ncm 100- lecture
TRANSCRIPT
NCM 100- Lecture (3 units) Foundation of Nursing
Course Description: The course provides the students with the overview of nursing as a profession, science, & as an art. It shall include a discussion on the different roles of a nurse emphasizing on
health promotion, illness prevention & utilizing the nursing process as a basis for nursing practice.
Three Main Topics
I. Nursing as a ProfessionII. Nursing as a ScienceIII. Nursing as an Art
Nursing as a Profession Definition of Nursing:It is a caring profession. A unique profession, it is practiced with an earnest concern for the art of care & the science of health.The profession involves a humanistic blend of scientific knowledge, & holistic nursing practice.
Definition of Nursing
The art & science by which people are assisted in learning to care for themselves whenever possible & cared for by others when they are unable to meet their own needs.
Florence Nightingale (1860). The act of utilizing the environment of the patients to assist him in his recovery.
Definition of Nursing
Virginia Henderson (1960). The unique function of the nurse is to assist the individual, sick or well, in the performance of those
activities contributing to health or it’s recovery ( or to peaceful death) that he would perform unaided if he had the necessary strength, will, or knowledge, & to do this in such a way as to help him gain independence as rapidly as possible.
Virginia Henderson (1960). The unique function of the nurse is to assist the individual, sick or well, in the performance of those
activities contributing to health or it’s recovery ( or to peaceful death) that he would perform unaided if he had the necessary strength, will, or knowledge, & to do this in such a way as to help him gain independence as rapidly as possible.
Orem A helping or assisting service to persons who are wholly or partly dependent- infants, children, &
adults- when they, their parents & guardians, or other adults responsible for their care are no longer able to give or supervise their care.
American Nurses Association (ANA;1980) The diagnosis and treatment of human responses to actual & potential health problems.
Canadian Nurses Association (CAN;1984) The identification & treatment of human responses to actual & potential health problems & includes
the practice of & supervision of functions & services that directly or indirectly in collaboration with client or providers of health care other than nurses, have as their objectives the promotion of health, prevention of illness, alleviation of suffering, restoration of health & optimum development of health potential & includes all aspects of the nursing process.
Nursing Is a profession that serves the need of society, in the area of health. The practice of nursing
addresses a wide range of health problems, both actual & potential, requiring of its practitioners a special body of knowledge including skills to meet client needs & a value system that recognizes the client as autonomous human being with rights.
The Philippine Nursing Act
Professional Nursing as the “performance for a fee, salary or other reward or compensation of professional nursing services to individuals, families, communities in various stages of development toward the promotion of illness, restoration of health, & alleviation of suffering through:
Professional Nursing as the “performance for a fee, salary or other reward or compensation of professional nursing services to individuals, families, communities in various stages of development toward the promotion of illness, restoration of health, & alleviation of suffering through: communities & the like settings: Undertaking consultation services & engaging in such other activities that require the use of knowledge & decision-making skill of a registered nurse.
1. Utilization of the nursing process.2. Establishment of connection with community resources & coordination of the heath team.3. Motivation of individuals, families, & communities & coordination of services with other members
of the health team.4. Participation in teaching, guidance & supervision of students in nursing education programs as
well as administering of nursing services in varied settings such as homes, hospitals,5. Undertaking nursing & health manpower development training & research & soliciting finances,
therefore, in cooperation with the appropriate government & private agencies.”Concepts of Profession Is a calling, an occupation that requires special knowledge, skill & preparation. A profession is generally distinguished from other kinds of occupation by: a) its requirement of
prolonged, especialized 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 team organization.
FOUR GREAT PERIODS IN NURSING:
1.INTUITIVE:UNTAUGHT,INSTINCTIVE. It dated from prehistoric times; was practiced among primitive tribes and lasted through the Christian era. It was performed out of feeling of compassion for others, out of desires to help and out of a wish to “do good”.
2.APPRENTICE: on-the-job training, without formal education. It extends from the founding of religious nursing orders in the 6th century, through the Crusades which means bean in the 11th century, to 1836.
3.EDUCATED: June 1860 when Nightingale School of Nursing opened in London. Forma education for nurses.
4. CONTEMPORARY: Began at the end of World War II.INTUITIVE:Reference to nursing was mother role because pre-historic man was a nomad who had to search
for food and shelter. Philosophy then was self-preservation Cause of illness was invasion of victim’s body by an evil spirit Trephine is drilling a hole in the skull with a rock or stone to remove the evil spirit without the
benefit of anesthesia Shaman or witch doctor – had the power to heal by using white magic, but he also had the
ability to inflict greater harm through black magic. Nurse’s role: instinctive – directed towards comforting, practicing midwifery and being wet
nurse to a child without training or direction.Near East:
A. Babylonia
King Hammurabi – codified Babylonian Laws Code of Hammurabi – medical regulations established. Discouraged
experimentation, designed doctors for each diseases, and patients were given the choice between the use of charms and medicine or surgery and cure of his disease.
History of Nursing
Ancient Civilization: The evolution dated back to 400 BC to primitive societies in which mother nurse worked with the priest. In 200 BC , the use of wet nurses is recorded in Babylonia. During this time, beliefs about the cause of disease were embedded in superstitions & magic, caused by
angry spirit(demons) Treatment : exorcism, drugs obtained from plants, fruits, animals.
B. Egypt:Herodotus Time: 485 – 425 B.C., neurosurgery was advanced. Imhotep – Chief physician and advisor to Pharaoh, contributions in architecture, care of the sick and
formulated wise proverbs. Greeks believed in life after death Developed the ability to make clinical observation Healthiest of all countries because of Hygiene principles Exhibited careful planning to meet certain community needs and avert public health problems. Art of Embalming – for human anatomy but since done on dead, they learn nothing in physiology.C. Hebrew:
Leviticus: Laws controlling the spread of communicable diseases Judaic Covenant with God directing the ritual of circumcision of the male child on the 8 th day. Mosaic Code – “Physical purity is equivalent to moral purity” Reference to nurses are midwives and wet nurses Music Therapy: David played the harp for King Saul when depressed Aaron – The High Priest as physician of the people Moses – father of sanitation
Far EastA. China:
Belief in spirits and demons Practice of ancestor worship prohibiting dissection of human body Materia Medica (Pharmacology) – 52 volumes of Chinese Medicine Huae To – exponent of acupuncture Emperor Shen Nung – father of Chinese Medicine Diagnosis was made on the basis of the “Pulse Theory” Yang and Yin Theory – established some scientific basis for disease Yang (Male principle) – positive, active, fiery and full of life Yin (Female Principle) – negative, cold, weak, dark, an lifeless
B. India:
Built hospitals, practiced asepsis Proficient in medicine and surgery First reference to nurses taking care of the sick Writings of Sushurutu – found a list of functions and qualifications of the nurses Medical practice declined with the fall of Buddhism Diet was according to patient’s condition
India Early hospitals were staffed by male nurses who were required to meet 4 qualifications:
Knowledge of drugs Cleverness Devotedness to patient Purity of mind & body.
C. Greece:
Nursing was the task of untrained slave. Caduceus – insignia of the medical profession, associated with Aesculapius “father of Medicine”
in Greek Myth Hippocrates – Father of Medicine Practices that brought about cure were rest, wholesome food, physiotherapy fresh air, sunshine
Greek medicine Two kinds of refuges for the sick:1. Secular- directed by physicians. Which corresponds roughly to our spas or health resorts of today.2. Religious institutions-governed by priests. Prietesses attended to patients who were housed in the
temple. They were known for their practice of gods & goddesses.
Apollo- of health; Aesculapius –god of healing Hygeia- goddes of health.
