Dire Dawa University Faculty of Medical and

Health Science
Department of Nursing

Fundamentals of Nursing

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 Dictionary meaning
-Nursing means to care for, to nurture &to foster.
 WHO(World Health Organization)
-Nursing is both an art and science based on knowledge,
skill and attitude aimed at assisting individual, family
and community in health and illness to promote health,
to prevent illness and to maintain physical ,biological
and psychological pain to avoid complication and to
full fill self reliance in meeting daily health needs.

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 American Nursing Association (ANA)
-Nursing is a diagnosis and treatment of human response
to actual and potential problems.
 Florence Nightingale
-Nursing is the act of utilizing the environment of the
patient to assist him/her in his/her recover.


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 Profession is an occupation based on specialized
intellectual study and training.
 An occupation that regulates the activities of its
members by
› requiring specialized training

› requiring some sort of certification/ formal

qualification
› having professional organization

› having a code of ethics

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1-has well defined body of knowledge( practical rather
than theoretical)
2-presence of strong service orientation
3-presence of recognized authority by professional
group
4-governed by code of ethics
5-has professional organization that sets standards
6-conduct ongoing research & has autonomy

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 Occupation — any work for hire or employment
through which someone makes a living
 Occupation is like something you are occupied with,
and you're not necessarily doing it as a 'business' thing.
 Profession would be what you studied and are qualified
for, and your occupation would be what it is that you are
currently working as.

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 Example1.If you studied law and are practicing lawyer,
your profession and occupation would be the same thing,
but if you studied law and you are currently working as,
say, a bank teller, then your profession would be lawyer,
but your occupation would be bank teller.
 Example2: Designing a building would be called a
profession, whereas, constructing a building is an
occupation. A profession needs extensive training and
specialized knowledge. On the other hand, an occupation
does not need any extensive training. A person with an
occupation need not have specialized knowledge of his
trade.

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Occupation profession

Training may occur on job education takes place in college and university

Varied length of training definite and prolonged length of education

Value, beliefs and Ethics are Value beliefs, and Ethics are
not Prominent features of integral part of preparation
Preparation

Commitment & personal Commitment & personal

Identification vary identification are strong

Workers are supervised Workers are autonomous

Peoples often change jobs People unlikely to change jobs

paid for what he produces paid for his skills and his knowledge

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1)Promoting wellness
Wellness- well being
2) Preventing illness - the main objectives are
-To reduce the risk for illness
-To promote good health habit
-To maintain optimal functioning
3) Restoring health
- Providing direct care of the person
4) Facilitating coping
 The nurses facilitate patient& family coping with
altered function, life crisis& death.
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 Caring for patients requires that nurses take on different
roles at different times
 Nurses need to fulfill their varied roles as best as possible
by understanding their roles and knowing how to improve
in each role
 To meet aims of nursing nurses use knowledge, skill&
critical thinking

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 Care provider
 Caring/Comforting involve knowledge and sensitivity to
what matter and what is important to the client.
Coordinator
 Coordinates and plans care
 Prepares patient for discharge
 Liaison in health care team
Communicator/Helper
 Establish rapport
 It helps the client to explain the internal feeling
 Establish therapeutic (helping) relationship

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 Teacher
 Educate patient to develop self-care abilities based on the case
 Provide knowledge to allow patient to make informed decisions
 Promote health, prevent illness, restore health & facilitate coping

