
> Progresses to the neck, thorax,
abdomen, and extremities; and ends
> Important for maintaining rapport
at the toes.
and trust and for facilitating future
PLANNING THE INTERVIEW interactions.

Time DATA VALIDATION

> Nurses need to plan interviews with > Data are validated whether complete &
clients when the client is physically accurate.
comfortable and free of pain.
> VALIDATION is the act of “double-
Place checking” or verifying data to confirm that
> A well-lighted, well-ventilated room it is accurate and factual.
that is relatively free of distractions
encourages communication. > The nurse validates data when there are
discrepancies between data obtained in
Seating Arrangement
the nursing interview (subjective data) and
> When a client is in bed, the nurse the physical examination (objective data),
can sit at a 45-degree angle to the or when the client’s statements differ at
bed. different times in the assessment.

Distance DATA ORGANIZATION

> The distance between the > Nurse organizes & clusters the
interviewer and interviewee should be information together in order to identify
neither too small nor too great. areas of strength & weaknesses.
Language
> Often referred to as a nursing health
> The nurse must convert complicated history, nursing assessment, or nursing
medical terminology into common database form.
English usage.
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CONCEPTUAL MODELS/ B. DIAGNOSIS

FRAMEWORKS > Interpretation of assessment data
and identification of the client’s
Gordon's functional health pattern
strengths and problems.
Orem's self-care model
Roy's adaptation model
> The term diagnosing refers to the
Body systems model
reasoning process.
GORDON'S FUNCTIONAL HEALTH
> A pivotal step in the nursing
PATTERN
process.
Health Perception
Nutritional-Metabolic Pattern > A statement or conclusion regarding
Elimination Pattern the nature of a phenomenon.
Activity-Exercise Pattern
Cognitive Perceptual Pattern NURSING DIAGNOSIS
Sleep-Rest Pattern > A clinical judgement about individual,
Self-Perception Pattern family or community responses to actual
Role Relationship Pattern or potential health problems/life
Sexuality-Reproductive Pattern processes.
Coping-Stress Tolerance Pattern
Value-Belief Pattern
NANDA
> North American Nursing Diagnosis
BODY SYSTEM'S MODEL Association
Integumentary system
Respiratory system > To define, refine, and promote a
Cardiovascular system taxonomy of nursing.
Nervous system
Musculoskeletal system DIAGNOSTIC LABEL
Gastrointestinal system > Standardized name and problem oriented.
Genitourinary system
Reproductive system ETIOLOGY
Immune system > Causal relationship between a problem
and its related or risk factors.
DATA DOCUMENTATION
NURSING DIAGNOSIS COMPONENT
> Basis for determining quality of care and
should include appropriate data to support > Diagnostic Label + Etiology
identified problems.
NURSING DIAGNOSIS
> Refers to client’s responses to a disease
> Data are recorded in a factual manner
process & vary among individuals.
and not interpreted by the nurses.

DATA INTERPRETATION > Changes as the client’s response

> Translation of the information into changes.
nursing diagnosis.
> Treatment is mainly dependent on the
nurse.
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MEDICAL DIAGNOSIS Defining Characteristics

> Refers to disease processes & fairly > As evidence or manifested by
uniform in all patients.
> Cluster of signs and symptoms that
> Remains the same for as long as the indicate the presence of a particular
disease process is present. diagnostic label.
QUALIFIERS
COLLABORATIVE PROBLEM
> Words that have been added to some
> Potential problems that may arise out of
NANDA labels to give additional meaning
a disease process (EX. complications)
to the diagnostic statement.
> Treatment requires a health care team ACCEPTABLE QUANTIFIERS TO
effort.
A DIAGNOSTIC LABEL
TYPES OF NURSING DIAGNOSIS DEFICIENT
Actual > Inadequate in amount, quality, or
> A client problem that is present at degree; not sufficient; incomplete.
the time. IMPAIRED
> Made worse, weakened, damaged,
> Based on the presence of associated reduced, deteriorated.
signs and symptoms.
DECREASED
Potential/Risk
> Lesser in size, amount, or degree.
> A clinical judgement that a problem
does not exist, but the presence of INEFFECTIVE
risk factors indicates that a problem > Not producing the desired effect.
is likely to develop unless nurses COMPROMISED
intervene.
> To make vulnerable to threat.
Health Promotion
FORMULATING
> Relates to clients’ preparedness to
implement behaviors to improve their DIAGNOSTIC STATEMENT
health condition. Basic Two Part Diagnostic Statement
COMPONENTS OF NANDA > Problem + Etiology
NURSING DIAGNOSIS Basic Three Part Diagnostic Statement
Problem (Diagnostic Label) > Problem + Etiology + Signs &
Symptoms
> Describes the client’s health
problem or response for which One-part Statement
nursing therapy is given. > Wellness/syndrome diagnosis

