Fundamentals

of Nursing

Dannah Louise O. Palanca


Concept of Man, Health, and Illness
Terms
● Health - a state of complete physical, mental, and social
well-being, not merely the absence of disease or infirmity
● Illness - the unique response of a person to a disease; an
abnormal process involving changed level of functioning
○ Acute Illness - Generally has a rapid onset of
symptoms and lasts only a relatively short time Ex.
appendicitis, pneumonia, diarrhea, common cold
○ Chronic Illness - A broad term
encompassess many di erent physical and mental
alteration in health
● Disease - medical term, referring to pathological changes in
structure or function of the body or mind
● Wellness - an active state of being healthy by living a
lifestyle promoting good physical, mental, and emotional
health
Concepts of Health and Wellness:
● Health
○ Health is traditionally defined by the World Health
Organization (1974) as a state of complete
physical, mental, and social well-being, not merely
the absence of disease or infirmity.
○ Public health measures include morbidity
(frequency of disease) and mortality (death rates).
○ Personal health definitions vary based on
individual feelings, symptom presence, or ability to
perform daily activities.
○ Personal health perceptions are influenced by
individual values, beliefs, family, culture,
community, and society.
● Wellness
○ Wellness, often used interchangeably with health,
is an active state of achieving good physical,
mental, and emotional health.
○ Dunn (1977) described wellness as functioning to
one's maximum potential while maintaining
balance and a purposeful direction, di erentiating
it from the passive state of good health.
○ Wellness involves being, belonging, becoming, and
befitting as processes in one's perception of their
wellness state.
Concepts of Illness and Disease:
● Disease refers to pathologic changes in the body or mind,
with various causes listed in medical literature.
that ● Illness is the individual's response to disease, characterized
by a change in functioning and influenced by personal and
cultural factors.
● The distinction between disease (medical diagnosis) and
illness (personal experience) emphasizes the role of nurses
in caring for the person, not just the disease.
● Diseases and illnesses can coexist; for instance, an individual
can have both acute (short-term) and chronic (long-term)
illnesses simultaneously.
Classifications of Illness:
● Acute Illness:
○ Rapid onset of symptoms, lasting a short time.
○ Includes life-threatening and non-life-threatening
conditions.
○ Treatment may involve medication, surgery, or
other medical interventions to restore normal
functioning.
● Chronic Illness:
○ Broad term for physical and mental health
alterations.
○ Characteristics include permanence, irreversible
alterations in anatomy or physiology, need for
special education for rehabilitation, and long-term
care or support.
○ Often has a slow onset and can have periods of
remission and exacerbation.
CONCEPT OF MAN CONCEPTS OF HEALTH, WELLNESS, AND WELL-BEING

Bio-psycho-socio-spiritual human being ● Health was defined in terms of the presence or absence of
disease.
● Man is a BIOPSYCHOSOCIAL and SPIRITUAL being who is in
● Health as a state of being well and using every power the
constant contact with the environment.
individual possesses to the fullest extent. Florence
● As a biologic being, man is like other men.
Nightingale (1860/1969)
● As a psychologic being, man is like no other man.
● Health has also been defined in terms of role and
● As a social being, man is like some other man.
performance. Talcott Parsons (1951)
● As a spiritual being, man is like all other men.
● "Health is not a condition; it is an adjustment. It is not a
● Man is composed of subsystems and suprasystems.
state but a process. The process adapts the individual not
● Man is a unified whole composed of parts which are
only to our physical but also our social environments" U.S.
interdependent and interrelated with each other.
President's Commission on Health Needs of the Nation
● Man is composed of parts which are greater than and
(1953)
di erent from the sum of all his parts.
● "Health as a state of complete physical, mental, and social
well-being, and not merely the absence of disease or
Four Major Attributes of a Human Being
infirmity." (WHO) (1948)
1. The capacity to think or conceptualize on the abstract level. ● "Health and illness are human experiences. The presence of
2. Family formation illness does not preclude health, nor does optimal health
3. The tendency to seek and maintain territory preclude illness" ANA (2010)
4. The ability to use verbal symbols as language, a means of
PERSONAL DEFINITIONS OF HEALTH
developing and maintaining culture

● Being free from symptoms of disease and pain as much as

Basic Human Needs
possible
● Each individual has a unique characteristic but certain needs ● Being able to be active and to do what they want or must
are common to all people. ● Being in good spirits most of the time.
● Human needs are physiologic and psychologic conditions ● Definitions vary according to an individual's previous
that an individual must meet to achieve a state of experiences, expectations of self, age, and sociocultural
well-being. influences.
● A person's definition of health influences behavior related to
Human Needs health and illness.

