CENTRAL MINDANAO UNIVERSITY

University Town, Musuan, Maaramag, Bukidnon

NCM56

FUNDAMENTALS OF NURSING PRACTICE

BS NURSING 1C

JANUARY 27, 2020

I. Concept of Man, Health and Illness

A. Factors and Issues Affecting Health and Illness

1. What is health, wellness and well being?

Health, it is a state of complete physical, mental, social wellbeing, and

not merely the absence of disease or infirmity. It is more than a good or bad
feeling, an external aesthetic look, or numbers on a medical chart. It is the all
encompassing state of who we are as individuals. Health is the most
important aspect of our existence, it affects us every moment of the day, can
change instantly or overtime, and is the number one determinant of the
trajectory our life takes.
Health is also defined in 4 areas:
1. Physical Health- it is the state that your bodily structures and systems
are in at any given time.It encompasses what you feel and what you sense.
When you are not physically healthy, you can barely feel pain, headaches,
rashes, or anything that manifests your physical body.
2. Mental & Emotional Health- it refers to the condition of your mind and
ability to balance your emotions. It includes on how you respond to daily
stress, the life situations you encounter and how self-aware you are.
3. Social Health- it involves the quality and types of relationships you
have with the people in your life. It is also a measure of how well you get
along with others. The ability to develop and maintain friendships is very
important.
4. Spiritual Health- it can have something to do with someone’s
religiosity, it is not necessity to be involved in a religious community. It has
more to do in developing your morals and values and how they influence the
direction your life takes.

Wellness, is the quality or state of being healthy in body and mind, as a

result of deliberate effort. It also refers to physical health. It is an active
process of becoming aware of and making choices toward a healthy and
fulfilling life, more than being free from illness, a dynamic process of change
and growth. Wellness matters because everything we do and every emotion
we feel relates to our well-being.
 There are 8 Dimensions of Wellness:
1. Emotional wellness- relates to understanding your feelings and coping
effectively with stress.
2. Environmental Wellness- inspires us to live a lifestyle that is respectful
of our surroundings. It encourages us to live in harmony with the Earth by
taking action to protect it. It also promotes interaction with nature and with
your personal environment.
3. Financial Wellness- involves the process of learning how to
succesfully manage financial expenses.Financial stress is repeatedly found
to be a common source of stress, anxiety and fear for college students.
4. Intellectual Wellness- it involves in having an open mind when you
encounter new ideas and continuing to expand your knowledge. It
encourages active participation in scholastic, Cultural, and community
activities.
5. Occupational Wellness- it is about enjoying your occupational
endeavors and appreciating your contributions. It encourages personal
satisfaction and enrichment in one’s life through work.
6. Physical Wellness- it relates to maintaining a healthy body and
seeking care when needed.It is attained through exercise, eating well,
getting enough sleep and paying attention to the signs of illness and getting
help whwn needed.
7. Social wellness- it helps you perform social roles effectively and
comfortably, and create a support network. It also allows you to not only
develop encouraging relationships with peers, but also intimate relationships
with romantic partners.
8. Spiritual Wellness- it allows you to develop a set of values that help
you seek meaning and purpose. Being spiritually well means knowing which
resources to use to cope with issues that come up in everyday life.

