FUNDAMENTALS OF NURSING - 1847

- University of Santo Tomas College of Nursing

- Manila Central University College of Nursing
+ Florence Nightingale went to train as a nurse in - University of the Philippines College of Nursing,
Kaiserwerth, Germany where she stayed for 3 months. Manila
HISTORY OF NURSING - FEU Institute of Nursing
> Early Civilization - 1853 - UE College of Nursing
- Cause of Disease + Nightingale trained in the Sisters of Charity
- Medicine Man + Paris > Nursing Leaders
- Mother Surrogate + Returning to London, she worked as - Anastacia Giron - Tupaz
administrator and director of nurses at the + Nurse Chief Superintendent of PNA
- Cause of Disease Establishment for Gentlewomen During Illness where + Founder of PNA
- Temples she remained
+ Until she was called into service during the > Nursing Organizations
> Code of Hammurabi: Oldest Sanitation Code Crimean War - Philippine Nurse’s Association (PNA) – National
- 1760 BC - First President
- Law codes - 1860 + Rosario Delgado
- Sanitation + Nightingale opened the Nightingale Training - Current President
School for Nurses + Leah Samaco Pacquiz
> Early Christian Period + Served as model for other nursing schools
- Deaconesses, Crusaders, Hospitals, Good + Its graduates traveled to other countries to
Samaritan Law manage hospitals and nurse training schools NURSE
- Parabolani Brotherhood > came from the Latin word “Noutrix” or “To Nourish”
- Teutonic Knights > Nightingales biggest contributions in Nursing:
- Knights of St. John of Jerusalem - Sanitation Practices AS A PROFESSION
- Knights of Lazarus - Nursing Education > Body of specific and unique knowledge
- First Nurse Theorist > Strong service orientation
> Throughout history, wars have accentuated the + Notes on Nursing: What It Is And What It Is Not > Recognized authority by a professional group
need for nurses: > Code of ethics and laws 
 - WWI, WWII, American Civil War, Vietnam War HISTORY OF NURSING IN THE PHILIPPINES > Professional organization
(Recruitment of Nurses) > Earliest Hospitals > Ongoing research
 + Free Education for Nurses - Hospital de Real de Manila (1577) > Autonomy
 - Crimean War - San Lazaro Hospital (1578) > CARE
+ Sir Sidney Herbert - San Juan de Dios Hospital (1596)
+ Florence Nightingale
> Earliest Nursing Schools
- Iloilo Mission Hospital School of Nursing (1906)
LEVELS OF NURSES
> Florence Nightingale
> 5 Levels of Nurses
- 1836 - St. Luke’s Hospital School of Nursing (1907)
- Level I
+ Theodor Fliedner, a German pastor in - Mary Johnston Hospital and School of Nursing
+ No experience 
Kaiserwerth, opened a hospital with a training school (1907)
+ Novice
for nurses - Philippine General Hospital School of Nursing (1910)
- Level II
 Training School of Deaconesses
+ Has acceptable performance and has
> Earliest Nursing Universities
experienced enough situations 
 + Advanced beginner
- Level III > Nurse Practitioner NURSING ROLES
+ Has 2 to 3 years of experience  - A nurse with an advanced degree, certified for > Caregiver
+ Competent (Employed overseas) a special area or age of patient care - Primary role of the nurse
- Level IV - Delivers independent practice to make health - The provision of care
+ Has 3 to 5 years of experience assessments and deliver primary care - MOTHER SURROGATE ROLES
+ Proficient  + Diagnose + Complete Assistance
- Level V  + Prescribe medications + Partial Assistance
+ Highly proficient  Does not require guidance + Supportive/Educative
and rules > Nurse Anesthetist
+ Expert (Capable of managing hospital units) - A nurse who completes a course of study > Communicator
in an anesthesia school - With Patients
+ Carries out preoperative visits and assessments + To establish Therapeutic Communication
FIELDS OF NURSING PRACTICE + Administers and monitors anesthesia during + To identify health problems
1) Institutional or Hospital Nursing surgery - With Health Care Professionals
- Employment in hospitals and health institutions + Evaluates postoperative status of patients + Documentation
- Biggest field of nursing practice + Reporting / Endorsements
+ Staff Nurse > Nurse midwife
+ Nurse Managers - A nurse who completes a program in midwifery > Teacher/Educator
