Fundamentals of nursing practice
CONCEPTS OF MAN, HEALTH AND ILLNESS
ATTRIBUTES OF HUMAN BEING
1. The capacity to think or conceptualized
on the abstract level
2. Family formation
3. The tendency to seek and maintain
territory
4. The ability to use verbal symbols as
language
MAN
 Biopsychosocial being
 Social being
 Spiritual being
Man is open system (Roy)
Open system – allows input and output to and
from its boundaries
 Constantly affected by matter, energy
and information
Closed system – will not allow input and
output
 Will not allow exchange of matter,
energy and information
HEALTH – “being healthy means being able to
function well physically and mentally and to
express the full range of one’s potentialities
within the environment in which on is living.” -
Dubos and Dunn
CONCEPTS OF HEALTH AND ILLNESS
Health
Fundamental right of every human being
Health and illness are highly individualized
HEALTH – ability to maintain internal milieu
illness is the result of failure to maintain internal
environment (Claude Bernard)
 Ability to maintain homeostasis or
dynamic equilibrium (Walter Cannon)
HEALTH AND ILLNESS
 Being well and using one’s power to the
fullest extent. It is maintained through
prevention of disease via
Environmental Health Factors.
(Nightingale)
HEALTH – Individual’s ability to perform 14
components of nursing care unaided
(Henderson)
 Positive health symbolizes wellness.
(Rogers)
 Health is state and a process of being
becoming an integrated and whole
person. (Roy)
 Soundness or wholeness of developed
human structures and of bodily and
mental functioning. (Orem)
 Dynamic state in the life cycle. Illness is
an interference in life cycle. (King)
WELLNESS
 Condition in which all parts and subparts
of an individual are in harmony with the
whole system. (Neuman)
 Is choice
 A way of life
 Involves engaging in attitudes and
behaviors that enhance quality of life
and maximize personal potential
 Loving acceptance of one’s self
FACTORS AFFECTING HEALTH AND
ILLNESS
 Genetic influence (aspect of genes)
 Cognitive abilities
 Age
 Sex
 Environmental lifestyle
 Mental health counseling and crisis intervention
Factors Child safety classes
 Geographical location
 Culture
SECONDARY CARE SERVICES (ACUTE
 Religion CARE)
 Standard of living
 Health beliefs  Radiologic procedures
 Previous health experiences  Laboratory and diagnostic procedures
 Support system  Surgical procedures
 Inpatient services
HEALTH CARE DELIVERY SYSTEM  Emergency care
 Has primary, secondary & tertiary  Restorative care
 Rehabilitative services
Health systems – a well-functioning health
 Physical therapy
system working in harmony is built on having
 Speech therapy
trained and motivated health workers, a well
 Occupational therapy
maintained infrastructure, and a reliable supply
of medicines and technologies, backed by  Home health care
adequate funding, strong health plans and  Cardiovascular and pulmonary
evidence- based policies. outpatient rehabilitation

HEALTH CARE SERVICES TERTIARY CARE

Preventive and Primary Care  Extended (long term) care

 Chronic disease management
Health promotion  Assistive – living care
Prenatal care  Medical homes
 In home personal care
Well- baby care - preventive
 Hospice care
Family planning  Palliative home care practice settings
- Hospitals
Meditation classes
- Extended care facilities (rehabilition,
preventive custodial care)
- Physician’s clinics
Fire prevention classes - Ambulatory clinics
Driver classes - Renal dialysis center
- Hospice and Palliative Homes
Smoking cessation - Emergency centers / hospitals
Physical examination / annual check up - Correctional facilities
- School
Illness prevention
Immunization
Blood pressure screening
Health fairs and screening

