NCM 56 Fundamentals of Nursing Practice Lecture

2nd Sem SY 2020-2021

I. Concepts of Man, Health and Illness placement.
1. Factors and Issues Affecting Health and Illness
Health - Dunn's high-level wellness grid- High-level wellness
- Presence or absence of disease in a favorable environment; Emergent high-level
- Complete physical, mental, social well-being wellness in an unfavorable environment; Protected
- Ability to maintain normal roles poor health in a favorable environment; Poor health in
- Developmental and behavioral potential is an unfavorable environment
realized to fullest extent possible - Illness–wellness continuum- Arrows pointing in
- Striving toward optimal functioning opposite directions and joined at a neutral point; Some
Personal definitions of health feel real concepts more complex than on continuum.
-Individual perception
-Some individuals believe they are health even though Variables Influencing Health Status, Beliefs, and
they have physical impairments that some would Practices
consider an illness. 1. Internal, external variables- People can usually
- Ongoing process choose between healthy or unhealthy activities.;
Wellness and Well-Being People have little or no choice over genetic makeup,
Wellness age, sex, culture, and sometimes geographic
- State of well-being environment.
- A dynamic, growing process Internal Variables
- Daily decision-making regarding nutrition, Biologic dimension
stress management, physical fitness, - Genetic makeup
preventive health care, and emotional health - Gender
- Whole being of the individual - Age
Basic components - Developmental level
a. Environmental- Ability to promote health measure Psychologic dimension
that improves: Standard of living, Quality of life - Mind–body interactions
- Influences such as food, water, and air - Self-concept
b. Social- Interact successfully; Develop and maintain Cognitive dimension
intimacy; Develop respect and tolerance for others -Lifestyle choices: A person's general way of living,
c. Emotional- Ability to manage stress; Ability to including conditions and individual patterns of behavior
express emotion influenced by social and personal factors
d. Physical- Carry out daily tasks; Achieve fitness; - Spiritual and religious beliefs
Maintain nutrition; Avoid abusing substances; Practice
positive lifestyle habits External Variables
e. Spiritual- Belief in some force that gives life meaning Environment
and purpose; Person's own morals, values, and ethics - Geographic location
f. Intellectual- Ability to learn; Ability to use information - Hazards and contamination
effectively; Striving for continued growth; Learning to Standards of living
deal with new challenges - Reflect occupation, income, and education
g. Occupational- Ability to achieve balance between - Related to health, morbidity, and mortality
work and leisure Family and cultural beliefs
- Pass on patterns of daily living
Well-being - How a person perceives, experiences, and copes with
- Subjective perception of vitality and feeling well; Can illness
be described objectively, experienced, measured; Can Social support networks
be plotted on a continuum - Family, friends, and/or confidant

Models of Health and Wellness Health Belief Models

1. Clinical model- Provides narrowest interpretation of Help determine whether individual is likely to participate
health; People viewed as physiologic systems; Health in disease prevention and health promotion activities
identified by absence of disease or injury; State of not 1. Health Locus of Control Model
being "sick"; Opposite of health-Disease or injury Internals- Health status is under their own or others'
2. Role performance model- Able to fulfill societal roles; control.
Viewed as healthy even if clinically ill, if still able to fulfill Externals- Health is largely controlled by outside
roles; Sickness- inability to perform one's role sources.
3. Adaptive model- Creative process; Disease- a failure 2. Rosenstock and Becker's Health Belief Models
in adaptation or maladaptation; Extreme good health- Individual perceptions
flexible adaptation to the environment; Focus is - Perceived susceptibility
stability, with ability to grow and change. - Perceived seriousness
4. Eudemonistic model- Comprehensive view of health; - Perceived threat
Actualization or realization of a person's potential;
Illness- Condition that prevents self-actualization; Modifying factors
Human potential through goal-directed behavior, - Demographic variables
competent self-care; Satisfying relationships with - Sociopsychological variables
others; Maintaining structural integrity and harmony -Structural variables
with social and physical environments; Health- - Cues to action
Expansion of consciousness
5. Agent–host–environment model-- Each factor Likelihood of action
constantly interacts with the others.; When in balance, - Perceived benefits of the action
health is maintained.; When not in balance, disease -Perceived barriers to action
occurs. -Sources to evaluate options, plan interventions
6. Health–illness continua- Measures person's >Guide to Community Preventive Services
perceived level of wellness; Health and illness/disease >Guide to Clinical Preventive Services
opposite ends of a health continuum; Move back and
forth within this continuum day by day; How people
perceive themselves and how others see them affects

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 NCM 56 Fundamentals of Nursing Practice Lecture
2nd Sem SY 2020-2021
Health Care Adherence
Adherence- The extent to which an individual's
behavior coincides with medical or health advice
Upon recognizing nonadherence: Establish why client
not following the regimen; Demonstrate caring;
Encourage healthy behaviors through positive
reinforcement; Use aids to reinforce teaching; Establish
therapeutic relationship of freedom, mutual
understanding, and mutual responsibility with client and
support persons
Illness and Disease
Illness- A highly personal state; Person's physical,
emotional, intellectual, social, developmental, or
spiritual functioning is diminished.; Not synonymous
with disease; May or may not be related to disease;
Only person can say he or she is ill.
Disease
Alteration in body function ; Reduction of capacities or
shortening of normal life span
Etiology- Causation of disease
Acute illness- Characterized by symptoms of relatively
short duration; Symptoms appear abruptly, subside
quickly ; May or may not require intervention by health
care professionals; Most people return to normal level
of wellness.
Chronic illness- Usually slow onset and lasts for 6
months or longer; Often has periods of remission
(symptoms disappear) and exacerbation (symptoms
reappear); Care includes promoting independence,
sense of control, and wellness.; Client must learn how
to live with physical limitations and discomfort.
