I.

INTERVENTION
 Nursing Intervention Classification
 Types: Independent, Dependent, and Interdependent
 Health Education
A. Procedures Basic to Nursing Care
1. Asepsis and Infection Control
2. Safety, security, and emergency
3. Complementary and alternative therapies
4. Medication
B. Nursing Interventions to Promote Healthy Physiologic Responses
1. Hygiene
2. Skin integrity
3. Mobility
4. Rest and Sleep
5. Pain Management
6. Nutrition
7. Urinary elimination
8. Bowel elimination
9. Oxygenation
10. Fluid Electrolyte and Acid Base Balance
C. Nursing Interventions to Promote Healthy Psychosocial Responses
1. Self-concept
2. Stress and Adaptation
3. Loss, Grief and Dying
4. Sensory Functioning
5. Sexuality and Gender
6. Spirituality
II. EVALUATION
 Types: Planned, On-going, and Purposeful
A. Documentations and Reporting
1. Guidelines/Protocols/Tools in documentations related to client care
2. Subjective Information, Assessment, Plan, Implement and Evaluate (SOAPIE)
3. Focus, Data, Action, Response (FDAR)
4. Electronic Health Record (EHR)
5. Problem-Oriented Medical Record
B. Guidelines/Protocols/Tools in Reporting Related to Client Care
1. Identity, Situation, Background, Assessment, Recommendation, Read Back (ISBARR)
2. Change of Shift Report
3. Incident Report
4. Referral System
5. Health Care Electronic Databases
III. EVIDENCE-BASED PRACTICE IN NURSING
A. Research Related Roles and Responsibilities
IV. CONCEPTS AND PRINCIPLES OF PARTNERSHIP, COLLABORATION, AND TEAMWORK
A. Development of Teamwork and Collaboration
B. Tools for facilitating Teamwork
C. Roles of the Nurse
V. CONCEPTS OF LEADERSHIP AND MANAGEMENT
A. Role of the Nurse as Leader/Manager
B. Positive Practice Environment
VI. CONCEPTS OF CONTINUING PROFESSIONAL DEVELOPMENT
A. Life-long learning
B. Career Path/Development Map
VII. FILIPINO CULTURE, VALUES AND PRACTICES IN RELATION TO HEALTH CARE
VIII. ETHICO-MORAL AND LEGAL CONSIDERATIONS IN THE PRACTICE OF NURSING
A. Phil. Nursing Law of 2012: RA 9173 Art of IV, Sec 28: Scope of Nursing Practice
B. National Nursing Core Competency Standards
C. Patient’s Bill of Rights
D. Informed Consent
E. Data Privacy Law
F. Code of Ethics for Nurses
 Philippine Professional Nursing Roadmap
 INTERVENTION

Nursing Intervention Classification

Nursing interventions are identified and written during the planning step of the nursing
process; however, they are actually performed during the implementation phase. A taxonomy of
nursing interventions referred to as the Nursing Interventions Classification (NIC) taxonomy,
developed by the Iowa Intervention Project, was first published in 1992 with three levels that includes:
level 1, domains; level 2, classes; and level 3, interventions.
Domains Classes
Domain 1 Physiological: Basic A. Activity and Exercise Management: Interventions to
Care that supports physical organize or assist with physical activity and energy
functioning conservation and expenditure
B. Elimination Management: Interventions to establish and
maintain regular bowel and urinary elimination patterns and
manage complications due to altered patterns
C. Immobility Management: Interventions to manage
restricted body movement and the sequelae
D. Nutrition Support: Interventions to modify or maintain
nutritional status
E. Physical Comfort Promotion: Interventions to promote
comfort using physical techniques
F. Self-Care Facilitation: Interventions to provide or assist
with routine activities of daily living
Domain 2 Physiological: Complex G. Electrolyte and Acid-Base Management: Interventions
Care that supports homeostatic to regulate electrolyte/acid-base balance and prevent
regulation complications
H. Drug Management: Interventions to facilitate desired
effects of pharmacological agents
I. Neurologic Management: Interventions to optimize
neurologic functions
J. Perioperative Care: Interventions to provide care before,
during, and immediately after surgery
K. Respiratory Management: Interventions to promote
airway patency and gas exchange
L. Skin/Wound Management: Interventions to maintain or
restore tissue integrity
M. Thermoregulation: Interventions to maintain body
temperature within a normal range
N. Tissue Perfusion Management: Interventions to optimize
circulation of blood and fluids to the tissue
Domain 3 Behavioral O. Behavior Therapy: Interventions to reinforce or promote
Care that supports psyschosocial desirable behaviors or alter undesirable behaviors
functioning and facilitates lifestyle P. Cognitive Therapy: Interventions to reinforce or promote
changes desirable cognitive functioning or alter undesirable cognitive
functioning
Q. Communication Enhancement: Interventions to facilitate
delivering and receiving verbal and nonverbal messages
R. Coping Resistance: Interventions to assist another to
build on own strengths, to adapt to a change in function, or to
achieve a higher level of function
S. Patient Education: Interventions to facilitate learning
T. Psychological Comfort Promotion: Interventions to
promote comforts using psychological techniques
Domain 4 Safety U. Crisis Management: Interventions to provide immediate
Care that supports protection against short-term help in both psychological and physiological crisis
harm V. Risk Management: Interventions to initiate risk-reduction
activities and continue monitoring risks over time
Domain 5 Family W. Childbearing Care: Interventions to assist in
Care supports the family unit understanding and coping with the psychological and
physiological changes during the childbearing period
 Z. Childbearing Care: Interventions to assist in child rearing
X. Lifespan Care: Interventions to facilitate family unit
functioning and promote and health and welfare of the family
members throughout the lifespan
Domain 6 Health System Y. Health System Mediation: Interventions to facilitate the
Care that supports effective use of interface between patient/family and the health care system
the health care delivery system Ya. Health System Management: Interventions to provide
and enhance support services for the delivery of care
Domain 7 Community Yb. Information Management: Interventions to facilitate
Care that supports the health of the communication among health care providers
community Yc. Community Health Promotion: Interventions that
promote the health of the whole community
Yd. Community Risk Management: Interventions that assist
in detecting or preventing health risks to the whole community

BENEFITS OF THE NURSING INTERVENTIONS CLASSIFICATION

 Helps demonstrate the impact that nurses have on the health care delivery system.
 Standardizes and defines the knowledge base for nursing curricula and practice.
 Facilitates the appropriate selection of a nursing intervention.
 Facilitates communication of nursing treatments to other nurses and other providers.
 Enables researchers to examine the effectiveness and cost of nursing care.
 Assists educators to develop curricula that better articulate with clinical practice.
 Facilitates the teaching of clinical decision making to novice nurses.
 Assists administrators in planning more effectively for staff and equipment needs.
 Promotes the development of a reimbursement system for nursing services.
 Facilitates the development and use of nursing information systems.
 Communicates the nature of nursing to the public.

Types of Nursing Interventions

1. Independent Interventions
 These are activities that nurses are licensed to initiate on the basis of their knowledge and
skills.
 These include physical care, ongoing assessment, emotional support and comfort,
teaching, counselling, environmental management, and making referrals to other health
care professionals.
2. Dependent Interventions
 These are activities carried out under the physician’s orders or supervision, or according to
specified routines.
 The nurse is responsible for assessing the need for, explaining, and administering the
medical records.
3. Interdependent Interventions
 These are actions the nurse carries out in collaboration with other health team members,
such as physical therapies, social workers, dietitians, and physicians.

Health Education
Health education involves giving information and teaching individuals and communities how
to achieve better health, a common role within nursing.
HEALTH MAINTENANCE
Health maintenance is a guiding principle in health care that emphasizes health promotion
and disease prevention rather than the management of symptoms and illness. It includes the full
array of counselling, screening, and other preventive services designed to minimize the risk of
premature sickness and death and to assure optimal physical, mental, and emotional health
throughout the natural life cycle.
Health promotion is an important component of nursing practice. It is a way of thinking that
revolves around a philosophy of wholeness, wellness, and well-being.
Disease prevention/health protection as a behavior motivated by a desire to actively avoid
illness, detect it early, or maintains functioning within the constraints of illness.
 Levels of Prevention
a. Primary Prevention
 Focuses on health promotion and protection against specific health problems
 The purpose of primary prevention is to decrease the risk or exposure of the
individual or community to disease.
b. Secondary Prevention
 Focuses on early identification of health problem
 Prompt intervention to alleviate health problems
 Its goal is to identify individuals in an early stage of a disease process and to
limit future disability
c. Tertiary Prevention
 Focuses on restoration and rehabilitation with the goal of returning the
individual to an optimal level of functioning.
DIFFERENCES BETWEEN HEALTH PROMOTION AND HEALTH PROTECTION
Health Promotion Disease Prevention/Health Protection
-Not disease oriented -Illness or injury specific
-Motivated by personal, positive “approach” to -Motivated by “avoidance” of illness
wellness
-Seeks to expand positive potential for health -Seeks to prevent the occurrence of insults
to health and well-being

NURSES’ ROLE IN HEALTH PROMOTION

 Model healthy lifestyle behaviors and attitudes
 Facilitate client involvement in the assessment, implementation, and evaluation of health
goals.
 Teach clients self-care strategies to enhance fitness, improve nutrition, manage stress, and
enhance relationships.
 Assists individuals, families, and communities to increase their levels of health.
 Educate clients to be effective health care consumers.
 Assist clients, families, and communities to develop and choose health-promoting options.
 Guide clients; development in effective problem solving and decision making.
 Reinforce client’s personal and family health-promoting behaviors.
 Advocate in the community for changes that promote a healthy environment.

References
Berman, Snyder, Kozier, & Erb. (2008). Kozier and Erb's Fundamentals of Nursing, 8th ed. Vol. 1.
Pearson Education, Inc.
 PROCEDURES BASIC TO NURSING CARE

1. Asepsis and Infection Control

Asepsis is the freedom from disease-causing microorganisms. Aseptic technique is done to
decrease the possibility of transferring microorganisms from one place to another.
TYPES OF ASEPSIS
1. Medical Asepsis
 Includes all practices intended to confine a specific microorganism to a specific area.
 Limits the number, growth, and transmission of microorganisms.
 Objects are referred to as:
 Clean (absence of almost all microorganisms)
 Dirty (likely to have microorganisms)
2. Surgical Asepsis/ Sterile Technique
 Refers to those practices that keep an area or object free of all microorganisms.
 Includes practices that destroy all microorganisms and spores.
 Is used for all procedures involving the sterile areas of the body.
PRINCIPLES OF SURGICAL ASEPSIS
1. All objects used in a sterile field must be sterile.
2. Sterile objects become unsterile when touched by unsterile objects.
3. Sterile items that are out of vision or below the waist or table level are considered unsterile.
4. Sterile objects can become unsterile by prolonged exposure to airborne microorganisms.
5. Fluids flow in the direction of gravity.
6. Moisture that passes through a sterile object draws microorganisms from unsterile surface
above or below to the sterile surface by capillary action.
7. The edges of a sterile field are considered unsterile.
8. The skin cannot be sterilized and is unsterile.
9. Conscientiousness, alertness, and honesty are essential qualities in maintaining surgical
asepsis.
*Sepsis is the state of infection and can take many forms, including septic shock.
*Sterile Field is a microorganism-free area.

Infection is an invasion of body tissue by microorganisms and their growth there. Such
microorganism is called an infectious agent. If the microorganism produces no clinical evidence of
disease, the infection is called asymptomatic or subclinical. A detectable alteration in normal tissue
function is called disease.

TYPES OF MICROORGANISMS CAUSING INFECTIONS

1. Bacteria
 The most common infection-causing microorganisms.
 Hundreds of species can cause disease in humans.
 Can live and be transported through air, water, food, soil, body tissues and fluids, and
inanimate objects.
2. Viruses
 Consists primarily of nucleic acid.
 Must enter living cells in order to reproduce.
3. Fungi
 Include yeasts and molds.
4. Parasites
 Live on other living organisms.

TYPES OF MICROORGANISMS CAUSING INFECTIONS

1. Local Infection
  Limited to the specific part of the body where the microorganisms remain
2. Systemic Infection
 Happens when microorganisms spread and damage different parts of the body
3. Bacteremia
 Happens when a culture of the person’s blood reveals microorganisms
4. Septicemia
 Happens when bacteremia is results in systemic infection
5. Acute Infection
 Generally appear suddenly or last a short time
6. Chronic Infection
 May occur slowly, over a very long period, and may last months or years
7. Nosocomial Infections
 Infections which are associated with the delivery of health care services in a health
care facility.
 Either develop during a client’s stay in a facility or manifest after discharge.
 May also be acquired by health personnel working in the facility.
 Endogenous Source (originate from the client themselves)
 Exogenous Source (originate from the hospital environment or personnel)
 Latrogenic Infections (are the direct result of diagnostic or therapeutic procedures)

CHAIN OF INFECTION
1. Etiologic Agent
 Any microorganism that is capable of producing an infectious process.
2. Reservoir
 Any sources of microorganisms
 Carrier (a person or animal reservoir of specific infectious agent that usually does
not manifest any clinical signs of disease.
3. Portal of Exit from Reservoir
 Route where the microorganism must pass through to exit the reservoir
4. Method of Transmission
 Microorganisms need a means of transmission to reach another person or host
through a receptive portal of entry.
TYPES OF TRANSMISSION
 Direct Transmission
 Involves immediate and direct transfer of microorganisms from person to
person through touching, biting, kissing, or sexual intercourse.
 Droplet spread is also a form of direct transmission but can only occur if
the source and the host are within 3 feet of each other.
 Indirect Transmission
 Vehicle-borne Transmission
o A vehicle is any substance that serves as an intermediate means
to transport and introduce an infectious agent into a susceptible
host through a suitable portal of entry.
 Vector-borne Transmission
o A vector is an animal or flying or crawling insect that serves as an
intermediate means of transporting the infectious agent.
o May occur by injecting the salivary fluid during biting or by
depositing feces or other materials on the skin.
 Airborne Transmission
 May involve droplets or fine dust
 Droplet nuclei (residue of evaporated droplets emitted by an infected
host.
 Dust particles containing the infectious agent can be transmitted by air
currents to a suitable portal of entry.
 5. Portal of Entry to the Susceptible Host
 Any route suitable for the infectious agent to enter.
 Commonly, break in the skin can readily serve as a portal of entry.
 Microorganisms can also enter the body of the host by the same route they used to
leave the reservoir.
6. Susceptible Host
 Any person who is at risk for infection
 Compromised Host (a person at increased risk)

NURSING INTERVENTIONS THAT BREAK THE CHAIN OF INFECTION

1. Etiologic Agent
 Ensure that articles are correctly cleaned and disinfected or sterilized before use.
 Educate clients and support persons about appropriate methods to clean, disinfect,
and sterilize articles.
2. Reservoir
 Change dressings and bandages when they are soiled or wet.
 Assist client to carry out appropriate skin and oral hygiene.
 Dispose of damp, soiled linens appropriately.
 Dispose of feces and urine in appropriate receptacles.
 Ensure that all fluid containers, such as bedside water jugs and suction and drainage
bottles, are covered or capped.
 Empty suction and drainage bottles at the end of each shift or before they become full,
or according to agency protocols.
3. Portal of exit from the Reservoir
 Avoid talking, coughing, or sneezing over open wounds or sterile fields, and cover the
mouth and nose when coughing and sneezing.
4. Method of Transmission
 Cleanse hands between client contacts, after touching body substances, and before
performing invasive procedures or touching open wounds.
 Instruct clients and support persons to cleanse hands before handling food or eating,
after eliminating, and after touching infectious material.
 Wear gloves when handling secretions and excretions.
 Wear gowns if there is danger of soiling clothing with body substances.
 Place discarded soiled materials in moisture-proof refuse bags
 Hold used bedpans steadily to prevent spillage, and dispose of urine and feces in
appropriate receptacles.
 Initiate and implement aseptic precautions for all clients
 Wear masks and eye precaution when in close contact with clients who have
infections transmitted by droplets from the respiratory tract.
 Wear masks and eye protection when sprays of body fluid are possible

5. Portal of entry to the Susceptible Host

 Use sterile technique for invasive procedures
 Use sterile technique when exposing open wounds or handling dressings.
 Place used disposable needles and syringes in puncture-resistant containers for
disposal.
 Provide all clients with their own personal care items.
6. Susceptible Host
 Maintain the integrity of the client’s skin and mucous membranes.
 Ensure that the client receives a balanced diet.
 Educate the public about the importance of immunizations.

SIGNS AND SYMPTOMS OF AN INFECTION IN THE SKIN AND MUCOUS MEMBRANES

1. Localized swelling
2. Localized redness
 3. Pain or tenderness with palpation or movement
4. Palpable heat at the infected area
5. Loss of function of the body part affected, depending on the site and extent of involvement
SIGNS OF SYTEMIC INFECTION
1. Fever
2. Increased pulse and respiratory rate if the fever is high
3. Malaise and loss of energy
4. Anorexia, and in some conditions, nausea and vomiting
5. Enlargement and tenderness of lymph nodes that drain the area of infection
BODY DEFENSES AGAINST INFECTION
1. Nonspecific Defenses
a) Anatomic and Physiologic Barriers
 Intact skin and mucous membranes
 Moist mucous membranes and cilia in nasal passages
 Alveolar macrophages in the lungs
 Mucosal epithelium in the oral cavity
 The flow of saliva
 Tears from the eyes
 High acidity of the stomach
 Resident flora of the large intestine
 Peristalsis
 Low pH in the vagina
 Urine flow in the urethra
 Intact mucosal surface
b) Inflammatory Response
 It is a local and nonspecific defensive response of the tissues to an injurious or
infectious agent.
 It is an adaptive mechanism that destroys or dilutes the injurious agent, prevents
further spread of the injury, and promotes the repair of damaged tissue.
 Five Signs of Inflammatory Response:
o Pain
o Swelling
o Redness
o Heat
o Impaired function of the part
 Three Stages of the Inflammatory Response:
o First Stage: Vascular and Cellular Responses
o Second Stage: Exudate Production
o Third Stage: Reparative Phase
2. Specific Defenses
 Involves the immune system
 Antigen (a substance that induces a state of sensitivity or immune responsiveness)
 Autoantigen (if proteins originate in a person’s own body
COMPONENTS OF IMMUNE RESPONSE
a) Antibody-Mediated Defenses
 Humoral or Circulating Immunity
 Resides in the B lymphocytes
 Mediated by antibodies produced by B cells
 Antibodies, also called immunoglobulins, are part of the plasma proteins.
 Defend primarily against the extracellular phases of bacterial and viral
infrections
 TYPES OF IMMUNITY:
 Active Immunity
 Natural active immunity
o Antibodies are formed in presence of active infection
in the body
o Duration lifelong
 Artificial active immunity
o Antigens administered to stimulate antibody formation
o Lasts for many years
o Reinforced by booster
 Passive Immunity
 Host receives natural or artificial antibodies produced from
another source
 Natural passive immunity
o Antibodies transferred naturally from an immune
mother to baby through the placenta or in colostrum’s
o Lasts 6 months to 1 year
 Artificial passive immunity
o Occurs when immune serum (antibody) from an
animal or another human is injected
o Lasts 2 to 3 weeks

b) Cell-Mediated Defenses
 Cellular immunity
 Occur in the T-cell system
 On exposure to antigen, the lymphoid tissues release large numbers of
activated T-cells into the lymph system.
 These T-cells pass into the general circulation
MAIN GROUPS OF T-CELLS:
 Helper T-cells
o Help in the function of the immune system
 Cytotoxic T-cells
o Attack and kill microorganisms
o Sometimes attack the body’s own cells
 Suppressor T-cells
o Suppress the functions of the helper t-cells and the cytotoxic
T-cells

FACTORS INCREASING SUSCEPTIBILITY TO INFECTION

1. Age
 Newborns and older adults have reduced defences against infections
 Infections are a major cause of death of newborns who have immature immune
systems.
2. Heredity
 Influences the development of infection in that some people have a genetic
susceptibility to certain infections.
3. Physical and Emotional Stressors
 Stressors elevate blood cortisone, which if prolonged, decreases anti-inflammatory
responses, depletes energy stores, leads to a state of exhaustion, and decreases
resistance to infections.
4. Nutritional Status
 Since antibodies are proteins, the ability to synthesize antibodies may be impaired by
inadequate nutrition.
5. Present Medical Therapies
  Radiation may destroy good cells
 Antineoplastic medications may depress bone marrow and lessen the production of
WBCs
 Some antibiotics can induce resistance in some strains of organisms.
6. Preexisting Diseases
 Chronic Pulmonary Disease: impairs ciliary action and weakens mucous barrier
 Peripheral Vascular Disease: restricts blood flow
 Burns: impair skin integrity
 Chronic or Debilitating Diseases: depletes protein reserves
 Immune System Diseases: alter production of WBCs

SUPPORTING DEFENSES OF A SUSCEPTIBLE HOST

1. Hygiene
 Regular and thorough bathing, brushing of teeth, shampooing remove microorganisms
and dirt that can result to infections.
2. Nutrition
 Adequate nutrition enables tissues to maintain and rebuild themselves and helps keep
the immune system functioning well.
3. Fluid
 Fluid intake permits fluid output that flushes out the bladder and urethra, removing
microorganisms that could cause an infection.
4. Sleep
 Adequate sleep is essential to health and to renewing energy.
5. Stress
 Nurses can assist clients to learn stress-reducing techniques.
6. Immunizations
 Decreases the incidence of infectious diseases.

PREVENTING NOSOCOMIAL INFECTIONS

1. Hand Hygiene
 Considered one of the most effective infection control measures.
2. Disinfecting
 A process where the used of disinfectants of inanimate objects.
 Disinfectants are caustic and toxic to tissues, which is why it is only used on inanimate
objects.
 Disinfectants have bactericidal (destroys bacteria) and bacteriostatic (prevents
growth and reproduction of some bacteria) properties.
3. Sterilizing
 A process that destroys all microorganisms, including spores and viruses.
FOUR COMMON METHODS OF STERILIZATION
 Moist Heat
o Steam under pressure is used because it attains
temperatures higher than the boiling point.
 Gas
o Destroys microorganisms by interfering with their metabolic
processes.

 Boiling Water
o Most practical and inexpensive method of sterilizing.
o Spores and some viruses are not killed by this method
 Radiation
o Ionization (alpha, beta, x-rays) and Nonionization (UV
light)
PERSONAL PROTECTIVE EQUIPMENT
1. Gloves
 They protect the hands when the nurse is likely to handle any body substances.
 Reduce the likelihood of nurses transmitting their own endogenous microorganisms to
individuals receiving the care.
 Reduce the chance that the nurse’s hands will transmit microorganisms from one
client to another client.
2. Gowns
 Worn during procedures when the nurse’s uniform is likely to become soiled.
3. Face Masks
 Worn to reduce the risk for transmission of organisms by the droplet contact and
airborne routes, and by splatters of body substances.
4. Eyewear
 Worn when there is a possible splatter of body substances and protects the eyes.

CDC ISOLATION PRECAUTIONS

1. Standard Precautions
 These precautions are used in the care of all hospitalized persons regardless of their
diagnosis or possible infection status.
 Performing hand hygiene
 Usage of Personal Protective Equipment (gloves, gowns, eyewear, face masks)
2. Transmission-Based Precautions
 These are used in addition to standard precautions for clients with known or
suspected infections that area spread in one of three ways: by airborne or droplet
transmission, or by contact.
TYPES OF TRANSMISSION-BASED PRECAUTIONS
 Airborne Precautions
o Are used for clients known to have or suspected of having serious illnesses
transmitted by airborne droplet nuclei smaller than 5 microns.
 Droplet Precautions
o Are used for clients known or suspected to have serious illnesses
transmitted by particle droplets larger than 5 microns.
 Contact Precautions
o Are used for clients known or suspected to have serious illnesses easily
transmitted by direct client contact or by contact with items in the client’s
environment.

References:
Berman, Snyder, Kozier, & Erb. (2008). Kozier & Erb's Fundamentals of Nursing, 8th ed. Vol. 1.
Pearson Education, Inc.
2. Safety, security, and emergency

Nurses need to be aware of what constitutes a safe environment for a particular person or for
a group of people in home and community settings. This is why it has become a fundamental
concern of nurses that extends from the bedside to the home to the community, is prevention of
accidents and injury, as well as assisting the injured.

FACTORS AFFECTING SAFETY

1. Age and Development
2. Lifestyle
3. Mobility and Health Status
4. Sensory-Perceptual Alterations
5. Cognitive Awareness
6. Emotional State
7. Ability to Communicate
8. Safety Awareness
9. Environmental Factors
10. Home
11. Workplace
12. Community
13. Health Care Setting
14. Bioterrorism

FACTORS THAT INCREASE THE RISK OF HUMAN ERROR IN A HEALTH CARE SETTING
1. Limited Short-term Memory
Nurses have rapidly changing information coming at them continuously in busy hospital
environments. Systems that rely on human memory are prone to failure.
2. Being late or in a hurry
People start cutting corners when they are late or in a hurry. This may get the work
done quicker; however. it also contributes to the possibility of missing an important detail or
piece of information that could cause client harm.
3. Limited ability to multitask
People perform better at a single task.
4. Interruptions
Many interruptions occur in complex environments such as a hospital. It is more difficult
to get back on task or to remember what you were thinking with frequent interruptions.
5. Stress
Stress causes anxiety, and anxiety affects performance.
6. Fatigue and other physiological factors
Studies show that fatigue affects a person’s ability to process complex information.
7. Environmental factors
Heat, noise, distractions, visual stimuli, and lighting can affect performace and lead to
mistakes.

