NURSING AS A SCIENCE

A. PROBLEM SOLVING
PROCESSS
(CRITICAL THINKING IN
NURSING PRACTICE)
• Contemporary nursing practice needs effective thinkers and
decision makers who are capable of analyzing clinical data, medical
and nursing knowledge, and environment data, translating the
analyses into life-saving interventions

• The nurse applies her knowledge, clinical experiences and

professional standards when thinking critically and making decisions
about patient care.

• Critical thinking is the ability to think in a systematic and logical

manner with openness to question and reflect on the reasoning
process
• It involves
• Open-mindedness
• Continual inquiry
• Perseverance
• It considers
• What is important in clinical situations
• Imagines and explores alternatives
• Ethical principles
• Make informed decisions about the care of the patient
It requires reflection.
Purposeful thinking back or recalling a situation to
discover its purpose or meaning.
 CRITICAL THINKING & CLINICAL
JUDGEMENT SKILLS

SKILL NURSING PRACTICE APPLICATION

1. INTERPRETATION  Be orderly in collecting data about patients
 Apply reasoning while looking for patterns to
emerge
 Categorize the data
 Gather additional data or clarify any data about
which you are uncertain.
 CRITICAL THINKING & CLINICAL
JUDGEMENT SKILLS

SKILL NURSING PRACTICE APPLICATION

2. ANALYSIS  Be open-minded as you look at information
about the patient
 Do not make careless assumptions

3. INFERENCE  Look at the meaning and significance of the

findings. Are there relationships about the
findings? Does the data about the patient help
you see that a problem exists?
 CRITICAL THINKING & CLINICAL
JUDGEMENT SKILLS

SKILL NURSING PRACTICE APPLICATION

4. EVALUATION  Look at all situations objectively
 Use criteria to determine results of nursing
interventions
 Reflect on your own behavior
5. EXPLANATION  Support your findings and conclusions
 Use knowledge and experience to choose
strategies to use in the care of patients
 CRITICAL THINKING & CLINICAL
JUDGEMENT SKILLS

SKILL NURSING PRACTICE APPLICATION

6. SELF-REGULATION  Reflect on your experiences
 Be responsible for connecting your actions
with outcomes
 Identify the ways you can improve your own
performance. What will make you believe that
you have been successful?
 CONCEPTS FOR A CRITICAL THINKER

SKILL NURSING PRACTICE APPLICATION

1. TRUTH SEEKING  Seek the true meaning of a situation. Be
courageous, honest and objective about asking
questions.

2. OPEN-MINDEDNESS  Be tolerant of different views; be sensitive to

the possibility of your own prejudices; respect
the right of others to have different opinions
 CONCEPTS FOR A CRITICAL THINKER

SKILL NURSING PRACTICE APPLICATION

3. ANALYTICITY  Analyze potential problematic situations;
anticipate possible results or consequences;
value reason; use evidence-based knowledge

4. SYSTEMACITY  Be organized, focused; work hard in any inquiry

5. SELF-CONFIDENCE  Trust in your own reasoning processes.

 CONCEPTS FOR A CRITICAL THINKER

SKILL NURSING PRACTICE APPLICATION

6. INQUISITIVENESS  Be eager to acquire knowledge and learn
explanations even when applications of the
knowledge are not immediately clear.Value
learning for learning’s sake.

7. MATURITY  Multiple solutions are acceptable. Reflect on

your own judgements; have cognitive maturity
 LEVELS OF CRITICAL
THINKING IN NURSING
 LEVEL III:
COMMITMENT

LEVEL 1I:
COMPLEX CRITICAL
THINKING

LEVEL 1:
BASIC CRITICAL THINKING
 LEVEL 1:
BASIC CRITICAL THINKING

• A learner trusts that experts have the right answers for every
problems.
• Thinking is concrete and based on a set of rules or principles
• The nurse does not have enough experience to anticipate how to
individualize the procedure when problems arise.
• Answers to complex problems either right or wrong
• A basic critical thinker learns to accept diverse opinions and
values of experts
 LEVEL II:
COMPLEX CRITICAL THINKING

• Begins to separate themselves from experts

• The nurse analyzes the situation and examine choices more
independently
• Learns that alternatives and perhaps conflicting solutions exist
• The complex critical thinkers is willing to consider different
options from routine procedures when complex situations
develop.
 LEVEL III:
COMMITMENT