Illness Behaviors
- Coping mechanism
- Parson's four aspects of sick role
>Right to not be held responsible for their
condition
>Right to be excused from certain social roles
and tasks
>Obligation to try to get well as quickly as
possible
>Obligation to seek competent help
- Five stages described by Suchman, 1979
Stage 1: Symptom experiences- Believes something is
wrong; Physical experience, cognitive aspect, and
emotional response
Stage 2: Assumption of the sick role- Accepts the sick
role and seeks confirmation
Stage 3: Medical care contact- Seeks advice of a health
professional ; Validation, explanation, and reassurance
Stage 4: Dependent client role- Becomes dependent on
professional for help; Complicated by role obligations
Stage 5: Recovery or rehabilitation- Relinquishes
dependent role; Resumes former roles and
responsibilities
Effects of Illness
Impact on the client
- Behavioral and emotional changes
- Self-concept and body image changes
- Loss of autonomy
- Lifestyle changes
Impact on the family
Depends on:
>Which family member is ill
> Seriousness and length of illness
>Cultural and social customs of family
- Role changes
- Task reassignments
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- Increased demands on time
- Stress due to anxiety about outcomes
- Conflict about unaccustomed responsibilities
- Financial problems
- Loneliness as result of separation or loss
- Change in social customs
2. Health Care Delivery System
Health care system- Totality of services provided by all
health disciplines
Types of Health Care Services
Categorized by type and level
a. Primary prevention- Health promotion, illness
prevention
b. Secondary prevention- Diagnosis, treatment
c. Tertiary prevention-Rehabilitation, health restoration,
palliative care
Primary Prevention: Health Promotion and Illness
Prevention
Healthy People 2020 goals
-Increase quality and years of healthy life
-Achieve health equity and eliminate health disparities
-Create healthy environment for everyone
-Promote health and quality life across the life span
-Address adequate and proper nutrition, weight control
and exercise, and stress reduction
-Emphasize the important role clients play in
maintaining their own health and encourage them to
maintain the highest level of wellness they can achieve
Secondary Prevention: Diagnosis and Treatment
Hospitals
Emergency care
Intensive care
Around-the-clock care
Health promotion services
Early detection
Routine screening
Tertiary Prevention: Rehabilitation, Health Restoration,
and Palliative Care
-Restoration to previous level of health or highest level
possible, given current health status
-Rehabilitation to function adequately in the physical,
mental, social, economic, and vocational areas of their
lives
-Outreach programs for mental health illness
Palliative care-Providing comfort and treatment
End-of-life care conducted in many settings including
the home
Types of Health Care Agencies and Services
1. Public health- Local health departments develop
programs to meet the health needs of the people,
providing necessary nursing and staff to carry out these
programs, continue evaluating the effectiveness of the
program, and monitoring changing needs.
2. Physicians' offices-Family practice physicians,
specialists
Routine health screening, illness diagnosis, and
treatment
NPs more common than RNs in this setting
3. Ambulatory care centers- Diagnostic treatment
facilities; Minor surgery
4. Occupational health clinics- Run by companies for
employees; Health promotion activities
5. Hospitals- Acute inpatient services; Outpatient and
ambulatory care; Emergency department; Hospice
care
6. Subacute care facilities- Variation of inpatient care;
Technically complex treatments
7. Extended (long-term) care facilities - Formerly called
nursing homes; Independent living; Assisted, skilled,
extended care facilities; Rehabilitation; Custodial care;
 NCM 56 Fundamentals of Nursing Practice Lecture
2nd Sem SY 2020-2021
Insurance criteria, treatment needs, and nursing care
requirements must all be assessed before admittance
8. Retirement and assisted living centers- For clients
unable to stay at home, but do not require hospital or
nursing home; Relative independence
9. Rehabilitation centers- Restore or recuperate health;
Drug and alcohol
10. Home health care agencies- Education to clients
and families; Care to acute, chronic, or terminally ill
11. Day care centers- Infants or children; Adults who
cannot be left at home
12. Rural care- Federal funding; Services for rural
residents; Office of Rural Health Programs in each
state
13. Hospice services- Care for dying in home or facility;
Improve or maintain quality of life until death; Ongoing
assessment of needs of client and family; Help in
finding resources and services
14. Crisis centers- Emergency services for life crises;
Counseling and support
15. Mutual support and self-help groups- Health
problems; Life crises
Providers of Health Care
1. Nurse- RN; Licensed vocational nurse (LVN);
Licensed practical nurse (LPN)
2. Alternative (complementary) care provider- Practices
not commonly part of Western medicine
3. Case manager- Ensures fiscally sound, appropriate
care in the best setting
4. Dentist- Mouth, jaw, and dental problems
5. Dietitian or nutritionist- Dietitian has knowledge
about diets required to maintain health, treat disease. ;
Nutritionist has knowledge about nutrition and food;
works in community.