Wellbeing, it refers to a more holistic, whole of life experience, a good

feeling condition of existence. A state characterized by your health,
happiness, and prosperity. It is a measurements that recognises humans are
emotional and values non financial benefits. A state of which there is a
general contentment with life and the way things are, we experience balance
in body, mind, and spirit and the feeling of being connected to purpose,
people, and community.
 Personal wellbeing is a particularly important dimensions which we
define as how satisfied we are with our lives, our sense that what we do in
life is worthwhile, our day to day emotional experiences and our wider mental
wellbeing.
Wellbeing comes from within when you proceed in:
>Listening to your body and mind and noticing what is going on.
>Taking small steps and investigating the results.
>Creating a positive environment where you can succeed.
>Includes support from others.
>Being compassionate to yourself as you go through and start again
whenever you need to.
>Remebering that wellbeing is our natural inclination. Trusting your
sense of what is right for you.
>Savoring successes.
There are 5 Dimensions of Wellbeing:
1. Career Wellbeing- it is a large part of wellbeing as it is how we spend
most of our days. Increase your career wellbeing by, ensuring that you are
able to use the skills you feel are your strongest. This will help in in making
sure that you are satisfied and lead to both higher quantity and quality of
work.
2. Social Wellbeing- it encompasses a large part of our time not spent at
work and includes almost all of our personal and professional
realationships.It is important to find people at home and at work that can
have a positive outlook and effect on you during the day. Increase your
ssocial wellbeing by, trying in strengthening the mutual connections in your
network of friends, family, co-workers and surround yourself with positive
and happy people.
3. Financial Wellbeing- it is being able to effectively manage your
economic life. Increasing your financial wellbeing by, spending money on
experiences, like a dinner with friends or vacation with love ones, or put
money aside in a savings account.
4. Physical Wellbeing- it is not only being generally healthy and feeling
well but also having the energy to participate in the activies in which you
would be interested. Increasing your physical wellbeing by, making sure to
have a regular exercise,eating plenty of fruits and vegetables and ensuring
to get some sleep.
 5. Community Wellbeing- it is a feeling of having a sense of engagement
in the area in which you live. Incresing your community wellbieng by, trying in
opting into community events with people who share your passions or
volunteer in community groups to give back.

2. Models of Health and Wellness

a. Clinical Model

It is the narrowest interpretation of health. It is medically oriented

model. According to this model, Health is seen as freedom from
disease and Illness is seen as the presence of disease.

b. Role Performance Model

In this model, health is defined in term of the individual ability to

perform work, which is fulfilled by the societal roles.
According to this model, Health is seen as the ability to fulfill
societal roles and Illness is seen as the inability to fulfill societal
roles.

c. Adaptive Model

This model is a biased on the ability to adopt to the environment

and interact with it.
According to this model, Health is seen as adaptation while
Illness is seen as a failure of adaptation, or maladaptation.

d. Eudemonistic Model
 It is the most comprehensive, holistic view of health.
According to this model, Health is actualization or realization of
one’s potential while the Illness is seen as the failure to actualize or
realize one’s potential.

e. Agent-Host-Environment Model

It describes the cause of illness, it is used primarily in predicting

illness rather than promoting wellness.

This model is composed of three dynamic, interactive elements:

1. Agent- it is any factor or stressor. It can be biological,
chemical, physical, mechanical, and psychosocial.
2. Host- Living beings (e.g. human or animal)
3. Environment- this includes all the external factors that make
illness more or less likely to occur.

According to this model, Health is seen when all three elements

are in balance while Illness is seen where one, two or all three
elements are not in balance.

3. Variables Influencing Health Status, Beliefs and Practices

1.Internal factors
>Biologic dimension
>genetic make up
>sex
>age
>developmental level
>race
>Psychological and Emotional dimension
 >Mind-Body Interaction
>Cognitive dimension
>Self-concept and self-perception
>Lifestyle
>Spiritual and religious beliefs and values

2. External Factors
>Environmental
>Geographical location
>Housing
>Sanitation
>Climate
>Pollution of food, air, water
>Standard of living
>Class of Family
>Occupation
>Economic levels
>Education
>Family and cultural beliefs
>Pattern of daily living
>Social Dimension
>Social network (family, friends)
>Job satisfaction

4. Health Belief Models

 It is a theoritical model that can be used to guide health promotion and
disease preventions programs. It is used to explain and predict individual
changes in health behaviors. It is one of the most widely used models for
understanding health behaviors.

A. Health Locus of Control Model

Locus of Control (LOC) is a concept from social learning theory that
nurses can use to determine whether clients are likely to take action
regarding health, that is, whether clients believe that their health status is
under their own or others control.
Locus of Control plays a role in client’s choices about health
behaviors. It is also a measurable concepts that can be used to predict
which people are most likely to change their behavior.

