1. State the definition of professional nursing.

2. Enumerate criteria of a profession

3. Adheres to practices in accordance with the nursing law and other relevant legislation
4. Respects the rights of individual / groups
5. Adheres to the national and international code of ethics for nurses
6. Performs function according to professional standards
I-INTRODUCTION – ORIENTATION DAY
Introduction
In 1958, Ida Jean Orlando started the nursing process that still guides nursing care today. Defined as a
systematic approach to care using the fundamental principles of critical thinking, client-centered
approaches to treatment, goal-oriented tasks, evidence-based practice (EDP) recommendations, and
nursing intuition. Holistic and scientific postulates are integrated to provide the basis for compassionate,
quality-based care
Function
The NURSING PROCESS functions as a systematic guide to client-centered care with 5
SEQUENTIAL STEPS. These are assessment, diagnosis, planning, implementation, and evaluation.
ADPIE

ASSESSMENT
DIAGNOSIS
PLANNING
IMPLEMENTATION
EVALUATION

ADPIE helps nurses by outlining the steps they can take to provide quality care to their patients. ADPIE,
also known among healthcare professionals as the nursing process, gives nurses the tools to apply their
knowledge in a clinical setting, solve problems and expand their skill set.

ASSESSMENT
Assessment is the first step and involves critical thinking skills and data collection; subjective and
objective.
Subjective data involves verbal statements from the patient or caregiver (INTERVIEW)
Objective data is measurable, tangible data such as vital signs, intake and output, and height and weight
(PHYSICAL CHARACTERISTICS)
Data may come from the patient directly or from primary caregivers who may or may not be direct
relation family members. Friends can play a role in data collection. Electronic health records may
populate data in and assist in assessment.
Critical thinking skills are essential to assessment, thus the need for concept-based curriculum changes.
DIAGNOSIS
The formulation of a nursing diagnosis by employing clinical judgment assists in the planning and
implementation of patient care.
The North American Nursing Diagnosis Association (NANDA) provides nurses with an up-to-date list of
nursing diagnoses.
A nursing diagnosis, according to NANDA, is defined as a clinical judgment about responses to actual
or potential health problems on the part of the patient, family or community.
A nursing diagnosis encompasses MASLOW'S HIERARCHY OF NEEDS and helps to prioritize and
plan care based on patient-centered outcomes. In 1943, Abraham Maslow developed a hierarchy based on
basic fundamental needs innate for all individuals.
Basic physiological needs/goals must be met before higher needs/goals can be achieved such as self-
esteem and self-actualization.
Physiological and safety needs provide the basis for the implementation of nursing care and nursing
interventions.
Thus, they are at the base of Maslow's pyramid, laying the foundation for physical and emotional health.
Maslow's Hierarchy of Needs
 Basic Physiological needs: Nutrition (water and food), elimination (Toileting), airway (suction)-
breathing (oxygen)-circulation (pulse, cardiac monitor, blood pressure) (ABC's), sleep, sex,
shelter, and exercise.
 Safety and Security: Injury prevention (side rails, call lights, hand hygiene, isolation, suicide
precautions, fall precautions, car seats, helmets, seat belts), fostering a climate of trust and safety
(therapeutic relationship), patient education (modifiable risk factors for stroke, heart disease).
 Love and Belonging: Foster supportive relationships, methods to avoid social isolation (bullying),
employ active listening techniques, therapeutic communication, sexual intimacy.
 Self-Esteem: Acceptance in the community, workforce, personal achievement, sense of control or
empowerment, accepting one's physical appearance or body habitus.
 Self-Actualization: Empowering environment, spiritual growth, ability to recognize the point of
view of others, reaching one's maximum potential.
PLANNING
The planning stage is where goals and outcomes are formulated that directly impact patient care based on
EDP guidelines. ELECTRONIC DATA PROCESSING
These patient-specific goals and the attainment of such assist in ensuring a positive outcome. Nursing
care plans are essential in this phase of goal setting. Care plans provide a course of direction for
personalized care tailored to an individual's unique needs. Overall condition and comorbid conditions
play a role in the construction of a care plan.
Care plans enhance communication, documentation, reimbursement, and continuity of care across the
healthcare continuum.
Goals should be:
1. Specific
2. Measurable or Meaningful
3. Attainable or Action-Oriented
4. Realistic or Results-Oriented
5. Timely or Time-Oriented
IMPLEMENTATION
Implementation is the step which involves action or doing and the actual carrying out of nursing
interventions outlined in the plan of care. This phase requires nursing interventions such as applying a
cardiac monitor or oxygen, direct or indirect care, medication administration, standard treatment protocols
and EDP standards.
EVALUATION
This final step of the nursing process is vital to a positive patient outcome. Whenever a healthcare
provider intervenes or implements to ensure the desired outcome has been met. Reassessment may
frequently be needed depending upon overall patient condition care, they must reassess or evaluate. The
plan of care may be adapted based on new assessment data.