6. Emergency medical personnel- Several categories of
first-responder care, such as fire departments
7. Occupational therapist- Assists clients with impaired
functions to gain skills to perform ADLs
8. Paramedical technologist- Laboratory; Radiologic;
Nuclear medicine
9.Pharmacist- Prepares, dispenses pharmaceuticals in
hospital and community settings
10. Physical therapist- Assists clients with
musculoskeletal problems
11. Physician- Responsible for medical diagnosis,
determining therapy; Primary care or specialists;
Allopathic, osteopathic
12. Physician assistant- Performs certain tasks under
direction of physician; May have similar job description
to NP
13. Podiatrist- Diagnoses, treats foot and ankle
conditions
14. Respiratory therapist- Knowledgeable about
oxygen therapy devices, accessory devices;
Administers pulmonary function tests
15. Social worker- Counsels clients and support
persons regarding finances, marital difficulties,
adoption of children
16. Spiritual support personnel- Chaplains, pastors,
rabbis, priests, and other religious or spiritual advisers
Most volunteer
17. Unlicensed assistive personnel (UAP)- Assumes
delegated aspects of basic client care; Bathing,
assisting with feeding, collecting specimens
Factors Affecting Health Care Delivery
a. Increasing number of older adults- By 2020, over 62
million adults over 65; Substantial home management,
nursing support services required; Community
involvement
b. Advances in technology- New procedures,
medications; Bedside charting and computers; Costly
c. Economics- Health spending predicted to increase
substantially after Affordable Care Act; Cost increases,
mostly in outpatient and prescriptions
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d. Women's health issues- Until recently, only
reproductive focus; Need for research that examines
women equally to men; Increased emphasis on
psychosocial aspects of women's health
e. Uneven distribution of services - Increased
specialization; Fragmentation, higher cost of care;
Remote, rural locations
f. Access to health insurance- Those without insurance
diagnosed later in illnesses; Those with greatest need
for care often least able to pay for it
g. The homeless and the poor- General poor health
exacerbated; Lack of convenient, timely transportation
h. Health Insurance Portability and Accountability Act-
Regulations to protect privacy of individuals including
electronic health records; Clients provided with notice
i. Demographic changes- Increasing alternative family
structures; Cultural, ethnic diversity
Frameworks for Care
1. Managed care- Health care system whose goals are
to provide cost-effective, quality care with decreased
costs and improved outcomes for groups of patients;
Customer satisfaction; Preventive services
2. Case management- Range of models for integrating
health care services; Critical pathways- Plan that tracks
client's progress
3. Differentiated practice- Best possible use of nursing
personnel based on education and skill sets;
Customized within each institution
4. Case method- Total care; One nurse responsible for
comprehensive care of a group during an 8- or 12-hour
shift
5. Functional method- Focuses on jobs to be
completed; Production, efficiency may cause neglect of
client's emotional needs
6. Team nursing- Group of providers led by a
professional nurse (RN); RNs, LPNs, and UAPs
7. Primary nursing- One nurse responsible for
overseeing total care of client(s) 24/7 even if care is not
all delivered personally; Technical knowledge and
management
II. CONCEPT OF NURSING
Nursing as a Profession
Historical Perspectives
-Dramatic change in response to societal needs,
influences
- Struggle for autonomy and professionalization
Women's Roles
-Care and nurturing of other family members
-Subservient, dependent role in community
Religion
-Christian parable of the Good Samaritan
-Roman Empire
-Conversion to Christianity
Houses of care and healing
-Fabiola
-Crusades
-Knights Hospitalers
-Knights of Saint Lazarus
Medieval
-Alexian Brothers
-Deaconess groups suppressed
1800s
-Order of Deaconesses reinstituted 1836
War
Crimean War- Florence Nightingale
American Civil War- Harriet Tubman
Sojourner Truth
Dorothea Dix
World War I- Harsh environments and new injuries
 NCM 56 Fundamentals of Nursing Practice Lecture
2nd Sem SY 2020-2021
Harriet Tubman (1820–1913) was known as "The
Moses of Her People" for her work with the
Underground Railroad. During the Civil War she nursed
the sick and suffering of her own race.
Universal Images Group/Getty Images.
Sojourner Truth (1797–1883), abolitionist,
Underground Railroad agent, preacher, and women's
rights advocate, was a nurse for more than 4 years
during the Civil War and worked as a nurse and
counselor for the Freedmen's Relief Association after
the war.
National Portrait Gallery, Smithsonian Institution/Art
Resources, NY.
Dorothea Dix (1802–1887) was the Union's
superintendent of female nurses during the Civil War.
World War I
Progress in the field of surgery
World War II- Acute shortage of caregivers; Cadet
Nurse Corps
Vietnam War- Youngest group of medical personnel to
serve in wartime
Societal Attitudes
Before mid-1800s, woman's place in the home
Victorian era
Women should be wives and mothers.
Negative image of Dickens character Sairy Gamp
Positive image of Florence nightingale
Doctor's handmaiden
Societal Attitudes
Nurse as heroine, sex object, surrogate mother,
tyrannical mother
1990s Tri-Council for Nursing to improve image
Nursing Leaders
Nightingale (1820–1910)
Improved standards of care for war casualties
Nursing's first scientist-theorist, nurse researcher
Notes on Nursing: What It Is, and What It Is Not
Nightingale Training School for Nurses
Considered the founder of modern nursing, Florence
Nightingale (1820-1910) was influential in developing
nursing education, practice, and administration. Her
publication, Notes on Nursing: What It Is, and What It
Is Not, first published in England in 1859 and in the
United States in 1860, was intended for all women.
Barton (1821–1912)
Volunteer nurse in American Civil War
Establishment of American Red Cross
Clara Barton (1821–1912) organized the American Red
Cross, which linked with the International Red Cross
when the U.S. Congress ratified the Geneva
Convention in 1882.
Richards (1841–1930)
America's first trained nurse
Initiated practice of wearing uniforms
Linda Richards (1841–1930) was America's first trained
nurse.
Mahoney (1845–1926)
First African American professional nurse
Worked for acceptance and equal opportunity
Mary Mahoney (1845–1926) was the first African
American trained nurse.
Wald (1867–1940)
Founder of public health nursing
Trained services to poor in NYC slums
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Henry Street Settlement
Lillian Wald (1867–1940) founded the Henry Street
Settlement and Visiting Nurse Service (circa 1893),
which provided nursing and social services and
organized educational and cultural activities. She is
considered the founder of public health nursing.
Dock (1858–1956)
Protest movements for women's rights
Legislation to allow nurses control their own profession
Precursor to National League of Nursing
Nursing leader and suffragist Lavinia L. Dock (1858–
1956) was active in the protest movement for women's
rights that resulted in the constitutional amendment in
1920 that allowed women to vote.
Sanger (1879–1966)
Considered founder of Planned Parenthood
Nurse activist Margaret Sanger (1879–1966),
considered the founder of Planned Parenthood, was
imprisoned for opening the first birth control information
clinic in Baltimore in 1916.
Breckinridge (1881–1965)
Established Frontier Nursing Service (FNS) in rural
U.S.
Started one of the first midwifery training schools in
U.S.
Mary Breckinridge (1881–1965), a nurse who practiced
midwifery in England, Australia, and New Zealand,
founded the Frontier Nursing Service in Kentucky in
1925 to provide family-centered primary health care to
rural populations.