● Necessary, useful, or desirable to maintain wellbeing & life; WELLNESS AND WELL-BEING
motivation for behavior.
● May be met consciously or unconsciously ● Environmental
● Characteristics of Basic Human Needs: ● Social
○ Needs are universal. ● Occupational
○ Needs may be met in di erent ways. ● Intellectual
○ Needs may be deferred. ● Emotional
○ Needs may be interrelated. ● Physical
● An unmet human need results in disruption of normal body ● Spiritual
activities and frequently leads to eventual illness.
MODELS OF HEALTH AND WELLNESS Agent-Host-Environment Model

● clinical model ● The agent-host-environment model of health and illness, also

● the role performance model called the ecologic model.
● the adaptive model ● The model is used primarily in predicting illness rather than
● the eudaimonistic model in promoting wellness.
● the agent-host-environment model ● The model has three dynamic interactive elements:
● Health-illness continua 1. Agent
2. Host
Clinical Model
3. Environment

● The narrowest interpretation of health occurs in this model.

Health-Illness Continua
● People are viewed as physiological systems
● It is considered the state of not being "sick." ● Health-illness continua (grids or graduated scales) can be
used to measure a person's perceived level of wellness.
Role Performance Model
● Health and illness or disease can be viewed as the opposite
ends of a health continuum.
● Health is defined in terms of an individual's ability to fulfill
societal roles.
Illness-Wellness Continuum
● According to this model, people who can fulfill their roles
are healthy even if they have clinical illness. ● ranges from optimal health to premature death
● It is assumed in this model that sickness is the inability to ● The model illustrates arrows pointing in opposite directions
perform one's work role. and joined at a neutral point. Movement to the right of the
neutral point indicates increasing levels of health and
Adaptive Model
wellness for an individual.
● In contrast, movement to the left of the neutral point
● In the adaptive model, health is a creative process; disease
indicates progressively decreasing levels of health.
is a failure in adaptation, or maladaptation.
● According to this model, extreme good health is flexible
VARIABLES INFLUENCING HEALTH STATUS, BELIEFS, AND
adaptation to the environment and interaction with the
PRACTICES
environment to maximum advantage.
● Health status - state of health of an individual at a given
Eudaimonistic Model
time
● Health beliefs - concepts about health that an individual
● The eudaimonistic model incorporates a comprehensive view
believes are true.
of health.
● Health behaviors - The actions people take to understand
● Health is seen as a condition of actualization or realization of
their health state, maintain an optimal state of health,
a person's potential.
prevent illness and injury, and reach their maximum physical
● In this model the highest aspiration of people is fulfillment
and mental potential
and complete development, which is actualization.
● Internal Variables
● Illness, in this model, is a condition that
○ Biologic dimension
prevents self-actualization.
○ Psychological dimension
○ Cognitive dimension
○
O
 ● External variables ILLNESS AND DISEASE
○ Environment
● Illness is a highly personal state in which the person's
○ Standards of living
physical, emotional, intellectual, social, developmental, or
○ Family and cultural beliefs
spiritual functioning is thought to be diminished.
○ Social support networks
● Disease can be described as an alteration in body functions
HEALTH BELIEF MODELS resulting in a reduction of capacities or a shortening of the
normal life span.
● Health Locus of Control Model
● Etiology - the causation of a disease or condition
○ is a concept from social learning theory that
● Remission - when the symptoms disappear
nurses can use to determine whether clients are
● Exacerbation - when the symptoms reappear
likely to take action regarding health, that is,
○ Nurses are involved in caring for chronically ill
whether clients believe that their health status is
individuals of all ages in all types of settings.
under their own or others' control.
○ Care needs to be focused on promoting the
● Rosenstock and Becker's Health Belief Models
highest level possible of independence, sense of
○ Individual perceptions
control, and wellness.
○ Modifying factors
○ Clients often need to modify their activities of
○ Likelihood of action
daily living, social relationships, and perception of
self and body image.
HEALTH CARE ADHERENCE
○ In addition, many must learn how to live with
● Adherence is the extent to which an individual's behavior (for increasing physical limitations and discomfort.
example, taking medications, following diets, or making
Illness Behaviors
lifestyle changes) coincides with medical or health advice
● Factors Influencing Adherence
● coping mechanism, involves ways individuals describe,
○ motivation
monitor, and interpret their symptoms, take remedial
○ lifestyle change
actions, and use the health care system.
○ perceived severity
○ beliefs Talcott Parsons' Sick Role Theory (1951)
○ cost of therapy
Rights:
● When a nurse identifies nonadherence, it is important to
take the following steps:
1. Clients are not held responsible for their condition. Even if
○ Establish why the client is not following the
the illness was partially caused by an individual's behavior.
regimen.
2. Clients are excused from certain social roles and tasks.
○ Demonstrate caring.
3. Clients has right to be taken care of
○ Encourage healthy behaviors through positive
reinforcement. Obligations:
○ Use aids to reinforce teaching.
○ Establish a therapeutic relationship of freedom, 1. Clients are obliged to try to get well as quickly as possible.

