FOUNDATIONS OF PROFESSIONAL

NURSING (BIO 211/212)

OUTLINE
• Nature of health and illness

• The organization of resources for the practice of

comprehensive health care

• Contribution of individual nurse organized nursing services

and the nursing profession at the local world community

• Introduction to ethical consideration in Nursing

• Consideration of the major concepts, assumption and skills

underlying professional nursing practice

• Function of the professional nurse including the nurse-patient

interaction

• The application of scientific principles and the nursing process

in the practice of nursing

• Selected clinical experiences and services provided in

community by health agencies.
1
 UNIT 1

NATURE OF HEALTH AND ILLNESS

INTRODUCTION

Traditionally, health was defined in terms of the presence or absence of disease.

Florence nightingale (1860/1969) defined health as a state of being well and using
every power the individual possesses to the fullest extent. The world health
organization (WHO) (1948) takes a more holistic view of health. It defines health as
‘a state of complete physical, mental and social well-being, and not merely the
absence of disease or infirmity’. This definition reflects concern for the individual
as a total person functioning physically, psychologically, and socially. Mental
processes determine people’s relationship with their physical and social
surroundings, their attitudes about life and their interaction with others. It also
places health in the context of environment, people’s lives, and therefore their health,
are affected by everything they interact with- not only environmental influences such
as climate and the availability of food, shelter, clean air and water to drink, but also
other people, including family, lovers, employers, coworkers, friends and associate.
Many people define and describe health as;

• Being free from symptoms of disease and pains as

much as possible
• Being able to be active and do what they want or must

• Being in good spirits most of the time

• The opposite of illness.

These characteristics indicates that health is not something that a person achieves
suddenly at a specific time. It’s an ongoing process-a way of life-through which a
person develops and encourages every aspect of the body, mind, and feelings to
interrelate harmoniously as much as possible

2
A person’s definition of health influences behavior related to health and illness. By
understanding client’s perceptions of health and illness, nurses can provide more
meaningful assistance to help them maintain, regain, or attain a state of health.

THE NATURE OF HEALTH

Health is a dynamic state of wellbeing emergent from conducive interactions

between individuals’ potentials, life’s demands, and social and environmental
determinants. The overall concept is that a person’s health and wellbeing result from
complex interplays among biological, lifestyle, socioeconomic, societal and
environmental factors, many of which can be modified to some extent by health care
and other interventions. Many things can affect how healthy we are, ranging from
the macro to the molecular: from society-wide influences to highly individual
factors, such as genetic make-up. And, of course, our health is also affected by the
quality of health care we receive. Some of these effects can be direct (such as being
burnt by the sun), while others are less direct (such as access to shade combined with
knowledge of the health risks associated with exposure to the sun influencing health
through effects on behavior). These influences or factors are known as health
determinants because they help determine how likely we are to stay healthy or
become ill or injured.

DETERMINANTS OF HEALTH

The range of personal, social economic, and environmental factors that influence
health status are known as determinants of health and they include;

i. Social factors; social determinants of health reflect the social factors and physical
conditions of the environment in which people are born, live, learn, age etc. example
of social determinants include

a. Availability of resources to meet daily needs such as educational and job

opportunities, living wages etc

b. Socioeconomic conditions such as poverty

c. Culture

3
d. Exposure to crime, violence and social disorder

ii. Environmental factors; examples include;

a. Natural environment, such as weather, climate change

b. Exposure to toxic substances

c. Housing, homes and neighborhood

d. Worksites, schools and recreational settings.

iii. Biological and genetic factors; some biological and genetic factors affect
specific populations more than others. For example, older adult are biologically
prone to being in poorer health than adolescents due to the physical and cognitive
effects of aging. Sickle cell disease is a common example of a genetic determinant
of health.

iv. Individual factor; individual behaviour also play a role in health outcomes. For
example if an individual quits smoking, his or her risk of developing heart disease
is greatly reduced. Examples of individual behavior determinants of health include;
a. Diet

b. Physical activities

c. Alcohol, cigarette, and other drug use

d. Handwashing etc

v. Access to health services; both access to health services and the quality of health
services can impact health. Lack of access, or limited access, to health services
greatly impacts an individual’s health status.

ILLNESS

Illness is a state in which a person’s physical, emotional, intellectual, social,

developmental, or spiritual functioning is diminished or impaired. It is not
synonymous with disease and may or may not be relate to disease. Illness is then
defined as a response made by an individual to alteration in the body system in form

4
of diseases. An individual could have a disease and not feel ill. Similarly a person
can feel ill, that is, feel uncomfortable, and yet have no discernible disease. Illness
is highly subjective; only the individual person can say he or she is ill. Disease on
the other hand can be described as an alteration in body functions resulting in a
reduction of capacities or a shortening of the normal life span. It is viewed as the
opposite of health.
THE CLASSIFICATION OF ILLNESS

An illness may be acute or chronic in nature. Both acute and chronic illnesses are
two general classifications of illnesses, have the potential to be life threatening.

• Acute Illness; an acute illness is usually reversible, has a short duration

lasting less than 3 months, and is often severe. The symptoms appear abruptly,
are intense, and often subside after a relatively short period. Severe symptoms
which appear suddenly may result to complete recovery, death or develop into
a chronic disease.
• Chronic Illness; a chronic illness persists, usually longer than 6 months, is
irreversible, and affects functioning in one or more systems. Patients often
fluctuate between maximal functioning and serious health relapse that may be
life threatening.

MODELS OF HEALTH AND ILLNESS

i. Clinical model; the narrowest interpretation of health occurs in the clinical model.
People are viewed as physiological systems with related functions, and health is
identified by the absence of signs and symptoms of disease or injury. It is considered
the state of not being ‘sick’. In this model, the opposite of health is disease or injury
or illness.

ii. Host-agent-environment Model; the agent-host-environment model of health

and illness, also called the ecologic model, originated in the community health work
of Leavell and Clark (1965) and has been expanded into a general theory of the
multiple causes of disease. The model is used primarily in predicting illness rather
than in promoting wellness, although identification of risk factors that result from
the intersections of agents, host, and environment are helpful in promoting and
maintaining health. The model has three dynamic interactive elements.

5
a. Agent; any environmental factor or stressor (biologic, chemical, mechanical,
physical, or psychosocial) that by its presence or absence (e.g, lack of essential
nutrients) can lead to health, illness or disease.

b. Host; person(s) who may or may not be at risk of acquiring a disease. Family
history, age, and lifestyle habits influences the host’s reaction.
c. Environment; all factors external to the host that may or may not predispose the
person to the development of disease physical environment includes climate, living
conditions, sound (noise) levels, and economic level. Social environment includes
interactions with others and life events, such as the death of a spouse. Because each
of the agent-host-environment factors constantly interacts with the others, health is
an ever-changing state. When the variables are in balance, health is maintained;
when the variables are not in balance, disease occurs.

iii. Holistic health Model; health care has begun to take a more holistic view of
health by considering emotional and spiritual well-being and other dimensions of an
individual to be important aspect of physical wellness. This model attempts to create
conditions that promote a patient’s optimal level of health. Holism acknowledge and
respects one’s interaction between spirit, body and mind.

iv. Health-illness continuum; According to this model, health is a dynamic state

that fluctuate as a person adapts to changes in the internal and external environments
to maintain a state of wellbeing. Health and illness or disease can be viewed as the
opposite ends of a health continuum. From a high level of health a person’s condition
can move through good health, normal health, poor health and extremely poor
health, eventually to death. People move back and forth within this continuum day
by day. How people perceive themselves and how others see them in terms of health
and illness will also affect their placement on the continuum.