• The nurse anticipates when to make choices without

assistance from others and accepts accountability for
decisions made
• Nurse do more than just consider the complex
alternatives that a problem poses.
 ATTITUDES FOR
CRITICAL THINKING
1. Confidence 8. Creativity
2. Independence 9. Curiosity
3. Fairness 10.Integrity
4. Responsibility 11.Humility
5. Risk Taking
6. Discipline
7. Perseverance
THE NURSING
PROCESS
• The cornerstone of the nursing profession.
• Synonymous with the problem-solving approach for discovering
healthcare and nursing care needs of clients.
• The nursing process is:
• Organized
• Systematic EFFECTIVE
• Goal-Oriented EFFICIENT

• Humanistic Care
PHASES OF THE NURSING PROCESS

ASSESSEMENT

EVALUATION
DIAGNOSIS

INTERVENTION PLANNING
 CHARACTERISTICS OF A NURSING PROCESS

Problem-Oriented. It is comparable with scientific problem-solving

approach.
Goal oriented
Systematic
Flexible to meet the unique needs of the patient, family, group or
community (dynamic).
Interpersonal
Permits creativity among nurses and patients
Cyclical
Universal
BENEFITS OF THE NURSING PROCESS FOR THE PATIENTS
Quality patient care
Continuity of care
Participation by the patients in their healthcare

BENEFITS OF THE NURSING PROCESS FOR THE NURSE

Consistent and systematic nursing education
Job satisfaction
Personal growth
Avoidance of legal action
Meeting professional nursing standards
Meeting standards of accredited hospitals
THE HEART OF THENURSING PROCESS

KNOWLEDGE SKILLS

CARING
 KNOWLEDGE

Broad
Varied
 SKILLS
A.MANUAL (Technical Skills)
B.INTELLECTUAL ( Critical Thinking)
C.INTERPERSONAL (Positive Relationships)
CARING - WILLINGNESS
Being able to care
Understanding ourselves

To be able to understand others

To be more objective / nonjudgmental

Requires the ability to listen empathetically
Listen with intent
Enter another’s way of thinking and viewing the world
Connecting with another’s way of thinking and viewing the
world
Connecting with another’s feeling and perceptions
Identifying with another’s struggles, frustrations, and desires
Able to detach from feelings and returning to our own
frame reference
 WILLINGNESS TO CARE

Keep the focus on what is best for the patient

Respect the beliefs and values of others
Stay involved
Maintain a healthy lifestyle
 CARING BEHAVIORS
Inspiring someone/instilling hope and faith
Demonstrating patience, compassion and willingness to persevere
Offering companionship
Helping someone stay in touch with positive aspect of his life
Demonstrating thoughtfulness
Bending the rules when it really counts
Doing the “little things”
Keeping someone informed
Showing your human side by sharing stories
 I. NURSING
ASSESSMENT
 Assessment is
collecting,
validating,
organizing, and
recording data about the patient’s health status.
 The patient may be individual, family or community.
 The purpose of assessment is to establish a data base
 1. COLLECTION OF DATA

• Gathering information about the patient, considering the

physical, psychological, emotional, sociocultural, and spiritual
factors that may affect his/her health status.
2 Types of Data
1. SUBJECTIVE DATE (Symptoms)
Those that can be described only by the person experiencing it.
Example: Vertigo Tinnitus
Nausea Pain
Shortness of breath

2. OBJECTIVE DATA (Signs)

Those that can be observed and measured.
Example: Pallor Diaphoresis
Blood pressure Reddish Urine
Noisy breathing
Methods of Data Collection
a. Interview
b. Observation

A Cue is information that is obtained through the use of senses

An Inference is the nurse’s judgement or interpretation of these cues
Sources of Data
a. Primary
Patient
b. Secondary
Family members, significant others, patient’s records,
Health team members, Related Literature, Nurse’s
experience
 II. VERIFYING OR VALIDATING DATA

• Making sure that the information is accurate.

 III. ORGANIZING DATA

• Clustering facts into groups of information

A patient-centered interview becomes the basis for
forming trust and effective long-term therapeutic
relationships with patient.

