FUNDAMENTALS OF NURSING PRACTICE
LECTURE
CANVAS
A. CU1 - Nursing as a Profession
• INTRODUCTION
- nursing today is far different from nursing as it
was practiced years ago
- continue changing during the 21st century
- to comprehend present-day nursing and at the
same time prepare for the future, one must
understand not only past events but also
contemporary nursing practice and the
sociologic and historical factors that affect it
• HISTORICAL PERSPECTIVES
- nursing’s beginnings reveal its continuing
struggle for autonomy and professionalization
1) Women’s Roles
o Traditional female roles of wife,
mother, daughter, and sister have
always included the care and nurturing
of other family members.
o From the beginning of time, women
have cared for infants and children;
thus, nursing could be said to have its
roots in “the home”.
2) Religion
o Although many of the world’s religions
encourage benevolence; it was the
Christian value of “love thy neighbor as
thyself” and Christ’s parable of the
Good Samaritan that had the significant
impact on the development on the
development of Western nursing.
o The Knights of Saint Lazarus dedicated
themselves to the care of people with
leprosy, syphilis, and chronic skin
conditions.
o The Alexian Brothers organized care for
victims of the Black Plague in the 14th
century in Germany.
3) War
o During the Crimean War (1854-1856),
the inadequacy of care given to soldiers
led to a public outcry in Great Britain.
o The role of Florence Nightingale played
in addressing this problem is well-
known. She was asked by Sir Sidney
Herbert of the British War Department
to recruit a contingent of female nurses
to provide care to the sick and injured
in the Crimea.
o During the American Civil War (1861-
1865), several nurses emerged who
were notable for their contributions to
a country torn by internal strife. Harriet
Tubman and Sojourner Truth provided
care and safety to slaves fleeing to the
North on the Underground Railroad.
4) Societal Attitudes
o Before the mid-1800s, nursing was
without organization, education, or
social status; the prevailing attitude was
that a woman’s place was in the home
and that no respectable woman should
have a career.
o Nurses in hospitals during this period
were poorly educated; some were even
incarcerated criminals.
• NURSING EDUCATION
- The practice of nursing is controlled from within
the profession through the state boards of
nursing and professional nursing organizations.
- These groups also determine the content and
type of education that is required for different
levels or scopes of nursing practice.
➢ Types of Education Programs
1. Licensed Practical (Vocational) Nursing
Programs
2. Registered Nursing Programs
2.1 Diploma Programs
2.2 Associate Degree Programs
2.3 Baccalaureate Degree Programs
3. Graduate Nursing Programs
3.1 Master’s Degree Programs
3.2 Doctoral Programs
4. Continuing Education
➢ Nursing Leaders
➢ Definitions of Nursing
✓ Nursing is caring
✓ Nursing is an art
✓ Nursing is a science
✓ Nursing is client centered
✓ Nursing is holistic
✓ Nursing is adaptive
✓ Nursing is concerned with health
promotion, health maintenance, and health
restoration
✓ Nursing is a helping profession
• CONTEMPORARY NURSING PRACTICE
➢ Recipients of Nursing
1. Patient
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 – A Latin word meaning “to suffer” or “to bear”;
person who is waiting for or undergoing
medical treatment and care.
- Usually, people become patients when they
seek assistance because of illness or for surgery.
2. Client • ROLES AND FUNCTIONS OF THE NURSE
– a person who engages the advice or services
of another who is qualified to provide this
service.
- The term client presents the receivers of
health care as collaborators in the care, that is,
as people who are also responsible for their
own health.
➢ Settings for Nursing
- In the past, the acute care hospital was the
main practice setting open to most nurses. - Expanded Career Roles
- Today many nurses work in hospitals, but
increasingly they work in clients’ homes,
community agencies, ambulatory clinics, long-
term care facilities, health maintenance,
organizations (HMOs), and nursing practice
centers.
➢ Nurse Practice Acts
- or legal acts for professional nursing practice,
differ in various jurisdictions, they all have a
common purpose: to protect the public. • NURSING ORGANIZATIONS
- Nurses are responsible for knowing their state’s
nurse practice act as it governs their practice.
- Standards of Nursing Practice
- the purpose is to describe the responsibilities
for which nurses are accountable.
- Establishing and implementing standards of
practice are major functions of a professional
organization.
- Standards of Professional Performance describe
behaviors expected in the professional nursing
role.
- Scope of Nursing
✓ Promoting health and wellness
✓ Preventing illness
✓ Restoring health • TERMINOLOGIES
✓ Caring for dying ✓ Nursing
- Criteria of a Profession
✓ Specialized Education
✓ Code of Ethics
✓ Body of Knowledge
✓ Autonomy
✓ Service Orientation
✓ Professional Organization
✓ Ongoing Research
• FACTORS INFLUENCING CONTEMPORARY NURSING
PRACTICE
- Health Care Reform
- Family Structure ✓ Profession
- Legislation
- Demography
- Science and Technology
- Quality and Safety in Health Care
- Consumer Demands
- Information, Telehealth, and Telenursing
- The Current Nursing Shortage
- Caregiver
- Communicator
- Teacher
- Change Agent
- Client Advocate
- Research Consumer
- Manager
- Leader
- Counselor
✓ Nurse Researcher
✓ Nurse Practitioner
✓ Nurse Administrator
✓ Clinical Nurse
✓ Specialist Nurse
✓ Educator Nurse
✓ Anesthetist Nurse
✓ Entrepreneur Nurse
✓ Midwife Forensic Nurse
- As nursing has developed, an increasing number
of nursing organizations have formed.
- These organizations are at the local, state,
national, and international levels.
- Participation in the activities of nursing
associations enhances the growth of involved
individuals and helps nurses collectively
influence policies affecting nursing practice.
1. ANA (1896) American Nurses Association
2. NLN (1952) National League for Nursing
3. ICN (1899) International Council of Nurses
4. NSNA (1953) National Student Nurses
Association
5. Sigma Theta Tau (1922)
- “The act of utilizing the environment of the
patient to assist him in his recovery”- as nursing
defined nearly 150 years ago (Nightingale,
1860/1969).
- “The unique function of the nurse is to assist
the individual, sick or well, in the performance
of those activities contributing to health or its
recovery (or to peaceful death) that he would
perform unaided if he had the necessary
strength, will, or knowledge, and to do this in
such a way as to help him gain independence as
rapidly possible” (Henderson, 1966).
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 - an occupation that requires extensive education
or a calling that requires special knowledge,
skill, and preparation.
- A profession is generally distinguished from
other kinds of occupations by (a) its
requirement of prolonged, specialized training