6
 UNIT 2

THE ORGANIZATION OF RESOURCES FOR THE PRACTICE OF

COMPREHENSIVE HEALTH CARE

Comprehensive health care is health care which provides for all patient needs at all
stages of life. The goal of this type of health care is usually to keep patients fit and
healthy, and to encourage people to address medical needs as soon as they arise,
rather than waiting for them to become serious. It provides for the full range of
personal health services for diagnosis, treatment, follow-up and rehabilitation. This
type of healthcare is sometimes referred to as ‘cradle to grave healthcare,’
referencing the fact that someone covered under a comprehensive coverage, there
are no exclusions or exceptions, and patients are encouraged to seek medical
treatment promptly, rather than waiting out of fear about expenses, thereby making
their condition worse.

Routine diagnosis, treatment, follow-up and rehabilitation are all covered by

comprehensive healthcare. Many such plan also provide preventive medicine, such
as nutrition classes, psychological therapy, routine physicals, and other interventions
which are designed to prevent the emergence of medical problems.

By providing care at all stages of life and in all situations, comprehensive healthcare
can save money in the long term, especially in situations where everyone in a nation
is covered under a healthcare plan. These plans promote the use of preventive
education, reducing long-term healthcare cost by lowering the incidence of
avoidable healthcare problems, and also reduce employee sick days and other
problems associated with healthcare systems which are not comprehensive.

HEALTHCARE RESOURCES

Health care resources are defined as all materials, personnel, facilities, funds, and
anything else that can be used for providing health care services. Health resources
includes financial resources (health spending), human resources, physical resources
etc.

7
 HUMAN RESOURCES IN HEALTHCARE
Human resource is defined as all people engaged in actions whose primary intent is
to enhance health. This is an important block of any functioning health system in
any country, in the absence of which clinical and public health services cannot be
delivered to the population. They include;

i. Nurses; the role of the nurse varies with the needs of the client, the nurse’s
credentials and the type of employment setting. A nurse assess a client’s health
status, identifies health problems, and develops and co-ordinates care.

ii. Midwives; are health professionals trained to support and care for women during
pregnancy, labor and birth. A midwives help women to stay healthy during
pregnancy and if no complications arise, to give birth with little intervention.

iii. Physicians/doctors; the physician is responsible or medical diagnosis and for

determining the therapy required by a person who has a disease or injury. The
physician’s role has traditionally been the treatment of diseases and trauma (injury);
however, many physicians include health promotion and disease prevention in their
practice. Some physicians are primary care practitioners (also known as general or
family practitioners); others are specialists such as dermatologists, neurologists,
oncologists, pediatricians’ etc.

iv. Pharmacists; a pharmacist prepare and dispenses pharmaceuticals in hospital

and community settings. The role of the pharmacist in monitoring and evaluating the
actions and effects of medications on client is becoming increasingly prominent. A
clinical pharmacist is a specialist who guides primary care providers in prescribing
medications. Pharmacists also work directly with clients and other health care team
members to ensure safe integration of medications into client’s comprehensive
health plan.

v. Dentists; dentists diagnose and treat mouth, jaw and dental problems. Dentists
(and their dental hygienists) are also actively involved in preventive measures to
maintain healthy oral structures (e.g teeth and gums)
vi. Allied health professional e.g anesthesia technician, dental assistant,
occupational therapist etc
vii. Dietitian or nutritionist; a dietitian has special knowledge about the diets are
concerned with therapeutic diets, supervise the preparation of meals to ensure that
8
clients receive the proper diet, and may design special diets to meet the nutritional
needs of individual clients. A nutritionist on the other hand is a person who has
special knowledge about nutrition and food. The nutritionist in a community setting
recommends healthy diets and provides broad advisory services about the purchase
and preparation of foods.

vii. Social health worker and other healthcare providers as well as health
management and support personnel those who may not deliver services directly but
are essential to effective health system functioning including health service
managers, medical records and health information technicians, etc

PHYSICAL RESOURCES IN HEALTHCARE

These are the materials and equipment that aid in the provision of comprehensive
health care which include;

i. Infrastructures e.g clinical support unit( e.g hospitalization wards, outpatient

care, emergency care, diagnostic support unit, pharmacy, special units, operating
rooms etc), administrative services (e.g offices, administration, supplies),
availability of sources of power, internet services, water, solar panels, fuel etc

ii. Medical equipment /devices (e.g ventilators, medicinal gases, hospital beds etc
iii. Medical supplies (e.g. facemask, plastic gloves, medications, diagnostic test kit
etc)

FINANCIAL RESOURCES IN HEALTHCARE

The sources of financial resources in comprehensive health care system include;

i. General taxation to the government; taxation is a term used to describe

imposition of compulsory levies on individuals or entities by the governments.
Taxes are levied in almost every country of the world, primarily to raise revenue for
government expenditures, although they serve other purposes as well.

ii. National health insurance ; national health insurance otherwise known as

statutory health insurance is a system of health that insures a national population
against the costs of health care. It may be administered by the public sector, the
9
private sector, or both. It is a social system that guarantees the provision of needed
health services to persons on the payment of token contribution at regular intervals.
They are pre-payment where participants pay a fixed regular amount which are used
to pay for the medical services of such individuals when the need arises. Example of
public health insurance include NHIS (national health insurance scheme.

The private health insurance are regulated by the NHIS and operated by HMOs
(health maintenance organization). E.g include hygeia HMO, Avon HMO, Princeton
HMO, Clearline international limited HMO etc national health insurance is indeed
regarded as the most widely used form of health care financing worldwide.

iii. Out-of-pocket payments; these refers to costs that individuals pay out of their
own cash reserves. The term can also be used in health insurance where it refers to
the portion of the bill that the insurance company doesn’t and that the individual
must pay on their own.

iv. Non-governmental organizations (NGOs) interventions; these are gifts of cash

or properties made to a non-profit organization or the government to help accomplish
its goal for which the donor receives nothing of value in return.

IMPORTANCE OF RESOURCES IN COMPREHENSIVE HEALTHCARE

• Resources in client’s care is effective and makes work easier

• For smooth running of the healthcare system
• To improve the health status of the general populace
• For provision of high quality care to the public

10
 UNIT 3
CONTRIBUTION OF INDIVIDUAL NURSE ORGANIZED NURSING
SERVICES AND THE NURSING PROFESSION AT THE LOCAL WORLD
COMMUNITY

CONTRIBUTION OF THE INDIVIDUAL NURSE

According to Virginia Henderson, 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, and to do this in such a way as to help him
gain independence as rapidly as possible.

