FUNDA REVIEWER

PRELIM

and standards for the protection of the

Topic Outline: public and the professionals.
● Concept of Nursing
● Fundamentals of Nursing Practice
● Nursing as an Art PROFESSIONAL NURSING
● An art and science, dominated by an ideal
or service in which certain principles are
CONCEPT OF NURSING applied in the skillful care of the well and the
ill, and through relationship with the
NURSING IS AN ART AND SCIENCE client/patient, significant others, and other
● As a professional nurse, you will learn to members of the health team
deliver care artfully with compassion, caring,
PROFESSIONAL NURSE
and respect for each patient’s dignity and
personhood. ● Is one who has acquired the art and science
● As a science, nursing practice is based on a of nursing through her basic education, who
body of knowledge that is continually interprets her role in nursing in terms of the
changing with new discoveries and social ends for which it exists – the health
innovations and welfare of society and who continues to
● The Quality of Care is at level of excellence add to her knowledge, skills, and attitudes
that benefits patients and their families through continuing education and scientific
inquiry (research) or the use of the results of
SCIENCE AND ART OF NURSING PRACTICE such inquiry
● Nursing practice requires a blend of the
BENNER: NOVICE TO EXPERT
most current knowledge and practice
standards with an insightful and
NOVICE
compassionate approach to patient care
● Beginning nurse or any nurse entering a
● The nurse’s care will reflect the needs and
situation in which there is no previous level
values of society and professional
of experience
standards of care and performance, meet
the needs of each patient, and integrate
ADVANCED BEGINNER
evidence-based findings to provide highest ● A nurse who has had some level of
level of care experience with the situation
● Nursing has a specific body of knowledge ● Experience may only be observational in
but it is also helpful to socialize within the nature
profession and practice to fully understand COMPETENT
and apply this knowledge to develop ● Has been in same clinical position for 2-3
professional expertise years
● Understands the organization and specific
NURSING AS A PROFESSION
care required by the type of patients
● Can anticipate nursing care and establish
PROFESSION
long-range goal
➢ An organization of an occupational group
based on the application of special
PROFICIENT
knowledge which establishes its own rules

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● With more than 2-3 years of experience in STANDARD 4: PLANNING
the same clinical position ● The registered nurse develops a plan that
● Perceives a patient’s clinical situation as a prescribes strategies and alternatives to
whole attain expected outcomes
● Can assess the entire situation and transfer
knowledge from previous experiences STANDARD 5: IMPLEMENTATION
● Nurse implements the identified plan
EXPERT ● Nurse coordinates care delivery
● Has intuitive grasp of an existing or potential ● Nurse employs strategies to promote health
clinical problem and safe environment
● Is skilled at identifying both patient-centered
problems and problems related to the HCS STANDARD 6: EVALUATION
● The registered nurse evaluates progress
SCOPE AND STANDARDS OF PRACTICE toward attainment of outcomes

NURSING STANDARDS OF PROFESSIONAL PERFORMANCE

● Is the protection, promotion, and ● It describes a competent level of behavior in
optimization of health and abilities; the professional role
prevention of illness and injury, alleviation of ● Provides method to assure that high-quality
suffering through the diagnosis and care is rendered to patients
treatment of human response, and
advocacy in the care individuals, families CODE OF ETHICS

and communities (ANA, 2010) ● Is the philosophical ideals of right and

● Encompasses autonomous and wrong; which defines the principles a
collaborative care of individuals of all ages, professional will use to provide care
families, groups and communities, sick or
PROFESSIONAL RESPONSIBILITIES AND ROLES
well, and in all settings (ICN, 2014)
● It includes the promotion of health;
AUTONOMY AND ACCOUNTABILITY
prevention of illness; and the care of ill,
● Autonomy –Involves initiation of
disabled and dying people
independent nursing interventions
● Accountability – Individual is responsible
ANA STANDARDS OF NURSING PRACTICE
professionally and legally for the type and
STANDARD 1: ASSESSMENT quality of nursing care provided
● The registered nurse collects
CAREGIVER
comprehensive data pertinent to the
● Helps patient to maintain and regain health,
patient’s health or situation
manage disease and symptoms, and attain
STANDARD 2: DIAGNOSIS a maximal level of function and
● The registered nurse analyzes the independence through the healing process
assessment data to determine the diagnosis
ADVOCATE
or issues
● Protects your patient’s human and legal
STANDARD 3: OUTCOMES IDENTIFICATION rights and provide assistance in asserting
● The registered nurse identifies expected their rights
outcomes for a plan individualized to the
EDUCATOR
patient or the situation

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● Explain concepts and facts about health, CRITERIA OF PROFESSION
describe the reason for routine care
activities EDUCATION
● Requires an extended education and basic
COMMUNICATOR liberal foundation
● Allows the nurse to know the patients as
well as their strengths, weaknesses and THEORY

needs ● Has theoretical body of knowledge

● Conceptual frameworks needed for nursing
MANAGER practice, education & research
● Establish a collaborative patient-centered
care to provide safe, quality care with SERVICE ORIENTATION

positive patient outcomes ● Altruism “hallmark of a profession (selfless

concern for others)
LEADER ● Guided by rules, policies and COE
● The nurse helps client make decisions in
establishing and achieving goals to improve AUTONOMY

his well-being through the process of ● Self-regulation and standards

interpersonal influences ● Needed in making decisions and in practice

COUNSELOR CODE OF ETHICS

● Helps the client to recognize and cope with ● Based on International Council of Nurses
stressful psychological or social problems, ● Worth dignity of others and integrity of
to develop improved personal relationships members
and to promote personal growth. It also
CARING
include providing of emotional, intellectual
and psychological support
HISTORICAL INFLUENCES

