FUNDAMENTALS OF NURSING

Week 1: The Nature of Nursing

A. History of Nursing
i. Nursing today is far different from nursing as it was practiced years ago, and it is
expected to continue changing during the 21st century.
ii. Nursing has undergone dramatic change in response to societal needs and influences iii.
Recurring themes of women’s roles and status, religious (Christian) values, war, societal attitudes,
and visionary nursing leadership have influenced nursing practice in the past. Many of these
factors still exert their influence today.
1. Women’s roles
a. Traditional female roles of wife, mother, daughter, and sister have always
included the care and nurturing of other family members.
b. Nursing could be said to have its roots in “the home.”
c. The traditional nursing role has always entailed humanistic caring,
nurturing, comforting, and supporting.
2. Religion
a. The Christian value of “love thy neighbor as thyself” and Christ’s parable
of the Good Samaritan that had a significant impact on the development
of Western nursing.
b. Fabiola, one of several wealthy matrons of the Roman Empire, converted
to Christianity and used their wealth to provide houses of care and
healing (the forerunner of hospitals) for the poor, the sick, and the
homeless.
c. The Crusades - Knights of Saint John of Jerusalem (also known as the
Knights Hospitalers), the Teutonic Knights, and the Knights of Saint
Lazarus provided nursing care to their sick and injured comrades.
d. The Knights of Saint Lazarus dedicated themselves to the care of people
with leprosy, syphilis, and chronic skin conditions.
e. The Alexian Brothers organized care for victims of the Black Plague in
the 14th century in Germany
f. Theodor Fliedner reinstituted the Order of Deaconesses in 1836 and
opened a small hospital and training school in Kaiserswerth, Germany.
Florence Nightingale received her “training” in nursing at the
Kaiserswerth School.
3. War
a. During the Crimean War (1854–1856), Nightingale and her nurses
transformed the military hospitals by setting up sanitation practices, such
as hand washing and washing clothing regularly.
b. During the American Civil War (1861–1865), several nurses emerged:
Harriet Tubman and Sojourner Truth, Mother Biekerdyke and Clara
Barton, Walt Whitman and Louisa May Alcott, and Dorothea Dix
c. The arrival of World War I resulted in American, British, and French
women rushing to volunteer their nursing services.
d. During the World War II, auxiliary health care workers became
prominent. “Practical” nurses, aides, and tech- nicians provided much of
the actual nursing care under the instruc- tion and supervision of better
prepared nurses. Medical specialties also arose at that time to meet the
needs of hospitalized clients.
e. During the Vietnam War, approximately 11,000 American military women
stationed in Vietnam were nurses.
4. Societal Attitudes
a. Before the mid-1800s, nursing was without organization, educa- tion, or social
 status; the prevailing attitude was that a woman’s place was in the home
and that no respectable woman should have a ca- reer.
b. In the latter part of the 19th century, the guardian angel or angel of mercy
image arose largely because of the work of Florence Nightingale during
the Crimean War. After Nightingale brought re- spectability to the nursing
profession, nurses were viewed as noble, compassionate, moral,
religious, dedicated, and self-sacrificing.
5. Nursing Leaders
a. Florence Nightingale (1820-1910). She was the first nurse to exert
political pressure on government. She is also recognized as nursing’s
first scientist-theorist for her work Notes on Nursing: What It Is, and What It
Is Not (1860/1969).
b. Clara Barton (1821-1912). Barton is noted for her role in establish- ing the
American Red Cross, which linked with the International Red Cross
when the U.S. Congress ratified the Treaty of Geneva (Geneva
Convention).
c. Linda Richards (1841-1930). She was America’s first trained nurse. She
graduated from the New England Hospital for Women and Children in
1873. Richards is known for introducing nurse’s notes and doctor’s
orders. She also initiated the practice of nurses wearing uniforms. She is
credited for her pioneering work in psychiatric and industrial nursing.
d. Mary Mahoney (1845-1926). She was the first African American
professional nurse. She constantly worked for the ac- ceptance of African
Americans in nursing and for the promotion of equal opportunities
e. Lillian Wald (1867-1940). She is considered the founder of public health
nursing.