mutual understanding, and mutual responsibility 2. Clients or their families are obliged to seek competent help.

with the client and support persons.

Edward A. Suchman's 5 stages of illness
● Stages of Illness
● Stage 1 - Symptom experience
● Stage 2 - Assumption of sick role
● Stage 3 - Medical care contact
● Stage 4 - Dependent client care
● Stage 5 - Recovery or rehabilitation
E ects of Illness
● Impact on the client.
○ body image or physical appearance
○ self-esteem and self-concept
○ dependence on others
○ unemployment, financial problems
○ inability to participate in social functions
● impact on the family
○ Role changes
○ Increased stress
○ Financial problems
○ Loneliness as a result of separation and pending
loss
○ Change in social customs.
● Nurses need to help clients express their thoughts and
feelings, and to provide care that helps the client e ectively
cope with change.
● Nurses need to support clients' right to self-determination
and autonomy as much as possible by providing them with
su cient information to participate in decision-making
processes and to maintain a feeling of being in control.
● Nurses can help clients adjust their lifestyles
Concept of Man, Health, and Illness
● Concept of Man: Nursing theories often view the concept
of man (or humans) from a holistic perspective, emphasizing
the integration of physical, psychological, social, and
spiritual dimensions. This holistic view is crucial for nursing,
as it guides nurses to care for patients not just in terms of
their physical health but considering their entire being and
context.
● Health: Health is typically defined more broadly than the
mere absence of disease. The World Health Organization
(WHO) describes health as a state of complete physical,
mental, and social well-being. In nursing, health is seen as a
dynamic and continuous adjustment process to the changing
demands of living and is significantly influenced by both
internal and external factors.
● Illness: Illness, in contrast, refers to the personal,
interpersonal, and cultural reaction to disease or discomfort.
It is not just a physical phenomenon but also has
psychological, social, and sometimes spiritual dimensions.
The perception of illness varies widely among individuals and
communities, influenced by cultural norms and personal
experiences.
Factors and Issues A ecting Health and Illness
● Biological Factors: Genetic predispositions, age, and sex
are among the biological factors that can influence health
and illness. For example, some genetic conditions can make
an individual more susceptible to certain diseases.
● Environmental Factors: Environmental factors include the
physical, social, and economic environments in which people
live. These can range from air and water quality to access to
healthcare and educational opportunities.
● Lifestyle Factors: Personal behaviors and lifestyle choices,
such as diet, exercise, smoking, and alcohol consumption,
significantly impact health and the risk of developing various
illnesses.
● Psychosocial Factors: Mental health, stress levels, social
connections, and support systems play crucial roles in
overall health and well-being. Chronic stress, for example,
has been linked to a variety of health issues.
● Cultural Factors: Cultural beliefs and practices can
influence health behaviors, perceptions of illness, and
decisions about seeking care. Cultural competency in
nursing is vital to address these factors e ectively.
Nursing as a Profession
● Specialized Body of Knowledge: Nurses are required to
have a broad and deep knowledge base acquired through
rigorous academic and practical education.
 ● Autonomy in Practice: While working within
interdisciplinary teams, nurses exercise autonomy in their
decision-making and practice, grounded in professional
standards and ethical principles.
● Commitment to Service: Nursing is fundamentally
oriented towards the welfare of patients and communities,
emphasizing compassion and ethical service.
● Standards for Entry and Practice: Entry into the nursing
profession requires meeting specific educational and
licensure standards. Continuous professional development is
also a requirement to maintain competence.
Fields of Nursing
● Code of Ethics: Nurses adhere to a professional code of
ethics that guides their decisions and actions, emphasizing
respect for individuals, commitment to patient care, and
integrity in practice.
Nursing as Science and Art
● Science of Nursing: The scientific aspect of nursing
involves the application of evidence-based knowledge to
understand health and illness, guide clinical judgment, and
provide e ective care. It encompasses understanding of
biological sciences, social sciences, and pharmacology,
among others, in the context of health care.
● Art of Nursing: The art of nursing is reflected in the
skillful, empathetic, and culturally sensitive application of
knowledge to care for patients. It involves the ability to
communicate e ectively, build therapeutic relationships, and
tailor interventions to meet the unique needs of individuals
and families.
Personal and Professional Qualities of a Nurse
● Compassion and Empathy: The ability to understand and
share the feelings of others is central to providing
patient-centered care.