> Direct the formation of client goals > Composed of NANDA/Problem label
and desired outcomes. only.
Etiology (Related & Risk Factors) Collaborative Problem
> Related/Secondary to > Should begin with potential
complication of.
> Identifies one or more probable
causes of the health problem and
enables the nurse to individualize the
client’s care.
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TAXONOMY PATTERNS 10. Life Principles

1. Health Promotion Values

Beliefs
Health Awareness
Action congruence
Health Management
11. Safety/Protection
2. Nutrition
Infection
Ingestion Physical Injury
Digestion Violence
Absorption Environmental Hazard
Metabolism Defensive Processes
Hydration Thermoregulation
3. Elimination 12. Comfort
Urinary System Physical comfort
Gastrointestinal Environmental comfort
Integumentary System Social comfort
Pulmonary System
13. Growth/Development
4. Activity/Rest
Growth
Sleep/Rest Development
Activity/Exercise
Energy Balance EVIDENCE-BASED PRACTICE
Cardiovascular/Pulmonary
> •Use of nursing dx offers an approach to
Responses
ensure more comprehensive nursing
Self-care
assessment and identification of patients
5. Perception/Cognition health problems.
Attention
Orientation > Use of nursing dx can improve selection
Sensation/Perception of nursing intervention by nurses in all
Cognition settings.
Communication
> Contribution from research will build on
6. Self-perception
the evidence for use of defining
Self – Concept
characteristics and nursing diagnoses in
Self – Esteem
identification of patient’s health care
Body Image
problems.
7. Role Relationship
Caregiving Roles
C. PLANNING
Family Relationships
Role Performance > The nurse and client develop client
goals/desired outcomes and nursing
8. Sexuality
interventions to prevent, reduce, or
Sexual Identity
alleviate client’s health problems.
Sexual Function
Reproduction
TASKS IN PLANNING:
9. Coping/Stress Tolerance
Post – Trauma Responses
Coping Responses
Neuro – behavioral Stress
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Setting Priorities
Client’s health values and beliefs
> Process of establishing a Client’s priorities
preferential sequence for addressing Resources available to the nurse
nursing diagnoses and interventions. and client
Urgency of the health problem
> Instead of rank-ordering diagnoses, Medical Treatment Plan
nurses can group them as having high,
medium, or low priority. PURPOSE OF GOAL & OUTCOME
Establishing Client Provide direction for planning nursing
Goals/Desired Outcomes interventions.
Serve as criteria for evaluating client
> Describes as what the nurse hopes
progress.
to achieve by implementing the
Enable the client and nurse to determine
nursing interventions.
when the problem has been resolved.
Selecting Nursing Interventions and Help motivate the client and nurse by
Activities providing a sense of achievement.
> The actions that a nurse performs
to achieve client goals.
COMPONENTS OF GOAL OR
EXPECTED OUTCOMES
Writing Individualized Nursing
Interventions on Care Plans SUBJECT
> Date nursing interventions on the > the client, any part or attribute of
care plan when they are written and the client (EX: pulse, blood pressure).
review regularly at intervals that VERB
depend on the individual’s needs. > specifies an action the client is to
perform.
MASLOW'S HIERARCHY OF NEED
> denotes directly observable
behaviors.
CONDITIONS/MODIFIERS
> added to the verb to explain the
circumstances under which the
behavior is to be performed.
CRITERION OF DESIRED PERFORMANCE
> indicates the standard by which a
performance is evaluated.