II-Review of Nursing as a Profession

A. Profession
1. Definition
NURSING AS PROFESSION
A variety of career opportunities are available in nursing, including clinical practice, education, research,
management, administration, and even entrepreneurship.
As a student it is important for you to understand the scope of professional nursing practice and how
nursing influences the lives of your patients, their families, and their communities.
The PATIENT is the center of your practice.
Your patient includes individuals, families, and/or communities.
Patients have a wide variety of health care needs, knowledge, experiences, vulnerabilities, and
expectations; but this is what makes nursing both challenging and rewarding.
Making a difference in your patients' lives is fulfilling (e.g., helping a dying patient find relief from pain,
helping a young mother learn parenting skills, and finding ways for older adults to remain independent in
their homes).
Nursing offers personal and professional rewards every day.
This chapter presents a contemporary view of the evolution of nursing and nursing practice and the
historical, practical, social, and political influences on the discipline of nursing.
Nursing is not simply a collection of specific skills, and you are not simply a person trained to perform
specific tasks. Nursing is a profession.
No one factor absolutely differentiates a job from a profession, but the difference is important in terms of
how you practice.
 To act professionally you administer quality patient-centered care in a safe, prudent (acting with
or showing care and thought for the future) and knowledgeable manner.
 You are responsible and accountable to yourself, your patients, and your peers.
Health care advocacy groups recognize the importance of the role quality professional nursing has on the
nations' health care. One such program is the Robert Wood Johnson Foundation (RWJF) Future of
Nursing: Campaign for Action (RWJF, 2014a). This program is a multifaceted campaign to transform
health care through nursing, and it is a response to the Institute of Medicine (IOM) publication on The
Future of Nursing (IOM, 2010). Together these initiatives prepare a professional workforce to meet health
promotion, illness prevention, and complex care needs of the population in a changing health care system.
NURSING AS A PROFESSION
Nursing is an ART AND A SCIENCE AS WELL as a humanitarian service.
It is a unique profession within the health care sector focused on the care of individuals, families, and
communities. Florence Nightingale was the founder of modern nursing.
She laid the foundation of professional nursing with the establishment of her nursing school at St Thomas
Hospital, London in 1860.
Nurses play a vital role in the health care system of any country whose main goals are to promote
healthy lifestyles, prevent diseases, alleviate suffering and rehabilitate individuals that are
differently abled. Therefore, most of the countries have strengthened their nursing profession through
degree level education and specialization in selected fields of nursing in order to provide effective and
efficient health care for the public.
Nursing is identified as a profession based on the criteria that a profession must have; a systematic
body of knowledge that provides the FRAMEWORK FOR THE PROFESSION’S PRACTICE,
STANDARDIZED FORMAL HIGHER EDUCATION, COMMITMENT TO PROVIDING A
SERVICE THAT BENEFITS INDIVIDUALS and the COMMUNITY, MAINTENANCE OF A
UNIQUE ROLE THAT RECOGNIZES AUTONOMY, RESPONSIBILITY AND
ACCOUNTABILITY, CONTROL OF PRACTICE RESPONSIBILITY of the profession through
standards and a code of ethics, EVIDENCE BASED PRACTICE and COMMITMENT TO
MEMBERS OF THE PROFESSION through professional organizations and activities.
The nurse’s primary professional responsibility is providing NURSING CARE for patients, family, and
community.
Nurses are accountable for facilitating safe and therapeutic environment for the patients, delivering
holistic and personalized care, maintaining accurate and up to date records and report, protecting
patient’s legal rights and privacy, maintaining collaborative relationship with other health
workers , working within ethical and legal boundaries, delegating responsibility appropriately,
providing health education, focusing on evidence-based practice and contributing to the
professional development
2. Criteria
CRITERIA OF A PROFESSION
Nursing is gaining recognition as a profession.
A profession has been defined as an occupation that requires extensive education or a calling that requires
special knowledge, skill, and preparation.
A profession is generally distinguished from other kinds of occupations by
(a) its requirement of prolonged, specialized training to acquire a body of knowledge pertinent to the role
to be performed.