Men in Nursing
Schools of nursing for men in U.S. from late 1880s to
1969
American Assembly for Men in Nursing (AAMN)
Originally National Male Nurses Association
Recruitment, retention by changing image of male
nurses
Luther Christman
Discrimination because of gender
First man to be a dean at a university school of nursing
Barriers
-Image of femininity
-Belief that only homosexual men are nurses
-Suspicion surrounding intimate touch
DEFINITIONS OF NURSING
Common themes
Caring
Art/science
Client centered, holistic, and adaptive
Concerned with health promotion, health promotion,
and health maintenance
Helping profession
Recipients of Nursing Care
Consumer
Patient-Person waiting for, undergoing medical
treatment and care
Client-Person who engages in advice, services of
another who is qualified to provide service
Increasingly used over patient
Scope of Nursing
Promotion of health and wellness
Individual and community activities to enhance health
lifestyles
Prevention of illness
Immunizations
Prenatal and infant care
Prevention of STIs
Restoring health
 NCM 56 Fundamentals of Nursing Practice Lecture
2nd Sem SY 2020-2021
Direct care to ill person
Diagnostic and assessment procedures PROFESSION- Occupation that requires extensive
Consulting other health care professionals education; Special knowledge, skill, and preparation
Teaching clients recovery activities Professionalism- Professional character, spirit,
Rehabilitating clients to optimal functional level methods
Care for the dying Professionalization- Process of becoming professional
Comforting people of all ages- In homes, hospitals,
extended care facilities, and hospices Criteria of a Profession
a. Specialized education- Hospital diploma, associate
Settings for Nursing degree, baccalaureate degree, master's degree, and
Acute care hospitals doctoral degree
Clients' homes b. Body of knowledge- Nursing conceptual frameworks
Community agencies c. Service orientation- Altruism and service to others;
Ambulatory clinics Guided by rules, policies, ethics
Long-term care facilities d. Ongoing research- Contemporary practice-related
Health maintenance organizations (HMOs) issues
Nursing practice centers e. Code of ethics- Integrity; Member expected to do
what is considered right regardless of personal cost
Roles and Functions of Nurses f. Autonomy-Self-regulating; Setting standards for
Caregiver- Assist client physically and psychologically members; Independence at work, responsibility,
while preserving client's dignity accountability for one's actions
Communicator- Identify client problems and g. Professional organization- Governance
communicate them to other members of the health care
team Professions vs. Occupation
Teacher- Help clients learn about health and health Profession Occupation
care procedures to restore or maintain health -College or University -On the job training
Client advocate- Represent, protect the client's needs -Prolonged education -Length varies
and wishes -Mental Creativity -Largely manual work
Counselor- Help client to recognize and cope with -Decisions based on science or theoretical constructs
stressful psychological or social problems, develop - Guided decision making
improved relationships, and promote personal growth -Values, beliefs & ethics integral part of preparation
Change agent- Assist clients to make modifications in - Values, beliefs & ethics
behavior not part of preparation
Leader- Influence others to work together to -Strong commitment - Commitment may vary
accomplish specific goal(s) - Autonomous - Supervised
Manager- Manage care of individuals, families, and -Unlikely to change professions -Often change jobs
communities -Commitment > reward -Motivated by reward
- Delegate nursing activities -Individual accountability -Employer is primarily
Case manager- Work with or act as primary nurse to accountable
oversee care of specific caseload
Research consumer- Use research to improve client 10 Qualities That Make a Great Nurse
care 1. High Standards of Professionalism
2. Never-Ending Diligence
Expanded Career Roles 3. Exceptional Communication Skills
Nurse practitioner 4. Effective Interpersonal Skills
Clinical nurse specialist 5. Attention to Detail
Nurse anesthetist 6. Quick Problem-Solving Abilities
Nurse midwife 7. Action-Oriented
Nurse researcher 8. Empathetic Disposition
Expanded Career Roles 9. Solid Stamina
Nurse administrator 10. Sense of Humor
Nurse educator
Nurse entrepreneur Nursing as an Art
Forensic nurse A. Caring
Caring- Sharing deep and genuine concern about the
Fields/Specializations in Nursing welfare of another person
1. Neonatal Nurse Clients and families with illness suffer from an
2. Nurse Midwife impersonal health care system.
3. Clinical Nurse Nurses can create a more relationship-centered health
4. Critical Care Nurse care system.
5. Dialysis Nurse Caring means that people, relationships, and things
6. Nurse Practitioner matter.
7. Health Policy Nurse
8. Informatics Nurse Professionalization of Caring
9. Nurse Anesthetist Caring practice involves connection, mutual
10. Nurse Educator recognition, and involvement between nurse and client.
11. Nurse Advocate
12. Nurse Researcher Mayerhoff
13. Pain Management Nurse -Caring is helping growth and actualization of another.
14. Psychiatric Nurse -Caring process develops over time.
15. Trauma Nurse -Supports client's potential and need to grow
16. Travel Nurse
17. Pediatric Nurse Caring as "Helping the Other Grow"
18. Geriatric Nurse Major ingredients of caring:
19. Public Health Nurse -Knowing
20. Oncology Nurse -Alternating rhythms

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 NCM 56 Fundamentals of Nursing Practice Lecture
2nd Sem SY 2020-2021
-Patience
-Honesty
-Trust
-Humility
-Hope
-Courage
Nursing Theories on Caring
Professional discipline- Derived from belief and value
system, the nature of service, and area of knowledge
development
Focus of nursing- Caring in the human health
experience; "Nurturance"
Nurse scholars use literature, research, and nurses'
experiences to develop theories and models of caring
1. Culture Care Diversity and Universality (Leininger)-
Understand different cultures in order to function
effectively
Action–decision care approaches:
a. Preservation of client's familiar lifeways
b. Accommodations that help clients adapt to or
negotiate for satisfying care
c. Repatterning nursing care to help client move toward
wellness
2. Theory of Bureaucratic Caring (Ray)- Caring is
contextual, influenced by organizational structure.