● Communication Skills: E ective communication with
patients, families, and healthcare team members is crucial
for ensuring quality care and coordination.
● Critical Thinking and Problem-Solving: Nurses must be
able to assess complex situations, make informed decisions,
and implement solutions in a dynamic healthcare
environment.
● Adaptability and Flexibility: The ability to adapt to
changing conditions and needs is vital in the fast-paced
world of healthcare.
● Ethical Integrity: Nurses are often faced with ethical
dilemmas and must act with integrity, adhering to ethical
principles and the professional code of conduct.
● Leadership and Teamwork: While nurses work
autonomously, they also function as integral members of the
healthcare team, requiring leadership skills and the ability to
collaborate e ectively.
1. Medical-Surgical Nursing
● Focuses on providing care to adult patients with a
variety of medical issues or who are undergoing
surgical procedures. Nurses in this field need a
broad knowledge base to manage di erent health
conditions and collaborate closely with the
healthcare team.
2. Pediatric Nursing
● Specializes in caring for children, from infants to
adolescents, in health and illness. Pediatric nurses
must understand the unique physiological and
psychological needs of children and communicate
e ectively with both young patients and their
families.
3. Obstetric/Gynecologic Nursing
○ Also known as OB/GYN nursing, this field focuses
on women's health, including childbirth,
postpartum care, and gynecological health. Nurses
work in settings such as hospitals, birthing
centers, and outpatient care clinics.
4. Psychiatric-Mental Health Nursing
● Involves caring for patients of all ages with mental
illnesses or behavioral disorders. This specialty
requires strong therapeutic communication skills
and an understanding of psychiatric conditions and
their treatments.
5. Critical Care Nursing
● Provides care to patients with life-threatening
Healt Car Deliver Syste i
conditions, often in intensive care units (ICU). th Philippine
● Critical care nurses must have advanced skills in
monitoring vital signs, using life-support ● It encompasses various levels of care, facilities, and
equipment, and making rapid decisions. professionals working in both the public and private sectors,
6. Emergency Nursing aimed at promoting, maintaining, and restoring health
○ Emergency nurses work in emergency among Filipinos.
departments, providing care for patients with ● The system is structured to ensure that comprehensive,
acute injuries or illnesses. This field requires the equitable, and accessible healthcare is available to all
ability to triage and prioritize care quickly under citizens, regardless of their geographical location or
pressure. economic status.
7. Gerontological Nursing
● Focuses on caring for the elderly, addressing the Levels of Care:
complex health issues associated with aging.
1. Primary Care: This is the first point of contact for
● Gerontological nurses work in various settings,
individuals, families, and communities, providing a broad
including long-term care facilities, hospitals, and
range of preventive, promotive, curative, and rehabilitative
community-based services.
services. Services are delivered through barangay (village)
8. Oncology Nursing
health stations, rural health units, and private clinics.
● Specializes in the care of patients with cancer.
2. Secondary Care: O ers specialized medical services,
Oncology nurses support patients through
typically provided in district hospitals and private hospitals.
diagnosis, treatment, symptom management, and
It requires a referral from a primary care provider.
palliative care.
3. Tertiary Care: Provides highly specialized care and is
9. Community/Public Health Nursing
usually delivered in regional, specialty, and private hospitals
○ Focuses on promoting and protecting the health of
equipped with advanced medical technology.
populations. This field involves working in the
community to educate about health issues, It is large, complex, multi-level and multidisciplinary
advocate for health policies, and provide services consisting of:
to prevent disease and improve health outcomes.
● Public Sector
10. Nurse Practitioner (NP)
○ This sector is primarily government-funded and
○ NPs are advanced practice registered nurses
managed. It includes a network of health facilities
(APRNs) who provide a range of healthcare
ranging from barangay (village) health stations,
services, including diagnosing and treating
rural health units, and city health o ces at the
illnesses, prescribing medications, and managing
primary care level to district, provincial, and
patient care. NPs may specialize in areas such as
tertiary hospitals.
family practice, pediatrics, or psychiatric-mental
○ The Department of Health (DOH) is the main
health.
governing body responsible for overseeing the
implementation of national health policies,
programs, and services.
 ○ The public healthcare system aims to provide
accessible and a ordable healthcare services,
especially to the underprivileged and those living
in remote areas.
○ PhilHealth, the national health insurance program,
plays a significant role in the public health sector
by ensuring that Filipinos have access to
