Fundamentals of Nursing

Nursing as a
PROFESSION, an ART ,
AND as a SCIENCE

MODULE -2 NURSING AS PROFESSION, ART, AND SCIENCE

IAN N. ALEJANDR, RN
INSTRUCTOR
 Learning Objectives

1. Identify the purpose of nurse practice acts and standards

of professional nursing practice correctly.
2. Describe the different roles of nurses accurately.
3. Discuss the criteria of a profession and the
professionalization of nursing comprehensively.
4. Explain how the definition of nursing has evolved since
Florence Nightingale correctly.
5. Identify the four major areas of nursing practice.
 NURSING AS A
PROFESSION
CONCEPT A
Definition of profession, professionalism, professionalization
Qualities of a professional and personal nurse
Fields of nursing
Development of modern nursing
Professional nursing practice
Roles and responsibilities of professional nurse
Scope of nursing
 NURSING 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;
• Its requirement of prolonged, specialized training to
acquire a body of knowledge pertinent to the role to be
performed;
• An orientation of the individual toward service, either to a
community or to an organization;
• Ongoing research;
• A code of ethics;
• Autonomy; and
• A professional organization.
 PROFESSIONALISM
AND PROFESSIONALIZATION
• PROFESSIONALISM refers to
professional character, spirit, or
methods.

• Professionalization is the process of

becoming professional, that is, of
acquiring characteristics considered to
be professional.
 Top Qualities of a Personal and
professional Nurse
• A caring nature
• Be empathetic
• Write everything down (in detail)
• Be organized
• Be emotionally stable
• Be adaptable
• Have physical and mental endurance
• Be a quick thinker (and have great judgement)
• Be hard-working
• Be a good communicator
 FIELDS OF NURSING
Nursing generally falls into three
categories: non-degree, degree and
advanced degree.
• Non-degree: Certified Nurse's Aides
(CNAs) and Licensed Practical Nurses
(LPNs), Nursing Attendants Philippines)
• Degree: Registered Nurses (RNs).
• Graduate Studies and Specialization:
Masters and Doctorate degree programs;
Specialized nursing practice with trainings
and experiences
 FIELDS OF NURSING
Fields of Nursing may also be based
on the recipient of care-PATIENTS,
CLIENTS OR CONSUMERS:
1. INDIVIDUALS
• Newborns, infants , and children
• Teens, adults, and elders
2. FAMILIES
3. COMMUNITIES
 FIELDS OF NURSING
Fields of Nursing BASED ON
SPECIALIZATION:
1. General Nursing
2. Medical Nursing
3. Surgical Nursing
4. Maternal and Child Nursing
5. Psychiatric or Mental Health Nursing
6. Intensive Care Nursing
7. Dialysis Nurse
8. Community Health Nursing
 FIELDS OF NURSING
Fields of Nursing BASED ON
SPECIALIZATION:
9. Rehabilitation Nursing
10. Oncology Nursing
11. Plastic Surgery Nurses
12. Corrections Facility Nurses
13. Home care Nursing ( Special Nurse)
14. Radiology Nurse
15. Academe/ Nurse Educator and
Administrator
15. Certified registered nurse anesthetist.
16. OTHERS
 Development of Modern Nursing

• Florence Nightingale’s Role as Founder of Nursing

Profession
• Recurring themes of women’s roles and status, religious
(Christian) values, war, societal attitudes, and visionary
nursing leadership have influenced nursing practice in the
past
• Nursing’s beginnings reveals its continuing struggle for
autonomy and professionalization.
• Nursing has undergone dramatic change in response to
societal needs and influences.
 Development of Modern Nursing

• Florence Nightingale, Clara Barton, Linda Richards, Mary

Mahoney, Lillian Wald, Lavinia Dock, Margaret Sanger,
and Mary Breckinridge are among the leaders who have
made notable contributions both to nursing’s history and
to women’s history.
• Contemporary nursing leaders, such as Virginia
Henderson, who created a modern worldwide definition
of nursing, and Martha Rogers, a catalyst for theory
development
 Development of Modern Nursing
• During the 20th century, men were denied admission to most
nursing programs. Today, there are clinical areas or health
facility employers which/who prefer male nurses
• The practice of nursing is controlled from within the
profession through state boards of nursing and professional
nursing organizations.
• Nursing roles have evolved in response to new scientific
knowledge; advances in technology; and cultural, political,
and socioeconomic changes in society
• Nursing education curricula have been revised to enable
nurses to work in more diverse settings and assume more
diverse roles
 Development of Modern Nursing