D. Rome( early Christian church & hospital)
Illness was a sign of weakness Sick was left to care of slaves Evidence of specialization Translation of Greek medical terms to Latin Celsius – his concept of cardinal signs of inflammation: redness, swelling, heat, pain Christianity – value life and equality
a. Phoebe – first visiting nurseb. Fabiola – her home was the first hospital in the Christian World
APPRENTICE:
Medicine in Europe was under two influences – lay medicine and ecclesiastical medicine During the middle ages, thousands of years after the death of Christ, three organizations were
developed – military orders, regular vows (with vows) and the secular orders (without vows) Nursing care performed by people who are directed by more experienced nurses
Europe:
A. Crusades: (began before 1100-1300 Military religious orders founded during the Crusades. Established hospitals and staffed
them with men who served as nurses.B. Military Orders (Knight Hospitaliers)
Knights of St. John – established organization of rank and the principles of complete and unquestioned devotion of duty
Teutonic Knights – German equivalent of St. John Knight of St. Lazarus – for lepers Alexian Brothers – one of the largest school of nursing under religious auspices operated
exclusively for men in the US.C. Secular Orders – the work of these nurses was complicated by religious taboos and the social restrictions of
their cultures and education Augustinian Sisters Third Order of St. Francis Order of St. Vincent de Paul Ladies of Charity Benedictines
Order nuns prayed with and took care of patient; younger ones washed soiled linens
D. Regular Orders: These religious orders gave rise to nursing saints:1. St. Catherine of Siena – Original Lady with a Lamp2. St. Hildegarde – prescribed cures and was supposed to have performed miracles3. St. Elizabeth of Hungary –”Patroness of Nurses”
Care of the sick were performed mainly by volunteers who devoted themselves to nursing.
Renaissance : 14-15-17th century the period of great revival of learning. Forerunners of the great development during this period were:
Leonardo da Vinci- anatomical studies, described muscle & arteries. Andreas Vesalius- described human anatomy. William Harvey- discovered how blood circulates. Ambroise Pare- surgeon, developed principles of surgery.
During this period, nursing reached a high level of organization & efficiency with religious & military orders.
Because of renewed interest in science, universities were established, but no formal nursing schools were founded.
Women continued to fullfill the traditional role of nurturer & caregiver in the home.Reformation (1600) religious movement that aimed in reforming the Roman catholic church &
resulted in establishing the Protestant Churches.Religious upheaval of the 16th century which destroyed the unity of Christian faith in Europe Transition from medieval to modern civilization which left the world with the following:
a. Economic changesb. political changesc. cultural changes
Reformation: 17th to 19th century, nursing sank to its lowest levels. This is the DARK Period of Nursing.
Crimean War: FLORENCE NIGHTINGALE took care of wounded soldiers, believed that a clean environment played an important role in early recovery.
Nursing during the Civil War: Early American Nursing
Miss Dorothy Dix, though not a nurse, as appointed Superintendent of Female Nurses, and got together the first Nurse Corps of US Army
Clara Barton was president of the American Association of the Red Cross in the District of Colombia
Period of Educated Nursing This period began on June15, 1860 when the Florence Nightingale School of Nursing opened at St.
Thomas Hospital in London (St. Thomas School of Nursing). The development of nursing during this period was strongly influenced by:
Trends resulting from wars From arousal of social consciousness From the emancipation of women From the increased educational opportunities offered to women.
FLORENCE NIGHTINGALE: Recognized as the “Mother of Modern Nursing”; known as the “Lady with the Lamp”. Born on May 12, 1820 in Florence Italy Raised in England in an atmosphere of culture & affluence. Learned languages, literature, mathematics, & social graces. Her education was rounded out by a continental tour. Not contented with social custom imposed upon her as a Victorian Lady, she develop her self-appointed
goal: “To change the profile of Nursing”.
Compiled notes of her visits to hospitals, her observation of the sanitary facilities & social problems of the places she visited.
Noted the need for preventive medicine & good nursing. Advocated for care of those afflicted with diseases caused by lack of hygienic practices. At the age of 31, she overcame the family’s resistance.
She entered the Deaconess School at Kaiserwerth , Germany- where she received training for three months.
In 1853- studied in Paris with the sister of Charity –after which she returned to England, & worked as a superintendent of a charity hospital for ill governesses.
Disapproved of the restrictions on admission of patients & considered this as unchristian & incompatible with health care.
Upgraded the practice of nursing & made nursing an honorable profession for gentlewomen.
Led the nurses that took care the wounded during the Crimean War.(1854-1856) She implemented her principles in the areas of nursing practice & environmental
modification resulted in reduced morbidity & mortality during the war. As a result of her experiences , she forged the future of nursing education, she believed
that nurses should be formally educated & should function as client advocates. 1860 establishment of the Nightingale Training School of Nurses. Put down her ideas in two published books: Notes in Nursing and Notes on Hospitals.
The Nightingale PledgeI solemnly pledge myself before God,and in the presence of this assembly,to pass my life in purity & to practice my profession faithfully.I will abstain from whatever is deleterious and mischievous, and will not take or knowingly
administer any harmful drugs.
I will do all in my power to maintain and elevate the standard of my profession, and will hold in confidence all personal matters committed to my keeping and all family affairs, coming to my knowledge in the practice of my profession,
With loyalty, Will I endeavor to work closely with the health team, and devote myself to the welfare of those committed to my care.
So help me GOD.
Nightingale Pledge was written in 1893 by: Canadian born Lystia Grette- principal of the Farrand Training School for Nurses in Detroit.
It reflects Nightingale’s philosophy & styles.
EDUCATED: Established of the Nightingale System of Nursing for improve nursing practice. First decade of the 20th century: age of specialization. Standard curriculum for nursing was prepared by the National League for Nursing Education between 1913 & 1937.
Early Schools:1. Bellevue Training School of Nurses in NY.2. Connecticut Training School of New Haven, Conn3. John Hopkins in Baltimore, MarylandLeaders:1. Linda Richards – instituted the system of keeping records and orders. The first graduate nurse in the US
2. Isabel Hampton Robb – standardized nursing education programs and prepared teachers’ instruction in schools of nursing3. Mary Adelaide Nutting – had a unique collection of works on the history of nursing4. Lilian Wald – first President of the National Organization for Public Health Nursing5. Isabel Maitland Stewart – first nurse to receive an MA degree6. Mary Elizabeth Mahoney – first professional black nurse in the US7. Florence Nightingale – stated that environment played an important role in man’s health
Period of contemporary Nursing
This period covers the period after World War II to the present.Scientific & technological developments as well as social changes mark this period.- The United Nations was created in 1945. Under this was the World Health Organization, created to fight
diseases by providing health information and improving the living standards of all people
- WHO – was formed to assist in fighting disease by providing health information and improving the nutrition, living standards and environmental conditions for all people.Use of atomic & nuclear energy for medical diagnosis & treatment.Utilization of computers for collecting data, teaching etc.The advent of space medicine also brought about the development of aerospace nursing.Health is perceived as a fundamental human right .Nursing involvement in community is greatly intensified.Development of the expanded role of nurses.
History of Nursing in the PhilippinesEarly Beliefs & Practices1. ANCIENT TIME
Care of the sick was based on mythical superstitions and mythical background. Disease and death were said to be god-given in a way of punishment. People found relief from pain or illness from herbs, roots and tubers without knowing the
principles People were graced with amulates to subdue the spirits that caused illness Persons with powers to expel demons can drive away evil spirits (Herbolarios)
Early care of the sickThe early Filipinos subscribed to superstitious beliefs & practices in relation to health & sickness.Herbmen were called “herbicheros” meaning the one who practiced witchcraft.Persons suffering from diseases without any identified cause were believed to be bewitched by the “mangkukulam” or “mangagaway”
Difficult childbirth & some diseases (called “pamao”) were attributed to “nonos”. Midwife assisted in childbirth. During labor, the mabuting hilot (good midwife) was called in. If the birth became difficult witches were supposed to be the cause. Spanish Regime The religious orders exerted effort to care for the sick by building hospitals. Earliest Hospitals Established:1. Hospital Real de Manila (1577)- to care for the Spanish King’s soldiers & Spanish civilians.2. San Lazaro Hospital (1578)- was built exclusively for patients with leprosy. Hospital de Indio (15 86)-established by the Franciscan Order; service was supported by alms &
contributions from charitable institutions. Hospitals de Aguas Santas (1590) estabished in Laguna, near a medicinal spring. San Juan de Dios Hospital (1596). Founded by the brotherood of Misericordia ; support was derived
from alms & rents; rendered general services to the public. Nursing began during the Revolution against the Spanish Sovereignty in 1896. Filipino women volunteered to take care of the sick & the wounded Filipino soldiers. Humanitarian work Concept of Nursing-as the taking care of the sick & the injured .