B. Rosentock’s and Becker’s Health Beliefs Models

Rosentock(1974) prposed the health belief model intended to predict

which individuals would or would not use such preventive measures as
screening for early detection of cancer. While, Becker in 1974 modified
the health belief model to include these components: individual
perceptions, modifying factors, and variables likely to affect initiating
action.

A. Individual Perception

a. Perceived Susceptibility- it is a family history of a certain

disorder like, diabetes or heart diseases, may make the
individual feel high at risk.

b. Percieved Seriousness- one question here is, In the

perception of the individual, does the illness cause death or have
serious consequences? It is the concern about the spread of the
acquired immune deficiency syndrome (AIDS) reflects the
general public’s perception of the seriousness of this illness.
 c. Perceived Threat- according to Becker percieved susceptibility
and perceived seriousness are combined to determine the total
perceived threat of an illness to a specific individual.

5. Define Health Care Adherence

Health care adherence is the extent of which an individual’s behavior

concides with medical or health advice such as taking medications, following
diets or lifestyle changes.
There are factors that influence adherence such as:
 Client motivation to become well
 Degree of lifestyle change necessary
 Percieved severity of the health care problem
 Value placed on reducing the threat of illness
 Difficulty in understanding and performing specific behaviors
 Degree of the inconvenience of the illness itself
 Beliefs thst the prescribed therapy or regimen will or will not help
 Complexity , side effects, and duration of the proposed therapy
 Specific cultural heritage taht may make adherence difficult
 Degrees of satisfaction and quality and type of relationship with the health
care providers
 Overall cost prescribed therapy

There is also a Nursing Action on Non Adherence

 Establish why the client is not folowing the regimen
 Demonstrate caring
 Encourage healthy behaviors through positive reinforcements
 Use aids to reinforce teaching
  Establish a therapeuticn ralationship of freedom, mutual understanding,
and mutual responsibility with the client and the support persons.

6. Differentiate Illness and Disease

Illness is something that needs to be managed such as the feeling of

pain, discomfort, distress, weakness, fatigue, etc. It is also defined as the ill
health the person identifies themselves with, often based on self reported
mental or physical symptoms. In some cases also this may mean only minor
or temporary problems. Illness may also include health conditions that limit
the person’s ability to lead a normal life. It is ussually associated with
disease but may occur independently of it.

Disease usually causes illness though one can have a disease without
illness. It is defined as a condition that is diagnosed by a physician or other
medical expert. Can be described as an alteration of inbody functions
resulting in a reduction of capacities or shortening of the normal lifespan.

7. Describe Suchman’s five stages of Illness

 Stage 1: Symptoms experiences

It is where the person is aware that something is wrong. A person
usually recognizes a physical sensation or a limitation in functioning but
does not suspect a specific diagnosis.
There are 3 Aspects:
1. Physical (Fever, Muscle aches, Malaise, Headache)
2. Cognitive (Perception of “having flu”)
3. Emotional (Worry on consequence of illness)

 Stage 2: Assumption of the sick role confirmation from the family and friends
At this point, the illness becomes a social phenomenon, and sick
people seek confirmation from their families and social groups that they
 are indeed ill and that they be excused from normal duties and roel
expectations.

 Stage 3: Medical care contact

In this stage, the client seeks expert acknowledgement of the illness
as well as the treatment.
Validation of the real illness: Explanation of the syptoms,;
Reassurance or prediction of outcome.

 Stage 4: Dependent Client role

In this stage the client depends on the healthcare professionals for
the relief of symptoms. The client accepts care, sympathy and protection
from the demands and stresses of life.

 Stage 5: Recovery or Rehabilitation

This stage can arrive suddenly, such as when the symptoms
appeared. In this case chronic illness, the final stage may involve in an
adjustments to a prolong in health and functioning.
It gives up the sick role and returns to former roles and functions.