(b) an orientation of the individual toward service, either to a community or to an organization.
(c) ongoing research.
(d) a code of ethics.
(e) autonomy; and
(f) a professional organization.
Two terms related to profession need to be differentiated: PROFESSIONALISM AND
PROFESSIONALIZATION.
Professionalism refers to professional character, spirit, or methods. It is a set of attributes, a way of life
that implies responsibility and commitment. Nursing professionalism owes much to the influence of
Florence Nightingale.
Professionalization is the process of becoming professional, that is, of acquiring characteristics
considered to be professional.
Specialized Education
Specialized education is an important aspect of professional status.
In modern times, the trend in education for the professions has shifted toward programs in colleges and
universities. Many nursing educators believe that the undergraduate nursing curriculum should include
liberal arts education in addition to the biologic and social sciences and the nursing discipline. In the
United States today, there are FIVE means of entry into registered nursing: hospital diploma, associate
degree, baccalaureate degree, master’s degree, and doctoral degree. These programs are discussed in
Chapter 2.
Body of Knowledge
As a profession, nursing is establishing a well-defined body of knowledge and expertise. A number of
nursing conceptual frameworks (discussed in Chapter 3) contribute to the knowledge base of nursing and
give direction to nursing practice, education, and ongoing research.
Service Orientation
A service orientation differentiates nursing from an occupation pursued primarily for profit.
Many consider altruism (selfless concern for others) the hallmark of a profession. Nursing has a
tradition of service to others. This service, however, must be guided by certain rules, policies, or codes
of ethics. Today, nursing is also an important component of the health care delivery system.
Ongoing Research
Increasing research in nursing is contributing to nursing practice.
In the 1940s, nursing research was at a very early stage of development.
In the 1950s, increased federal funding and professional support helped establish centers for nursing
research.
Most early research was directed at the study of nursing education.
In the 1960s, studies were often related to the nature of the knowledge base underlying nursing practice.
Since the 1970s, nursing research has focused on practice related issues.
Nursing research as a dimension of the nurse’s role is discussed further in Chapter 2 .
Code of Ethics
Nurses have traditionally placed a high value on the worth and dignity of others.
The nursing profession requires integrity of its members; that is, a member is expected to do what is
considered right regardless of the personal cost.
Ethical codes change as the needs and values of society change.
Nursing has developed its own codes of ethics and in most instances has set up means to monitor the
professional behavior of its members. See Chapter 5 for additional information on ethics.
Autonomy
A profession is autonomous if it regulates itself and sets standards for its members.
Providing autonomy is one of the purposes of a professional association. If nursing is to have professional
status, it must function autonomously in the formation of policy and in the control of its activity.
To be autonomous, a professional group must be granted legal authority to define the scope of its practice,
describe its particular functions and roles, and determine its goals and responsibilities in delivery of its
services.
To practitioners of nursing, autonomy means independence at work, responsibility, and accountability
for one’s actions.
Autonomy is more easily achieved and maintained from a position of authority.
For example, all states have passed legislation granting NPs supervisory, collaborative, or independent
authority to practice (Phillips, 2010), and currently, 27 states do not require physician oversight of NPs to
practice (Selway, 2012).
Professional Organization
Operation under the umbrella of a professional organization differentiates a profession from an
occupation.
Governance is the establishment and maintenance of social, political, and economic arrangements by
which practitioners control their practice, their self-discipline, their working conditions, and their
professional affairs.
Nurses, therefore, need to work within their professional organizations. The ANA is a professional
organization that “advances the nursing profession by fostering high standards of nursing practice,
promoting the rights of nurses in the workplace, projecting a positive and realistic view of nursing, and by
lobbying the Congress and regulatory agencies on health care issues affecting nurses and the public”
(ANA, 2013a)