• Education programs available for nurses include practical

or vocational nursing, registered nursing, graduate
nursing, and continuing education
• In the past, the acute care hospital was the main practice
setting open to most nurses. Today many nurses work in
hospitals, but increasingly they work in clients’ homes,
community agencies, ambulatory clinics, long-term care
facilities, health maintenance organizations (HMOs), and
nursing practice centers
 Development of Modern Nursing
• Different definitions of nursing with common themes:
• Nursing is caring.
• Nursing is an art.
• Nursing is a science.
• Nursing is client centered.
• Nursing is holistic.
• Nursing is adaptive.
• Nursing is concerned with health promotion, health
maintenance, and health restoration.
• Nursing is a helping profession
• Evidence based researches
• Field of specialization in the nursing practice
Overview of Professional Nursing
Practice
Level of Proficiency

Roles and Responsibilities of

Professional Nurse

Scope of Nursing practice based

on RA 9173
Level of
Proficiency
Level of
Proficiency
 Roles and Responsibilities of
Professional Nurse
• Initiation of independent nursing
interventions
AUTONOMY • Having the authority to make decisions
and the freedom to act in accordance with
one's professional knowledge base. .

• Responsible professionally and legally for

the type and quality of nursing care
ACCOUNTABILITY provided.
• Remain current and competent in nursing
and scientific knowledge and technical
skills.
 Roles and Responsibilities of
Professional Nurse

Change
leader
agent
CAREGIVER

counsellor manager
COMMUNICATOR

Client Research
TEACHER
advocate Consumer
 Scope of Nursing Practice based on RA
9173, "Philippine Nursing Act of 2002“
ARTICLE VI SECTION 26-SCOPE OF NURSING
• A person shall be deemed to be practicing nursing
within the meaning of this Act when he/she singly or
in collaboration with another, initiates and performs
nursing services to individuals, families and
communities in any health care setting.
• It includes, but not limited to, nursing care during
conception, labor, delivery, infancy, childhood,
toddler, pre-school, school age, adolescence,
adulthood and old age
• As independent practitioners, nurses are primarily
responsible for the promotion of health and
prevention of illness.
 Scope of Nursing Practice based on RA
9173, "Philippine Nursing Act of 2002“
ARTICLE VI SECTION 26-SCOPE OF NURSING

• As members of the health team, nurses

shall collaborate with other health care
providers for the curative, preventive,
and rehabilitative aspects of care,
restoration of health, alleviation of
suffering, and when recovery is not
possible, towards a peaceful death. It
shall be the duty of the nurse to:
 Scope of Nursing Practice based on RA
9173, "Philippine Nursing Act of 2002“
ARTICLE VI SECTION 26-SCOPE OF NURSING
• It shall be the duty of the nurse to:
✓Provide nursing care through the utilization of the
nursing process. Nursing care includes, but not
limited to, traditional and innovative approaches,
therapeutic use of self, executing health care
techniques and procedures, essential primary health
care, comfort measures, health teachings, and
administration of written prescription for treatment,
therapies, oral, topical and parenteral medications,
internal examination during labor in the absence of
antenatal bleeding and delivery. In case of suturing
of perineal laceration, special training shall be
provided according to protocol established
 Scope of Nursing Practice based on RA
9173, "Philippine Nursing Act of 2002“
ARTICLE VI SECTION 26-SCOPE OF NURSING

✓Establish linkages with community resources and

coordination with the health team;
✓Provide health education to individuals, families
and communities;
✓Teach, guide and supervise students in nursing
education programs including the administration of
nursing services in varied settings such as hospitals
and clinics; undertake consultation services; engage
in such activities that require the utilization of
knowledge and decision-making skills of a registered
nurse
 Scope of Nursing Practice based on RA
9173, "Philippine Nursing Act of 2002“
ARTICLE VI SECTION 26-SCOPE OF NURSING

✓Undertake nursing and health human

resource development training and
research, which shall include, but not
limited to, the development of advance
nursing practice
 Scope of Nursing Practice based on RA
9173, "Philippine Nursing Act of 2002“
ARTICLE VI SECTION 26-SCOPE OF NURSING

• Provided, That this section shall not apply to nursing

students who perform nursing functions under the
direct supervision of a qualified faculty
• Provided, further, That in the practice of nursing in all
settings, the nurse is duty-bound to observe the Code
of Ethics for nurses and uphold the standards of safe
nursing practice. The nurse is required to maintain
competence by continual learning through continuing
professional education to be provided by the accredited
professional organization or any recognized
professional nursing organization
 Scope of Nursing Practice based on RA
9173, "Philippine Nursing Act of 2002“
ARTICLE VI SECTION 26-SCOPE OF NURSING