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Counselor
 counseling is a process of helping a client to cope with
stressful psychological or social problem, to develop
improved interpersonal relation ships and promote personal
growth=psychotherapy
 Assist and guide patient in solving problems or making
decisions
 Nurse doesn’t tell patient how to solve the problem
but, guides patient to decisions
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 Change agent
 a change agent is a person or group who initiates changes
or who assists others in making modification in them selves
or in the system
Manager
 is a person who plans, gives direction, developing staff,
monitoring operations, giving rewards fairly and
representing both staff member and administration as
needed
 Planning-Identify needs, developing goals
 Organizing - Identify resources to meet goals
 Directing- leading others in reaching goals
 Control- monitoring ongoing evaluations
 Delegates-Nurse who delegates maintains accountability
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 Leader
 leader ship is defined as mutual process of interpersonal
influence through which the nurse helps a client make
decision in establishing and achieving goals to improve the
client well being
 Have visions to energize others
 Motivates others to achieve goals
 Encourages others to do their best
 Works collaboratively
 Have wider variety of roles than managers

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Managers
 Administrators
 Relies on control
 Short term plans
 Eye on bottom line
 Does things right
Leaders
 Innovators
 Inspires trust
 Long term plans
 Eye on the horizon
 Does the right thing

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 Nurses are part of a team
 Don’t work in isolation

Motivator
 Motivation- Internal impulse that allows one to take
action or change behaviors.
 Nurses motivate patients to make changes by: having
a positive attitude, listening to patient needs,
encouraging, rewarding, and devoting time and
energy to assist with changes.

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 Critical Thinker
 A way of looking at problems other than the obvious
 “Thinking outside the box”
 Looking at the big picture
 Question why something is being done
 Ask, “what if…..”
 Open to new ideas
Advocate
 acting on behalf of the client group
 Protect and support the patient
 Patient representative
 Assertiveness/self-confidently
 Promote self determination
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Definition:
• Thenursing process is an organised, systematic and
deliberate approach to nursing in partnership with the
patient and their family with the aim of improving
standards in nursing care (Rush et al, 1996)

• It is a holistic and interactive approach through

which nursing care provision is organised to achieve
patient centred nursing interventions and involves
assessment, planning, implementation and evaluation
of care (Arnold and Boggs, 1999 and Heaven and
Maguire, 1996)

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 The cornerstone of the nursing profession is
the nursing process

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 An organized sequence of problem-solving steps used to

identify and to manage the health problems of clients

 An organizational framework for the practice of nursing

 It is patient centered and outcome oriented

 The steps are interrelated and dependent on the accuracy of

each of the preceding steps

 It is used to identify, diagnose, and treat human responses to

health and illness

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 Provides an orderly & systematic method for planning &
providing care
 Enhances nursing efficiency by standardizing nursing
practice
 Facilitates documentation of care
 Provides a unity of language for the nursing profession
 Is economical
 Stresses the independent function of nurses
 Increases care quality through the use of deliberate actions

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 Access to quality nursing care
 Continuity of care
 Patient participation reflects respect for
human dignity

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 Consistent and systematic nursing
education and care provision
 Job satisfaction
 Professional development
 Avoidance of legal action
 Meeting code of ethics and professional
nursing standards

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 In working with patients and carers, the nurse must:
o Listen and respond to their concerns and
preferences
o Promote their independence and involvement

o Meet their language and communication needs

o Provide individualised information for health

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 Within the legal scope of nursing

 Based on knowledge &critical thinking enables

 Planned—steps in nursing process are organized and systematic

 Patient-centered—plan of care individualized for each person

where pt is encouraged to actively participate.

 Goal-directed—effort between the patient and nursing team to

achieve desired outcomes—short and long term goals

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 Prioritized—in order of importance to shorten hospital stays to

maximize efficiency in minimal time

 Dynamic—health status of pt is constantly changing, therefore in

evaluation, new data is collected and the process begins again

 cyclical

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 Problem-oriented
 Goal-oriented
 Orderly, planned, systematic
 Open to accepting new information during its
application
 Interpersonal
 Permits creativity among nurses and clients
 Universal