B. Health Care Delivery System

8. Types of Health Care Services
Health care services cover many different types of medical issues. Many
people think of primary care, outpatient or emergency care when they need
an illness managed or are genarlly not feeling well.
There are more health services that is dedicated to certain illnesses or
issues. This are:
 Mental Healthcare
 Dental care
 Laboratory and Diagnostic care
 Substance abuse treatment
  Preventative care
 Physical and occupational therapy
 Nutritional support
 Pharmaceutical care
 Transportation
 Prenatal care

9. Types of Health Care Agencies

Healthcare is provided in various settings:

1. Outpatient services- patients who don’t require hospitalization can

recieve a healthcare in a clinic. It is designed to be convenient and easily
acccessible to the patient. Its services are generally directed at primary and
secondary health centers.

2. Clinics- it involves a department in a hospital where patients not

requiring hospitalizations, recieve medical care.

3. Institutions-Hospital- it has been the major agency of health care

system. It is classified as:
a) Public- it is financed and operated by the government agency at
the local, state or national level. It provides services at free of cost.

b) Private- it is owned and operated by churches, coprporations,

individuals and charitable oraganizations. It is operated on a for-profit-basis.

c) Military- provieds medical care for the armed forces and their
family.
10. Providers of Healthcare services

There are 6 Different Types of Healthcare Providers and What they do:

1. Doctors

They are the primary care providers. They studied for how many years
and gains experience for a few more years befofre he or she can actually
practice as a doctor. There are different types of doctors, like the doctor we
all refer as a ‘doctor’ is also called a physician or general practitioner.
Other doctors are specialists and have specialized in a field that usually
requires more studying after after completing their normal medicine studies.
There is a wide range of specialists that include urologists, neurologists,
cardiologists, oncologists, chiropractors, pschologists, dentists,
paediatrecians and etc.

2. Nurses

Nurses work closely with the patients and their job in the health care
process is often more important for recovery than the doctor’s. They take
care the patients and are there when things go wrong. Nurses can have
different levels of qualification based on their studies and experience. Not all
the nurses are in the hospitals, there may be trained and registered nurses in
a doctor’s office to take blood pressure, do blood sugar tests , draw blood
and etc.

3. Pharmacists
 They are the one who have to study for a long time and know about
chemicals, medicines, side effects,and toxins. They are the healthcare
provider which provides patients medications that the doctor’s prescribed for
a specific condition. Pharmacists often help doctors understand what types
of medicine to prescribe together to avoid serious side effects in the patient.
They offer instruction on how to take the medication and an answer the
quetion of the patients.

4. Administrations Staff

They handle appointments, payments, patient files, health insurance

companies, specialists, medical reps, etc. They make the doctor’s office or
the hospital run. They are definitely part of the team, without them things
may go wrong.

5. Technologies and Technicians

They are the one who works in the laboratory to look for all kinds of
things in the blood or urine to be analysed and to help the doctor do the
diagnosis. They are called the laboratory technicians. There are also other
set of technicians, the radiology technicians. They are the people who take
xrays so a radiologist can evaluate them and make a diagnose. There are
also the pharmacy technicians, they help the pharmacists get the
prescriptions ready and even help with the customers. All this technicians
play an important role of the team.

6. Therapists

This people are specialists, but unlike the services of Doctors, they help
people recover from illness or injury through working on physical aspects like
speech, movement, coordination and etc.
 There are other types of therapists like:

a. Physical Therapists

They work with the person’s muscle movements, strenght, etc. They
are also part of the rehabilitation after an injury. Some people also visits them to
loosen tense muscles or get rid of build-up tension especially sports players they
make use of physical therapists on a regular basis.

b. Occupational Therapists

They are the one who work with children with developmental or
mental problems. They are also part of the rehabilitative types of services. They
work with patients who were injured or had a stroke and need to learn to walk,
talk, brush their teeth, pick up spoon and etc.

c. Speech Therapists

They work with people who struggled in speaking, language or even

swallowing. They also help children with speech defects, or those who troubled
in using a language correctly.