Prominent Women involved in Nursing Work Josephine Bracken, wife of Jose Rizal, installed a field in an state house in Tejeros: provided nursing
care to the wounded,night & day. Rosa Sevilla de Alvero. Converted their house into quarters for the filipino soldiers, during the
Philippine-American War that broke out in 1899.
Filipino Red Cross Malolos, Bulacan was the location of the National head quarters. Established branches in the provinces. Functions:1. Collection of war funds & materials through concerts, charity bazzars, & voluntary contributions.2. Provision of nursing care to wounded fil. soldiers
Requirements for membership:1. At least 14 y/o, age requirement for officer was 25y/o.2. Of sound reputation.
INTUITIVE:Reference to nursing was mother role because pre-historic man was a nomad who had to search for
food and shelter. Philosophy then was self-preservation Cause of illness was invasion of victim’s body by an evil spirit Trephine is drilling a hole in the skull with a rock or stone to remove the evil spirit without the
benefit of anesthesia Shaman or witch doctor – had the power to heal by using white magic, but he also had the ability
to inflict greater harm through black magic. Nurse’s role: instinctive – directed towards comforting, practicing midwifery and being wet nurse
to a child without training or direction. Dona Hilaria de Aguinaldo. Wife of Emilio Aguinaldo; organized Filipino Red Cross under the
inspiration of Apolinario Mabini. Dona Maria Agoncillo de Aguinaldo. Second wife of Emilio Aguinaldo; provided nursing care to
Filipino soldiers during the revolution. President of the Phil. Red Cross in Batangas. Melchora Aquino (Tandang Sora). Nursed the wounded soldiers, gave them shelter & food. August, 1898- there was a great need for doctors & nurses to help prevent the recurring epidemic
of communicable diseases. 1906- strong agitation for establishment of nursing schools began. Capitan Salome. A revolutionary leader in Nueva Ecija, provided nursing care t the wounded, when
not in combat. Agueda Kahabagan. Revolutionary leader in Laguna, also provided nursing services to her troops. Trinidad Tecson.”Ina ng Biac Bato”, stays in the hospital at Biac na Bato to care for the wounded
solders.
Hospitals & Schools of Nursing1. Iloilo Mission hospital School of Nursing (Iloilo City, Aug. 19060)- ran by the Baptist Foreign
mission Society of America. Established when the American system of education was just introduced in the country. Miss rose Nicolet- waa the first superintendent- who was a graduate of
New England Hospital for Women & Children in Boston, Massachusetts. Miss Flora Ernst -American nurse, took charge in 1942. 1909-graduated the ist class of trained nurses. 1944- 22 nurses graduated & took the first board exam held in Iloilo Mission Hospital.2. St. Paul’s Hospital School of Nursing (Manila,1907) Established by the Archbishop of Manila, located in Intramuros & provided general hospital
services. It had a free dispensary & dental clinic. Training School for nurses opened in 1908, with Rev. Mother Melanie as superintendent & Miss E
chambers as Principal.3. The Philippine General Hospital School of Nursing (1907) Began in 1901 as a small dispensary- mainly for “civil officers & employees” in Manila & later
grew into Civil Hospital. 1906, Mrs Mary Coleman Masters, an educator advocated for idea of training Filipino girls for the
profession of Nursing. 1907, with the support of Governor General Forbes & the Director of Health among others,
opened classes in nursing under the auspices of the Bureau of Education Admission was based on entrance examination. The applicant must have completed elementary education to seventh grade. Julia Nichols & Charlotte Clayton taught nursing subjects & American physicians served as lecturers. 19010,Act No. 1976 modified the organization of the school, placing it under the supervision of the
Director of Health. The civil hospital was abolished, & became the Philippine General Hospital. The school became known as the Philippine General Hospital school of Nursing. Elsie McCloskey Gaches became the chief nurse, & introduced several improvements, that made
nursing attractive & more practical. Anastacia Geron Tupas- the first Filipino nurse to occupy the position of chief nurse &
superintendent in the country.
4. St. Luke’s Hospital School of Nursing (Quezon City,1907) It began as a small dispensary in 1903. 1907, the school was opened with three Filipino girls admitted. These girls had their first year in
combined classes with PGHSN & SPHSN Helen Hicks was the first principal. Vitallana Beltran was the first Filipino superintendent. Dr. Jose Fores was the first Filipino medical director 1907-1910- the period of reorganization, the first year nursing students of PGHSN, SLHSN, SPHSN had a
common first year course-known as the Central School idea in nursing education. They were later own fused in one class, lived in a dormitory, & received the same instruction in
anatomy & physiology, massage, practical nursing, materia medica, bacteriology & English. The three schools agreed on how students were selected.1. Educational preparation, at least completion of seventh grade.2. Sound physical & mental health.3. Good moral character.4. Good family & social standing.5. Recommendations from three different persons well known in the community.5. Mary Johnston Hospital & School of Nursing (Manila, 1907)Funded by Methodist mission The nurses training course began with three fil. young girls from elementary grade, which was
organized by Sr. Rebecca Parrish together with the registered nurses Rose Dudely & Gertrude Dreisback.
It was burned down in 1945 & was reconstructed in 1947. Mis Librada Javalera was the first fil. Director of the school.
6. Philippine Christian Institute Schools of Nursing The United Christian Missionary Society of Indianapolis, Indiana, a Protestant organization of the
Disciples of Christ, operated three schools of nursing:1. Salle Long Road Memorial Hospital School of Nursing (Laog, Ilocos Norte, 1903)2. Mary Chiles Hospital School of Nursing (1911)3. Frank Dunn Memorial Hospital (Vigan, Ilocos Sur,19127. San Juan de Dios hospital School of Nursing ( Manila, 1913) The school was opened through the initiative of Dr. Benito Valdez. The school is run by the Daughters of Charity since then Sister Taciana Trinanes was the first directress of the school. 8. Emmanuel Hospital School of Nursing (Capiz,1913) The school offered a three year training course for an annual fee of P100.00. Miss Ciara Pedrosa was the first filipino principal.9. Southern Islands School of Nursing (cebu,1918) Anastacia Giron-Tupas organized the school. Visitacion Perez was the first principal. 10. Other schools of Nursing established: Zamboanga General Hospital school of Nursing (1921) Chinese General Hospital school of Nursing (1921) Baguio General Hospital school of Nursing (1923) Manila Sanitarium & Hospital school of Nursing (1930) St. Paul’s school of Nursing in Iloilo city(1945)
The first Colleges f Nursing in the Philippines1. University of Santo Thomas college of Nursing (1945) The college began as the UST School of Nursing Education on feb. 11,1941 Manila central University college of Nursing (1947) University of the Philippines College of Nursing (1948) Julita Sotejo was the first dean
Nursing Leaders in the Philippines1. Anastacia Giron-Tupas- the first fil. Nurse to hold the position of Chief Nurse Suprintendent;
founder of PNA.2. Cesaria Tan. First fil. to receive a Mastrs degree in Nursing Abroad.3. Socorro Sirilan. Pioneered in Hospital Social Service in San Lazaro Hospital where she was the
Chief Nurse.4. Rosa Militar. A pioneer in school health Education.5. Sor Ricarda Mendoza. A pioneer in nursing education6. Socorro diaz. First editor of the PNA magazine called the “Message”.7. Conchita Ruiz. First full- time editor of the newly named PNA magazine “the filipino Nurse”8. Loreto Tupaz. “Dean of the Philippine Nursing”; Florence Nightingale of Iliolo
Far EastA. China:
Belief in spirits and demons Practice of ancestor worship prohibiting dissection of human body Materia Medica (Pharmacology) – 52 volumes of Chinese Medicine Huae To – exponent of acupuncture Emperor Shen Nung – father of Chinese Medicine Diagnosis was made on the basis of the “Pulse Theory” Yang and Yin Theory – established some scientific basis for disease Yang (Male principle) – positive, active, fiery and full of life Yin (Female Principle) – negative, cold, weak, dark, an lifelessNURSING LEADERS:
1. Annie Sand- Chief Nurse of the San Lazaro Hospital in Manila2. Loreta Tupaz- “Dean of Philippine Nursing”, Florence Nightingale of Iloilo3. Jovita Sotejo- Graduate of PGH 1929, elevated nursing education to its professional level4. Maria Tinawin- Chairman, Board of Examiner for Nurses5. Anastacia Giron- Tupas- Superintendent and Chief Nurse of PGH, founder of PNA6. Leah Samaco- Paquiz- Present PNA President7. Dean Carmelita Divinagracia- President ADPCN8. First BON that gave the first nurse exam- Dr Juan Cabarrus, Belen del Rosario, Anastacia Giron-
Tupas The first Nursing Law –Act No. 2808 .An act Regulating the Practice of Nursing Profession in the
Philippines Islands. June 1919 nurses were registered without taking the examination. June 1920. the first Nursing Board Examination. Definition:
Profession – is an occupation or calling requiring advanced training and experience in some specific or specialized body or knowledge which provides service to society in that special field.