B. Nursing
1. Definition
DEFINITIONS OF NURSING
Definitions of Nursing Florence Nightingale defined nursing nearly 150 years ago as “the act of utilizing
the environment of the patient to assist him in his recovery” (Nightingale, 1860/1969).
NIGHTINGALE considered a clean, well-ventilated, and quiet environment essential for recovery.
Often considered the first nurse theorist, Nightingale raised the status of nursing through education.
Nurses were no longer untrained housekeepers, but people educated in the care of the sick.
VIRGINIA HENDERSON was one of the first modern nurses to de fine nursing.
She wrote, “The unique function of the nurse is to as sist 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 6tvffrapidly as possible” (Henderson, 1966, p. 3).’ Like Nightingale, Henderson
described nursing in relation to the client and the client’s environment. Unlike Nightingale, Henderson
saw the nurse as concerned with both healthy and ill individuals, acknowledged that nurses interact with
clients even when recovery may not be feasible, and mentioned the teaching and advocacy roles of the
nurse. In the latter half of the 20th century, a number of nurse theorists developed their own theoretical
definitions of nursing.
Theoretical definitions are important because they go beyond simplistic common definitions.
They describe what nursing is and the interrelationship among nurses, nursing, the client, the
environment, and the intended client outcome: health.
Certain themes are common to many of these definitions:
• Nursing is caring.
• Nursing is an art.
• Nursing is a science.
• Nursing is client centered.
• Nursing is holistic.
• Nursing is adaptive.
• Nursing is concerned with health promotion, health maintenance, and health restoration.
• Nursing is a helping profession
Definition of Nursing Lippincott
1. Nursing is an art and a science.
Science and Art of Nursing Practice fundamentals of nursing
Science and Art of Nursing Practice Because nursing is both an art and a science, nursing practice
requires a blend of the most current knowledge and practice standards with an insightful and
compassionate approach to patient care.
Your patients' health care needs are multidimensional and constantly changing.

Thus, your care will reflect the needs and values of society and professional standards of care and
performance, meet the needs of each patient, and integrate evidence-based findings to provide the
highest level of care.
Nursing has a specific body of knowledge; however, it is essential that you socialize within the
profession and practice to fully understand and apply this knowledge and develop professional
expertise.
Clinical expertise takes time and commitment.

According to BENNER (1984), an expert nurse passes through five levels of proficiency when
acquiring and developing generalist or specialized nursing skills

Expert clinical nursing practice is a commitment to the application of knowledge, ethics,

aesthetics, and clinical experience. Your ability to interpret clinical situations and make complex
decisions is the foundation for your nursing care and the basis for the advancement of nursing
practice and the development of nursing science (Benner, 1984; Benner et al., 1997, 2010).
Critical thinking skills are essential to nursing (see Chapter 15). When providing nursing care,
 you need to make clinical judgments and decisions about your patients' health care needs based
on knowledge, experience, critical-thinking attitudes, and standards of care.

Use critical thinking skills and reflections to help you gain and interpret scientific knowledge,
integrate knowledge from clinical experiences, and become a lifelong learner (Benner et al.,
2010).
Use the competencies of critical thinking in your practice.

This includes integrating knowledge from the basic sciences and nursing, applying knowledge
from past and present experiences, applying critical thinking attitudes to a clinical situation, and
implementing intellectual and professional standards. When you provide well thought out care
with compassion and caring, you provide each patient the best of the science and art of
nursing care
2. Earlier emphasis focused on care of the sick patient; now, the promotion of health is stressed.
3. American Nurses Association (ANA) definition (1980): Nursing is the diagnosis and treatment of the
human response to actual and potential health problems.