CHANGE AGENT
FLORENCE NIGHTINGALE
● Initiates changes and assist in the
● Established the first nursing philosophy
modification of client’s lifestyle to promote
based on health maintenance and
health
restoration
● Identified the role of nursing as having
RESEARCHER
“charge of somebody’s health” based on the
● Participates in scientific investigation and
knowledge of “how to put the body in such a
uses research findings in practice
state to be free of disease or to recover
CASE MANAGER from disease
● Coordinates the activities of the members of ● Developed the first organized program for
the HC team in managing a group of client’s training nurses, the Nightingale Training
care School for Nurses (St. Thomas Hospital,
COLLABORATOR London)
● Works together with all those involved in ● First practicing nurse epidemiologist
care delivery, for mutually acceptable plan ● She volunteered during the Crimean war
in order to achieve common goal; thus the (1853)
nurse initiates nursing actions in the health
team THE CIVIL WAR TO THE BEGINNING OF THE 20TH
CENTURY

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 CLARA BARTON ● 1 st nursing professor (Columbia Teachers
● Founder of American Red Cross College, 1906)
● Tended soldiers on the battlefields, cleaning ● Contributed in moving nursing education
their wounds, meeting their basic needs, into universities
and comforting them in death
TWENTY-FIRST CENTURY
MOTHER MARY ANN BICKERDYKE ● Nurse and nurse educators are revising
● Organized ambulance services and walked nursing practice and school curricula to
abandoned battlefields at night, to look for meet the ever-changing needs of society,
wounded soldiers including aging population, bioterrorism,
emerging infections and disaster
HARRIET TUBMAN management, the high acuity level care of
● Active in the Underground Railroad hospitalized patients, and early discharge
Movement and helped to lead over 300 from health care institutions require nurses
slaves to freedom in all settings to have a strong and current
knowledge base from which to practice
MARY MAHONEY
● Nursing organizations and the RWJF
● The 1st professionally trained African-
involvement in supporting nursing scholars,
American nurse
decreasing the nursing shortage, and
● Concerned with the effect culture had on
improve the health of the nation’s population
health care
● Nursing takes a leadership role in
● Brought awareness of cultural diversity and
developing standards and policies to
respect for the individual, regardless of
address the needs of the population
background, race, color or religion
CONTEMPORARY INFLUENCES
LATE 19TH CENTURY
● Expansion of hospitals IMPORTANCE OF NURSES’ SELF-CARE
● A nurse cannot give fully engaged,
LILIAN WALD AND MARY BREWSTER
compassionate care to others when there’s
● Opened the Henry Street Settlement
a feeling of depletion or does not feel cared
● It focused on the health needs of poor
for herself. Nurses also experience grief and
people who lived in tenements (NYC)
loss
● Compassion fatigue: a state of burnout
TWENTIETH CENTURY
and secondary traumatic stress. It occurs
● Early 20th century development of scientific,
without warning and often results from
research-based defined body of nursing
giving high levels of energy and compassion
knowledge and practice
over a prolonged period to those who are
● Nurses began to assume expanded and
suffering, often without experiencing
advanced practice roles
improved patient outcomes
● Army and Navy Nurse Corps was
● Secondary traumatic stress: trauma that
established
HCP experience when witnessing and
● 1920s specialization of nursing began
caring for others suffering trauma
● Graduate Nurse-midwifery programs began
● Burnout: a state of physical and mental
● Last half of century : creation of specialty-
exhaustion that often affects HCPs because
nursing organization
of the nature of their work environment, it
MARY ADELAIDE NUTTING
occurs when perceived demands outweigh
perceived resources

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THE AFFORDABLE CARE ACT AND RISING HEALTH ● San Lazaro Hospital (1578) – Built
CARE COSTS exclusively for patients with leprosy,
● ACA affects how health care is paid for and founded by Brother Juan Clemenete and
delivered was administered by Hospitalliers of San
● Greater emphasis on health promotion, Juan de Dios
disease prevention and illness management ● Hospital de Indio (1586) – Supported by
● More nurses will be in community-based alms and contributions from charitable
setting like community care centers, schools persons and established by the Franciscan
and senior centers Order
● Hospital de Aguas Santas (1590) –
DEMOGRAPHIC CHANGES
Founded by Brother J. Bautista of the
Franciscan Order in Laguna
MEDICALLY UNDERSERVED
● San Juan de Dios Hospital (1596) –
HISTORY OF NURSING IN THE PHILIPPINES
Founded by Brotherhood of Misericordia
and supported by the Hospitallers of San
EARLY BELIEFS AND PRACTICES Juan de Dios
● Diseases and causes and treatment were
shrouded with a mysticism and superstitions NURSING DURING THE PHILIPPINE REVOLUTION

● Beliefs about causation of disease (another ● Prominent persons involved in nursing

person like an enemy or witch; evil spirits) works were:
● People believed that evil spirits could be ● Josephine Bracken – Installed a field
driven away by persons with powers to hospital in an estate house in Tejeros;
expel demons provided care to the wounded night and day
● People believe in special gods of healing, ● Rosa Sevilla de Alvero – Converted their
with the priest physician (word doctors) as house into quarters for the Filipino soldiers
intermediary. Herbolarios (herb doctors) in 1899 during Philippine-American War
● Dona Hilaria de Aguinaldo – (Wife of
EARLY CARE OF THE SICK Emilio Aguinaldo), organized Filipino Red
● Superstitious beliefs and practices in Cross under the inspiration of Apolinario
relation to health and sickness. Herb Men Mabini
(Herbicheros) , one who practices ● Dona Maria Agoncillo de Aguinaldo –
witchcraft. Midwife assisted in childbirth. (2nd wife of Emilio Aguinaldo) –
During labor, the ‘mabuting hilot’ (good President of Filipino Red Cross Batangas
midwife) was called in. If there’s difficulty in branch; provided nursing care to Filipino
labor, witches were supposed to be the soldiers during the revolution
cause. To disperse this influence, ● Melchora Aquino (Tandang Sora) –
gunpowder was exploded from a bamboo Provided nursing care to the wounded
cane close to the head of the sufferer Filipino soldiers and gave them shelter and
food
HEALTH CARE DURING SPANISH REGIME ● Capitan Salome – Revolutionary leader in
● The religious orders exerted their efforts to Nueva Ecija; provided nursing care to the
care for the sick by building hospitals in the wounded when not in combat
various part of the Philippines ● Agueda Kahabagan – Provided nursing
● Hospital real de Manila (1577) – Was services to her troops and she was a
established mainly to care for Spanish revolutionary leader in Laguna
King’s soldiers, but also admitted Spanish
civilians