to acquire a body of knowledge pertinent to the
role to be performed; (b) an orientation of the
individual toward service, either to a
community or to an organization; (c)ongoing
research; (d) a code of ethics; (e) autonomy;
and (f) professional organization.
✓ Professionalism
- refers to professional character, spirit, or
methods.
- It is a set of attributes, a way of life that implies
responsibility and commitment.
✓ Professionalization
- It is the process of becoming professional, that
is, of acquiring characteristics considered to be
professional.
B. CU2 - Health, Illness and Filipino Culture, Values
and Practices
• HISTORY OF NURSING IN THE PHILIPPINES
- Nursing in the Philippines has a deep and
enigmatic history. History does matter. This
statement must have been self-evident over the
years, decades, and centuries past. It is
inescapable. Far from being a ‘dull and boring’
subject, its depth excitingly connects things
through time and encourages starters to take a
long view of such connections for a better
understanding of their chosen path.
• EARLY BELIEFS & PRACTICES
1) Mysticism and Superstitions
o These two words were the early beliefs
of health and illness in the Philippines.
o The cause of a disease was primarily
believed to be due to either another
person, whom which was an enemy, or
a witch or evil spirits.
o In the early times, Filipinos were very
cautious not to disturb other people or
the evil spirits for the good of their
health.
2) Early Care of the Sick
o The early Filipinos subscribed to
superstitious belief and practices in
relation to health and sickness.
o If the birth became difficult, witches
were supposed to be the cause.
o To disperse their influence, gunpowder
was exploded from a bamboo cane
close to the head of the sufferer.
3) Health Care During the Spanish Regime
o The context of nursing has manifested
through simple nutrition, wound care,
and taking care of an ill member of the
family.
o Certain practices when taking care of a
sick individuals entails interventions
from babaylan (priest physicians) or
albularyo (herb doctor).
o In 1578, male nurses were
acknowledged as Spanish Friars’
assistants for caring sick individuals in
the hospital. These male nurses were
referred as practicante or enfermero.
• THE EARLIEST HOSPITALS IN THE PHILIPPINES
1) 1577 - Hospital Real de Manila
o was established mainly to care for the
Spanish king’s soldiers, but also
admitted Spanish civilians; founded by
Gov. Francisco de Sande
2) 1578 - San Lazaro Hospital
o founded by Brother Juan Clemente and
was administered for many years by the
Hospitalliers of San Juan de Dios; built
exclusively for patients with leprosy
3) 1586 - Hospital de Indios
o established by the Franciscan Order;
service was in general supported by
alms and contributions from charitable
persons.
4) 1590 - Hospital de Aguas Santas
o established in Laguna; near a medicinal
spring, founded by Brother J. Bautista of
the Franciscan Order.
5) 1596 - San Juan de Dios Hospital
o founded by the Brotherhood of
Misericordia and administered by the
Hospitaliers of San Juan de Dios;
support was delivered from alms and
rents; rendered general health service
to the public.
• NURSING DURING THE PHILIPPINE REVOLUTION
- In the late 1890’s, the war between Philippines
and Spain emerges which resulted to significant
amount of casualties.
- With this, many women have assumed the role
of nurses in order to assist the wounded
soldiers.
- The emergence of Filipina nurses brought about
the development of Philippines Red Cross.
1. Josephine Bracken
2. Rosa Sevilla de Alvero
3. Dona Hilaria de Aguinaldo
4. Dona Maria Agoncillo de Aguinaldo
5. Melchora Aquino or "Tandang Sora"
6. Capitan Salome
7. Agueda Kahabagan
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 8. Trinidad Tecson
• HOSPITALS AND NURSING SCHOOLS
- Americans began training the first Filipino
nursing students in 1907.
- Nursing students in the Philippines studied
many of the same subjects as nursing students
in the U.S. However, it was believed that the
curriculum in the Philippines “was never a
mirror-image reproduction of the American
nursing curriculum” and involved more than a
simple transfer of knowledge from American
nurses to Filipino nurses.
• HOSPITAL SCHOOL OF NURSING’S FORMAL
TRAINING (1901 – 1911)
1) 1906
- Iloilo Mission Hospital School of Nursing (Iloilo
City)
o The first hospital in the Philippines,
which trained Filipino nurses
established by the Baptist Missionaries.
- Saint Paul’s Hospital School of Nursing
(Manila)
o The hospital was established by the
Archbishop of Manila, Jeremiah Harty
under the supervision of the sisters of
St. Paul de Chartres located in
Intramuros.
o It provided general hospital services. It
opened its training school for nurses in
1908, with Mother Melanie as
superintendent and Miss Chambers as
Principal.
- Philippine General Hospital School of Nursing
(Manila)
o PGH began in 1901 as a small
dispensary for Civil officers and
Employees in the City of Manila and
later grew as a Civil Hospital.
o In 1906, Mary Coleman Masters, an
educator advocated for the idea of
training Filipino girls for the profession
of nursing with the approval of
Government officials, she first opened a
dormitory for Girls enrolled at the
Philippine Normal Hall and the
University of the Philippines.
2) 1907
- St. Luke’s Hospital School of Nursing (Quezon
City)
o The hospital is an Episcopalian
Institution. It began as a small
dispensary in 1903.
o In 1907, the school opened with three
girls admitted. These three girls had
their first year in combined classes with
the PGH School of Nursing and St. Paul’s
Hospital School of Nursing.
o Miss Helen Hicks was the first principal.
o Mrs. Vitaliana Beltran was the first
Filipino superintendent of nurses and
Dr. Jose Fores was the first medical
director of the hospital.
- Mary Johnston Hospital and School of Nursing
(Manila)
o It started as a small dispensary on Calle
Cervantes (now Avenida).
o It was called the Bethany Dispensary
and funded by the Methodist Mission
for the relief of suffering among women
and children.
o In 1907, Sister Rebecca Parrish together
with registered nurses Rose Dudley and
Gertude Dreisbach, organized the Mary
Johnston School of Nursing.
o The nurses’ training course began with
three Filipino young girls fresh from
elementary as their first students.
- Philippine Christian Mission Institute Schools
of Nursing
o The United Christian Missionary Society
of Indianapolis, Indiana- a Protestant
organization of the disciples of Christ
operated three schools of nursing.
3) 1903
- Sallie Long Read Memorial Hospital School of
Nursing (Laoag, Ilocos Norte)
• THE START OF NURSING PRACTICE (1911- 1921)
- Promulgation of Act No. 2493 which amends
Medical Law (Act No. 310) allowing the
regulation of nursing practice transpired during
this period.
- However, in 1919, the First True Nursing Law
was enacted through Act 2808. During this
period the Board Examiners for Nursing was
also created.
- The first nursing board examination was given