HISTORICAL EVOLUTION OF NURSING
I. PERIOD OF INTUITIVE NURSNG /
MEDIEVAL PERIOD
 Nursing was “untaught” and instinctive.
It was performed out of compassion for
others, out of the wish to help others
 Nursing was a function that belonged to
women. It was viewed as a natural
nurturing job for women. She is
expected to take good care of children,
the sick and the aged
 No caregiving training is evident. It was
based on experience and observation
 Primitive men believed that illness was
caused by invasion of the victim’s body
of evil spirits
 They believed that the medicine
man, shaman or witch doctor had the
power to heal by using white magic,
hypnosis, charms, dances,
incantation, purgatives, massage,
fire, water, herbs as means of driving
illness from the victim
 Trephining – drilling a hole in skull
with rock or stone without
anesthesia. It was a last resort to
drive evil spirits from the body of
afflicted
II. PERIOD OF APPRENTICE
NURSING / MIDDLE AGES /
RENAISSANCE
 Care was done by crusaders,
prisoners, religious orders
 Nursing care was performed without
any formal education and by people
who were directed by more
experienced nurses ( on the job
training)
 This kind of nursing was
developed by religious orders of
the Christian church
 Nursing went down to the lowest
level (dark period of nursing 17th to
19th century)
 The wrath / anger of Protestantism;
confiscated properties of hospitals
and schools connected with roman
Catholicism
 Nurses fled their lives; soon there
was shortage of people to care for
the sick
 Hundred of hospitals closed, there
was no provision for the sick, no one
to care for the sick
 Nursing became the work of the
least desirable of woman –
prostitutes, alcoholics, prisoners
 Pastor Theodore Fliedner and his wife,
Frederika established the
Kaiserswerth Institute for the training
of Deaconesses ( the first formal
training school for nurses) in
Germany.
 This was where Florence Nightingale
received her 3 month course of study in
nursing
III. PERIOD OF EDUCATED
NURSING / NIGHTINGALE ERA
19TH – 20TH CENTURY / MODERN
NURSING
 The development of nursing this period
was strongly influenced by:
 Trends resulting from wars – crimean
, civil war
 Arousal of social consciousness
 Emancipation of woman
 Increased educational opportunities
offered to women
 Florence Nightingale was asked by Sir
Sidney Herbert of British War
Department to recruit female nurses to
provide care for the sick and injured in
crimean war.
 In 1860, The Nightingale Training
School of Nurses opened at St.
Thomas Hospital in London.
 The school served as a model for
other training schools. Its graduates
 traveled to other countries to  Use of sophisticated equipment for
manage hospitals and institute diagnosis and therapy
nurse-training programs.
 Nightingale focus: vision of nursing
was more on developing the
profession within hospitals. Nurses
should be taught in hospitals
associated with medical schools and
that the curriculum should include
both theory and practice
 It was the 1st school of nursing that
provided both theory based
knowledge clinical skill building.

NURSING EVOLVED AS AN ART AND

SCIENCE HISTORY OF NURSING IN THE
PHILIPPINES
FORMAL NURSING EDUCATION AND
NURSING SERVICE BEGUN  EARLY BELEFS, PRACTICES AND
CARE OF THE SICK
IV. PERIOD OF CONTEMPORARY
 EARLY HOSPITALS DURING THE
NURSING / 20TH CENTURY
SPANISH REGIME
 Licensure of nurses started
 PROMINENT PERSONAGES
 Specialization of hospital and diagnosis INVOLVED DURING THE
 Training of nurses in diploma program PHILIPPINE REVOLUTION
 Development of baccalaureate and  HOSPITALS AND SCHOOLS OF
advance degree programs NURSING
 Scientific and technological  COLLEGES OF NURSING
development as well as social changes  EARLY BELIEFS, PRACTICES
marked this period AND CARE OF THE SICK
 Health is perceived as a fundamental  RELIGIOUS ORDERS EXERTED
human right
EFFORTS TO CARE FOR THE
 Nursing involvement in community
SICK BY BUILDING HOSPITALS IN
health
DIFFERENT PARTS OF THE
 Technological advances – disposable
PHILIPPINES
supplies and equipment
 1577 – HOSPITAL REAL DE MANILA
 Expanded roles of nurses was
 1578 – SAN LAZARO HOSPITAL
developed
 1586 – HOSPITAL DE INDIOS
 WHO was established by the United
 1590 – HOSPITAL DE AGUAS SANTAS
Nations
 1596 – SAN JUAN DE DIOS HOSPITAL
 Aerospace nursing was developed
 PROMINENT PERSONS INVOLVED
 Use of atomic energies for medical
DURING THE PHILIPPINE
diagnosis, treatment
REVOLUTION
 Computers were utilized for data
collection, teaching, diagnosis,
inventory, payrolls, record keeping,
billing.