Nurses provide care and comfort for patients in all health care settings. Nurses’
concerns for meeting their patients’ needs remains the same whether care focuses on
health promotion and illness prevention, disease and symptoms management, family
support, or end-of-life care. Some of the contribution of the nurse in healthcare
include;

i. Rendering of health care services; as a caregiver, the nurse helps patients

maintain and regain health, manage diseases and symptoms, and attain a maximal
level of function and independence through the healing process. The nurse needs to
meet all health care needs of a patient by providing measures to restore a patient’s
emotional, spiritual, and social well-being.

ii. Counselling; counselling is the process of helping a client to recognize and cope
with stressful psychological or social problems, to develop improved interpersonal
relationship, and to promote personal growth. It involves providing emotional,
intellectual, and psychological support by the nurse.

iii. Education; as an educator the nurse explains concept and facts about health,
describe the reason for routine care activities, demonstrate procedures such as self-
care activities, reinforce learning or patient behavior, and evaluate the patient’s
progress in learning. For example, teaching patient how to self-administer insulin
injection.

11
iv. Advocacy; as a patient advocate, the nurse protects the patient’s human and legal
rights and provide assistance in asserting these rights if the need arises. As an
advocate, the nurse act on behalf of the patient and secure the patient’s care rights.

v. In Research studies; as a nurse, regardless of your educational preparation, you

need to be able to assume two research-related roles; that of research consumer and
research team. Being a research consumer means routinely searching and reading
the current research literature in order to stay current with new insights in client
experiences and nursing and medical interventions. In addition to being
wellinformed research consumers, in today’s evidence-based practice environment,
nurses need to be able to function as a member of research team. Nurses often use
research to improve client’s care.

vi. Change agent; the nurse acts as a change agent when assisting clients to make
modifications in their behaviors. Nurses often act to make changes in a system such
as clinical care, if it is not helping a client return to health.

NURSING PROFESSION AT THE LOCAL COMMUNITY

A community is described as the geographic location that consists of people having

a common attributes, rights or interest. It may include people living in a common
house, neighborhood those with common occupation, religion or ethnic group.

Nursing is identified as a profession based on the criteria that a profession must have;
i. A systematic body of knowledge that provides the framework for the profession’s
practice

ii. Standardized formal higher education

iii. Commitment to providing a service that benefits individuals and the community
iv. Control of practice responsibility of the profession through standards and a code
of ethics
v. Maintenance of a unique role that recognizes autonomy, responsibility and
accountability and
vi. Evidenced-based practice and commitment to members of the profession through
professional organizations and activities.

12
The nurse’s primary professional responsibility is providing nursing care for
patients, family and community. Nurses in the community work to improve the
health and well-being of communities they serve by educating them about illness
and disease prevention, safe health practices, nutrition, and wellness. They often
provide treatment for poor, culturally diverse, and uninsured population.

AIMS/OBJECTIVES OF NURSING AT THE COMMUNITY

i. To participate in the development of an overall health plan for the community.

ii. To provide quality nursing services to individuals, families & communities.

iii. To coordinate nursing services with various members of health team.

iv. To ascertain the nature & extent of disease & disability in the community.

ROLES/RESPONSIBILITIES OF THE NURSE AT THE COMMUNITY

i. As a clinician, the nurse ensures that health care services are provided to everyone
in the community.
ii. Community advocacy and organizer
iii. The nurse as a leader directs, influences, or persuades others to make change to
positively influence people’s health.
iv. Assessments, interventions, and evaluations of nursing services
v. Agency referrals
vi. Health promotion: nutrition, wellness, and disease prevention.
vii. Collaborate with other members of the health team in provision of health care
services etc.
IMPORTANCE OF NURSING AT THE COMMUNITY
i. Community health nursing is concerned with the people who are sick as well as
the healthy, young and old, male and female.
ii. At the same time community health nurse is responsible for family centered care
rather than an individual oriented one.
iii. The community health nurse job is not only limited to the sick but has equal
responsibility to prevent the disease and to preserve and promote the health of the
people.

13
 UNIT 4
INTRODUCTION TO ETHICAL CONSIDERATIONS IN NURSING

Ethics is the study of conduct and character. They are set of principles governing an
individual or a group of people or an organization. It is concerned with determining
what is good or valuable for individuals, groups, and society at large. Ethics are also
the moral code of conduct, principles and values that govern the conduct individuals
in a given society or profession.

ETHICAL PRINCIPLES

i. Autonomy; this refers to freedom from external control. In health care the concept
applies to provider respect for the autonomy of patients. It can also apply to
institutional respect for the autonomy of providers. A commitment to respect the
autonomy of others is a fundamental principle of ethical practice. Respect for patient
autonomy refers to the commitment to include patients in decisions about all aspects
of care. In respecting patient autonomy, the nurse acknowledges and protects a
patient’s independence. As a nurse you will respect patient autonomy in all of your
patient’s care by taking time to explain nursing procedures such as obtaining a blood
pressure or administering medications.

ii. Beneficence; means doing good’. This refers to taking positive actions to help
others. The principle of beneficence is fundamental to the practice of nursing and
medicine. The agreement to act with beneficence implies that the best interests of
the patient remain the best more important than self-interest.

iii. Nonmaleficence; is the duty to ‘do no harm’. This refers to the avoidance of
harm or hurt. In health care ethical practice not only the will to do good but the equal
commitment to do no harm. A health care professional tries to balance the risks and
benefits of care while striving at the same time to do the least harm possible.

iv. Justice; this refers to fairness. The term is most often used in discussions about
access to health care resources, including the just distribution of scarce resources.

v. Fidelity; refers to the agreement to keep promises by following through on your

actions and interventions. If you assess a patient for pain and offer a plan to manage
the pain, the standard of fidelity encourages you to monitor the patient’s response to
the plan.
14
vi. Veracity; refers to telling the truth. Although this seems straight forward in
practice, the choices are not always clear. Should a nurse tell the truth when it is
known that it will cause harm? Does a nurse tell a lie when it is known that the lie
will relieve anxiety and fear? Lying to sick or dying people is rarely justified, the
loss or trust in the nurse and the anxiety caused by not knowing the truth, for
example, usually outweigh any benefits derived from lying.

vii. Accountability; means ‘answerable to one’s own action’. Whereas

responsibility refers to ‘the specific accountability or liability associated with the
performance of duties of a particular role. Thus, the ethical nurse is able to explain
the rationale behind every action and recognize the standards to which he or she will
be held.

NURSING CODE OF ETHICS

A code of ethics is a formal statement of a group’s ideals and values. It is a set of

ethical principles that; (a) is shared by members of the group, (b) reflects their moral
judgments over time, and (c) serves as a standard for their professional actions.

Nurses have four fundamental responsibilities: to promote health, to prevent illness,

to restore health and to alleviate suffering. The need for nursing is universal. Inherent
in nursing is respect for human rights, including cultural rights, the right to life and
choice, to dignity and to be treated with respect. Hence the reason for the code of
ethics which guides the professional practice of the nurse.