2) Community / Public Health Nursing + Provides prenatal and postnatal care - Providing education about a client’s health and
- Subdivision: + Delivers babies for women with uncomplicated health care procedures they need to perform to restore
+ School Nursing pregnancies or maintain their health

3) Private Duty Nursing > Nurse Educator > Teaching Strategies

- One to one care - A nurse usually with an advanced degree, who - Assess client’s
- Total nursing care or Case Management teaches in educational or clinical settings + Readiness to learn
- Home or hospital based + Assess the client’s knowledge
4) Military Nursing > Nurse Administrator - Simple to complex
5) Company / Industrial Nursing - A nurse who functions at various levels of - One to One Discussion or Group Discussion
management + Explanation and Description
- Responsible for management and + Answering Questions
EXPANDED EDUCATIONAL AND administration of resources and personnel involved + Visual Assisted Learning Programs
in giving patient + Demonstration
CAREER ROLES Care Actual performance of an activity
> Clinical Nurse Specialist > Nurse Researcher
- A nurse with an advanced degree, education, or - A nurse with an advanced degree who conducts > Counselor
experience research relevant to the definition and improvement of - Facilitates the patient’s problem solving and
- Considered to be an expert in a specialized area of nursing practice and education decision – making skills
nursing
- By providing information, make appropriate
Example: Geriatric Nurse, Oncology Nurse, > Nurse Entrepreneur referrals
Maternal and Child Nurse - A nurse, usually with an advance degree who may
manage a clinic or health related business > Researcher
 - The participation in or conduct of research > Referring
- To increase knowledge in nursing and improve NON-VERBAL MESSAGES
patient care > carry more meaning than verbal messages and > Reporting
involves the following: - Endorsement
>  Advocate - Body movement or kinetics - Transferring pertinent information regarding a
- Safeguarding the rights of the patients - Voice quality (pitch and range) and non-language patient to a concerned person
- Patients Bill of Rights sounds (sobbing or laughing) - Outgoing nurse to a incoming nurse
- Staff nurse to physician
> Proxemics – use of personal or social space
COMMUNICATION - Intimate Distance – actual contact to 1.5 feet > Conferring
> the interchange of information between two or more - Personal Distance – 1.5 to 4 feet or 3 to 4 feet for - To verify information
people interviews - Rephrasing
> the exchange of ideas or thoughts - Social Distance – 4 to 12 feet + To validate doctor’s orders
- Public Distance – 12 feet and beyond + To validate a nurse’s endorsement
ELEMENTS OF COMMUNICATION
> Sender > Cultural Artifacts – items in contact with interacting > Referring
- Originator of the information persons that may act as non-verbal stimuli (i.e., clothes, - To endorse patient’s special concern to a higher
> Message cosmetics, jewelry, cars) authority or a specialized department or personnel
- Information being transmitted + A community nurse referring a client to a
> Receiver hospital or a doctor
- Recipient of information THERAPEUTIC RESPONSES IN + A staff nurse to a dietitian
> Channel COMMUNICATING WITH PATIENTS
- Mode of communication THERAPEUTIC RESPONSES
> Feedback > Identify therapeutic and non-therapeutic phrases THEORIES OF NURSING
- Return response > Open-ended or Closed-ended question? > Theory
> Context > ‘Why’ or ‘What’ questions? - A hypothesis or system of ideas that is proposed to
- The setting of the communication > Avoid false reassurances explain a given phenomenon
> Use direct questions for suicidal cases - Purpose: Directs and guide nursing practice
LEVELS OF COMMUNICATION > Avoid the ‘Authoritarian Answer’
> Intrapersonal - Giving advices > Nightingale's Environmental Theory
- Occurs when a person communicates within > In initiating conversation - The act of utilizing the environment of the patient to
himself - Use Broad Openings assist him in his recovery
> Interpersonal - Linked health with 5 environmental factors:
- Takes place within dyads (groups of two persons) > In ending conversation + Pure or fresh air
and in small groups. - Summarizing + Pure water
> Public + Efficient drainage
- Communication between a person and several + Cleanliness
other people COMMUNICATING WITH HEALTH CARE + Light
PROFESSIONALS - Addition:
MODES OF COMMUNICATION > Documentation + Education of nurses
> Verbal Communication > Reporting + Keeping the client warm
> Non-verbal Communication > Conferring + Maintaining a noise free environment
 + Attending to the client’s diet 1. Attachment
2. Affiliative > Imogene King’s Goal Attainment Theory
> Hildegard Peplau’s Interpersonal Relations Model 3. Dependency - Patient has THREE (3) interacting systems
- Peplau is a psychiatric nurse 4. Ingestive + Personal systems
- Focus: Therapeutic process 5. Eliminative + Group systems / Interpersonal systems
- Attained through: 6. Sexual Achievement + Social systems
+ Healthy Nurse 7. Aggressive
+ Patient Relationship > Betty Neuman’s Health Care Systems Model
- Four Phases of the Nurse – Patient Interaction > Faye Abdellah’s 21 Nursing Problems - The concern of nursing is to prevent Stress
+ Preorientation 1. good hygiene Invasion
+ Orientation 2. optimal activity + Physiological
+ Working / Exploitation 3. safety + Psychological
+ Termination/Resolution 4. good body mechanics + Developmental
5. Oxygen + Sociocultural
> Virginia Henderson’s 14 Fundamental Needs of a 6. nutrition + Spiritual
Person 7. elimination
- Assisting sick or healthy individuals to gain 8. fluid and electrolytes balance > Sister Callista Roy’s Adaptation Model
independence in meeting 14 fundamental needs 9. physiologic response of the body to disease - Man is a Biopsychosocial Being that requires a
 1) Breathing normally 10. regulatory mechanisms feedback cycle
 2) Eating and drinking adequately 11. sensory function. - The goal is to enhance life processes through
 3) Eliminating body waste 12. positive and negative expressions, feelings and adaptation in four adaptive models
 4) Moving and maintaining a desirable position reactions. + The Physiologic Mode
 5) Sleeping and resting 13. accept the interrelatedness of emotions and illness + Self Consent Mode
 6) Selecting suitable clothes 14. self awareness + Role Function Mode
 7) Maintaining body temperature within normal range 15. optimum possible goals + Interdependence Mode
by adjusting clothing and modifying the environment 16. use community resources
 8) Keeping the body clean and well groomed to 17. role of social problems > Madeline Leininger’s Transcultural Nursing
protect the integument - Emphasizes human caring varies among cultures
 9) Avoiding dangers in the environment and avoiding > Martha Roger’s Science of Unitary Human Beings + Culture Care Preservation and Maintenance
injuring others - Views the person as a irreducible whole, the whole + Culture Care Accommodation and Negotiation
 10) Communicating with others in expressing being greater than the sum of its parts + Culture Care Restructuring and Repatterning
emotions, needs, fears, or opinions - Man is composed of energy fields, which are in
 11) Worshipping according to one’s faith constant interaction with the environment
 12) Working in a such way that one feels a sense of - Seek to promote harmonic interactions between CONCEPT OF MAN
accomplishment the two energy fields (Human and Environmental) > Nurse’s Clients
 13) Playing or participating in various forms of - Individuals
recreation > Dorothea Orem’s Self Care and Self Care Deficit - Families
 14) Learning, discovering, or satisfying the curiosity Theory - Communities
that leads to normal development and health, and using - Identified three nursing systems
available health facilities + Wholly compensatory systems  BIOLOGIC like ALL other men
+ Partial compensatory systems  PSYCHOLOGICAL like NO OTHER man
> Dorothy Johnson’s Seven Subsystems + Supportive – Educative systems  SOCIAL like SOME OTHER men
 SPIRITUAL like SOME OTHER men - Able to fulfill needs and ambitions
- Maximizing one’s full potential
ABRAHAM MASLOW’S HIERARCHY OF NEEDS
ILLNESS, WELLNESS AND
> 5 Human Needs > Self Actualization HEALTH