 Who was Josephine Bracken? What
was her contribution to nursing?
 Who was Rose Sevilla de Alvaro? What
was her contribution to nursing?
 Who was Hilaria de Aguinaldo? What
was her contribution to nursing?
 Who was Melchora Aquino? What was
her contribution to nursing?
 Prominent persons involved during the
Philippine Revolution
 Who was Agueda Kahabagan? What
was her contribution to nursing?
 Who was Gregoria de Jesus? What
was her contribution to Philippine
nursing?
 She rendered “GREAT SERVICE TO
THE REVOLUTIONARY” cause either
in nursing the sick and wounded soldiers
of raising material relief for them or both
 Hospitals & Schools of Nursing
 1900 – St. Paul’s Hospital School of
Nursing, Intramuros Manila
 1906 – Iloilo Mission Hospital Training
School of Nursing
 1909 – distinction of graduating the 1st
trained nurses in the Philippine. With no
standard requirements for admission of
applicants except their “WILLINGNESS
TO WORK”
 April 1949 – a board exam was held
outside of Manila. It was held in the Iloilo
Mission Hospital thru the request of Ms.
Loreto Tupas, principal of the school.
 1907 – St. Luke’s Hospital School of
Nursing opened after 4 years as a
dispensary clinic
 1907- Mary Johnston Hospital School of
Nursing
 1910 – Philippines General Hospital
School of Nursing
 Colleges of Nursing
 UST college of nursing – 1st college of
nursing in the Philippines: 1946
 MCU College of Nursing – June 1947
(1st college who offered BSN – 4 year
program)
 UP College of Nursing – June 1948
 FEU institute of nursing – June 1955
 UE college of nursing – Oct 1958
 Milestones of Nursing in the
Philippines
 1909 – 3 female “graduated as qualified
medical surgical nurses”
 1920 – 1st board examination of nurses
was conducted by the board of
examiners, 93 candidates took the
exam, 68 passed with the highest rating
of 93.5% Anna Dahlgren
 Theoretical exam was held at the UP
Amphitheater of the college of medicine
and surgery. Practice exam at the PGH
Library
 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
 1922 – (October 15, 1922) filipino
nurses association was established
(now PNA) as the National Organization
of Filipino Nurses
 PNA first president – Rosario Delgado
 PNA Founder – Anastacia Giron –
Tupas
  HOSPICE AND PALLIATIVE HOMES
 EMERGENCY CENTERS / HOSPITALS
 CORRECTIONAL FACILITIES
 SCHOOL
SAN PEDRO COLLEGE
 Found in 1956 by the Dominican
Sisters of the Trinity from Quebec,
Canada
 Began as a school of nursing of San
Pedro Hospital, the first catholic hospital
in Mindanao, which the religious sisters
have been operating since their arrival in
1948
 San Pedro Hospital School of Nursing:
 Foundation laid by Sr. Pauline
Guilmette, OP and Sr. Cecil Denis, OP
 Acquisition of land was facilitated by
Most Rev. Clovis Thibaut, PME
EVOLUTION OF NURSING EDUCATION
 Florence Nightingale emphasized
that the focus for preparing nurses
should be through nursing education,
not nursing service
EVOLUTIONARY PROCESS OF NURSING
EDUCATION
 Began as simple teaching on how to
carry nurturing measures
 Progressed to apprenticeships under
physicians and nurses
 Moved into hospitals where schools
were established (on the job training)
 Entered colleges and universities –
formal education programs leading to
academic degrees