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● Trinidad Tecson – “Ina ng Biak na Bato’ ● Southern Islands Hospital School of
cared for the wounded soldiers in the Nursing (Cebu, 1918)
hospital at Biak na Bato
THE FIRST COLLEGES OF NURSING IN THE
HOSPITALS AND SCHOOLS OF NURSING PHILIPPINES
● Iloilo Mission Hospital School of Nursing ● University of Santo Tomas College of
(Iloilo City, 1906) - It was ran by Baptist Nursing (1946)
Foreign Mission Society of America; Miss ● Manila Central University College of Nursing
Rose Nicolet (first superintendent). Miss (1947)
Flora Ernst an American nurse took charge ● University of the Philippines College of
in 1942; in March 1944, 22 nurses Nursing (1948)
graduated and in April 1944 the graduated
nurses took the first Nurses Board NURSING LEADERS IN THE PHILIPPINES

Examination in Iloilo Mission Hospital ● Anastacia Giron-Tupas – Founder of PNA;

● St. Paul’s Hospital School of Nursing 1st Filipino to hold the Chief Nurse
(Manila, 1907) - The hospital was Superintendent position
established by the Archbishop of Manila, the ● Cesaria Tan – 1st Filipino to receive
Most Reverend Jeremiah Harty under the Masters degree in Nursing abroad
supervision of the Sisters of St. Paul de ● Socorro Sirilan – Chiefnurse and
Chartres. It provided general services and Pioneered in Hospital Social Services in
had a free dispensary and dental clinic. In San Lazaro Hospital
1908, it opened its training school for nurses ● Rosa Militar – Pioneer in school health
with rev. Mother Melanie (superintendent) education
and Miss E. Chambers (Principal) ● Ser Ricardo Mendoza – Pioneer in nursing
● Philippine General Hospital School of education
Nursing (1907) - Began in 1901 as a small ● Socorro Diaz – 1st editor of the PNA
dispensary mainly for Civil Officers and magazine “the Message”
Employees in Manila City, then became a ● Conchita Ruiz – 1st fulltime editor of PNA
Civil Hospital magazine named “The Filipino Nurse”
● St. Luke’s Hospital School of Nursing ● Loreto Tupaz – Dean of the Philippine
(Quezon City, 1907) - The hospital is an Nursing ; Florence Nightingale of Iloilo
Episcopalian Institution which began as a
PERSONAL QUALIFICATIONS OF A NURSE
small dispensary (1903) and the school
opened with three Filipino girls admitted
PHILOSOPHY OF LIFE
(1907)
● Concerned with those basic truths that
● Mary Johnston Hospital and School of
contribute to personal growth in a
Nursing (Manila, 1907) - It was called
systematic fashion and with those principles
Bethany Dispensary and was funded by the
that relate to the moral values that shape
Methodist Mission for the relief of suffering
the facets of the character
among women and children
● Philippines Christian Mission Institute GOOD PERSONALITY
Schools of Nursing ● Personality consists of the distinctive
● San Juan de Dios Hospital School of individual qualities that differentiate one
Nursing (Manila, 1913) person from another
● Emmanuel Hospital School of Nursing ● It is the impression one makes on others
(Capiz, 1913) which will include more than that which
meets the eye
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 ● Components: CONTINUING AND IN-SERVICE EDUCATION
1. Personal appearance
2. Character CONTINUING EDUCATION

3. Attitude ● Involves formal, organized educational

4. Charm programs offered by universities, hospitals,
state nurses associations, professional
PERSONALITY CAN BE DEVELOP THROUGH: nursing organizations and educational and
● Warmth of manner, a ready smile, sincere health care institutions
laugh, genuine interest in others ● Updates your knowledge about the latest
● Complete sincerity research and practice developments, helps
● Sympathetic grooming in specializing in a particular area of
practice developments, and teaches new
PROFESSIONAL REGISTERED NURSE EDUCATION skills and techniques (Hale et.al, 2010)

ASSOCIATE DEGREE PROGRAM CONTINUING EDUCATION PROGRAMS

● 2-year program usually offered by a ● Help nurses maintain current nursing skills,
university or community college gain new knowledge and theory, and obtain
● The program focuses on the basic sciences new skills reflecting the changes in the
and theoretical and clinical courses related healthcare delivery system
to the practice of nursing
IN-SERVICE EDUCATION PROGRAM
BACCALAUREATE DEGREE PROGRAM ● Are instruction or training provided by a HC
● 4 years of study in a college or university agency or institution
● It focuses on the basic sciences; theoretical ● Designed to increase knowledge, skills, and
and clinical courses; and courses in the competencies of nurses and other health
social sciences, arts, and humanities to care professionals employed by the
support nursing theory institution
● Often it focuses on new technologies
GRADUATE EDUCATION
● Provides the advanced clinician with strong NURSING PRACTICE ACTS
skills in nursing science and theory ● Regulate the scope of nursing practice and
● Emphasizes advance knowledge in the protect public health, safety and welfare
basic sciences and research-based clinical
practice LICENSURE
● Master’s degree in nursing ● Provides standardized minimum knowledge
● Doctoral degree base for nurses
● License: legal credential awarded by an
DOCTORAL PREPARATION individual state that grants permission to
● Professional doctoral programs in nursing that individual to practice a given profession
(DSN or DSNc) prepare graduates to apply
research findings to clinical nursing CERTIFICATION
● Doctor of Philosophy (PhD) in Nursing is a ● Granted on completion of an education
research and theory development program and the passing of a standardized
● Doctor of Nursing Practice (DNP) is a examination
practice-focused doctorate; terminal ● Certified or registered
practice degree and required preparation for
all APRNs CAREER DEVELOPMENT