Meaning of caring varies in emergency department,
intensive care unit, oncology unit, etc.
Role and position of staff members
Spiritual-ethical caring influences each branch of
bureaucratic system
3. Caring, the Human Mode of Being (Roach)- Center
of all attributes used to describe nursing
All individuals are caring and develop caring abilities by
being true to self, being real, and being who they truly
are.
Six C's as broad framework
The Six C's of Caring in Nursing:
-Compassion: awareness of one’s relationship to
others, sharing their joys, sorrows, pain, and
accomplishments. Participation in the experience of
another.
-Competence: having the “knowledge, judgement,
skills, energy, experience and motivation required to
respond adequately to the demands of one’s
professional responsibilities.”
-Confidence: comfort with self, client, and others that
allows one to build trusting relationship.
- Conscience: morals, ethics, and an informed sense
of right and wrong. Awareness of personal
responsibility.
-Commitment: the deliberate choice to act in
accordance with one’s desire as well as obligations,
resulting in investment of self in a task or cause.
-Comportment: appropriate bearing, demeanor, dress
and language that are in harmony with a caring
presence. Presenting oneself as someone who
respects others and demands respect.
4. Nursing as Caring (Boykin and Schoenhofer)- Know
people and nurture them; Person as whole and
complete in the moment
- Importance of nurse knowing self; People are not
perfect, but constantly growing and changing.
5. Theory of Human Care (Watson)- Basis for nursing's
role in society
- Commitment to care of the whole person as well as
individuals and groups
>Transpersonal human caring
>Metaphysical
Each person seeks harmony within mind, body, and
soul, actualizing real self.
6. Theory of Caring (Swanson)- One feels a personal
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sense of commitment to a valued "other"
Five caring processes as nursing interventions:
a. knowing- striving to understand an event as it has
meaning in the life of other
b. being with- being emotionally present to the other
c. doing for- doing for the other as he/she would do for
the self if it were at all possible
d. enabling- facilitating the other’s passage through life
transitions and unfamiliar events
e. maintaining belief- sustaining faith in the other’s
capacity to get through an event or transition and face
a future with meaning
Types of Knowledge in Nursing
- Identified by Carper, 2009
- Method for developing each type is unique.
- Integrating all types leads to holistic care.
Types of Knowledge in Nursing
1. Empirical knowing: the science of nursing; From
factual, observable phenomena to theoretical analysis
2. Personal knowing: the therapeutic use of self;
Promotes wholeness, integrity in personal encounter;
Achieves engagement
3. Ethical knowing: the moral component; "Matters of
obligation on what ought to be done"; Beyond
observing code of ethics
4. Aesthetic knowing: the art of nursing; Expressed by
individual nurse's creativity and style in meeting needs
of clients; Care that is effective and satisfying
5. Developing ways of knowing- Methods required for
one pattern cannot be used to develop knowledge
within another pattern.; Effective nurses integrate all
types to understand situations holistically.
Caring Encounters
-Contextual
-Caring responses as varied as clients' needs
-Clients experience: Increased sense of dignity and
self-worth; Expression of feelings of connectedness
Knowing the Client
-Uniqueness
-Physiological variables- Perception of pain; Meaning
of diagnosis, surgery
-Support persons and family
-Increases possibilities for therapeutic interventions to
be perceived as relevant
Nursing Presence
-Mutuality
-Transpersonal caring relationship
-Openness and consciousness of self and client:
Authenticity
- Emotional, physical presence: Responding promptly
Empowering the Client
-Mutual respect, trust, confidence in other's abilities
and motives
-Substitutive care, but no more than is needed at the
time
-Environment in which client can function safely,
effectively
-Advocating
- Mindfulness of professional boundaries
Compassion
-Warm, empathetic
-Concerned
-Requires courage and openness
-Attenuation to spiritual needs
-Comfort: Based on individual's perceptions; Creative,
innovative interventions based on client's preferences
Competence
-Necessary knowledge, judgment, skills, motivation to
respond adequately to client's needs
 NCM 56 Fundamentals of Nursing Practice Lecture
2nd Sem SY 2020-2021
-Understanding of client's condition, treatment, and
associated care
-Ability to assess, plan, implement, and evaluate a plan
of care
-Cognitive, affective, technical, and administrative skills
Maintaining Caring Practice
-Emphasis on meeting others' needs
-Obstacles to self-care
>Professional
>Demands of particular work setting
>Personal: Poor health habits; Unrealistic
expectations of self
Caring for Self
-Care of self is central to care of others.