PRATICE SETTINGS
 HOSPITALS
 EXTENDED CARE FACILITIES
(REHAB, CUSTODIAL CARE)
 PHYSICIANS CLINICS
 AMBULATORY CLINICS
 RENAL DIALYSIS CENTERS
CONCEPTS OF NURSING • Expanded career roles:
WHAT IS NURSING? - Nurse practitioner
 The protection, promotion and - Clinical nurse specialist
optimization of client’s health and
- Nurse anesthetist
abilities
 The prevention of disease and illness - Nurse midwife
 Alleviation of suffering
- Nurse researcher
 Through the diagnosis and treatment of
human response to disease and injury - Nurse administrator
(American Nurses Association)
- Nurse educator
- Nurse entrepreneur
NURSING AS A PROFESSION
- Forensic nurse
A. Criteria
B. Personal and Professional Qualities of - Nurse informaticist
nurse
- Nurse geneticist
C. Fields of nursing
D. History of nursing Key terms:
Profession
NURSING Occupation
• The protection, promotion and Vocation
optimization of client’s health and abilities
Professionalism
• The prevention of disease and illness
Professionalization
• Alleviation of suffering
• Through the diagnosis and treatment of
CRITERIA OF PROFESSION
human response to disease and injury
ROLE BASIC TO NURSING CARE  Specialized education
 Body of knowledge
• Caregiver  Service orientation
• Communicator  Ongoing research
 Code of ethics
• Teacher  Autonomy
• Client advocate  Profession organization (e.g. ANA, PNA,
ICN)
• Counselor
• Change agent
• Leader
• Manager
• Case manager
• Research consumer

PERSONAL AND PROFESSIONAL
QUALITIES
1. GOOD APPEARANCE
(Posture, grooming, dress, uniform, cap)
2. CHARACTER
(Moral values, beliefs, emotional and
intellectual growth, understanding, charity,
honesty, loyalty, tolerance, judgement,
reliability, motivation, resourcefulness,
moderation)
3. ATTITUDE
(Acceptance, helpfulness, friendliness,
firmness, permissiveness, limit setting,
sincerity, competence)
4. CHARM
(Voice, manner, heart, intelligence, poise)
PROFESSIONAL QUALITIES
1. Has faith in fundamental values:
- Respect for human dignity
- Self sacrifice
- Strong sense of responsibility
2. Has a sense of responsibility to
understand others
- Utilizing relevant concepts of
psychology
- Working effectively through
therapeutic relationship
3. Has faith in reality of spiritual and
aesthetic values and pleasure of self-
development
4. Critical thinking
5. Communication skills (written / oral)
6. Appreciates and understand the
importance of good health
7. Emotional balance
8. Likes hard work and possesses a
capacity for it.
9. Appreciates high standards of
workmanship
10. ACCEPTS AND UNDERSTAND
PEPLE OF ALL SORTS
11. CARE
DIFFERENT FIELDS OF NURSING
1. INSTITUTIONAL NURSING
- Nursing in hospitals and related
health facilities
- Nurse participates as a member of
health care team in all phases of
patient care
2. COMMUNITY HEALTH NURSING
- Emphasis is on health promotion
and disease prevention
3. SCHOOL NURSING
- Primacy function is health
education
4. INDUSTRIAL NURSING
- Gives immediate care to
personnel or staff with serious
injuries
5. OCCUPATIONAL HEALTH NURSING
- Primary focus is on the health
care and safety of the adult
working population
6. INDEPENDENT NURSING PRACTICE
- Gives comprehensive care to
client in a one on one ratio
7. NURSE EDUCATOR
- Guide, supervise student nurses
8. MILITARY NURSING
- Ensures that the soldier, his
family and other significant
groups will have adequate
personal care, maintenance,
safety and comfort
EXPANDED CAREEER ROLE FOR NURSES
1. CLINICAL SPECIALISTS NURSING AS AN ART
- Provides expert care to
A. CARING
individuals
1. CARING PRACTICE MODEL
- Participates in educating health
2. 6 CS OF CARING
care professionals and ancillary
3. CARING FOR SELF AND OTHERS
- Acts as a clinical consultant and
participates in research

2. NURSE PRACTIONER CARING – sharing deep and genuine concern

- She is skilled at making nursing about the welfare of another person
assessments CARING PRACTICE – involves connection,
- Performing P.E mutual recognition and involvement between
- Counseling nurse and client
- Teaching
- Treating minor and self limiting CARING – as helping the other grow
illness

3. NURSE MIDWIFE MILTON MAYEROFF 1990 – Caring is a

- A nurse who has completed a
program in midwifery:
- Provides prenatal and postnatal
care and delivers babies to
women with uncomplicated
pregnancies
process that develops over time, resulting in a
deepening and transformation of the
relationship. Caring to help another person to
grow.