on 1920.
- The first executive officer of the Board
Examiners for Nurses is a physician.
o Mary Chilles Hospital School of Nursing
(Manila, 1911)
o Frank Dunn Memorial Hospital (Vigan,
Ilocos Sur, 1912)
o San Juan de Dios Hospital School of Nursing
(Manila, 1913)
o Emmanuel Hospital School of Nursing
(Capiz, 1913)
o Southern Islands Hospital School of Nursing
(Cebu, 1918)
• PUBLIC HEALTH NURSING DEVELOPMENT: 1931 –
1941
- In 1933, the nursing institution have increased
their requirement. During this period, they have
implemented that to enter nursing education
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 an applicant must be able to complete
secondary education.
- The first collegiate nursing graduates of the
Philippines graduated from University of the
Philippines School of Public Health Nursing in
1938.
• NURSING DURING WORLD WAR II
- While in the Philippines, World War II made
public health nurses in Manila assigned to
devastated areas to attend the sick and the
wounded.
- A year after, thirty-one nurses who were taken
prisoners of war by the Japanese army and
confined at the Bilibid Prison in Manila were
released to the Director of the Bureau of
Health. And just like in the US, a lot of public
health nurses joined the guerillas or went to
hide in the mountains during this time.
• THE DEGREE OF BACHELOR OF SCIENCE IN
NURSING: 1941 – 1951
- A nursing curriculum which was based on the
thesis presented by Julita V. Sotejo, graduate of
the Philippine General Hospital School of
Nursing, tackles on the development of a
nursing education within a university-based
College of Nursing.
- This dissertation was the beginning of nursing
curriculum that have made the Nursing
Institution of the country as a baccalaureate
course. During this period, College of Nursing
was also created. When the Japanese occupied
the Philippines in 1942, training and practice at
the hospital schools of nursing in Manila was
“violently disrupted.”
- However, U.S. colonial patterns in Philippine
nursing education soon returned after the U.S.
reclaimed the country in 1945 and even after
the Philippines gained independence from the
U.S. July 4, 1946.
• THE FIRST COLLEGES OF NURSING IN THE
PHILIPPINES
1. University of Sto. Tomas (1877)
2. Manila Central University (1947)
3. University of the Philippines (1948)
4. Far Eastern University (1955)
5. University of the East (1958)
• FILIPINO NURSES’ HEALTH BELIEFS, BEHAVIORS,
AND PRACTICES
- Based in the article of Ordonez and Gandeza
(2004), understanding the culture, health care
beliefs, and practices of Filipino nurses is
important, as it affects the way they assess the
needs and provide care for their clients.
- This article provided a general profile of the
health care beliefs, behaviors, and practices of
Filipino nurses in the United States within the
context of the general Filipino culture.
- Like any other ethnic group, Filipinos have
become acculturated at various levels after
coming to work and live in this country over the
years. It is the integration of their cultural
beliefs, values, and behaviors that affects their
caregiving attitudes and practices.
• GENERAL VALUES OF FILIPINO NURSES
- The cultural background of Filipino nurses may
have a strong influence on their selection of
nursing as a profession, because caring for
others is emphasized and valued, especially
among females.
1) Work Ethic
- As a group, Filipino nurses are well liked
because they are hardworking.
- They place high value on responsibility and
seldom complain.
- Joyce and Hunt (1982) commented, “Many
[Filipino nurses] work nights, holidays and/or
overtime. So, during this time of nursing
shortage, one can rely on a Filipino nurse to
volunteer to cover the shift”.
2) Spirituality
- Filipino nurses are very religious people. There
is a deep faith in God that is reflected in the
expression of “bahala na” — “it is up to God” or
“leave it to God.”
- Although it is an indication of acceptance of the
nature of things including one’s own inherent
limitations, bahala na operates psychologically
to elevate one’s courage and conviction to
persist in the face of adversity and improve
one’s situation (Okamura & Agbayani, 1991).
3) Sensitivity
- Filipinos are generally sensitive and equally
sensitive to the feelings of others, so they try to
find a way to say things diplomatically.
- Being sensitive to the feelings of others is also
reflected in the way Filipino nurses conduct
patient teaching, especially with the elderly,
immigrants, and the less fortunate.
4) Interpersonal Relationships
- Filipinos are generally quiet.
- Very conservative families do not allow their
younger members to join the conversation of
adults without an invitation.
- Engaging in arguments, especially with
someone who is older or holds an authority
position, is considered uncivilized.
- Filipinos also have difficulty turning down
requests from supervisors to whom they feel
obligated.
5) Respect And Reverence
- One’s position in society, professional
achievements, and age carry a lot of weight in
the Philippine society.
- Physicians, lawyers, priests, engineers, teachers,
and nurses are among the well-respected
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 professionals in the Philippines. Hence, their
opinion is generally accepted without question.
- Filipino nurses highly value their elderly clients.
Elderly individuals are given high respect and
revered.
- Family commitment fosters a sense of pride,
and therefore, caring for others is embedded in
the culture.
6) Modesty
- Filipino nurses find it uncomfortable to accept
even a well-deserved compliment.
- Filipino nurses are less likely to use I to express
what they have achieved. More than likely, they
will use we to acknowledge others’
contributions no matter how insignificant the
contributions might be.
- This may explain why they work well with
others.
- This may come from the practice of Bayanihan.
- In the Philippines, if you want something done,
it is easy to get a group together to work on a
project so that it will get done faster and better.
7) Language
- Respect is integrated in the Filipino language.
Reference to the elderly is the use of the third
person.
8) Close Family Ties
- Filipino nurses have strong family ties. They
tend to eat the same food and mingle with
individuals of the same ethnic background.
Hence, the old health beliefs and practices
continue.
• HEALTH BELIEFS
- Culture
- It is defined as the “totality of socially
transmitted pattern of thoughts, values,
meanings, and beliefs” (Purnell 2005).
- It is not limited to any specific ethnic group,
geographical area, language, religious belief,
manner of clothing, sexual orientation, and
socioeconomic status (Fisher 1996). In
Revisiting usog, pasma, and kulam,
- Tan explains that “culture is inscribed in our
bodies and in our minds” (Tan 2008).
- As such, the relationship of culture and health is
important to understand as it impacts an
individual’s worldview and decision-making
process (Purnell 2005).
- Like in other fields of medicine, the impact of
