Discussion: Basic concept of Nursing I. Nursing as a Profession A. Profession 1.

Definition: is an occupation that requires

extensive education or a calling that requires special knowledge, skill, and preparation.
2. Criteria: a. To provide a needed service to the

society. b. To advance knowledge in its field. c. To protect its members and make it possible to practice effectively. 3. Characteristics: a. A basic profession requires an extended education of its members, as well as a basic liberal foundation. b. A profession has a theoretical body of knowledge leading to defined skills, abilities and norms. c. A profession provides a specific service. d. Members of a profession have autonomy in decision-making and practice. e. The profession has a code of ethics for practice.
B. Nursing 1. Definition: is a disciplined involved in

the delivery of health care to the society a. Is a helping profession b. Is service-oriented to maintain health and well being of people.

c. Is an art and science Nurses rely on knowledge from the biological, behavioral, physical, and social sciences to make decisions Nursing knowledge is gained in several ways (formal education, clinical practice, and research) The art of nursing is built upon such thing as wisdom, compassion, effective communication, and respect for human dignity 2. Characteristics of Nursing: a. Nursing is caring. b. Nursing involves close personal

contact with the recipient of care. c. Nursing is concerned with services that take humans into account as physiological, psychological, and sociological organisms. d. Nursing is committed to promoting individual, family, community, and national health goals in its best manner possible. e. Nursing is committed to personalized services for all persons without regard to color, creed, social or economic status.

f. Nursing is committed to

involvement in ethical, legal, and political issues in the delivery of health care.
3. Personal and Professional qualities of a nurse a. Must have a Bachelor of Science degree in nursing b. Must be physically and mentally fit c. Must have a license to practice nursing in the country A professional nurse therefore, is a person who has completed basic nursing education program and licensed in his country to practice professional nursing. C. History of Nursing 1. Intuitive period: Nursing started as an intuitive way of caring for the sick members of the family. Nursing was untaught and instinctive. Nursing was a function that belongs to women; it was based on experience an observation. Early Christian era: women began Nursing as an expression of Christianity (act of mercy). Renaissance Period (1500AD- 1850AD): The dark period of nursing- Nurses of this period considered as Wayward women of low status who become nurse instead of going to jail. Poor single women with no family or hope of marriage become nurses 2. Apprentice Period:

 Pastor Theodore Fliedner and his wife Frederika , established the Kaiserswerth Institute for the training of Deaconesses in Germany (The first formal training school for nurses). Its most famous student was FLORENCE NIGHTINGALE (1820-1910). Nursing was viewed as a very low job in the social hierarchy. 3. Educative Period: Nightigales Era Florence Nightingale (12 May 1820 13 August 1910) was an English nurse, writer and statistician. The Lady with the Lamp She came to prominence during the Crimean War for her pioneering work in nursing, and was dubbed The Lady with the Lamp after her habit of making rounds at night to tend injured soldiers. Nightingale laid the foundation of professional nursing with the establishment, in 1860, of her nursing school at St. Thomas Hospital in London, the first secular nursing school in the world. It was the 1st school of nursing that provided both theory-based knowledge and clinical skill building, Nursing evolved as an Art and Science. Formal nursing education and nursing services begun. The Pioneer of Nursing (Florence Nightingale) The Nightingale Pledge taken by new nurses was named in her honor, and the annual International Nurses Day is

celebrated around the world on her birthday. 4. Contemporary Period Licensure of nurses started. Training of nurses in diploma programs. Development of advanced degree programs. Scientific and technological development, as well as social changes marked this period. Nursing raised as a Profession D. Growth of Professionalism 1. Profession a. Specialized Education b. Body of Knowledge c. Ethics d. Autonomy 2. Types of Nursing Knowledge: Carpers (1978) four patterns of knowing that make up the basic core of nursing knowledge a. Nursing Science Scientific knowledge Is the Cognitive brain of Nursing and includes knowledge obtained through nursing research and research done in other discipline b. Nursing Esthetics The way in which nursing knowledge is expressed It is the art or the heart of nursing Involves feelings gained by subjective experience