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 A – Assessment

 D – Diagnosis

 O – Outcome Identification

 P – Planning

 I – Implementation

 E – Evaluation
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BY.Nigatu.A 04/08/24 30
 A nursing assessment is the collection and
documentation of important data(subjective and
objective) regarding a patient’s health status
 Subjective data are what the patient/client actually
states (e.g., "I'm tired."). These are his feelings
and perceptions.
 Objective data are concrete, observable
information such as:
- vital signs
- laboratory studies, and
- changes in physical appearance
 to compare what you observe to what the patient
actually tells you.
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 Nursing assessments do not duplicate medical
assessments
 Medical assessments target data pointing to
pathologic conditions
 Nursing assessments focus on the patient’s responses
to health problems or potential health problems

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=>Four types
(1) Observation
(2) Interviewing
(3) Physical examination
(4) Intuition
(1) Observation: - Just more than to see b/c you can use sense of smell,
vision, touch & taste (rare)
(2) Interviewing
 Communication b/n the pt & health care provider
 Its on actual Hx taking phase
 Subjective and organized
 Has four phases
a. Preparatory phase ( for admitted pt )- gathering some information
about the pt
b. Introductory phase- “verification of self” in order to reduce pt
anxiety
c. Activity phase ( working phase)- It’s the actual working phase
d. Closure ( conclusion) phase
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(3) Physical examination
- identifying the pt problems using techniques of
examination, such as:
- Inspection
- Palpation
- Auscultation
- Percussion
(4) Intuition
› It’s an ability to know or understand something through
feeling, rather than evidence.
› Use of sense of insight or instinct when the information is
vague or sketchy.
› Its understanding without learning the formal education

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A. Data collection:- compiling of information using different
techniques of Hx taking (observation, physical examn &
interviewee)
(1) Subjective data
 are symptoms or covert cues that is expressed by pt.
 its subjected to the pt only E.g. Headache
(2) Objective data
- are sign or overt cues/ observable (not hidden / secrete)
e.g. Ulcer on the skin
- validate the subjective data
- Laboratory value

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Source of data
** Primary source => pt. him/her self
** Secondary data => obtaining data other
than the pt include:
 Significant others/families, friends/
 Health record
 Text books, articles, journals
 Lab test result
 Health care teams
 Literature
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B. Data Validation
 Confirming the compiled data
 Recheck the cue
 Referring books, journal etc

C. Organizing data
• Organization of data using various models

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1. Initial assessment – comphrensive assessment
2. Focused assessment
 Focusing on specific areas where the pt is complaining
3. Emergency assessment
 at emergency time
4. Time-lapsed assessment
 assessing for any improvement
 particularly for a pt with chronic illness like TB, leprosy,
DM etc

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 Subjective Data
› Information perceived only the affected person

› Cannot be perceived or verified by another person

› Examples of Subjective data:

• I am feeling nervous, nauseated, chilly

• "I feel sick to my stomach."
• "I have a stabbing pain in my side."
• "I wish I were home."
• "I feel like nobody likes me."

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 Objective Data
› Observable and measurable data
› Data that can be see, heard or felt by someone other
than the person experiencing it
› Examples of objective data:
 elevated temperature (>101 F),
 moist skin,
 Refusal to eat,
 Blood pressure of 110/70 mmHg.
 Rash on right arm
 Walks with a limp
 Ate all of his breakfast
 Urinated 150 ml clear urine
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 Assessment tools of health Hx
A. Old Medical Model (system Review)
Includes:
 Date
 Identification
 Source of information
Source of referral
 C/C
 HPI
 PHI (past medical illness )
 FHx
 Psychological Hx
 Systemic Review
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 Systemic review (P/E) includes:-
• General appearance
• HEENT
• Breast
• Chest /respiratory system
• CVS
• Abdomen
• GUS
• Mss
• Intigumentary system
• CNS
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Applying clinical critical thinking
 Summarize abnormal finding
 Localize to anatomical region
 Process the identified problem in probable
process
 Impression/ tentative Dx/Assessment /
 Lab result
 Nursing Dx
 Rx (used)
 Appointment

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=> Used mostly in admitted pt in hospital
Assessing eleven function health pattern