ELEMENTS OF THE CODE

The Code of Ethics for Nurses has four principal elements that outline the
standards of ethical conduct and they include;
i. Nurses and people
ii. Nurses and practice
iii. Nurses and profession
iv. Nurses and co-workers
1. Nurses and People
The nurse’s primary professional responsibility is to people requiring nursing care.
In providing care,

15
 • The nurse promotes an environment in which the human rights, values,
customs and spiritual beliefs of the individual, family and community are
respected.
• The nurse ensures that the individual receives accurate, sufficient and timely
information in a culturally appropriate manner on which to base consent for
care and related treatment
• The nurse holds in confidence personal information and uses judgments in
sharing this information.
• The nurse advocates for equity and social justice in resource allocation, access
to health care, and other social and economic services.
• The nurse demonstrates professional values such as respectfulness,
responsiveness, compassion, trustworthiness, and integrity.

2. Nurses and Practice

• The nurse carries personal responsibility and accountability for nursing

practice, and for maintaining competence by continual learning.
• The nurse maintains a standard of personal health such that the ability to
provide care is not compromised.
• The nurse uses judgment regarding individual competence when accepting
and delegating responsibility.
• The nurse at all times maintains standards of personal conduct which reflect
well on the profession and enhance public confidence.
• The nurse, in providing care, ensures that use of technology and scientific
advances are compatible with the safety, dignity and rights of people

3. Nurses and the Profession

• The nurse assumes the major role in determining and implementing acceptable
standards of clinical nursing practice, management, research and education.
• The nurse is active in developing a core of research-based professional
knowledge. The nurse is active in developing and sustaining a core of
professional values.

16
 • The nurse, acting through the professional organization, participates in
creating and maintaining safe, equitable social and economic working
conditions in nursing.
• The nurse practices to sustain and protect the natural environment and is aware
of its consequences on health.
• The nurse contributes to an ethical organizational environment and challenges
unethical practices and settings.

4. Nurses and Co-workers

• The nurse sustains a co-operative relationship with coworkers in nursing and

other fields.
• The nurse takes appropriate action to safeguard individuals, families and
communities when their health is endangered by a coworker or any other
person.
• The nurse takes appropriate action to support and guide coworkers to advance
ethical conduct

SPECIFIC ETHICAL ISSUES

Some of the ethical problems nurses encounter most frequently are issues in the care
of clients with HIV/AIDS, abortion, organ or tissue transplantation, end-of-life
decisions, breaches of client confidentiality (e.g., computerized information
management) etc.

i. Acquired Immunodeficiency Syndrome (AIDS); Because of its association with

sexual behavior, illicit drug use, and physical decline and death, AIDS bears a social
stigma. According to an ANA position statement, the moral obligation to care for a
client with HIV infection cannot be set aside unless the risk exceeds the
responsibility (ANA, 2006). Other ethical issues center on testing for HIV status and
for the presence of AIDS in health professionals and clients. Questions arise as to
whether testing of all providers and clients should be mandatory or voluntary and
whether test results should be released to insurance companies, sexual partners, or
caregivers. As with all ethical dilemmas, each possibility has both positive and
negative implications for specific individuals.

17
ii. Abortion; Abortion is a highly publicized issue about which many people feel
very strongly. Debate continues, pitting the principle of sanctity of life against the
principle of autonomy and a woman’s right to control her own body. This is an
especially volatile issue because no public consensus has yet been reached. Most
state laws have provisions known as conscience clauses that permit individual
primary care providers and nurses, as well as institutions, to refuse to assist with an
abortion if doing so violates their religious or moral principles.

iii. Organ and Tissue Transplantation; Organs or tissue for transplantation may
come from living donors or from donors who have just died. Many living people
choose to become donors by giving consent under the Uniform Anatomical Gift Act.
Ethical issues related to organ transplantation include allocation of organs, selling of
body parts, involvement of children as potential donors, consent, clear definition of
death, and conflicts of interest between potential donors and recipients. In some
situations, a person’s religious belief may also present conflict. For example, certain
religions forbid the mutilation of the body, even for the benefit of another person.

iv. End-of-Life Issues; The increase in technologic advances and the growing
number of older adults have expanded ethical dilemmas. Providing information and
professional assistance, as well as the highest quality of care and caring, is of the
utmost importance during the end-of-life period. Some of the most frequent
disturbing ethical problems for nurses involve issues that arise around death and
dying. These include euthanasia, assisted suicide, termination of life-sustaining
treatment, and withdrawing or withholding of food and fluids.

a. Euthanasia and assisted suicide; Euthanasia, a Greek word meaning “good

death,” is popularly known as “mercy killing.” Active euthanasia involves actions to
bring about the client’s death directly, with or without client consent. An example
of this would be the administration of a lethal medication to end the client’s
suffering. Regardless of the caregiver’s intent, active euthanasia is forbidden by law
and can result in criminal charges of murder. A variation of active euthanasia is
assisted suicide, or giving clients the means to kill themselves if they request it (e.g.,
providing lethal doses of pills). Some countries or states have laws permitting
assisted suicide for clients who are severely ill, who are near death, and who wish to
commit suicide. Although some people may disagree with the concept, assisted
suicide is currently legal in the states of Montana, Oregon, Vermont, and
18
Washington and several countries. The ANA (American nurses association)’s
position statement on assisted suicide and active euthanasia (2013) states that both
active euthanasia and assisted suicide are in violation of the Code of Ethics for
Nurses.

b. Passive euthanasia, more commonly referred to now as withdrawing or

withholding life-sustaining therapy (WWLST), involves the withdrawal of
extraordinary means of life support, such as removing a ventilator or withholding
special attempts to revive a client (e.g., giving the client “no code” status) and
allowing the client to die of the underlying medical condition. WWLST may be both
legally and ethically more acceptable to most people than assisted suicide.

c. Termination of life-sustaining treatment; Antibiotics, organ transplants, and

technologic advances (e.g., ventilators) help to prolong life, but not necessarily to
restore health. Clients may specify that they wish to have life-sustaining measures
withdrawn, they may have advance directives on this matter, or they may appoint a
surrogate decision maker. However, it is usually more troubling for health care
professionals to withdraw a treatment than to decide initially not to begin it. Nurses
must understand that a decision to withdraw treatment is not a decision to withdraw
care. Nurses must ensure that sensitive care and comfort measures are given as the
client’s illness progresses.

d. Withdrawing or withholding food and fluids; It is generally accepted that

providing food and fluids is part of ordinary nursing practice and, therefore, a moral
duty. However, when food and fluids are administered by tube to a dying client, or
are given over a long period to an unconscious client who is not expected to improve,
then some consider it to be an extraordinary, or heroic, measure. A nurse is morally
obligated to withhold food and fluids (or any treatment) if it is determined to be more
harmful to administer them than to withhold them. The nurse must also honor
competent and informed clients’ refusal of food and fluids. The ANA Code of Ethics
for Nurses (2010) supports this position through the nurse’s role as a client advocate
and through the moral principle of autonomy.
v. Management of Personal Health Information; In keeping with the principle of
autonomy, nurses are obligated to respect clients’ privacy and confidentiality.
Privacy is both a legal and ethical mandate. Clients must be able to trust that nurses
will reveal details of their situations only as appropriate and will communicate only
the information necessary to provide for their health care.