• Provided, finally, That the program and

activity for the continuing professional
education shall be submitted to and
approved by the Board.
 STANDARDS OF PROFESSIONAL
PERFORMANCE
• Ethics- The registered nurse practices ethically.
• Education- The registered nurse attains knowledge and
competency that reflects current nursing practice.
• Research- The registered nurse integrates evidence and
research finding into practice.
• Quality of Practice- The registered nurse contributes to
quality nursing practice.
• Communication- The registered nurse communicates
effectively in all areas of practice.
• Leadership- The registered nurse demonstrates leadership in
the professional practice setting and the profession.
 STANDARDS OF PROFESSIONAL
PERFORMANCE
• Collaboration- The registered nurse collaborates with
health care consumer, family, and others in the conduct
of nursing practice.
• Professional Practice Evaluation- The registered nurse
evaluates her or his own nursing practice in relation to
professional practice standards and guidelines, rules
and regulations.
• Resource- The registered nurse uses appropriate
resources to plan and provide nursing services that are
safe, effective and financially responsible.
• Environmental Health- The registered nurse practices in
an environmentally safe and healthy manner.
NURSING AS AN ART
CONCEPT B
CARING
COMMUNICATING
TEACHING
 What is the ART of NURSING?

• Caring is a dimension of human relating, and often referred

to as the art of nursing.
• Nursing cannot exist without caring.
• Caring is central to all helping professions, and enables
people to create meaning in their lives.
• Caring is sharing deep and genuine concern about the
welfare of another person.
• Caring practice involves connection, mutual recognition,
and involvement between nurse and client
 Theories and
Models of
Caring • Notes that caring, as nurturing
behavior, has been present
throughout history and is one of the
most critical factors in helping people
maintain or regain health
Culture Care • Emphasizes care as a “distinct,
Diversity and dominant, unifying, and central focus
Universality of nursing” (George, 2011, p. 406)
( Madelein Leininger) • Theory of culture care diversity and
universality is based on the
assumption that nurses must
understand different cultures in order
to function effectively.
 Theories and
Models of
Caring • Bureaucratic caring focuses on caring
in organizations (e.g., hospitals) as
cultures.
• the meaning of caring was further
Theory of influenced by the role and position a
Bureaucratic Caring person held.
(Marilyn Anne Ray) • “Spiritual-ethical caring for nursing
does not question whether or not to
care in complex systems, but
intimates how sincere deliberations
and ultimately the facilitation of
choices for the good of others can or
should be accomplished.”
 Theories and
Models of
Caring • Respect for people as caring
individuals and respect for
what matters to them are
Nursing as Caring assumptions underlying the
(Anne Boykin theory of nursing as caring.
and Savina • Emphasize the importance of
Schoenhofer) the nurse knowing self as a
caring person.
• Caring is a lifetime process
 Theories and
Models of
Caring • The theory of human care
views caring as the essence
and the moral ideal of nursing
Theory of • The nurse and client are co-
Human Care participants in the client’s
movement toward health and
(Jean Watson) wholeness and this human
connection is labelled
transpersonal human caring
 Theories and
Models of
Caring • Caring as “a nurturing way of
relating to a valued ‘other,’
toward whom one feels a
personal sense of
Theory of commitment and
responsibility”
Caring (Kristen • A client’s well-being should be
Swanson) enhanced through the caring
of a nurse who understands
the common human
responses to a specific health
problem.
 Theories and Models of Caring
• The theory focuses on caring
processes as nursing
interventions.
Theory of 1. Knowing
Caring
2. Being with
(Swanson)
3. Doing for
4. Enabling
5. Maintaining Belief
 Theories and
Models of
Caring• Focuses on caring as a
philosophical concept and
proposes that caring is the human
mode of being
Caring, the • Visualizes caring to be unique in
nursing however, because caring is
Human Mode of the center of all attributes she
Being (Simone uses to describe nursing.
Roach) • Defines attributes that defines
nursing through the six C’s of
caring: compassion, competence,
confidence, conscience,
commitment, and comportment
 Theories and Models of Caring
• Compassion- Awareness of one’s
relationship to others, sharing
their joys, sorrows, pain, and
Caring, the accomplishments. Participation in
Human Mode the experience of another.
of Being • Competence- Having the
(Roach) “knowledge, judgment, skills,
energy, experience and motivation
required to respond adequately to
the demands of one’s professional
responsibilities” (Roach, 2013
 Theories and
Models of
Caring
• Confidence- Comfort with self,
client, and others that allows
Caring, the one to build trusting
Human Mode relationships.
of Being • Conscience- Morals, ethics,
(Roach) and an informed sense of right
and wrong. Awareness of
personal responsibility
 Theories and
Models of
Caring • Commitment- The deliberate
choice to act in accordance with
one’s desires as well as
obligations, resulting in
Caring, the investment of self in a task or
cause.
Human Mode
of Being • Comportment- Appropriate
bearing, demeanour, dress, and
(Roach) language that are in harmony
with a caring presence.
Presenting oneself as someone
who respects others and
demands respect.
COMMUNICATION-is central to successful caring
relationships. Listening is important for effective
understanding and communication
 COMMUNICATION
• Communication is the interchange of information
between two or more people; in other words, the
exchange of ideas or thoughts.
• Methods: talking and listening or writing and
reading, painting, dancing, and storytelling,
gestures and body actions
• The intent of any communication is to obtain a
response. Thus, communication is a process.
• It has two main purposes: to influence others and
to gain information.
COMMUNICATION
 COMMUNICATION PROCESS
SENDER RECEIVER
ENCODE MESSAGE DECODE