GUIDELINES IN WRITING
GOALS/DESIRED OUTCOMES
1. Make sure that it is SMART.
2. Write goals and outcomes in terms of
client responses, not nurse activities.
FACTORS TO CONSIDER IN S: Specific
SETTING PRIORITY: M: Measurable
A: Attainable
R: Realistic
T: Time Bound
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NURSING INTERVENTIONS DEPENDENT

> The activity that the nurse will execute > Activities carried out under the
for and with the client to enable orders or supervision of a licensed
accomplishments of goals. physician or other health care provider
authorized to write orders to nurses.
COMPOSITION OF
COLLABORATIVE
NURSING INTERVENTIONS
> Actions the nurse carries out in
Direct Care collaboration with other health team
> Performed by the nurse through members.
interaction with the client.
CRITERIA FOR CHOOSING
> Nurses are giving care, health NURSING INTERVENTIONS
teaching. Safe and appropriate for the individual’s
age, health, and condition
Indirect Care
Achievable with the resources available
> Delegated by the nurse to another Congruent with the client’s values,
provider or performed away from but beliefs, and culture.
on behalf of the client. Congruent with other therapies
GUIDELINES FOR WRITING A Based on nursing knowledge and
experience or knowledge from relevant
NURSING CARE PLAN
sciences
Date and sign the plan Within established standards of care
Use category headings
Use standardized medical or English FORMAT IN WRITING
symbols and key words rather than INTERVENTIONS
complete sentences > Verb + Condition and Modifiers + time
Be specific element
Refer to procedure books or other
sources of information rather than > Explain (to the client) the actions of
including all the steps in a care plan insulin.
Tailor the care plan to the unique
characteristic of the patient > EX. Measure and record ankle
Ensure that the care plan incorporates circumference daily at 9 am
preventive and health maintenance
aspects as well as restorative ones RELATIONSHIP OF NURSING
Ensure that the plan contains INTERVENTIONS TO PROBLEM
interventions for ongoing assessment STATUS
Include collaborative and coordination
activities in the plan OBSERVATIONS
Include plans for the client’s discharge > Assessments made to determine
and home care needs whether a complication is developing
as well as observation of the client’s
TYPES OF NURSING response to nursing and other
INTERVENTIONS therapies.
INDEPENDENT PREVENTION INTERVENTIONS
> Activities that nurses are licensed > Prescribe the care needed to avoid
to initiate on the basis of their complications or reduce risk factors.
knowledge and skills.
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TREATMENTS ACTIVITIES OR PROCESS OF

> Teaching, referrals, physical care IMPLEMENTING
and other care needed for an actual
Reassess the client to update the
nursing diagnosis.
database
HEALTH PROMOTION INTERVENTIONS Determine the need for nursing
> Appropriate when the client has no assistance
health problems or when the nurse Perform planned nursing interventions
makes a wellness nursing diagnosis. Supervise the delegated care
Document nursing activities

GUIDELINES IN IMPLEMENTING
D. IMPLEMENTATION INTERVENTIONS
> Carrying out the planned nursing
Base nursing interventions on scientific
interventions.
knowledge, nursing research and
professional standards of care whenever
> Consists of doing and documenting
possible
the activities that are the specific
Clearly understand the orders to be
nursing actions needed to carry out
implemented and question any that are
the interventions.
not understood
IMPLEMENTING SKILLS Adapt activities to the individual client
Implement self-care
Cognitive/Intellectual Skills
Provide teaching, support and comfort
> Include problem solving, Be holistic
decision making, critical thinking, Respect the dignity of the client and
clinical reasoning, and creativity. enhance the client’s self-esteem
Interpersonal Skills Encourage active participation
> All of the activities, verbal and
non-verbal, people use when
interacting directly with one E. EVALUATION
another. > Influence goal achievement.

> The effectiveness of a nursing > Measuring the degree to which

action often depends largely on goals/outcomes have been achieved
the nurse’s ability to and identifying factors that support
communicate with others. the evaluations.

Technical Skills
> To evaluate is to judge or to
> Purposeful “hands-on” skills appraise.
such as manipulating equipment,
giving injections, bandaging, ACTIVITIES OR COMPONENTS
moving, lifting, and repositioning OF EVALUATION
clients. Collect data related to expected
outcomes
> Require knowledge and, Compare data with outcomes
frequently, manual dexterity. Related nursing activities to outcomes
Draw conclusions about problem status
Continuing, modifying, or terminating
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COMPONENTS OF
EVALUATION STATEMENT
CONCLUSION
> A statement that the
goal/expected outcome has been:

Met
Partially met
Not met

SUPPORTING DATA
> List of client responses that
support the conclusion.