 Its is through the art of nursing that nurses express caring Esthetics includes: - Attitudes - Beliefs - Values - Sensitivity and empathy (enable the nurse to be aware of the clients perspective and to be attentive to verbal and nonverbal cues to the clients psychological state c. Nursing Ethics Refers to the knowledge of accepted professional standards of conduct Concerned with matters of obligation, or what ought to be done Consist of information about basic moral principles and processes for determining right actions Ex: Nurse are accountable to consumers and each other for the ethical performance of their work d. Personal Knowledge Concerned with knowing oneself Having a conscious awareness of ones own values, beliefs, attitudes and abilities

 Involves knowing of self in relation to another and interaction on a person to person, rather than a role to role basis

E. Overview of the Professional Nursing Practice 1. Level of Proficiency according to Benner a. Novice A nursing student or any nurse entering a clinical setting where that person has no experience Ability is extremely limited, inflexible and governed by structures rules and protocols b. Beginner Can demonstrate marginally accepted performance Has had experience with enough real situations to be aware of the meaningful aspects of a situation The ability to recognize an clients readiness to learn how to manage a treatment plan c. Competent Competence is manifested by the nurse who has been on the job in a similar situation for 2 or 3 years Competence develops when the nurse consciously and deliberately plans nursing care and coordinates multiple complex care demands

 At this stage the nurse demonstrate organizational ability by lacks the speed and flexibility of the proficient nurse Knows how to prioritize care requirements for an individual or groups of clients Ex. The competent nurse will ensure that Intravenous infusions are running, that clients are receiving required medications, and that clients are receiving required medications d. Proficient The proficient nurse perceives a situation as a whole rather than just its individual aspects The nurse focuses on longterm goals and is oriented toward managing the nursing care of client rather than performing specific tasks Uses maximum as guides but applies then only after acquiring a deep understanding of the situation The nurse makes the decision according to the demands of the situation and le lessons of the past experiences e. Expert The expert performer no longer relies on rules, guidelines or maxims to

connect an understanding of the situation to an appropriate action The expert nurse intuitively grasps each situation and focuses on the accurate are of the problem without wasteful consideration of large rages of unnecessary alternative diagnosis The nurses highly skilled analytic ability can be transferred to situations with which the nurse has had no previous experience 2. Roles and Responsibilities of a Professional Nurse a. Caregiver/ Care providers the traditional and most essential role. Functions as nurturer, comforter and provider Mothering actions of the nurse Provides direct care and promotes comfort of client b. Teacher provides information and helps the client to learn or acquire new knowledge and technical skills. Encourages compliance with prescribed therapy Promotes healthy lifestyle interprets information to the client

c. Counselor- helps client to recognize and cope with stressful psychological or social problems; to develop and improve interpersonal relationships and to promote personal growth. Provides emotional, intellectual to and psychological support Focuses on helping a client to develop new attitudes, feelings and behaviors rather than promoting intellectual growth. Encourages the client to look at alternative behaviors recognize the choices and develop a sense of control. d. Change agent- initiate changes or assist clients to make modifications in them or in the system of care. e. Client advocate- involves concern for and actions in behalf of the client to bring about a change.

Promotes what is best for the client, ensuring that the clients needs are met and protecting the clients right. Provides explanation in clients language and support clients decisions.

f. Manager makes decisions, coordinates activities of others, allocate resources, and evaluate care and personnel. Plans, give direction, develop staff, monitors operations, give the rewards fairly and represents both staff and administrations as needed g. Researcher participates in identifying significant researchable problems Participates in scientific investigation and must be a consumer of research findings Must be aware of the research process, language of research, and a sensitive to issues related to protecting the rights of human subject. F. Different Fields of Nursing a. Hospital/Institutional Nursing- a nurse working in an institution with patients (Ex. Rehabilitation, lying-in) b. Public Health Nursing/Community Health Nursing- usually deals with families and communities: No confinement or OPD only (Ex. Barangay Health Center) c. Private Duty/special Duty Nurse