iv. Nursing History in the Philippines
1. Early Beliefs and Practices
a. The early Filipinos subscribed to superstitious belief and practices in
relation to health and sickness.
b. Herb men were called “herbicheros”meaning one who practiced
witchcraft.
c. Persons suffering from diseases without any identified cause were
believed bewitched by “mangkukulam” or “manggagaway”.
d. Difficult childbirth and some diseases (called “pamao”) were attributed to
“nunos”.
e. Midwives assisted in childbirth. During labor, the “mabuting hilot” (good
midwife) was called in.
f. If the birth became difficult, witches were supposed to be the cause. To
disperse their influence, gunpowder were exploded from a bamboo cane
close to the head of the sufferer.
2. Health Care During the Spanish Regime
a. Certain practices when taking care of a sick individuals entails
interventions from babaylan (priest physicians) or albularyo (herb doctor).
b. The religious orders exerted their efforts to care for the sick by building
hospitals in different parts of the Philippines. The earliest hospitals were: i.
Hospital Real de Manila (1577)
ii. San Lazaro Hospital (1578)
iii. Hospital de Indios (1586)
iv. Hospital de Aguas Santas (1590)
v. San Juan de Dios Hospital (1596)
c. Nursing During the Philippine Revolution
 i. Josephine Bracken — wife of Jose Rizal, installed a field hospital in an
estate house in Tejeros. She provided nursing care to the wounded
night and day.
ii. Rosa Sevilla de Alvero — converted their house into quarters for the
Filipino soldiers; during the Philippine-American War that broke out
in 1899
iii. Dona Hilaria de Aguinaldo — wife of Emilio Aguinaldo who organized
that Filipino Red Cross under the inspiration of Mabini. iv. Dona Maria
Agoncillo de Aguinaldo — second wife of Emilio Aguinaldo; provided
nursing care to Filipino soldiers during the revolution, President of the
Filipino Red Cross branch in
Batangas.
v. Melchora Aquino a.k.a. “Tandang Sora” — nursed the wounded
Filipino soldiers and gave them shelter and food.
vi. Capitan Salome — a revolutionary leader in Nueva Ecija; provided
nursing care to the wounded when not in combat. vii. Agueda
Kahabagan — revolutionary leader in Laguna, also provided nursing
services to her troops
d. Hospital School of Nursing’s Formal Training
i. Iloilo Mission Hospital School of Nursing (Iloilo City, 1906) ii. Saint
Paul’s Hospital School of Nursing (Manila, 1907) iii. Philippine General
Hospital School of Nursing (Manila, 1907) iv. St. Luke’s Hospital School of
Nursing (Quezon City, 1907) v. Mary Johnston Hospital and School of
Nursing (Manila, 1907) e. Pioneer Nursing Colleges
i. UST College of Nursing – 1st College of Nursing in the Phils: 1877
ii. MCU College of Nursing – June 1947 (1st College who offered BSN –
4 year program)
iii. UP College of Nursing – June 1948
iv. FEU Institute of Nursing – June 1955
v. UE College of Nursing – Oct 1958
f. Nursing Profession Development
i. 1919 - The 1st Nurses Law (Act 2808) was enacted regulating the
practice of the nursing profession in the Philippines Islands. It also
provided the holding of exam for the practice of nursing on the 2nd
Monday of June and December of each year
ii. 1920 - 1st board examination for nurses was conducted by the Board
of Examiners, 93 candidates took the exam, 68 passed with the
highest rating of 93.5%-Anna Dahlgren.
iii. 1921 - Filipino Nurses Association was established (now PNA)
as the National Organization Of Filipino Nurses
iv. 1953 - Republic Act 877, known as the “Nursing Practice Law”
was approved.