11. Factors affecting health care delivery

A. Increasing Number of Older Adults

B. Advance Technology
C. Economics
D. Womens Health
E. Uneven Distribution of Service
F. Access to Health Insurance
 G. The Homeless and the Poor
H. Health Insurance Portability and Accountability Act
I. Demographic Changes

12. Frameworks for care

A. Manage Care
B. Case Management
C. Differentiated Practice
D. Case Method
E. Funtional Method
F. Primary Nursing

II. Concept of Nursing

A. Describe Nursing as:

1. Profession-its strives to compensate its pratitioners by providing

freedom of action, opportunity for continuous professional growth and
economic security. It also attracts individuals of intellectual and personal
qualities who exalt service above personal gain and who recognize thier
choosen occupation as a life work.

2. Science-it is the development of theories and practical concepts for

improving how clinicians and patients administer care and manage
conditions. it is merges the worlds of natural, applied, and human
science into a multi dimensional lens that explores new and better ways
to deliver health services.
 3. Art-It is more than a great deal of science. It is more than just
knowing;it is doing. It bridges information from nurses to patients in a
skilfull way. It is the application of all the science known to nursing to
give the utmost care the patient needs.

B. What are the basic roles and functions of a nurse?

1. Caregiver- as a caregiver, nurses are expected to assist the client

physical, psychological developmental, cultural and spiritual needs. It
involves a full care to a completely dependent client, partial care for the
partially dependent client, and supportive-educative,care in order to
attain the highest possible level of health and wellness.

2. Communicator- Communication is very important in nnursing roles. It

is vital to establish nurse-client relationship. Nurse who communicate
effectively get better information about the clients problem either from
itself or from his family. With better information nurses will be able to
identify and implement better interventions and or nursing care thet
promotes fast recovery health and wellness.

3. Teacher- being a teacher is a important role for a nurse. It is her duty

to give health education to the clients, families and community, however,
the nurse must be able to assess the knowledge level, learningneeds
and readness of the clients, families and community to give appropraite
and necessary health care education they need to restore and maintain
thier health.

4. Client Advocate- A nurse may act as an advocator. an advocator is

the one who expresses and defends the cause of another or acts as
representatives. Some people who are ill maybe too weak o do on his
own and or even to know his rights to health care. In this instance, the
nurse may convey is clients wish like change of physician, change of
food, upgrade his room or even to refuse a particular type of treatment.
5. Counselor- A nurse may act as a Counselor. She provides emotional,
intellectual and psychological support. She helps a client to recognize
with stressfull psychological or social problems, to develop and improved
interpersonal relationship and to promote personal growth.

6. Change Agent- As a change agent, oftentimes a nurse change or

modify nursing care plan based on her assessments on the clients health
condition. This change and modification will only happen when the
interventions/s does not help and improve a clients health

7. Leader- Nurse often assumes the role of leader. Not all nurses have
the ability and capacity to become a leader. As a leader it allows you to
participate in and guide teams that assess the effectiveness of care,
implement-based practices, and construct process improvement
strategies. You may hold a variety of positions like shift team leader,
ward incharge, board of directors, etc.

8. Manager- As a maneger, a nurse has the authority, power, and

responsibility for planning, organizing, coodinating and directing work of
others. She is responsible for setting goals, Make decisions, and solve
problems that the organizations may encounter. It is also her
responsiblity to supervise and avaluate the performance of her
subordinates. The maneger always ensures that nursing care for
individuals, families and communities are met.

9. Case manager-In some hospitals, a case maneger is a primary nurse

who provides direct care to the client or family e.g. case maneger for
diabetic client, she he has the responsiblity to give health education,
measure the effectiveness of the nursing care plan and monitor the
outcomes of interventions whether effective or not.

10. Research consumer-Nurses often do research to improve nursing

care, define and expand nursing knowledge.