Effective communication with patients during an assessment

interview requires communication skills.
1. Courtesy
2. Comfort
3. Connection
4. Confirmation
II. NURSING
DIAGNOSIS
 Diagnosing is a process which results to a diagnostic statement
or nursing diagnosis.
 It is the clinical act of identifying problems
 To diagnose in nursing means to analyze assessment
information and derive meaning from this analysis.
 The purpose is to identify the client’s health care needs and to
prepare diagnostic statements
 The Nursing Diagnosis is a patient’s potential or actual
alteration of health status. It uses the critical thinking skills of
analysis and synthesis.
 FORMAT

Problem
Etiology or related factors
Signs & Symptoms of defining characteristics

Example:
Impaired Physical Mobility related to incisional pain as evidenced by
restricted turning and positioning
 COMPARISON
MEDICAL DIAGNOSIS NURSING DIAGNOSIS COLLABORATIVE
PROBLEM
 The identification of a  Is a clinical judgement  An actual or potential
disease condition based concerning a human physiological
on physical signs and response to health complication that nurses
symptoms, medical conditions or life m0nitor to detect the
history, result of processes or vulnerability onset of change is a
diagnostics tests and for that response by a patient’s health status.
procedures. patient.  Nurses intervene in
collaboration with
 Physician treats the  The nurse treats the personnel from other
disease condition or response health care disciplines
(nurses, therapists,
dieticians, physicians)
 NANDA
North American Nursing Diagnosis Association
Purposes:
1. Provides precise definition of a patient’s responses to health
problems that gives nurses and other members of the health care
team a common language for understanding a patient’s needs.
2. Allows nurse to communicate what they do among themselves with
other healthcare professionals and the public
3. Distinguishes the nurse’s roles from that of other health care
providers
 NANDA
Purposes: cont.
4. Helps nurses focus on the scope of nursing practice
5. Fosters the development of nursing knowledge
6. Promotes creation of practice guidelines that reflect the essence and
science of nursing
 TYPES OF NURSING DIAGNOSIS

1. PROBLEM-FOCUSED NURSING DIAGNOSIS

Concerning an undesirable human response to a health condition/life processes that
exist in an individual, family of community

2. RISK NURSING DIAGNOSIS

Concerning the vulnerability of an individual, family, group or community in
developing an undesirable human response to health conditions/life processes

1. HEALTH PROMOTION NURSING DIAGNOSIS

Concerning a patient’s motivation and desire to increase well-being and actualize
human health potential.
 NANDA TAXONOMY II
1. Health Promotion 8. Sexuality
2. Nutrition 9. Coping/Stress Tolerance
3. Elimination & Exchange 10.Life Principles
4. Activity/Rest 11.Safety/Protection
5. Perception/Cognition 12.Comfort
6. Self-Perception 13.Growth & Development
7. Role relationship
 ACTIVITIES DURING DIAGNOSING

1. Organize, cluster, or group data

2. Compare data against standards
3. Analyze data against comparing with standards
4. Identify gaps and inconsistencies in data
5. Determine the client’s health problems, health risks and
strengths
6. Formulate Nursing Diagnoses statement
LET’S PRACTICE!
ASSESSMENT:
Active stage of Labor (Uterine contractions Duration:
60seconds; Interval q 3 mins)
Pain Scale 9/10
Facial grimace
States “Ma’am sakit na jud kaayo akong tiyan”

What is the Nursing Diagnosis?

ASSESSMENT:
Patient is 80 years old
Right hemiplegia noted
Disoriented

What is the Nursing Diagnosis?

ASSESSMENT:
Watery stool; 15x/day
Dry skin and oral mucosa
Dry & cracked lips
Pulse rate: 138bpm
States: “Pirme ko malipong maam”

What is the Nursing Diagnosis?

PLANNING
Involves determining beforehand the strategies or
course of actions to be taken before implementation
of nursing care.
To be effective, this requires communicating closely
with patient, their families and the health care team
and ongoing consultation with team members.
A plan of care is dynamic and changes as a patient’s
needs change
PURPOSES:
1.To identify the patient’s goal and appropriate
nursing interventions
2.To direct patient care activities
3.To promote continuity of care
4.To focus charting requirements
5.To allow for delegation of specific activities
 ACTIVITIES DURING PLANNING

1. ESTABLISHING PRIORITIES
A priority is something that takes precedence in position
Priority setting is a decision-making process
Use the principle of ABC’s
Use Maslow’s Hierarchy of needs
Nursing Diagnoses are classified as:
High priority
Medium priority
Low priority
 ACTIVITIES DURING PLANNING