healthcare services without financial hardship.
● Private Sector
○ The private sector includes privately owned
facilities such as clinics, hospitals, and specialty
centers. It operates alongside the public sector
and caters to a wide range of healthcare needs.
○ The services in the private sector are generally
considered to be of higher quality and more
e cient but come at a higher cost, making them
less accessible to the low-income population.
○ Private healthcare providers range from small
clinics to large medical centers equipped with
advanced medical technologies. Many Filipinos
with the financial means or private health
insurance opt for private healthcare services for
their medical needs
Public Sector
1. Department of Health (DOH): The DOH is the principal
health agency in the Philippines, responsible for ensuring
access to basic public health services to all Filipinos. It
formulates health policies, regulations, and standards;
provides health services and technical support; and enforces
laws on health. The DOH also oversees public hospitals and
health facilities.
2. Philippine Health Insurance Corporation (PhilHealth):
PhilHealth is a government-owned and controlled
corporation that administers the National Health Insurance
Program (NHIP). It aims to provide health insurance
coverage and ensure a ordable, acceptable, available, and
accessible health care services for all citizens of the
Philippines.
3. Local Government Units (LGUs): Health services at the
local level are partly managed by LGUs, including provinces,
cities, and municipalities. They are responsible for operating
public health centers, rural health units (RHUs), and
barangay (village) health stations. LGUs play a critical role in
delivering primary healthcare services and implementing
public health programs in their respective areas.
4. Government Hospitals: These are hospitals funded and
operated by the government, ranging from primary to
tertiary care facilities. They provide a wide range of health
services, from preventive to curative and rehabilitative
services, to the general public at minimal or no cost.
Examples include the Philippine General Hospital (PGH),
regional and provincial hospitals.
5. Rural Health Units (RHUs) and Barangay Health
Stations (BHS): RHUs serve as the primary public health
care facilities in municipalities, providing outpatient
services, maternal and child health care, immunization, and
basic medical services. BHS, on the other hand, are
community-based health units managed by barangays,
o ering basic health care services and serving as the first
point of contact for health care in rural areas.
6. Specialty Hospitals and Centers: The government also
operates hospitals and centers that specialize in specific
areas of health, such as the Philippine Heart Center, Lung
Center of the Philippines, and the National Kidney and
Transplant Institute. These institutions provide specialized
care and conduct research in their respective fields.
Private Sectors
1. Private Hospitals and Medical Centers: These are
healthcare institutions owned and operated by private
entities or individuals. They o er a broad spectrum of
medical services, ranging from general healthcare to
specialized treatments and surgeries. Private hospitals are
known for having more modern facilities and shorter waiting
times compared to public hospitals, but they also tend to be
more expensive.
2. Private Clinics and Specialty Clinics: These facilities are
often operated by individual healthcare providers or groups
of specialists. They provide outpatient services in various
medical fields such as pediatrics, obstetrics and gynecology,
cardiology, and many others. Some specialty clinics focus on
specific treatments like dialysis centers, cosmetic surgery
clinics, and dental clinics.
3. Health Maintenance Organizations (HMOs): HMOs o er
prepaid health plans that provide members access to a
network of healthcare providers, including doctors,
hospitals, and clinics. These organizations contract with
healthcare providers and medical facilities to create a
healthcare network for their members, o ering them a range
of services at predetermined rates.
4. Pharmaceutical Companies: This sector includes
companies involved in the research, development,
production, and marketing of medications and
pharmaceutical products. They play a crucial role in the
healthcare system by providing essential drugs and vaccines
needed for treating various diseases and conditions.
5. Medical Laboratories and Diagnostic Centers: These
facilities o er a wide range of diagnostic services such as
blood tests, imaging tests (e.g., X-rays, MRIs, CT scans), and
other medical examinations. They are crucial for the
accurate diagnosis and management of illnesses.
6. Professional Medical Associations: These are
organizations composed of health professionals who work
together to improve healthcare standards, provide
continuing education for members, and advocate for the
welfare of healthcare providers and patients.
7. Private Practice Professionals: Many healthcare
professionals, including doctors, nurses, therapists, and
dentists, operate private practices. They may provide
services in their clinics or o er consultations in private
hospitals and medical centers.