Professional nursing associations have also examined nursing and developed their definitions of it. In
1973, the
ANA (American Nurses Association) described nursing practice as “direct, goal oriented, and adaptable
to the needs of the individual, the family, and community during health and illness” (ANA, 1973, p. 2).
In 1980, the ANA changed this definition of nursing to this: “Nursing is the diagnosis and treatment of
human responses to actual or potential health problems” (ANA, 1980, p. 9).
In 1995, the ANA recognized the influence and contribution of the science of caring to be nursing
philosophy and practice.
The current definition of nursing remains unchanged from the 2003 edition of Nursing’s Social Policy
Statement: “Nursing is the protection, promotion, and optimization of health and abilities, preventions of
illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and
advocacy in the care of individuals, families, communities, and populations” (ANA, 2010, p. 10).
Research to explore the meaning of caring in nursing has been increasing.
RECIPIENTS OF NURSING
The recipients of nursing are sometimes CALLED CONSUMERS, sometimes patients, and sometimes
clients.
A consumer is an individual, a group of people, or a community that uses a service or commodity.
People who use health care products or services are consumers of health care. A patient is a person who is
waiting for or undergoing medical treatment and care. The word patient comes from a Latin word
meaning “to suffer” or “to bear.” Traditionally, the person receiving health care has been called a patient.
Usually, people become patients when they seek assistance because of illness or for surgery. Some nurses
believe that the word patient implies passive acceptance of the decisions and care of health professionals.
Additionally, with the emphasis on health promotion and prevention of illness, many recipients of nursing
care are not ill. Moreover, nurses interact with family members and significant others to provide support,
information, and comfort in addition to caring for the patient. For these reasons, nurses increasingly refer
to recipients of health care as clients. A client is a person who engages the advice or services of another
who is qualified to provide this service. The term client presents the receivers of health care as
collaborators in the care, that is, as people who are also responsible for their own health. Thus, the health
status of a client is the responsibility of the individual in collaboration with health professionals. In this
book, client is the preferred term, although consumer and patient are used in some instances.

2. Characteristics
3. Human Responses
For nurses, human response is a complex phenomenon that encompasses the physical, social, emotional,
and spiritual aspects of being. Through the art of being present and the science of evidence-based
interventions, palliative nurses assess, diagnose, and intervene to support or modify these responses in
patients with acute or chronic, potentially life-limiting illnesses and their families to achieve positive
patient outcomes that maximize quality of life and alleviate suffering. As the palliative nurse comes to
know the patient and family in the nurse-patient relationship, the values, beliefs, past experiences, and
goals of all parties emerge and shape future care from symptom management, to advanced directives,
treatment choices, and care at the time of death.
4. Personal and professional qualities of a nurse
Googol
1. Without a foundation of caring, it doesn't matter how good your nursing skills are.
“By far, the number one quality of a good nurse is caring,” Pfeiffer says,” If you do not care about others
and yourself, you cannot be compassionate and provide quality care to others.”
Nurses care for people during some of the most vulnerable and scary times of their lives, and usually act
as the most regular and accessible point of contact for patients and families. A great nurse is able to do
their job effectively while also showing compassion, concern, and sympathy for each individual they
serve.
2. The key to being a successful nurse is communication.
Communication skills are one of the most important requirements of a nurse’s job—both following
directions and communicating with patients and families. Patients who are sick or suffering often are not
in a position of strength to speak up for themselves. Patients and families rely primarily on their nurse for
this kind of support. For a good nurse, being supportive includes being an effective advocate for the
patient when you anticipate a problem or see a concern that needs to be addressed.
“A nurse’s communication skills take many different forms,“ Pfeiffer says. “Their smile is the most
important one. A genuine smile gives a patient a sense of comfort, knowing that their nurse cares about
them."
Of course, nurses have been wearing masks and other PPE since the COVID-19 pandemic began, so
smiles can be a little harder to come by these days.
"Beyond that, there are many communication styles a good nurse knows how to work with, and not all of
them are verbal. A great nurse can communicate in ways that make a patient feel at ease and feel
confident that they will be cared for.”
3. Empathy must be one of your nursing strengths.
Caring, compassion, and empathy sometimes are confused as one and the same, but there is an important
distinction. Empathy is the ability to really hear and share in a patient’s feelings. For a nurse, this doesn’t
mean you always have to agree with what a patient or their family thinks. And for your own self-
preservation, you don’t need to internalize the pain and suffering they may be experiencing. But it is very
important that you listen and try to understand where they’re coming from.
4. A good nurse displays a keen attention to detail.
When it comes to providing medical care, attention to detail is crucial. Even in the most busy, hectic
environment, a good nurse must be detail-oriented, making sure that instructions are followed to the
letter, ensuring proper medication dosages, and keeping accurate records.
In the home care setting, a nurse serves as the detail-oriented coordinator of patient care. A good nurse
will be the first to notice subtle changes in a patient’s medical condition and alert physicians and other
members of a health care team to respond in ways that can avoid a serious adverse health event or
unnecessary hospitalization.
5. Most jobs call for them, but problem-solving skills are also important characteristics of nursing.
Similarly, a great nurse exercises excellent judgment and can think quickly to anticipate and address
problems. Kathleen Pfeiffer tells us, “No two patients are ever the same, so a good nurse is always
solving problems and trying to individualize what is the best care for each patient.”
Being set in one’s ways is not a useful quality for a nurse. Providing excellent health care can be very
dynamic and unpredictable at times. A great nurse is willing and able to be flexible and adapt to any
unforeseen circumstance.
In the day-to-day provision of health care, it is up to nurses to sometimes juggle hectic schedules and
competing demands, to make calm decisions and respond to unexpected events effectively, and often, to
find creative ways to make a difference for patients in the limited time you are able to spend with them.
6. One of the best qualities in a person—but especially a nurse—is respect.
Decision-making on the job can be a delicate balancing act, and when it comes to nursing, respect goes a
long way. Whatever may come, it is important for a good nurse to honor healthy boundaries and respect
all of the diverse people you serve and work with.
A nurse who exercises respect for all coworkers, patients, and families will receive the same in return.
This quality is demonstrated by a professional demeanor, a mindfulness for rules and confidentiality, and
a high regard for each patient’s wishes.
In the home care setting, when a nurse enters a patient’s home, they enter the patient’s life. It is crucial to
get to know each patient and their family as individuals, and to respectfully and unobtrusively work in
concert with their desires and schedules. “We are in our patients’ homes and we must respect their
lifestyle, their environment, and everything they believe in like it is our own,” Pfeiffer says, “Without
respect, you cannot succeed as a home care nurse.”
A great nurse can make each patient feel seen and heard, without judgment, and with a recognition that
each individual has their own valid set of values, life experiences, and perspectives.
7. A successful nurse is a self-aware nurse.
To create a great career in nursing that works for you, it is important to really know yourself. Not every
work environment will be the best fit for you. Some nurses thrive on the excitement of a busy emergency
ward. Others prefer the quieter, longer term, one-on-one attention they can give patients in the home care
setting.