PROMOTING SAFETY IN THE HEALTH CARE SETTING

 Establishing a National Center for Patient Safety
 Establishing a reporting system
 Promoting effective teamwork and communication
 Creating a culture of trust
 Involving health care workers in the design of work processes and work spaces to provide
efficiency and safety

SAFETY HAZARDS THROUGHOUT THE LIFE SPAN

 Developing Fetus: Exposure to maternal smoking, alcohol consumption, addictive drugs, x-
rays, certain pesticides
  Newborns and Infants: Falling, suffocation in crib, choking from aspirated milk or ingested
objects, burns from hot water or other spilled hot liquids, automobile accidents, crib or
playpen injuries, electric shock, poisoning
 Toddlers: Physical trauma from falling, banging into objects, or getting cut by sharp objects;
automobile accidents; burns; poisoning; drowning; and electric shock
 Preschoolers: Injury from traffic, playground equipment, and other objects; choking,
suffocation, and obstruction of airway or ear canal by foreign objects; poisoning; drowning;
fire and burns; harm from other people or animals
 Adolescents: Vehicular accidents, recreational accidents, firearms, substance abuse
 Older adults: Falling, burns, and pedestrian and automobile accidents

PROMOTING SAFETY ACROSS THE LIFE SPAN

 Newborns and Infants
Accidents are a leading cause of death during infancy, especially during the first year of
life. Infants are completely dependent on others for care; they are oblivious to such dangers
as falling or ingesting harmful substances.
 Use a federally approved car seat at all times.
 Never leave the infant unattended on a raised surface.
 Check the temperature of the infant’s bath water and formula prior to using.
 Hold the infant upright during feeding.
 Do not prop the bottle.
 Cut food in small pieces.
 Do not feed the infant peanuts or popcorns.
 Investigate the infant’s crib for compliance with federal safety regulations.
 Use a playpen with sides made of small-size netting.
 Provide large soft toys with no small detachable or sharp-edged parts.
 Use guard gates on stairs and screens on windows.
 Cover electric outlets. Coil cords out of reach.
 Place plants, household cleaners, and wastebaskets out of reach.
 Toodlers
Toddlers are curious and like to feel and taste everything. They are fascinated by
potential dangers, such as pools and busy streets, so they need constant supervision and
protection.
 Continue to use federally approved car seats at all times.
 Teach children not to put objects in the mouth, including pills.
 Keep objects with sharp edges out of children’s reach.
 Place hot pots on burners with handles turned inward.
 Keep cleaning solutions, insecticides, and medicines in locked cupboards.
 Keep windows and balconies screened.
 Supervise toddlers in the tub.
 Fence in pools, and supervise toddlers at all times when in near pools. Do not
overfill bathtub. Do not let toddlers play near ditches or wells.
 Teach children not to run or ride a tricycle into the street.
 Obtain a low bed when the child begins to climb.
 Cover outlets with safety covers or plugs.
 Preschoolers
Children of preschool age are active and often very clumsy, making them susceptible to
injury. Safety education must begin at this stage.
 Do not allow children to run with candy or other objects in the mouth.
 Teach children not to put small objects in the mouth, nose, and ears.
 Remove doors from unused equipment such as refrigerators.
 Always supervise pre-schoolers crossing streets and begin safety teaching about
obeying traffic signals and looking both ways.
 Teach children to play in “safe” areas, not on streets .
 Teach pre-schoolers the dangers of playing with matches and playing near
charcoal, fire, and heating appliances.
 Teach children to avoid strangers and keep parents informed of their
whereabouts.
 Teach pre-schoolers not to walk in front of swings and not to push others off
playground equipment.
  School-Age Children
When children attend school, they are learning to think before they act. They prefer
adult equipment to toys and want to play with other children.
 Teach children safety rules for recreational and sports activities.
 Supervise contact sports and activities in which children aim at a target.
 Teach children safe ways to use the stove, garden tools, and other equipment.
 Supervise children when they use saws, electric appliances, tools, and other
potentially dangerous equipment.
 Teach children not to play with fireworks, gunpowder, or firearms.
 Teach children to avoid excavations, quarries, vacant buildings, and playing
around heavy machinery.
 Teach children health hazards of smoking.
 Teach children the effects of drugs, and alcohol on judgement and coordination.
 Adolescents
Adolescents are at risk for sports injuries because of coordination skills are not fully
developed. They are also at risk for suicide, homicide and automobile accidents.
 Have adolescents complete a drivers’ education course, and take practice drives
with them in various kinds of weather.
 Set firm limits on automobile use.
 Restrict number of passengers in car during the first year of driving.
 Teach adolescents to wear a safety helmet when riding motorcycles.
 Encourage to use proper equipment when participating in sports.
 Encourage to swim, jog, and go boating in groups so they can obtain help in case
of an accident.
 Teach safety measures for use of power tools.
 Teach rules for hunting and the proper care and use of firearms.
 Inform them about the dangers of drugs, alcohol, and unprotected sex.
 Teach dangers of sunbathing and tanning beds.
 Be alert to changes in the adolescent’s mood and behaviour.
 Set a good example of behaviour that the adolescents can follow.
 Young Adults
Motor vehicle crashes are by far the leading cause of mortality for this group; other
causes of death for young adults include drowning, fires, burns and firearms.
 Reinforce motor vehicle safety.
 Remind the young adult to repair potential fire hazards, such as electric wiring.
 Reinforce water safety.
 Discuss evaluating the potential for workplace injuries or death when making
decisions about a career or occupation.
 Discuss avoiding excessive sun radiation.
 Encourage young adults who are unable to cope with the pressures,
responsibilities, and expectations of adulthood to seek counselling.
 Middle-Aged Adults
Changing physiologic factors, as well as concern over personal and work-related
responsibilities, may contribute to the injury rate of middle-aged persons.
 Reinforce motor vehicle safety.
 Make certain stairways are well lighted and uncluttered.
 Equip bathrooms with hand grasps and non-skid bath mats.
 Test smoke detectors and fire alarms regularly.
 Keep all machines and tools in good working condition at work and at home.
 Reinforce safety measures taught earlier in life, such as the hazards of excessive
such exposure.
 Elders
Because of limited vision, slowed reflexes, and brittle bones, climbing stairs, driving
cars, and even walking require caution.
 Encourage the client to have regular vision and hearing tests.
 Assist the client to have a home hazard appraisal.
 Encourage the client to keep as active as possible.

PREVENTING SPECIFIC HAZARDS

1. Scalds and Burns
  Scald (a burn from a hot liquid or vapour)
 Burn (results from excessive exposure to thermal, chemical, electric, or radioactive
agents)
 The risk of scalds and burns is greater for clients whose skin sensitivity to
temperature is impaired.
2. Fires
 Constant risk in both health care settings and home.
TYPES OF FIRE
 Agency Fires
 In health care facilities, fire is particularly hazardous when people are
incapacitated and unable to leave the building without assistance.
 This incapacity makes nurses be knowledgeable of fire safety regulations and
fire prevention practices.
1. Protect and evacuate clients who are in immediate danger.
2. Report the fire.
3. Contain the fire.
4. Extinguish the fire.
 Home Fires
 Nursing interventions for home fires focus on teaching fire safety
1. Keep emergency numbers near the telephone, or stored for speed
dialling.
2. Be sure the smoke alarms are operable and appropriately located.
3. Teach clients to change the batteries in their smoke alarms
annually.
4. Have a family fire drill plan.
5. Keep fire extinguishers available and in working condition.
6. Close windows and doors possible.
3. Falls
 Infants and elders are particularly prone to falling and causing serious injury.
 Falls are the leading cause of injuries among older adults.
 Weak leg muscles, weak knees, poor balance, and loss of flexibility contribute to
falls in the elderly.
4. Seizures
 A seizure is a sudden onset of excessive electrical discharges in one or more areas
of the brain.
 It can develop at any time in a person’s life and can occur anytime.
SEIZURE CATEGORIES
 Partial Seizures
 Also called focal seizures
 Involve electrical discharges from one area of the brain.
 Generalized Seizures
 Affects the entire brain
5. Poisoning
 Inadequate supervision and improper storage of many household toxic substances
are the major reasons for poisoning in children.
 Adolescents and adults poisoning are usually caused by insect or snake bites and
drugs used for recreation or suicide attempts.
 Poisoning in elders usually results from accidental ingestion of a toxic substance or
an overdose of a prescribed medication due to impaired memory and failing
eyesight.
6. Carbon Monoxide Poisoning
 Carbon Monoxide is an odourless, colorless, tasteless gas that is very toxic.
 Exposure to CO can cause symptoms including headache, nausea, dizziness,
weakness, vomiting, or loss of muscles control.
 Prolonged exposure can cause unconsciousness, brain damage, or death.
7. Suffocation and Choking
 Also called asphyxiation is lack of oxygen due to interrupted breathing.
 One common reason for chonking is that food or a foreign object has become
lodged in the throat.
 Other cause of suffocation includes drowning, gas or smoke inhalation, accidental
coverage of the nose and mouth by a piece of plastic, by strangulation.
  If a person does not receive immediate relief, may lead to respiratory and cardiac
arrest and death.
8. Excessive Noise
 It is a health hazard that can cause hearing loss, depending on:
1. overall level of noise
2. frequency range of the noise
3. duration of exposure and individual susceptibility
9. Electric Hazards
 Electric shock occurs when a current travels through the body to the ground rather
than through electric wiring, or from static electricity that builds up on the body.
 When major injury does occur, the victim may sustain both superficial and deep
burns, muscle contractions, and cardiac and respiratory arrest, necessitating CPR
and life support.
10. Firearms
 Parents who bring guns into their homes must accept full responsibility for teaching
safety rules to any children.
11. Radiations
 Radiation injury can occur from overexposure to radioactive materials used in
diagnostic and therapeutic procedures.
 But radiation exposure can be minimized by:
1. limiting the time near the source
2. providing as much distance as possible from the source
3. using shielding devices such as lead aprons when near the source
12. Bioterrorism Attack
 No one knows when a bioterrorism attack will occur, thus, it is important that health
care personnel and facilities plan and prepare for the unknown.

RESTRAINING CLIENTS
 Restraints are protective devices used to limit the physical activity of the client or a part of the
body.
 The purpose of restraints is to prevent the client from injuring self or others.
CLASSIFICATION OF RESTRAINTS
1. Physical Restraints
 These are manual method or physical or mechanical device, material, or
equipment attached to the client’s body.
 They cannot be removed easily and they restrict the client’s movement.
2. Chemical Restraints
 These are medications such as neuroleptics, anxiolytics, sedatives, and
psychotropic agents used to control socially disruptive behaviour.

References
Berman, Snyder, Kozier, & Erb. (2008). Kozier and Erb's Fundamentals of Nursing, 8th ed. Vol. 1.
Pearson Education, Inc.
3. Complementary and alternative therapies

The term alternative medicine or complementary medicine are use to describe as many
as 1,800 other therapies practiced all over the world. Many of these have been handed down over
thousands of years, orally and in written records. They are based on the medical systems of
ancient people.

CONCEPTS COMMON TO MOST ALTERNATIVE PRACTICES

1. Holism
 Based on the paradigm of whole systems and the belief that people are more than
physical bodies with fixable and replaceable parts.
 Combined mental, emotional. Spiritual, relationship, and environmental components
make up holism.
2. Humanism
 Believes that:
1. the mind body are indivisible
2. people have the power to solve their own problems
3. people are responsible for the patterns of their lives
4. well-being is a combination of personal satisfaction and contributions to the
larger community
3. Balance
 Balance and equilibrium among the components must be achieved.
1. Physical aspects include optimal functioning of all body systems
2. Emotional aspects include the ability to feel and express the entire range of
human emotions
3. Mental aspects include feelings of self-worth, positive identity, a sense of
accomplishment, and the ability to appreciate and create
4. Spiritual aspects involve moral values, a meaningful purpose in life, and a
feeling of connectedness to others and a divine source
5. Environmental aspects include physical, biologic, social, and political
conditions.
4. Spirituality
 Spirituality includes the drive to become all that one can be, and is bound to intuition,
creativity, and motivation.
 It is the dimension that involves relationship with oneself, with others, and with a
higher power.
 For some people, it gives a meaning and purpose in their lives.
5. Energy
 It is viewed as the force that integrates the body, mind, and spirit.
 It connects everything.
1. Grounding
 One’s whole contact to reality.
 Being grounded suggests stability, security, independence, having a solid
foundation and living in the present rather than escaping into dreams.
2. Centering
 Process of bringing oneself to the center or the middle.
 When people are centered, they are more connected to other parts of their
bodies.
6. Healing Environments
 Nurses create healing environments when they empower others by providing the
knowledge, skills, and support that allow them to tap into their wisdom and make
healing decisions for themselves.

SYSTEMATIZED HEALTH CARE PRACTICES

 1. Ayurveda
 The Indian system of medicine
 Emphasizes the interdependence of the health of the individual and the quality of societal
life.
1. Mentally healthy people have good memory, comprehension, intelligence, and
reasoning ability.
2. Emotionally healthy people experience evenly balanced emotional states and a sense
of well-being or happiness.
3. Physically healthy people have abundant energy with proper functioning of the senses,
digestion, and elimination.
4. Spiritually healthy people have a sense of aliveness and richness of life, are developing
in the direction of their full potential, and are in good relationships with themselves,
other people, and the larger cosmos.
5. Environmentally healthy people have minimal economic, social, and political stress.
2. Traditional Chinese Medicine
 Based on the premise that the body’s vital energy or qi circulates through pathways or
meridians and can be accessed and manipulated through specific anatomical points along
the surface of the body.
3. Native American Healing
 Medicine women and men see themselves as channels through which the Great Power
helps others achieve well-being in the mind, body, and spirit.
 Health is viewed as a balance or harmony of mind and body.
 The goal is to be in harmony with all things.
4. Curanderismo
 It is a cultural healing tradition found in Latin America and among many Latinos in the US.
 Utilizes Western biomedical beliefs, treatment, and practices.
 Three levels are practiced among curanderos or curanderas: material level, spiritual level,
and the mental level.

BOTANICAL HEALING
1. Herbal Medicine
 Conventional primary care providers use plant-derived products and even some medicine
are derived from plants.
2. Aromatherapy
 It is the therapeutic use of essential oils of plants in which the odor or fragrance plays an
important part.
3. Homeopathy
 It is a self-healing system, assisted by small doses of remedies or medicines, which is
useful in a variety of acute and chronic disorders.
4. Naturopathy
 Naturopathic medicine is not only a system of medicine but also a way of life.
 The goal of the treatment is the restoration of health and normal body function, rather than
the application of a particular therapy.

MANUAL HEALING METHODS

1. Chiropractic
 Chiropractic practitioners believe that health is a state of balance, especially of the nervous
and musculoskeletal systems.
 The ROM is improved when fibrous adhesions within joints are broken from the joint
capsule are released through manipulation.
2. Massage
 Aids the ability of the body to heal itself and is aimed at achieving or increasing health and
well-being.
 Mental level: relieves muscle tension, reduces muscle spasms, improves joint flexibility
and ROM, improves posture, lowers blood pressure, slows heart rate, promotes deeper
and easier breathing, and improves health of the skin.
 Physical level: induces a relaxed state of alertness, reduces mental stress, and increases
capacity for clearer thinking.
 Emotional level: satisfies the need for caring and nurturing touch, increases feelings of
well-being, decreases mild depression, enhances self-image, reduces levels of anxiety,
and increases awareness of mind-body connection.
 3. Acupuncture/Acupressure/Reflexology
 Techniques of applying pressure or stimulation to specific points on the body, known as
acupuncture points.
 To relieve pain, cure certain illnesses, and promote wellness.
 Acupuncture uses needles.
 Acupressure uses finger pressure
 Reflexology is a form of acupressure most commonly performed on the feet but the hands
or ears may also be manipulated.
 Balances the energy or qi to promote optimal health and well-being.
4. Hand-Mediated Biofield Therapies
 Utilizes three prominent hand-mediated therapies: therapeutic touch (TT), healing touch
(HT) and Reiki.
 The goals are to accelerate the person’s own healing process and to facilitate healing at all
levels of body, mind, emotions, and spirit.

MIND-BODY THERAPIES
1. Yoga
 Yoga has been practiced for thousands of years in India.
 For Indians, it is a way of life that includes ethical models for behaviour and mental and
physical exercises aimed at producing spiritual enlightenment.
2. Meditation
 Relaxing the body and easing the mind.
 It is a process that anyone can use to calm themselves, cope with stress, and, for those
with spiritual inclinations, feel as one with God or the universe.
3. Hypnotherapy
 It is the application of hypnosis in a wide variety of medical and psychological disorders.
 Hypnosis is a trance state or an altered state of consciousness in which an individual’s
concentration is focused and distraction is minimized.
 It can be used to help people gain self-control, improve self-esteem, and become more
autonomous.
4. Guided Imagery
 Guided Imagery is a state of focused attention that encourages changes in attitudes,
behaviour, and physiologic reactions.
 It can help stop troublesome thoughts and focus on images that help the client relax.
5. Biofeedback
 It is a method for learned control of physiologic responses of the body.
 It is a relaxation technique that uses electronic equipment to amplify the electrochemical
energy produced by body responses.
6. Qigong and T’ai Chi
 Qigong is a Chinese discipline consisting of breathing and mental exercises combined with
body movements.
 T’ai Chi, which arose form Qigong, is a discipline that combines physical fitness,
meditation, and self-defense.
 Both disciplines consist of soft, slow, continuous movements that are circular in nature. The
slowness of movements requires attentive control that quiets the mind an develops one’s
powers of awareness and concentration.
7. Pilates
 It is a method of physical movement and exercise designed to stretch, strengthen, and
balance the body, in particular the core or center including the abdominal region.

SPIRITUAL HEALING
1. Faith and Prayer
 Faith refers to our beliefs and expectations about life, ourselves, and others. It refers to a
belief in a Supreme Being who listens and responds to people and cares about their well-
being.
 Prayer is most often defined simply as a form of communication and fellowship with the
Deity or Creator.

MISCELLANEOUS THERAPIES
1. Music Therapy
  Music is often used in healing, from the ancient sounds of the drum, rattle, bone flute, and
other primitive instruments to the use of current music as a prescription for health.
 Often used to relax and distract clients in operative settings, ICU, birthing rooms,
rehabilitation and physical therapy units, and sleep induction units.
2. Humor and Laughter
 In Nursing, it helps the client to perceive, appreciate, and express what is funny, amusing,
or ludicrous in order to establish relationships, relieve tension, release anger, facilitate
learning, or cope with painful endings.
3. Bioelectromagnetics
 Magnets are used to relieve joint pain and headaches, to speed up healing of wounds by
increasing blood flow, and to improve bone repair.
4. Infrared Photoenergy Therapy
 It is a safe and effective treatment to improve sensory impairment associated with
peripheral neuropathy.
 It is believed that the treatment works by increasing energy inside cells and improving
blood circulation.
5. Detoxifying Therapy
 Belief that physical impurities and toxins must be cleared from the body to achieve better
health.
1. Hydrotherapy (the use of water as a healing treatment)
2. Colonics (procedure for washing the inner wall of the colon by filling it with water or
herbal solutions and then draining it)
3. Chelation Therapy (introduction of chemicals into the bloodstream that bind with
heavy metals in the body)
6. Animal-Assisted Therapy
 The use of specifically selected animals as a treatment modality in health and human
service settings.
7. Horticultural Therapy
 Healing garden
 It is an adjunct therapy to occupational and physical therapy.
 It stimulates the five senses, provides leisure activities, improves motor function, provides
sense of achievement, and improves self-esteem.

References
Berman, Snyder, Kozier, & Erb. (2008). Kozier and Erb's Fundamentals of Nursing, 8th ed. Vol. 1.
Pearson Education, Inc.
4. Medication

A medication is a substance administered for the diagnosis, cure, treatment, or relief of a

symptom or for prevention of disease.. In health care context, medication and drug are
interchangeably used. The term drug, however, has a connotation of an illicitly obtained
substance such as heroin, cocaine, or amphetamines.
Pharmacology is the study of the effect of drugs on living organisms. While the term
pharmacy, is the art of preparing, compounding, and dispensing drugs. A written direction for the
preparation and administration of a drug is called prescription.
KINDS OF DRUG NAMES
1. Generic Name
It is given before a drug becomes officially an approved medication.
2. Official Name
It is the name under which it is listed in one of the official publications.
3. Chemical Name
It is the name by which a chemist knows it and which describes the constituents of drug
precisely.
4. Trade Name/Brand Name
It is the name given by the drug manufacturer.

TYPES OF DRUG PREPARATION TEN “RIGHTS” OF MEDICATION

1. Aerosol Spray or Foam ADMINISTRATION
2. Aqueous Solution 1. Right Medication
3. Aqueous Suspension 2. Right Dose
4. Caplet 3. Right Time
5. Capsule 4. Right Rout
6. Cream 5. Right Client
7. Elixir 6. Right Client Education
8. Extract 7. Right Documentation
9. Gel of Jelly 8. Right to Refuse
10. Liniment 9. Right Assessment
11. Ointment 10. Right Evaluation
12. Lotion ROUTES OF ADMINISTRATION
13. Lozenge 1. Oral
14. Paste 2. Sublingual
15. Pill 3. Buccal
16. Powder 4. Rectal
17. Suppository 5. Vaginal
18. Syrup 6. Topical
19. Tablet 7. Transdermal
20. Tincture 8. Subcutaneous
21. Transdermal Patch 9. Intramuscular
10. Intradermal
EFFECTS OF DRUGS 11. Intravenous
1. Therapeutic Effect 12. Inhalation
 It is the desired effect.
 The primary effect intended, that is, the reason the drug is prescribed.
2. Side Effect
 It is also called the secondary effect which is the unintended.
 Side effects are usually predictable and may be either harmless or potentially harmful.
 More severe side effects are called adverse effects.
3. Drug Toxicity
  A deleterious effect of a drug on an organism or tissue.
 Results from overdosage, ingestion of a drug intended for external use and buildup of
the drug in the blood.
4. Drug Allergy
 It is an immunologic reaction to drug.
 Severe allergic reaction that occurs immediately after the administration of the drug is
called an anaphylactic reaction.
5. Drug Tolerance
 Exists in a person who has usually low physiologic response to a drug and who
requires increases in the dosage to maintain a given therapeutic effect.
 A cumulative effect is the increasing response to repeated doses of a drug that
occurs when the rate of administration exceed the rate of metabolism or excretion.
 An idiosyncratic effect is one that is unexpected and may be individual to a client.
6. Drug Interaction
 Occurs when the administration of one drug before, at the same time as, or after
another drug alters the effect of one or both drugs.
 Synergistic (when two different drugs increase the action of one or another drug.
7. Latrogenic Disease
 The disease caused unintentionally by medical therapy.

THERAPEUTIC ACTIONS OF DRUGS FACTORS AFFECTING MEDICATION ACTION

1. Palliative 1. Developmental Factors
2. Curative 2. Gender
3. Supportive 3. Cultural, Ethnic, and Genetic Factors
4. Substitutive 4. Diet
5. Chemotherapeutic 5. Environment
6. Restorative 6. Psychologic Factors
7. Illness and Disease
8. Time of Administration
PHARMACOKINETICS
1. Absorption
 The process by which a drug passes into the bloodstream.
2. Distribution
 The transportation of a drug from its site of absorption to its site of action.
3. Biotranformation
 Also called detoxification or metabolism
 A process by which a drug is converted to a less active form.
4. Excretion
 The process by which metabolites and drugs are eliminated from the body.

TYPES OF MEDICATION ORDERS

1. Stat Order
 Indicates that the medication is to be given immediately and only once.
2. Single Order
 For medication to be given once at a specified time.
3. Standing Order
 May be carried out indefinitely until an order is written to cancel it.
 May be carried out for a specified number of days.
4. Prn Order
 Permits the nurse to give a medication when, in the nurse’s judgment, the client
requires it.

ESSENTIAL PARTS OF A MEDICATION ORDER PROCESS OF ADMINISTERING MEDICATIONS

1. Full name of the client 1. Identify the client
2. Date and time the order is written 2. Inform the client
3. Name of the drug to be administered 3. Administer the drug
4. Dosage of the drug 4. Provide adjunctive interventions as indicated
5. Frequency of administration 5. Record the drug administered
6. Route of administration 6. Evaluate the client’s response to the drug
7. Signature of the person writing the order
ORAL MEDICATIONS
The oral route is the most common route by which medications are given. As long as a client
can swallow and retain the drug in the stomach, this is the route of choice.
 Know the reason why the client is receiving the medication, the drug classification,
usual dosage range, side effects, and nursing considerations,
 Check the medication administration record (MAR)
 Verify he client’s ability to take medication orally
 Organize the supplies

NASOGASTRIC AND GASTROSTOMY MEDICATIONS

This is an alternative route for administering medications for clients who cannot take anything
by mouth because of a nasogastric tube or gastrostomy tube in place.