19
 UNIT 5
THE MAJOR CONCEPTS, ASSUMPTION AND SKILLS UNDERLYING
PROFESSIONAL PRACTICE

MAJOR CONCEPTS UNDERLYING NURSING PRACTICE

The main concepts of nursing are persons (patients/clients), environment, health and
nursing. The individuals or clients or persons are the recipients of nursing care, the
environment is the internal and external surroundings that affect the client which
includes people in the physical environment, such as families, friends, and
significant others. While health is the degree of wellness or well-being that the client
experiences and finally nursing which involves the attributes, characteristics, and
actions of the nurse providing care on behalf of, or in conjunction with, the client.

i. Persons; the first basic concept is that of the human being, or that each person
comprises several different aspects to create a whole. This includes psychological,
social, physical and spiritual areas of a person's life. It also includes cultural aspects
that might be important to the patient. Understanding how a patient is more than just
the medical condition that brought him into the hospital is essential to his care.

ii. Environment; A patient's environment, which includes where they spend their
time and their socio-economic status, as well as the people within their environment,
is another concept of nursing. One of the most influential aspects of environment is
the health care a person has access to. For example, the health of someone who has
had regular access to quality health care has a better chance of catching serious
conditions, such as cancer, in the very early stages, giving them a better chance of
recovery. Environment also includes the social support a patient receives and the
environment of the hospital, which is partially controlled by nurses. A comfortable
environment and proper care can influence the speed of a patient's recovery.

iii. Health; the fourth concept health, is the degree of wellness or well-being that the
client experiences. The whole essence of the nursing practice is maintenance of
optimal health which could be achieved by promotion of health, prevention of illness
and restoring health. When health is defined broadly as actualization of human
potential, it has been called wellness.

20
iv. Nursing; the fourth concept is the actual process of nursing. As a concept, nursing
is considered not only a science, but also an art. It includes learning leadership,
decision making, and approaches for meeting all of a patient's needs, not just their
immediate health concerns. The four main duties of a nurse as part of the nursing
concept are to promote well-being, prevent disease and injury, assist in healing and
do whatever is possible to ease suffering, as long as it is both ethical and legal.

SKILLS UNDERLYING PROFESSIONAL PRACTICE

i. Compassion & Empathy; As a nurse, compassion and empathy are at the core of
your role; having compassion allows you to provide support for patient families
while also having concern for patient suffering so that you can provide accurate care.
By understanding the patients suffering, it allows you to place yourself in their shoes,
taking into consideration how scared they may feel and how worried their families
must be.

ii. Communication Skills; the nurse’s effectiveness as a communicator is central to

the nurse-patient relationship. It allows the nurse know his/her patient’s strength,
weakness, and needs. Without clear communication it is impossible to advocate for
patients or to give comfort and emotional support, give care effectively, make
decisions with patients and families, protect patients from threat to well-being,
coordinate and manage patient care, assist patients in rehabilitation, or provide
patient education.

iii. Clinical skills; The term 'clinical skills' involves history-taking, physical
examination, clinical investigations, using diagnostic reasoning, procedural
perfection, effective communication, team work and professionalism. Clinical Skills
for Nurses covers the skills and procedures used most frequently in clinical practice.

iv. Case management skills; Case management is related to patient care, but serves
on its own as a vital nursing skill. The fact is, nurses’ work with a lot of patients on
a day-to-day basis. They are constantly creating treatment plans, monitoring patient
conditions, and taking action to keep patients healthy and safe. In addition, they must
serve as advocates for their patients and ensure all their needs are met, which requires
a constant monitoring of cases.

21
v. Teamwork skills; Nurses often work as part of a team of medical professionals
caring for a patient or group of patients. For example, a nurse may work with doctors,
other nurses, anesthesiologists, social workers and others to provide comprehensive
care to patients. Because of this, nurses must have excellent teamwork and
collaboration skills.

vi. Critical thinking; Nurses have to make several decisions every day. It is
important to have the critical thinking skills necessary for quick decision making.
Being able to critically think about a situation is vital to good patient care. Nurses
have to be able to assess a situation and act quickly in life or death moments.

vii. Adaptability; Every day on the ward is unique, from the patients you care for
to the sudden and unexpected situations you must deal with. This means that, as a
nurse, you must be able to adapt to various environments and unique under pressure
situations. The healthcare industry is constantly evolving, which means that you
must be able to adapt to new treatments and care.

viii. Patience; Dealing with all sorts of patients requires patience. People are never
thrilled to be in the hospital. Excessive pain, grim diagnoses, and terrible illness
make people behave badly. It takes patience to deal with such unpredictable
behavior.

ASSUMPTIONS UNDERLYING PROFESSIONAL NURSING PRACTICE

Assumption is a statement that is taken for granted or considered true, even though
it may not have been scientifically tested. There are several assumptions underlying
the nursing profession which tends to portray the profession on a bad limelight. Some
of the assumptions include;

1. “Nursing is a woman’s job”

While it’s true the profession has historically been dominated by women, the
historical view just doesn’t hold up today. This assumption continues to persist,
despite reports that there have been increase in the number of male nurses. In some
specialties, like nurse anesthetists, the ratio of male nurses to female nurses is
nearing an even split.

2. “Nurses are just doctors’ personal assistants”

22
Nurses are much more than just assistants to the “real” medical professionals. Nurses
undergo in-depth medical training and are knowledgeable in their areas of expertise.
They don’t just follow doctors’ orders; they work on a team alongside doctors and
other medical specialists to provide patient care.
3. A Nurse Is ‘Just a Nurse’

Hearing someone say you’re ‘just a nurse’ is devaluing, healthcare as an industry is

evolving incredibly fast and nurses are becoming more and more specialized within
our roles. Nurses obtain qualifications in either undergraduate or post graduate
education to become health professionals, they are taught to deliver health care that
integrates evidence based practice from research which guides them on the job
clinical expertise. Generalizing that ‘nurses are just nurses’ forgets how many roles
are present within the profession, no two roles in nursing are the same. Each role
may require different knowledge, specific skills, different technologies and care
interventions, for example – an Oncology nurse & Intensive care nurse have very
specific but different roles.

4. “Nurses are too busy to get to know their patients”

Many people think nurses are perpetually busy due to the nursing shortage, with
nurses rushing through one patient interaction so they can get to the next. While there
are certainly nurses with a lot of patients to care for, this assumption doesn’t take
into account that many nurses still do whatever they can to slow down and spend as
much time with their patients as possible.

5. “Nurses don’t need breaks”

Nurses may be known for their strong work ethic, but that doesn’t mean they don’t
need breaks. Regular breaks throughout the day give nurses a chance to eat, rest and
recharge so they can bring their best efforts to caring for patients.

6. “Nurses have to do whatever their patients ask”

It’s part of a nurse’s job to be compassionate and empathetic toward their patients.
That means actively listening to patients’ concerns—but it doesn’t mean acting as a
servant who caters to their every whim. Nurses are professionals with a duty to act
in the best interest of their patients.