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 Assessing eleven function health pattern
(1). Health perception health mgt.
(2). Activity & exercise
(3) Nutrition & metabolism
(4) Elimination pattern
(5) Stress & copping tolerance
(6) Role & relationship
(7) Self perception self concept
(8) Cognition & perception
(9) Sleep & rest pattern
(10) Reproductive & sexual pattern
(11) Belief & value – Assessing religion

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The health Hx
 When obtaining health Hx, attention is focused on the impact of
psychosocial, ethnic and cultural backgrounds on the person's
health illness and health promotion behaviors.
 In describing health Hx, many nurses are responsible for
obtaining a detailed Hx of the person's current health problems,
past medical Hx, family Hx, and a review of the person's
functional status.

Contents of health History

 When the pt. is seen for the 1st time by a member of the health
care team, the 1st requirement
 is a database (except in emergency situation)

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 The sequence and format of obtaining data about the pt.
in traditional approach includes:-
1. Biographical data:- it puts the pt's health Hx in the
context
It includes:  the pt's name
Occupation
Address & age
Ethnic origins
 Gender
 Marital status
2. Chief compliant: - is the issue that brings the patient
(person) to the attention of the health care provider
Questions- such as:
 "why have you come to the health center today"?

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 3. Present health concern (illness) : -
 It is the single most important factor in helping the health care
team to arrive at a Dx. or determine the Person's needs
 It includes information such as date and manner (sudden or
gradual), in which the problem occurred, the setting in which the
problem occurred (at home, at work, after an argument, after
exercise) manifestation of the problem and the course of the
illness or problems.
 Specific symptoms ( pain, headache, fever, change in bowel
habits) are described in detail, along with the location and
radiation (if pain), quality, severity and duration
 Ask about the problems, is that persistent or intermittent, what
factors aggravate or alleviate it.

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4. Past Medical History: - is an important part of
the data base.
 After determining the general health status, the
interviewer asks about:
› Immunization
› known allergies, to medications or other substances
› Previous illness
› dates or the age of the pt. at the time of illness
› The name of the 10 health care provider & hospital.

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Hx of the ff areas are elicited here:
› Child hood illness (rubella, polio, mumps, chicken pox,
rheumatoid fever)
› Psychiatric illness
› Injuries- burns, fractures, head injuries
› Hospitalization
› Surgical and diagnostic procedures
› Current medications- (prescription, homo medication)
› Use of alcohol & other drugs

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5. Family History: - includes the age and health status, or the age and
cause of death:-
 1st order relatives (parents, siblings spouse, children)
 2nd order relatives (grand parents, cousins) are
 Elicited to identify diseases that may be genetic in origin,
communicable, or possibly environmental in causes.
 the ff diseases are generally included:-
 Cancer  diabetes  tuberculosis
 HPN epilepsy  kidneys disease
Heart disease Mental illness Arthritis
 Allergies Asthma
Alcoholism
 Obesity

6. Review of System: - includes an over view of general health as well as

symptoms related to each body systems.

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BY.Nigatu.A 04/08/24 52
• Nursing diagnosis is the process of collecting
information from patients and results from
vital signs assessment to make a series of
clinical/nursing judgements (Dougherty and
Lister, 2008)
• It also involves patient data analysis in order
to identify a patient’s health care needs and to
prepare diagnostic statements

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Phase 2 of the Nursing Process

Data is useless if not used

An important part of nursing practice is determining what

the client needs

Looking at the data, we can see both problems treated by

nursing (nursing diagnosis) and treated by other
disciplines (collaborative problems).

Nursing diagnosis are not medical diagnosis

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 PHYSICIAN vs NURSING DIAGNOSIS
Physician diagnosis is disease focused, for e.g.
 “Ato Yidnek has pain and swelling in all joints.
Diagnostic studies indicate that he has rheumatoid
arthritis”.