cultural beliefs is increasingly being recognized
as an essential component in the genetic
counseling process (Cohen et al. 1998; Edwards
et al. 2008; Penn et al. 2010).
- Filipino Cultural Beliefs
1. Namamana - Inheritance
2. Lihi - Conception or maternal cravings
3. Sumpa and gaba - Curse
4. Pasma - Hot and cold syndrome
5. Namaligno - Mystical and supernatural
causes
6. Kaloob ng Diyos - God’s will
- Once cultural health beliefs and practices are
known, interventions can be properly instituted
so that despite these beliefs, genetic counselors
can ensure that surveillance, management, and
other medical recommendations are done.
- The selected Filipino cultural beliefs discussed
in this paper can guide in the provision of
psychosocial support as it provides clues on the
coping mechanisms of Filipino patients and
their families.
- It is also important to recognize that some of
these Filipino beliefs are embodied in larger
sociological and economic factors. Tan (2008)
emphasized that bahala na (and, by extension,
kaloob ng Diyos) are not just forms of fatalism
or passive acceptance.
• TERMINOLOGIES
✓ Herbolarios
- It was believed that evil spirits could be driven
away by persons with power to banish demons.
- Belief in special gods of healing, with the priest -
physician (called “word doctors”) as
intermediary.
- If they used leaves or roots, they were called
herb doctors (“herbolarios”) Filipinos who
became sick were usually cared for by the
female family members or friends in the home.
✓ Herbicheros
- Herb men, meaning one who practiced
witchcraft.
✓ Mangkukulam
- manggagaway
- Persons suffering from diseases without any
identified cause were believed bewitched by
these people.
✓ Pamao
- or difficult childbirth, and some diseases were
attributed to “nunos”.
- Midwives assisted in childbirth. During labor,
the “mabuting hilot” (good midwife) was called
in.
✓ Filipino values
- are, for the most part, centered at maintaining
social harmony, motivated primarily by the
desire to be accepted within a group.
- The main sanction against diverging from these
values are the concepts of "Hiya", roughly
translated as 'a sense of shame', and "Amor
propio" or 'selfesteem'.
✓ Folk beliefs
- Otherwise known as “superstitious beliefs”
(pamahiin), form part of a people’s value
system and culture.
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 - They basically reflect the customs, traditions,
and mores of a group, which may be based on
religious beliefs, opinions, old or popular
practices.
C. CU3 - Therapeutic Communication: Key to Efficient
Nurse-Patient Collaboration
• TERMINOLOGIES
✓ Therapeutic Communication
- the exchange of information between a nurse
and a client that promotes positive behavioral
change.
✓ Active Listening
- the nurse focus on what the patient is saying to
interpret and respond to the message
objectively.
✓ Proxemics
- It is the study of distance zones between people
during communication.
• THERAPEUTIC COMMUNICATION
- During assessment, a good relationship
between the nurse and the client is very
important.
- This promotes client comfort, thus, facilitates
disclosure of relevant assessment data.
- Therapeutic communication is affected by
various factors such as preparation, nurse’s
attitude and communication technique, client’s
experiences and environment.
• ELEMENTS/COMPONENTS OF THERAPEUTIC
COMMUNICATION
1. Trust
- nurse should be consistent in words and
actions
- being friendly, caring, interested,
understanding, consistent
2. Genuine Interest
- self disclosure
- self-awareness
- the patient can distinguish when there is
dishonesty or artificial behavior
3. Empathy
- ability to perceive the meaning and feeling of
the client
- listening and sensing situation - positively
influence client’s outcome
- Open non-judgmental acceptance and
communicating understanding
4. Positive Regards
- unconditional, nonjudgmental attitude
5. Acceptance
- not easily upset and avoiding judgment
• WAYS TO THERAPEUTIC RELATIONSHIP
1. Privacy and respecting boundaries
- Boundaries are the defining limit of individual
o Material boundaries
o Personal boundaries
o Physical boundaries
o Psychological boundaries
o Social boundaries
o Professional boundaries
- Proxemics
o is the study of distance zones between
people during communication. People feel
more comfortable with smaller distances
when communicating with someone they
know rather than with strangers.
o four distance zones:
▪ Intimate zone (6 to 18 inches
between people)
▪ Personal zone (18 to 47 inches)
▪ Social zone (47 inches to 3yard)
▪ Public zone (over 3 yard)
2. Touch
- five types of touch:
a. Functional-professional touch
- used in examinations or procedures.
b. Social-polite touch
- used in greeting, such as a handshake
and the “air kisses” some women use to
greet acquaintances, or when a gentle
hand guides someone in the correct
direction.
c. Friendship-warmth touch
- involves a hug in greeting, an arm
thrown around the shoulder of a good
friend, or the back slapping some men
use to greet friends and relatives.
d. Love-intimacy touch
- involves tight hugs and kisses between
lovers or close relatives.
e. Sexual-arousal touch
- used by lovers
- touching a client can be comforting
and supportive when it is welcome and
permitted
- the nurse should observe the client for
cues that show if touch is desired or
indicated.
3. Active Listening and Observation
- Passive Listening, sitting quietly and letting the
patient to talk, does not focus or guide
- thought process of patient, does not foster
therapeutic relationship
- Active listening, the nurse focus on what the
patient is saying to interpret and respond to the
message objectively.
4. Communication skills
➢ Modes of Therapeutic Communication
a. Non-Verbal Communication
DO’s
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 o Appearance
- Comfortable and neat uniform
- Hair should be neat and pulled back (if long)
- Fingernails should be short and neat
- Minimal jewelry
o Demeanor
- Professional and poise
- Greet client calmly and with proper references
- DO NOT be overwhelmingly friendly or touchy
Maintain professional distance
o Facial Expression
- Closely monitor facial expressions
- Display a NEUTRAL expression
o Attitude
- Nonjudgmental attitude
- All clients should be accepted, regardless of
beliefs, ethnicity, lifestyle, and health care
practices.
• PHASES OF AN INTERVIEW
1. Pre-Introductory Phase
- The nurse prepares himself/herself for the
interview
- The nurse reviews the medical record before
meeting with the client.
2. Introductory Phase
- The nurse introduces himself/herself to the
client.
- The nurse explains the purpose of the
interview, the types of questions, reasons for
taking notes
- The nurse assures the client that confidential
information will remain confidential
3. Working Phase
- The nurse elicits the client’s comments about
major biographical data, reasons for seeking
care, health history, review of body systems for
current health problem, lifestyle and health
practices, and developmental level.