privately hired d. Industrial/Occupational Nursing a nurse working in factories, office, companies

e. Nursing Education nurses working in

school, review center and in hospital as a CI. f. Military Nurse nurses working in a military base. g. Clinic Nurse nurses working in a private and public clinic. h. Independent Nursing Practice Private practice, BP monitoring, home service.
II. The concept of Man and his basic needs A. Four major attributes of human being a) The capacity to think or conceptualize on the abstract level b) Family formation c) The tendency to seek and maintain territory d) The ability to use verbal symbols as language, a means of developing and maintaining culture B. Nursing concepts of man a) Man is a biopsychosocial and spiritual being who is in constant contact with the environment Biologic being- all men have the same basic human needs Psychologic being- man is unique, irreplaceable, one-time being. No two persons are exactly alike. Spiritual being- all men are spiritual in nature; all men are endowed with virtues of faith, hope and charity. Men believe in the existence of Supreme power who guides our fate and destiny Social being- man is like some other men. Group of people have some common attributes Culture, age, a groups, social status, educational status, etc

b) Man is an open system in constant interaction with a changing environment. An open system is one that allows input and output Food, energy, microorganism c) Man is a unified whole Composed of parts which are interdependent and interrelated with each other To have adequate oxygenation, there should be normal functioning of the respiratory system, cardiovascular system, and nervous system d) Man is composed of parts which are greater than and different from the sum of all its parts Man is greater than the sum of all its parts because man is simply a composite of physiologic body parts. Man is endowed with intellect, will, judgment ability, decision-making ability, talents, strengths, etc Man is different from the sum of all his parts because at time his responses are predictable but at time unpredictable. Sometimes he responds favorably to some factors (food, medications, treatments) but at times he responds unfavorably. C. Basic needs for Human Being 1. Maslows Hierarchy of Basic Needs

a) Physiological needs (oxygen, water, food, temperature, elimination, sexuality, physical activity, and rest) must be met at least minimally to maintain life. The highest priority.

b) Safety needs- it involve both physical and emotional components. - Nurses activities to meet patients physical needs (using proper hand washing and sterile techniques to prevent infection) - Emotional safety and security involves trusting others and being free of fear, anxiety, and apprehension. Nurse role (encouraging spiritual practices that are source of strength and support and by allowing independent decision making and control a possible, and by carefully explaining new and unfamiliar procedures and treatments) c) Love and belongingness needs- include the understanding and acceptance of others in both giving and receiving love, and the feeling of belonging to families, peers, friends, a neighborhood, and a community - Nurse role (include family and friends in the care; establishing a nurse-patient relationship based on mutual understanding and trust- encouraging communication) d) Self-esteem needs -which include the need for a person to feel good about himself or herself, to feel pride and a sense of accomplishment, and to believe that others also respect and appreciate those accomplishment. - Nurse role (respecting their values and beliefs, encouraging patients to set attainable goals, and facilitating support from family or significant others) e) Needs for self-actualization- the highest level of needs, which include the need for individuals to reach their full potential

through development capabilities. -

of

their

unique

In general, each lower of need must be met to some degree before this need can be satisfied. The process of self-actualization is one that continues throughout life. List of the following qualities that indicate achievement of ones potential: a) Acceptance of self and others as they are b) Focus of interest on problems outside oneself c) Ability to be objective d) Feeling of happiness and affection for others e) Respect for all people

- Nurse role (focus on the persons strengths and possibilities rather than problems

Significance to nursing a) To identify clients unmet needs b) To realize and understand clients words and behaviors c) To predict clients unspoken needs d) To collect clients data comprehensively in case of missing e) To put clients nursing problems in adequate order 2. Characteristics of basic human needs a. Needs are universal- all human beings have the same basic human needs b. Needs maybe met in different ways c. Needs maybe stimulated by external and internal factors d. Needs maybe deferred e. Needs interrelated