23
7. ‘Nurses Just Sit At The Nurses Station Talking On The Phone’ or ‘Gossip’
or ‘All They Do Is Look At The Computer Screens’
There are several activities nurses may be doing behind the nurses’ station which
may include;

i. A doctor may prescribe a medication but nurses have to determine whether it is

safe to administer a medication, for example- a patient may have a low blood
pressure, yet a nurse has to judge whether the medication for hypertension (high
blood pressure) can be given safely. Giving that medication without checking may
drop the person’s blood pressure further and in turn a medical emergency may occur.

ii. A nurse at the nurses station may be looking at a computer screen or reading
paperwork- they may be checking previous orders, checking for blood results or
other test results, making sure referrals to health professionals/services have been
made etc. A lot of information is exchanged via computers and telephones, they are
essential communication tools.

iii. Communication is important in the care of patient. A nurse talking to a doctor or

another health professional may be receiving verbal instruction on how to manage a
patient or nurses may be having a verbal handover at change of shift

8. ‘Night Nurses Do Nothing Because Patients Sleep All Night’

Many hospitals with an Emergency department attached are open 24/7. People are
admitted into hospital at any time therefore patient flow needs to run smoothly as
well. Here are examples of the work that happens during the night in hospitals;

i. Emergency departments are open and run around the clock, where anyone can seek
urgent medical care and treatment.

ii. Operating theatres are available and continue running till late therefore surgical
schedules need to be maintained. iii. Midwives are delivering babies and caring for
mothers.

iii. Ward nurses are ever present to meet healthcare needs of patients in acute,
subacute or palliative care setting etc.

9. “It is a Nurses responsibility to deal with problems that are created by others

24
 UNIT 6

FUNCTION OF THE PROFESSIONAL NURSE INCLUDING THE

NURSE-PATIENT INTERACTION

The functions of the professional nurse include;

• Nurse as a care giver

• Nurse as a counsellor(psychological support)
• Nurse as a communicator(communicates with clients, families and
health professionals)
• Nurse as a client advocate(protect the client)
• Nurse as a change agent(help client to make modification in their own
behavior about health)
• Nurse as a researcher
• Nurse as a teacher
• Nurse as a rehabilitator(help patient return to maximal level of
functioning after illness)

Other functions include;

• Conduct physical exams

• Listen to patients and analyze their physical and emotional needs
• Coordinate care with other health care providers and specialists
• Check patients’ vital signs
• Monitor patient health and record signs.
• Administer medications and treatments etc

NURSE-PATIENT INTERACTION/RELATIONSHIP

The nurse–client relationship otherwise known as therapeutic nurse-patient

relationship is an interaction between a nurse and "client" (patient) aimed at
enhancing the well-being of the client, who may be an individual, a family, a group,
or a community. It is also a helping relationship that's based on mutual trust and
25
respect, the nurturing of faith and hope, being sensitive to self and others, and
assisting with the gratification of your patient's physical, emotional, and spiritual
needs through your knowledge and skill. This caring relationship develops when the
nurse and the patient come together in the moment, which results in harmony and
healing. Effective verbal and nonverbal communication is an important part of the
nurse-patient interaction, as well as providing care in a manner that enables your
patient to be an equal partner in achieving wellness.

COMPONENTS OF NURSE-PATIENT RELATIONSHIP

i. Professional intimacy; Professional intimacy is inherent in the type of care and

services that nurses provide. It may be the physical activities, such as bathing, that
nurses perform for and with clients that create this closeness. Professional intimacy
may involve psychological, spiritual and social elements that are identified in the
plan of care. Access to the client’s personal information also contributes to
professional intimacy

ii. Power; the nurse-client relationship is one of unequal power. Although a nurse
may not immediately perceive it, the nurse has more power than the client does. This
power imbalance arises from the nurse having more authority and influence in the
health care system, specialized knowledge, access to privileged information, and the
ability to advocate for the client and the client’s significant other. If a nurse misuses
the power in the relationship, it’s considered abuse.

iii. Empathy; Empathy refers to expressing an understanding of what the health care
experience means from the client’s perspective. It includes validating and resonating
with the meaning of that experience. In nursing, empathy includes maintaining an
appropriate emotional distance from the client to ensure objectivity

iv. Respect; Respect is the recognition of the inherent dignity, worth and uniqueness
of every individual, regardless of the client’s socio-economic status and personal
attributes, and the nature of the client’s health problem.

v. Trust; Trust is critical in the nurse-client relationship because the client is in a

vulnerable position. At the beginning of a relationship, trust is fragile so it’s
especially important to keep promises to a client. It’s difficult to re-establish trust
once it has been breached.

26
HILDERGARD PEPLAU’S THEORY OF INTERPERSONAL
RELATIONSHIP

Hildegard Peplau, a psychiatric nurse, introduced her interpersonal concepts in 1952.

Central to Peplau’s theory is the existence of a therapeutic relationship between the
nurse and the client. Nurses enter into a personal relationship with an individual
when a need is present. According to her theory, the nurse–client relationship
evolves in four phases: the first which is Orientation where the client seeks help and
the nurse assists the client to understand the problem and the extent of the need for
help. The next is identification where the client assumes a posture of dependence,
interdependence, or independence in relation to the nurse (relatedness). The nurse’s
focus is on ensuring the individual that the nurse understands the interpersonal
meaning of the client’s situation. The third is the Exploitation where the client
derives full value from what the nurse offers through the relationship. The client uses
available services based on self-interest and needs. Power shifts from the nurse to
the client. Finally, Resolution or the termination phase.

PHASES OF INTERPERSONAL RELATIONSHIP

The four sequential phases identified by the theory in the interpersonal relationship
include;

i. Orientation phase; this is also known as problem defining phase. Orientation. At

this phase;

a. The client seeks help and the nurse assists the client to understand the problem
and the extent of the need for help.

b. Client seeks assistance, conveys needs, asks questions, shares preconceptions and
expectations of past experiences

c. Nurse responds, explains roles to client, helps to identify problems and to use
available resources and services

27
ii. Identification phase; At this phase,

a. There is selection of appropriate professional assistance

b. Patient begins to have a feeling of belonging and a capability of dealing with the
problem which decreases the feeling of helplessness and hopelessness

iii. Exploitation phase; At this phase,

a. The use of professional assistance for problem solving is employed.

b. Services used are based on the needs and interests of the patients

c. Individual feels as an integral part of the helping environment

d. The principles of interview techniques must be used in order to explore,

understand and adequately deal with the underlying problem

e. Nurse aids the patient in exploiting all avenues of help and progress is made
towards the final step

iv. Resolution/ termination phase; At this phase,

a. There is termination of professional relationship

b. The patient’s needs have already been met by the collaborative effect of patient
and nurse

c. Now the nurse and patient need to terminate their therapeutic relationship and
dissolve the links between them.

d. Sometimes may be difficult for both as psychological dependence persists

e. Patient drifts away and breaks bond with nurse and healthier emotional balance is
demonstrated and both becomes mature individuals

28
 STEPS IN CARRYING OUT NURSE-PATIENT INTERACTION

i. Introduction; Introduce self to your patient and use his/her name while talking
with him/her. A handshake at your initial meeting is often a good way to quickly
establish trust and respect.

ii. Provide privacy; make sure your client/patient has privacy when you provide
care.

iii. Actively listen to your patient; make sure you understand his/her concerns by
restating what he/she has verbalized. For example, "Mr. or Mrs. Smith, you
mentioned that you were concerned that your bone pain won't be addressed in a
timely manner?" However, don't use restating too much in a conversation because it
can be perceived by your patient that you aren't really listening to her. Be real,
showing your genuine self when communicating with him/her.

iv. Maintain eye contact; Remember, too much eye contact can be intimidating.
Smile at intervals and nod your head as you and your patient engage in conversation.
Speak calmly and slowly in terms that she can understand. Your voice inflection
should say "I care about you."

v. Maintain professional boundaries; some patients need more therapeutic touch,

such as hand-holding and hugging, than others and some patients prefer no touching.
Always respect differences in cultures.