B. Nursing
i. Definition
1. “The act of utilizing the environment of the patient to assist him in his recovery”
(Nightingale, 1860/1969)
2. “The unique function of the nurse is to as- sist the individual, sick or well, in the
performance of those activities contributing to health or its recovery (or to
peaceful death) that he would perform unaided if he had the necessary strength,
will, or knowledge, and to do this in such a way as to help him gain indepen
dence as rapidly as possible” (Henderson, 1966)
3. Nursing Theorists in the 20th Century
 a. Nursing is caring.
b. Nursing is an art.
c. Nursing is a science.
d. Nursing is client centered.
e. Nursing is holistic.
f. Nursing is adaptive.
g. Nursing is concerned with health promotion, health maintenance,
and health restoration.
h. Nursing is a helping profession.
4. “Nursing is the diagnosis and treatment of human responses to actual or
potential health problems” (American Nurses Association, 1980)
5. “Nursing is the protection, promotion, and optimization of health and abilities,
preventions of illness and injury, alleviation of suffering through the diagnosis and treatment of
human response, and advocacy in the care of individuals, families, communities, and populations”
(American Nurses Association, 2010 to present) ii. Recipients
1. A consumer is an individual, a group of people, or a community that uses a
service or commodity. People who use health care products or services are
consumers of health care.
2. A patient is a person who is waiting for or undergoing medical treatment and care.
3. A client is a person who engages the advice or services of another who is
qualified to provide this service.
iii. Scope
1. Promoting health and wellness - improving nutrition and physical fit- ness,
preventing drug and alcohol misuse, restricting smoking, and preventing
accidents and injury in the home and workplace.
2. Preventing illness - immunizations, prenatal and infant care, and prevention of
sexually transmitted infections.
3. Restoring health
a. Providing direct care to the ill person
b. Performing diagnostic and assessment procedures
c. Consulting with other health care professionals about client problems
d. Teaching clients about recovery activities
e. Rehabilitating clients to their optimal functional level following physical or
mental illness, injury, or chemical addiction.
4. Caring for the Dying - helping clients live as comfortably as possible until death and
helping support persons cope with death
iv. Settings/Fields
1. Clinics/Hospitals
a. An RN assesses a client’s health status, identifies health problems, and
develops and coordinates care
b. Nurses can pursue a variety of practice specialties (e.g., critical care,
mental health, oncology).T
c. These nurses have education and cer- tifications that—depending on state
regulations—may allow them to provide primary care, prescribe
medications, and receive third-party (insurance) reimbursement directly
for their services.
2. Community
a. Visiting a newly admitted client in the hospital to take a detailed nursing
history, confer with the pri- mary nurse, and begin discharge planning
b. Making several home visits to monitor a client recently transferred from a
hospital to a long-term care agency to discuss the client’s progress with
the nurs- ing staff; or
 c. Making consultative telephone calls to other health professionals
(physicians, social workers, respiratory therapists, and so on) and to
clients who are managing self-care independently but who may need
support.
3. Home
a. Provide a variety of intravenous therapies in the home setting and
monitor clients who are dependent on technologically complex medical
equipment, such as ventilators.
b. These nurses collaborate with physicians and other health care
professionals in providing care.
c. They play a key role in facilitating an effective plan of care as clients move
among hospitals, home, school, work, and other care settings such as clinics
or long-term care.
4. Selected Expanded Career Roles for Nurses
a. Nurse Researcher - employed in academic institutions, teaching
hospitals, and re- search centers. They usually have advanced education at
the doctoral level.
b. Nurse Administrators - The functions of nurse administrators include
budgeting, staffing, and planning programs. The educational preparation for
nurse admin- istrator positions is at least a baccalaureate degree in
nursing and frequently a master’s or doctoral degree.
c. Nurse Educator - employed in nursing programs, at educational
institutions, and in hospital staff education. The nurse educator usually
has a baccalaureate degree or more advanced preparation and
frequently has expertise in a particular area of practice. The nurse
educator is responsible for classroom and, often, clinical teaching.
d. Nurse Entrepreneur - has an advanced degree and manages a
health-related business.
e. Forensic Nurse - provides specialized care for individuals who are
victims and/or perpetrators of trauma. Forensic nurses have knowledge
of the legal system and skills in injury identification, evaluation, and
documentation.