PARENTERAL MEDICATIONS
Parenteral administration of medications is commonly done because some medications like
intradermal (ID), subcutaneously, intramuscularly (IM), or intravenously (IV) are absorbed more
quickly than oral medications and are irretrievable once injected.

*EQUIPMENT NEEDED
 Syringes
 Have three parts: the tip, which connects with the needle; the barrel, which the
scales are printed; the plunger, which fits inside the barrel.
KINDS OF SYRINGES
1) Hypodermic Syringe
2) Insulin Syringe
3) Tuberculin Syringe
 Needles
 These are made of stainless steel, and most are disposable
 Has three discernible parts: the hub, which fits onto the syringe; the cannula or
shaft, which is attached to the hub; the bevel, which is the slanted part at the tip
of the needle.
 Ampules and Vials
 An ampule is a glass container usually designed to hold a single dose of a drug
and has distinctive shape with a constricted neck.
 A vial is a small glass bottle with a sealed rubber cap.
1. Intradermal Injections
 It is the administration of a drug into the dermal layer of the skin just beneath the epidermis.
 This method of administration is frequently used for allergy testing and tuberculosis
screening.
 Common sites: inner lower arm, upper chest, back beneath the scapulae
2. Subcutaneous Injections
 Usually for vaccines, insulin, and heparin.
 Common sites: outer aspect of the upper arms and the anterior aspect of the thighs.
3. Intramuscular Injections
 Injections into the muscle tissue are absorbed more quickly than subcutaneous injections
because of the greater blood supply to the body muscles.
 Ventrogluteal Site
 Vastus Lateralis Site
 Dorsogluteal Site
 Deltoid Site
 Rectus Femoris Site
4. Intravenous Medications
 This is appropriate because it enters the client’s bloodstream directly via veins and has a
rapid effect.
 This is also done when medications are too irritating to tissues to be given by other routes.
 Large-volume infusion of IV fluid
 Intermittent IV infusion
 Volume-controlled infusion
 IV push or bolus
 Intermittent injection ports
TOPICAL MEDICATIONS
A topical medication is applied locally to the skin or to mucous membranes in areas such as
the eye, external ear canal, nose, vagina, and rectum. Most topical medications used therapeutically
are not absorbed well, completely, or predictably when applied to intact skin.
A particular type of topical or dermatologic medication delivery system is the transdermal
patch. This system administers sustained-action medications via multi-layered films containing the
drug and an adhesive layer.
1. Skin Applications
 Include ointments, pastes, creams, lotions, powders, sprays, and patches.
2. Ophthalmic Medications
 Medications may be administered to the eye using irrigations or instillations.
 Eye irrigation is administered to wash out the conjunctival sac to remove secretions or
foreign bodies or to move chemical that may injure the eye.
3. Otic Medications
 Consist of instillations or irrigations of the external auditory canal and are generally
carried out for cleaning purposes.
4. Nasal Medications
 Usually instilled for their astringent effect, to loosen secretions and facilitate drainage, or
to treat infections of the nasal cavity or sinuses.
5. Vaginal Medications
 This are inserted as creams, jellies, foams, or suppositories to treat or to relieve vaginal
discomfort.
6. Rectal Medications
 Rectal medication is a convenient and safe method of giving certain medications.
 Advantages include: avoids irritation of the upper gastrointestinal tract, when
medication has an objectionable taste or odor, when the drug is released at a
slow but steady rate, and it provide higher bloodstream levels.

RESPIRATORY INHALATION
Nebulizers deliver most medications administered through the inhaled route. A nebulizer is
used to deliver a fine spray of medication or moisture to a client.
There are two kinds of nebulization: atomization and aerosolization. In atomization, a device
called atomizer produces rather large droplets for inhalations. In aerolosolization, the droplets are
suspended in a gas, such as oxygen.
1. Large-volume Nebulizer
 Provides a heated or cool mist that can be used for long-term therapy, such as
tracheostomy.
2. Ultrasonic Nebulizer
 Provides 100% humidity and can provide particles small enough to be inhaled deeply
into the respiratory tract.
3. Metered-dose Inhaler (MDI)
 A handheld nebulizer which is pressurized container of medication that can be used by
the client to release the medication through a nosepiece or mouthpiece.

IRRIGATIONS
Irrigation is the washing out of a body cavity by a stream of water or fluid that may or may not
be medicated.
 To clean the area, that is, to remove a foreign object or excessive secretions or
discharge
 To apply heat or cold
 To apply a medication such as an antiseptic
 To reduce inflammation
 To relieve discomfort

References
Berman, Snyder, Kozier, & Erb. (2008). Kozier and Erb's Fundamentals of Nursing, 8th ed. Vol. 1.
Pearson Education, Inc.
NURSING INTERVENTIONS TO PROMOTE HEALTHY PHYSIOLOGIC RESPONSES

1) Hygiene
Hygiene is the science of health and its maintenance. Personal hygiene is the self-care by
which people attend to such functions as bathing, toileting, general body hygiene, and grooming.
Hygiene is a highly personal matter determined by individual values and practices.

HYGIENIC CARE
1. Early Morning Care
This is provided to clients as they awaken in the morning.
2. Morning Care
This is often provided after clients have breakfast and sometimes before having
breakfast.
3. Hour of Sleep (HS)/ PM Care
This is provided to clients before they retire for the night.
4. As-needed (prn) Care
This is provided as required by the client.

FACTORS INFLUENCING INDIVIDUAL HYGIENIC PRACTICES

 Culture
 Religion
 Environment
 Developmental Level
 Health and Energy
 Personal Preferences

GENERAL GUIDELINES FOR SKIN CARE

1. An intact, healthy skin is the body’s first line of defense.
2. The degree to which the skin protects the underlying tissues from injury depends on the
general health of the cells, the amount of subcutaneous tissue, and the dryness of the skin.
3. Moisture in contact with the skin for more than a short time can result in increased bacterial
growth and irritations.
4. Body odors are caused by resident skin bacteria acting on body secretions.
5. Skin sensitivity to irritation and injury varies among individuals and in accordance with their
health.
6. Agents used for skin care have selective actions and purposes.

AGENTS COMMONLY USED ON THE SKIN

1. Soap
 Lowers surface tension and thus helps in cleaning.
2. Detergent
 Used instead of soap for cleaning.
3. Bath Oil
 Used in bathwater; provides an oily film on the skin that softens and prevents
chapping.
4. Skin cream and Lotion
 Provides a film on the skin that prevents evaporation and therefore chapping.
5. Powder
 Can be used to absorb water and prevent friction.
6. Deodorant
 Masks or diminishes body odors.
7. Antiperspirant
 Reduces the amount of perspiration.
COMMON SKIN PROBLEMS
1. Abrasion
 Superficial layers of the skin are scraped or rubbed away. The area is reddened and
may have localized bleeding or serous weeping.
2. Excessive Dryness
 Skin can appear flaky and rough.
3. Ammonia Dermatitis
 Caused by skin bacteria reacting with urea in the urine and the skin becomes reddened
and is sore.
4. Acne
 Inflammatory condition with papules and pustules.
5. Erythema
 Redness associated with a variety of conditions such as rashes, exposure to sun,
elevated body temperature.
6. Hirsutism
 Excessive hair on a person’s body and face, particularly in women.

BATHING
Bathing removes accumulated oil, perspiration, dead skin cells, and some bacteria. Bathing
also stimulates circulation and also produces a sense of well-being. It is refreshing and relaxing and
frequently improves morale, appearance, and self-respect.
CATEGORIES OF BATH
1. Cleaning Baths
 Complete bed bath
The nurse washes the entire body of a dependent client in bed.
 Self-help bed bath
Clients confined to bed are able to bathe themselves with help from the nurse for
washing the back and perhaps the feet.
 Partial bath
Only the parts of the client’s body that might cause discomfort or odor are
cleaned for this type of bath.
 Bag Bath
This bath is a commercially prepared product that contains 10 to 12 presoaked
disposable washcloths that contain no-rinse cleanser solution.
 Tub Bath
This are often preferred to bed baths because it is easier to wash and rinse in a
tub.
 Sponge Bath
This is suggested for the newborn because daily tub baths are not considered
necessary.
 Shower
Many ambulatory clients are able to use shower facilities and require only
minimal assistance from the nurse.
2. Therapeutic Baths
These are given for physical effects, such as to soothe irritated skin or to treat an area.
Medications may be placed in the water.

PERINEAL-GENITAL CARE
Perineal-genital care is also referred to as perineal care or pericare. Perineal care as part of
bed bath is embarrassing for many clients and so as nurses, particularly with clients of the opposite
sex. Most clients who require a bed bath from the nurse are able to clean their own genital areas with
minimal assistance.

HAIR CARE
The appearance of the hair often reflects a person’s feelings of self-concept and
sociocultural well-being. Patient's hair can be washed with shampoo and conditioner in the shower,
bathtub and in bed with a special bed tray or dry shampoo. Patients should also be encouraged to
comb or brush their hair a couple of times a day.

BEARED AND MUSTACHE CARE

 Male clients often want a facial shave once a day or once every couple of days; female
patients usually want their underarms and legs about once a week. Food particles rend to collect in
beards and mustaches, and they need washing and combing periodically.

ORAL HYGIENE
Oral hygiene is done at least twice a day and more often as needed. Oral hygiene consists
of brushing the teeth, flossing the teeth, and rinsing the mouth. Partial and full dentures are also
brushed and rinsed.

NAIL CARE
Client nail care is another important area of hygiene and client's nails need to be checked
daily, to observe them for any irregularities. To provide care the nurse needs a nail cutter or sharp
scissors, a nail file, an orange stick to push back the cuticle, hand lotion or mineral oil to lubricate any
dry tissue around the nails and a basin of water to soak the nails if they are particularly thick and
hard.

FOOT CARE
Feet are washed with the bath and more often as needed. Diabetics and other patients at
risk for infections should get special foot and toenail care and monitoring. For example, the feet must
be completely cleaned and dried and examined daily for any signs of skin breakdown, corns,
bleeding, broken, chipped or absent nails, as well as blue or pale nail beds.

References
Berman, Snyder, Kozier, & Erb. (2008). Kozier and Erb's Fundamentals of Nursing, 8th ed. Vol. 1.
Pearson Education, Inc.
2) Skin Integrity
Intact skin refers to the presence of normal skin and skin layers uninterrupted by wounds. The
appearance of the skin and skin integrity are influenced by internal factors such as genetics, age,
and the underlying health of the individual as well as external factors such as activity.
TYPES OF WOUNDS
1. Intentional Wounds
This occurs during therapy.
2. Unintentional Wounds
A person may fracture an arm in an automobile collision.
DEGREE OF WOUND CONTAMINATION
1. Clean Wounds
These are uninfected wounds in which minimal inflammation is encountered and the
respiratory, alimentary, genital, and urinary tracts are not entered.
2. Clean-contaminated Wounds
These are surgical wounds in which the respiratory, alimentary, genital, or urinary tract
has been entered.
3. Contaminated Wounds
These include open, fresh, accidental, wounds involving a major break in sterile
technique or a large amount of spillage from the gastrointestinal tract.
4. Dirty or infected Wounds
These include wounds containing dead tissue and wounds with evidence of a clinical
infection, such as purulent drainage.

WOUND HEALING
This is also referred to as regeneration of tissues. Healing can be considered in terms of
types of healing, having to do with the caregiver’s decision on whether to allow the wound to seal
itself or to purposefully close the wound, and phases of healing, which refer to the steps in the body’s
natural processes of tissue repair.
TYPES OF WOUND HEALING
1. Primary Intention Healing
 Occurs where the tissue surfaces have been approximated and there is minimal or no
tissue loss.
 Characterized by the formation of minimal granulation tissue and scarring.
2. Secondary Intention Healing
 A wound that is extensive and involves considerable tissue loss, and in which the
edges cannot or should not be approximated.
 Secondary intention healing differs from the primary one because its repair time is
longer, the scarring is greater, and the susceptibility to infection is greater.

PHASES OF WOUND HEALING

1. Inflammatory Phase
 This is initiated immediately after injury and lasts 3 to 6 days.
 Two major processes occur during this phase: hemostasis and phagocytosis.
2. Proliferative Phase
 This phase extends from day 3 to 4 to about day 21 postinjury.
 Fibroblasts migrate into the wound starting about 24 hours after injury and begin to
synthesize collagen.
3. Maturation Phase
 The maturation phase begins about day 21 and can extend 1 or 2 years after the injury.
 TYPES OF WOUND EXUDATE
Exudate is material, such as fluid and cells, which has escaped from blood vessels during
the inflammatory, process and is deposited in tissue or on tissue surfaces.
1. Serous Exudate
 Consists chiefly of serum derived from blood and the serous membranes of the body,
such as the peritoneum.
2. Purulent Exudate
 This is thicker than serous exudate because of the presence of pus, which consists of
leukocytes, liquefies dead tissue debris, and dead and living bacteria.
3. Sanguineous Exudate
 Consists of large amount of RBCs, indicating damage to capillaries that is severe
enough to allow the escape of the RBCs from plasma.
 A serosanguineous exudate is commonly seen in surgical incisions and which consist
of clear and blood-tinged drainage.
COMPLICATIONS OF WOUND HEALING
1. Hemorrhage
 A dislodged clot, a slipped stitch, or erosion of a blood vessel may cause severe
bleeding.
 This may be detected by selling or distention in the area of the wound and, possibly, by
sanguineous drainage from a surgical drain.
 Hemorrhage is an emergency and nurses should apply pressure dressings to the area
and monitor the client’s vital signs.
2. Infection
 This happens because of microorganisms colonizing the wound, multiply excessively
and invade tissues.
 A wound can be infected with microorganisms at the time of injury, during surgery, or
postoperatively.
3. Dehiscence with Possible Evisceration
 Dehiscence is the partial or total rupturing of a sutured wound. It usually involves an
abdominal wound in which layers below the skin also separate.
 Evisceration is the protrusion of the internal viscera through an incision,
 Wound dehiscence is more likely to occur 4 to 5 days postoperatively before extensive
collagen is deposited in the wound.

FACTORS AFFECTING WOUND HEALING SUPPORTING WOUND

 Developmental Considerations HEALING
 Nutrition  Moist Wound
 Lifestyle Healing
 Medications  Nutrition and
Fluids
DRESSING WOUNDS  Preventing
 To protect the wound from mechanical injury Infection
 To protect the wound from microbial  Positioning contamination
 To provide or maintain moist wound healing
 To provide thermal insulation
 To absorb drainage or debride a wound or both
 To prevent haemorrhage
 To splint or immobilize the wound site and hereby facilitate healing and prevent injury
TYPES OF DRESSINGS
*The types of dressing used depends on the
 location, size, and type of the wound
 amount of exudate
 whether the wound requires debridement or is infected
 frequency of dressing change
 ease or difficulty of dressing application
 cost
1. Transparent Dressings
These are often applied to wounds including ulcerated or burned skin areas.
2. Hydrocolloid Dressings
 These are frequently used over pressure ulcers.
3. Securing Dressings
The nurse tapes the dressing over the wound, ensuring that the dressing covers the
entire wound and does not become dislodged.
CLEANING WOUNDS
Wound cleaning involves the removal of debris such as foreign materials, excess slough,
necrotic tissue, bacteria, and other microorganisms.
An irrigation is the washing or flushing out of an area. Sterile technique is required for a
wound irrigation because there is a break in the skin integrity. Gauze packing using the damp-to-
damp technique has been used to pack wounds that require debridement

SUPPORTING AND IMMOBILIZING WOUNDS

1. Bandages
These are strips of cloth used to wrap some part of the body. There are many types of
materials used for bandages. Gauze is one of the most commonly used because it is light,
porous and inexpensive which it can be used to retain dressings on wounds and to bandage
the fingers, hands, toes, and feet. Elasticized bandages are applied to provide pressure to an
area.
*Basic Turns for Roller Bandages
 Circular Turns
 Spiral Turns
 Spiral Reverse Turns
 Recurrent Turns
 Figure-Eight Turns
2. Binders
A binder is a type of bandage designed for a specific body part. This is used to support
large areas of the body and is simple to use, inexpensive and customizable using plain
material.
 Triangular Arm Sling
 Straight Abdominal Binder
 Securing Peritoneal Dressing

PRESSURE ULCERS
A pressure ulcer is any lesion caused by unrelieved pressure that results in damage to
underlying tissue. Pressure ulcers are a problem in both acute care settings and long-term care
settings, including homes.

RISK FACTORS PREVENTING PRESSURE ULCERS

 Friction and Shearing  Providing Nutrition
 Immobility  Maintaining Skin Hygiene
 Fecal and Urinary Incontinence  Avoiding Skin Trauma
 Decreased Mental Status  Providing Supportive Devices
 Diminished Sensation
 Excessive Body Heat
 Advanced Age
 Chronic Medical Conditions

STAGES OF PRESSURE ULCERS

 Stage I (formation of nonblanchable erythema signalling a potential ulceration)
 Stage II (a partial-thickness skin loss appears involving the epidermis and possibly the dermis)
 Stage III (a full-thickness skin loss involving damage or necrosis of subcutaneous tissue)
 Stage IV (a full-thickness skin loss appears with tissue necrosis or damage to muscle, bone,
or supporting structures)

NURSING INTERVENTIONS
 Supporting Wound Healing
 Preventing Pressure Ulcers
 Treating Pressure Ulcers
 Dressing Wounds
  Cleaning Wounds
 Supporting and Immobilizing Wounds
 Heat and Cold Applications
References
Berman, Snyder, Kozier, & Erb. (2008). Kozier and Erb's Fundamentals of Nursing, 8th ed. Vol. 1.
Pearson Education, Inc.

3) Mobility
Mobility is the ability to move freely, easily, rhythmically, and purposefully in the environment.
People often define their health and physical fitness by their activity because mental well-being
and the effectiveness of body functioning depend largely on their mobility status, The ability to
move without pain also influences self-esteem and body image, thus, creating a sense of
independence on individuals.
ELEMENTS OF A BODY MOVEMENT
1. Alignment and Posture
Proper body alignment and posture bring the body parts into position in a manner that
promotes optimal balance and maximal body function whether the person is standing, sitting,
or lying down.
2. Joint Mobility
Joints are the functional units of the musculoskeletal system and are responsible for
movements such as bending of knees and lifting of arms.
3. Balance
This mechanisms involved in maintain balance and posture are complex and involve
informational inputs from the inner ear, vision, and receptors of muscles and tendons.
4. Coordinated Movement
Balanced, smooth, purposeful movement is the result of proper functioning of the
cerebral cortex, cerebellum, and basal ganglia.
FACTORS AFFECTING BODY ALIGNMENT AND ACTIVITY
 Growth and Development
 Nutrition
 Personal Values and Attitudes
 External Factors
 Prescribed Limitations
EFFECTS OF IMMOBILITY
 Musculoskeletal System
 Disuse Osteoporosis
 Disuse Atrophy
 Contractures
 Stiffness and pain in the joints
 Cardiovascular System
 Diminished cardiac reserve
 Increased use of the Valsalva maneuver
 Orthostatic hypotension
 Venous vasodilation and stasis
 Dependent edema
 Thrombus Formation
 Respiratory System
 Decreased respiratory movement
 Pooling of respiratory secretions
 Atelectasis
 Hypostatic pneumonia
 Metabolic System
 Decreased Metabolic Rate
 Negative Nitrogen balance
  Anorexia
 Negative calcium balance
 Urinary System
 Urinary stasis
 Renal calculi
 Urinary retention
 Urinary infection
 Gastrointestinal System
 Decreased peristalsis and colon motility
 Integumentary System
 Reduced Skin turgor
 Skin breakdown
 Psychoneurologic System
 Low self-esteem
EXERCISE
Physical activity is bodily movement produced by skeletal muscle contraction that increases
energy expenditure. Exercise is a type of physical activity defined as a planned, structured, and
repetitive bodily movement performed to improve or maintain one or more components of physical
fitness.
TYPES OF EXERCISES
1. Isotonic Exercises- are those in which the muscle shortens to produce muscle contraction
and active movement.
2. Isometric Exercises- are those in which there is muscle contraction without moving the joint.
3. Isokinetic Exercises- involve muscle contraction or tension against resistance.
4. Aerobic Exercises- are those during which the amount of oxygen taken in the body is greater
than that used to perform the activity.
5. Anaerobic Exercises- involves activities in which the muscles cannot draw out enough
oxygen from the bloodstream, and anaerobic pathways are used to provide additional energy
for a short time.
BENEFITS OF EXERCISE
 Musculoskeletal System
 Size, shape, and tone of muscles are maintained
 Bone density and strength are maintained
 Increases joint flexibility, stability and ROM
 Cardiovascular System
 Increased cardiac output
 Prevents stroke and cardiovascular diseases
 Improved oxygen uptake
 Improved circulation
 Respiratory System
 Improving gas exchange
 Elimination of toxins with deeper breathing
 Prevents pooling of secretions in the bronchi and bronchioles
 Enhances oxygenation and circulation
 Metabolic System
 Stabilizes blood sugar
 Increases the use of triglycerides
 Increases the production of body heat and waste products and calorie use
 Urinary System
 Promotes efficient blood flow
 Gastrointestinal System
 Improves appetite
 Increases GI tract tone and facilitating peristalsis
 Relieves constipation
 Psychoneurologic System
 Elevating mood and relieving stress
NURSING INTERVENTIONS
 Using Body Mechanics
 Preventing Back Injury
 Positioning Clients
  Moving and Turning Clients in Bed
 Transferring Clients
 Using a Hydraulic Lift
 Providing ROM Exercises
 Ambulating Clients
 Using Mechanical Aids for Walking

References
Berman, Snyder, Kozier, & Erb. (2008). Kozier and Erb's Fundamentals of Nursing, 8th ed. Vol. 1.
Pearson Education, Inc.

4) Rest and Sleep

Sleep is a basic human need and it is a universal biological process common to all people.
Sleep is required for many reasons: to cope up with daily stresses, to prevent fatigue, to conserve
energy, to restore the mind and body, and to enjoy more life fully.

NORMAL SLEEPING PATTERNS AND REQUIREMENTS

 Newborns \hrough 3 months of age typically sleep 14 to 17 hours a day

 Infants from 4 months of age to 11 months of age should normally sleep about 12 to 15 hours
a day
 Toddlers up to 3 years of age should sleep 11 to 14 hours a day
 Preschoolers from 3 to 5 years of age should sleep 10 to 13 years of age
 School- age children from 6 to 12 years of age need 9 to 11 hours of sleep each day
 Adolescents from 13 to 17 years of age should sleep about 8 to 10 hours of sleep
 Young adults and middle aged adults need about 7 to 9 hours of sleep
 Older adults over 65 years of age tend to require slightly less sleep than the middle age
adults and only 7 to 8 hours of sleep per night

TYPES OF SLEEP
1. NREM Sleep (Non-rapid-eye-movement)
 NREM sleep occurs when activity in the reticular activating system (RAS) is inhibited and
about 75% to 80% of sleep during the night is NREM.
 Stage I is the stage of very light sleep and lasts only a few minutes. During this stage the
person feels drowsy and relaxed, eyes roll from side to side, and respiratory and heart
rates slightly drop.
 Stage II is the stage of light sleep during which the body processes continue to slow down.
The eyes are still, the heart and respiratory rates decrease slightly, and body temperature
falls. This lasts for 10 to 15 minutes but constituents to 40% to 55% of total sleep.
 Stage III and IV are the deepest stages of sleep, differing only in the percentage of delta
waves recorded during a 30 second period. The heart and respiratory rates drop 20% to
30% below those exhibiting during waking hours. The sleeper is difficult to arouse and not
disturbed by sensory stimuli, skeletal muscles are very relaxed, reflexes are diminished,
and snoring is most likely to occur.
Physiologic Changes during NREM Sleep
 Arterial blood pressure falls
 Pulse rate decreases
 Peripheral blood vessels dilate
 Cardiac Output decreases
 Skeletal muscles relax
 Basal metabolic rate decreases 10 % to 30%
 Growth hormone levels peak
 Intracranial pressure decreases
2. REM Sleep (Rapid-eye-movement)
 REM sleep usually recurs about every 90 minutes and lasts 5 to 30 minutes.
 Most dreams take place during REM sleep but usually will not be remembered unless the
person arouses briefly at the end of the REM period.
  During REM sleep, the brain is highly active, and brain metabolism may increase as much
as 20%
 Distinctive eye movement occur, voluntary muscle tone is dramatically decreased, and
deep tendon reflexes are absent.
 In this phase, sleeper may be difficult to arouse or may wake spontaneously.
 Gastric secretions increase, and heart and respiratory rates often are irregular.