Nursing jobs vary greatly in terms of how emotionally and physically demanding they can be, and in
different ways. A good nurse will enjoy a long and fulfilling career by being self-aware and gravitating to
the kinds of work that best suit their own personality, priorities, interests, and physical stamina.
8. One of the most important nursing strengths is a desire to keep learning.
Medical knowledge and technology are advancing very rapidly, and a great nurse must have a genuine
sense of curiosity to keep working on their professional development, improving their skills, and learning
new things.
“Health care is constantly changing," says Pfeiffer, “and a great nurse changes with it and stays
knowledgeable of all things small or big.”
C. Overview of the Professional Nursing Practice
1. Levels of Proficiency according to Benner
Benner
From Novice to Expert
• Novice: Beginning nursing student or any nurse entering a situation in which there is no previous level
of experience (e.g., an experienced operating room nurse chooses to now practice in home health). The
learner learns via a specific set of rules or procedures, which are usually stepwise and linear.
• Advanced Beginner: A nurse who has had some level of experience with the situation. This experience
may only be observational in nature, but the nurse is able to identify meaningful aspects or principles of
nursing care.
• Competent: A nurse who has been in the same clinical position for 2 to 3 years. This nurse understands
the organization and specific care required by the type of patients (e.g., surgical, oncology, or orthopedic
patients). He or she is a competent practitioner who is able to anticipate nursing care and establish long-
range goals. In this phase the nurse has usually had experience with all types of psychomotor skills
required by this specific group of patients.
• Proficient: A nurse with more than 2 to 3 years of experience in the same clinical position. This nurse
perceives a patient's clinical situation as a whole, is able to assess an entire situation, and can readily
transfer knowledge gained from multiple previous experiences to a situation. This nurse focuses on
managing care as opposed to managing and performing skills.
• Expert: A nurse with diverse experience who has an intuitive grasp of an existing or potential clinical
problem. This nurse is able to zero in on the problem and focus on multiple dimensions of the situation.
He or she is skilled at identifying both patient-centered problems and problems related to the health care
system or perhaps the needs of the novice nurse.