Characteristics & Attributes of a Professional Person
Profession
A calling in which members profess to have acquired special knowledge, by training or experience or both, so that they may guide, serve or advice others in that special field
1. Is concerned with quality. He/she possesses competence to practice the profession in terms of scientific knowledge, technological skills & desirable attitudes & values.
2. Is self-directed, responsible & accountable for his/her actions.3. Is able to make independent & sound judgment including high moral judgment.4. Is dedicated to improvement of life.5. Is committed to the spirit of inquiry. Demonstrates zest for continued studies including research
which will steadily increase & improve knowledge, skills & attitude needed by the profession.Nursing as a Profession6. Education. A profession requires an extended education of its members, as well as basic liberal
foundation.7. Theory. A profession has theoretical body of knowledge leading to defined skills, abilities & norms.8. Service. A profession provides basic service.4. Autonomy. Members of a profession have autonomy in decision making & in Practice.5. Code of Ethics. The profession as whole has a code of ethics for practice.6. Caring. The most unique characteristic of nursing as a profession is that, it is a CARING profession.
Flexner’s Criteria for a Profession compared with Nursing.
Patterns of Developing Profession Nursing Profession
Profession are basically intellectual Nurses are educated institution of higher learning & function in a responsible & accountable manner. Critical thinking is being emphasized to a great extent at all levels of nursing function.
Profession are based on a specific body of knowledge that can be learned. Nursing has identified and continues to develop its own
specific body of knowledge from which nursing practice emerges. Application of theory derived from research provides the rationale for action.
Professions are practical as well as theoretical. Nursing professionals accept great responsibility for providing for people’s healthcare needs. The profession evolved in response to needs identified by society and is guided by an ethical code.Professional work can be taught through
professional educationNurses are educated primarily in different types of degree programs – baccalaureate degree and advanced nursing degree programs (Master’s degree and Doctorate degree).Professions have strong internal
organization.
Practitioners are guided by altruism.
The Philippines Nurses Association (PNA) and other bodies provide internal organization
Many nurses enter the profession out of a desire to help others.
Benner’s Stages of Nursing Expertise
Stage I –Novice No experience Performance is limited, inflexible, governed by context-free rules & regulations, rather than
experience. Stage II –Advanced Beginner
Demonstrates marginally acceptable performance. Recognizes the meaningful “aspects” of real situation. Has experienced enough real situation to make judgements about them.
Stage III-Competent Has 2-3 years experience Demonstrates organizational & planning abilities. Differentiates important factors from less important aspects of care.
Stage IV-Proficient Has 3-5 years experience Perceives situation as whole rather than as parts. Uses maxims as guides for what to consider in a situation. Has holistic understanding of the client, which improves decision making. Focuses on long term goals.
Stage V- Expert Performance is flexible & highly proficient No longer requires rules, guidelines or maxims to connect an understanding of the situation to
appropriate action. Demonstrates highly skilled intuitive & analytic activity in new situations. Is inclined to take certain action because it felt right.
Professional Nurse Is one who has acquired the art and science of nursing through her basic education, who
interprets her role in nursing in terms of the social ends for it exists - the health and welfare of society and who continues to add to her knowledge, skills, and attitudes through continuing education and scientific inquiry (research) or the use of the results of such inquiry.
Professional Nurse – is a person who has completed a basic nursing education program and is licensed in his / her country or state to practice professional nursing.
Qualifications and Abilities of a Professional Nurse Professional preparation:
1. Have a license to practice nursing in the country2. A Bachelor of Science degree in Nursing3. Be physically and mentally fit
Personal Qualities and Professional Nurse
Professional proficiencies:1. Interest and willingness to work and learn with individuals/groups in a variety of setting.2. A warm personality and concern for people.3. Resourcefulness and creativity as well as well-balanced emotional condition4. Capacity and ability to work cooperatively with others.5. Initiative to improve self and service.6. Competence in performing work through the use of nursing process.7. Skill in decision-making, communicating, and relating with others and being research oriented.8. Active participation in issues confronting nurses and nursing.
Basic Educational Program in Nursing Before 1983, Basic three-year hospital-based program leading to the title Graduate in Nursing Until 1983, Only basic educational program in nursing ~ the four-year collegiate degree leading to
the Bachelor of Science in Nursing (BSN). Council of Deans Philippine Colleges of Nursing Department of Education Nursing Practitioners1998-1999: Effective Enforcement of the common two- year Associate in Health Science Education
(AHSE). The BSN intends to produce a professional nurse who demonstrates the ff. behaviours:1. Caring behaviours ( compassionate, committed, competent, & confident).2. Ability to practice legal, ethico-moral, social responsibilities & accountabilities.3. Critical & creative thinking4. Skills in practicing KSA for the promotion of health, prevention of illness, restoration of health,
alleviation of sufferings & assisting client to face death with dignity & in peace. Professional NursingIs an art and a science, dominated by an ideal of service in which certain principles are applies in the
skillful care of the well and the ill, and through relationship with the client/patient, significant others, and other members of the health team.
The performance for salary or remuneration, of professional nursing service, particularly that of
diagnosing and treating human responses and potential health problems. Types of Educational Program1. LPN/LVN Program
Lasts 9 or 12 months ( classroom & clinical practice. A graduate takes the NCLEX-PN to obtain license. Practice is under the supervision of an RN. Provide basic technical care to client.
2. Registered Nursing Program Diploma Program patterned after Florence Nightingale.
3. Associate Degree Program First & only program for nursing that were systematically developed from planned research &
controlled experimentation.4. Baccalaureate Program
First school of nursing in a university setting. 2 years of liberal arts & basic 3 year diploma prog.
5. Graduate Nursing Program Master’s Program-(1.5-2years) provides specialized knowledge & skills that enable nurses to assume
advanced roles in practice, education administration & research. Doctoral Program (PhD, DNS) emphasis is on theory development; research.Nursing Practice Nurses practice in an ever- increasing variety of ways & setting. The focus of all nursing practice is the client, who may be an individual, family. Group or community. RA No. 9173- Philippine Nursing Act- an act providing for a more responsive nursing profession, repealing
for the purpose RA No.7164, otherwise known as the “the Philippine Nursing Act of 1991”. The Recepients of nursing1. Consumer- people who use health care products or services are consumer of health.2. Patient- a person who is waiting for or undergoing medical treatment & care; traditionally we call them
patients when they seek assistance because of illness or for surgery.3. Client- a person who engages the advice or services of another who is qualified to provide care or to
provide this services. Refers as the receivers of health care less as passive recepients & more as collaborators in the care,
that is a person who are responsible for their health.
Different Fields of Nursing
1. Institutional Nursing- nursing in hospitals & related health facilities. The nurse provides direct nursing care, using the nursing process & critical thinking skills. The nurse participates in all phases of patient care of the acutely ill, the convalescing & the
ambulatory patient.2. Community Health Nursing/Public Health Nursing. Public Health Nursing- focus requires understanding the needs of a population, or a collection of
individuals who have in common one or more personal or environmental characteristics. Community Health Nursing- is a nursing approach that merges knowledge from the public health
sciences with professional nursing theories to safeguard & improve the health of population in the community.