2. SETTING GOALS & EXPECTED OUTCOMES

A client goal is an educated guess, made as a broad statement, about
what the client’s state will be after the nursing intervention is carried
out.
The goal may be Short-term or Long-term
Outcome criteria are specific, measurable, realistic statements of goal
attainment.
They answer the questions: who, what actions, under what
circumstances, how well and when.
The characteristics of a well-stated outcome criteria
are:
S Specific
M Measurable
A Attainable
R Realistic
T Time-Framed
 ACTIVITIES DURING PLANNING

3. PLANNING NURSING INTERVENTIONS APPROPRIATE FOR

EACH DIAGNOSIS
To direct activities to be carried out in the implementation phase
Nursing Interventions are any treatment, based upon clinical
management and knowledge that a nurse performs to enhance client
outcomes.
Nursing interventions are independent, dependent and
interdependent or collaborative activities that nurses carry out to
provide client care
 ACTIVITIES DURING PLANNING

4. WRITING A NURSING PLAN OF CARE

The “blueprint” of the nursing process
The nursing plan of care is a written summary of the care that a client
is to receive
The plan of care is nursing-centered
The plan of care is a step-by-step process
The plan of care is a step-by-step process. This is evidenced by
the following:

Sufficient data are collected to substantiate each nursing diagnoses

At least one goal must be stated for each nursing diagnosis.
Outcome criteria must be specifically designed to meet identified
goal
Each intervention should be supported by a scientific rationale. The
scientific rationale is the justification or reason for carrying out the
intervention.
Evaluation must address whether each goal was completely met,
partially met, or completely unmet.
EXAMPLE:
GOAL – The client will report a decreased anxiety level
regarding surgery
OUTCOME CRITERIA
• During client teaching, the client discusses fears and
concerns regarding surgical procedure
• After teaching, the client verbalizes decreased anxiety
• The client identifies a support system and strategies to
use to reduce stress and anxiety related to the surgical
experience
IMPLEMENTATION
Implementation is putting the nursing care plan into action.

Purpose:
To carry out planned nursing interventions to help the
patient attain goals and achieve optimal level of health.

A nursing intervention is any treatment based on clinical

judgment and knowledge that a nurse performs to enhance
patient outcomes.
 IMPLEMENTATION PROCESS
1. REASSESSING A PATIENT
2. REVIEWING & REVISING THE EXISTING NURSING
CARE PLAN
3. PREPARING FOR IMPLEMENTATION
4. ANTICIPATING & PREVENTING COMPLICATIONS
5. IMPLEMENTATION SKILLS
6. COMMUNICATING NURSING INTERVENTIONS
7. DELEGATING, SUPERVISING, & EVALUATING THE
WORK OF OTHER STAFF MEMEBERS
EVALUATION
Evaluation is assessing the patient’s response to nursing
interactions and the comparing the response to predetermined
standards or outcome criteria.

The purpose is to appraise the extent to which goals and

outcome criteria of nursing care have been achieved.

Critical thinking is the key to evaluation.

 FOUR INDICATORS REFLECTING THE NURSE’S
ABILITY TO PERFORM EVALUATION

I. EXAMINE THE RESULTS ACCORDING TO CLINICAL DATA

COLLECTED
II. COMPARE ACHIEVED EFFECT WITH GOALS AND EXPECTED
OUTCOMES
III. RECOGNIZE ERRORS
IV.UNDERSTAND A PATIENT SITUATION, PARTICIPATE IN SELF-
REFLECTION, AND CORRECT ERRORS
REMEMBER:
Evaluation is continuous, occurring through each step of the nursing
process.