2. Roles and Responsibilities of a Professional Nurse

ROLES AND FUNCTIONS OF THE NURSE
Nurses assume a number of roles when they provide care to clients. Nurses often carry out these roles
concurrently, not exclusively of one another. For example, the nurse may act as a counselor while
providing physical care and teaching aspects of that care. The roles required at a specific time depend on
the needs of the client and aspects of the particular environment.
Caregiver
The caregiver role has traditionally included those activities that assist the client physically and
psychologically while preserving the client’s dignity. The required nursing actions may involve full care
for the completely dependent client, partial care for the partially dependent client, and supportive-
educative care to assist clients in attaining their highest possible level of health and wellness. Caregiving
encompasses the physical, psychosocial, developmental, cultural, and spiritual levels. The nursing process
provides nurses with a framework for providing care . A nurse may provide care directly or delegate it to
other caregivers.
Communicator
Communication is integral to all nursing roles. Nurses communicate with the client, support persons,
other health professionals, and people in the community. In the role of communicator, nurses identify
client problems and then communicate these verbally or in writing to other members of the health care
team. The quality of a nurse’s communication is an important factor in nursing care. The nurse must be
able to communicate clearly and accurately in order for a client’s health care needs to be met
Teacher
As a teacher, the nurse helps clients learn about their health and the health care procedures they need to
perform to restore or maintain their health. The nurse assesses the client’s learning needs and readiness to
learn, sets specific learning goals in conjunction with the client, enacts teaching strategies, and measures
learning. Nurses also teach unlicensed assistive personnel (UAP) to whom they delegate care, and they
share their expertise with other nurses and health professionals. See Chapter 27 for additional details
about the teaching–learning process. Client Advocate A client advocate acts to protect the client. In this
role the nurse may represent the client’s needs and wishes to other health professionals, such as relaying
the client’s request for information to the health care provider. They also assist clients in exercising their
rights and help them speak up for themselves (see Chapter 5 ). Counselor Counseling is the process of
helping a client to recognize and cope with stressful psychological or social problems, to develop
improved interpersonal relationships, and to promote personal growth. It involves providing emotional,
intellectual, and psychological support. The nurse counsels primarily healthy individuals with normal
adjustment difficulties and focuses on helping the person develop new attitudes, feelings, and behaviors
by encouraging the client to look at alternative behaviors, recognize the choices, and develop a sense of
control.
Change Agent
The nurse acts as a change agent when assisting clients to make modifications in their behavior. Nurses
also often act to make changes in a system, such as clinical care, if it is not helping a client return to
health. Nurses are continually dealing with change in the health care system. Technologic change, change
in the age of the client population, and changes in medications are just a few of the changes nurses deal
with daily. See Chapter 28 for additional information about change. Leader A leader influences others to
work together to accomplish a specific goal. The leader role can be employed at different levels:
individual client, family, groups of clients, colleagues, or the community. Effective leadership is a learned
process requiring an understanding of the needs and goals that motivate people, the knowledge to apply
the leadership skills, and the interpersonal skills to influence others. The leadership role of the nurse is
discussed in Chapter 28.
Manager
The nurse manages the nursing care of individuals, families, and communities. The nurse manager also
delegates nursing activities to ancillary workers and other nurses and supervises and evaluates their
performance. Managing requires knowledge about organizational structure and dynamics, authority and
accountability, leadership, change theory, advocacy, delegation, and supervision and evaluation. See
Chapter 28 for additional details
Case Manager
Nurse case managers work with the multidisciplinary health care team to measure the effectiveness of the
case management plan and to monitor outcomes. Each agency or unit specifies the role of the nurse case
manager. In some institutions, the case manager works with primary or staff nurses to oversee the care of
a specific caseload. In other agencies, the case manager is the primary nurse or provides some level of
direct care to the client and family. Insurance companies have also developed a number of roles for nurse
case managers, and responsibilities may vary from managing acute hospitalizations to managing high-cost
clients or case types. Regardless of the setting, case managers help ensure that care is oriented to the
client, while controlling costs. Research Consumer Nurses often use research to improve client care. In a
clinical area, nurses need to (a) have some awareness of the process and language of research, (b) be
sensitive to issues related to protecting the rights of human subjects, (c) participate in the identification of
significant researchable problems, and (d) be a discriminating consumer of research findings.
Expanded Career Roles
Nurses are fulfilling expanded career roles, such as those of NP, clinical nurse specialist, nurse midwife,
nurse educator, nurse researcher, and nurse anesthetist, all of which allow greater independence and
autonomy (see Box 1–2).