FUNCTIONS OF SLEEP
 Restores normal levels of activity
 Normal balance among parts of the nervous system
 Necessary for protein synthesis

FACTORS AFFECTING SLEEP

 Illness
 Environment
 Lifestyle
 Emotional Stress
 Stimulants and Alcohol
 Diet
 Smoking
 Motivation
 Medications
COMMON SLEEP DISORDERS
1. Insomnia
 This is described as the inability to fall asleep or remain asleep.
 Acute insomnia lasts one to several nights and is often caused by personal stressors
and/or worry.
2. Hypersomnia
 This refers to conditions where the affected individual obtains sufficient sleep at night but
still cannot stay awake during the day.
3. Narcolepsy
 Narcolepsy is a disorder of excessive daytime sleepiness caused by the lack of the
chemical hypocretin in the area of the central nervous system that regulates sleep.
 People who are narcoleptic have sleeping attacks or excessive daytime sleepiness and
their sleep at night starts with seep-onset REM.
4. Sleep Apnea
 This is characterized by frequent short breathing pauses during sleep.
 Symptoms include: loud snoring, frequent nocturnal awakenings, excessive daytime
sleepiness, difficulties falling asleep at night, morning headaches, memory and cognitive
problems, and irritability.
5. Parasomnias
 These are behaviors that may interfere with sleep and may even occur during sleep.
1. Bruxism
The clenching and grinding of the teeth during stage II NREM sleep.
2. Enuresis
Bed-wetting during sleep that usually occur in children.
3. Periodic limb movements (PLMs) disorder
The legs jerk twice or three times per minute during sleep.
4. Sleeptalking
Talking during sleep occurs during NREM sleep before REM sleep.
5. Somnambulism
Sleep walking that occurs during stages III and IV of NREM sleep.
*Sleep hygiene is a term referring to interventions used to promote sleep. This involves different
nonpharmacologic measures that enhance the quality and quantity of client’s sleep.
NURSING INTERVENTIONS
 Client Teaching
Healthy individuals need to learn the importance of sleep in maintaining active and
productive lifestyles.
 Supporting Bedtime Rituals
Most people are accustomed to bedtime rituals or presleep routines that are conducive
to comfort and relaxation and altering this may affect the client’s sleep.
  Creating a Restful Environment
All people need a sleeping environment with minimal noise, a comfortable room
temperature, appropriate ventilation, and appropriate lighting.
 Promoting Comfort and Relaxation
Comfort measures are essential to help the client fall asleep and stay asleep, especially
if the effects of the person’s illness interfere with sleep.
 Enhancing Sleep with Medications
Sleep medication is often prescribed on a prn basis for clients include the sedative-
hypnotics which induce sleep , antianxiety drugs and tranquilizers which decrease
anxiety and tension.
References
Berman, Snyder, Kozier, & Erb. (2008). Kozier and Erb's Fundamentals of Nursing, 8th ed. Vol. 1.
Pearson Education, Inc.

5) Pain Management
Pain is an unpleasant and highly personal experience that may be imperceptible to other,
while consuming all parts of the person’s life. Pain, by definition, “is an unpleasant sensory and
emotional experience associated with actual or potential tissue damage, or described in terms of
such damage”.
TERMS DESCRIBING THE TYPES OF PAIN
 Location
 Classification of pain based on where it is in the body may be useful in determining the
client’s underlying problem or needs.
 Duration
 When pain lasts only through the expected recovery period, it is called acute pain.
 Chronic pain is a prolonged recurring or persisting for over 6 months or longer and may
interfere with functioning.
 Intensity
 Categorization of pain according to intensity has become a useful way to identify pain.
 By using a 0 to 10 pain scale where: 1-3 is considered mild pain, rating 4-6 is moderate
pain, and pain reaching 7-10 is ranked severe pain.
 Etiology
 Designation of the types of pain through etiology is done under broad categories of
physiological and neuropathic pain.
CATEGORIES OF PAIN BY ETIOLOGY
1. Physiological pain
This is experienced when an intact, properly functioning nervous system sends
signals that tissues are damaged, requiring attention and proper care.
 Somatic Pain (originates in the skin, muscle, bone, or connective tissue)
 Visceral Pain (poorly located, and may have cramping, throbbing, pressing, or
aching quality)
2. Neuropathic pain
This is experienced by people who have damaged or malfunctioning nerves.
 Peripheral neuropathic pain (follows damage and/or sensitization of peripheral
nerves)
 Central neuropathic pain (results from malfunctioning nerves in the central
nervous system)
 Sympathetically maintained pain (occurs occasionally when abnormal
connections between pain fibers and the sympathetic nervous system perpetuate
problems with both the pain and sympathetically controlled functions)

*Pain Tolerance is the maximum amount of painful stimuli that a person is willing to withstand
without seeking avoidance of the pain or relief.
*Pain threshold is the least amount of stimuli that is needed for a person to label a sensation as
pain.
FACTORS AFFECTING THE PAIN EXPERIENCE
 Ethnic and Cultural Values
 Developmental Stage
  Environment and Support People
 Past Pain Experiences
 Meaning of Pain

Pain management is the alleviation of pain or a reduction in pain to a level of comfort that is
acceptable to the client. It includes two basic types of nursing interventions: pharmacologic and
nonpharmacologic.
PAIN ASSESSMENT (COLDERR Mnemonic)
 Character : describe the sensation
 Onset : when it started, how it has changed
 Location : where it hurts
 Duration : constant versus intermittent in nature
 Exacerbation : factors that make it worse
 Relief : factors that make it better
 Radiation : pattern of shooting/spreading/location of pain away from its origin
INDIVIDUALIZING CARE FOR CLIENTS WITH PAIN
 Establish a trusting relationship.
 Consider the client’s ability and willingness to participate actively in pain relief measures.
 Use a variety of pain relief measures.
 Provide measures to relieve pain before it becomes severe.
 Use pain-relieving measures that the client believes are effective.
 The selection of pain relief measures should be aligned with the client’s report of the pain.
 If a pain relief measure is ineffective, encourage the client to try it again before giving up.
 Maintain an unbiased attitude about what may relieve the pain.
 Keep trying.
 Prevent harm to the client.
 Educate the client and caregivers about pain.

KEY STRATEGIES IN PAIN MANAGEMENT

 Acknowledging and accepting client’s pain
According to the professional standards of conduct, nurses have a duty to ask clients
about their pain and to believe their reports of discomfort.
 Acknowledge the possibility of pain
 Listen attentively to what the client says about the pain.
 Convey that you need to ask about the pain.
 Attend to the client’s needs promptly.
 Assisting support persons
Support person often need assistance to respond in a helpful manner to the person
experiencing pain. Nurses can help by giving them accurate information about the pain and
providing opportunities for them to discuss their emotional reactions.
 Reducing misconceptions about pain
Reducing a client’s misconceptions about the pain and its treatment will remove one of
the barriers to optimal pain relief. The nurse should explain to the client that pain is a highly
individual experience and that it is only the client who really experiences the pain.
 Reducing fear and anxiety
It is important to help relieve string emotions capable of amplifying pain. By providing
accurate information, the nurse can also reduce many of the client’s fears or anxiety, while
clarifying expectation can minimize frustrations and anger.
 Preventing pain
A preventive approach to pain management involves the provision of measures to treat
the pain before it occurs or before it becomes severe.

NURSING INTERVENTIONS
 PHARMACOLOGIC PAIN MANAGEMENT
This involves the use of opioids (narcotics), nonopioids/nonsteroidal anti-inflammatory drugs
(NSAIDs), and conanalgesic drugs. The principles of modern analgesic use are built on a foundation
established by the World Health Organization (WHO).
1. Nonopioids/NSAIDS
 Nonopiods include acetaminophen and NSAIDs such as ibuprofen or aspirin. NSAIDs
have anti-inflammatory, analgesic and antipyretic effects, whereas acetaminophen has
only analgesic and antipyretic effects.
 2. Opioids
 Full agonists
These are pure opioid drugs that are bind tightly to mu receptor sites, producing
maximum pain inhibition, an agonist effect. These include morphine, and
hydromorphone.
 Mixed agonists-antagonists
These are drugs that can act like opioids and relieve pain when given to a client
who has not taken any pure opioids.
 Partial agonists
Partial agonists have a ceiling effect in contrast to a full agonist. These drugs
such as buprenorphine block the mu receptors or are neutral at that receptor but bind at
a kappa receptor site.
3. Coanalgesics
 A coanalgesic agent is a medication that is not classified as pain medication but has
properties that may reduce pain alone or in combination with other analgesics to relieve
other discomforts, potentiate the effect of pain medications, or reduce the pain
medication’s side effects.
 NONPHARMACOLOGIC PAIN MANAGEMENT
Nonpharmacologic pain management consists of a variety of physical, cognitive-behavioral,
and lifestyle pain management strategies that target the body, mind, spirit, and social interactions.
1. Physical Interventions
The goals of physical interventions include providing comfort, altering physiologic
responses to reduce pain perception, and optimizing functioning.
 Cutaneous Stimulation
This provides effective temporary pain relief wherein it distracts the client and
focuses attention on the tactile stimuli, away from the painful sensations, thus reducing
pain perception.
 massage
 application of heat or cold
 acupressure
 contralateral stimulation
 Immobilization/Bracing
Immobilizing or restricting the movement of a painful body part may help to
manage episodes of acute pain. Splint or supportive devices should hold joints in the
position of optimal function and should be removed regularly depending on the agency
protocol.
 Transcutaneous Electrical Nerve Stimulation
This is a method of applying low-voltage electrical stimulation directly over
identified pain areas, at an acupressure pint, along peripheral nerve areas that
innervate the pain area, or along the spinal column.
2. Cognitive-Behavioral Interventions
The goals of cognitive-behavioral intervention include providing comfort, altering
psychologic responses to reduce pain perception, and optimizing functioning.
 Distractions
 Eliciting the Relaxation Response
 Repatterning Unhelpful Thinking
 Facilitating Coping
 Selected Spiritual Interventions

References
Berman, Snyder, Kozier, & Erb. (2008). Kozier and Erb's Fundamentals of Nursing, 8th ed. Vol. 1.
Pearson Education, Inc.
6) Nutrition
Nutrition is the sum of all the interactions between an organism and the food it consumes. It
is what a person eats and how the body uses it. Nutrients are organic and inorganic substances
found in foods that are required for body functioning and metabolisms.
ESSENTIAL NUTRIENTS
 WATER
The body’s most basic nutrient need; it serves as a medium for metabolic reactions
within cells and a transporter of nutrients, waste products and other substances.
 MACRONUTRIENTS
Include carbohydrates, fats and proteins that are needed in large quantities.
1. Carbohydrates
 Carbohydrates are composed of the elements carbon, hydrogen, and oxygen.
 The primary sources of these are plant.
Types of Carbohydrates
a. Simple (sugars) such as glucose, galactose, and fructose

b. Complex sugars such as starches (which are polysaccharides) and fibers

(supplies bulk or roughage to the diet)
2. Proteins
 These are organic substances made up of amino acids.
3. Lipids
 These are organic substances that are insoluble in water but soluble in alcohol
and ether.
 Fatty acids – the basic structural units of all lipids and are either saturated (all
the carbon atoms are filled with hydrogen) or unsaturated (could accommodate
more hydrogen than it presently contains)
 Food sources of lipids are animal products (milk, egg yolks and meat) and plants
and plant products (seeds, nuts,oils)
 MICRONUTRIENTS
Include vitamins and minerals which are needed in small amounts.
1. Vitamins
 These are organic compounds not manufactured in the body and needed in
small quantities to catalyze metabolic processes.
Classification of Vitamins
a. Water-soluble vitamins include C and B-complex vitamins
b. Fat-soluble vitamins include A, D, E, and K and these can be stored in limited
amounts in the body
2. Minerals 
 These are compounds that work with other nutrients in maintaining structure
and function of the body
Types of Minerals
a. Macrominerals – calcium, phosphate, sodium, potassium, chloride, magnesium
and sulphur.
 b. Microminerals (trace elements) – iron, iodine, copper, zinc, manganese and
fluoride. The best sources are vegetables, legumes, milk and some meats.
ENERGY BALANCE
Energy balance is the relationship between the energy derived from food and the energy used
by the body. The body obtains energy in the form of calories from carbohydrates, protein, fat, and
alcohol.
ENERGY INTAKE
 Caloric value is the amount of energy that nutrients or foods supply to the body.
 A calorie is a unit of heat energy.
 A small calorie is the amount of heat required to raise the temperature of 1 gram of water 1
degree Celsius.
 A large calories is the amount of heat energy required to raise the temperature of 1 gram of
water 15 to 16 degrees Celsius and is the unit used in nutrition
 4 Calories/gram (17kJ) of carbohydrates
 4 Calories/gram (17kJ) of proteins
 9 Calories/gram (38kJ) of fat
 7 Calories/gram (29kJ) of alcohol
ENERGY OUTPUT
 Metabolism refers to all biochemical and psychologic processes by which the body grows
and maintains itself.
 Metabolic rate is normally expressed in terms of the rate of heat liberated during these
chemical reactions.
 The basal metabolic rate (BMR) is the rate at which the body metabolizes food to maintain
the energy requirements of a person who is awake and at rest.
 Resting energy expenditure (REE) is the amount of energy required to maintain basic
body functions; in other words, the calories required to maintain life.

BODY WEIGHT AND BODY MASS STANDARDS

 Ideal body weight (IBW) is the optimal weight recommended for optimal health.
APPROXIMATING IDEAL BODY WEIGHT
Rule of 5 for Females:
 100lb for 5ft of height
 + 5lb for each inch over 5ft
 ± 10% for body-frame size
Rule of 6 for Males:
 106lb for 5ft of height
 + 6lb for each inch over 5ft
 ± 10% for body-frame size
 The body mass index (BMI) is an indicator of changes in the body fat stores and whether a
person’s weight is appropriate for height, and may provide a useful estimate of malnutrition.
Weight in kilograms
BMI = (Height in meters)2

FACTORS AFFECTING NUTRITION

 Development
 Gender
 Ethnicity and Culture
 Beliefs about Food
 Personal Preferences
 Religious Practices
 Lifestyle
 Economics
 Medications and Therapy
 Health
 Alcohol Consumptions
 Advertising
 Psychologic Factors

STANDARDS FOR A HEALTHY DIET

1. Dietary Guidelines for a Healthy Diet
 Consume nutrient-dense foods within caloric needs
  Maintain weight in a healthy range
 Engage in regular physical activity
 Consume recommended amounts of fruit, vegetables, whole grains, and milk everyday
 Keep total fat intake within 20% to 35% of total calories and less than 10% from saturated
fatty acids
 Consume less than 2,300 mg of sodium per day and add potassium-rich foods
 If you drink alcohol, do so in moderation (1/day for women and 2/day for men)

COMPONENTS OF A NUTRITIONAL ASSSESSMENT

1. Anthropometric Data
 Height
 Weight
 Ideal body weight
 Usual body weight
 Body mass index
 Triceps skinfold
 Mid-arm circumference
 Mid-arm muscle circumference
2. Biochemical Data
 Hemoglobin
 Serum albumin
 Total lymphocyte count
 Serum transferrin level
 Urinary urea nitrogen
 Urinary creatinine excretion
3. Clinical
 Skin
 Hair and nails
 Activity level
 Hair analysis
 Neurological testing
4. Dietary Data
 24-hour food recall
 Food frequency record
 Selective food frequency record
 Food diary
 Diet History

NURSING INTERVENTIONS THAT PROMOTES OPTIMAL NUTRITION

 Assisting with Special Diets
 Stimulating the Appetite
 Assisting Clients with Meals
 Special Community Nutritional Services
 Enteral Nutrition
 Managing Clogged Feeding Tubes
 Parenteral Nutrition
IMPROVING APPETITE
 Provide familiar food that the person likes.
 Select small portions so as not to discourage the anorexic client.
 Avoid unpleasant or uncomfortable treatments immediately before or after a meal.
 Provide a tidy, clean environment that is free of unpleasant sights and odors.
 Encourage or provide oral hygiene before mealtime.
 Relieve illness symptoms that depress appetite before mealtime.
 Reduce psychologic stress.

SPECIAL DIETS
 Clear Liquid Diet
 Limited to water, tea, coffee, clear broths, ginger ale, or other carbonated beverages,
strained and clear juices, and plain gelatin.
 Full Liquid Diet
 Contains liquids or foods that turn to liquid at body temperature, such as ice cream.
  Full liquid diets are often eaten by clients who have gastrointestinal disturbances or are
otherwise unable to tolerate solid or semisolid foods.
 Soft Diet
 The soft diet is easily chewed and digested.
 It is often ordered for clients who have difficulty chewing and swallowing.
 It is a low-residue diet containing very few uncooked foods.
 Diet as Tolerated
 Diet as tolerated is ordered when the client’s appetite, ability to eat, and tolerance for
certain foods may change.
 Modification for Disease
 Many special diets may be prescribed to meet requirements for disease process or
altered metabolism.

References
Berman, Snyder, Kozier, & Erb. (2008). Kozier and Erb's Fundamentals of Nursing, 8th ed. Vol. 1.
Pearson Education, Inc.

7) Urinary Elimination
Urinary elimination depends on effective functioning of the upper urinary tract: kidneys and
ureters, and the lower urinary tract: urinary bladder, urethra, and pelvic floor. This is usually taken
for granted until a problem arises and aware people of their urinary habits and any associated
symptoms.
Micturition, voiding, and urination all refers to the process of emptying the urinary bladder.
FACTORS AFFECTING MICTURITION
 Developmental Factors
 Children only gain bladder control between 2-5 years old
 Mentally disabled people may not have the control of urine elimination.
 Enuresis: bed wetting
 Psychosocial Factors
 Some people who experience stress void smaller amounts of urine at more frequent
intervals.
 Stress can also interfere with the ability to relax the muscles and sphincter, and the
person may have the urge to void but it becomes difficult.
 Fluid and Food Intake
 Dehydrated: kidneys reabsorb fluids; the urine produced is more concentrated and
decreased in amount.
 Fluid overload: kidneys excrete a large quantity of diluted urine.
 Alcohol produces a diuretic effect: increase urine production.
 Foods and beverages with high sodium content cause sodium and water reabsorption:
decrease urine formation.
 Foods such as asparagus and onions may affect the odor of the urine.
 Beets affect the color of the urine: red
 Medications
 Sedatives and tranquilizers may diminish awareness of the need to urinate.
 Diuretics: usually to treat HTN, prevents reabsorption of water and certain electrolytes in
tubules. This increases urine production and dilute urine.
 Cholinergic medications: stimulate contraction of detrusor muscle, producing urination.
 Analgesics and tranquilizers: supress CNS and diminish effectiveness of neural reflex.
 Nephrotoxic medication: capable of causing kidney damage.
 Muscle Tone
 Exercise increases urine production and elimination
 Immobility may result to poor urine production and elimination.
 Pathologic conditions
 Multiple sclerosis
 Hematuria
 UTI
 HTN
  Heart and circulatory disorders
 High fever
 Hypertrophy of the prostate gland
 Surgical and Diagnostic Procedures
 The urethra may swell after a cystoscopy and other surgical procedures on any part of
the urinary tract.
 Spinal anesthetics can affect the passage of urine because they decrease the client’s
awareness of the need to void.
 Surgery on the structure near the urinary tract can also affect urination because of
swelling in the lower abdomen.
ALTERED URINE PRODUCTION
 Polyuria (production of abnormally large amounts of urine by the kidneys)
 Polydipsia (excessive fluid intake)
 Oliguria (low urine output)
 Anuria (lack of urine production)
ALTERED URINE ELIMINATION
 Urine frequency (voiding at frequent intervals)
 Nocturia (voiding two or more times at night)
 Urgency (sudden strong desire to void though there may not be a great deal of urine in the
bladder)
 Dysuria (voiding that is either painful or difficult)
 Enuresis (involuntary urination in children beyond the age when voluntary bladder control is
normally acquired)
 Urinary incontinence (involuntary urination suggesting a symptom not a disease)
 Urinary retention (accumulation of urine in the bladder that over distends)
 Neurologic bladder (impaired neurologic function that interfere with the normal mechanisms
of urine elimination)
URINARY INCONTINENCE
Urinary incontinence or involuntary urination, is a symptom, not a disease. It can have significant
impact on the client’s life, creating physical problems such as skin breakdown and possibly leading to
psychosocial problems such as embarrassment, isolation, and social withdrawal.
TYPES OF URINARY INCONTINENCE
 Transient
 Appears suddenly and lasts for 6 months or less
 Caused by treatable factors such as confusion secondary to acute illness, infection, and
as a result of medical treatment.
 Stress
 Involuntary loss of urine related to an increase in intra-abdominal pressure.
 Occurs during coughing, sneezing, laughing, or other physical activities, childbirth,
menopause, obesity, or straining from chronic constipation.
 Urge
 Involuntary loss of urine that occurs soon after feeling an urgent need to void.
 Mixed
 Urine loss with features of two or more types of incontinence
 Overflow
 Voluntary loss of urine associated with over distention and overflow of bladder.
 Chronic retention of urine
 May be due to a secondary effect of some drugs, fecal impaction or neurologic
conditions.
 Functional
 Urine loss caused by the inability to reach the toilet because of environmental barriers,
physical limitation, loss of memory or disorientation
 Reflex
 Emptying of the bladder without sensation of need to void.
 Spinal cord injuries can lead to this type of urinary incontinence.
 Total
 Continuous, unpredictable loss of urine resulting from surgery, trauma or physical
malformation.
MANAGING URINARY INCONTINENCE
 Introduce continence training
 Pelvic muscle exercises
  Maintaining skin integrity
 Applying external urinary drainage devices

URINARY CATHETERIZATION
Urinary catheterization is the introduction of a catheter into the urinary bladder. This is usually
performed only when absolutely necessary, because the danger exists of introducing microorganisms
into the bladder.
TYPES OF CATHETER
 Indwelling urethral catheter
 Catheter than remains in place for continuous urine drainage.
 Intermittent urethral catheter
 Catheter that is used to drain the bladder for shorter periods.
 Suprapubic catheter
 Catheter that is used for long term continuous drainage.
 External condom catheter
 A soft, pliable sheath made of silicone material applied externally to the penis.

URINARY IRRIGATIONS
An irrigation is a flushing or washing-out with a specified solution.
 Bladder irrigation is carried out on a primary care provider’s order, usually to wash out
the bladder and sometimes to apply a medication to the bladder lining.
 Catheter irrigation may be performed to maintain or restore the patency of the catheter,
for example, to remove pus or blood clots blocking the catheter.

ASSESSMENT
 History and Urinary Status
 Physical Assessment
 Measuring Urinary Output
 Measuring Residual Urine

NURSING INTERVENTIONS
1. MAINTAINING NORMAL URINARY ELIMINATION
 Promoting Fluid Intake
 Maintaining Normal Voiding Habits
 Assisting with Toileting
2. PREVENTING URINARY TRACT INFECTIONS
 Drink eight 8-ounce glasses of water per day to flush the bacteria out of the urinary
system.
 Practice frequent voiding.
 Avoid using harsh soaps, bubble bath, powder, or sprays in the perineal area.
 Avoid tight0fitting pants or other clothing that creates irritation to the urethra and
prevents ventilation of the perineal area.
 Wear cotton rather than nylon underclothes.
 Girls and women should always wipe the perineal area from front to the back to
prevent introduction of gastrointestinal bacteria into the urethra.
 Take showers instead of tub baths because bacteria present in the water can readily
enter the urethra.

Refences
(n.d.). Retrieved May 25, 2020, from Studocu: http://www.studocu.com/en-us/document/nova-
southeastern-university/foundations-of-professional-nursing/summaries/1-ch-36-urinary-
elimination/1078888/view

Berman, Snyder, Kozier, & Erb. (2008). Kozier and Erb's Fundamentals of Nursing, 8th ed. Vol. 1.
Pearson Education, Inc.
8) Bowel Elimination
Bowel elimination or defecation is the expulsion of feces from the anus and rectum. The
frequency of defecation is highly individual, varying from several times per day to two to three
times a week.
FACTORS AFFECTING DEFECATION
 Developmental Factors
 Infants- characteristics of stool and frequency depend on formula or breast feedings.
 Toddler- physiologic maturity is first priority for bowel training.
 Child, Adolescent, Adult- defecation patterns vary in quantity, frequency, and
rhythmicity.
 Older Adults- constipation is often a chronic problem; diarrhea and fecal incontinence
may result from physiologic or lifestyle changes.
 Diet
 Sufficient bulk (cellulose, fiber) in the diet is necessary to provide fecal volume.
 Certain foods are difficult or impossible for some people to digest.
 Spicy foods can produce diarrhea and flatus in some individuals.
 Gas-producing foods
 Laxative-producing foods
 Constipation-producing foods
 Fluid
 Healthy fecal elimination usually requires a daily fluid intake of 2,000 to 3,000 mL.
 Activity
 Activity stimulates peristalsis, thus facilitating the movement of chyme along the colon.
 Psychologic Factors
 People who are anxious or angry experience increased peristaltic activity and
subsequent nausea or diarrhea.
 People who are depressed may experience slowed intestinal motility, resulting in
constipation.
 Defecation Habits
 Bowel habits may affect the frequency of defecating.
 Ignoring the urge to defecate may result to lost defecation.
 Medications
 Some drugs have side effects that can interfere with normal elimination.
 Diagnostic Procedures
 Before certain diagnostic procedures, such as visualization of the colon, the client is
restricted from ingesting food or fluid.
 Anesthesia and Surgery
 General anesthetics cause the normal colonic movements to cease or slow by blocking
parasympathetic stimulation to the muscles of the colon.
 Surgery that involves direct handling of the intestines can cause temporary cessation of
the intestinal movement.
  Pathologic Conditions
 Spinal cord injuries and head injuries can decrease the sensory stimulation for
defecation.
 Impaired mobility may limit the client’s ability to respond to the urge to defecate and the
client may experience constipation.
 Pain
 Clients who experience discomfort when defecating often suppress the urge to
defecate to avoid the pain.