Histor of Nursin
Early Civilizations to the 16th Century:
● Illness was often attributed to supernatural causes, with
treatment involving rituals to dispel evil spirits.
● The role of the nurse, often a family member providing care
and herbal remedies, was distinct from that of the medicine
man.
● Ancient Greeks and Hebrews linked health with religious and
ethical conduct, leading to organized caregiving and the
foundation of nurse-midwifery.
● Early Christian period saw formalization of nursing roles,
with deaconesses and religious orders providing care,
leading to the establishment of hospitals during the
Crusades.
Florence Nightingale and Modern Nursing:
● The 19th and 20th centuries marked a shift to modern
nursing, significantly influenced by Florence Nightingale.
● Nightingale, opposing her a uent family's expectations,
trained as a nurse and made notable contributions during
the Crimean War.
● She established the first training school for nurses, authored
healthcare books, and laid the groundwork for professional
nursing.
● Contributions include identifying patient needs and the
nurse's role, setting hospital management standards,
establishing nursing as a respected profession and
education, emphasizing nutrition and therapeutic activities,
advocating for continuing education, and initiating the
practice of maintaining accurate records for nursing
research.
Legacy and Development:
● Nightingale's work helped to elevate the status of women
and nurses, distinguishing nursing from medicine.
● The establishment of nursing education and recognition of
the profession's importance to health and illness care
continue to influence contemporary nursing practices.
● Historical and monumental moments in nursing, alongside
key figures in its early development, highlight the
profession's evolution and its foundational documents and
contemporary leaders are acknowledged in further
discussions and reports, such as the WHO's State of the
world's nursing 2020.
Development of Nursing from the 19th to 21st
Centuries
● 19th Century and Earlier: Nursing, influenced by Florence
Nightingale and the Civil War, highlighted the need for
educated nurses. Early nursing education, tied to hospitals,
largely followed an apprenticeship model lacking clear
educational standards, and was influenced by economic
interests of hospitals, male dominance in healthcare, and
societal views on women's roles.
● World War Il Impact: The war catalyzed changes for
women and nursing. Women's increased independence and
societal shifts towards education led to a demand for more
nurses and expanded roles due to medical and technological
advancements. Post-war, nursing education moved towards
university and college settings, promoting degrees for a
diverse nursing workforce
● Broadening of Nursing Roles: Nursing roles have
diversified beyond direct patient care to include setting
practice standards, developing quality assurance, and
managing complex care systems. Nursing operates as an
independent discipline, not merely auxiliary to medicine.
● 21st Century Nursing Education: Emphasizes diversity,
equity, inclusion, and addresses contemporary healthcare
needs across four spheres: wellness and disease prevention,
chronic disease management, regenerative/restorative care,
and hospice/palliative care. The American Association of
Colleges of Nursing (AACN) underscores the importance of
preparing nurses for these broad roles, highlighting the need
for systems-based practice, informatics, and continuous
learning.
 ● Future Vision for Nursing: The AACN's "The Essentials: 4. Client Advocate: Protecting clients' interests by
Core Competencies for Professional Nursing Education" representing their needs and wishes to other healthcare
document outlines a vision for nursing education that is professionals, assisting them in exercising their rights and
responsive to current trends, advocating for a workforce that speaking up for themselves.
is "work ready" and capable of addressing diverse healthcare 5. Counselor: O ering support to help clients cope with
needs through lifelong learning and adaptation to emerging psychological or social problems, develop better
healthcare challenges. interpersonal relationships, and promote personal growth by
exploring alternative behaviors and developing a sense of
Four Spheres of Nursing Care control.
6. Change Agent: Assisting clients in modifying behaviors and
● Wellness, Disease Prevention - Promotion of physical and
advocating for systemic changes in healthcare that benefit
mental health in all patients as well as management of