3. School Health Nursing. they are responsible for the school’s activities in the areas of health service, health
education & environmental health & safety.4. Occupational health Nursing/Industrial Nursing. Provides & delivers health care services to workers. The practice focus on promotion, protection &
supervision of workers’ health within the context of safety & healthy work environment.5. Private Duty Nursing. Nurses in private practice, who undertakes to give a comprehensive nursing care to a client on one-
to-one ratio. She/he is an independent contractor. General Private Duty Nurse Private Duty Especialist
6. Nursing Education. Role can be developed in many settings including schools of nursing & hospital staff development
departments.7. Military Nursing (The Nurse Corps) Provides comprehensive & quality nursing care to all military personnel, dependents & authorized
relative. Flight Nursing or Aero- Space Nursing. Responsible for patients, military or otherwise, who have
been evacuated from battle areas to the nearest installation for treatment.
8. Clinic Nursing. Requires that a nurse possesses general skills. The nurse acts as a receptionist, answers phone, does
the billing, takes x-rays, ECG, changes dressing & assist in physical examination.9. Advanced Nursing Practice. The field of nursing synonymous with specialization. For example clinical nurse specialist or a nurse
specialist, nurse clinician or clinical specialist. Expanded Nursing Roles1. Nurse Practitioner (NP)- has advanced education (at least MA) & is a graduate of nurse practitioner
program. Nurse practitioner function with more independence & autonomy than other nurses. They are highly skilled in performing nursing assessment, PE, counseling, teaching, & treating minor
health problems.2. Clinical Nurse Specialist (CNS). Has MA & may have advanced experience in specialized area of
practice (e.g.,Gerontology, Pediatric, Critical Care, Oncology0. Clinical nurse specialists work in various settings, depending on their specialty. Roles of clinical nurse specialists include clinician, educator,, manager, consultant & researcher.3. Nurse Midwife. Is educated in Nursing & midwifery & is licensed.4. Nurse Anaesthetist. Provides general anaesthesia for clients undergoing surgery, under the
supervision of a physician prepared in anaesthesiology. Nurse anaesthetist are the RNs with advanced education in anaesthesiology.5. Nurse Researcher. Is responsible for the continued development & refinement of nursing knowledge
& practice through investigation of nursing problems. 6. Other Opportunities Immigration (USA, Canada ) Short Term Employment.
Nurses who work in Germany, Vienna, Saudi Arabia, & other middle East countries are not required to take the board exam.
Entrepreneurship. Day Care Special school Geriatric Care
Roles & Functions of a Professional Nurse
1. Care Provider. Referred as the mothering actions in nursing. The nurse supports the client by attitudes & actions that show concern for client welfare & acceptance
of the client as a person. The nurse s primarily concerned with the client’s needs.2. Communicator. Effective communication is an essential element of all helping profession. Communication shapes relationships between nurses & clients. The nurse communicates with clients, supports person & colleagues to facilitate all nursing actions.3. Teacher. The nurse provides health teaching to effect behaviour change which focuses on acquiring
new knowledge or technical skills.4. Counselor. Counselling –is the process of helping a client to recognize & cope with stressful psychologic or social
problems, to develop improve interpersonal relationships & to promote personal growth. This role includes providing emotional, intellectual & psychologic support. Counselling is done to help client increase their coping skills. 5. Client Advocate- the nurse promotes what is best for the client, ensures that client’s needs are met,
protects the client’s right.6. Change agent. The nurse initiates changes & assists the client make modifications in the lifestyle to
promote health. This involves the use of nursing process, & will help the client to propose, implement & maintain
change that promote the client’s change. 7. Leader. The nurse through the process of interpersonal influence helps the client make decision in
establishing & achieving goals to improve his well being.8. Manager. The nurse plans, gives direction, develop, staff, monitors operations, gives rewards fairly, &
represents both staff members & administration as needed.9. Team member/collaborator. A vital role of a nurse. The nurse works in a combined effort with all those
involved in care delivery.
10. Researcher. The nurse participates in scientific investigation & uses research findings in practice.11. Case Manager. The nurse coordinates the activities of other members of the health team, such as
nutritionists & physical therapist, when managing a group of client.12. Resource Person. The nurse function as a resource person by providing skilled intervention, &
information.
Ethico-Moral-Legal Responsibilities in Nursing Safe & compassionate nursing practice includes an understanding of the ethico-moral &
legal boundaries within which nurses must function. To be able to determine what is good or valuable for all people & to judge what is right &
wrong. The nurse must understand the law to protect themselves from liability & to protect
their client’s right. Ethics – a branch of philosophy that examines differences between right & wrong.
(study of morality). Refers to expected standards of behaviour of a particular group.(professional ethics). It came from the Greek word ethos which means moral duty. Morals- are specific ways of behaviour or of accomplishing ethical practices. Morality derived from the Greek word moralis which refers to social consensus about
moral conduct for human beings & society. Ethical problems are created as a result of;
Changes in the society Advances in technology Conflicts within the nurses role itself Nurses conflicting loyalties & obligation.
As technology, has expanded the role of the nurse, the ethical dilemmas associated with the client care have increased & often become legal issues as well.
Nurses familiarity with ethico-moral-legal implications of nursing enhances their ability to be client advocate.
Nurse’s Ethical Decision are influenced by:1. Role perception & responsibilities. Nurses are responsible for determining their own action & for
supporting clients who are making ethical decision. What is a good decision?2. Moral theories. Teleology- looks to the consequences of an action in judging whether the action is right or wrong. Deontology or duty oriented theory.
Ethical theory that considers the intrinsic significance of the act itself as criterion for determination of right or wrong.
The morality of a decision is not determine by its consequences.3. Moral Principles. can be used as guidelines in analyzing dilemmas, they can also serve as justification for the resolution
of ethical problems.4. Nursing Code of Ethics. A formal statement of a group’s ideals & values.
Provide direction for nurses to act morally.5. Cognitive Moral Development- ethics problems requires nurses to think & reason in making decisions,
judgment & choices.6. Values, Beliefs, & Attitudes. Nurses should be aware of their values. Moral Principles When a nurse is confronted with situations where moral judgment is necessary, the nurse may be guided
by the following principles or rules:
1. The Golden Rule - “Do unto others what you would like others do unto you.” Since nurses like others to treat them kindly and with respect, they should be willing to do same to others too.
2. The Two-fold Effect – when a nurse is faced with situation which may have both good and bad effects, The basis of action may be the following:
•That the action must be morally good•That the good effect must be willed and the bad effect merely allowed•That the good effect must not come from an evil action but from the initial action itself
directly•That the good effect must be greater than the bad effect.
Examples:•It is not morally good if a boy steals in order to alleviate his hunger because the action
itself is already bad. •If the patient who has a cancer of the uterus submits to hysterectomy she will not be able
to bear a child. If she does not have the operation, she will die. It is the gynecologist’s intention to help the mother and not to harm her. The surgeon’s action is morally good since saving the mother’s life is of primary importance. Also the doctor himself did not will that the patient lose her child-bearing function.
Examples:•It is not morally good if a boy steals in order to alleviate his hunger because the action
itself is already bad. •If the patient who has a cancer of the uterus submits to hysterectomy she will not be able
to bear a child. If she does not have the operation, she will die. It is the gynecologist’s intention to help the mother and not to harm her. The surgeon’s action is morally good since saving the mother’s life is of primary importance. Also the doctor himself did not will that the patient lose her child-bearing function.
One who acts through an agent is himself responsible – Example: A patient wants to have an abortion and asks a nurse if she can do it. The nurse refuses, but recommends a doctor who is capable of performing. The nurse is liable to such crime, since he / she is an accomplice of the said doctor.5. No one is obliged to betray himself / herself. – In testifying before the court, no one can force any person to answer a question if such will incriminate him / her.6. The end does not justify the means. Example: Giving sleeping tablet to a chronically ill person so she / he can die in peace is morally wrong.