FECAL ELIMINATION PROBLEMS

 Constipation
 This may be defined as fewer than three bowel movements per week.
 This infers the passage of dry, hard stool or the passage of no stool.
 Occurs when the movement of feces through the large intestine is slow, thus allowing
time for additional reabsorption of fluid from the large intestine.
 Diarrhea
 This refers to the passage of liquid feces and an increased frequency of defecation.
 It is the opposite of constipation and results from rapid movement of fecal contents
through the large intestine.
 Bowel Incontinence
 This refers to the loss of voluntary ability to control fecal and gaseous discharges
through the anal sphincter.
 This may occur at specific times, such as after meals, or it may occur irregularly.
 Flatulence
 This is the presence of excessive flatus in the intestines and leads to stretching and
inflation of the intestines.
 There are three primary sources of flatus: action of bacteria on the chyme in the large
intestines, swallowed air, and gas that diffuses between the bloodstream and the
intestine.
BOWEL DIVERSION OSTOMIES
 Ostomy (opening for the gastrointestinal, urinary, or respiratory tract onto the skin)
 Gastrostomy (opening through the abdominal wall into the stomach)
 Jejunostomy (opening through the abdominal wall into the jejunum)
 Ileostomy (opening into the ileum)
 Colostomy (opening into the colon)
NURSING INTERVENTIONS
 Promoting Regular Defecation
 Teaching about Medications
 Administering Enemas
 Decreasing Flatulence
 Digital Removal of a Fecal Impaction
 Bowel Training Programs
 Introducing Fecal Incontinence Pouch
 Ostomy Management

References
Berman, Snyder, Kozier, & Erb. (2008). Kozier and Erb's Fundamentals of Nursing, 8th ed. Vol. 1.
Pearson Education, Inc.
9) Oxygenation and Perfusion
Respiration is the process f gas exchange between the individual and the environment.
Oxygenation on the other hand, is the mechanism that facilitates or impairs the body’s ability to
supply oxygen to all cells of the body.
PROCESS OF OXYGENATION
1. Ventilation
 The process of moving gases into and out of the lungs.
2. Diffusion
 The movement of gases or other particles from an area of greater pressure or
concentration to an area of lower pressure concentration.
3. Perfusion
 The ability of the cardiovascular system to pump oxygenated blood to the tissues
and return deoxygenated blood back to the lungs.
FACTORS AFFECTING RESPIRATORY FUNCTION
 Age
 Changes in aging affect the respiratory system by infection, physical or emotional stress,
surgery, anesthesia, or other procedures.
 Environment
 Altitude, heat, cold, and air pollution affect oxygenation.
 Lifestyle
 Physical exercise or activity increases the rate and depth of respirations and hence the
supply of oxygen in the body.
 Health Status
 Diseases of the respiratory system can adversely affect the oxygenation of the blood.
 Medications
 A variety of medications can decrease the rate and depth of respirations.
 Stress
 When stress and stressors are encountered, both psychologic and physiologic responses
can affect oxygenation.
ALTERATIONS IN RESPIRATORY FUNCTION
 Hypoxia
 This is a condition of insufficient oxygen anywhere in the body, from the inspired gas to the
tissues.
 Hypercabia is a condition that suggests an accumulation of carbon dioxide in the blood.
 Hypoxemia refers to reduced oxygen in the blood and is characterized by a low partial
pressure of oxygen in arterial blood or low haemoglobin saturation.
 Altered Breathing Patterns
 Breathing patterns refer to the rate, volume, rhythm, and relative case or effort of
respiration.
 Eupnea is the normal respiration that is quiet, rhythmic, and effortless.
  Tachypnea is the rapid rate observed with fevers, metabolic acidosis, pain and
hypercabia or hypoxemia.
 Bradypnea is an abnormally slow respiratory rate, which may be seen in clients who have
taken drugs such as morphine, who have metabolic alkalosis, or who have increase
intracranial pressure.
 Apnea is the cessation of breathing.
 Orthopnea is the inability to breathe except in an upright or standing position.
 Dyspnea is the difficulty or uncomfortable breathing.
 Obstructed Airway
 A completely or partially obstructed airway can occur anywhere along the upper or lower
respiratory passageways.
ASSESSMENT FOR OXYGENATION
 Current Respiratory Problems
 History of Respiratory Disease
 Lifestyle
 Presence of Cough
 Description of Sputum
 Presence of Chest Pain
 Presence of Risk Factors
 Medication History
NURSING INTERVENTIONS
 Promoting Oxygenation
 Sit straight and stand erect to permit full lung expansion
 Exercise regularly
 Breathe through the nose
 Breathe in to expand the chest fully
 Do not smoke cigarettes, cigars, or pipes
 Eliminate or reduce the use of household pesticides and irritating chemical substances.
 Do not incinerate garbage in the house
 Use building materials that do not emit vapors
 Make sure furnaces, ovens, and wood stoves are correctly ventilated
 Support a pollution-free environment
 Deep Breathing and Coughing
 The nurse can facilitate respiratory functioning by encouraging deep breathing
exercises and coughing to remove secretions from the airways.
 When coughing raises secretions high enough, the client may either expectorate or
swallow them.
 Hydration
 Adequate hydration maintains the moisture of the respiratory mucous membranes,
 Medications
 A number of types of medication can be used for clients with oxygenation problems.
 Bronchodilators, anti-inflammatory drugs, expectorants, and cough suppressants are
some medications that may be used to treat respiratory problems.
 Incentive Spirometry
 Incentive spirometers also referred to as sustained maximal inspiration devices (SMIs),
measure the flow of air inhaled through the mouthpiece and are used to: improve
pulmonary ventilation, counteract the effects of anesthesia or hypoventilation, loosen
respiratory secretions, facilitate respiratory gaseous exchange, and expand collapsed
alveoli.
 Percussion, Vibration, and Postural Drainage
 Percussion is the forceful striking of the skin with cupped hands. Cupping the hands
trap the air against the chest and cause vibrations through the chest wall to the
secretions.
 Vibration is a series of vigorous quiverings produced by hands that are placed flat
against the client’s chest wall.
 Postural drainage is the drainage by gravity of secretions from various lung segments. A
wide variety of positions is necessary to drain all segments of the lungs, but not all are
required for every client.
 Oxygen Therapy
  Clients who have difficulty ventilating all areas of their lungs, those whose gas
exchange is impaired, or people with heart failure may benefit from oxygen therapy to
prevent hypoxia.
 Oxygen therapy is prescribed by the primary care provider, who species the
concentration, method of delivery, and depending on the method, liter flow per minute.
 Oxygen Delivery Systems
 A number of systems are available to deliver oxygen to the client.
 The choice of system depends on the client’s oxygen needs, comfort, and
developmental considerations.
Types of Oxygen Delivery System
 Cannula
 Face Mask
 Face Tent
 Artificial Airways
 Artificial airways are inserted to maintain a patent air passage for clients whose airway
have become or may become obstructed.
 A patent airway is necessary so that air can flow to and from the lungs.
Types of Artificial Airways
 Oropharyngeal and Nasopharyngeal Airways
 Endotracheal Tubes
 Tracheostomy
 Suctioning
 When clients have difficulty handling their secretions or an aorway is in place,
suctioning may be necessary to clear air passages.
 Suctioning is aspirating secretions through a catheter connected to a suction machine
or wall suction outlet.
 Chest Tubes and Drainage Systems
 Chest tubes may be inserted into the pleural cavity to restore negative pressure and
drain collected fluid or blood.
 When the chest tubes are inserted, they must be connected to a sealed drainage
system or a one-way valve that allows air and fluid to be removed from the chest cavity
but prevents air from entering from the outside.

The respiratory and cardiovascular systems are closely linked and dependent on one another
to deliver oxygen to the tissues of the body. Perfusion is the ability of the cardiovascular system to
pump oxygenated blood into tissues and return deoxygenated blood to the lungs.

ARTERIAL CIRCULATION AND VENOUS RETURN

Arterial Circulation
The arterial circulation moves blood pumped by the heart to the tissues, maintaining a
constant flow of the capillary beds despite the intermittent pumping action of the heart.
Venous Return
In contrast to the high-pressure arterial system, venous pressure is too low to
adequately return blood from peripheral tissues to the heart without resistance.

FACTORS AFFECTING CARDIOVASCULAR FUNCTION

 Risk Factors
 Nonmodifiable Risk Factors
 Elevated Serum Lipid Levels
 Hypertension
 Cigarette Smoking
 Diabetes
 Obesity
 Sedentary Lifestyle
 Heat and Cold
 Health Status
 Stress and Coping
 Diet
 Alcohol
 Elevated Homocysteine Level
ALTERATIONS IN CARDIOVAASCULAR FUNCTION
 Decreased Cardiac Output
 The vessels that supply blood to the heart muscle may become occluded by
artherosclerosis or a blood clot, shutting off the blood supply to a portion of the
myocardium.
 Myocardial infarction or heart attack happened when the tissue of the myocardium
becomes necrotic and dies.
 Heart Failure may develop if the heart isn’t able to keep up with the body’s need for
oxygen and nutrients to the tissues.
 Impaired Tissue Perfusion
 Artherosclerosis is by far the most common cause of impaired blood flow to organs and
tissues.
 Ischemia is a lack of blood supply due to obstructed circulation,
 On the venous side, incompetent valves may allow blood to pool in veins, causing
edema and decreasing venous return to the heart.
 Blood Alterations
 Because most oxygen is transported to the tissues in combination with haemoglobin,
the problems of inadequate RBCs, low haemoglobin levels, or abnormal haemoglobin
structure can affect tissue oxygenation.
 Blood volume also affects tissue oxygenation.

NURSING INTERVENTIONS
 Promoting Circulations
Changing position frequently, ambulating and exercising usually maintain adequate
cardiovascular functioning.
 Medications
Many classes of medication are administered to clients with cardiovascular disorders.
Drugs such as nitrates, calcium channel blockers, and angiotensin-converting enzyme
inhibitors reduce the workload of the heart and prevent vasoconstrictions.
 Preventing Venous Stasis
Preventing venous stasis is an important nursing intervention to reduce the risk of
complications following surgery, trauma, or major medical problems. Sequential compression
devices are additional measures to help prevent venous stasis.
 Cardiopulmonary Resuscitation
This is a combination of oral resuscitation, which supplies oxygen to the lungs, and
external cardiac massage, which is intended to re-establish cardiac function and blood
circulation.
References
Berman, Snyder, Kozier, & Erb. (2008). Kozier and Erb's Fundamentals of Nursing, 8th ed. Vol. 1.
Pearson Education, Inc.
10)Fluid, Electrolyte, and Acid-Base Balance
In good health, a moderate balance of fluids, electrolytes, and acids and bases is
maintained in the body. This balance, or physiologic homeostasis, depends on multiple
physiologic processes that regulate fluid intake and output and the movement of water and the
substances dissolved in it between the body compartments.
BODY FLUIDS AND ELECTROLYTES
Water is vital to health and normal cellular function, serving as:
 A medium for metabolic reactions within cells.
 A transport for nutrients, waste products, and other substance.
 A lubricant.
 An insulator and shock absorber.
 One means if regulating and maintaining body temperature.
Electrolytes are charged ions capable of conducting electricity and are present in all body
fluids and fluid compartments.
 Distribution of Body Fluids
The body’s fluid is divided into two major compartments, intracellular and extracellular.
 Intracellular Fluid (ICF) is found within the cells of the body and constitutes
approximately two-thirds of the total body fluid in adults.
 Extracellular Fluid (ECF) is found outside the cells and accounts for about one-
third of the total body fluid.
 Intravascular fluid, or plasma, accounts for approximately 20% of the
ECF and is found within the vascular system.
 Interstitial fluid, accounting for approximately 75% of the ECF, surrounds
the cells.
 Composition of Body Fluids
Extracellular and Intracellular fluids contain oxygen from the lungs, dissolved nutrients
from the gastrointestinal tract, excretory products of metabolism such as carbon dioxide, and
charged particles called ions
 Electrolytes
 Cations
 Anions
 Movement of Body Fluids and Electrolytes
The body fluid compartments are separated from one another by cell membranes and
the capillary membrane. While these membranes are completely permeable to water, they are
considered to be selectively permeable to solutes.
  Osmosis is the movement of water across cell membranes, from the less
concentrated solution to the more concentrated solution.
 Diffusion is the continual intermingling of molecules in liquids, gases, or solids
brought about by the random movement of the molecules.
 Filtration is a process whereby fluid and solutes move together across a
membrane from one compartment to another and the movement is from an area
of higher pressure to one of lower pressure.
 Active Transport is the process where substances can move across cell
membranes from a less concentrated solution to a more concentrated one.
 Regulating Body Fluids
In a healthy person, the volumes and chemical composition of the fluid compartments
stay within narrow safe limits.
 Fluid Intake
Water as a by-product of food metabolism accounts for most of the remaining
fluid volume required. This quantity is approximately 200mL per day for the
average adult.
 Fluid Output
Fluid losses from the body counterbalance the adult’s 2500mL average daily
intake of fluid.
 Maintaining homeostasis
The volume and composition of the body’s fluids is regulated through several
homeostatic mechanisms.
 Kidneys
 Antidiuretic Hormone
 Renin-Angiotensin-Aldosterone System
 Atrial Natriuretic Factor
 Regulating Electrolytes
Most electrolytes enter the body through dietary intake and are excreted in the urine.
Some electrolytes, such as sodium and chloride, are not store by the body but must be
consumed daily to maintain normal levels
 Sodium
 Potassium
 Calcium
 Magnesium
 Chloride
 Phosphate
 Bicarbonate

ACID-BASE BALANCE
An important part regulating the chemical balance or homeostasis is of body fluids is regulating
their acidity or alkalinity. An acid is a substance that releases hydrogen ions in solution. Bases or
alkalis have a low hydrogen ion concentration and can accept hydrogen ions in solution.
 Regulation of Acid-Base Balance
Body fluids are maintained within a narrow range that is slightly alkaline. The normal pH
of arterial blood is between 7.35 and 7.45.
 Buffers prevent excessive changes in pH by removing or releasing hydrogen
ions.
 Respiratory Regulation helps regulate acid-base balance by eliminating or
retaining carbon dioxide, a potential acid.
 Renal Regulation

FACTORS AFFECTING BODY FLUID, ELECTROLYTES, AND ACID-BASE BALANCE

 Age
 Gender and Body Size
 Environmental Temperature
 Lifestyle

DISTURBANCES IN FLUID VOLUME, ELECTROLYTE, AND ACID-BASE BALANCES

 Fluid Disturbances
 Fluid imbalances are of two basic types: isotonic and osmolar. Isotonic imbalances
occur when water and electrolytes are lost or gained in equal proportions. Osmolar
imbalances involve the loss or gain of only water.
 Fluid Volume Deficit
 Fluid Volume Excess
 Dehydration
 Overhydration
 Electrolyte Imbalances
The most common and most significant electrolyte imbalances involve sodium,
potassium, calcium, magnesium, chloride, and phosphate.
 Sodium
 Hyponatremia is a sodium deficit
 Hypernatremia is excess sodium in ECF
 Potassium
 Hypokalemia is a potassium deficit
 Hyperkalemia is a potassium excess
 Calcium
 Hypocalcemia is a calcium deficit
 Hypercalcemia is excess of calcium
 Magnesium
 Hypomagnesemia is a magnesium deficiency
 Hypermagnesemia is an excess of magnesium
 Chloride
 Hypochloremia is a decreased serum chloride level
 Hyperchloremia is an increase of serum chloride level
 Phosphate
 Hypophosphatemia is a decrease in phosphate level
 Hyperphosphatemia is an excess in phosphate level
 Acid-Base Imbalances
Acid-base imbalances are generally classified as respiratory or metabolic by the
general or underlying cause of the disorder. Acidosis is the increase in the pH level while
alkalosis is the decrease of pH level.
 Respiratory Acidosis
 Respiratory Alkalosis
 Metabolic Acidosis
 Metabolic Alkalosis

NURSING INTERVENTIONS
 Promoting Wellness
 Enteral Fluid and Electrolyte Replacement
 Parenteral Fluid and Electrolyte Replacement
 Blood Transfusions

References
Berman, Snyder, Kozier, & Erb. (2008). Kozier and Erb's Fundamentals of Nursing, 8th ed. Vol. 1.
Pearson Education, Inc.
 NURSING INTERVENTIONS TO PROMOTE HEALTHY PSYCHOSOCIAL RESPONSES

1. Self-Concept
Self-concept is one’s mental image of oneself. A positive self-concept is essential to a
person’s mental and physical health. However, a person with a negative self-concept may express
feelings of worthlessness, self-dislike, or even self-hatred.
Self-concept is a complex idea that influences the following:
 How one thinks, talks, and eat
 How one sees and treats other people
 Choices one makes
 Ability to give and receive love
 Ability to take action and to change things
FOUR DIMENSIONS OF SELF-CONCEPT
 Self-knowledge: the knowledge that one has about oneself. Including insights into one’s
abilities, nature, and limitations
 Self-expectation: what one expects of oneself; may be a realistic or unrealistic expectation
 Social Self: how a person is perceived by others and society
 Social Evaluation: the appraisal of oneself in relationship to others, events, or situation

ERIKSON’S STAGES OF PSYCHOSOCIAL DEVELOPMENT

a. Infancy: trust vs. mistrust
b. Toddler: autonomy vs.
c. Early Childhood: initiative vs. guilt
d. Early School years: industry vs. inferiority
e. Adolescence: identity vs. role confusion
f. Early adulthood: intimacy vs. isolation
g. Middle-aged adults: generativity vs. stagnation
h. Older adults: integrity vs. despair

*Global self refers to the collective beliefs and images one holds about oneself. It is the most
complete description that individuals can give of themselves at any one time.
COMPONENTS OF SELF-CONCEPT
 Personal Identity
Personal identity is the conscious sense of individuality and uniqueness that is
continually evolving throughout life. It also includes beliefs and values, personality, and
character.
 Body Image
This is how a person perceives the size, appearance, and functioning of the body and
its parts. Body image has both cognitive and affective aspects. The cognitive is the knowledge
of the material body; the affective includes the sensations of the body, such as pain, pleasure,
fatigue, and physical movement.
 Role Performance
A role is a set of expectations about how the person occupying one position behaves.
Role performance relates what a person in a particular role does to the behaviors expected of
that role.
 Self-Esteem
Self-esteem is one’s judgment of one’s own worth that is how that person’s standards
and performances compare to others and to one’s ideal self.
 Global Self-esteem is how much one likes oneself as a whole.
 Specific Self-esteem is how much one approves of a certain part of oneself.

FACTORS THAT AFFECT SELF-CONCEPT

 Stage Development
 Family and Culture
 Stressors
 Resources
 History of Success and Failure
 Illness

STRESSORS AFFECTING SELF-CONCEPT

 Identity Stressors
 Change in physical appearance
 Declining physical, mental, or sensory abilities
 Inability to achieve goals
 Relationship concerns
 Sexuality concerns
 Unrealistic ideal self
 Body Image Stressors
 Loss of body parts
 Loss of body functions
 Disfigurement
 Unrealistic body ideal
 Self-esteem Stressors
 Lack of positive feedback from significant others
 Repeated failures
 Unrealistic expectations
 Abusive relationship
 Loss of financial security
 Role Stressors
 Loss of parent, spouse, child, or close friend
 Change or loss of job or other significant role
 Divorce
 Illness
 Ambiguous or conflicting role expectations
 Inability to meet role expectations

NURSING INTERVENTIONS
 Identifying Areas of Strength
 Enhancing Self-Esteem
References
Berman, Snyder, Kozier, & Erb. (2008). Kozier and Erb's Fundamentals of Nursing, 8th ed. Vol. 1.
Pearson Education, Inc.
2. Stress and Adaptation
Stress is a universal phenomenon. It is a condition in which the person experiences changes
in the normal balanced state. A stressor is any event or stimulus that causes an individual to
experience stress. When a person faces stressors, responses are referred to as coping strategies,
coping responses, or coping mechanisms.
SOURCES OF STRESS
 Internal stressors originate within a person, for example, infection or feelings of depression.
 External stressors originate outside the individual, for example, a move to another city, a
death in the family, or pressure from peers.
 Developmental stressors occur at predictable times throughout an individual’s life.
 Situational stressors are unpredictable and may occur at any time during life.
MODELS OF STRESS
1. Stimulus-Based Models
 In this model, stress is defined as a stimulus, a life event, or a set of
circumstances that arouses physiologic and/or psychologic reactions that may
increase the individual’s vulnerability to illness.
2. Response-Based Models
 Stress may also be considered as a response. The term stressor to denote any
factor that produces stress and disturbs the body’s equilibrium.
 The initial reaction of the body is the alarm reaction, which alerts the body’s
defenses. This stage is divided by two parts: the shock phase and the
countershock phase.
 During the shock phase, the stressor may be perceived consciously or
unconsciously by the person.
 The countershock phase, is when the body’s adaptation takes place.
 Stage of resistance: when the body’s adaptation takes place and the body
attempts to cope with the stressor and to limit the stressor to the smallest area of
the body that can deal with it.
 Stage of exhaustion: the adaptation that the body made during the second
stage cannot be maintained and means that the ways used to cope with the
stressor have been exhausted.
 3. Transaction-Based Models
 Transactional theories of stress states that the stimulus theory and the response
theory do not consider individual differences.
 This encompasses a set of cognitive, affective, and adaptive responses that
arise out of person-environment transactions.
INDICATORS OF STRESS
1. Physiologic Indicators
Clinical Manifestations Stress
 Pupils dilate to increase visual perception when serious threats to the
body arise.
 Sweat production (diaphoresis) increases to control elevated body heat
due to increased metabolism.
 Heart rate and cardiac output increase to transport nutrients and by-
products of metabolism more efficiently.
 Skin is pallid because of constriction of peripheral blood vessels an effect
of norepinephrine.
 Sodium and water retention increase due to release of mineralocorticoids,
which increases blood volume.
 Rate and depth of respirations increase because of dilation of the
bronchioles, promoting hyperventilation.
 Urinary output decreases.
 Mouth may be dry.
 Peristalsis of the intestines decreases, resulting in possible constipation
and flatus.
 For serious threats, mental alertness improves.
 Muscle tension increases to prepare for rapid motor activity or defense.
 Blood sugar increases because of release of glucocorticoids and
gluconeogenesis.
2. Psychologic Indicators
 Anxiety and Fear
Anxiety is a state of mental uneasiness, apprehension, dread, or
foreboding or a feeling of helplessness related to an impending or anticipated
unidentified threat to self or significant relationships.
Fear is an emotion or feeling of apprehension aroused by impending or
seeming danger, pain, or another perceived threat.
 Anger
Anger is an emotional state consisting of a subjective feeling of animosity
or strong displeasure.
 Depression
Depression is an extreme feeling of sadness, despair. Dejection, lack of
worth, or emptiness, affects millions of Americans a year.
 Ego Defense Mechanisms
Ego defense mechanisms are unconscious psychologic adaptive
mechanisms or, mental mechanisms that develop as the personality attempts to
defend itself, establish compromises among conflicting impulses, and calm inner
tensions.
3. Cognitive Indicators
Cognitive indicators of stress are thinking responses that include problem
solving, structuring, self-control or self-discipline, suppression, and fantasy.
 Problem solving involves thinking through the threatening situation, using
specific steps to arrive at a solution.
 Structuring is the arrangement or manipulation of a situation so that threatening
events do not occur.
 Self-control is assuming a manner and facial expression that convey a sense of
being in control or in charge.
 Suppression is consciously and wilfully putting a thought or feeling out of mind.
 Fantasy is likened to make-believe.
4. Coping
Coping may be described as dealing with change – successfully or
unsuccessfully. A coping strategy is a natural or learned way of responding to a
changing environment or specific problem or situation.
 Types of Coping Strategies
a. Problem-focused coping refers to efforts to improve a situation by making
changes or taking some action.
b. Emotion-focused coping includes thoughts and actions that relieve emotional
distress.
c. Long-term coping strategies can be constructive and realistic.
d. Short-term Coping strategies can reduce stress to a tolerable limit temporarily
but are ineffective ways to permanently deal with reality.
e. Adaptive coping helps the person to deal effectively with stressful events and
minimizes distress associated with them.
f. Maladaptive coping can result in unnecessary distress for the person and
others associated with the person or stressful event.
NURSING INTERVENTIONS
 Encouraging Health Promotion Strategies
 Minimizing anxiety
 Mediating Anger
 Using Relaxation Techniques
 Crisis Intervention
 Stress Management for Nurses
References
Berman, Snyder, Kozier, & Erb. (2008). Kozier and Erb's Fundamentals of Nursing, 8th ed. Vol. 1.
Pearson Education, Inc.