29
 UNIT 7

THE APPLICATION OF SCIENTIFIC PRINCIPLES AND THE NURSING

PROCESS IN THE PRACTICE OF NURSING

INTRODUCTION

Scientific principles are ideas based on scientific rules and laws that are generally
accepted by scientists. Scientific principles are based on laws. These concepts are
built on rules assumed to be present, true, and valid.

Using scientific principles complements the nursing practice and ensures the
standards of nursing practice. The nursing process involves a change in the character
of the student/nurse that causes him/her to become involved in giving him/herself,
thinking in a scientific manner, and habitually relating general principles to
immediate perception as a basis for rational decision making.

While the scientific method is a process for creating and performing experiments
objectively, the nursing process is a method for creating and implementing patients’
care plans. Perception and intuition are an important part of this process, as opposed
to being strictly scientific and only considering data.

As such the need for the use of scientific methods or principles in nursing which
include;

1. Make an observation/ state the problem

2. Ask a question/ research the problem( collect information)

3. Form a hypothesis (assumptions)

4. Test the hypothesis

5. Observe, record and analyze data

6. State the conclusion

30
 NURSING PROCESS

The nursing process is a scientific method used by nurses to ensure the quality of
patient care. It is defined as a scientific step by step client centered, goal oriented
and problem solving techniques that provide a framework for nursing practice. The
purpose of nursing process is to provide a logical framework for client’s care.

CHARACTERISTICS OF THE NURSING PROCESS

• It is continuous
• It is dynamic
• It is client centered
• It is goal oriented
• It is universally applicable
• It promotes report between nurses and clients

PHASES/COMPONENTS OF THE NURSING PROCESS

There are six phases of the nursing process and they include;

• Assessment
• Diagnosis
• Outcome identification
• Planning
• Implementation
• Evaluation

1. ASSESSMENT PHASE

This is the first in the nursing process and it involves data collection, organization of
data, analysis and validation of data interpretation.

Method of data collection/assessment

i. Interview; An interview is a planned communication or a conversation with a

purpose, for example, to get or give information, identify problems of mutual
concern, evaluate change, teach, provide support, or provide counseling or therapy.
31
This is the commonest method of assessment. There are different types of interview
and they are direct interview and non-direct interview.

In assessment the commonest model used in collecting data during the interview of
the client is Gordon’s typology of the functional health patterns. The health pattern
include;

• Health perception/ health management pattern

• Nutritional/metabolic pattern
• Elimination pattern
• Activity/exercise pattern
• Sleep/rest pattern
• Cognitive/perceptional pattern
• Self-perception/self-concept pattern
• Role-relationship
• Sexuality-reproductive pattern
• Coping/stress tolerance pattern
• Value-belief pattern
ii. Direct/indirect observation; to observe is to gather data by using the senses.
Observing is a conscious, deliberate skill that is developed through effort and with
an organized approach. Although nurses observe mainly through sight, most of the
senses are engaged during careful observations.

iii. Physical examination; the physical examination or physical assessment is a

systematic data collection method that uses observation (i.e., the senses of sight,
hearing, smell, and touch) to detect health problems. To conduct the examination,
the nurse uses techniques of inspection, auscultation, palpation, and percussion. The
physical examination is carried out systematically. It may be organized according to
the examiner’s preference, in a head-to-toe approach or a body systems approach.
Usually, the nurse first records a general impression about the client’s overall
appearance and health status: for example, age, body size, mental and nutritional
status, speech, and behavior. Then the nurse takes such measurements as vital signs,
height, and weight. The cephalocaudal or head-to-toe approach begins the
examination at the head; progresses to the neck, thorax, abdomen, and extremities;
32
and ends at the toes. The nurse using a body systems approach investigates each
system individually, that is, the respiratory system, the circulatory system, the
nervous system, and so on.

iv. Review of medical records; Client records include information documented by

various health care professionals. Client records also contain data regarding the
client’s occupation, religion, and marital status. By reviewing such records before
interviewing the client, the nurse can avoid asking questions for which answers have
already been supplied. Repeated questioning can be stressful and annoying to clients
and cause concern about the lack of communication among health professionals.
Types of client records include medical records, records of therapies, and laboratory
records. Medical records (e.g., medical history, physical examination, operative
report, progress notes, and consultations done by primary care providers) are often
a source of a client’s present and past health and illness patterns. These records can
provide nurses with information about the client’s coping behaviors, health
practices, previous illnesses, and allergies.

Types of data

i. Subjective data; Subjective data, also referred to as symptoms or covert data, that
are apparent only to the person affected and can be described or verified only by that
person. e.g patient verbalizing pain Itching, pain, and feelings of worry etc.

ii. Objective data; Objective data, also referred to as signs or overt data, that are
detectable by an observer or can be measured or tested against an accepted standard.
They can be seen, heard, felt, or smelled, and they are obtained by observation or
physical examination. For example, a discoloration of the skin, a blood pressure or
temperature reading are objective data. During the physical examination, the nurse
obtains objective data to validate subjective data and to complete the assessment
phase of the nursing process.

Sources of data

i. Primary sources; e.g. data from client except in cases where the client is a minor
i.e. a child who can’t express him/herself mentally deranged individual or in the case
of an unconscious client.

33
ii. Secondary sources; data from friends, relatives, medical records etc.

Reasons for assessment

i. To have a baseline data of a patient’s health state

ii. To improve nurse-client relationship

iii. To identify patient’s problems

iv. To help develop a care plan for the client care

2. NURSING DIAGNOSIS PHASE

Diagnosing is the second phase of the nursing process. In this phase, nurses use
critical thinking skills to interpret assessment data and identify client strengths and
problems. The formulation of a nursing diagnosis by employing clinical judgement
assists in the planning and implementation of patient’s care. The North American
Nursing Diagnosis Association (NANDA) provides nurses with an up to date list of
nursing diagnosis.

According to NANDA, nursing diagnosis is defined as a clinical judgment about

responses to actual or potential health problems on the part of the patient, family or
community. The diagnoses phase is a critical step as it is used to determine the course
of treatment.

Types of nursing diagnosis

i. actual nursing diagnosis; the problem is present in the client as the time of
assessment e.g. deficient fluid volume related to vomiting as evidenced by signs of
moderate dehydration e.g. dry mucus membrane.

ii. Risk nursing diagnosis; this describe human response that may develop in a
client. These diagnosis do not have a definite cause or defining characteristics,
instead has risk factors which the client might be exposed to. The risk factors are the
environmental physiological, psychological, genetic or chemical elements that a
person is at risk for as a health problem.