 Nursing diagnosis is holistic, considering both the

problem and its effect on the patient and family, for
e.g.
 “Ato Yidnek has pain and swelling in all joints,
making it difficult to feed and dress himself. He has
voiced that it's difficult to feel worthwhile when he
can't even feed himself”.
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1. Identify how an individual, group or community
responds to an actual or potential health and life
processes

2. Identify factors that contribute to or cause health

problems (etiology).

3. Identify resources or strengths the individual, group

or community can utilize to prevent or resolve
problems BY.Nigatu.A 04/08/24 56
BY.Nigatu.A 04/08/24 57
 Summary of a 3-part statement for actual
nursing diagnosis
1. Health Problem: Ineffective Airway
Clearance.
2. Etiology: related to weak cough and
incisional pain.
3. Signs and symptoms as manifested by poor
or no cough (defining characteristics):
effort and statements that incision hurts too
much when he coughs.
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 PES Format:
• The PES format describes the problem and its
causes(etiology), together with data(signs and
symptoms) that validate the chosen diagnosis.

• To write the nursing diagnostic statement, you link

the problem and its cause by using “ related to”
then add “as manifested by” or “as evidenced by”
and state the major signs and symptoms that
validate the diagnosis

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 Examples of Actual Nsg Dx.
› Contain diagnostic label + Related factor + defining
characteristics (evidence )
E.g.: Impaired physical mobility related to pain as
evidenced by limited range of motion, reluctance to
move, grimacing.
 If there is lesion in the body observed itching, oozing:
Nsg Dx. – Impaired skin integrity related to unknown
cause as itching lesion, pustule…

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 “ineffective airway clearance related to
incisional pain as manifested by poor cough
effort”
 “impaired communication related to inability
to speak Amharic as manifested by inability
to follow instructions in Amharic and
verbalisation of requests in English

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 Writing Diagnostic Statements for Potential
Nursing Diagnoses
• If you assess a patient and note there are some high-
risk factors present that may cause him to have a
certain nursing diagnosis, then you have identified a
potential nursing diagnosis.

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Writing Diagnostic Statements for Potential
Nursing Diagnoses

• Document the potential nursing diagnosis by writing

a two-part statement that describes both the problem
and its cause (e.g. Potential Impaired Skin Integrity
related to advanced age, immobility, and
confinement to bed).

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 Potential problems are prefaced by "risk for" and are
related to a cause specific to the dx, but can not have s/s.
 A problem that the client is a high risk for developing

E.g 1. High fluid volume deficit in related to/risk of diarrhea

evidenced by B/P – 60/40 mmHg skin pinch goes back
slowly

Risk for FVD related to diarrhea => potential Dx
E.g 2. Risk for disturbed sleep pattern related to changed env’t

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• A problem that is suspected but more data needed before making
decision
• No clear cut for the problem happen or not

When it is uncertain whether or not a problem exists use "possible“

it is looking to the future, but the data is incomplete ,there are no s/s

there is a reason you think this may become a problem and you must
relate it to that reason.
E.g. Possible parental role conflict related to impending divorce

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4. Wellness Dx ( Wellness Nsg Dx)
Wellness diagnoses are health related problems with which a
healthy person obtains nursing assistance to maintain or perform at
a higher level and is prefaced by the phrase "potential for
enhanced"
No problem exist

› E.g. potential for enhanced breastfeeding

› E.g. - the client desires a highest level of wellness “potential

for enhanced physical fitness”
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5. Syndrome Nsg Dx.
•Used when the Dx is associated with a cluster of other
diagnoses
•Disuse syndrome:-
o Impaired physical mobility
o Risk for constipation
o Risk for ineffective breathing pattern
o Risk for injury
o Risk for disturbed thought processes
o Risk for powerlessness etc