C. Roles and Functions of the Nurse
i. Caregiver - This may involve full care for the completely dependent client, partial care for the
partially depen- dent client, and supportive-educative care to assist clients in attaining their
highest possible level of health and wellness. Caregiving encompasses the physical,
psychosocial, developmental, cultural, and spiritual levels.
ii. Communicator - nurses identify client problems and then communicate these verbally or in
writing to other members of the health care team.
iii. Teacher - the nurse helps clients learn about their health and the health care procedures they
need to perform to restore or main- tain their health.
iv. Client Advocate - the nurse acts to protect the client
v. Counselor - helping a client to recognize and cope with stressful psychological or social
problems, to develop improved interpersonal relationships, and to promote personal growth. It
involves providing emotional, intellectual, and psychological support.
vi. Change Agent - The nurse acts as a change agent when assisting clients to make modifications
in their behavior. Nurses also often act to make changes in a system, such as clinical care, if
it is not helping a client return to health.
D. Nursing as a Profession
i. Profession - an occupation that requires extensive education or a calling that requires special
knowledge, skill, and preparation.
ii. Professionalism - refers to professional character, spirit, or methods. It is a set of
 attributes, a way of life that implies responsibility and commitment.
iii. Professionalization - the process of becoming professional, that is, of acquiring
characteristics considered to be professional.
1. Specialized Education - Bachelor of Science in Nursing
2. Body of Knowledge - Nursing conceptual frameworks, theories etc.
3. Service Orientation - “service to others”
4. Ongoing Research
5. Code of Ethics - a nurse is expected to do what is considered right regardless of the
personal cost.
6. Autonomy - independence at work, responsibility, and accountability for one’s
actions.
7. Professional Organization - Philippine Nurses’ Association
E. Benner’s Stages of Nursing Expertise
i. STAGE I: NOVICE - No experience (e.g., nursing student). Performance is limited, in flexible,
and governed by context-free rules and regulations rather than experience. ii. STAGE II:
ADVANCED BEGINNER - Demonstrates marginally acceptable performance. Recognizes the
meaningful “aspects” of a real situation. Has experienced enough real situations to make
judgments about them.
iii. STAGE III: COMPETENT - Has 2 or 3 years of experience. Demonstrates organizational and
planning abilities. Differentiates important factors from less impor- tant aspects of care.
Coordinates multiple complex care demands.
iv. STAGE IV: PROFICIENT - Has 3 to 5 years of experience. Perceives situations as wholes rather
than in terms of parts, as in Stage II. Uses maxims as guides for what to consider in a
situation. Has holistic understanding of the cli- ent, which improves decision making. Focuses
on long-term goals.
v. STAGE V: EXPERT - Performance is fluid, flexible, and highly proficient; no longer re quires
rules, guidelines, or maxims to connect an understanding of the situation to appropriate
action. Demonstrates highly skilled intuitive and analytic ability in new situations. Is
inclined to take a certain action because “it felt right.”
F. Nursing in the Philippines Today
i. The Professional Regulation Commission (PRC) oversees the licensing of registered nurses as
authorized by the Philippine Nursing Act of 2002 otherwise known as RA 9173 ii. The Philippines is
the leader in exporting nurses to meet the demands of the United States and other developed
nations.
G. Legal Roles of Nurses
i. Provider of Service
1. Responsibilities
a. To provide safe and competent care commensurate with the nurse’s
preparation, experience, and circumstances
b. To inform clients of the consequences of various alternatives and
outcomes of care
c. To provide adequate supervision and evaluation of others for whom the
nurse is responsible
d. To remain competent
2. Rights
a. Right to adequate and qualified assistance as necessary
b. Right to reasonable and prudent conduct from clients
ii. Employee or Contractor for Service
1. Responsibilities
a. To fulfill the obligations of contracted service with the employer
b. To respect the employer
c. To respect the rights and responsibilities of other health care providers
 2. Rights
a. Right to adequate working conditions (e.g., safe equipment and facilities) b.
Right to compensation for services rendered
c. Right to reasonable and prudent conduct by other health care providers
iii. Citizen
1. Responsibilities
a. To protect the rights of the recipients of care
2. Rights
a. Right to respect by others of the nurse’s own rights and responsibilities
b. Right to physical safety