EVALUATION STATEMENT
> Either on the care plan or in the nurse’s
notes.
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LESSON 5: FIELDS OF School Nursing

> Making sure that every student has
NURSING
access to mental & physical health
services throughout the day.
LEVELS OF NURSING:
A. LEVEL 1 > Supporting holistic assessment of
No experience children & your people's mental
Novice health and wellbeing needs and
providing mental health promotion,
B. LEVEL 2 prevention and early intervention
Has acceptable performance and approaches.
has experience enough
situations > Subspecialty of public health
Advance beginner nursing.

C. LEVEL 3 Private Duty Nurse

> One on one care.
Has 2-3 years of experience
Competent
> Total nursing care or case
D. LEVEL 4 management.
Has 3-5 years of experience
Proficience > Home or hospital based.
Military Nurse
E. LEVEL 5
> Trained to provide medical care to
Highly proficient
patients in military clinics/hospitals
Does not require guidance
or in makeshift medical facilities
Capable of managing hospital
near combat zones.
units
Expert
> They may care for soldiers or other
military personnel, veterans or
DIFFERENT FIELDS OF
service members families.
NURSING:
Company/Industrial Nursing
Institutional/Hospital Nursing > Known as occupational heatlh
> Employment in the hospitals & nurse & safety officer
health institutions.
> A qualified nurse who is employed
> Biggest field of nursing practice: by a company.
Staff nurse
Nurse manager > Provide general first aid to
employees when required, assess
Community/Public Health Nursing
employee health risks and promote
> A nurse that ensures the overall employee health.
health and safety of communities
through education, advocacy and
delivery of care. EXPANDED EDUCATIONAL
AND CAREER ROLES
> ROLE: promote public wellness,
prevent disease & reduce health risk.
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Clinical Nurse Speacialist Nurse Administrator

> A nurse with an advanced degree, > A nurse who functions at various
education or experience. levels of management.

> Considered to be an expert in a > Responsible for management &

specialized area of nursing. administration of resources &
personnel involved in giving patient
> EX. geriatric nurse, oncology nurse care.
and maternal & child nurse
Nurse Researcher
Nurse Practitioner
> A nurse with an advanced degree
> A nurse with an advanced degree, who conducts research relevant to the
certified for a special area or age of definition and improvement of nursing
patient care. practice & education.

Nurse Entrepreneur
> Delivers independent practice to
make health assessments & deliver > A nurse usually with an advance
primary care like diagnose & degree who may manage a clinic or
prescribe medications. health related business.

Nurse Anesthetist Forensic Nurse

> A nurse who completes a course of > Provides specialized care for
study in an anesthesia school. individuals who are victims of trauma.

> Carries out preoperative visits and > Has the knowledge of the legal
assessments. system and skills in injury
identification, evaluation and
> Administers and monitors documentation.
anesthesia during surgery.

> Evaluate postoperative status of

patients.

Nurse Midwife
> A nurse who completes a program in
midwifery.

> Provides prenatal & postnatal care.

> Delivers babies for women with

uncomplicated pregnancies.

Nurse Educator
> A nurse usually with an advanced
degree that teaches in educational or
clinical settings.
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LESSON 6: ASEPSIS Sterile objects can become unsterile by

prolong exposure to airborne
microorganisms.
ASEPSIS Fluids flow in the direction of gravity.
> The freedom from disease-causing Moisture that passes through a sterile
microorganisms. object draws microorganism from
unsterile surfaces above or below to
> To decrease the possibility of the surface by capillary reaction.
transferring microorganisms from one The edges of a sterile field are
place to another considered unsterile.
Skin cannot be sterilized and it is
SEPSIS
unsterile.
> Condition in which acute organ
Conscientiousness, alertness and
dysfunction occurs secondary to
honesty are essential qualities in
infection.
maintaining surgical aspects.
PATHOGENICITY
TYPES OF INFECTION:
> The ability to produce a
1. Local Infection
disease.
> Limited to the specific part of the
BASIC TYPES OF ASEPSIS body where the microorganisms
A. Medical Asepsis remain.
> Includes all practices intended to SYSTEMIC INFECTION
confine a specific microorganism to > Microorganisms spread and damage
a specific area, limiting the number, different parts of the body.
growth, and transmission of
2. Acute Infection
microorganisms.
> Generally appear suddenly or last a
> Objects are referred to as clean short time.
which means the absence of almost 3. Chronic Infection
all microorganisms, or dirty. > Occur slowly, over a very long
B. Surgical Asepsis period, and may last months or years.
> Also called as sterile technique.
SIGNS OF LOCALIZED INFECTIONS
> Refers to those practices that keep Localized swelling
an area or object free of all Localized redness
microorganisms. Pain/tenderness with palpation or
movement
> It includes practices that destroy Palpable hat in the infected area
all microorganisms and spores. Loss of function of the body part
affected depending in the site & extent
> Used for all procedures involving of involvement
the sterile areas of the body.
SIGNS OF SYSTEMIC INFECTIONS
PRINCIPLES OF ASEPTIC Fever
TECHNIQUE: Increased pulse & respiratory rate
Sterile objects become unsterile when Malaise and loss of energy
touched by unsterile objects. Anorexia and in some situation, nausea
Sterile items that are out of vision or & vomiting
below the waist level of the nurse are Enlargement & tenderness of lymph
considered unsterile. nodes that drain the area of infection
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FACTORS INFLUENCING Potential Complication of Infection:

Fever
MICROORGANISM/S CAPABILITY
Imbalanced Nutrition: Less Than Body
TO PRODUCE INFECTION Requirements if the client is too ill to
Number of microorganisms present eat adequately
Virulence and potency of the Acute Pain if the client is experiencing
microorganisms (pathogenicity) tissue damage and discomfort
Ability to enter the body Impaired Social Interaction or Social
Susceptibility of the host Isolation if the client is required to be
Ability to live in the host’s body separated from others during a
contagious episode
ANATOMIC & PHYSIOLOGIC
Anxiety if the client is apprehensive
BARRIERS DEFENCE regarding changes in life activities
AGAINST INFECTION
INTERVENTIONS TO REDUCE
Intact skin & mucous membranes
Moist mucous membranes and cilia of RISK FOR INFECTION
the nasal passages Proper hand hygiene techniques
Alveolar macrophages Environmental controls
Tears Sterile technique when warranted
High acidity of the stomach Identification and management of
Resident flora of the large intestine clients at risk
Peristalsis
Low pH of the vagina
Urine flow through the urethra

RISK FOR INFECTION

> The NANDA nursing diagnostic label for
problems associated with the
transmission of microorganisms.

> An individual is at increased risk for

being invaded by pathogenic
microorganisms.
WHEN USING THIS LABEL,
THE NURSE SHOULD IDENTIFY SIX LINKS MAKE UP THE CHAIN
RISK FACTORS: OF INFECTION
Inadequate Primary Defenses 1. Etiologic Agent
> broken skin, traumatized tissue, > The place where the organism
decreased ciliary action naturally resides.
Inadequate Secondary Defenses NURSING INTERVENTIONS THAT
> leukopenia, decreased hemoglobin, BREAK THE CHAIN OF INFECTION
or suppressed inflammatory response Correctly cleaning and disinfecting or
sterilizing articles before use.
EXAMPLES OF NURSING Educate clients and support people
DIAGNOSES OR COLLABORATIVE about appropriate methods for
cleaning, disinfecting, and sterilizing
PROBLEMS THAT MAY ARISE FROM
articles.
THE ACTUAL PRESENCE OF AN
INFECTION
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2. Reservoir Disposing of urine and feces in

> Sources of microorganisms. appropriate receptacles.
Initiate and implement infection
NURSING INTERVENTIONS THAT
prevention strategies for all clients.
BREAK THE CHAIN OF INFECTION
Wear mask and eye protection when in
Change dressings and bandages when close contact with clients who have
they are soiled or wet. infections transmitted by droplets from
Assist clients to carry out appropriate the respiratory tract.
skin and oral hygiene. Wear mask and eye protection when
Disposing of damp, soiled linens sprays of body fluid are possible.
appropriately.
Dispose of feces and urine in 5. Portal of Entry
appropriate receptacles. > Any break in the skin can readily
Ensuring that all fluid containers are serve as a portal of entry.
covered or capped. NURSING INTERVENTIONS THAT
Empty suction and drainage bottles at BREAK THE CHAIN OF INFECTION
the end of each shift or before they
Use sterile technique when exposing
become full, or according to agency
open wounds or handling dressings.
policy.
Placing used disposable needles and
3. Portal of Exit syringes in puncture resistant
> Before an infection can establish containers for disposal.
itself in a host, the microorganisms Provide all clients with their own
must leave the reservoir. personal care items.