MESSAGE
DECODE (RESPONSE, ENCODE
FEEDBACK)

RED AND GREEN YELLOW ARROWS

ARROWS indicates indicates
intrapersonal interpersonal
communication communication
 MODES OF COMMUNICATION

VERBAL NON-VERBAL ELECTRONIC

• Uses the • Uses other • Uses

spoken or forms, such technological
written word as gestures means such
or facial as email ,
expressions, others
and touch.
 THERAPEUTIC COMMUNICATION
TECHNIQUES
TECHNIQUE DESCRIPTION EXAMPLE

Broad opening To allow the patient to pick the Where would you like to
topic, take the initiative to begin? What is on your
statements express self, and set the direction mind today? What are you
of the conversation. thinking about? Is there
anything you would like to
discuss?
Offering Encourages the client to continue Go on. And then? Tell me
and that the nurse is interested about it.
general leads in what comes next.
 THERAPEUTIC COMMUNICATION
TECHNIQUES

TECHNIQUE DESCRIPTION EXAMPLE

Exploring Examines certain ideas, experiences,
or relationships more fully.
Focusing Helps the patient focus on a certain
point when they are jumping from
topic to topic.
Tell me more about that. What
kind of relationship do you have
with your children? Could you
talk about how you felt when
you learned you had cancer?
Let’s stop and look more closely
at your feelings about managing
your medications. You’ve
mentioned many things. Let’s go
back to your thinking of “giving
up”.
 THERAPEUTIC COMMUNICATION
TECHNIQUES
TECHNIQUE DESCRIPTION
Silence Provides time for the patient to put
thoughts or feelings into words,
regain composure or continue
talking.
Accepting Indicated the patient has been
understood. It does not indicate
agreement and is non-judgmental.
Giving Indicated awareness of change in
personal efforts. Does not imply
recognition good or bad, right or wrong.
EXAMPLE
Maintain an interested,
expectant silence
Uh-hmm. Yes. I’m following you.
Nodding.
Good morning, Mr. Jones. I see
you have put on your jewelry
today. You’ve finished your list of
things to do.
 THERAPEUTIC COMMUNICATION
TECHNIQUES

TECHNIQUE DESCRIPTION EXAMPLE

Offering self Offers presence, interest, and a I’ll sit with you her for a while. I
desire to listen to the patient. would like to spend some time with
you. I’m available if you need to talk.
Making Calls attention to the patient’s You appear tense. I noticed that you
physical behavior or emotional are biting your lip. You seem upset.
observations state. Verbalizing what the nurse You are trembling
perceives.
Acknowledging To help the patient know that Patient: “I hate it here. I wish I could
feelings feelings are understood and go home.” Nurse: “It must be
accepted. difficult to stay in a place you hate.”
(empathy)
 THERAPEUTIC COMMUNICATION
TECHNIQUES
TECHNIQUE DESCRIPTION
Reflecting Directing questions, feelings and
ideas back to the patient.
Acknowledges the patient’s right
to have opinions and make
decisions
Providing Makes facts available in order to
assist in decision-making or
information drawing conclusions.
EXAMPLE
Patient: “What do you think I should
do about telling my employer about
my illness?” Nurse: “What have you
been thinking about this situation?”
Patient: “Everyone ignores me”.
Nurse: “Ignores you?”
This medication is for you high blood
pressure. This test will determine
your treatment options. My purpose
for being here is…..
 THERAPEUTIC COMMUNICATION
TECHNIQUES