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ADVANCED PRACTICE REGISTERED NURSE (APRN) ● Works primarily in nursing schools, staff
● Is the considered as the most independently development departments of HC agencies
functioning nurse and patient education department
● Has advanced education in ● Needs clinical practice in order to provide
pathophysiology, pharmacology and the students with practical skills and
physical assessment and certification and theoretical knowledge
expertise in specialized area of practice ● Faculty member in nursing program
● CORE ROLES OF APRN; educates students to become professional
1. Clinical Nurse Specialist - Is an nurse
expert clinician in a specialized area ● Nursing faculty member is responsible in
of practice. The specialty may be teaching current nursing practice; trends;
identified by a population, setting, theory and necessary skills in classroom,
disease specialty, type of care or laboratories and clinical settings
type of problem ● Primary focus of nurse educator in a patient
2. Nurse Practitioner (NP) - Provides education: to teach and coach patients and
health care to a group of patients their families how to self-manage their
usually in an outpatient ambulatory illness or disability and make positive
care or community-based setting. choices or change their behaviors to
Provides comprehensive care, promote health. Usually specialized or has
directly managing the nursing and certification like a certified diabetes
medical care of patients with educator (CDE) or ostomy care nurse
complex problems and a more
holistic approach than physicians NURSE ADMINISTRATOR
3. Certified Nurse-Midwife (CNM) - ● Manages patient care and the delivery of
Also educated in midwifery and is specific nursing services within a health
certified. Provides independent care care agency
for women during normal pregnancy, ● Has master’s degree in nursing
labor and delivery and care of the administration, hospital administration
newborn. It also includes some (MHA), public health (MPH) or an MBA
gynecological services (ex: Pap ● Functions includes:
smear, FP and treatment of minor 1. Budgeting
vaginal infections) 2. Staffing
4. Certified Registered Nurse 3. Strategic planning of programs and
Anesthetist (CRNA) - Had services
advanced education from a nurse 4. Employee evaluation
anesthesia-accredited program. 5. Employee development
Must have at least 1 year of critical
care or emergency experience. NURSE RESEARCHER
Provide anesthesia under the ● Conducts evidenced-based practice and
supervision and guidance of the research
anesthesiologist (physician with ● Works in and academic setting, hospital or
advanced knowledge of surgical independent professional or community
anesthesia service agency
● Requires a doctoral degree with at least a
NURSE EDUCATOR master’s degree in nursing
● Has master’s degree in nursing or earned
doctorate in nursing or related field MANAGEMENT

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 ENTREPRENEURSHIP ● Is a newer term that describes the study of
all genes in a person and interactions of
FIELDS OF NURSING these genes with one another and with that
1. Hospital or Institutional Nursing person’s environment (CDC, 2015)
2. Public Health Nursing or Community Health ● Genetics is the study of inheritance, or the
Nursing way traits are passed down from one
3. Private Duty or Special Duty Nursing generation to another
4. Industrial or Occupational Health Nursing
5. Nursing Education
6. Military Nursing FUNDAMENTALS OF
7. School Nursing NURSING PRACTICE
8. Clinic Nursing
9. Independent Nursing Practice CONCEPT OF MAN, HEALTH AND ILLNESS
● Health is a fundamental right of every
TRENDS IN NURSING
human being. It is a state of integration of
the body and mind
EVIDENCE-BASED PRACTICE
● In the practice of nursing, it should be based
FACTORS AND ISSUES AFFECTING HEALTH AND
on current evidence, not just according to ILLNESS
your education or experiences and the
policies and procedures of health care HEALTH
facilities ● A state of physical, mental, and social well-
● The general public has knowledge on health being, not merely the absence of disease or
care needs, the cost of health care, and the infirmity. (WHO, 1947)
incidence of medical errors within health ● The actualization of inherent and acquired
care institution human potential through goal-oriented
behavior, competent self-care, and
QUALITY AND SAFETY EDUCATION FOR NURSES satisfying relationships with others while
(QSEN)
adjustments are made as needed to
● Addresses the challenge to prepare nurses maintain structural integrity and harmony
with the competencies needed to with the environment (Pender, 2015)
continuously improve the quality of care in
their environment MODELS OF HEALTH AND ILLNESS
● Competencies of patient-centered care,
teamwork and collaboration, EBP, quality MODEL
improvement (QI), safety and informatics ● Is a theoretical way of understanding a
concept or idea
IMPACT OF EMERGING TECHNOLOGIES ● Represent different ways of approaching
● This helps nurses use noninvasive, more complex issues
accurate assessment tools, implement EBP,
collect and trend patient outcome data and HEALTH BELIEFS
use clinical decision support system ● Person’s ideas, convictions and attitudes
● Electronic Health Record (HER) offers about health and illness
efficient method to record and manage ● Positive health behaviors- activities related
patient health care information to maintaining, attaining or regaining good
health and preventing illness
GENOMICS ● Negative health behaviors- practices
actually or potentially harmful to health
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 HEALTH-ILLNESS CONTINUUM (DUNN) 1. Individual characteristics and
experiences
2. Behavior specific knowledge and
affect
3. Behavioral outcomes, in which the
patient commits to or changes a
behavior

MASLOW’S HIERARCHY OF NEEDS

● Nurses use this model to understand the
interrelationships of basic human needs
● It provide basis for nurses to render care to
patients across lifespan in different settings

HEALTH BELIEF MODEL

● Developed in effort to understand why
people do not engage in certain health
behaviors
● Argues that our belief in the threat of an
illness/diseases (ex. Obesity) plus our belief
in the effectiveness in a proposed behavior
(ex. Physical activity) determines whether
we will engage in that behavior
● Had several theoretical constructs
1. Perceived susceptibility, perceived
severity, perceived benefits,
perceived barriers
2. Modifying variables, cues to action,
self efficacy (1980s)
● Addresses the relationship between a HOLISTIC HEALTH MODEL
person’s beliefs and behaviors ● Attempts to create conditions that promote a
1. 1st component: individual’s patient’s optimal level of health
perception of susceptibility to an ● Involvement of patient in their healing
illness process; assumes responsibilities on health
2. 2nd component: individual’s maintenance
perception of the seriousness of the
illness VARIABLES INFLUENCING HEALTH
3. 3rd component: likelihood that a
INTERNAL VARIABLES
person will take preventive action
● Developmental stage
HEALTH PROMOTION MODEL (PENDER) ● Intellectual background
● Health is a positive dynamic state not ● Perception of functioning
merely the absence of disease ● Emotional factors
● Designed to be a complementary ● Spiritual factors
counterpart to models of health protection
EXTERNAL VARIABLES
● Focuses on:

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● Family practices – the way the patient’s ● Any situation, habit, or other variable such
families use HC services as social, environmental, physiological,
● Psychosocial and Socioeconomic factors psychological, developmental, intellectual,
1. Socioeconomic variables or spiritual that increases the vulnerability of
2. Economic variables an individual or group to an illness or
● Cultural background- influences beliefs, accidents
values and customs ● Categories:
1. Genetic and physiological factors
HEALTH PROMOTION 2. Age
● Activities that help patients maintain or 3. Environment
enhance their present health level 4. Lifestyle
● Ex: routine exercise and good nutrition
ILLNESS
WELLNESS ● Is a state in which a person’s physical,
● Strategies that help people to achieve new emotional, intellectual, social,
understanding and control of their lives developmental, or spiritual functioning is
● Ex: health education diminished or impaired
● Acute illness: usually has a short duration,
ILLNESS PREVENTION reversible and is often severe
● Activities that motivate people to avoid a ● Chronic illness: usually longer than 6
decline in health or functional levels months, is irreversible, and affects the
functioning in one or more systems
LEVELS OF PREVENTIVE CARE
● Illness behavior:
1. Are acts exhibited by people who
PRIMARY PREVENTION
are ill
● Aimed at health promotion
2. Includes how monitoring of bodies,
● Precedes disease or any dysfunction for
define and interpret the symptoms,
patients who are considered physically and
take remedial actions and use of the
emotionally healthy
resources in the HCS
SECONDARY PREVENTION
VARIABLES INFLUENCING ILLNESS AND ILLNESS
● It focuses on people who are experiencing
BEHAVIOR
health problems or illnesses, and who are at
risk for developing complications INTERNAL VARIABLES
● The activities are directed at diagnosis and ● Patient perception of symptoms
prompt intervention, which reduces severity ● The nature of the illness
and enable patient to return to normal level
of health EXTERNAL VARIABLES
● Visibility of symptoms
TERTIARY PREVENTION ● Social group
● Involves minimizing the effect of long-term ● Cultural background
disease or disability by interventions in ● Economic variable
order to prevent complications ● Accessibility of health care system
● It occurs when a defect or disability is ● Social support
irreversible
STAGES OF ILLNESS
RISK FACTOR
SYMPTOM EXPERIENCE

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 ● Transition stage when a person believes ● Person who may or may not be affected by
something is wrong and experiences some a disease
symptoms
● Aspects: physical, cognitive, emotional ENVIRONMENT
● Any external factor that may or may not
ASSUMPTION OF THE SICK ROLE predispose the person to certain disease
● Acceptance of the illness and seeks advice
or support to give up some activities HEALTH CARE DELIVERY SYSTEM
● Nursing is a caring discipline
MEDICAL CARE CONTACT ● Values of the nursing profession are rooted
● Confirmation of real illness, explanation of in helping people to regain, maintain, or
symptoms and reassurance of outcome improve health; prevent illness; and find
comfort and dignity
DEPENDENT PATIENT ROLE
● A person becomes more passive and INSTITUTE OF MEDICINE (2011)
accepting while becoming dependent on ● Has a vision for transformed HCDS which
health professional makes quality care accessible to all
populations, focuses on wellness and
RECOVERY/REHABILITATION disease prevention, improve health
● Returns to former roles and function by outcomes, and provides compassionate
giving up the sick role care across the life span
● Encourages a safe, effective, patient
ECOLOGIC MODEL (LEAVELL AND CLARK’S AGENT- centered, timely efficient, and equitable
HOST-ENVIRONMENT MODEL)
health care delivery system
● Nurses faces challenges to provide
evidence-based, compassionate care and
as a patient advocate

INSTITUTE OF MEDICINE REPORT

● Practicing to the full extent of their
education and training
● Achieving higher levels of education and
training through an improved education
system that provides seamless progression
● Becoming full partners with physicians and
other health care providers in redesigning
the healthcare system
● Improving data collection and information
infrastructure for effective workforce
planning and policy making

HEALTH CARE SETTINGS AND SERVICES

AGENT LEVELS OF HEALTH CARE

● Any factor or stressor that can lead to ● Disease prevention
illness or disease ● Health promotion
● Primary level
HOST ● Secondary level
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 ● Tertiary level ● Discharge planning: is a centralized,
coordinated, interdisciplinary process that
HEALTH CARE SETTINGS ensuring that a patient has a plan for
● Preventive continuing begins the moment a patient is
● Primary admitted to a health care facility
● Secondary
● Tertiary INTENSIVE CARE
● Restorative ● An ICU or critical care unit provides close
● Continuing care monitoring and intensive medical care to
● Integrated Delivery Networks – has patients
network of facilities, providers, and services ● Has advanced technologies
which deliver continuum of care to a ● Medical and nursing staff have specialized
population of patients at particular setting knowledge on critical care principles and
techniques
PREVENTIVE AND PRIMARY HEALTH CARE (HEALTH
PROMOTION) PSYCHIATRIC FACILITIES
● Primary health care: focuses on improved ● It cater services to patients who are
health outcomes for an entire population suffering from emotional and behavioral
● Health promotion programs: reduces problems
incidence of disease, minimizing ● This require special counseling and
complications treatment
● Preventive care: is more disease oriented ● Offers inpatient and outpatient services,
and focused on reducing and controlling risk depending on the severity of mental health
factors for disease problem
● Ex: primary care and health education ● The health care team (medical, nursing,
proper nutrition maternal/child health care, social work and activity therapy) work
family planning immunizations, control of together to develop a plan of care that
diseases enable patients to return to functional states
● Settings: schools, physician’s offices, within the community
occupational health clinics, community ● Located in hospitals, independent outpatient
health centers, nursing centers clinics or private mental health hospitals,
psychiatric facilities
SECONDARY AND TERTIARY CARE (ACUTE CARE)
● Diagnosis and treatment of illnesses RURAL HOSPITALS
● Disease management most common and
most expensive service of HCDS RESTORATIVE CARE
● Chronic illness causing disability, decreased ● Provide care to patients recovering from an
quality of life and increased health care acute or chronic illness or disability which
costs requires additional services in order to
return to previous level of function or reach
HOSPITALS the new level of function limited by their
● Provides comprehensive and specialized illness or disability
tertiary care to seriously ill patients ● Goal: to help individuals regain maximal
● Focus: quality, safe care functional status and enhance quality of life
● Ex: hospital emergency departments, through promotion of independence and self
urgent care centers, critical care units, in- care
patient MS units
HOME CARE