NURSING INTERVENTIONS THAT 6. Susceptible Host

BREAK THE CHAIN OF INFECTION > Any person who is at risk for
Avoid talking, coughing, or sneezing infection.
over open wounds or sterile fields. NURSING INTERVENTIONS THAT
Covering the mouth and nose when BREAK THE CHAIN OF INFECTION
coughing and sneezing.
Maintaining the integrity of the client’s
4. Methods of Transmission skin and mucous membranes.
> After a microorganism leaves its Ensuring that the client receives a
source or reservoir, it requires a balanced diet.
means of transmission to reach Educating the public about the
another person. importance of immunizations.
NURSING INTERVENTIONS THAT MODE OF TRANSMISSION
BREAK THE CHAIN OF INFECTION
A. DIRECT TRANSMISSION
Proper hand hygiene.
> Immediate and direct transfer of
Instructing clients and support people
microorganisms from person to
to cleanse hands before handling food
person.
or eating, after eliminating, and after
touching infectious material.
> (EX.) touching, biting, kissing, or
Wearing gloves when handling
sexual intercourse.
secretions and excretions.
Wearing gowns if there is danger of
> DROPLET SPREAD is also a form of
soiling clothing with body substances.
direct transmission that can occur
Placing discarded soiled materials in
only if the source and the host are
moisture-proof refuse bags.
within 1 m (3 ft) of each other.
Holding used bedpans steadily to
prevent spillage.
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B. INDIRECT TRANSMISSION 2. PASSIVE IMMUNITY

> May be either vehicle borne or > Develops after you receive
vector borne. antibodies from someone or
somewhere else.
> FOMITES ~ inanimate object,
anything that contain microorganism. > Can be natural and artificial.
NATURAL
> VECTOR ~ animals/insect.
> Antibodies received from the
C. AIRBORNE TRANSMISSION mother.
> Involve droplets or dust.
ARTIFICIAL
> Antibodies received from a
VEHICLE-BORNE
medicine.
TRANSMISSION
> Any substance that serves as an
NOSOCOMIAL INFECTIONS
intermediate means to transport and > Classified as infections that originate in
introduce an infectious agent into a the hospital.
susceptible host through a suitable
portal of entry. > Can either develop during a client’s stay
in a facility or manifest after discharge.
VECTOR-BORNE
TRANSMISSION > A subgroup of health care–associated
infections (HAIs) — those that originate in
> An animal or flying or crawling insect
any health care setting.
that serves as an intermediate means of
transporting the infectious agent. IATROGENIC INFECTION
DROPLET NUCLEI > Direct result of diagnostic or
> the residue of evaporated droplets therapeutic procedures.
emitted by an infected host such as EXOGENOUS INFECTION
someone with tuberculosis.
> Result of the healthcare facility
environment or personnel.
> Can remain in the air for long periods.

ACQUIRED IMMUNITY ENDOGENOUS INFECTION

> Occur from clients themselves or as
> Immunity that develops during your
a reactivation of a previous dormant
lifetime.
organism such as tuberculosis.
TYPES OF IMMUNITY
ISOLATION
1. ACTIVE IMMUNITY > Refers to measures designed to prevent
> Immunity that develops during your the spread of infections or potentially
lifetime. infectious microorganisms to health
personnel, clients, and visitors
> Can be natural and artificial.
CATEGORY-SPECIFIC ISOLATION
NATURAL
PRECAUTIONS
> Antibodies developed in
Strict Isolation
response to an infection.
Contact Isolation
ARTIFICIAL Respiratory Isolation
> Antibodies developed in Tuberculosis Isolation
response to a vaccination. Enteric Precautions
Drainage/Secretions Precautions
Blood/Body Fluid Precautions
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DISEASE-SPECIFIC
ISOLATION PRECAUTION
> Provide precautions for
specific diseases

UNIVERSAL/STANDARD
PRECAUTIONS
> Used in the care of all hospitalized
individuals regardless of their diagnosis
or possible infection status.