4. NURSE ANESTHETIST
- A nurse who completed the
course of study in a an anesthesia
school and carries out pre
operative status of clients

5. NURSE ENTREPENEUR
- A nurse who has an advanced
degree, and manages health
related business

MAJOR INGREDIENTS OF CARING:
1. KNOWING – understanding the other’s
needs and how to respond to these
needs
2. ALTERNATING RHYTHMS – signifies
moving back and forth between and long
term meanings of behavior, considering
the past
3. PATIENCE – enables the other to grow
in his own way and time
4. HONESTY – awareness and openness
to one’s feelings and genuineness in
caring for the other
5. TRUST – involves letting go, to allow the
other to grow in his own way an down
time
6. HUMILITY – acknowledging that there is
always more to learn and that learning
may come from any source
7. HOPE – belief in the possibilities of
other’s growth
8. COURAGE – the sense of going into
unknown, informed by insight from past
experiences.
MODELS / THEORIES OF CARING
1. CULTURE CARE DIVERSITY AND
UNIVERSALITY CARING – assistive,
supportive and enabling experiences or
ideas towards others with evident or
anticipated needs to ameliorate or
improve human condition or lifeways
THREE ACTIONS OF CULTURALLY
CONGRUENT CARE:
 Preservation of client’s familiar lifeways
 Accommodations that help client adapt
to or negotiate for satisfying care
 Repatterning nursing care to help client
moved towards wellness
2. BUREAUCRATIC CARING (MARILYN
RAY)
 Focuses on caring in organization as
cultures
 Suggest that caring in nursing is
contextual and is influenced by the
organizational structure
 Influenced by the role and position a
person hold.
According to Ray:
“ Spiritual ethical caring for nursing does
not question whether or not to care in
complex systems, but intimates how
sincere deliberations and ultimately the
facilitation of choices for the goods of
others can or should be accomplished
3. CARING, THE HUMAN MODE OF
BEING ( SISTER MARIE SIMONE
ROACH, 2013) CARING: IS THE
HUMAN MODE OF BEING
6 C’s of Caring:
1. COMPASSION – awareness of one’s
relationship to others, sharing their joys,
sorrows, pain and accomplishment in
the experience of another
2. COMPETENCE – having the
knowledge, judgement, skills, energy,
experience and motivation required to
respond adequately to the demands of
one’s professional responsibilities
3. CONFIDENCE – comfort with self, client
and others that allows one to build
trusting relationship
4. CONSCIENCE – morals, ethics and
informed sense of right and wrong.
Awareness of personal responsibility
5. COMMITMENT – the deliberate choice
to act in accordance with one’s desires
as well as obligations, resulting in
investment of self in a task or cause
6. COMPORTMENT – appropriate bearing,
demeanor, dress and language that are
in harmony with a caring presence.
 Presenting oneself as someone who
respects others and respect
4. NURSING AS CARING (BOYKIN AND  DOING FOR
SCHOENHOFER)
(DOING FOR THE OTHER AS HE / SHE
“Respect for people and respect what WOULD DO FOR THE SELF IF IT WERE
matters to them” AT ALL POSSIBLE)
“Emphasize the importance of the nursing - Comforting
knowing self as a caring person” - Anticipating
- Performing competently / skillfully
5. THEORY OF HUMAN CARE
- Protecting
(WATSON)
- Preserving dignity
- Carative Factors
- Nursing commitment to care of the
 ENABLING
whole person, concerns for the
health of individual and groups (Facilitating the other’s passage through the
transitions and unfamiliar events
6. THEORY OF CARING ( SWANSON)
- Informing / explaining
Caring – a nurturing way of relating to a - Supporting / allowing
valued others toward whom one feels a - Focusing
personal sense of commitment and - Generating alternatives / thinking it
responsibility through
- Validating / giving feedback
 KNOWING
( Striving to understand an event as it has  MAINTAINING BELIEF
meaning in the life of other)
(Sustaining faith in the other’s capacity to get
- Avoiding assumptions through an event or transition and face a future
- Centering on the one cared for meaning)
- Assessing thoroughly
- Believing in / holding in esteem
- Seeing cues
- Maintaining a hope filled attitude
- Engaging the self of both
- Offering realistic optimism
- Going the distance
 BEING WITH
(Being emotionally present to the other)
- Being there
- Conveying ability
- Sharing feelings
- Not burdening
NURSING AS AN ART THERAPEUTIC COMMUNICATION
B. COMMUNICATION  Promotes understanding
- Any means of exchanging  Helps establish constructive relationship
information or feelings between two between nurse and client
or more people  Client centered
- Basic component of human  Goal directed / helping relationship
MODES OF COMMUNICATION  Active listening
 Visibly tuning in
VERBAL COMMUNICATION
PHASES OF THE HELPING RELATIONSHIP
 Pace and Intonation
 Simplicity 1. PRE – INTERACTION PHASE
 Clarity and brevity - Before the face to face meeting
- Planning stage
 Timing and relevance
2. INTRODUCTORY / ORIENTATION /
 Adaptability
INITIATION PHASE
 Credibility
- Sets the tone of the relationship
 Humor - To develop trust and security within
NON VERBAL COMMUNICATION the relationship
- Identification of the problem
 Personal appearance 3. WORKING PHASE
 Posture and gait - Major phase
 Facial expression - Exploring and understanding
 Gestures thoughts and feelings facilitating and
taking action
4. TERMINATION PHASE
- Healthy closure
ELECTRONIC COMMUNICATION
- Summary and evaluation of the goals
 E-mail - Need to start in advance