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● Provides medically related professional and
paraprofessional services and equipment to CONTINUING CARE
patient and families in their homes for health ● Refers to a variety of health, personal, and
maintenance, education, illness prevention, social services provided over a prolonged
diagnosis and treatment of disease, period
palliation, and rehabilitation ● It cater services for people who are:
● It also includes medical and social services: 1. Disabled
physical, occupational, speech and 2. Never functionally independent
respiratory therapy and nutritional therapy 3. Suffering from terminal disease
● Coordinates the access and delivery of
home health equipment, or medical NURSING CENTERS OR fACILITIES

equipment ● It provides a 24-hour intermediate and

● Primary objective: health promotion and custodial care like nursing, rehabilitation,
education dietary, recreational, social and religious
services
REHABILITATION ● It includes:
● Restores a person to the fullest physical, 1. Nursing centers or facilities
mental, social, vocational, and economic 2. Assisted living
potential ● Interdisciplinary functional assessment of
● It begins from the moment the patient enters residents is the cornerstone of clinical
a health care setting for treatment practice within nursing centers
● Patients who had physical or mental illness,
injury, or chemical addiction require ASSISTED LIVING

rehabilitation ● Offers an attractive long-term care setting

● Focuses on : with an environment more like home and
1. Preventing complications related to greater resident autonomy
illness or injury ● Promote physical and psychosocial health
2. Helps to maximize a patient’s ● Activities include:
functioning and level of 1. Assistance in the ADL
independence 2. Medication administration (for some
● Rehabilitation services include: assisted living facilities)
1. Physical
RESPITE CARE
2. Occupational
● Provides short-term relief or “time-off” for
3. Speech therapy
people providing home care to individual
4. Social services
who is ill, disabled, or frail
EXTENDED CARE FACILITIES ● It can be offered in the home, a day care
● Provides intermediate medical, nursing, or setting, or a health care institution that
custodial care for patients recovering from provides overnight care
acute illness or those with chronic illnesses
ADULT DAY CARE CENTERS
or disabilities
● Provide a variety of health and social
● It includes:
services to specific patient populations who
1. Intermediate care and skilled nursing
live alone or with family in the community
facility- caters skilled care from
● It is associated with a hospital or nursing
licensed nursing staff
home or independent centers
2. Long-term care and assisted-living
facilities
HOSPICE
● Primarily, provides care for older adults
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 ● A system of family- centered care that ● A universal phenomenon influencing the
allows patients to live with comfort, ways in which people think, feel and behave
independence, and dignity while easing the in relation to one another
pains of terminal illness ● Personal concern for another person, an
● Focus: event, or a thing provides motivation and
1. Is palliative care direction for people to care
● People, events, projects, and things matter
ISSUES AND CHANGES IN HEALTH CARE DELIVERY to people (Benner et.al. 2010)
● Nursing shortage ● A word for being connected
● Competency ● Facilitates a nurse’s ability to know a
1. Emphasize the importance public patient, allowing the nurse to recognize a
service, caring for the health of patient’s problems and find and implement
communities, and developing individualized solutions on the basis of the
ethically responsible behaviors patient’s unique needs
2. IOM Competencies for the 21st ● If patient sense that HC providers are
century sensitive, sympathetic, compassionate, and
3. Provide patient-centered care interested in them as people, they usually
4. Work in interdisciplinary team become active partners in the plan of care
5. Use evidence-based practice
6. Apply quality improvement CARING IN NURSING PRACTICE
7. Use informatics
PROVIDING PRESENCE
QUALITY AND SAFETY IN HEALTH CARE DELIVERY ● Person-to-person encounter conveying a
● Is the degree to which health services for closeness and sense of caring
individuals and populations increase the ● Presence involves “being there” and “being
likelihood of desired health outcomes and with”
are consistent with current professional ● Presence is an interpersonal process
knowledge characterized by sensitivity, wholism,
● Globalization in Health Care intimacy, vulnerability, and adaptation to
● Nursing informatics and Technological unique circumstances
Advancements ● Nursing presence is the connectedness
1. Nursing informatics: uses between the nurse and the patient
information and technology to
communicate, manage knowledge, COMFORTING
and mitigate error. And support ● The use of touch is relational and leads to a
decision-making connection between nurse and patient
2. Ex: Telemedicine, telehealth ● It is a comforting approach that reaches out
to patients to communicate concern and
THE FUTURE OF HEALTHCARE support
● Change is often threatening, but it also 1. Contact touch
opens up opportunities for improvement. 2. Non Contact touch
The ultimate issue is designing and ● Caring touch is a form of nonverbal
delivering health care in ensuring the health communication which influences a patient’s
and welfare of the population comfort and security, enhances self-esteem,
increases confidence and improves mental
NURSING AS AN ART well-being (like holding patient’s hand, back
massage)
CARING
LISTENING
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● Is a planned and deliberate act in which the ● Involves caring nursing actions that gives
listener is present and engages the patient patient comfort, dignity, respect, and peace
in a nonjudgmental and accepting manner and provide necessary comfort and support
● Needs silence and listen with openness to the family or significant others
● Involves paying attention to the individual’s ● Through skillful and accurate assessment of
words, and tone of voice and entering patient’s condition, (like pain) the nurse can
his/her frame of reference; observe design a patient-centered care to improve
expressions and body language the level of comfort
● Human suffering is multifaceted, affecting a
KNOWING THE PATIENT patient physically, emotionally, socially, and
● Is a complex process with a temporal nature spiritually
that occurs within the context of the nurse-
patient relationship FAMILY CARE
● Comprises both as nurse’s understanding of ● Nurse caring behaviors as perceived by
a specific patient and his/her subsequent families
selection of interventions (Swanson, 1991) 1. Provide honest, clear, and accurate
● Elements that facilitates knowing: information
1. Continuity of care 2. Listening to patient and family
2. Clinical expertise concerns, complaints, fears
● Factors that contribute to knowing the 3. Advocating for patient’s care
patient: preferences and end-of-life
1. Time decisions
2. Continuity of care 4. Asking permission before doing
3. Teamwork of nursing staff something to the patient
4. Trust 5. Providing comfort
5. Experience 6. Reading patient passages from
● Barriers to knowing the patient: religious texts, favorite books, cards
1. Organizational structure of the or mail
organization 7. Providing for and maintaining patient
2. Economic constraints privacy
8. Informing the patient about the types
SPIRITUAL CARE of nursing services and the people
● Offers a sense of interconnectedness who may enter the personal acre
● Include nurses who are able to identify area
methods to incorporate the spiritual caring 9. Assuring the patient that nursing
practices into routine care and do not services will be available
perceive variables e.g. (lack of sufficient 10. Teaching the family how to keep the
time, patient census) relative physically comfortable
● Spirituality offers a sense of connectedness:
1. Intrapersonally (connected with THEORETICAL VIEWS ON CARING
oneself) (CARING PRACTICE MODELS)
2. Interpersonally (connected with
others and the environment) LEININGER’S TRANSCULTURAL CARING