TRANSMISSION-BASED
PRECAUTIONS
> Used in addition to standard precautions
for clients with known or suspected
infections.
TYPES OF TRANSMISSION-
BASED PRECAUTIONS
AIRBORNE
> Used for clients known to have or
suspected of having serious illnesses
transmitted by airborne droplet nuclei
smaller than 5microns.
DROPLET
> Used for clients known to have or
suspected of having serious illnesses
transmitted by particle droplets
larger than 5 microns.
CONTACT
> Used for clients known to have or
suspected of having serious illnesses
easily transmitted by direct client
contact or by contact with items in
the client’s environment.

DISEASE-SPECIFIC
PRECAUTIONS
Universal precautions
Body-substance precautions
Standard precautions
Transmission-based precaution
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LESSON 7: HEALTH AND G. Occupational

> The ability to achieve a balance
ILLNESS between work and leisure time.

HEALTH WELL-BEING
> Defined in terms of the presence or > A subjective perception of vitality and
absence of disease. feeling well.

> Acc. to Florence Nightingale, she > Can be described objectively,

defined health as a state of being well experienced and measured.
and using every power the individual
possesses to the fullest extent.
MODELS OF HEALTH & WELLNESS
Clinical Model
> According to WHO, health is the > People are viewed as physiological
complete physical, mental, social well- systems with related functions, and
being and not merely the absence of health is identified by the absence of
disease or infirmity. signs and symptoms of disease or
injury.
WELLNESS
Role Performance Model
> State of well-being.
> According to this model, people who
> Basic aspects of wellness include self- can fulfill their roles are healthy even
responsibility. if they have clinical illness.
Adaptive Model
COMPONENTS OF WELLNESS
> According to this model, extreme
A. Environmental good health is flexible adaptation to
> The ability to promote health the environment and interaction with
measures that improve the standard the environment to maximum
of living and quality of life in the advantage.
community.
Eudaimonistic Model
B. Social
> Incorporates a comprehensive view
> The ability to interact successfully of health.
with people and within the
Agent–Host–Environment Model
environment.
> Also called the ecologic mode.
C. Emotional
> The ability to manage stress and to
> Used primarily in predicting illness
express emotions appropriately.
rather than in promoting wellness.
D. Physical
Health–Illness Continua
> The ability to carry out daily tasks,
achieve fitness. > Can be used to measure a person’s
perceived level of wellnesss.
E. Spiritual
> Includes a person’s own morals, DUNN’S HIGH-LEVEL
values, and ethics.
WELLNESS GRID
F. Intellectual
> Described a health grid in which a health
> Involves striving for continued
axis and an environmental axis intersect.
growth and learning to deal with new
challenges effectively.
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ILLNESS–WELLNESS SUCHMAN STAGES OF ILLNESS

CONTINUUM A. STAGE 1: Symptom Experiences
> Developed by Anspaugh, Hamrick, and > It has three aspects:
Rosato (2011). The physical experience of
symptoms
> Ranges from optimal health to premature The cognitive aspect
death. The emotional response
B. STAGE 2: Assumption of the Sick Role
> The model illustrates arrows pointing in > The individual now accepts the sick
opposite directions and joined at a neutral role and seeks confirmation from
point. family and friends.
HEALTH BELIEF MODELS C. STAGE 3: Medical Care Contact
> Can be useful tools in developing > Sick people seek the advice of a
programs for helping people with healthier health professional either on their
lifestyles and more positive attitudes own initiative or at the urging of
toward preventive health measures. significant others.
D. STAGE 4: Dependent Client Role
LOCUS OF CONTROL
> People vary greatly in the degree of
> A concept from social learning theory
ease with which they can give up their
that nurses can use to determine whether
independence.
clients are likely to take action regarding
health. E. STAGE 5: Recovery of Rehabilitation
> The client is expected to relinquish
ILLNESS the dependent role and resume
> Highly personal state in which the former roles and responsibilities.
person’s physical, emotional, intellectual,
social, developmental, or spiritual
functioning is thought to be diminished.

DISEASE
> Can be described as an alteration in
body functions resulting in a reduction of
capacities or a shortening of the normal
life span.

CLASSIFICATION OF ILLNESS
ACUTE ILLNESS
> Typically characterized by
symptoms of relatively short duration.

> EX. headache, stomachache &

diarrhea
CHRONIC ILLNESS
> Lasts for an extended period,
usually 6 months or longer, and often
for the person’s life.

> EX. arthritis, heart and lung

diseases, and diabetes mellitus
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