3. Loss, Grief, and Dying

Loss is an actual or potential situation in which something that is valued is changed or no
longer available.
TYPES OF LOSS
a. Actual loss can be recognized by others.
b. Perceived loss is experienced by one person but cannot be verified by others.
SOURCES OF LOSS
 Aspect of Self
 External Objects
 Familiar Environment
 Loved Ones

Grief is the total response to the emotional experience related to loss. And this is manifested
in thoughts, feelings, and behaviors as sociated with overwhelming distress or sorrow. Bereavement
is the subjective response experienced by the surviving loved ones after the death of a person with
whom they have shared a significant relationship. Mourning is the behavioural process through
which grief is eventually resolved or altered.

TYPES OF GRIEF RESPONSES

a. Abbreviated grief is brief but genuinely felt.
b. Anticipatory grief is experienced in advance of the event.
c. Disenfranchised grief occurs when a person is unable to acknowledge the loss to other
persons.
d. Complicated grief exists when the strategies to cope with the loss are maladaptive.
e. Unresolved/chronic grief is extended in length and severity.
f. Inhibited grief suppresses many of the normal symptoms of grief.
g. Delayed grief occurs when feelings are purposely or subconsciously suppressed until a much
later time.

STAGES OF GRIEVING
1. Denial Stage
 Refuses to believe that loss is happening.
  Is unready to deal with practical problems.
 May assume artificial cheerfulness to prolong denial.
2. Anger Stage
 Client or family may direct anger at nurse or staff about matters that normally
would not bother them.
3. Bargaining
 Seeks to bargain to avoid loss.
 May express feelings of guilt or fear of punishment for past sins, real or
imagined.
4. Depression
 Grieves over what has happened and what cannot be.
 May talk freely or may withdraw.
5. Acceptance
 Comes to terms with loss.
 May have decreased interest in surroundings and support people.
 May wish to begin making plans.

FACTORS INFLUENCING THE LOSS AND GRIEF RESPONSES

 Age
 Significance of the Loss
 Culture
 Spiritual Beliefs
 Gender
 Socioeconomic Status
 Support System
 Cause of Loss or Death

Death is a fundamental loss, both for the dying person and for those who survive. Death can
be viewed as the dying person’s final opportunity to experience life in ways that bring significance
and fulfilment.
RESPONSES TO DYING AND DEATH
 Grieving
 Fear
 Hopelessness
 Powerlessness
NURSING INTERVENTIONS
 Helping Clients Die with Dignity
 Hospice and Palliative Care
 Meeting the Physiologic Needs of the Dying Client
 Providing Spiritual Support
 Supporting the Family
 Postmortem Care

References
Berman, Snyder, Kozier, & Erb. (2008). Kozier and Erb's Fundamentals of Nursing, 8th ed. Vol. 1.
Pearson Education, Inc.
4. Sensory Functioning
An individual’s senses are essential for growth, development, and survival. Sensory stimuli
give meaning to events in the environment and any alteration in a person’s sensory function can
affect their ability to function within the environment.
SENSORY ALTERATIONS
 Sensory Deprivation is generally thought of as a decrease in or lack of meaningful stimuli.
 Sensory Overload generally occurs when a person is unable to process or manage the
amount or intensity of sensory stimuli.
 Sensory Deficits is impaired reception, perception, or both, of one or more of the senses.
FACTORS AFFECTING SENSORY FUNCTION
 Developmental Stage
 Culture
 Stress
 Medications and Illness
 Lifestyle and Personality
CLINICAL MANIFESTATIONS SENSORY DEPRIVATION
 Excessive yawning, drowsiness, sleeping
 Decreased attention span, difficulty concentrating, decreased problem solving
 Impaired memory
 Periodic disorientation, general confusion, or nocturnal confusion
 Preoccupation with somatic complaints, such as palpitations
 Hallucinations or delusions
 Crying, annoyance over small matters, depression
 Apathy, emotional lability
NURSING INTERVENTIONS
 Promoting Health Sensory Function
 Adjusting Environmental Stimuli
 Managing Acute Sensory Deficits
 Sensory Aids
 Promoting the Use of Other Senses
 Communicating Effectively
PREVENTING SENSORY OVERLOAD
 Minimize unnecessary light, noise, and distraction. Provide dark glasses and earplugs as needed.
 Control pain as indicated at the level desired by the client, on a scale of 0 to 10.
  Introduce yourself by name, and address the client by name.
 Provide orienting cues, such as clocks, calendars, equipment, and furniture in the room.
 Provide a private room.
 Limit visitors.
 Plan care to allow for uninterrupted periods for rest or sleep.
 Schedule a routine of care so the client knows when and what to expect.
 Speak in a low tone of voice and in an unhurried manner.
 Provide new information gradually to enable the client to process the meaning.
 Describe any test and procedures to the client beforehand.
 Reduce noxious odors.
 Take time to discuss the client’s problems and to correct misinterpretations.
 Assist the client with stress-reducing techniques.
PREVENTING SENSORY DEPRIVATION
 Encourage the client to use eyeglasses and hearing aids.
 Address the client by name and touch the client while speaking if this is not culturally offensive.
 Communicate frequently with the client and maintain meaningful interactions.
 Provide a telephone, radio and/or TV, clock, and calendar.
 Provide murals, pictures, sculptures, and wall hangings.
 Have family and friends bring freshly cut flowers and plants.
 Consider having a resident pet.
 Include different textured objects to feel.
 Increase tactile stimulation through physical care.
 Encourage social interaction through activity groups or visits by family and friends.
 Encourage the use of crossword puzzles or games to stimulate mental function.
 Encourage environment changes.
 Encourage the use of self-stimulation techniques.
References
Berman, Snyder, Kozier, & Erb. (2008). Kozier and Erb's Fundamentals of Nursing, 8th ed. Vol. 1.
Pearson Education, Inc.

5. Sexuality and Gender

Sexuality is an individually expressed and highly personal phenomenon whose meaning
evolves from life experiences. All humans are sexual beings regardless of age, gender, race,
socioeconomic status, religious beliefs, physical and mental health, or other demographic factors.
DEVELOPMENT OF SEXUALITY
1. Infancy (Birth to 18 months)
 Given gender assignment of male or female.
 Differentiates self from others gradually.
 External genitals are sensitive to touch.
 Male infants have penile erections; females, vaginal lubrication.
2. Toddler (1-3 years)
 Continues to develop gender identity.
 Able to identify own gender.
3. Preschooler (4-5 years)
 Becomes increasingly aware of self.
 Explores own and playmates’ body parts.
 Learns correct names for body parts.
 Learns to control feelings and behaviour.
 Focuses love on parent of the other sex.
4. School Age (6-12 years)
 Has strong identification with parent of same gender.
 Tends to have friends of the same gender.
 Has increasing awareness of self.
 Increased modesty, desire for privacy.
 Continues self-stimulating behaviour.
 Learns the role and concepts of own gender as part of the total self-concept.
 At about 8 or 9 years becomes concerned about specific sex behaviors and often
approaches parents with explicit concerns about sexuality and reproduction.
5. Adolescence (12-18 years)
 Primary and secondary sex characteristics develop.
 Menarche usually takes place.
  Develops relationships with interested partners.
 Masturbation is common.
 May participate in sexual activity.
 May experiment with homosexual relationships.
 Are at risk for pregnancy and sexually transmitted diseases.
6. Young Adulthood (18-40 years)
 Sexual activity is common.
 Establishes own lifestyle and values.
 Homosexual identity usually established by mid-20s.
 Many couples share financial obligations and household tasks.
7. Middle Adulthood (40-65 years)
 Men and women experience decreased hormone production.
 The menopause occurs in women, usually anywhere between 40 to 55 years.
 The climacteric occurs gradually in men.
 Quality rather than the number of sexual experiences becomes important.
 Individuals establish independent moral and ethical standards.
8. Late Adulthood (65 years and over)
 Interest in sexual activity often continues.
 Sexual activity may be less frequent.
 Women’s vaginal secretions diminish, and breasts atrophy.
 Men produce fewer sperm and need more time to achieve an erection and to
ejaculate.
Sexual health is an individual and constantly changing phenomenon falling within the wide
range of human sexual thoughts, feelings, needs, and desires.

COMPONENTS OF SEXUAL HEALTH

 Sexual self-concept
This determines with whom one will have sex, the gender and kinds of people a person
is attracted to, and the values about when, where, with whom, and how one expresses
sexuality.
 Body Image
This is a central part of the sense of self, is constantly changing.
Pregnancy, aging, trauma, disease, and therapies can alter an individual’s
appearance and function, which can affect body image.
 Gender Identity
This is one’s self-image as a female or male. It is more than just the biologic
component; it also includes social and cultural norms. Gender identity is the result of a long
series of developmental events that may or may not conform to one’s apparent biologic sex.
 Gender-role behaviour
This is an outward expression of a person’s sense of maleness or femaleness as well
as the expression of what is perceived as gender-appropriate behavior.
 Androgyny
The flexibility in gender roles and is the belief that most characteristics and behaviors
are human qualities that should not be limited to one specific gender or the other.

VARIETIES OF SEXUALITY
 Sexual Orientation
This is referred to as one’s attraction to people of the same sex, other sex, of both
sexes.
 Gender Identity
This is deeply committed to the idea that there are only two sexes.
 Intersex is a condition in which there are contradictions among chromosomal
gender, gonadal gender, internal organs, and external genital appearance.
 Transsexuals are those who have a condition called gender dysphoria or
gender identity disorder.
  Cross-Dressers are typically those who cross-dress to express either their
feminine side or manliness side of their personality.
 Erotic Preferences
These are sexual activities which serves as a common sexual outlets for women and
men, single and couples persons, and heterosexual, gay/lesbian, and bisexual persons.

FACTORS INFLUENCING SEXUALITY

 Family
 Culture
 Religion
 Personal Expectations and Ethics

SEXUAL RESPONSE CYCLE

1. Desire Phase
 The response cycle starts in the brain which has a conscious sexual desire. Sight,
hearing, smell, touch, and imagination can all invoke sexual arousal.
2. Excitement Phase
 This involves two primary physiologic changes.
 Vasocongestion is an increase in the blood flow to various body parts resulting in
erection of the penis and clitoris and swelling of the labia, testes, and breasts.
 Myotonia is an increase of tension in muscles and may increase more until released
by orgasm.
3. Orgasmic Phase
 This is the involuntary climax of sexual tension accompanied by physiologic and
psychologic release.
4. Resolution Phase
 The period of return to the unaroused state, may last 10 to 15 minutes, or longer if
there is no orgasm.

SEXUAL DESIRE DISORDERS

 Hypoactive sexual desire disorder is a deficiency in or absence of sexual fantasies and
persistently low interest or a total lack of interest in sexual activity.
 Sexual aversion disorder is a severe distaste for sexual activity or the thought of sexual
activity, which then leads to a phobic avoidance of sex.

SEXUAL AROUSAL DISORDERS

 Female arousal disorder is the lack of vaginal lubrication and causes discomfort or pain
during sexual intercourse
 Male erectile disorder is usually made when the man has erection problem during 25%
or more of his sexual interactions.
ORGASMIC DISORDERS
 Female orgasmic disorder which means that the sexual response stops before orgasm
occurs.
 Male orgasmic disorder is common among men that can maintain erection for long
periods of time but has extreme difficulty in ejaculating.
SEXUAL PAIN DISORDERS
 Dyspareunia is pain both experienced by men and women during or immediately after
intercourse.
 Vaginismus is the involuntary spasm of the outer one-third of the vaginal muscles,
making penetration of the vagina painful and sometimes impossible.
 Vulvodynia is constant, unremitting burning that is localized to the vulva with an acute
onset.
 Vestibulitis causes severe pain only on touch or attempted vaginal entry.

NURSING INTERVENTIONS
 Promoting Sexual Health Teaching
 Counselling for Altered Sexual Function
 Dealing with Inappropriate Sexual Behavior
References
Berman, Snyder, Kozier, & Erb. (2008). Kozier and Erb's Fundamentals of Nursing, 8th ed. Vol. 1.
Pearson Education, Inc.

6. Spirituality
Spirituality refers to that part of being human that seeks meaningfulness through intra-, inter-,
and transpersonal connection. Spiritually generally involves a belief in a relationship with some higher
power, creative force, divine being, or infinite source of energy.
Spiritual health or spiritual well-being is manifested by a feeling of being “generally alive,
purposeful, and fulfilled” (Ellison, 1983).
Spiritual Distress refers to a challenge to the spiritual well-being or to the belief system that
provides strength, hope, and meaning to life.
CHARACTERISTICS OF SPIRITUAL DISTRESS
 Expresses lack of hope, meaning and purpose in life, forgiveness of self
 Expresses being abandoned by or having anger toward God
 Refuses interaction with friends and family
 Sudden changes in spiritual practices
 Requests to see a religious leader
 No interest in nature, reading spiritual literature
SPIRITUAL DEVELOPMENT
1. 0-3 years
 Neonates and toddlers are acquiring fundamental spiritual qualities of trust, mutuality,
courage, hope and love.
 Transition to next stage of faith begins when child’s language and thought begin to allow
use of symbolism.
2. 3-7 years
 Make-believe is experienced as reality influenced by examples, moods, and actions.
3. 7-12 years, even into adulthood
 Child accepts stories and beliefs literally.
 Ability to learn the beliefs and practice of the culture and religion.
4. Adolescence
 Generally conform to the beliefs of those around them; begin to examine beliefs
objectively, especially in late adolescence.
 5. Young Adulthood
 Develops independent commitments, lifestyle, beliefs, and attitudes.
 Begins to develop personal meaning for symbols of religion and faith.
6. Mid-Adulthood
 Newfound appreciation for the past.
 Increased respect for inner voice.
 More aware of myths, prejudices, and images that exist because of social background.
7. Mid-to late Adulthood
 Able to believe in, and live with a sense of participation in, a nonexclusive community.

SPIRITUAL PRACTICES AFFECTING NURSING CARE

 Holy Days
 Sacred Writings
 Sacred Symbols
 Prayer and Meditation
 Beliefs Affecting Diet and Nutrition
 Beliefs Related to Healing
 Beliefs Related to Dress
 Beliefs Related to Birth
 Beliefs Related to Death
NURSING INTERVENTIONS
 Providing Presence
 Supporting Religious Practices
 Assisting Clients with Prayer
 Referring Clients for Spiritual Counselling

References
Berman, Snyder, Kozier, & Erb. (2008). Kozier and Erb's Fundamentals of Nursing, 8th ed. Vol. 1.
Pearson Education, Inc.

EVALUATION

Evaluating is a planned, ongoing, and purposeful activity in which clients and health care
professionals determine (a) the client’s progress toward achievement of goals/ outcomes and (b) the
effectiveness of the nursing care plan. Evaluation is an important aspect of the nursing process
because conclusions drawn from the evaluation determine whether the nursing interventions should
be terminated, continued, or changed.
Evaluation is continuous. Evaluation done while or immediately after implementing a nursing
order enables the nurse to make on-the-spot modifications in an intervention.
TYPES OF EVALUATION
 Planned
Evaluation performed at specified intervals which shows the extent of progress toward
goal achievement which then enables the nurse to correct any deficiencies and modify the
care plan needed.
 Ongoing
Evaluation done during an intervention. The nurse uses his/her senses to observe any
result of the intervention.
 Purposeful
Evaluation done to gain information whether the intervention has become successful
and if there are any modification to be done.

References
Berman, Snyder, Kozier, & Erb. (2008). Kozier and Erb's Fundamentals of Nursing, 8th ed. Vol. 1.
Pearson Education, Inc.
 DOCUMENTATION AND REPORTING

1. Guidelines/Protocols/Tools in Documentations related to client care

Health care personnel must not only maintain the confidentiality of the client’s record but also
meet legal standards in the process of recording.
GENERAL GUIDELINES FOR RECORDING
 Date and Time
 Document the date and time of each recording,
 A legal reason and for client safety.
 The use of AM and PM is necessary to avoid confusion.
 Timing
 Follow the agency’s policy about frequency of documentation.
 Documentation should be done as soon as possible after an assessment or
intervention.
 No recording should be done before providing nursing care.
 Legibility
 All entries must be legible and easy to read to prevent misinterpretation.
 Permanence
 All entries in the client’s record are made in dark ink so that the record is permanent and
changes can be identified.
 Accepted Terminology
 Use only commonly accepted abbreviations, symbols, and terms that are specified by
the agency.
 When in doubt about whether to use an abbreviation, write that term out in full until
certain about the abbreviation.
 Correct Spelling
 Correct spelling is essential for accuracy in recording.
  If unsure how to spell the word, check out the dictionary.
 Signature
 Each recording on the nursing notes is signed by the nurse making it.
 The signature includes the name and title.
 Accuracy
 The client’s name and identifying information should be stamped or written on each
page of the clinical record.
 Before making any entry, check that it is the correct chart.
 Notations on the records must be accurate and correct
 When describing avoid using general words.
 When a mistake has been recorded, draw a line through it and write the words mistaken
entry.
 Write on every line but never between lines; if a blank appears in a notation, draw a line
through the blank space so that no additional information can be recorded.
 Sequence
 Document events in the order in which they occur.
 Update or delete problems as needed.
 Appropriateness
 Record only information that pertains to the client’s health problems and care.
 Recording irrelevant information may considered an invasion of the client’s privacy
and/or libellous.
 Completeness
 The information that is recorded needs to be complete and helpful to the client and
health care professionals.
 Nurses’ notes must reflect the nursing process.
 Conciseness
 Recording need to be brief as well as complete to save time in communication.
 Legal Prudence
 Accurate, complete documentation should give legal protection to the nurse, the client’s
other caregivers, health facility, and the client.
 Admissible in court as a legal document, the clinical record provides proof of the quality
of care given to a client.

DOCUMENTATION METHODS
 Kardexes
This is a widely used, concise method of organizing and recording data about client,
making information quickly accessible to all health professionals. The system consists of a
series of cards kept in a portable index.
 Flow Sheets
A flow sheet enables nurses to record nursing data quickly and concisely and provides
an easy-to-read record of the client’s condition over time.
 Graphic Record
Indicates body temperature, pulse, respiratory rate, blood pressure,
weight, and, in some agencies, other significant clinical data such as admission
or postoperative bowel movements, appetite, and activity.
 Intake and Output Record
All routes of fluid intake and all routes of fluid loss or output are measured
and recorder on this form.
 Medication Administration Record
Medication flow sheets usually include designated areas for the date of
the medication order, the expiration date, the medication name and dose, the
frequency of administration and route, and the nurse’s signature.
 Skin Assessment Record
A skin or wound assessment is often recorded on a flow sheet such as the
one shown.
 Progress Notes
Provides information about the progress a client is making toward achieving desired
outcomes. These include information about client problems and nursing interventions.
 Referral Summaries
 A discharge note and referral summary are completed when the client is being
discharged and transferred to another institution or to a home setting where a visit by a
community health nurse is required.

2. Subjective Information, Assessment, Plan, Implement and Evaluate (SOAPIE)

This is a type of format used as progress notes by nurses.
S- Subjective data
Consist of information obtained from what the client says. It describes the client’s
perceptions and experience with the problem. And is only included when it is important and
relevant to the problem.
O- Objective data
Consist of information that is measured or observed by use of the senses.
A- Assessment
This is the interpretation or conclusions drawn about the subjective and objective data.
This describes the client’s condition and level of progress rather than merely restating the
diagnosis or problem.
P- Plan
This is the plan of care designed to resolve the stated problem. The initial plan is written
by the person who enters the problem into the record.
I- Interventions
These refer to the specific interventions that have actually been performed by the
caregiver.
E- Evaluation
This includes client responses to nursing interventions and medical treatments.

3. Focus, Data, Action, Response (FDAR)

Focus charting is intended to make the client and client concerns and strengths the focus of
care. Commonly, there are three columns for recording namely: date and time, focus, and progress
notes. The focus may be a condition, a nursing diagnosis, a behavior, a sign or symptom, an acute
change in the client’s condition, or client strength.
The progress notes are organized into (D) data, (A) action, and (R) response.
D- Data
This reflects the assessment phase of the nursing process and consists of
observations of client status and behaviors, including data from flow sheets. The nurse
records both the subjective and objective data in this section.
A- Action
Reflects planning and implementation and includes immediate and future nursing
actions. It may also include any changes to the plan of care.
R- Response
Reflects the evaluation phase of the nursing process and describes the client’s
response to any nursing and medical care.

4. Electronic Health Record (EHR)

Electronic health records (EHRs) were developed to standardize documentation, prevent
errors, promote concise charting, and have a way of storing medical records long-term while having a
straightforward way to retrieve them.
ADVANTAGES OF EHRs
 Standardization
EMRs promote standard record-keeping to include staff and physician notes,
assessment findings, and ordering processes.
 Improved accessibility
EMRs allow members of the healthcare team to access pertinent parts of the medical
record easily. Also, records can effortlessly be retrieved- sometimes between different
healthcare organizations.
 Reduction of errors
This is probably the most significant benefit of electronic medical records. Computerized
physician ordering has helped reduce errors related to misinterpreted handwriting and
transcription errors.
 Improved privacy and security for patients
The more hands that touch paper records, the more at risk private health information is.
Paper charts sent to chart rooms or outside a facility is more at risk of a privacy breach. EMRs
 have safeguards in place to prevent violations. Access to certain parts of the medical record is
given only to the appropriate employees.
 Improved efficiency
EMRs allow for quicker documentation, which can benefit patients needing rapid
treatment. For example, an EKG can be performed and uploaded to a record in real-time, and
a specialist can pull it up and advise within minutes. This leads to improved patient care
outcomes as delays are shortened.

5. Problem-Oriented Medical Record (POMR)

Problem-oriented medical record was established by Lawrence Weed, are data arranged
according to the problems the client has rather than the source of the information. Members of the
health care team contribute to the problem list, plan of care, and progress notes.
ADVANTAGE OF POMR
 Encourages collaboration
 Alerts caregivers with the client’s needs
 Makes it easier to track the status of each problem
FOUR BASIC COMPONENTS
1. Database
Consists of all information known about the client when the client first enters the health
care agency. It includes the nursing assessment, the physician’s history, social and family
data.
2. Problem List
This was derived from the database. Usually kept at the front of the chart and serves as
an index to the numbered entries in the progress notes. Problems are listed in the order in
which they are identified and the list is continually updated as new problems are identified and
others resolved.
3. Plan of Care
Care plans are generated by the person who lists the problems. Physician’s write
physician’s orders or medical care plans; nurses write nursing orders or nursing care plans.
4. Progress Notes
Chart entry made by all health professionals involved in a client’s care; they all use the
same type of sheet for notes. Numbered to correspond to the problems on the problem list and
may be lettered for the type of data

References
Berman, Snyder, Kozier, & Erb. (2008). Kozier and Erb's Fundamentals of Nursing, 8th ed. Vol. 1.
Pearson Education, Inc.

GUIDELINES/PROTOCOLS/TOOLS IN REPORTING RELATED TO CLIENT CARE

1. Identity, Situation, Background, Assessment, Recommendation, Read Back (ISBARR)
The ISBARR communication tool is a successful and widely used communication tool within
the healthcare setting. In addition to providing a framework for preparation, this communication tool
ensures important details are not missed and minimizes the risk of communication error.
I- Identify
 State name and title
S-Situation
 Write who is the patient, what room and bed.
B- Background
 Admitting Diagnosis
 Admission Date
 Relevant medical history
 Brief overview of relevant treatment
A- Assessment
 Noticeable assessment data
 Most current vital signs
 How these assessments differ from previous ones
R- Recommendation
 What you think is need to be done.
 Frequency of assessment
 Laboratory tests
  Medicine changes
 Patient care goals
R- Read Back
 Restate relevant information for clarity

2. Change of Shift Report

Change-of-shift-report is the time when one nurse transfers accountability and responsibility
of patients to another nurse. The transfer involves a handoff from one nurse who has observed and
cared for a patient to the next nurse who may not know the patient. Report is therefore informational
as details about a patient’s condition, treatment, and care planning are shared.
The personal meaning of report may underlie staff willingness to welcome patients and
families during report.
 First, report can have emotional meaning for the nurse.
It is a time to connect with other staff and share the emotional distress and
struggles endured over the course of a shift. Nurses may take this time to complain
about other staff, patients, or their families.
 Second, report may be a time when we socialize with one another.
Sharing updates on the personal lives of their colleagues and themselves. It is
not unusual during report to learn of life events such as births, marriages, or vacation
adventures.

3. Incident Report
An incident report is a form that filled up in order to record the details of accidents, patient
injury and other unusual events that occur in a health care facility such as a hospital or nursing home.
It is also called an accident report which documents the exact details of the accident or unusual
event while the information is still fresh in the minds of those who witness the event.
 Written at the first opportunity after the incident so that the details are not blurry or
forgotten.
 Written with a pen (ink) not pencil. Information written using a pencil can be erased.
 Details should be complete and accurate. The patient should be identified with the
following details:
o Full name
o Hospital bed number
o Hospital ID
o Patients diagnosis
o Patient’s condition before and after the incident

Other details included are:

o Details of ward or clinical area
o Date, time and place of incident
o Details of equipments used including the serial number or asset tag identification (if
appropriate)
 Written as statement of facts without interpretation or opinion. Descriptive adjectives
should not be used.