o Silence 4. Summary and Closing Phase

- Allows the nurse and the client to reflect - The nurse summarizes information obtained
organize thoughts, which facilitate more during working phases and validates problems
accurate reporting and data collections and goals with the client.
- The nurse identifies and discusses possible
o Listening plans to resolve the problem with the client.
- Demonstrate active listening
- Maintain good eye contact • SPECIAL CONSIDERATIONS DURING THE INTERVIEW
- Appropriate facial expression 1. Communicating with the elderly
- Open body position (arms, hands) - Consider the hearing ability of the client
- Lean forward - Speak clearly
- Use straightforward language
DON’Ts - If the old client is confused or forgetful,
- Excessive or Insufficient Eye Contact interview the client with significant others
- Distraction & Distance
- Standing 2. Communicating with Children
- Interview toddlers, pre-schoolers and schoolers
b. Verbal Communication with their parents.
DO’s - Use simple words
o Open Ended Questions - Maintain eye contact and same eye level with
- Used to elicit the client’s feelings and the child.
perceptions
3. Communicating with the people of different
o Closed-Ended Questions culture
- Used to obtain facts and to focus on specific - Reluctance to reveal personal information to
information strangers for various culturally-based reasons
- Variation in meaning conveyed by language
o Laundry List - Variation in use and meaning of non-verbal
- Providing clients with a list of words to choose communication: eye contact, stance gestures,
from in describing symptoms, conditions or demeanor
feelings. - Variation in disease/illness perception
- Variation in family roles
o Rephrasing, Well-placed Phrases, Inferring, - Variation in cultural health practices
Providing Information
- Helps to clarify information the client has stated 4. Communicating with highly emotional clients
- Clients’ emotions vary for a number of reasons
DON’Ts - Clients may have some sensitive issues with
- Biased or Leading Question which they are grappling.
- Rushing through the Interview
- Reading the Questions