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 Actual: Imbalanced nutrition less than body
requirements RT chronic diarrhea, nausea, and
pain AEB height 55 weight 105 lbs.
 Risk(Potential): Risk for falls RT altered gait and
generalized weakness
 Wellness : Family coping potential for growth RT
unexpected birth of twins.
 Possible : possible spiritual distress related to terminal/
chronic illness(cancer).
The nurse is responsible and accountable for:
 Correlating medical Dx or medical Rx measures that have the
risk for unique complications
 Making pertinent assessments to detect complications
 Reporting trends that suggest a complication is developing
 Managing the emerging problem with collaboration
 Evaluating the outcomes

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 Third step of the Nursing Process
 Designing nursing strategies to give intervention or to resolve
patient problem.
 This is when the nurse organizes a nursing care
plan based on the nursing diagnoses.
 Nurse and client formulate goals to help the
client with their problems
 Expected outcomes are identified
 Interventions (nursing orders) are selected to
aid the client reach these goals.
1. Take care of immediate life-threatening issues.

2. Safety issues.

3. Patient-identified issues.

4. Nurse-identified priorities based on the overall picture, the

patient as a whole person, and availability of time and

resources.

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In order to prioritize the problem follows the ff
factor.
(1) Pt. concern
(2) Available resource
(3) Feasibility
(4) Magnitude
(5) Manageability

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 Planning Begin by prioritizing client problems
 Rank as high, intermediate or low
 Client specific
 Priorities can change
 Setting priorities-based on pt diagnosis
 Writing goals and expected outcome
 Selecting nursing intervention
 Communicating care plan to the patent.
 Goals-are broad statement about state of the
patient after nursing intervention are carried out.
 It addresses directly the problem stated in nursing
diagnosis
 Of two types :-
short term: Can be met in relatively short time
within a day or a week
Long term : Require more time to achieve,
perhaps several weeks or months.
criteria’s are specific , measurable, realistic statements
of goal attainment and time bounded(SMART).
 They answer the questions who, what action under
what circumstance. How well and when .
 Interventions are selected and written.
 The nurse uses clinical judgment and professional
knowledge to select appropriate interventions
that will aid the client in reaching their goal.
 Interventions should be examined for feasibility
and acceptability to the client
 Interventions should be written clearly and
specifically.
 Interventions 3 types
 Independent ( Nurse initiated )- any action the
nurse can initiate without direct supervision
 Dependent ( Physician initiated )-nursing actions
requiring MD orders
 Collaborative- nursing actions performed jointly
with other health care team members
 The fourth step in the Nursing Process
 It is the action phase of the nursing process in
which nursing care is provided.
 It is defined as the actual initiation of the
plan ,evaluation of the response to the plan and
recording of nursing action.
 This is the Doing step
 Carrying out nursing interventions (orders)
selected during the planning step
 This includes monitoring, teaching, further
assessing, reviewing NCP, incorporating
physicians orders and monitoring cost
effectiveness of interventions
 Actualization of the plan of care through nursing interventions.
 Implementation of established plan of care is putting the plan into action
and it includes the following activities:

1. Ongoing collection of information to determine how the patient is

responding to nurses’ actions and to identify new problems.

2. Carrying out the Nursing Interventions and Activities prescribed in the

nursing care plan during the planning phase.
3. Recording (Charting) and Communicating patient's health status and
response to nursing interventions.

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 To determine effectiveness of NCP
 Final step of the Nursing Process but also done
concurrently throughout client care
 A comparison of client behaviour and/or
response to the established outcome criteria
 Continuous review of the nursing care plan
 Examines if nursing interventions are working
 Determines changes needed to help client reach
stated goals.
 Actualization of the plan of care through nursing interventions.
 Implementation of established plan of care is putting the plan into action
and it includes the following activities:

1. Ongoing collection of information to determine how the patient is

responding to nurses’ actions and to identify new problems.

2. Carrying out the Nursing Interventions and Activities prescribed in the

nursing care plan during the planning phase.
3. Recording (Charting) and Communicating patient's health status and
response to nursing interventions.

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 . .
… …
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ha n
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