The four possible judgments that may be made are as follows:

 The goal was completely met
 The goal was partially met
 The goal was completely unmet
 New problems or nursing diagnoses have developed
DOCUMENTATION
/REPORTING
Documentation is the “hallmark of professionalism” among
nurses.
Documentation serves as a permanent record of patient
information and care
Reporting takes place when two or more people share
information about patient care, either face to face or by
telephone
A nursing action that produces a written account of pertinent
patient data, nursing clinical decisions and interventions, and
patient responses in a health record.
It needs to be accurate and comprehensive
Your documentation may save you or sink you
 REMEMBER:

“Whatever is not written is considered

as not done”
 PURPOSES
• Communication
• Legal Documentation
• Reimbursement
• Auditing and Monitoring
• Research
• Education
 GUIDELINES FOR ELECTRONIC &
WRITTEN DOCUMENTATION

RATIONALE CORRECT ACTION

Do not document Statements can be used Enter only objective and

retaliatory or critical as evidence for factual observations of a
comments about a nonprofessional patient’s behavior or the
patient or care provided behavior or poor quality actions of another
by another health care of care healthcare professional.
professional. Do not Quote all patient
enter personal opinions. statements
 GUIDELINES FOR ELECTRONIC &
WRITTEN DOCUMENTATION
RATIONALE
Correct all errors promptly. Errors in recording can lead
to errors in treatment or
may imply an attempt to
mislead or hide evidence
Record all facts Record must be accurate,
factual, and objective.
CORRECT ACTION
Avoid rushing to complete
documentation; be sure that
information is accurate and
complete
Be certain that each entry is
factual and thorough. A
person reading your
documentation needs to be
able to determine that a
patient received adequate
care
 GUIDELINES FOR ELECTRONIC &
WRITTEN DOCUMENTATION
RATIONALE CORRECT ACTION
Document discussions If you carry out an Do not record
with providers that you order that is written “physician made error.”
initiate to seek incorrectly, you are just Instead document that
clarification regarding an as liable for prosecution “Dr. B. was called to
order that is questioned. as the health care clarify order for
provider. analgesic.” Include the
date and time of the
phone call, with whom
you spoke, and the
outcome.
 GUIDELINES FOR ELECTRONIC &
WRITTEN DOCUMENTATION
RATIONALE CORRECT ACTION
Document only for You are accountable for Never enter
yourself. information that you documentation for
enter into patient’s someone else.
record.

Avoid using generalized, This type of Use complete, concise

empty phrases such as documentation is description of
“status unchanged” or subjective and does not assessments and care
“had a good day” reflect patient provided so,
assessment documentation is
objective and factual.
 GUIDELINES FOR ELECTRONIC &
WRITTEN DOCUMENTATION
RATIONALE CORRECT ACTION
Begin each entry with date Ensures that correct Never enter documentation
and time and end with your sequence of events is for someone else.
signature and credentials. recorded; signature
documents who is
accountable for care
delivered
Protect the security of your Maintains security and Once logged into a
password for computer confidentiality of patient computer, do not leave
documentation medical records computer screen
unattended. Log out when
you leave the computer.
 GUIDELINES FOR ELECTRONIC &
WRITTEN DOCUMENTATION
RATIONALE CORRECT ACTION
Do not erase, apply Charting become illegible; it Draw single line through
correction fluid or scratch appears as if you were error, write word error
out errors made while attempting to hide above it, and sign your name
recording information or deface a or initials and date it. Then
written record. record note correctly.
Do not leave blank spaces Allows another person to Chart consecutively line by
or lines in a written nurses’ add incorrect information in line, if space is left, draw a
progress note. open space. line horizontally through it
and place your signature and
credentials at the end.
 Error
SPM
4/10/24

The patient WAS will……

 GUIDELINES FOR ELECTRONIC &
WRITTEN DOCUMENTATION
RATIONALE
Record all written entries Illegible entries are easily
legibly and in black ink. Do misinterpreted, causing
not use felt-tip pens or errors and lawsuits; ink from
erasable ink. felt-tip pen can smudge or
run when wet and may
destroy documentation;
erasures are not permitted in
clinical documentation; black
ink is more legible when
records are photocopied or
scanned.
CORRECT ACTION
Never use pencil to
document in a written
clinical record. Never erase
entries, use correction fluids,
or use pencil. To indicate
error in written
documentation, place a
single line through the
inaccurate information and
write your signature with
credentials at the end of the
text that has been crossed
out.
 CONFIDENTIALITY
Nurses are legally and ethically obligated to keep information of patient confidential.
Nurses only discuss a patient’s diagnosis, treatment, assessment and/or any personal
conversations with members of the healthcare team who are involved in patient’s care.
Patients have the right to request copies of their medical records and read the information.
Sometimes nurses use healthcare records for the data gathering, research or continuing
education.
Nursing students in the clinical setting, are required to observe confidentiality as a part of
professional practice.
Not only is it unethical to view medical records of other patients but breaches of
confidentiality lead to disciplinary action and dismissal from work or nursing school.
To protect patient confidentiality, ensure that written or electronic materials used by the
students in clinical practice does not include identifiers.
 NURSING PROGRESS NOTES IN DIFFERENT FORMATS