-Helping oneself grow and self-actualize
-Taking time to nurture oneself
-A healthy lifestyle
>Nutrition
-Making good choices in foods eaten
-Eat regular meals
-Determine healthy weight
- Activity and exercise
Per week: 150 minutes of moderate-intensity or 75
minutes of vigorous aerobic activity
Moderate to high intensity muscle-strengthening 2
or more days
- Recreation: Reward; Spontaneity; Downtime
- Avoiding unhealthy patterns: Thought patterns,
identify negative feelings, Refocus on positive, Positive
affirmations - Mind–body therapies:
>Guided imagery, Imagination as therapeutic tool,
promote relaxation, decrease anxiety, Enhance
psychological, spiritual insight
>Meditation- Focusing mind on present, Relaxation
through deep breathing
>Storytelling-Communicate life experience for
greater understanding, Deeper meaning of clinical
experiences
>Music therapy- Listening, singing, rhythm, body
movement; Can be effective distraction technique
>Yoga- Unites body, mind, spirit; Improves balance,
flexibility, mental alertness, calmness
Reflection on Practice
Reflection: Thinking from a critical point of view;
Analyzing why one acted in a certain way; Assessing
the results of one's action; Thinking about what
happened in a nursing situation; Becoming aware of
how one feels about oneself
Requires discipline, action, openness, trust
Reflective journaling: Partnership with a mentor or
teacher
B. Communicating
Communication- Critical nursing skill used to gather
data, teach and persuade, express caring and comfort;
Interchange of information, ideas, or feelings between
two or more people
Process- To influence; To obtain information
-Includes verbal and nonverbal methods
-Includes self-talk
The Communication Process
1. Sender: Source-encoder; A person or group who
wishes to communicate a message to another
>Encoding- Selecting signs, symbols to transmit
2. Message- The message itself; What is said or
actually written
3. Receiver
The decoder-Relating message perceived to receiver's
storehouse to sort out the meaning
The listener
4. Response- Feedback; Message that receiver returns
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to sender
Modes of Communication
a. Verbal- Uses spoken or written word
Verbal communication
-Pace and intonation
-Simplicity
-Clarity and brevity
-Timing and relevance
-Adaptability
-Credibility
-Humor: Consider client's perceptions
b. Nonverbal-Uses gestures, facial expressions, touch,
and other forms; Makes up majority of communication
Nonverbal communication
-Personal appearance
-Posture and gait
-Facial expression
-Gestures: Consider cultural differences
c. Electronic- Technology such as e-mail
Electronic communication
>E-mail
Advantages: Fast, efficient, provides record, can
improve communication and continuity of care
Disadvantages: Risk to client confidentiality (HIPAA),
Socioeconomics, May not enhance communication
with all
Avoid when information is urgent to client's health,
highly confidential, or potentially distressing or
confusing
E.g., abnormal lab values
>Other guidelines- Agency standards, E-mail consent
form, considered a part of the client's medical record
(May be used as evidence during litigation),
Professional judgment
Factors Influencing the Communication Process
1.Development- Knowledge of client's stage, Varies
across life span
2. Gender- Girls seek confirmation, minimize
differences, and establish intimacy; Boys establish
independence and negotiate status within group.
3. Values and perceptions- Standards that influence
behavior, Personal view of an event
4. Personal space
Intimate (touching to 1-1/2 feet)
Personal (1-1/2 to 4 feet)
Social (4 to 12 feet)
Public (12 to 15 feet)
5. Territoriality- Space, things that individual considers
as belonging to self
6. Roles and relationships- Between sender and
receiver
7. Environment- Most effective communication in
comfortable environment, Privacy
8. Congruence- Verbal and nonverbal aspects of
message match
9. Interpersonal attitudes- Caring and warmth, Respect;
Elderspeak- Similar to baby talk, patronizing to older
adults, Acceptance
10. Boundaries- Limits crucial to nurse–client
relationship; PCA test
Therapeutic Communication
-Promotes understanding
-Establishes constructive relationships
-Attentive listening: Listening actively, mindfully, Listen
for key themes in communication
-Visibly tuning in: Manner of being present to another,
five actions (SOLER: face the person squarely, adopt
open posture, lean toward the person, maintain eye
contact, try to be relatively relaxed or neutral)
Therapeutic Techniques (refer to your books for
description and examples)
1. Using silence
 NCM 56 Fundamentals of Nursing Practice Lecture
2nd Sem SY 2020-2021
2. Providing general leads Facilitating and taking action; Helping client explore
3. Being specific and tentative thoughts, feelings, and actions; Helping client plan a
4. Using open-ended questions program of action to meet pre-established goals;
5. Using touch Exploring and understanding thoughts and feelings
6. Restating or paraphrasing -Empathetic listening and responding
7. Seeking clarification Empathy- Ability to experience, in the present, a
8. Perception checking or seeking consensual situation as another person did at some time in the past
validation -Exploring and understanding thoughts and feelings
9. Offering self >Empathetic listening and responding
10. Giving information -End result of empathy: Comforting and caring for the
11. Acknowledging client; Helping, healing relationship
12. Clarifying time or sequence -Respect
13. Presenting reality -Exploring and understanding thoughts and feelings:
14. Focusing Genuineness, Concreteness, Confronting avoidance
15. Reflecting empathetically
16. Summarizing and planning - Facilitating and taking action: Client must make
decision and take action.; The responsibility belongs to
Barriers to Communication (refer to your books for the client.; Nurse collaborates in these decisions,
description and examples) provides support, and may offer options or information.
Need to be recognized when they occur 4. Termination phase- Nurse and client accept feelings
Major barriers: Failure to listen; Improperly decoding of loss.; Client accepts the end of the relationship
client's intended message; Placing nurse's needs without feelings of anxiety or dependence.
above client's needs
1. Stereotyping Developing Helping Relationships
2. Agreeing and disagreeing -Listen actively
3. Being defensive -Help to identify feelings
4. Challenging -Put yourself in other's shoes
5. Probing -Be honest, genuine, and credible
6. Testing -Use ingenuity
7. Rejecting -Be aware of cultural differences
8. Changing topics and subjects -Maintain confidentiality
9. Unwarranted reassurance -Know your role and limitations
10. Passing judgement
11. Giving common advice Group Communication
Group- Two or more people with shared needs and
The Helping Relationships goals; Exists to help people achieve goals that would
Referred to as: Interpersonal relationships; Therapeutic be unattainable by individual effort alone
relationships
Three basic goals for helping clients: 1. Manage Group Dynamics
problems in living more effectively -Communication between any members of a group,
2. Become better at helping themselves in their affecting the group process
everyday lives, 3. Develop action-oriented prevention -Each member has effect on dynamics.
mentality in their lives -For a group to be effective, it must:
Keys: Development of trust and acceptance; >Maintain a degree of unity, cohesion
Underlying belief that the nurse cares about and wants >Develop, modify structure to improve effectiveness
to help the client >Accomplish its goals

Factors influencing helping relationships Types of Health Care Groups

-Age, sex 1. Task groups- Focus is completion of a certain task
-Appearance -Leader (chairperson) must be expert in the area of
-Diagnosis emphasis.
-Education -Target date for termination usually set
-Values 2. Teaching Groups-Impart information to participants
-Ethnic and cultural background -Nurse must be skilled in teaching–learning process.