7. Defects of nature may be corrected.- Example: Patient with a Harelip or cleft palate may have their defects corrected by plastic surgery.8. If one is willing to cooperate in the act, no injustice is done to him / her. - Example: A patient subjects himself / herself willingly to an experimental drug and she / he has been told of the possible effects of the same, is of right age, and is sane, there is no violation of human rights.9. A little more or less does not change the substance of an act. Example: If a nurse gets medicine from the hospital stock without permission or without prescription, he / she will be guilty of theft even if he / she got only one tablet of the same.
10. The greatest good for the greatest number. Example: During an epidemic, immunization against communicable diseases is administered to the people. If there may be some who may have slight reactions to the vaccine, the greater majority of the population shall be considered rather than the isolated few.
11. No one is held to the impossible. – Example: To promise that a patient with heart transplant will live may be impossible. Yet, such procedures are done in the hope of saving or prolonging a patient’s life. The doctor or the nurse cannot be held to the impossible if they have done their best to take care of the patient and the latter dies.
12. The morality of cooperation. – Formal cooperation in an evil act is never allowed. Immoral operations such as abortion shall not be participated upon by a nurse even if the doctor commands it.
13. Principle relating to the origin and destruction of life. – One of GOD’s commandments is “Thou shall not kill.”
1. Autonomy Self- governing
An individual has the right to make decisions and take independent actions without external control.
Based on the belief that a person has unconditional value and has the capacity to determine own destiny
Ethical Principles
Examples
Consent on all treatments Knowing policies on advance
directives like DNR Privileged Communication Physical privacy
Persons who lack capacity to be autonomous
Infants Irrationally suicidal individuals Drug-dependent individuals
2. BeneficenceDo good. The duty to do good to others and maintain balance between benefits and harms One person takes action for the
good of another person. Act in ways that benefit others
Examples Providing ALL patients including
terminally ill patients with EQUAL CARING attention
Organ donations Treating every patient with respect and
courtesy Obligation to help others further their
legitimate and important interests Contribute to the well being of another
3. Nonmaleficence
Do no harm Do not commit acts that cause
deliberate harm Ex. Experimental research
Avoid harm as a consequence of doing good Ex. Immunization of infants
Examples Working within the scope of
nursing practice Observing safety rules and
precautions Perform procedures according to
protocols. Never do shortcuts! Ask appropriate person if in doubt
or unsure Continuing Professional Update
4. Veracity*Obligation to tell the truth*Not to lie or deceive others essential to the integrity of
the client-provider relationship.
Examples
Admit mistakes promptly. Offer to do whatever is necessary to correct them
Refusal to participate in any fraud Give an “honest day work” every
day
5. Confidentiality
Non- disclosure of private or secret information with which one is entrusted.
Requires that information about client be kept private unless client consented.
6. Justice Fair, equitable and appropriate treatment
To each equally To each according to need To each according to merit To each according to social contribution To each according to the person’s rights To each according to individual effort To each as you would be done by To each according to the greatest good
to the greatest number
7. Fidelity Concept of faithfulness and the
practice of keeping promises Upholding the profession’s code of ethics Practice within the scope of nursingExamples:
a. Contractsb. loyalty within the nurse- patient relationship
1.The patient has the right to considerate and respectful care.
2.Except in emergencies when the patient lacks decision-making capacity and the need for treatment is urgent, the patient is entitled to the opportunity to discuss and request information related to the specific procedures and / or treatments, the crisis involved, the possible length of recuperation, and the medically reasonable alternatives and their accompanying risks and benefits.
Patient’s Bill of Rights:
3. The patient has the right to make decisions about the plan of care prior to and during the course of treatment and to refuse a recommended treatment or plan of care to the extent permitted by law and hospital policy and to be informed of the medical consequences of this action.
4.The patient has the right to have an advance directive (such as a living will, health care) concerning treatment or designating a surrogate decision maker with the expectation that the hospital will honor the intent of that directive to the extent permitted by law and hospital policy.
4. The patient has the right to every consideration of his privacy.
5. The patient has the right to expect that all communications and records pertaining to his / her care should be treated as confidential by the hospital.
6. The patient has the right to review the records pertaining to his / her medical care and to have the information explained or interpreted as necessary except when restricted by law.
7. The patient has the right to expect that, within its capacity and policies, a hospital will make reasonable response to the request of a patient for appropriate and medically indicated care and services.
8. The patient has the right to ask and be informed existence of business relationships among the hospital, educational institutions, other health care providers, or players that may influence the patient’s treatment and care.
9. The patient has the right to consent to or decline to participate in proposed research studies or human experimentation affecting his care and treatment or requiring direct patient involvement, and to have those studies fully explained prior to consent.
10. The patient has the right to expect reasonable continuity of care when appropriate and to be informed by physicians and caregivers of available and realistic patient care options when hospital care is no longer appropriate.
11. The patient has the right to be informed of hospital policies and practices that relate to patient care, treatment, and responsibilities.
Scope of Nursing Practice
The Phil. Nursing Act of 1991 (R.A. 7164) has been repealed by the Phil. Nursing Act of 2002 (R.A. 9173)
Section 28. scope of Nursing Practice
A person shall be deemed to be practicing nursing within the meaning of this act, when he/she singly or in collaboration with another, initiates & performs nursing services to individuals, families, communities in any health care setting.
It includes but not limited to, nursing care during conception, labour, delivery, infancy, childhood, toddler, pre-school, school age, adolescence, adulthood and old age.
As independent practitioners, nurses are primarily responsible for the promotion of health and prevention of illness.
As members of the health team, nurses shall collaborate with other health care providers for the curative, preventive and rehabilitative aspects of care, restoration of health, alleviation of suffering, and when recovery is not possible, towards a peaceful death.
It shall be the duty of the nurse to: Provide nursing care through the
utilization of the nursing process. Nursing care includes, but is not limited to, traditional and innovative approaches, therapeutic of use of self, executing health care techniques and procedures , essential primary health care, comfort measures, health teachings, and administration of written prescription for treatment, therapies, oral, topical and parenteral medications, internal examination during labour in the absence of antenatal bleeding and delivery, In case of suturing of perineal laceration, special training shall be provided according to protocol established;
Establish linkages with community resources and coordination with the health team;
Provide health education to individuals, families and communities;
Teach, guide and supervise students in nursing education programs including the administration of nursing services in varies settings such as hospitals and clinics; undertake consultation services; engage in such activities that require the utilization of knowledge and decision-making skills of a registered nurse;
Undertake nursing and health human resource development training and research, which shall include, but not limited to, the development of advanced nursing practice
Provided, that this section shall not apply to nursing students who perform nursing functions under the direct supervision of a qualified faculty:
Provided further, that in practice of nursing in all setting, the nurse is duty-bound to observe the Code of Ethics for nurses and uphold the standards of safe nursing practice. The nurse is required to maintain competence by continual learning through continuing professional education to be provided by the accredited professional organization or any recognized professional nursing organization:
Provided finally, that the program and activity for the continuing professional education shall be submitted to and approved by the board.
Legal Roles of Nurses
1. Provider of Service. The rights & responsibilities of the nurse in the role of a citizen are the same as those individual under the legal system.
2. Liability. Is the quality or state of being legally responsible for one’s obligations & actions & to make financial restitution for wrongful acts.
3. Standards of Care. It is by which a nurse acts or fails to act are legally defined by
nurse practice acts & by rule & reasonable prudent professional with similar preparation & experience would do in similar circumstances.
4. Employee or Contractor for Service. A nurse who is employed by a hospital work as an agent of the hospital & the nurses contract with the clients is an implied one.
5. Contractual Relationships. Independent Nurse Practitioner Nurse Employed by a Hospital
The nurse represents & acts for hospital & therefore must function within the policies of the agency.
6. Citizen. The rights & responsibilities of the nurse in the role of a citizen are the same as those individual under the legal system.
Documentation -as written evidence of:
The interaction between & among health professionals, clients, their families & health care organization.
The administration of tests procedures, treatments & client education.
The result or client’s response to these diagnostic tests & interventions.
Documentation provides a written records that reflect client care provided on the
basis of assessment data & the clients response to interventions.