FACTORS INFLUENCING COMMUNICATION

PROCESS
 Development
NURSING AS AN ART
 Gender
 Values and perceptions C. TEACHING
 Personal space / proxemics 1. Health promotion
 Territoriality 2. Disease prevention
 Roles and relationship 3. Health restoration and maintenance
4. Rehabilitation
 Environment
 Congruence
 Interpersonal attitudes
TEACHING
 Boundaries
 Client education is a right of all clients
  To help patient better participate in their
care and informed care decision (JOINT
COMMISSION INTERNATIONAL,
2011)
 Providers must perform a learning
needs assessment that includes the
patient’s cultural, religious beliefs,
emotional barriers, desires and
motivation to learn, physical or cognitive
limitations and barriers to
communication (THE JOINT
COMMISSION, 2012)
KEY TERMS
TEACHING – a system of activities intended to
produce learning
TEACHING PROCESS – intentionally
designed to produce specific learning
TEACHING LEARNING PROCESS – dynamic
interaction between teacher and learner
LEARNING – a change in human disposition. It
is presented in change in behavior
3. RESTORATION OF HEALTH
 Information about tests, diagnosis,
treatment and medications
 Self care skills or skills needed to care
for family member
 Resources within health care setting and
community
4. ADAPTING TO ALTERED HEALTH
AND FUNCTION
 Adaptions in lifestyle
 Problem solving skills
 Strategies to deal with current problems
 Strategies to deal with future problems
 Information about treatments and likely
outcomes
 Referral to other health care facilities or
services
 Facilitation of strong self image
 Grief and bereavement counseling

AREAS OF CLIENT EDUCATION

1. PROMOTION OF HEALTH Nurse as a profession
 Increasing person’s level of wellness Key terms:
 Growth and development topics
 Fertility control Profession
 Hygiene Occupation
 Nutrition
Vocation
 Exercise
 Stress management Professionalism
 Lifestyle modification
Professionalization
 Resources within the community

2. PREVENTION OF ILLNESS
 Health screening
 Reducing health risk factors
 Specific protective health measures
 First aid
 Safety measures