PURPOSE OF AN INCIDENT REPORT

 To document the exact detail of an accident or unusual incident that occurred in a health-care
institution.
 To be used in the future when dealing with liability issues stemming from the incident.
 To protect the nursing staff against unjust accusation.
 To protect and safeguard the client in case of negligence on the part of the nurse.
 Helps in the evaluation of nursing care to ensure safe care to all patients.

4. Referral Systems
These are different level of health care provided by health care professionals and facilities.
When a certain case isn’t curable or no equipment are available, then referring to a higher health
care facility takes place, thus, the referral system.
LEVEL 1
 Primary Health Care Clinic
A Primary Health Care Clinic is the first step in the provision of health care and offers
services such as immunisation, family planning, anti-natal care, and treatment of common
 diseases, treatment and management of Tuberculosis, HIV/AIDS counselling, amongst other
services.
 Community Health Care Centre
A Community Health Care Centre is the second step in the provision of health care
but can also be used for first contact care. A Community Health Care Centre offers similar
services to a Primary Health Care Clinic with the addition of a 24 hours maternity service,
emergency care and casualty and a short stay ward.
 District Hospital
This is the third step in the provision of health care. These hospitals will normally
receive referral from and provide generalist support to community health centers and clinics
such as diagnostic, treatment, care, counselling and rehabilitation services. Clinical services
include Surgery, Obstetrics & Gynaecology, Out-Patients Department, Medicine, Paediatrics,
Mental Health, Geriatrics, Casualty and Clinical Forensic Medical Services amongst other
services.
LEVEL 2
 Regional Hospital
This is the second level of health care. These hospitals will normally receive referral
from and provide specialist support to a number of district hospitals.
LEVEL 3
 Provincial Tertiary Hospital
These hospitals will receive referral from and provide sub-specialist support to a number
of regional hospitals and is the third level of health care. These hospitals are staffed by
specialists and generalists and offer services such as neurosurgery, neurology, Plastic &
reconstructive surgery, Cardiology, Urology, Paediatric surgery, maxillio-facial surgery,
Psychiatry, Occupational health and Orthopaedics amongst other services.
LEVEL 4
 Central Hospitals
The fourth and highest level of health care. These hospitals will consist of very highly
specialised referral units which together provide an environment for multi-speciality clinical
services, innovation and research. People are referred to these hospitals by Provincial Tertiary
Hospitals.
 Specialised Hospital
These hospitals will provide care only for certain specialised groups of patients. They
will include chronic psychiatric and TB hospitals, as well as specialised spinal injury and acute
infectious disease hospitals.

5. Health Care Electronic Databases

Healthcare databases are systems into which healthcare providers routinely enter clinical and
laboratory data. One of the most commonly used forms of healthcare databases are electronic
health records (EHRs).
Practitioners enter routine clinical and laboratory data into EHRs during usual practice as a
record of the patient’s care. Other healthcare databases include claims databases, which are
maintained by payers for reimbursement purposes, pharmacist databases and patient registries.

ADVATAGES OF HEALTH CARE ELECTRONIC DATABASES

 Real-world data on risks and benefits
The use of routinely collected data, such as data from EHRs, allows assessment of the
benefits and risks of different medical treatments, as well as the relative effectiveness of
medicines in the real world.
 Studies can be carried out quickly
Studies based on real-world data (RWD) are faster to conduct than randomised
controlled trials (RCTs).

LIMITATIONS OF USING HEALTH CARE ELECTRONIC DATABASES

 Data are not collected for research purposes
practitioners and healthcare professionals are not trained to collect data. The data
collection process may not be clear and may result in imprecise, incorrect or incomplete data
entry, however this may be avoided or reduced by training staff.
 Invalid, inaccurate or incomplete data
 routinely collected data may lack detailed information on indications, patient
characteristics, treatments and events, and may be less structured (van Staa et al, 2014).In
addition, data are typically obtained during clinical visits, which may be infrequent or irregular.
 Quality and completeness of data varies within and among databases
routinely used healthcare databases are varied and heterogeneous. Data quality
checks within the data collection system that detect incorrect or missing data, and specify
procedures for correction, may ensure that differences within and among databases are
detected and accounted for.
 Variable quality and completeness
EHR systems include patient data beyond that needed for a study. Access to these
data (rather than study-specific data) raises right-to-privacy concerns.

References
(2019, November 26). Retrieved May 25, 2020, from http://www.kznhealth.gov.za/Referral-
system.htm

Edwards, K. J. (2016). ISBARR Communication Workshop and its Effect on Novice Baccalaureate
Nursing Students’ Self-Confidence.

Griffin, T. (2010). Bringing Change-of-Shift Report to the Bedside.

RNpedia. (n.d.). Retrieved May 25, 2020, from http://www.rnpedia.com/nursing-notes/medical-

surgical-nursing/incident-report

RWE Navigator. (n.d.). Retrieved from http://www.rwe-navigator.eu/use-real-world-evidence/sources-

of-real-world-data/healthcare-databases-with-afocus-on-electronic-health-records/

EVIDENCE-BASED PRACTICE IN NURSING

A. Research Related Roles and Responsibilities

Clinical research is a team effort. Health care providers of all cadres are needed to ensure the
success of any research study. All categories of nurses are increasingly employed into research driven
organisations and are an integral part of these multi-disciplinary teams. They have a critical role in
recruitment, management and follow-up of participants.
ROLES AND RESPONSIBILITIES OF A RESEARCH NURSE
 File Preparation
Put all the documentation needed to complete a study visit in a file prior to the
participant’s arrival at the clinic,etc.
 Recruitment
This is a process that starts off with identifying where one will find the appropriate
subjects, informing the site staff of what the study entails and what patient population is
required for the study and then approaching the potential study participants of the study.
 Patient preparation
This ensures the participant understand what the procedures he/she will have for
the visit/s.
 Case report form entry
This gets done when all the relevant information is documented in specific forms
as requested by the sponsor.
 Education
 Ongoing education is given to the participants regarding the study; medication;
possible side-effects of medication; laboratory results etc.
 Counselling
This gets done at three sessions prior to the start of ARV’s or one at the start of
other medication. The research nurse continues with noting of adherence of medication
as well as follow-up visits. Compliance is vital as it will impact on the outcome of the
research results.
 Informed Consent
This is a process that starts at the first contact with the participant and ends at
the end of the study.
Reference
Berman, Snyder, Kozier, & Erb. (2008). Kozier and Erb's Fundamentals of Nursing, 8th ed. Vol. 1.
Pearson Education, Inc.

CONCEPTS AND PRINCIPLES OF PARTNERSHIP, COLLABORATION, AND TEAMWORK

A. Development of Teamwork and Collaboration

Self‐awareness is essential for nurses for improving nurse–patient relationship and patient
care. The overall aim is to improve person’s functioning in the group to which they return, whether
job, family, or community. The focus of this is interpersonal concerns around current situations and is
oriented to reality testing with a here-and-now emphasis.
The dyad is essentially a partnership where an administrative or nurse leader is paired with a
physician leader, bringing together “the best of both worlds” of skills and expertise. For example, in a
service line leadership dyad, the administrative leader is in charge of ensuring excellent management
of the business, while the physician leader is the champion for change, acting as the “influencer in
chief” of his or her clinical peers.
A group is two or more people who have shared needs and goals, who take each other into
account in their actions, and who thus are held together and set apart from others by virtue of their
interactions.
A team is defined as a “distinguishable set of two or more people who interact dynamically,
interdependently, and adaptively towards a common and valued goal/objective/mission, who have
been each assigned specific roles or functions to perform, and who have a limited lifespan of
membership”. Effective teamwork in health-care delivery can have an immediate and positive impact
on patient safety. The importance of effective teams in health care is increasing due to factors such
as: (a) the increasing complexity and specialization of care; (b) increasing co-morbidities; (c)
increasing chronic disease; (d) global workforce shortages; and (e) safe working hours initiatives.

TYPES OF HEALTH CARE TEAMS

 Core teams
Core teams consist of team leaders and members who are involved in the direct care of
the patient. Core team members include direct care providers (from the home base of
operation for each unit) and continuity providers (those who manage the patient from
assessment to disposition, for example, case managers).
 Coordinating teams
The coordinating team is the group responsible for:
• day-to-day operational management;
• coordination functions;
• resource management for core teams.
 Contingency teams
Contingency teams are:
• formed for emergent or specific events;
• time-limited events (e.g. cardiac arrest team, disaster response teams,
rapid response teams);
• composed of team members drawn from a variety of core teams.
 Ancillary services
Ancillary services consist of individuals such as cleaners or domestic staff who:
• provide direct, task-specific, time-limited care to patients;
• support services that facilitate care of patients;
• are often not located
 Support services
Support services consist of individuals who:
• provide indirect, task-specific services in a health-care facility,
• are service-focused, integral members of the team, helping to facilitate
the optimal healthcare experience for patients and their families.
 Administration
Administration includes the executive leadership of a unit or facility, and has 24-hour
accountability for the overall function and management of the organization. Administration
shapes the climate and culture for a teamwork system to flourish by:
• establishing and communicating vision;
• developing and enforcing policies;
• setting expectations for staff;
• providing necessary resources for successful implementation;
• holding teams accountable for team performance;
• defining the culture of the organization.

A multidisciplinary team involves a range of health professionals, from one or more

organisations, working together to deliver comprehensive patient care. Multidisciplinary teams convey
many benefits to both the patients and the health professionals working on the team. These include
improved health outcomes and enhanced satisfaction for clients, and the more efficient use of
resources and enhanced job satisfaction for team members.
Multidisciplinary team includes:
•general practitioners;
•practice nurses;
•community health nurses;
•allied health professionals (may be a mix of government and non-government
community health professionals) such as physiotherapists, occupational therapists,
dieticians, psychologists, social workers, podiatrists and Aboriginal Health Workers;
•health educators (such as diabetes educators) which provides promotion and
prevention clinics, and other activities.

B. Tools for facilitating Teamwork

1. SBAR tool
The SBAR communication tool, used in many NHS trusts, structures communication in four
stages:
 S: situation; Hello, this is Peter Jones. I am a staff nurse on Ward 25. I am calling about Mr
Smith.
B: background; Mr Smith is 92. He was admitted yesterday with chest pain. He has had two
MIs in the past and has heart failure.
A: assessment; I have assessed him today and I am worried – he looks very unwell. His
respiration rate is 34 and his oxygen saturations are 86% on 15L. His NEWS is eight.
R: recommendation; I would like you to come and see him now please.

2. Checklists
As well as maintaining our situational awareness and sharing observations with colleagues,
we need to be aware of our own vulnerability and potential for making errors. This can be done
through a simple self-checking exercise using either the I’M SAFE checklist or the ‘three bucket’
model.
The I’M SAFE checklist, which is a Team tool, stands for:
I: illness;
M: medication;
S: stress;
A: alcohol and drugs;
F: fatigue;
E: eating and elimination.

3. Safety huddles
A safety huddle is a brief coming together of staff, once or more in a shift, aimed at
maintaining situational awareness, sharing observations and going through risks: which patients
are causing concern? Is anyone at risk of deterioration? How is staffing? How is workload?
Anyone can take part or lead the safety huddle, whether they are nurses, doctors,
physiotherapists, housekeepers or ward clerks.

4. Closed-loop communication
Closed-loop communication is a technique that reduces the risk of errors arising from
misunderstandings and wrong assumptions. It is a good idea for team leaders to use closed-loop
communication in their communication with the team. This role modelling will encourage staff to
adopt the same good practice.

5. Readback
Readback is similar to closed-loop communication. It involves reading back to the sender
information they have given to you in order to check you have correctly understood it. Readback
can also help clarify who is responsible for what, as this can be unclear at handover and important
interventions might thus be missed or delayed.

C. Roles of the Nurse

Nurses are the only clinical professionals who are specially trained to understand the roles
of other healthcare providers; this training provides a strong foundation for successful
collaboration.

Effective communication is critical for a collaborative care plan to work; nurses are
trained to have adaptability, empathy, and communication skills, which allows for them to be
excellent leaders and members of a care team.

Nurses’ ability to understand and assess a patient’s clinical, emotional, and social
needs can help them to call upon available resources and create a patient-focused care plan. As
nurses are offering direct patient care around the clock, they have a unique and focused view of
how that care should be provided. Nurses can be role models in their honest and open
communication with team members about the quality of patient care which is being provided and
the work environment.
 Establish Team Goals
Examples of common health care goals can include improving patient care, shortening
response times, and decreasing waste. Setting a team goal provides every team member a
focused objective to work toward, which helps create team unity and provides space for feedback.
Without setting common goals, individuals on a team may have different outcomes in mind, which
can only serve to hinder progress.
  Assign Roles Within a Team
Nurses interact with many health care professionals, both within their own team and across
departments. It is crucial then, to understand key roles within individual teams to achieve greater
collaboration. If clear roles are not assigned, team members may duplicate efforts in some areas
while leaving gaps in others. This not only wastes time but could cause patient harm.
 Allow for Open Communication
Because nurses interact with many people, from patients to practitioners, they must
develop keen listening skills. Those working alongside nurses may have their individual feedback,
suggestions, or questions, making active listening an important aspect of team operations. On the
other hand, team members whose input and successes are verbally acknowledged to the greater
team are more likely to contribute their ideas, which builds team cohesion and efficiency.
 Promote Mutual Respect
Mutual respect is critical in health care settings, not just within the team but across
collaborative departments. Team members who are not feeling respected can become defensive,
foster hidden agendas, demonstrate a lack of engagement, and worse. Building mutual respect
comes through a common, focused goal; an understanding that each individual’s work is valuable
and an acknowledgment of the efforts of others.
 Handle Conflict Proactively
Effective teamwork and collaboration in nursing exist with the understanding that some
conflict is inevitable. By allowing for open communication and listening to team members’
concerns, nurses can encourage productive conflict resolution in its early stages.
 Be an Effective Leader
The field of health care is filled with leaders, and nursing is no exception. Specialized nurse
practitioners frequently assume leadership roles, taking charge of teamwork and collaborative
efforts. The best leaders can adapt to different circumstances based on the team, patient care
goals, and the needs of the health care organization. Quality leaders must be flexible while
helping their team members and other departments in an open and respectful manner.

References
Nursing Times. (2016, December 12). Retrieved May 24, 2020, from
http://www.nursingtimes.net/clinical-archive/patient-safety/tools-and-techniques-to-improve-
teamwork-and-avoid-patient-harm-12-12-2016/
Advisory Board. (n.d.). Retrieved May 24, 2020, from http://www.advisory.com/research/physician-
executive-council/prescription-for-change/2015/03/dyad-leadership-slides
Berman, Snyder, Kozier, & Erb. (2008). Kozier and Erb's Fundamentals of Nursing, 8th ed. Vol. 1.
Pearson Education, Inc.
NSW . (n.d.). Retrieved May 24, 2020, from
http://www.health.nsw.gov.au/healthone/Pages/multidisciplinary-team-care.aspx
Wiley Online Library. (n.d.). Retrieved May 24, 2020, from
http://www.onlinelibrary.wiley.com/doi/abs/10.1111/nhs.12671

CONCEPTS OF LEADERSHIP AND MANAGEMENT

A. Role of the Nurse as Leader/Manager

A leader influences others to work together to accomplish a specific goal. Leaders are
often visionary; they are informed, articulate, confident, and self-aware. Leaders also usually
have outstanding interpersonal skills and are excellent listeners and communicators.
The purpose of nursing leadership includes:
 Improving the health status of individuals and families
 Increasing the effectiveness and level of satisfaction among professional
colleagues
 Improving the attitudes of citizens and legislators toward the nursing profession
and their expectations of it.
A manager is an employee of an organization who is given authority, power, and responsibility
for planning, organizing, coordinating, and directing the work of others, and for establishing and
evaluating standards. Managers understand organizational structure and culture. They control
human, financial, and material resources. They set goals, make decisions, and solve problems.
As a manager, the nurse is responsible for:
 Efficiently accomplishing the goals of the organization
 Efficiently using the organization’s resources
 Ensuring effective client care
  Ensuring compliance with institutional, professional, regulatory, and governmental
standards.

B. Positive Practice Environment

Positive practice environments are cost-effective health care settings that support
excellence and decent work, have the power to attract and retain staff and to improve patient
satisfaction, safety and outcomes. Characteristically such settings:
1. ensure the health, safety and well-being of staff;
2. support quality patient care;
3. improve the motivation, productivity and performance of individuals and
organizations.
CHECKLIST FOR A POSITIVE PRACTICE ENVIRONMENT
 Professional Recognition
 Recognise health care professional competencies
 Promote professional autonomy and control
 Reward contribution and performance
 Measure employee satisfaction and act on outcomes.
 Management Practices
 Commit to equal opportunity and fair treatment
 Provide adequate and timely compensation
 Maintain effective performance management systems
 Offer decent and flexible benefit packages
 Involve employees in planning and decision making
 Encourage open communication and team work
 Foster a culture of mutual trust, fairness and respect
 Adopt policies to positively encourage reporting of professional misconduct
 Provide clear, comprehensive job descriptions
 Ensure effective grievance procedures are in place
 Support structures
 Invest sufficiently in health and work environments
 Foster strong employment relationships
 Apply regulatory frameworks for safe workplaces
 Provide adequate equipment, supplies and support staff
 Engage employees in continuous assessment
 Promote healthy work-life balance
 Offer employment security and work predictability
 Ensure practice under an overarching code of ethics
 Communicate and uphold standards of practice
 Review scopes of practice and competencies
 Education
 Support opportunities for professional development
 Offer thorough orientation programmes
 Foster effective supervisory/mentoring/coaching
 Occupational Health and Safety
 Adhere to safe staffing levels
 Adopt occupational safety and wellness policies
References
Berman, Snyder, Kozier, & Erb. (2008). Kozier and Erb's Fundamentals of Nursing, 8th ed. Vol. 1.
Pearson Education, Inc.
World Health Professions Alliance. (n.d.). Retrieved May 27, 2020, from
http:///www.whpa.org/activities/positive-practice-environments
 CONCEPTS OF CONTINUING PROFESSIONAL DEVELOPMENT

Continuing professional development, or CPD, is the ongoing process of developing,

maintaining and documenting your professional skills. These skills may be gained formally, through
courses or training, or informally, on the job or by watching others.
A. Life-long learning
Healthcare is complex and practices are always evolving. A large segment of the patient
population is over the age of 65, and older patients tend to suffer from one or more chronic health
conditions. Nurses must have the necessary expertise to treat elderly patients and help them manage
illnesses.
Lifelong learning gives nurses the critical-thinking and problem-solving skills needed to resolve
issues they may encounter while taking care of patients. When nurses are up to date on new
techniques, policies and procedures, they may influence healthcare in these ways:
•Build strong collaborative relationships with patients and coworkers.
•Improve patient outcomes.
•Decrease mortality rates.
•Reduce the chance of errors.
Constant updating and growth are essential to keep abreast of scientific and technological change
and changes within the nursing profession. It is a responsibility of each practicing nurse.
B. Career Path/Development Map
Career paths and career ladders are two traditional methods by which an employee can develop
and progress within an organization. Career ladders are the progression of jobs in an organization's
specific occupational fields ranked from highest to lowest based on level of responsibility and pay.
Career paths encompass varied forms of career progression, including the traditional vertical career
ladders, dual career ladders, horizontal career lattices, career progression outside the organization
and encore careers.
Employees usually feel more engaged when they believe that their employer is concerned about
their growth and provides avenues to reach individual career goals while fulfilling the company's
mission. A career development path provides employees with an ongoing mechanism to enhance
their skills and knowledge that can lead to mastery of their current jobs, promotions and transfers to
new or different positions. Implementing career paths may also have a direct impact on the entire
organization by improving morale, career satisfaction, motivation, productivity, and responsiveness in
meeting departmental and organizational
objectives.
The Development Map has been
designed to view a child’s thinking,
learning and development in a holistic way
so that you can see the ‘whole child’ and
how they are progressing through the
Early Years Foundation Stage.It is a
tracking tool which can be used in
‘everyday practice’ for assessing
children’s learning and progress through
the EYFS. The developmental map
enables immediate, simple, and effective
analysis of a child’s progress form starting
points to their current level of
achievement.
The developmental map is
informed by the one’s observation of
the child and all the information
gathered ad they play, talk, think and
learn. Observation should include
perspectives from parents and family
and from the child themselves.
Collectively this is the formative assessment of the child. As the map of the child’s progress and
collect all the informative information, one may want to stop at certain intervals to make a
summative analysis.
Figure 1 Developmental Map

References
SHRM. (n.d.). Retrieved May 26, 2020, from http://www.shrm.org/resourcesandtools/tools-and-
samples/toolkits/pages/developingemployeecareerpathsandladders.aspx

WatchMeGrow. (n.d.). Retrieved May 25, 2020, from http://watchmegrow.uk/development-map/

FILIPINO CULTURE, VALUES AND PRACTICES IN RELATION TO HEALTH CARE

Filipino older adults tend to cope with illness with the help of family and friends, and by faith in
God. Complete cure or even the slightest improvement in a malady or illness is viewed as a miracle.
Filipino families greatly influence patients’ decisions about health care. Patients subjugate personal
needs and tend to go along with the demands of a more authoritative family figure in order to
maintain group harmony. Before seeking professional help, Filipino older adults tend to manage their
illnesses by self-monitoring of symptoms, ascertaining possible causes, determining the severity and
threat to functional capacity, and considering the financial and emotional burden to the family.

COPING STYLES
Coping styles common among elderly Filipino Americans in times of illness or crisis include:
• Patience and Endurance (Tiyaga): the ability to tolerate uncertain situations
• Flexibility (Lakas ng Loob): being respectful and honest with oneself
• Humor (Tatawanan ang problema): the capacity to laugh at oneself in times of adversity
 • Fatalistic Resignation (Bahala Na): the view that illness and suffering are the unavoidable
and predestined will of God, in which the patient, family members and even the physician
should not interfere
• Conceding to the wishes of the collective (Pakikisama) to maintain group harmony

CULTURE & COMMUNICATION

•Multi-generational households; Care for and respect the elderly
•Value education
•Signs of disrespect: Showing open disagreement/Saying no/Direct eye contact with authority
figures
•Individuals are comfortable with silence

MAJOR HEALTH CONCERNS

•Diabetes
•Cervical/Breast Cancer
•Cardiovascular Disease
•Hepatitis B

HEALTH CARE DELIVERY

•Western medicine is familiar and accepted
•Sometimes incorporate indigenous sources of care
•Nuclear and extended family play an important role in a patient's health care decisions

PRACTICE OF TRADITIONAL MEDICINE

The Philippine Institute for Traditional and Alternative Health Care (PITACH), an agency of the
Department of Health (DOH), supports the integration of traditional and complementary medicine into
the national health care system.
Three Levels of Traditional Health Care
1. Folk doctor: combines traditional techniques with some Western medicine
2. Faith Healer: religion based health care; Psychic healers and surgeons; Christian or
Mystics
3. Shamans: Mystics; Conducts ceremonies, sacrifices and offerings to appease evil
spirits or witches/sorcerers

RESPONSES TO MENTAL ILLNESS

Indigenous traits common among elderly Filipino Americans when faced with illness related to
mental conditions:
• Devastating shame (Hiya)
• Sensitivity to criticism (Amor Propio)

COMMON PERCEPTIONS OF FILIPINOS ABOUT MENTAL ILLNESS

•Unwillingness to accept having mental illness, which leads to the avoidance of needed mental
health services due to fear of being ridiculed
• Involvement of other coping resources such as reliance on family and friends or indigenous
healers, and dependence on religion which can diminish the need for mental health services
• Prioritizing of financial and environmental needs which preclude the need for mental health
services
• Limited awareness of mental health services resulting in limiting access
• Difficulty in utilizing mental health services during usual hours because of the unavailability of
working adult family members
• Mental illness connotes a weak spirit, and may be attributed to divine retribution as a
consequence of personal and ancestral transgression
• Lack of culturally oriented mental health services
References
Stanford School of Medicine. (n.d.). Retrieved 2020, from
http://www.geriatrics.stanford.edu/ethnomed/filipino/fund/health_behaviors.html
 ETHICO-MORAL AND LEGAL CONSIDERATIONS IN THE PRACTICE OF NURSING

A. Phil. Nursing Law of 2012: RA 9173 Art of IV, Sec 28: Scope of Nursing Practice
NURSING PRACTICE SEC. 28. Scope of Nursing.
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 and performs nursing services to individuals,
families and communities in any health care setting. It includes, but not limited to, nursing care during
conception, labor, 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:
 a. Provide nursing care through the utilization of the nursing process.
b. Establish linkages with community resources and coordination with the health team;
c. Provide health education to individuals, families and communities;
d. Teach, guide and supervise students in nursing education programs including the
administration of nursing services in varied 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; and
e. Undertake nursing and health human resource development training and research,
which shall include, but not limited to, the development of advance nursing practice;