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D. CU4 - Critical Thinking and Assessment:
Foundation of Quality Nursing Care
• TERMINOLOGIES
✓ Critical Thinking
- a discipline specific, reflective reasoning process
that guides a nurse in generating,
implementing, and evaluating approaches for
dealing with client care and professional
concerns.
✓ Problem Solving
- a process that involves clarifying the nature of
the problem and suggesting possible solutions.
✓ Decision Making
- a critical thinking process for choosing the best
actions to meet a desired goal.
✓ Nursing Process
- a critical thinking five-step process that
professional nurses use to apply the best
available evidence to caregiving and promoting
human functions and responses to health and
illness.
✓ Assessment
- a reflective analysis of information to form an
inference as a basis for further actions.
• CRITICAL THINKING
- In nursing process, it is a discipline specific,
reflective reasoning process that guides a nurse
in generating, implementing, and evaluating
approaches for dealing with client care and
professional concerns (National League of
Nurses).
- This is important in ensuring that the nurse
delivers safe, competent and skillful practice. In
doing so, an excellent quality of care is received
by the client.
• USES OF CRITICAL-THINKING SKILLS AMONG
NURSES
1. Making inferences about the client’s
information based from various sources of
knowledge.
o In dealing with human responses,
nurses must be keen in applying a
holistic approach. Thus, drawing
meaningful information from areas,
other than nursing, is essential in
planning effective interventions.
2. Making quick discernment.
o Healthcare is a rapidly changing
profession.
o Clients may manifest common
conditions differently.
o Condition changes at a very unexpected
pace.
o Routine actions may therefore be
inadequate.
o Critical thinking enables the nurse to
recognize important cues, respond
quickly and adapt interventions to meet
specific client needs.
3. Decision-making.
o Nurses make important numerous
decisions during work hours.
o With critical thinking, relevant data can
be collected and interpreted, which is
important in decision-making.
o Decisions may include actions such as
prompt referral, reassessment or
carrying out of routine activities.
• QUESTIONING AND REASONING TECHNIQUES IN
CRITICAL THINKING
- These three techniques are used in critical
thinking.
- Decisions are made from facts taken from
interview and assessment procedures.
- Relevant facts are gathered by means of
employing Socratic questioning.
- A nurse may start with a general inference that
will be used to identify areas that must be
explored.
- With those facts are gathered, and a valid
generalization may be concluded.
1. Socratic Questioning
o this is a technique that helps to delve
on information beyond what can be
seen instantly. With the use of this
technique, inconsistencies are
searched, varying points of views are
examined and deeper approach to
situations are observed.
2. Inductive Reasoning
o this is the technique used in forming
generalization from a set of facts or
observations. For example, during
assessment the nurse observes that the
patient’s eyes are sunken, skin turgor is
poor, and the client’s urine is dark
amber in color. By putting the facts
together, the nurse may conclude that
the patients are dehydrated.
3. Deductive Reasoning
o this is the technique used in getting
specific facts or observations from a
generalized premise. For example, the
client mentioned that he is not well and
might be suffering from an illness, then
the nurse will look at different cues that
may be suggestive of an illness.
• PROBLEM SOLVING
- a process that involves clarifying the nature of
the problem and suggesting possible solutions.
In nursing, client’s condition is observed over
time to ensure its initial and continual
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 effectiveness. However, during observation,
nurses may encounter similar problems that
require alternative solutions.
- Commonly used approaches to problem solving
include trial and error, intuition, the research
process, and the scientific/modified scientific
method.
• DECISION MAKING
- a critical thinking process for choosing the best
actions to meet a desired goal.
- The decision-making process and the nursing
process share similarities, and the nurse uses
decision-making in all phases of the nursing
process.
- It is essential that the nurse use critical thinking
in each step or phase of these processes so that
decisions and care are well considered and
delivered with the highest possible quality.
• COMPARISON OF THE DIFFERENT STEPS OF THE
NURSING PROCESS AND DECISION-MAKING
PROCESS
Nursing Process Decision-Making Process
I – identify the purpose
A – asses S - set the criteria
D – diagnose W - weight the criteria
P – plan S - seek alternatives
I – implementation P – project
E – evaluation I – implement
E – evaluate the outcome
• NURSING PROCESS
- a five-step critical thinking and decision-making
process that the nurse may utilize in order to
provide individualized patient care.
- The steps of the nursing process are built upon
each other, overlapping previous and
subsequent steps.
- The nursing process may be used with clients
throughout their life span and in any setting
where care is provided to clients.
- The nursing process is not only aimed towards
promoting a systematic approach in the nursing
practice but is also promotes collaboration.
- As the client enters the health care system,
individual professional responsibilities of the
health care providers begin.
- Collaboration with the physician, nursing
professionals, and other disciplines is often
necessary to coordinate care and promote
health.
• IMPORTANCE OF NURSING PROCESS
✓ Promotion of improved quality and
continuity of care
✓ Increased client involvement and
participation
✓ Providing an organized, continuous and
systematic delivery of care and problem
solving
✓ Efficient utilization of time and resources
✓ Delivery of care that meets expectations of
both the health care consumer and
standards of the nursing profession.
✓ Holds the nurses accountable and
responsible for assessment, diagnosis,
planning, implementation and, evaluation
of client care.
• FIVE PHASES OF THE NURSING PROCESS
1. ASSESSMENT
o This is the deliberate and systematic
collection of information about a
patient to determine the patient’s
current and past health and functional
status and his or her present and past
coping patterns. (Carpenito-Moyet,
2013)
2. DIAGNOSIS
o This is the phase by which the nurse
analyzes gathered data and identifies
health problems, risks and strengths.
o The nurse will then make a clinical
judgement based from identified
problem.
3. PLANNING
o This involves prioritization of problems,
formulation of goals and desired
outcomes and selection of nursing
interventions.
4. IMPLEMENTATION
o This is the actual implementation of the
planned interventions. Also, this
involves continuous monitoring and
reassessment and documentation of
the client’s responses and needs for
assistance.
5. EVALUATION
o Determination of improvement of
patient’s condition or well-being after
the application of the first four steps of
the nursing process.
• ASSESSMENT
- This is the systematic and continuous collection,
organization, validation, and documentation of
data.
• TYPES OF DATA
1. OBJECTIVE DATA
o also referred to as signs or overt data.
o These are information detectable by an
observer or can be measured or tested
against an accepted standard.
o This information may be gathered
during physical examination.
2. SUBJECTIVE DATA
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 o also referred to as symptoms or covert
data.
o These are information apparent only to
the person affected and can be
described or verified only by that
person.
o This information is gathered through
interview.
• TYPES OF ASSESSMENT
a. INITIAL ASSESSMENT - provides an in-depth,
comprehensive database, which is critical for
evaluation changes in the client’s health status.
b. PROBLEM-FOCUSED ASSESSMENT - the nurse
determines whether the problem still exists and
whether the status of the problem has changed
(i.e., improved, worsened, or resolved)
c. EMERGENCY ASSESSMENT - takes place in life-
threatening situations in which preservation of
life is the top priority
d. TIME-LAPSED or ONGOING ASSESSMENT - takes
place after the initial assessment to evaluate
any changes in the client’s functional health.
• ASSESSMENT PROCESS
Collection of Organizing Validating Documenting
Data Data Data Data
A. Collection of data
- Sources of Data
✓ Client
✓ Support People
✓ Client Records
✓ Health Care Professionals
✓ Literature
• DATA COLLECTION METHODS
- Assessment data may be collected by three
important methods: (1) Observation, (2)
Interview, and (3) Examination.
➢ Observation
- occurs whenever the nurse is in contact with
the client or support persons.
- a method that makes use of the senses in
gathering data.
- It is a conscious, deliberate skill that is
developed through effort and with an organized
approach.
- It involves two important aspects: (a) noticing
the data, and (b) selecting, organizing, and
interpreting the data.
- Nursing observations must be organized so that
nothing significant is missed.
➢ Interviewing
- used mainly while taking the nursing health
history.
- a planned communication or a conversation
with a purpose.
- It can be:
(a) directive – a highly structured interview that
elicits specific information; or
(b) non directive – an unstructured interview
that provides flexibility on how the nurse
directs the focus of the conversation.
- Main classification of interview questions:
✓ Closed ended questions - are questions
that is restrictive that requires specific
answers such as a “yes”, a “no” or any
particular factual information.
✓ Open-ended questions - are questions that
encourage discovery, exploration,
elaboration, clarification or illustration of
the client’s experiences, thoughts or
feelings.
➢ Examining
- the major method used in the physical health
assessment.
- the process by which the nurse makes use of
his/her senses to gather relevant information
from the client.
- Unlike, interview, by which information is taken
from the responses of the client, examination is
a more accurate way of gathering relevant data
from the patient.
- Examination techniques
1. Inspection - the deliberate, purposeful,
observations in a systematic manner.
Nurse use the physical senses:
visualizing, hearing, and smelling
2. Palpation - the technique that uses the
sense of touch.
The hands and the fingers are the most
sensitive tool that a nurse has.
3. Percussion - the act of striking one
object against another to produce a
sound.
The tones produced during percussion
are used to assess location, shape, size
and density of a tissue.
4. Auscultation - the act of listening with a
stethoscope to sound produce within
the body. Pitch, loudness, quality and
duration of the sound are being
assessed during auscultation.
- Ways of examination:
a. Cephalocaudal - “head to toe approach”
This is an examination of the client that
follows the head-neck-thorax-abdomen-
extremities-toes sequence of assessment.
b. Body System - This type of examination
focuses on the structures and functions of a
specific body system: respiratory system,
circulatory system, nervous system, etc.
c. Screening examination - “review of
systems” This manner of examination gives
emphasis on the client’s chief complaint
and its associated signs. This is also a brief
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 review of essential functioning (nursing 1 slice of toast” rather than as “appetite good”
admission assessment form) or “normal appetite” a judgment.