3. Transpersonally (connected with ● Madeleine Leininger (1991) describes care

the unseen, God, or a higher power) as essence and central, unifying and
dominant domain that distinguishes nursing
RELIEVING SYMPTOMS AND SUFFERING from other health disciplines

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● Care is an essential human need, 1. Knowing
necessary for the health and survival of all 2. Being with
individuals 3. Doing for
● Stresses how important it is for nurses to 4. Enabling
understand cultural caring behaviors 5. Maintaining belief
● Caring includes knowing a patient’s cultural
values and beliefs CHALLENGE OF CARING
● “Transcultural nursing” ● Today’s health care system presents many
challenges for the nurse to provide a caring
WATSON’S TRANSPERSONAL CARING patient-centered plan of care. Nurses are
● Caring is a central focus of nursing and it is often torn between the human caring model
integral to maintain the ethical and and the task-oriented biomedical model and
philosophical roots of the profession institutional demands that consume their
● Suggest that a conscious intention to care practice.
promotes healing and wholeness ● As a nursing student, share your view
● 10 Carative factors: regarding this approaches in the care of a
1. Forming a human-altruistic value patient with end-stage renal disease
system
2. Instilling faith-hope THE 6 C’S
3. Cultivating a sensitivity to one’s self ● Care, Compassion, Competence,
and to others Communication, Courage and Commitment
4. Developing a helping, trusting, 1. Care: Helping people to stay
human caring relationship independent, maximize wellbeing
5. Promoting and expressing positive and improving health outcomes
and negative feelings 2. Compassion: Working with people
6. Using creative problem-solving, to provide a positive experience of
caring processes care.
7. Promoting transpersonal teaching- 3. Competence: Delivering high quality
learning care and measuring the impact
8. Providing for a supportive, 4. Communication: Building and
protective, and/or corrective mental, strengthening leadership
physical, societal, and spiritual 5. Courage: Ensuring we have the
environment right staff, with the right skills in the
9. Meeting human needs right place
10. Allowing for existential- 6. Commitment: Supporting positive
phenomenological-spiritual forces staff experience

SWANSON’S THEORY OF CARING CARING FOR SELF AND OTHERS

● Caring is nurturing way of relating to an ● Family: biologically, legally, or as a social
individual (when one feels commitment and network with personally constructed ties and
responsibility) ideologies
● The theory provides direction for how to ● Includes people related by marriage, birth,
develop useful and effective caring or adoption
strategies appropriate for multiple age- ● The family is the central institution in society
group and health care settings ● It faces many challenges which includes
● Objective: deliver care that promotes health and illness, childbearing and
dignity, respect and empowerment childrearing, changes in family structure and
● Components of caring: dynamics, and caring for older parents.
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● Attributes or characteristics of a family: ● Effective interprofessional communication is
1. Durability: system of support and important to provide safe transitions in care
structure within a family that extends ● Team communication and collaboration
beyond the walls of the household skills are necessary to ensure safe patient
2. Resiliency: ability of a family to care
cope with expected and unexpected ● Therapeutic communication occurs within a
stressors healing relationship between a nurse and
3. Diversity: the uniqueness of each patient
family unit
COMMUNICATION AND INTERPERSONAL
RELATIONSHIPS
● Caring relationships formed among a nurse
and those affected by the nurse’s practice
are at the core of nursing
● Caring through communication can be
expressed by:

● Family dynamics:
1. Family make-up (configuration)
2. Structure
3. Function
4. Problem-solving
5. Coping capacity
● Goal of family-centered nursing care: to
address the comprehensive health care
needs of the family as a unit; and to
advocate, promote, support, and provide for
the well-being and health of the patient and
individual family members ● Referent: motivates a person to
● Threats or concerns facing families: communicate with another
1. Changing economic status ● Sender: the person who encodes and
2. Homelessness delivers the message
3. Domestic violence ● Receiver: the person who receives and
4. The presence of acute or chronic decodes the message
illnesses or trauma ● Message: is the content of the
5. End-of-life care communication which includes verbal or
nonverbal expressions of thoughts and
COMMUNICATION feelings
● Is a powerful therapeutic tool and an ● Channels: are means of sending and
essential nursing skill that influences others receiving messages through visual,
and achieves positive health outcomes. auditory, and tactile senses.
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● Feedback: is the message a receiver INTRAPERSONAL COMMUNICATION
receives from the sender which indicate if ● also called as ‘self-talk’
the receiver understood the meaning of the ● It is used to develop self-awareness and a
sender’s message positive self-esteem that enhances
● Interpersonal variables: factors within both appropriate self-expression
the sender and receiver that influence ● Ex
communication
: transforming statement: “I’m scared to work with thi
● Environment: the setting for sender-
receiver interaction