Provided:
 That this section shall not apply to nursing students who perform nursing functions under the
direct supervision of a qualified faculty.
 That in the practice of nursing in all settings, the nurse is duty-bound to observe the Code of
Ethics for nurses and uphold the standards of safe nursing practice.
 That the program and activity for the continuing professional education shall be submitted to
and approved by the Board.
B. National Nursing Core Competency Standards
I. SAFE AND QUALITY NURSING CARE
CORE COMPETENCY 1:
Demonstrate knowledge based on health/illness status of individual/ groups
Indicators :
 Identifies health needs of patients/groups
 Explains patient/group status
CORE COMPETENCY 2:
Provides sound decision making in care of individual/groups considering their beliefs,
values
Indicators :
 Problem identification
 Data gathering related to problem
 Data analysis
 Selection appropriate action
 Monitor progress of action taken
CORE COMPETENCY 3:
Promotes patient safety and comfort
Indicators :
 Performs age-specific safety measures and comfort measure in all aspects of
patient care
CORE COMPETENCY 4:
Priority setting in nursing care based on patients’ needs
Indicators :
 Identifies priority needs of patients
 Analysis of patients’ needs
 Determine appropriate nursing care to be provided
CORE COMPETENCY 5:
Ensures continuity of care
Indicators :
 Refers identified problems to appropriate individuals/ agencies
 Establish means of providing continuous patient care
CORE COMPETENCY 6:
Administers medications and other health therapeutics
Indicators :
 Conforms to the 10 golden rules in medication administration and health
therapeutics
CORE COMPETENCY 7:
Utilizes nursing process as framework for nursing. Performs comprehensive,
systematic nursing assessment
Indicators :
 Obtains consent
 Complete appropriate assessment forms
 Performs effective assessment techniques
 Obtains comprehensive client information
  Maintains privacy and confidentiality
 Identifies health needs
CORE COMPETENCY 8:
Formulates care plan in collaboration with patients, other health team members
Indicators :
 Includes patients, family in care planning
 States expected outcomes in nursing interventions
 Develops comprehensive patient care plan
 Accomplishes patient centered discharge plan
CORE COMPETENCY 9:
Implements NCP to achieve identified outcomes
Indicators :
 Explain interventions to patient, family before carrying them out
 Implement safe, comfortable nursing interventions
 Acts according to client’s health conditions, needs
 Performs nursing interventions effectively and in timely manner
CORE COMPETENCY 10:
Implements NCP progress toward expected outcomes
Indicators :
 Monitors effectiveness of nursing interventions
 Revises care plan PRN
CORE COMPETENCY 11:
Responds to urgency of patient’s condition
Indicators :
 Identifies sudden changes in patient’s health conditions
 Implements immediate, appropriate interventions

II. MANAGEMENT OF RESOURCES AND ENVIRONMENT

CORE COMPETENCY 1:
Organizes workload to facilitate patient care
Indicators:
 Identifies task or activities that need to be accomplished
 Plans the performance of task or activities based on priority
 Finishes work assignment on time
CORE COMPETENCY 2:
Utilizes resources to support patient care
Indicators:
 Determines the resources needed to deliver patient care
 Control the use of equipment
CORE COMPETENCY 3:
Ensures the functioning of resources
Indicators:
 Check proper functioning of the equipment
 Refers Malfunctioning equipment to appropriate unit
CORE COMPETENCY 4:
Check the Proper functioning of the Equipment
Indicators:
 Determines the task and procedures that can be safely assigned to the other
members of the team
 Verifies the competence of the staff prior to delegating tasks
CORE COMPETENCY 5:
Maintains safe Environment
Indicators:
 Observe proper disposal of waste
 Adheres to policies, procedures and protocols on prevention and control of
infection
 Defines steps to follow incase of fire , earthquake and other emergency situation

III. HEALTH EDUCATION

CORE COMPETENCY 1:
Assesses the learning needs of the patient and the family
Indicators:
  Obtains learning information through interview, observation and validation
 Defines relevant information
 Completes assessment records appropriately
 Identify priority needs

CORE COMPETENCY 2:
Develops Health Education plan based on assessed and anticipated needs.
Indicators:
 Considers nature of the learner in relation to social, cultural, political, economic,
educational, and religious factor
CORE COMPETENCY 3:
Develops learning material for health education
Indicators:
 Involves the patient, family and significant others and other resources
 Formulates a comprehensive health educational plan with the following
components , objectives, content and time allotment
 Teaching-learning resources and evaluation parameters
 Provides for feedback to finalize plan
CORE COMPETENCY 4:
Implements the health Education Plan
Indicators:
 Provides for conducive learning situation in terms of timer and place
 Considers client and family preparedness○ Utilize appropriate strategies
 Provides reassuring presence through active listening, touch and facial
expression and gestures
 Monitors client and family’s responses to health education
CORE COMPETENCY 5:
Evaluates the outcome of health Education
Indicators:
 Utilizes evaluation parameters
 Documents outcome of care
 Revises health education plan when necessary

IV. ETHICO-MORAL RESPONSIBILITY

CORE COMPETENCY 1:
Respects the rights of individual/ groups
Indicator:
 Renders nursing care consistent with the patient’s bill of rights (ie. confidentiality
of information, privacy, etc.)
CORE COMPETENCY 2
Accepts responsibility & accountability for own decisions and actions
Indicators:
 Meets nursing accountability requirements as embodied in the job description
 Justifies basis for nursing actions and judgment
 Protects a positive image of the profession
CORE COMPETENCY 3
Adheres to the national and international code of ethics for nurses
Indicators:
 Adheres to the Code of Ethics for Nurses and abides by its provisions
 Reports unethical and immoral incidents to proper authorities

V. LEGAL RESPONSIBILITY
CORE COMPETENCY 1:
Adheres to practices in accordance with the nursing law and other relevant
legislation including contract and informed consent.
Indicators:
 Fulfill legal requirements in Nursing Practice
 Holds current professional license
 Acts in accordance with the terms of contract of employment and other rules and
regulation
  Complies with the required CPE
 Confirms information given by the doctor for informed consent
 Secures waiver of responsibility for refusal to undergo treatment or procedures
 Check the completeness of informed consent and other legal forms
CORE COMPETENCY 2:
Adheres to organizational policies and procedures, local and national
Indicators:
 Articulates the vision and mission of the institution where one belongs
 Acts in accordance with the established norms and conduct of the institution/
organization
CORE COMPETENCY 3:
Document care rendered to patients.
Indicators:
 Utilizes appropriate patient care records and reports
 Accomplish accurate documentation in all matters concerning patient care in
accordance with the standard of nursing practice.

VI. PERSONAL & PROFESSIONAL DEVELOPMENT

CORE COMPETENCY 1
Identifies own learning needs
Indicators:
 Verbalizes strengths, weaknesses, limitations.
 Determines personal and professional goals and aspirations.
CORE COMPETENCY 2
Pursues continuing education
Indicators:
 Participates in formal and non-formal education.
 Applies learned information for the improvement of care.
CORE COMPETENCY 3
Gets involved in professional organizations and civic activities
Indicators:
 Participates actively in professional, social, civic and religious activities
 Maintain membership to professional organizations
 Support activities related to nursing and health issues
CORE COMPETENCY 4
Projects a professional image of nurse
Indicators:
 Demonstrate good manners and right conduct at all times.
 Dresses appropriately.
 Demonstrates congruence of words and actions.
 Behaves appropriately at all times.
CORE COMPETENCY 5
Possesses positive attitude towards change and criticism
Indicators:
 Listens to suggestions and recommendations.
 Tries new strategies or approaches.
 Adapts to changes willingly.
CORE COMPETENCY 6
Performs function according to professional standards
Indicators:
 Assesses own performance against standards of practice.
 Sets attainable objectives to enhance nursing knowledge and skills.
 Explains current nursing practices, when situations call for it.

VII. RESEARCH
CORE COMPETENCY 1:
Gathers data using different methodologies
Indicators:
 Identifies researchable problems regarding patient care and community health
 Identifies appropriate methods of research for a particular patient/community
problem
  Combines quantitative and qualitative nursing design thru simple explanation on
the phenomena observed
 Analyzes data gathered
CORE COMPETENCY 2:
Recommends actions for implementation
Indicator:
 Based on the analysis of data gathered, recommends practical solutions
appropriate for the problem

CORE COMPETENCY 3:
Disseminates results of research findings
Indicators:
 Communicates results of findings to colleagues/patients/family and to others
 Endeavors to publish research
 Submits research findings to own agencies and others as appropriate
CORE COMPETENCY 4:
Applies research findings in nursing practice
Indicators:
 Utilizes and findings in research in the provision of nursing care to
individuals/groups/communities
 Makes use of evidence-based nursing to ameliorate nursing practice

VIII. RECORDS MANAGEMENT

CORE COMPETENCY 1:
Maintains accurate and updated documentation of patient care
Indicator:
 Completes updated documentation of patient care
CORE COMPETENCY 2:
Records outcome of patient care
Indicator:
 Utilizes a record system
CORE COMPETENCY 3:
Observes legal imperatives in recording keeping
Indicators:
 Observes confidentially and privacy of patient’s records
 Maintains an organized system of filing and keeping patient’s records in a
designated area
 Refrains from releasing records and other information without proper authority

IX. COMMUNICATION
CORE COMPETENCY 1:
Establishes rapport with patients, significant others and members of the health
team.
Indicators:
 Creates trust and confidence
 Listens attentively to client’s queries and requests
 Spends time with the client to facilitate conversation that allows client to express
concern.
CORE COMPETENCY 2:
Identifies verbal and non-verbal cues
Indicator:
 Interprets and validates client’s body language and facial expression
CORE COMPETENCY 3:
Utilizes formal and informal channels
Indicator:
 Makes use of available visual aids
CORE COMPETENCY 4:
Responds to needs of individuals, family, group and community
Indicator:
 Provides re- assurance through therapeutic, touch, warmth and comforting words
of encouragement
 Readily smiles
 CORE COMPETENCY 5:
Uses appropriate information technology to facilitate communication
Indicator:
 Utilizes telephone, mobile phone, email and internet, and informatics
 Identifies a significant other so that follow up care can be obtained
 Provides “holding” or emergency numbers of services

X. COLLABORATION and TEAMWORK

CORE COMPETENCY 1:
Establishes collaborative relationship with colleagues and other members of the
health team
Indicators:
 Contributes to decision making regarding patients” needs and concerns
 Participates actively in patients care management including audit
 Recommends appropriate intervention to improve patient care
 Respects the role of the other members of the health team
 Maintains good interpersonal relationships with patients, colleagues and other
members of the health team
CORE COMPETENCY 2:
Collaborates plan of care with other members of the health team
Indicator:
 Refers patients to allied health team partners
 Acts liaison / advocate of the patients
 Prepares accurate documentation of efficient communication of services

XI. QUALITY IMPROVEMENT

CORE COMPETENCY 1:
Gathers data for quality improvement
Indicators:
 Demonstrates knowledge of method appropriate for the clinical problems
identified
 Detects variation in the vital signs of the patient from day to day
 Reports necessary elements at the bedside to improve patient stay at hospital
 Solicits feedback from patient and significant others regarding care rendered
CORE COMPETENCY 2:
Participates in nursing audits and rounds
Indicators:
 Contributes relevant information about patient condition as well as unit condition
and patient current reactions
 Shares with the team current information regarding particular patients condition
 Encourages the patient to speak about what is relevant to his condition
 Documents and records all nursing care and actions
 Performs daily check of patient records/condition
 Completes patients records
 Actively contributes relevant information of patients during rounds thru readings
and sharing with others
CORE COMPETENCY 3:
Identifies and reports variances
Indicators:
 Documents observed variance regarding patient care and submits to appropriate
group within 24 hours
 Identifies actual and potential variance to patient care
 Reports actual and potential variance to patient care
 Submits report to appropriate groups within 24 hours
CORE COMPETENCY 4:
Recommends solutions to identified problems
Indicators:
 Gives appropriate suggestions on corrective and preventive measures
 Communicates and discusses with appropriate groups
 Gives and objective and accurate report on what was observed rather than an
interpretation of the event.
C. Patient’s Bill of Rights
1. Right to Appropriate Medical Care and Humane Treatment.
Every person has a right to health and medical care corresponding to his state of health,
without any discrimination and within the limits of the resources, manpower and competence
available for health and medical care at the relevant time. The patient has the right to appropriate
health and medical care of good quality. In the course of such, his human dignity, convictions,
integrity, individual needs and culture shall be respected.
2. Right to Informed Consent.
The patient has a right to a clear, truthful and substantial explanation, in a manner and
language understandable to the patient, of all proposed procedures, whether diagnostic,
preventive, curative, rehabilitative or therapeutic, wherein the person who will perform the said
procedure shall provide his name and credentials to the patient, possibilities of any risk of
mortality or serious side effects, problems related to recuperation, and probability of success and
reasonable risks involved.
3. Right to Privacy and Confidentiality.
The privacy of the patients must be assured at all stages of his treatment. The patient has the
right to be free from unwarranted public exposure.The patient has the right to demand that all
information, communication and records pertaining to his care be treated as confidential. Any
health care provider or practitioner involved in the treatment of a patient and all those who have
legitimate access to the patient's record is not authorized to divulge any information to a third party
who has no concern with the care and welfare of the patient without his consent
4. Right to Information.
In the course of his/her treatment and hospital care, the patient or his/her legal guardian has
a right to be informed of the result of the evaluation of the nature and extent of his/her disease,
any other additional or further contemplated medical treatment on surgical procedure or
procedures, including any other additional medicines to be administered and their generic
counterpart including the possible complications and other pertinent facts, statistics or studies,
regarding his/her illness, any change in the plan of care before the change is made
5. The Right to Choose Health Care Provider and Facility.
The patient is free to choose the health care provider to serve him as well as the facility
except when he is under the care of a service facility or when public health and safety so demands
or when the patient expressly waives this right in writing.
6. Right to Self-Determination.
The patient has the right to avail himself/herself of any recommended diagnostic and
treatment procedures.Any person of legal age and of sound mind may make an advance written
directive for physicians to administer terminal care when he/she suffers from the terminal phase of
a terminal illness:
7. Right to Religious Belief.
The patient has the right to refuse medical treatment or procedures which may be contrary to
his religious beliefs, subject to the limitations described in the preceding subsection: Provided,
That such a right shall not be imposed by parents upon their children who have not reached the
legal age in a life threatening situation as determined by the attending physician or the medical
director of the facility.
8. Right to Medical Records.
The patient is entitled to a summary of his medical history and condition. He has the right to
view the contents of his medical records, except psychiatric notes and other incriminatory
information obtained about third parties, with the attending physician explaining contents thereof.
9. Right to Leave.
The patient has the right to leave hospital or any other health care institution regardless of his
physical condition: Provided. That a) he/she is informed of the medical consequences of his/her
decisionl b) helshe releases those involved in his/her care from any obligation relative to the
consequences of his decision; c) his/her decision will not prejudice public health and safety.
10. Right to Refuse Participation In Medical Research.
The patient has the right to be advised if the health care provider plans to involve him in
medical research, including but not limited to human experimentation which may be performed
only with the written informed consent of the patient
11. RIght to Correspondence and to Receive Visitors.
The patient has the right to communicate with relatives and other persons and to receive
visitors subject to reasonable limits prescribed by the rules and regulations of the health care
institution.
12. Right to Express Grievances.
 The patient has the right to express complaints and grievances about the care and services
received without fear of discrimination or reprisal and to know about the disposition of such
complaints.Such a system shall afford all parties concerned with the opportunity to settle amicably
all grievances.
13. RIght to be Informed of His Rights and Obligations as a Patient.
Every person has the right to be informed of his rights and obligations as a patient. It shall be
the duty of health care institutions to inform of their rights as well as of the institution's rules and
regulations that apply to the conduct of the patient while in the care of such institution.
D. Informed Consent
Informed consent is an agreement by a client to accept a course of treatment or a procedure
after being provided complete information, including the benefits and risks of treatment, and
prognosis if not treated by a health care provider.
TYPES OF INFORMED CONSENT
1. Express Consent
This may be either an oral or written agreement. Usually, the more invasive the procedure
and/or the greater the potential for the risk to the client, the greater the need for written
permission.
2. Implied Consent
This exists when the individual’s nonverbal behaviour indicates agreement. Consent is also
implied in a medical emergency when an individual cannot provide and express consent because
of physical condition.
GENERAL GUIDELINES
 The diagnosis or condition that requires treatment
 The purposes of the treatment
 What the client can expect to feel or experience
 The intended benefits of the treatment
 Possible risks or negative outcomes of the treatment
 Advantages and disadvantages of possible alternatives to the treatment
MAJOR ELEMENTS
 The consent must be given voluntarily.
 The consent must be given by a client or individual with the capacity and competence to
understand.
 The client or individual must be given enough information to be the ultimate decision maker.

E. Data Privacy Law

DATA PRIVACY PRINCIPLES
 General Principles
The processing of personal data shall be allowed, subject to compliance with the
requirements of the Data Privacy Act, other laws allowing disclosure of information to the
public and these Rules. All natural and juridical persons and other body involved in processing
of personal data must ensure implementation of personal data processing principles set out in
the Act, these Rules and other issuances of the Commission.
 Principles of Transparency, Legitimate Purpose and Proportionality.
a. Transparency. Processing of personal data shall be known to the data subject, who
must be informed about the nature, purpose, method, and extent of processing, his or
her rights as data subject and how these can be exercised, and the identity and contact
details of the personal information controller.
b. Legitimate purpose. The processing of information shall be compatible with a
declared and specified purpose which must not be contrary to law, morals or public
policy.
c. Proportionality. The processing of information shall be adequate, relevant, suitable,
necessary and not excessive in relation to a declared and specified purpose.
 General principles in collection, processing and retention.
The processing of personal data shall adhere to the following general principles with
regard to collection, processing and retention.
a. Collection must be for a specified and legitimate purpose
1. There must be consent, which is time bound and may be withdrawn, unless
specifically provided by Act or these Rules that consent for collection and
processing is not required.
2. In obtaining consent, the data subject must be provided specific information
with regard to the purpose of processing. The data subject must be specifically
informed of passive or automatic processing of his or her personal data over a
 period of time, further processing of data for direct marketing and other
commercial purpose, or processing for data sharing.
3. The purpose shall be declared before collection unless it is not reasonable and
practicable, in which case purpose must be declared after collection but before
any other processing, provided that collection and processing of sensitive
personal information or privileged information is prohibited unless specifically
authorized by law or there is prior consent from data subject.
4. The data subject must be informed of what data will be collected, the period of
collection and how long the collected data will be stored.
5. Personal data to be collected shall only be that which is necessary and
compatible with declared, specified and legitimate purpose.
b. Personal data shall be processed fairly and lawfully
1. Processing shall be in accordance with the rights of the data subject, and shall
be transparent, affording data subject sufficient information as to the identity of
controller and recipients of data, right to withdraw consent or object, and other
information relevant to the processing.
2. Information provided to a data subject must always be in clear and simple
language and easily accessible.
3. Processing must be compatible with declared, specified and legitimate
purpose.
4. Processed personal data should be adequate, relevant and not excessive in
relation to the declared, specified and legitimate purpose.
5. Adequate privacy and security safeguards should be in place in the processing
of personal data.
c. Processing should ensure data quality
1. Personal data should be accurate, relevant and complete with respect to the
purpose of processing.
2. Personal data shall be kept up to date when necessary for the declared,
specified and legitimate purpose.
3. Inaccurate or incomplete data must be rectified, supplemented, destroyed or
their further processing restricted.
d. Personal Data shall not be retained longer than necessary
1. Retention of personal data shall only be until the declared, specified and
legitimate purpose has been achieved or the processing relevant to the purpose
has been terminated.
2. Retention of personal data may be allowed when necessary to establish,
exercise or defend legal claims, which must be in accordance with a disposition
schedule followed by the industry or approved by appropriate government
agency, and taking into consideration applicable prescriptive periods.
3. Personal data shall be disposed or discarded in a secure manner that would
prevent further processing, unauthorized access or disclosure to any other party
or the public, or prejudice to the interests of the data subjects.
e. Any authorized further processing shall have adequate safeguards. Personal
data originally collected for a declared, specified or legitimate purpose may be
retained longer and processed further for historical, statistical or scientific
purposes, and other purpose specifically authorized by law when there is
adequate safeguards for data privacy and security.
1. Personal data kept longer than necessary for the declared, specified and
legitimate purpose shall be aggregated or in a form which does not permit
identification of data subjects.
2. Further processing for historical, statistical, scientific or other legally authorized
purpose shall be allowed if there are adequate safeguards for data privacy and
security.
(a) The data subject consents, or personal data is contained in public
documents subject to reasonable requirements for access;
(b) The purpose of processing must be sufficiently clarified;
(c) The Commission may review the safeguards in place.
3. Personal data cannot be retained in perpetuity in contemplation of a possible
future use still to be determined.
 General principles for Data Sharing.
Further Processing of Personal Data collected from a party other than the Data Subject
shall be allowed under the following conditions:
 a. Data sharing is specifically provided by law, where the law authorizing the
sharing provides adequate safeguards for data privacy and security.
b. Data Sharing in the Private Sector shall be allowed if:
1. The data subject consents to data sharing provided that consent for data
sharing shall be required even when the data is to be shared with an affiliate or
mother company, or similar relationships.
2. Data sharing for commercial purpose, including direct marketing or marketing
research, shall be covered by a data sharing agreement.
3. The data subject shall be provided with the following information prior to
collection or before data is shared:
(a) Identity of all controllers or processors who will be given access
to data;
(b) Purpose of further processing;
(c) Categories of data concerned;
(d) Intended recipients or categories of recipients of data;
(e) Existence of rights of data subject, including right to access and
correction, and right to object;
(f) Other information that would sufficiently notify the data subject of
the extent of data sharing and manner of processing.
4. Further processing of shared data shall adhere to the data protection
principles laid down in the Act, these Rules and other issuances of the
Commission.
5. The data sharing agreement should put in place adequate safeguards for data
privacy and security, uphold rights of data subjects and provide a system by
which data subject can obtain relief for violations.
6. The data sharing agreement shall be subject to review of the Commission.
c. Data collected from parties other than the data subject for purpose of research
shall be allowed provided the personal data is publicly available or has the
consent of the data subject for purpose of research, adequate safeguards are in
place, and no decision directly affecting the data subject shall be made on the
basis of the data collected or processed.

d. Data Sharing for purpose of a public function or provision of a public service

shall be allowed provided the personal information controller sharing information
under its control or custody with another personal information controller enters
into a data sharing agreement approved by the Commission prior to data sharing.

F. Code of Ethics for Nurses

The Code of Ethics for Nurses with Interpretive Statements establishes the ethical standard
for the profession and provides a guide for nurses to use in ethical analysis and decision-making. It
is non-negotiable in any setting, neither is it subject to revision or amendment except by formal
process of revision by the American Nurses Association.
The Code of Ethics for Nurses arises from within the long, distinguished, and enduring moral
tradition of modern nursing in the United States. It is foundational to nursing theory, practice, and
praxis in its expression of the values, virtues and obligations that shape, guide, and inform nursing
as a profession.

The Code of Ethics for Nurses serves the following purposes:

o It is a succinct statement of the ethical values, obligations, duties, and professional
ideals of nurses individually and collectively.
o It is the profession’s nonnegotiable ethical standard.
o It is an expression of nursing’s own understanding of its commitment to society.
Provision 1
The nurse practices with compassion and respect for the inherent dignity, worth, and personal
attributes of every person, without prejudice.
Provision 2
The nurse’s primary commitment is to the patient, whether an individual, family, group,
community, or population.
Provision 3
The nurse promotes, advocates for, and protects the rights, health and safety of the patient.
Provision 4
 The nurse has authority, accountability, and responsibility for nursing practice, makes
decisions, and takes action consistent with the obligation to provide optimal care.
Provision 5
The nurse owes the same duties to self as to others, including the responsibility to promote
health and safety, preserve wholeness of character and integrity, maintain competence, and
continue personal and professional growth.
Provision 6
The nurse, through individual and collective action, establishes, maintains, and improves the
moral environment of the work setting and the conditions of employment, conducive to quality
health care.
Provision 7
The nurse, whether in research, practice, education, or administration, contributes to the
advancement of the profession through research and scholarly inquiry, professional standards
development, and generation of nursing and health policies.
Provision 8
The nurse collaborates with other health professionals and the public to protect and promote
human rights, health diplomacy, and health initiatives.
Provision 9
The profession of nursing, collectively through its professional organizations, must articulate
nursing values, maintain the integrity of the profession, and integrate principles of social justice
into nursing and health policy.

References
Official Gazette. (2002, October 21). Retrieved May 28, 2020, from
http://www.officialgazette.gov.ph/2002/10/21/republic-act-no-9173/
The Nursing Profession. (2009, September 13). Retrieved May 27, 2020, from
http://www.thenursingprofession.blogspot.com/2009/09/11-core-competencies.html?m=1
American Nurses Association. (2014). The Code of Ethics for Nurses with Interpretive Statements.
Berman, Snyder, Kozier, & Erb. (2008). Kozier and Erb's Fundamentals of Nursing, 8th ed. Vol. 1.
Pearson Education, Inc.
National Privacy Commission . (2016). Implementing Rules and Regulations of Republic Act No.
10173, known as the "Data Privacy Act of 2012".
Saint Anthony Mother and Child Hospital. (n.d.). Retrieved May 28, 2020, from
http://www.samch.doh.gov.ph/index.php/patients-and-visitors-corner/patients-rights

PHILIPPINE PROFESSIONAL NURSING ROADMAP

Figure 2 Philippine Nurses Association Roadmap 2030