1.NARRATIVE NOTE

2.SOAP NOTE (Subjective-Objective-Assessment-Plan)

3.PIE NOTE (Problem-Intervention-Evaluation)

4.FDAR (Focus-Data-Action-Response)
 PROCEDURES
BASIC TO NURSING
CARE
1. ASEPSIS &
INFECTION
CONTROL
Microorganisms are always present in the environment.
Some live on the skin, others are common inhabitants of
the intestinal tract and others are found among other
places----in the air, in the soil, in articles and equipment
in the hospitals and our clothes.
Infections pose severe problems to people at home, in
the community and in the health care facilities.
Infections cause great burden because treatments and
medications are becoming uncontrollably expensive.
 STAGES OF FINFECTION PROCESS

I. INCUBATION PERIOD – from the entry of the

microorganism to the onset of the signs and symptoms
II.PRODROMAL PERIOD – from the onset of non-specific
signs and symptoms to the appearance to the specific signs
and symptoms
III.ILLNESS PERIOD – Specific signs and symptoms develop
and become evident
IV.CONVALESCENT PERIOD – signs and symptoms start
to abate until the client returns to normal state of health
1. ETIOLOGIC/INFECTIOUS AGENT
MICROORGANISM (Bacteria, Fungi, Virus, Parasites)

2. RESERVOIR
Human beings, animals, inanimate objects, plants, general environment
(air, water, soil)

3. PORTAL OF EXIT
Respiratory Tract: droplets, sputum
Gastrointestinal Tract: vomitus, feces, saliva, drainage tubes
Urinary Tract: Urine, urethral catheters
Reproductive Tract: Semen, vaginal discharge
Blood: Open wound, needle puncture
4. MODE OF TRANSMISSION
a. Contact Transmission This may be indirect or indirect contact
Contact transmission of infectious organisms on the hands of caregivers is the
most frequent mode of transmission in healthcare facilities.

b. Droplet Transmission. May be considered a type of contact transmission.

It occurs when mucous membrane of the nose, mouth or conjunctiva are
exposed to secretions of an infected person who is coughing, sneezing, laughing,
or talking usually within 3 feet.

c. Vehicle Transmission. This involves the transfer of microorganisms by

way of vehicles or contaminated items that transmit pathogens. Examples:
food, water, milk, blood, eating utensils, pillows, and mattress
d. Airborne Transmission. This occurs when fine particles are suspended
in the air for a long time or when dust particles contain pathogens. Air
current disperses microorganisms, which can be inhaled or deposited on
the skin of a susceptible host.

e. Vector borne Transmission. Vector can be biologic or mechanical.

Biologic vectors are animals, like rats, snails, mosquitos
Mechanical vectors are inanimate objects that are infected with infected
body fluids like contaminated needles and syringes.
5. PORTAL OF ENTRY
This permits the organisms to gain entrance into the host
Pathogens can enter susceptible hosts through body orifices

6. SUSCEPTIBLE HOST
A host is a person who is at risk for infection; whose own body defense
mechanisms, when exposed are unable to withstand the invasion of
pathogens.
 TYPES OF IMMUNIZATION

1.ACTIVE IMMUNIZATION
Natural
Artificial
2. PASSIVE IMMUNIZATION
Natural
Artificial
BREAKING THE CHAIN OF INFECTION

Hand Hygiene / Handwashing

Cleaning, Disinfection, Sterilization
Use of Barriers
Isolation Systems
Surgical Asepsis
 HANDWASHING

The most effective basic technique in

preventing and controlling the transmission
of infection.
Contaminated hands of the health care
workers are a primary source of infection
transmission in health care settings.
 CLEANING, DISINFECTION,
STERILIZATION

CLEANING. The physical removal of visible dirt and debris by

washing, dusting or mopping surfaces that are contaminated.
DISINFECTION.The chemical or physical processes used to reduce
the number of potential pathogens on an object’s surface. But spores of
the pathogens are not necessarily destroyed.
STERILIZATION. The complete destruction of all microorganisms,
including spores, leaving no viable forms of microorganisms.
 REMEMBER!!!!