TECHNIQUE DESCRIPTION EXAMPLE

Clarifying To make clear that which is vague I am not sure I follow you. What
or maximize understanding would you say the main point of
between the nurse and patient. what you said was? Can you give me
an example of a time you thought
everyone hated you.
Seeking Searching for mutual Tell me whether my understanding
understanding especially when of it agrees with yours. Are you
consensual slang terms have been used. using this word to convey that …?
validation
 THERAPEUTIC COMMUNICATION
TECHNIQUES

TECHNIQUE DESCRIPTION EXAMPLE

Verbalizing To voice what the patient has Patient: “I can’t talk to you or
implied. To verify impressions to anyone else because it’s a waste of
implied help the patient more fully aware time.”
thoughts and of feelings expressed. Nurse: “Do you feel that no one
understands?”
feelings Patient: “My wife pushes me around
just like my mother and sister did.”
Nurse: “Is it your impression that
women are domineering?”
 THERAPEUTIC COMMUNICATION
TECHNIQUES

TECHNIQUE DESCRIPTION EXAMPLE

Sharing Discharge of energy through This gives a whole new meaning to

comic enjoyment of the “just relax”.
humor imperfect. Can reduce tension
and promote mental well-being.
Must be used carefully and
sparingly
Encouraging Brings out recurrent themes by Was it something like…..? Have you
looking at similarities or had a similar experience? Has this
comparison differences ever happened before?
 THERAPEUTIC COMMUNICATION
TECHNIQUES

TECHNIQUE DESCRIPTION EXAMPLE

Encouraging Assists the patient in considering What did it mean to you when he
things from their own set of said her couldn’t stay? How do you
evaluation values or perspective. feel about your recovery this time in
the hospital?

Encouraging Asking the patient to verbalize Tell me what is happening right

things from their own now? Tell me what you are thinking
description of perspective. when you feel anxious.
perception
 THERAPEUTIC COMMUNICATION
TECHNIQUES

TECHNIQUE DESCRIPTION EXAMPLE

Placing the To help the patient see cause and When did this happen? What
effect or identify patterns of seemed to lead up to….? Was it
event in time events and actions. before or after….?
or in
sequence
Presenting Indicated what is real without Your mother is not here. I am the
arguing. Presenting the facts of a nurse. I see no one else in the room
reality situation.
 THERAPEUTIC COMMUNICATION
TECHNIQUES
TECHNIQUE DESCRIPTION
Voicing Expressing uncertainty about the reality of
the patient’s perceptions. The patient can
doubt become aware that others do not
necessarily perceive things in the same
way. This is not an attempt to get the
patient to change their point of view
Attempting Seeking to verbalize the patient’s feelings
that are expressed only indirectly.
to translate
into feelings
EXAMPLE
Really? That’s hard to
believe. Isn’t that unusual.
Patient: “I’m dead inside.”
Nurse: “Are you saying you
feel lifeless?” Patient: “I’m
way out in the ocean.”
Nurse: “Are you saying you
feel lonely or deserted?”
 THERAPEUTIC COMMUNICATION
TECHNIQUES
TECHNIQUE DESCRIPTION EXAMPLE

Sharing hope Communicating a sense of I believe you will find a way to face
possibility to achieve their your situation because I have seen
potential. Commenting on the your courage and creativity.
positive aspects of the
patients behavior,
performance, and responses
Encouraging Asking patient to consider What could you do to let your
kinds of behavior likely to be anger our harmlessly? Next time
formulation of appropriate in future this comes up, how might you
an action plan situations handle it? What are other ways you
could approach your boss?
 THERAPEUTIC COMMUNICATION
TECHNIQUES
TECHNIQUE DESCRIPTION
Summarizing Concise review of the key
aspects of the interaction to
bring a sense of satisfaction
and closure.
GENERALIZED sharing of
Self-disclosure
personal experiences about
the self to benefit the patient.
EXAMPLE
During the past hour, you and I
have discussed….. We have
discussed many ways to deal with
your anger toward you mother. You
have agreed to try a few and let me
know how it works out
That happened to me once, too. It was
devastating, and I had to face some things
about myself that I didn’t like. I went for
counselling, and it really helped….What
are your thoughts about seeing a
therapist?
 THERAPEUTIC COMMUNICATION
TECHNIQUES
TECHNIQUE DESCRIPTION EXAMPLE

Confrontation Helping the patient become You say you have already decided
aware of inconsistencies in what to do, yet you are still talking
feelings, attitudes, beliefs or a lot about your options.
behaviors.

Recommend or Allows the patient to consider Have you thought about….? Here are some
options they may not have things other people in your situation have
suggest options previously considered
considered…..?
(do not advise)