III. Environmental Concept A. Sister Calista Roys definition of environment: the summation of all factors that surround and affect the behaviors and development of individual or collectivity. B. Virginia Hendersons definition of environment: a general name of all external factors that affect the life and development of organism. C. Classification of environment: a. Internal environment- the environment in the organism b. External environment i. Natural- air, water, sunlight and soil ii. Humanistic-social- interpersonal relationship, cultural education iii. Therapeutic environment- an environment that created by professionals aimed to fit the recovery of clients physiological and psychological health D. Relationship among environment, human being and health a. Human being and its environment are interdependent and interacted b. Human beings health is closely linked with the environment IV. Concept of health and Illness 1. Introduction - Health is a fundamental right of every human being - Across the lifespan, man moves from the health spectrum to the illness spectrum - Health and illness are highly individualized perceptions - Meanings and description vary among people in relation to geography and culture 2. Definitions of health - Health is a state of complete physical, mental and social well-being and not merely the absence of disease of infirmity. (WHO)

Health is being well and using ones power to the fullest extent. Health is maintained through prevention of disease via environmental factors. (Nightingale) - Health is the ability to maintain the internal milieu. Illness is the result of failure to maintain the internal environment. (Claude Bernard) 3. Illness and Disease - Illness is a personal (physical, emotional, intellectual, social, developmental or spiritual) state in with the person feels unhealthy. - Disease is an alteration in body functions resulting in reduction of capacities or shortening of normal life span. 4. Precursors of Illness a. Heredity- family history for DM; hypertension; cancer b. Behavioral factors- cigarette smoking; alcohol abuse; high animal fat intake c. Environmental factors- overcrowding; poor sanitation; poor supply of potable water 5. Common causes of Disease a. Biologic agents- microorganisms b. Inherited genetic defects- cleft palate c. Emotional/physical reaction to stress- anxiety or fear d. Developmental defects- imperforate anus e. Physical agents- hot and cold substances; radiation; UV rays 6. Stages of Illness a. Symptoms Experience- the person believes something is wrong Experience some symptoms: Three aspects 1. Physical- fever, muscle aches, malaise headache 2. Cognitive- perception of having flu 3. Emotional- worry on consequence of illness

b. Assumption of the Sick Role- acceptance of the illness: Seek advice, support for decision to give up some activities c. Medical care Contact- seeks advice of health professionals for the following reasons: 1. Validation of real illness 2. Explanation of symptoms 3. Reassurance or prediction of outcomes d. Dependent Patient Role- the client becomes dependent on the health professionals for help: 1. Accepts/rejects health professionals suggestions 2. Becomes more passive and accepting e. Recovery/rehabilitation- gives up the sick role and returns to former roles and functions. 7. Risk factors Any situation, habit, social or environment condition, physiological or psychological condition, developmental or intellectual condition, or spiritual or other variable that increases the vulnerability of an individual or group to an illness or accident. Presence of risk factors does not mean that a disease will develop, but risk factors increases the chance that individual will experience a particular dysfunction. 8. Risk factors of a Disease a. Genetic and Physiologic- heredity or genetic predisposition b. Age- age increases or decreases susceptibility to certain illness (e.g. the risk of heart diseases increases with age for both sexes) c. Environment- can increase the likelihood that certain illness will occur (e.g. pollution)

d. Lifestyle- behaviors and practices can have positive or negative affects on health (e.g. tobacco and alcohol abuse, stress, extreme sports) The goal of risk factor identification is to merely assist the clients in visualizing the areas in their life that can be modified or even eliminated to promote wellness and prevent illness. 9. Three level of prevention a. Primary Prevention To encourage optimal health and to increase the persons resistance to illness Seeks to prevent a disease To stop something from ever happening Health promotion Specific protection b. Secondary Prevention Also known as health maintenance Seeks to identify specific illness or condition at an early stage Early diagnosis/detection/screening Prompt treatment to limit disability c. Tertiary Prevention To support toward successful adaptation to known risks, optimal reconstitution, and or establishment of high-level wellness Occurs after a disease of disability has occurred and the recovery process has begun Intent is to halt the disease or injury process Rehabilitation

Nursing Process