ANY ITEM INTRODUCED INTO STERILE

TISSUES OR THE VASCULAR SYSTEM,
SUCH AS SURGICAL INSTRUMENTS,
CARDIAC AND URINARY CATHETERS,
VAGINAL SPECULUM, IMPLANTS, IV
FLUIDS AND NEEDLES MUST BE STERILE
BARRIERS (PERSONAL PROTECTIVE EQUIPMENTS)

MASKS
GOWNS
CAPS & SHOE COVERINGS
GLOVES
PRIVATE ROOMS
 HOSPITAL WASTE SEGREGATION

A.INFECTIOUS
• Blood and blood products, pathology laboratory specimen, laboratory
cultures, body parts from surgery, contaminated equipment, diapers
B.INJURIOUS
• Needles, scalpel blades, lancets, broken glass, pipettes
C.HAZARDOUS
• Radioactive materials
• Chemotherapy solutions and their containers
 ISOLATION SYSTEMS
Isolation refers to techniques used to prevent or to
limit the spread of infection.

Isolation precautions are classified as standard

precautions, transmission-based precautions and
protective isolation.
 STANDARD PRECAUTIONS

Wear clean gloves

Perform handwashing
Wear a mask, eye protection, face shield
Wear a cover gown
Remove soiled protective items
Discard all single –use items promptly and in appropriate
containers
Prevent injuries
Use private room
 TRANSMISSION-BASED PRECAUTION
AIRBORNE PRECAUTIONS. Used for microorganisms
transmitted by small particle droplets that can remain suspended
and become widely dispersed by air currents. Ex TB, varicella,
measles
DROPLET PRECAUTIONS. Used for microorganisms transmitted
by large-particle droplets which disperse into air currents. Example:
COVID -19, H. Influenzae, Diphtheria, Rubella, Mycoplasma Pneumonia
CONTACT PRECAUTIONS. Used with organisms that can be
transmitted through hand or skin-to-skin contact. Examples: C.difficile,
shigellosis, impetigo, COVID-19
 PROTECTIVE ISOLATION

 Implemented to prevent infection FOR people whose resistance to

infection/body defenses are lowered or compromised.
 The patient should be placed in a private room.
 Restrict visitors
 Persons with signs of infections are not allowed
 No fresh fruits or vegetables, raw foods, fresh flowers
 Only cooked and canned fruits are allowed
SURGICAL ASEPSIS
(STERILE
TECHNIQUE)
• The purpose of surgical technique is to prevent the
introduction of microorganisms.
• Surgical asepsis is required in the following situation:
• Surgical procedures
• All procedures that invade the bloodstream
• Procedures that cause a break in skin or mucous membranes
• Complex dressing changes and wound care
• Insertion of tubes, catheters, or devices into sterile body
cavities
• Care for high-risk groups
 PRINCIPLES OF SURGICAL ASEPSIS

1. Moisture causes contamination

2. Never assume that an object is sterile
3. Always face the sterile field
4. Sterile articles may touch only sterile articles or surfaces if they
are to maintain their sterility
5. Sterile equipment or areas must be kept above the waist and on
top of sterile field.
6. Fluid flows in the direction of gravity. Hold hands above elbows
during a surgical hand scrub
 PRINCIPLES OF SURGICAL ASEPSIS

7. The edges of a sterile field or container are considered to be

contaminated
8. Prevent unnecessary traffic and air currents around the
sterile area
9. Open, unused sterile articles are no longer sterile after the
procedure
10.A person who is considered sterile who becomes
contaminated must reestablish sterility
11.Surgical technique is a team effort
 RELATED NURSING SKILLS:
PERFORMING STERILE PROCEDURES
SURGICAL HAND SCRUB
APPLYING AND REMOVING STERILE GLOVES
DONNING STERILE GOWN AND CLOSED GLOVING
DONNING AND REMOVING CAPS, MASKS AND EYEWEAR
PREPARING AND MAINTAINING STERILE
OPENING STERILE DRAPE
ADDING STERILE SUPPLIES TO THE FIELD
POURING STERILE SOLUTIONS
CARE OF THE STERILE PICK-UP FORCEPS
SAFETY, SECURITY
& EMERGENCY
PREPAREDNESS