34
 3. OUTCOME IDENTIFICATION PHASE

This is the formulation of goals and measurable outcomes that provide the basis for
evaluating nursing diagnoses. Outcome identification is the most recent addition to
the nursing process.

An outcome is a measurable behavior demonstrated by the patient responsive to

nursing interventions. Outcomes should be identified before nursing interventions
are planned. Outcome identification includes setting short and long term goals and
then creating specific expected outcome statements for each nursing diagnosis.
Short-term outcomes are those that can be achieved fairly quickly, within hours or
days; that shows progress toward resolution of a problem; and that are often a
stepping stone toward reaching long-term goal. A long-term goal often requires
weeks or months to be achieved and usually reflects resolution or prevention of a
problem.

Goals and expected outcomes must be SMART i.e. Specific, Measurable,

Achievable, Realistic and Time bound. Example of goal and expected outcome of
acute pain related to trauma of incision as evidenced by verbalization of pain scale
of 7 and tensed facial expression.

Goal; Mr. Johnson will achieve pain relief by the day of discharge.

Expected outcome; i. Mr. Johnson will verbalize less pain at a scale of 5 by the end
of 1 hour of nursing intervention.

ii. Mr. Johnson will show less grimacing during movement by the end of 24 hours
of nursing intervention.

4. PLANNING PHASE

Planning is a deliberative, systematic phase of the nursing process that involves

decision making and problem solving. In planning, the nurse refers to the client’s
assessment data and diagnostic statements for direction in formulating client goals
and designing the nursing interventions required to prevent, reduce, or eliminate the
client’s health problems. The end product of the planning phase is a client care plan.

35
Phases of planning

i. Initial planning; this is done on the day of admission of the patient, it is usually
comprehensive.

ii. Ongoing planning; this is done continuously with constant interaction with the
patient. The purpose is to keep the plan of care up-to-date and promote function.

iii. Discharge planning; this is done on the discharge of the patient/client. It is

carried out by the nurse who has interacted with the client/patient closely. Health
teaching and counselling shills are majorly in this phase to re-enact the therapeutic
regimen.

Steps in planning
i. Priority setting
ii. State patients goal and expected outcomes
iii. Select appropriate nursing actions

iv. Develop a nursing care plan

NURSING CARE PLAN

This is a standardized evidence-based and holistic care that correctly identify

existing needs as well as recognizing potential and risk needs. Care plans include the
actions nurses must take to address the client’s nursing diagnoses and produce the
desired outcomes.

The nurse begins the plan when the client is admitted to the agency and updates it
throughout the client’s stay in response to changes in the client’s condition and
evaluations of goal achievement.

OBJECTIVES OF NURSING CARE PLAN

i. To promote evidence-based nursing care and provide comfortable and familiar

condition in the hospital or health care

ii. To provide a holistic care of the patient

36
IMPORTANCE OF NURSING CARE PLAN

i. For continuity of care

ii. Gives room for reassessment and evaluation

iii. Encourage individualized care

iv. Gives room for communication among nurses and other health care professionals.

A SAMPLE OF NURSING CARE PLAN FOR A PATIENT WITH MALARIA

Nursing diagnosis

i. Hyperthermia related to disease process evidenced by thermometer reading of 39

degree Celsius

ii. Acute pain (headache) 4/5 related to disease process evidenced by patient’s
verbalization.

iii. Imbalanced Nutrition less than body requirements related to disease process
evidenced by weight loss (40kg).

37
S/ Nursing Nursing Nursing Scientific rationale Evaluatio
N diagnosis objectives intervention n

1 Hypertherm The patient i. open i. to lose heat by The

i a related to ‘s body nearby convection patient’s
disease body
temperature windows ii.to lose heat by
process temperatu
will reduce ii. expose convection
evidenced the patient re was
by
by iii.tepid iii. to lose heat by reduced to
2⁰ within
thermomete conduction 37⁰ after
20minutes sponge the
r reading of 15
of nursing patient iv. to act on the
39 degree minutes of
intervention thermoregulating
Celsius iv.administe nursing
r prescribed centre(hypothalamu interventi
antipyretic s) to reduce the on
body temperature
e.g inj.
Paracetamol
600mg stat

2 Acute pain Patient will i.Minimize i. to reduce further Patient

(headache) verbalize noise in the irritation thereby verbalized
4/5 related reduction in environment reducing pain less pain
to disease severity of 1/5 after

38
 process pain (1/5) ii. Put off light ii. to provide comfort 15minutes
evidenced within on the patient environment thereby of nursing
by patient 20minutes bed side. easing pain interventi
verbalizatio of nursing iii.Encourage iii. to ensure comfort on.
n intervention patient to and
adopt any ease pain
comfortable
position.

iv. give iv. to raise the pain

prescribed threshold thereby
anlgesics e.g blocking the pain
tab the pain
paracetamol
1g
3 Imbalanced Patient will i. perform oral i. to stimulate Patient
Nutrition gain 0.5- hygiene before patient’s appetite gained
less than 1kg within and after meal 1kg within
ii. to stimulate
body one week ii.serve meal one week
appetite.
requirement of of patient’s of
s related to nursing choice in an iii. to aid in nursing
disease intervention attractive digestion and interventi
process . manner. absorption and boost on
evidenced patient immunity.
iii.ensure
by weight
intake of fruits
loss (40kg)

iv.weigh iv. to determine

patient on progress in patient’s
alternate days management

39
 5. IMPLEMENTATION PHASE

In the nursing process, implementing is the action phase in which the nurse performs
the nursing interventions. Implementation also known as intervention is the step
which involves action and the actual carrying out of nursing interventions outlined
in the care plan. Implementation consists of doing and documenting the activities
that are the specific nursing actions needed to carry out the interventions.

Types of nursing intervention

i. Independent nursing intervention

ii. Dependent nursing intervention

iii. Collaborative nursing intervention

6. EVALUATION PHASE

To evaluate is to judge or to appraise. Evaluating is the fifth phase of the nursing

process. In this context, evaluating is a planned, ongoing, purposeful activity in
which clients and health care professionals determine (a) The client’s progress
toward achievement of goals/ outcomes and (b) The effectiveness of the nursing care
plan.

Evaluation is an important aspect of the nursing process because conclusions drawn

from the evaluation determine whether the nursing interventions should be
terminated, continued, or changed. Evaluation continues until the client achieves the
health goals or is discharged from nursing care.

Reasons for evaluation

i. To determine the effectiveness of the nursing interventions

ii. To determine the strength and weakness of the nursing intervention instituted.
iii. To give room for reviewing the nursing care plan.

40
 IMPORTANCE OF THE NURSING PROCESS

• To the nurse

 It gives room for organization of nursing care

 It helps to arrange the independent, dependent and collaborative roles

of a nurse

 It gives the nurse the opportunity to choose alternatives to client’s care

 To the client/patient

 It provides individual nursing care

 It gives the nurse opportunity to provide holistic care to client

 Clients have the opportunity to be involved in their care

• To the nursing profession

 It forms the basis for developing the nursing profession as a scientific

discipline

 It gives room for information to be shared amongst nurses and other

health care professionals

 It forms a basis for improving research in nursing and increase the

knowledge base.

41