Reporting & recording are the major communication techniques used by health care provider.
The medical record serve as a legal document for recording all client’s activities assessed & initiated by health care provider.
Purposes of documentation or Client Record
1. Communication- the record serve as the vehicle by which health professionals who interact with a client communicate with each other.
2. Legal documentation. In the cases of law suit the record serve as the description of what exactly happen to a client.
3. Research. The information contained in a record can be valuable source of data for research.
4. Education. Students In health disciplines often use client records as educational tools, a record can frequently provide a comprehensive view of the client, illness & treatments.
5. Quality assurance Monitoring. Use to monitor the care the client is receiving & the competence of the people giving the care
6. Statistics- Statistical information from client records can help an agency anticipate & plan for future needs.
7. Accrediting & licensing. JCAHO, Phil. Health
8. Reimbursement. Helps facility receives reimbursement or received or obtained payment from Phil. Health.
Incident Report An agency record of any accident or
incident. The report should be completed as
soon as possible always within 24 hours.
The IR is not part of the client’s record, but the facts of the incident should be noted in the medical record.
When an accident occurs the nurse should assist first the client.
Information to include in an IR: Identify client with the hospital number. Date, time, & place of the incident. Describe the facts of the incident. Avoid
any conclusion or blame. Identify all the witnesses to the incident. Identify any equipment or medication. Document any circumstances surrounding
the incident.
II. Nursing as a Science
Definition of terms Concept- the building blocks of
theory. Abstract ideas or mental images of
phenomena or reality.(abstract or concrete ideas)
Concepts helps us to name things & occurrences in the world around us & assist us in communicating with each other about the world.
Conceptual framework- is a group of related concepts. It provides overall view or orientation to focus our thoughts.
Can be visualized as an umbrella under which many theories can exist.
Is a structure that links global concepts together & represents a unified whole of a larger reality.
The concepts in a conceptual framework are linked together to form proposition.
Proposition- is a statement that expresses the relationship between concepts & is capable of being tested, believed or denied.
E.g., “People & their Environment are open System”.
Theory- is a set of concepts & propositions that provide an orderly way to view phenomena.
a supposition or system of ideas that is proposed to explain a given phenomenon.
Purpose of a Theory: is to guide research to enhance the science by supporting existing knowledge or generating new knowledge.
Nursing Theory (purposes)1. To provide direction & guidelines for
structuring, a) professional nursing practice b) education c) research.
2. Differentiating the focus of nursing from other professions.
In Practice Assist nurses to describe, explain &
predict everyday experiences. Serve to guide assessment,
intervention, evaluation of nursing care.
Provide a rationale for collecting reliable & valid data about the health status of clients, which are essential for effective decision making & implementation.
Help to establish criteria to measure the quality of nursing care.
Help build a common nursing terminology to use in communicating with other health professionals. Ideas are developed & words defined.
Enhance autonomy of nursing through defining its own independent function.
In Education Provide a general focus for curriculum
design. Guide curricular decision making.
In Research Offer a framework for generating
knowledge & new ideas. Assist in discovering knowledge gaps in
the specific field of study. Offer a systematic approach to identify
questions for study, select variables, interpret findings, & validate nursing intervention.
General Nursing Theories1. Florence Nightingale’s
Environmental Theory (1859) The first theory of Nursing. Notes on
Nursing: What it is, what it is not. She focused on changing, &
manipulating the environment in order to put patient in the best possible conditions for nature to act.
She believed that nurturing the environment, the body could repair itself.
She linked health with 5 environmental factors; 1) Pure fresh air 2) pure water 3) efficient drainage 4) cleanliness 5) light especially direct sunlight. Deficiency in these five factors produce lack of illness or illness.
Her general concept about ventilation, cleanliness, quiet, warmth, & diet remain integral parts of nursing & health care today.
2. Virginia Henderson: Definition of Nursing (1955)
She postulated that the unique function of the nurse is to assist the client sick or well, in the performance of those activities contributing to health or its recovery, that client will perform unaided if they have the necessary strength, will or knowledge,
She further believed that nursing involves assisting the client, in gaining independence as rapidly as possible,
or assisting him achieve peaceful death if recovery is no longer possible.
3. Martha Rogers: Science of Unitary Human Beings. ( 1970)
Rogers views the person as an irreducible whole, the whole being greater than the parts. The distinctive properties of the whole are significantly different from its part
Unitary man is an energy field in constant interaction with the environment
She believed that human being is characterized by the capacity for abstraction & imagery language & thought, sensation & emotion.
E.g., Therapeutic touch- process by which energy is transmitted or transferred from one person to another with the intent of potentiating the feeling of healing process of who is ill or injured.
4. Dorothea Orem: Self care and Self care Deficit Theory (1971)
She defined self care as “the practice of activities that individuals initiate & perform on their own behalf in maintaining life, health & well being”.
According to this theory self care is a learned behaviour & a deliberate action in response to a need
She identified 3 kinds of self care requisites:
1. Universal requisites- common to all people, include the maintenance of air, water, food, elimination, activity & rest, solitude & social interaction,& the promotion of human functioning both physiological & social interaction needs.
2. Developmental requisites -are the needs that arise as the individual grows & develop.
3. Health deviation requisites- results from
the needs produced by disease or illness states. It impairs the individual to perform self care.
Theory of Self Care deficit. This theory purports (claims) that nursing
care is needed when people are affected by the limitation that do not allow them to met their self care needs.
The relationship between the nurse & client is established when a self care deficit is present.
It also determines the need for nursing care.
Nursing System Theory Attempts to answer the question “What
do nurses do”? Three types of Nursing Systems1. Wholly compensatory system: when
the nurse is expected to accomplish all the patient’s self care or to compensate for the client’s inability to care for self or when the client needs continuous guidance in self care.
2. Partially compensatory: are designed for individuals who are unable to perform some ( but not all) self care activities.
Both nurse & client engage in meeting self care needs.
3. Supportive Educative (developmental): the that requires assistance in decision making behaviour control & acquisition of knowledge & skills.
System Theories1. Sister Callista Roy: Adaptation
Model (1979,1984) Widely used by nurse educator,
researchers, & practitioners. She viewed each person as a unified
biopsychosocial adaptive system in constant interaction with the changing environment.
She viewed that the nurse must first assess how the client behaves in each adaptive mode & then determine what can be altered in that mode to produce more efficient & effective responses.
Four adaptive Modes:1. Physiologic mode- involves the body’s
basic physiologic needs & ways of adapting in regard to fluid & electrolytes, activity & rest, circulation & oxygen etc. e.g., caring for a patient with fever.
2. Self –Concept Mode- includes two components; the physical self,( sensation & body image) & the personal self ( whish involves of self ideal, self consistency & moral ethical self. E.g., patient who will undergo surgery & caring for an obese client.
3. The role function mode- is determine by the need for social integrity & refers to the performance of duties based on given positions within society.
4. The interdependence mode- involves one’s relation with significant others & support system that provide help, affection & attention. E.g., a grieving widow.
5. Imogene King: theory of goal Attainment (1971)
Derived from a conceptual framework of 3 dynamic interacting systems:
1. Personal system- perception, self, body image,, growth & development, space & time.
2. Interpersonal system- interaction, communication, transaction, roles & stress.
3. Social system- organization, authority power, status, & decision making.
To identify problems & establish goals the nurse & client perceive one another, act & react, interact & transact.
3. Betty Neuman: Health care system Model. (1972)
Based on the individual’s relationship to stress, the reaction to it & reconstitution (state of adaptation to stressors) .
She viewed the client as an open system consisting of a basic structure or central core of energy resources ( physiologic, psychologic, socio-cultural, developmental & spiritual) surrounded by two cocentric boundaries or rings referred as lines of resistance.
The two lines of resistance represent internal factors that help the client depend against on stressors.
The inner or normal lines of defense represents the persons state of equilibrium, or the state of adaptation developed & maintained overtime & considered normal for that person.
The flexible lines of defense is dynamic & can be rapidly altered over a short period of time. It is a protective buffer that prevents
stressors from penetrating the normal lines of defence.