B. Organizing data E. CU5 - NURSING DIAGNOSIS: UTILIZING NURSE’S

- The nurse uses an organized assessment framework REASONING PROCESS

• 11 TYPOLOGY OF FUNCTIONAL HEALTH PATTERN • TERMINOLOGIES

(GORDON)
1. Health perception/ Health Management-
describes the clients perceived pattern of
health and well-being and how health is
managed.
2. Nutritional/ Metabolic Pattern-describes client’s
pattern of food and fluid consumption.
3. Elimination Pattern-describes pattern of
excretory function (bowel, bladder and skin).
4. Activity-Exercise Pattern-describes pattern of
exercise, activity, leisure and recreation.
5. Sleep-Rest Pattern-describes pattern of sleep,
rest and relaxation.
6. Cognitive-Perceptual Pattern-describes sensory-
perceptual and cognitive patterns.
7. Self-Perception/ Self Concept Pattern-describes
client’s self-concept and perception of self-
pattern (self-worth, comfort, body image,
feeling state).
8. Role-relationship Pattern-describes pattern of
participation and relationship.
9. Sexuality-reproductive Pattern-describes
client’s pattern of satisfaction and
dissatisfaction with sexuality patterns; describes
reproductive patterns.
10. Coping/ Stress - tolerance Pattern-describes
client’s general coping pattern and
effectiveness of pattern in terms of stress
tolerance.
11. Values-beliefs Pattern-describes patterns of
values, beliefs and goal that guide the client’s
choices or decisions.
• ABRAHAM MASLOW’S HIERARCHY OF NEEDS
Self-actualization
Self esteem
Love and belongingness
Safety and Security
✓ NORTH AMERICAN NURSING DIAGNOSIS
ASSOCIATION (NANDA) - Define, refine and promote
taxonomy of nursing diagnostic terminology of
general use to professional nurses.
✓ DIAGNOSTIC LABEL – These are NANDA
standardized names for diagnoses
✓ ETIOLOGY – the cause of the problem.
✓ DEFINING CHARACTERISTIC – these are the
assessment cues that support the nursing diagnosis.
✓ TAXONOMY – a categorical system of classification
organized according to a single principle or a set of
principles.
✓ QUALIFIERS – are words that is added to the
diagnostic label to provide additional and more
definite meaning to the diagnostic statement.
• NURSING DIAGNOSIS
- This is a clinical judgment concerning human
response to health condition/s, life processes or
vulnerability for that response by an individual,
family, or community that a nurse is licensed
and competent to treat.
• MEDICAL DIAGNOSIS
- This is the identification of a disease condition
based on a specific evaluation of physical signs
and symptoms, a patient’s medical history, and
the results of diagnostic tests and procedures.
- This stays constant as a condition remains.
• DIFFERENCE BETWEEN MEDICAL DIAGNOSIS AND
NURSING DIAGNOSIS
MD ND
FOCUS Focuses on illness, Focuses on the
injury or disease responses to actual
process or
potential health
problems or life
processes

- Pneumonia - Ineffective Airway

C. Validating data - Diabetes mellitus Clearance
- double checking or verifying data to ensure that - Decreased Mobility
it is accurate and factual DURATION Remains constant Changes as the
- differentiate CUES from INFERENCES until a cure is client’s response
effected and/or
D. Documenting data health problem
- data are recorded in a factual manner and not changes
interpreted by the nurse.
- for example, the nurse must record the client’s Day 1 - COVID-19 Day 1 at the ward –
intake as “coffee 240 ml, juice 120 ml, 1 egg and Day 2 – COVID 19 Hyperthermia

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 … Day 10 – COVID Day 2 at the ward – o Risk Factors - They are the
19, discharged Ineffective Airway environmental, physiological,
Clearance psychological, genetic, or chemical
After 6 hours – elements that place a person at risk for
Ineffective breathing a health problem.
pattern - These are the diagnostic-related
MANAGE Identifies Identifies situations factors that help in planning preventive
MENT condition the in which the nurse is
health care measures.
health care licensed and
practitioner is qualified to
licensed and intervene. 3. HEALTH PROMOTION NURSING DIAGNOSIS
qualified to treat. - This is a clinical judgment concerning a patient’s
motivation and desire to increase wellbeing and
- Cerebrovascular - Self-Care Deficit: actualize human health potential.
Accident (Stroke) Dressing & Grooming - May be used clients in any health state that
express readiness to enhance specific health
• NANDA (North American Nursing Diagnosis behaviors
Association)
- Provides a precise definition of patient’s • Components of Nursing Diagnosis
responses to health problems that gives nurses
and other members of the health care team a
• Signs &
common language for understanding a patient’s • Problem Symptoms