- Judges people correctly > Health
> Physiologic needs  - Superior perception - World Health Organization
- Oxygen  - Decisive + Health is the complete physical,
- Fluids  + Capable of making decisions mental, social (totality) well-being and not merely the
 - Nutrition  - Clear notion as to what is right and wrong absence of disease or infirmity
 - Body Temperature - Health is individually defined by each
 - Elimination > Open to new ideas person
 - Rest and Sleep  - Not adopts new ideas - On a personal level, individuals define health
 - Sex  - Not one track mind according to
+ how they feel
> Safety and security (Physical and Psychological) > Highly creative and flexible + absence or presence of symptoms of
 - Protection  - Does not need fame illness
 - Security - Problem-centered rather than self- centered  + and ability to carry out activities
 - Order
 - Law > Additional needs: DISEASE
 - Limits - Need to know and understand  > Objective pathologic process
 - Stability - Aesthetic needs > Pathologic change in the structure or function of the
 - Transcendence mind and body
> Love and Belongingness
 - Family > Need to know and understand or Cognitive needs is > Acute
 - Affection supported by Richard Kalish who says that - Rapid onset of symptoms
 - Relationships  - Man needs stimulation  - Some are life threatening
 - Work group - Needs to explore  - Many do not require medical treatment
+ Sex
> Self-esteem  + Activity > Chronic
- Feeling good about one’s self  + New things - Broad term that encompasses many different
- Two factors affecting Self-esteem physical and mental alterations in health
+ Yourself > Aesthetic needs: + a permanent change
Sense of adequacy - Beauty + Requires special patient education for
Accomplishment  - Balance rehabilitation
Self worth & respect - Form + Requires long term of care and support
+ Others > Transcendence: 
Appreciation - Helping others to self-actualize ILLNESS
Recognition > Highly subjective feeling of being sick or ill
Admiration > How the person feels towards sickness
> Concerns the Nurse
> Self-actualization – essence of mental health
- Personal growth and fulfillment
ELEVEN STAGES OF ILLNESS AND HEALTH- HEALTH BELIEF MODEL BY ROSENTOCK NURSES PROCESS
SEEKING BEHAVIOR BY SUCHMAN > Concerned with what people perceive about
1. Symptom Experience themselves in relation to their health
 - Client realizes there is a problem > Consider perceptions (influences individuals
 - Client responds emotionally motivation toward results)
 - Perceived susceptibility
2. Sick Role Assumption  - Perceived seriousness
- Self-medication / Self-treatment  - Perceived benefit out of the action
- Communication to others
3. Assuming a Dependent Role FOUR LEVELS OF HEALTH BY SMITH
 - Accepts the diagnosis 1. Clinical Model
 - Follows prescribed treatment - Man is viewed as a Physiologic Being
4. Achieving recovery and rehabilitation - If there are no signs and symptoms of a disease,
 - Gives up the dependent role and assumes normal then you are healthy Definition:
activities and responsibilities 2. Role Performance Model > The Nursing Process is a systematic, organized,
 - As long as you are able to perform SOCIETAL rational method of planning and providing
CONCEPTS ON DISEASE AND ILLNESS functions and ROLES you are healthy individualized, humanistic nursing care
3. Adaptive Model
 Illness without disease is possible  - Health is viewed in terms of capacity to ADAPT
 Disease without illness is possible PURPOSES OF THE NURSING PROCESS
 - Failure to adapt is disease > To identify health status
4. Eudaemonistic Model  - Actual health problems
 - This is the BROADEST concept of health  - Potential health problems
MODELS OF HEALTH AND ILLNESS  - Because health is viewed in terms of Actualization > To establish plans
DUNN’S HIGH-LEVEL WELLNESS AND GRID MODEL > To deliver specific nursing care
> X-axis is HEALTH AGENT, HOST, ENVIRONMENT MODEL BY LEAVELL > To evaluate nursing care
> Y-axis is ENVIRONMENT AND CLARK
> Also known as the Ecologic Model
> Triad is composed of the agent, host and environment
> Based on the interplay of three components of the
model