The concern of nursing is to prevent stress invasion, to protect the client’s basic structure & to obtain or maintain a maximum level of wellness.
Nursing actions are carried out on the three preventive levels:
1. Primary prevention- identify risk factors, attempt to eliminate the stressors & focuses on protecting the first line of defense strengthening the first line of
defense.2. Secondary prevention- relate to
intervention or active treatment initiated after symptoms have occurred.
The focus is to strengthen the internal lines of resistance, reduce the reaction & increase resistance factors.
3. Tertiary prevention- refers to interventions following that in the secondary level.
It focuses on readaptation & stability &
protects reconstitution or return to wellness following treatment.
The nurse emphasizes educating the client in strengthening resistance to stressors & ways to help prevent recurrence of reaction or regression.
4. Dorothy Johnson: Behavioural System Model (1960)
She used her observation of behaviour over many years to formulate this theory.
Described the individual as a behavioural system composed of seven sub-systems:
1. Attachment- Affiliative subsystem – security seeking behaviour, provides survival & security.
Its consequences are social inclusion, intimacy, & the formation & maintenance of a strong social bond.
2. Dependency subsystem- promotes helping behaviour that calls for a nurturing response.
Its consequences are approval, attention or recognition & physical assistance.
3. The Ingestive subsystem- satisfies appetite. It governed by social & psychologic consideration as well as biologic.
4. The Eliminative subsystem- ridding the body waste in socially & culturally acceptable ways.
5. The Sexual subsystem- dually for procreation & gratification
6. The Achievement subsystem-attempts to manipulate the environment.
It controls or masters an aspect of the self or environment to some standard of excellence.
7. The Aggressive subsystem- protects & preserves the self & society & within the limits imposed by society.
Each of the above subsystem has the same functional requirements; protection, nurturance, & stimulation.
The subsystem responses are developed through motivation, experience & learning & are influenced by biopsychosocial factors.
Interpersonal/Caring Theories
1. Hildegard Peplau: Interpersonal Model / Psychodynamic Nursing Theory (1952 )
Psychodynamic Nursing- is defined as understanding one’s own behaviour to help others identify felt difficulties & applying principles of human relations to problem arising during the experience.
She defined nursing as an interpersonal process of therapeutic interaction between
an individual who is sick & in need of health services & a nurse especially educated to recognize & respond to the need for help.
She identified four phases of nurse-patient relationship namely:
1. Orientation: The nurse & client initially do not know each other. The patient seeks help, & the nurse assists the patient to understand the problem & the extent of need for help.
2. Identification: during this phase, the patient assumes a posture of dependence, interdependence in relation to the nurse.
The nurse’s focus to assure the person that the nurse understands, the interpersonal meaning of the patient situation.
3. Exploitation: in this phase the patient derives full value from what the nurse offers through the relationship.
The patient utilizes all available resources
to move toward a goal of maximum health or functionality.
4. Resolution: refers to the termination phase of the nurse-patient relationship. It occurs when the patient’s needs are met, & client can move toward new goal.
Peplau further assumed that that the nurse-patient relationship fosters growth for both the nurse & client.
2. Jean Watson: Philosophy & Science of Caring (1979 ).
She believes that the practice of caring is central to nursing & it is the unifying focus for practice.
Her theory is composed of ten (10) carative factors which are classified as nursing actions or caring process.
1. Forming a humanistic-altruistic system of values.
This factor relates to satisfaction through giving & extending of the sense of self.
Although the values are learned early in life, but they can greatly influenced by education.
2. Instilling Faith & Hope. Feeling of faith & hope promote
wellness by helping client adopt health seeking behaviours.
3. Cultivating sensitivity to one’s self & others.
Nurses who are able to recognize & express their feelings are better able to allow others to express theirs.
4. Developing a helping trust (human care) relationship.
This kind of relationship involves effective communication, empathy & non possesive warmth.
It promotes & accepts the expression of positive, & negative feelings.
5. Expressing positive & negative feelings.
Sharing feelings of sorrow, love & pain is risk taking experience. The nurse must be prepared for negative feeling.
6. Using a creative problem-solving approach or caring process.
7. Promoting transpersonal teaching –learning.
This factor separate caring from curing & shifts responsibility for wellness to the client.
8. Providing a supportive, protective or corrective mental, physical, socio-cultural, & spiritual environment.
The nurse must asses & facilitate the client’s abilities to cope with mental, emotional & physical changes.
9. Assisting with gratification of human needs.
Recognizing & attending to the physical, emotional, social, & spiritual needs of the client.
10. Being sensitive to existential phenomenologic- spiritual forces.
Existential psychology – is a science of human existence that employs the method of phenomenologic analysis.
Person possesses three spheres of being: mind , body, & soul.
Allowing for expression of these forces leads to better understanding of self & others.
3. Madeleine Leininger: Transcultural Care Theory (1978)
The goal of transcultural nursing is to develop a scientific & humanistic body of knowledge in order to provide- culture specific & culture-universal nursing practices.
She believes culture is the broadest & the most holistic means to conceptualize, understand & be effective with people.
“there can be no cure without caring but there may be caring without curing”.
Faye Abdellah (1960): Patient- Centered Approaches to Nursing Model.
She defined nursing as service to individuals & families; therefore to society.
She conceptualized nursing as an art & a science that molds the attitudes, intellectual competencies & technical skills of the individual nurse into the desire & ability to help people, sick or well, & cope with their health needs.
III. Nursing as an Art
Caring Theories
Peplau’s Interpersonal Nursing Theory Watson’s Philosophy & science of
Caring Leinnenger’s Transcultural Nursing
Theory
Therapeutic Use of Self A process in which nurses deliberately
plan their actions & approach the relationship with a specific goal in mind before interacting with the client.
The most effective tool for demonstrating caring is not some technologically sophisticated machines with lights & alarms but rather oneself.
Therapeutic use of self makes the art of nursing as different from science of nursing.
This is an “oppurtunity of the nurse to be with the person at a human to human level.
Characteristics of therapeutic Relationship
1. Warmth- exhibiting positive behaviour toward a client. Respect, genuine interest, caring are all expression of warmth.
2. Hope- means anticipating the future by
helping clients look realistically at their potentials.
Hope is the energy source that allows individuals to plan, act & achieve.
2. Rapport- is a bond or connection between people that is based on mutual trust.
3. Trust- must be present for help to be given & received. ( consistency, respect, honesty are essential in the development of trust.)
5. Empathy understanding another perception of the situation.
6. Acceptance- accepting client as a person & working with clients even those clients who exhibit undesirable behaviours.
7. Active Listening- is required in every nurse-client relationship.
8. Humor- can assist in establishing a relationship because it helps break the ice, decreases fear, & establish trust, & can help strengthen relationship.
9. compassion- you care what happen to another person.
Kindness & genuine concern are demonstrated through compassionate acts.
10. Self –Awareness- necessary to be therapeutic.
Being aware of one’s feeling is the first step in developing therapeutic behaviour.
Self-awareness allow the nurse to remain objective, that is separate enough to distinguish one’s own feelings.
11. Non-judgmental approach- acting without biases, pre conceptions or stereotypes.
12. Flexibility- a flexible nurse is one who is ready for the unexpected.
13. Risk taking- the nurse must give themselves permission to try something new, to step outside the ordinary & not to be bound by tradition or fear.
Phases of Nurse- Client Relationship
1. Orientation phase: Introductory phase, it sets the tone
for the rest of the relationship. Getting to know each other &
developing a degree of trust. Client may display some resistance
behaviour- inhibit involvement. Assessment of client is the most
important goal .
2. Working Phase: The nurse & client begin to view each
other as unique individuals. They begin to appreciate this
uniqueness & begin to care about each other.
Behaviours that indicate the client is in the working phase; asking questions about own problem, seeking clarification from the nurse, being attentive to instructions, asking for more information about his role in recovery.
3. Termination Phase- is often difficult & filled with ambivalence.
It focuses in evaluation of goal achievement & effectiveness of treatment.
Many methods can be used to terminate relationships;
Summarizing or reviewing the process can produce a sense of accomplishment.
Planning for termination is actually initiated during the beginning of the relationship.
Thank You