client health, while adapting to continual changes within the
minor-acute and intermittent care needs of generally
healthcare system.
healthy patient
7. Leader: Influencing others to work together towards a
● Chronic Disease Management - Management of chronic
common goal, requiring an understanding of motivation,
diseases and prevention of sequelae
knowledge of leadership skills, and interpersonal skills to
● Regenerative/Restorative Care - Critical/trauma care,
influence others.
complex acute care, acute exacerbations of chronic
8. Manager: Overseeing the nursing care of individuals,
conditions, and treatment of physiologically unstable
families, and communities, including assigning, delegating,
patients that generally requires care in a mega-acute
supervising, and evaluating the performance of other nursing
institution
sta and ancillary workers.
● Hospice/Palliative Care - Includes end-of-life care as well
9. Case Manager: Working with a multidisciplinary team to
as palliative and supportive care for individuals requiring
ensure client-oriented care while controlling costs, varying
extended care, those with complex, chronic disease states,
roles include overseeing care of specific caseloads to
or those requiring rehabilitative care
managing high-cost clients or case types.
10. Research Consumer: Using research findings to improve
Nursin Role client care, with nurses needing awareness of research
processes, sensitivity to human subjects' rights, and
1. Caregiver: Providing physical and psychological assistance
participation in identifying researchable problems.
while preserving dignity, ranging from full to
11. Expanded Career Roles: Nurses are taking on expanded
supportive-educative care, covering all aspects of a client's
roles such as Advanced Practice Registered Nurses (APRNs),
well-being.
including Certified Nurse Practitioner (CNP), Certified Nurse
2. Communicator: Essential for all nursing roles, involving
Midwife (CNM), Certified Registered Nurse Anesthetist
clear and accurate communication with clients, healthcare
(CRNA), and Clinical Nurse Specialist (CNS), along with roles
team members, and the community to identify and relay
like nurse educator, researcher, and informatics specialist,
client problems e ectively.
allowing for greater independence and autonomy.
3. Teacher: Helping clients understand their health and the
healthcare procedures required for their recovery or health
maintenance, involving assessing learning needs, setting
goals, employing teaching strategies, and evaluating learning
outcomes.
 Criteri of Nursin Professio
Nursing is gaining recognition as a profession. A profession has
been defined as 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. Specialized Education: Nursing requires extensive
education, often through college and university programs,
integrating liberal arts with biological, social sciences, and
nursing disciplines. There are multiple paths to become a
registered nurse, including diploma, associate,
baccalaureate, master’s, and doctoral programs.
b. Body of Knowledge: The profession has established a
significant body of knowledge and expertise, with nursing
theories and conceptual frameworks that guide practice,
education, and research.
c. Service Orientation: Nursing is di erentiated by its
service orientation, with a focus on altruism and serving
others rather than pursuing profit. This service is guided by
rules, policies, and ethical codes, making nursing a crucial
component of the healthcare delivery system.
d. Ongoing Research: Nursing research, supported by
increased funding and professional backing, has evolved to
focus on practice-related issues, enhancing the role of
research in nursing practice.
e. Code of Ethics: Integrity is central to nursing, with ethical
codes that evolve to meet changing societal needs and
values. Nursing has developed its own codes of ethics and
mechanisms to monitor professional behavior.
f. Autonomy: Nursing seeks to regulate itself, set standards,
and define the scope of practice, functions, roles, goals, and
responsibilities independently. Autonomy in nursing implies
independence in practice, accountability, and authority, with
legal support for nurse practitioners to practice
independently in many states.
g. Professional Organization: Governance and operation
within professional organizations, such as the American
Nurses Association (ANA), set a profession apart from an
occupation. These organizations adopt practice standards,
support nurse safety, promote health, and address
healthcare issues a ecting the public and professionals.