FORMS OF COMMUNICATION INTERPERSONAL COMMUNICATION

● Is one-on-one interaction between a nurse
VERBAL COMMUNICATION and another person that often occurs face to
● Vocabulary – communication is effective if face
the receiver and sender translate one ● Results in an exchange of ideas, problem
another’s words and phrases solving, expression of feelings, decision
● Denotative and Connotative Meaning – making, goal accomplishment, team
1. Denotative: individuals who use a building and personal growth
common language ● Ex: Use interaction to assess understanding
2. Connotative: is the shade or and clarify misinterpretation when teaching
interpretation of the meaning of the a patient about a health concern
word influenced by the thoughts,
feelings, or ideas that people have SMALL-GROUP COMMUNICATION
about the word ● Is the interaction that occurs when a small
● Pacing – appropriate speed or pace by number of people meet
speaking slowly and clearly d. Intonation – ● Usually goal directed which requires an
tone of voice understanding of group dynamics and
● Clarity and Brevity – effective feedback from participants
communication is simple, brief and direct ● Should be organized, concise and complete
● Timing and Relevance
PUBLIC COMMUNICATION
NONVERBAL COMMUNICATION ● An interaction with an audience to increase
● Includes the five senses and does not their knowledge about health-related topics,
involve the spoken or written word health issues and other issues important to
● Personal appearance the nursing profession
● Posture and gait ● It requires special adaptations in eye
● Facial expression contact, gestures, voice inflection, and use
● Eye contact of media materials to communicate
● Gestures messages effectively
● Sounds
● Territoriality and Personal Space ELECTRONIC COMMUNICATION
● Use of technology to create ongoing
METACOMMUNICATION relationships with patients and their HC
● Refers to all factors that influence team
communication
PROFESSIONAL NURSING RELATIONSHIPS
LEVELS OF COMMUNICATION
PHASES OF THE HELPING RELATIONSHIPS

19
● Pre Interaction phase: Before meeting a health care problem. Patient is able
patient to attend to appropriate stimuli.
● Orientation phase: When the nurse and Patient conveys clear and
patient meet and get to know one another understandable messages with the
● Working phase: When the nurse and health care team. Patient expresses
patient work together to solve problems and increased satisfaction with the
accomplish goals communication process
● Termination phase: During the ending of
the relationship IMPLEMENTATION
● Use communication techniques
COMMUNICATION AND THE NURSING PROCESS ● Therapeutic communication techniques (are
specific responses that encourage the
ASSESSMENT expression of feelings and ideas and
● Through the Patient’s eyes: Assess convey acceptance and respect
patient's values, preferences, and cultural, ● Active listening (being attentive wo what a
ethnic, and social backgrounds patient is saying both verbally and
● Physical and Emotional factors nonverbally) S-sit facing the patient O-
● Developmental factors Open position
● Sociocultural factors ● Sharing empathy (ability to understand and
● Gender accept another person’s reality, accurately
perceive feelings and communicate the
NURSING DIAGNOSIS understanding to the other
● Impaired Verbal Communication – Used ● Sharing hope
to describe a patient with limited or no ability ● Sharing humor
to communicate verbally. A state in which ● Sharing feelings
an individual experiences a decreased, ● Using touch
delayed or absent ability to receive, ● Using silence
process, transmit and use symbols for a ● Providing information
variety of reasons ● Clarifying
● Defining characteristics: ● Focusing
1. Inability to articulate words, ● Paraphrasing
inappropriate verbalization, difficulty ● Validation
forming words, and difficulty ● Asking relevant questions
comprehending ● Summarizing
2. Anxiety, social isolation, ineffective ● Self-disclosure
coping, compromised family coping, ● Confrontation
powerlessness, impaired social ● Non-therapeutic communication: Asking
interaction personal questions Giving personal options
Changing the subject Automatic responses
PLANNING
False reassurance Sympathy Asking for
● Goals and Outcomes:
explanations Approval or disapproval
1. Goal: At the end of 8 hours of
Defensive and aggressive responses
nursing intervention, the patient will
be able to; Express needs and EVALUATION
achieve understanding of physical ● Evaluate the effectiveness of your own
condition communication by conducting practice
2. Outcomes: Patient initiates sessions with peers or by making process
conversation about diagnosis or recording with patients
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● Ex: ● Disease prevention
1. Determine whether you encouraged ● Health restoration and maintenance
openness and allowed the patient to ● Rehabilitation
“tell his story’ expressing both
thoughts and feelings
2. Identify any missed verbal or
nonverbal cues
3. Determine whether nursing
responses were positive and
supportive

RELATED FACTORS
● Altered perceptions
● Biochemical alterations in the brain of
certain neurotransmitters
● Brain injury or tumor
● Cultural difference (e.g., speaks a different
language)
● Dyspnea
● Fatigue
● Psychological barriers (lack of stimuli)
● Sensory challenge involving hearing or
vision
● Side effects of medication
● Structural problem (e.g., cleft palate,
laryngectomy, tracheostomy, intubation,
wired jaws)

DEFINING CHARACTERISTICS
● Difficulty vocalizing words
● Difficulty discerning and maintaining the
usual communication pattern
● Disturbances in cognitive associations (e.g.,
perseveration, derailment, poverty of
speech, illogicality, neologism, and thought
blocking)
● Inability to find, recognize, or understand
words
● Inability to recall familiar words, phrases, or
names of known people, objects, and
places
● Inappropriate verbalization
● Problems in receiving the type of sensory
input being sent or sending the type of input
necessary for understanding

TEACHING
● Health promotion
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