-Personality 3. Self-help groups- Small, voluntary, composed of
-Expectations those who share a similar problem
-Setting - Available for range of problems, such as Alcoholics
Anonymous
Phases of the Helping Relationship 4. Self-awareness/growth groups- Develop, use
1. Preinteraction phase-Obtain information before first interpersonal strengths
face-to-face meeting: Name, address, age, medical - Improve individual's functioning in group to which they
history, and/or social history return
-Anxious feelings in nurse addressed by identifying 5. Therapy groups- Self-understanding
specific information to be discussed - Satisfactory ways of handling stress
-Positive outcomes can evolve. -Changing patterns of behavior toward health
2. Introductory phase- Orientation phase: Sets tone for 6. Work-related social support groups- Buffer high
rest of the relationship, develop trust and security, levels of vocational stress
getting to know each other, Resistive behaviors may be - Sharing joys of success, frustration of failure without
displayed-Inhibit involvement, cooperation, or change judgment
- Resistance can be overcome with:
>Caring attitude Assessing
>Genuine interest Impairments to communication:
>Competence -Language deficits
3. Working phase- View each other as unique -Sensory deficits
individuals; Once caring develops, empathy increases.; -Cognitive impairments
Exploring and understanding thoughts and feelings; -Structural deficits

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 NCM 56 Fundamentals of Nursing Practice Lecture
2nd Sem SY 2020-2021
-Paralysis in writing.
Style of communication: >Physicians are taught to be brief, to the point, and
-Verbal focused.
>Whether pattern is slow, rapid, quiet, etc. -Impatience may result.
>Vocabulary of individual SBAR approach describes:
>Presence of hostility, aggression, assertiveness, - Situation
reticence, anxiety - Background
>Difficulties such as slurring, stuttering - Assessment
>Refusal or inability to speak -Recommendations
-Nonverbal
Emotional intelligence
Diagnosing -Forming work relationships with colleagues
Impaired Verbal Communication- Not used when -Displaying maturity in a variety of situations
caused by a psychiatric illness - Resolving conflicts while taking into consideration
Anxiety the emotions of others
Powerlessness - Being approachable, easygoing
Situational Low Self-Esteem
Social Isolation Assertive communication
Impaired Social Interaction -Promotes client safety by minimizing
miscommunication with colleagues
Planning -Honest, direct, and appropriate; open to ideas
-Determine outcomes - Respects rights of others
-Plan ways to promote effective communication - "I" statements, not "you" statements
>Impaired Verbal Communication- Outcome to - "You" statements place blame and put the listener in
reduce or resolve factors impairing communication a defensive position.
-Specific nursing interventions planned for the stated - "I" statements encourage discussion.
etiology
Nonassertive communication
Implementing -Submissive communication
-Manipulate the environment >Allowing one's own rights to be violated by others
-Provide support >Meeting the demands and requests of others
-Employ measures to enhance communication without regard to own feelings and needs
-Educate the client and support persons >Believing own feelings are not important
>Being insecure and trying to maintain self-esteem
Evaluating by avoiding conflict
-Client communication: Listen actively; Observe - Aggressive communication
nonverbal cues; Use therapeutic communication skills >Can be blaming and delivered in a rushed manner
-Nurse communication >Becomes ineffective and leads to frustration for the
>Use of process recording nurse and physician
: A verbatim account of a conversation
: Analyzed in content and meaning of interaction C. Teaching
-Increases awareness and insight Health promotion- A philosophy of wholeness,
-Identify strengths and need for future skills wellness, and well-being
development Enhanced when nurses understand:
-Individuality
Communication among Health Professionals -Holism
Effective communication is important among health -Homeostasis
professionals. -Human needs
Problems cause of most client errors
Outrageous behavior still common in health care Individual Health
facilities -Total character: Behaviors, emotional state, attitudes,
values, motives, abilities, habits, and appearances
Disruptive Behaviors - Self-identity: Perception of self as separate, distinct
Incivility: Rudeness, discourtesy, disrespect entity alone and in interactions
Lateral violence: Negative physical, verbal, nonverbal, -Perceptions: How person interprets environment
or emotional behaviors directed at co-workers at same
organizational level Concept of Individuality
Bullying -Each individual is unique.
>Offensive, abusive, intimidating, insulting behavior -Total care context: All the principles that apply when
or abuse of power taking care of clients of that age and condition
>Recipient feels upset, threatened, humiliated, or - Individualized care context: Using total care principles
vulnerable. that apply to the particular individual at the present time
>Occurs repeatedly for at least 6 months
Concept of Holism
Responding to Disruptive Behaviors Explores how one area of concern relates to the whole
- Establish expectation of mutual respect person
-Raise awareness of and identify disruptive behaviors Concerned with individual as a whole, not an assembly
-Increase communication skills: Be as proficient as in of parts or systems
clinical skills Considers relationship of individuals to environment
-Provide training in conflict management and to others
-Establish zero tolerance for disruptive behaviors Interventions directed toward restoring overall harmony
-Model respectful, ethical behavior
Concept of Homeostasis
Nurse and Physician Communication Physiological homeostasis
Communication styles -Self-regulatory: Automatic in the healthy person
>Nurses are taught to be descriptive both verbally and -Compensatory mechanism: Counteract conditions that

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 NCM 56 Fundamentals of Nursing Practice Lecture
2nd Sem SY 2020-2021
are abnormal for the person
-System: Set of interacting, identifiable parts
-Boundary: Real or imaginary line that differentiates
one system from another system or a system from its
environment
- Closed system: Does not exchange energy, matter, or
information with environment
-Open system: Sharing across boundaries
-Input: Information, material, or energy that enters the
system
-Throughput: After input absorbed, processed in a way
useful to the system
-Output: Energy, matter, information given out by
system as a result of its processes
-Negative feedback, positive feedback
-Interventions to maintain or regain homeostasis
Feedback- Occurs when output of a system is return to
the system as input
-Negative feedback inhibits change.
-Positive feedback stimulates change.