3. Scope of Nursing Practice

SCOPE AND STANDARDS OF PRACTICE

When giving care, it is essential to provide a specified service according to standards of practice
and to follow a code of ethics (ANA, 2015). Professional practice includes knowledge from
social and behavioral sciences, biological and physiological sciences, and nursing theories. In
addition, nursing practice incorporates ethical and social values, professional autonomy, and a
sense of commitment and community (ANA, 2010b). The following definition from the
American Nurses Association (ANA) illustrates the consistent commitment of nurses to provide
 care that promotes the well-being of their patients and communities (ANA, 2010a). Nursing is the
protection, promotion, and optimization of health and abilities; prevention of illness and injury;
alleviation of suffering through the diagnosis and treatment of human response; and advocacy in
the care of individuals, families, communities, and populations (ANA, 2010b). The International
Council of Nurses (ICN, 2014) has another definition: Nursing encompasses autonomous and
collaborative care of individuals of all ages, families, groups, and communities, sick or well, and
in all settings. Nursing includes the promotion of health; prevention of illness; and the care of ill,
disabled, and dying people. Advocacy, promotion of a safe environment, research, participation
in shaping health policy and in patient and health systems management, and education are also
key nursing roles. Both of these definitions support the prominence and importance that nursing
holds in providing safe, patient-centered health care to the global community. Since 1960 the
ANA has defined the scope of nursing and developed Standards of Practice and Standards of
Professional Performance (ANA, 2010b). It is important that you know and apply these standards
in your practice (Box 1-2). Most schools of nursing and practice settings have published copies of
the scope and standards of nursing practice. The scope and standards of practice guide nurses to
make significant and visible contributions that improve the health and well-being of all
individuals, communities, and populations (A
PROMOTING HEALTH AND WELLNESS
When health is defined broadly as actualization of human potential, it has been called wellness (Pender,
Murdaugh, & Parsons, 2011, p. 20).
Nurses promote wellness in clients who are both healthy and ill. This may involve individual and
community activities to enhance healthy lifestyles, such as improving nutrition and physical fitness,
preventing drug and alcohol misuse, restricting smoking, and preventing accidents and injury in the home
and workplace. See Chapter 16 for details.
PREVENTING ILLNESS
The goal of illness prevention programs is to maintain optimal health by preventing disease. Nursing
activities that prevent illness include immunizations, prenatal and infant care, and prevention of sexually
transmitted infections.
RESTORING HEALTH
Restoring health focuses on the ill client, and it extends from early detection of disease through helping
the client during the recovery period. Nursing activities include the following:
• Providing direct care to the ill person, such as administering medications, baths, and specific procedures
and treatments
• Performing diagnostic and assessment procedures, such as measuring blood pressure and examining
feces for occult blood
• Consulting with other health care professionals about client problems
• Teaching clients about recovery activities, such as exercises that will accelerate recovery after a stroke
• Rehabilitating clients to their optimal functional level following physical or mental illness, injury, or
chemical addiction.
CARING FOR THE DYING
This area of nursing practice involves comforting and caring for people of all ages who are dying. It
includes helping clients live as comfortably as possible until death and helping support persons cope with
death. Nurses carrying out these activities work in homes, hospitals, and extended care facilities. Some
agencies, called hospices, are specifically designed for this purpose

D. Overview with the Ethico-Moral & Legal Consideration in the Practice of Nursing
1. Patient Bills of Right
2. Informed Consent
3. Data Privacy Law

1. Demonstrates knowledge base on health /illness

2. Formulate own concepts of health, wellness and holism.
3. Compare health concepts as viewed by other disciplines.
4. Discuss the different models of health and illness
III-Concept of Health

A. Definition of terms
1. Health
2. Wellness
3. Illness
4. Disease
B. Health as viewed by other discipline
C. Health-Illness Models
1. Host –Agent -Environment model
2. Holistic Health Model
3. Illness-Wellness Continuum
4. Dunn’s High Level Wellness Model
5. Iceberg Model
D. Levels of Care
1. Health promotion and maintenance
2. Disease prevention
3. Curative
4. Rehabilitative