needs. P • NANDA
Label
E • Etiology
• related to.. S • as
evidenced
by..
- Allows nurses to communicate what they do
among themselves with other health care
professionals and the public. 1. PROBLEM (DIAGNOSTIC LABEL)
- Define, refine and promote taxonomy of - This is the diagnostic label that describes
nursing diagnostic terminology of general use to client’s health problem or response for nursing
professional nurses. therapy given.
- Distinguishes the nurse’s role from that of other - The purpose of this is to direct the formation of
health care providers. client’s goals and desired outcomes.
- Helps nurses focus on the scope of nursing o Qualifiers may be added to NANDA
practice. labels to give additional meaning and a
- Fosters the development of nursing knowledge more specific approach to address the
- Promotes creation of practice guidelines that need of the client.
reflect the essence and science of nursing. ▪ Deficient (inadequate in
amount, quality or degree; not
• TYPES OF NURSING DIAGNOSIS sufficient; incomplete)
1. PROBLEM-FOCUSED NURSING DIAGNOSIS ▪ Impaired (made worse,
- This describes a clinical judgment concerning an weakened, damaged, reduced,
undesirable human response to a health deteriorated)
condition or life process that exists in an ▪ Decreased (lesser in size,
individual, family, or community. amount, degree)
- This is supported by: ▪ Ineffective (not producing the
a. Defining Characteristics - Observable desired effect)
assessment cues such as patient behavior and ▪ Compromised (to make
physical signs. vulnerable to threat)
b. Related Factor - This is the etiological or
causative factor for the diagnosis. 2. ETIOLOGY (RELATED FACTORS/RISK FACTORS)
- This allows the nurse to individualize a - Identifies one or more probable causes of
problem-focused diagnosis for a specific patient health problem, gives direction to the required
need. nursing therapy and enables the nurse to
individualized nursing care.
2. RISK NURSING DIAGNOSIS o Related factors are the etiological or
- This is a clinical judgment concerning the causative factors for the diagnosis.
vulnerability of an individual, family, group, or o Risk factors are the environmental,
community for developing an undesirable physiological, psychological, genetic, or
human response to health conditions/life chemical elements that place a person
processes. at risk for a health problem.
- This type of diagnosis DO NOT have defining
characteristics or related factors because they 3. SIGNS AND SYMPTOMS (DEFINING
have not yet occurred. CHARACTERICS)
- It is supported by: - These are the assessment cues that may
indicate the
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Diagnostic reasoning process follows a series of steps ➢ Determining Strengths
to guide nurses in formulating nursing diagnosis. - when problem is already identified, taking
inventory of strengths promotes self-concept
Formulation of and self-image.
Data Analysis Data
Nursing
Interpretation
Diagnosis - this strengths aid in mobilizing health and
regenerative process
a. ANALYSIS OF DATA
➢ Comparison of Data against standard and norms c. FORMULATION OF NURSING DIAGNOSIS
- This is done as an overlapping step on the • Different Formats of Nursing Diagnoses
transition between assessment and diagnostic ➢ One-part statement (Problem)
phase. - consist of NANDA label only
- Ways on comparing cues:
o Deviation from population norms ➢ Two-part statement (Problem + Etiology)
▪ Example: (cue) F- 5’2 in height, 240 - are joined by the words Related to
lbs -> (standard) F- 5’2 in height -
108-121 lbs (ideal weight) ➢ Three-part statement (Problem + Etiology + Signs/
o Dysfunctional behavior Symptoms)
▪ Example: (cue) Teen (16 y/o) not - are joined by the word related to; and
left the room for 2 days as manifested by for the signs/ symptoms
verbalized by the mother -> (norm) - e.g., Non-Compliance (Diabetic Diet) related to
Adolescents usually liked to be with unresolved anger about diagnosis as manifested
their peers by:
o Developmental Delay o S - “I forget to take my pills” “I can’t live
▪ Example: (cue) Child 17 months old, without sugar in my food”
still cannot speak as verbalized by o O - Weight 98 kg (215 lbs.); BP- 190/
the parent -> (standard) Children 100
usually speak their first word by 10-
12 months • Examples of Different Format of Nursing Diagnosis
o Changes in usual health status 1PS 2PS 3PS
▪ Example: (cue) client states “I’m not Feeding Self- Feeding Self-Care Feeding Self-Care
hungry these days” à (norm) Client Care Deficit Deficit RT Deficit RT
usually eats three balanced meals decreased decreased
per day strength and strength and
o Changes in usual behavior endurance endurance AEB
▪ Example: (cue) Reports that his inability to
husband angers easily à (norm) maintain fork in
hand from plate
Husband usually relaxed and
to mouth
easygoing
Ineffective Ineffective Ineffective
Airway Airway Clearance Airway Clearance
➢ Clustering of Cues Clearance RT fatigue RT fatigue AEB
- combining data from different assessment dyspnea at rest
areas to form a pattern and organizing Anxiety Anxiety RT Anxiety RT
subjective and objective data into appropriate change in role change in role
categories functioning functioning AEB
- putting different cues that are somewhat insomnia, poor
related to each other eye contact, and
- nurse interprets meaning of cues, label the cue quivering voice.
clusters with tentative diagnostic hypothesis Deficient Deficient Deficient
Knowledge Knowledge RT Knowledge RT
➢ Identifying gaps and Inconsistencies in Data misinterpretation misinterpretation
of information of information
- Final check to ensure that data are complete
AEB inaccurate
and correct.
return
- Possible sources: measurement error, demonstration of
expectations, and inconsistent or unreliable self-injection
reports. Spiritual Spiritual Distress Spiritual Distress
- E.g., Nursing history- not seen doctor in 15 Distress RT separation RT separation
years, stated my doctor takes my BP every year from religious from religious
ties ties AEB crying
b. DATA INTERPRETATION and withdrawal
➢ Determining Health Problems, Risk and Strengths
- Based from the clustered data, the nurse must • Variations of Basic Format
draw inference on the client’s existing health a. Unknown Etiology - does not know the cause
condition.

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 - e.g., Noncompliance (Medication Regimen)
related to unknown etiology

b. Complex Factors - too many etiologic factors

- e.g., Chronic Low Self- Esteem related to
complex factors

c. Possible - nurse believes more data are needed

about clients’ problem/ needs
- e.g., Possible Low Self-Esteem related to loss of
job and rejection by family

d. Secondary to - divide etiology in 2 parts; more

descriptive, useful; often pathophysiologic or
disease process or medical diagnosis
- e.g., Risk for Impaired skin integrity related to
decreased peripheral circulation secondary to
diabetes

• Sources of Diagnostic Errors

- Data Collection
- Interpretation and Analysis of Data
- Data Clustering
- Diagnostic statement
o Identify a patient’s response (NOT the
medical diagnosis)
o Identify a NANDA diagnostic statement
(NOT the symptom)
o Identify a treatable factor (be realistic)
o Identify the actual cause of a problem
o Identify the problem and the etiology

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