Psychological homeostasis
-Emotional or psychological balance, mental well-being
Prerequisites:
>Stable physical environment
>Safety and security
>Stable psychological environment
>Development of trust and love
> Social environment: Healthy role models
>Life experiences that provide satisfactions
Assessing the Health of Individuals
-Thorough assessment basic to health promotion
-Health history and physical examination
-Physical fitness assessment
-Lifestyle assessment
-Health risk appraisal
-Health beliefs review
-Life-stress review
Applying Theoretical Frameworks
Needs theories
1. Maslow's five levels of human needs- Ascending
order
-Physiological needs
-Safety and security needs
-Love and belonging needs
-Self-esteem needs
-Self-actualization needs
-Needs Theories
2. Kalish's hierarchy of needs- Adapted Maslow, Added
stimulation needs
Characteristics of basic needs
-People meet own needs relative to own priorities
-Some needs can be deferred, such as independence
when ill
-Failure to meet needs results in one or more
homeostatic imbalances
-Need itself felt by external, internal stimuli
-Person who receives a need can respond in several
ways to meet it
-Needs interrelated
-Needs can be satisfied in healthy and unhealthy ways.
Developmental Stage Theories
-Describe typical behaviors within a certain age group
-Explain the significance of those behaviors
-Predict behaviors that might occur in a given situation
-Provide rationale to control behavioral manifestations
-Can be used in parental and client education,
counseling, and anticipatory guidance
Healthy People 2020
Belief that individual health and community health are
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closely linked
Partnerships important to improve individual and
community health: Business, local government, and
civic, professional, and religious organizations
Defining Health Promotion
Three levels of prevention
1. Primary- Focuses on health promotion, protection
against specific health problems
2. Secondary- Focuses on early identification and
prompt intervention for health problems
3. Tertiary- Focuses on restoration and rehabilitation;
Goal to return individual to optimal level of functioning
Health promotion- Behavior motivated by desire to
increase well-being and actualize human health
potential
Disease prevention or health protection- Behavior
motivated by desire to actively avoid illness, detect it
early, or maintain functioning with constraints of illness
Sites for Health Promotion Activities
Various settings for programs
-Home
-Community setting: Groups of older adults
-Schools
-Hospitals
-Worksites
Health Promotion Model
-Competence or approach-oriented model
-Motivation for behavior change: Based on individual's
subjective value of the change
Individual Characteristics and Experiences
-Personal factors: Biologic, Psychological,
Sociocultural
-Prior related behaviors: Previous experience,
knowledge, and skill in health-promoting actions; How
to overcome “hurdles”
Behavior-Specific Cognitions and Affect
-Perceived benefits of action
-Perceived barriers to action
-Perceived self-efficacy
-Activity-related affect
-Interpersonal influences
-Situational influences
Commitment to a Plan of Action
Commitment- Alone often results in “good intentions”
and not actual performance of behavior
Identifying specific strategies for carrying out and
reinforcing behavior
Immediate Competing Demands and Preferences
Competing demands- Behaviors over which individual
has a low level of control
Individual's ability to be self-regulating or not “give in”
Behavioral Outcome
Health promoting behaviors should result in:
-Improved health
-Enhanced functional ability
-Better quality of life at all stages of development
Stages of Health Behavior Change
1. Precontemplation stage- Person does not think
about changing behavior in the next 6 months
2. Contemplation stage- Person acknowledges having
a problem; Verbalization of plans to change behavior in
the near future
3. Preparation stage- Person intends to take action in
the immediate future
4. Action stage- Person actively implements behavioral,
cognitive strategies of action plan
5. Maintenance stage- Person strives to prevent
 NCM 56 Fundamentals of Nursing Practice Lecture
2nd Sem SY 2020-2021
relapse; Estimated to last 6 months to 5 years
6. Termination stage- Point at which individual has Implementing
complete confidence that problem no longer a Provide and facilitate support
temptation or threat; Some behaviors may never reach -Individual counseling sessions
this stage. -Telephone or internet counseling
-Group support
The Nurse's Role in Health Promotion -Facilitating social support
-Model healthy lifestyle -Providing health education
-Facilitate client involvement -Enhancing behavior change
-Teach self-care strategies -Modeling
-Assist individuals, families, and communities to
increase levels of health Evaluating
-Educate clients to be effective health care consumers: Ongoing process
Avoidance of misinformation Client actions may include:
-Assist clients to develop and choose health-promoting -Continuing the plan
options -Reordering priorities
-Guide development of effective problem solving and -Changing strategies
decision making -Revising the contract
-Reinforce clients' personal and family health- Collaborative effort
promoting behaviors
-Advocate in the community for changes that promote
a healthy environment
Prepared by: Hannah Angelie M. Rey,RN
Nursing Management
Assessing
Health history and physical examination-Age of
individual must be considered; Nutritional assessment “Always pass on what you have
Physical fitness assessment- Muscle endurance, learned.’’- Yoda
flexibility; Body composition; Cardiorespiratory
endurance
Lifestyle assessment- Physical activity; Nutritional
practices; Stress management; Habits such as drug
use
Spiritual health assessment- Beliefs can affect a
person's interpretation of events in his or her life.
Social support system review- Individuals and groups;
Evaluate adequacy
Health risk assessment-Indicates individual's risk for
disease or injury during the next 10 years
Health beliefs review- Locus of control
Life-stress review- Impact of stress on mental and
physical well-being; Life-Change Index
Validating assessment data- Verbally review, validate,
and summarize information with the client

Diagnosing
Wellness diagnoses can be applied at all levels of
prevention.
Useful for healthy clients who require teaching
Provide clear focus for planning interventions without
indicating a problem exists
Health promotion modifier- Readiness for Enhanced

Planning
Based on needs, desires, and priorities of the client
Client decides on:
-Goals
-Activities or interventions to achieve goals
-Frequency and duration of activities
-Method of evaluation
Involves nurse and client
Steps in planning:
-Review and summarize assessment data
-Reinforce strengths and competencies
-Identify health goals
-Identify behavioral outcomes
-Develop a behavior-change plan
-Reiterate benefits of change
- Address environmental and interpersonal
facilitators and barriers
- Determine a time frame
-Formalize commitment to behavior-change plan

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