NRG106 FUNDAMENTALS OF NURSING PRACTICE OUTLINE

NURSING PROGRAM: DAVAO DOCTORS COLLEGE

NURSING AS AN ART
• As nurses, it is important now than ever to define the goals of nursing by using an aesthetic
approach.
• In everyday practice, the nurse must explore and adopt these functions, which constitute the
essence of nursing as an art.
• “Nursing is an art: and if it is to be made an art, it requires an exclusive devotion as hard a
preparation, as any painter’s or sculptor’s work; for what is the having to do with dead canvas or
dead marble, compared with having to do with the living body, the temple of God’s spirit?” (Sienna
Heights University, 2013)

CARING
In this age of technologic competence and efficiency, the knowledge and skills embedded in caring
practices are often overlooked. Technology does not negate caring; in fact, the isolation that may
accompany technology makes the significance of caring all the more important (Diener & Hobbs, 2012).
 a universal phenomenon influencing the ways in which people think, feel, and behave in relation to
one another.
 The American Organization of Nurse Executives (AONE, 2015) describes caring and knowledge as
the core of nursing, with caring being a key component of what a nurse brings to a patient
experience
 a product of culture, values, experiences, and relationships with others.
 Persons who do not experience care in their lives often find it difficult to act in caring ways.
o All individuals are caring, and develop their caring abilities by being true to self, being real,
and being who they truly are. Thus, caring is not unique to nursing. -Roach (2013)
o Roach (2013) visualizes caring to be unique in nursing however, because caring is the
center of all attributes she uses to describe nursing. Roach defines these attributes as the
six C’s of caring:
1. COMPASSION
 Awareness of one’s relationship to others, sharing their joys, sorrows, pain, and
accomplishments. Participation in the experience of another.
2. COMPETENCE

DOMINGO T.SO, JR., RN, MAN

Berman, A., Snyder, S. & Frandsen G. (2016). Kozier & Erb’s fundamentals of nursing: Concepts, process, and practice (10th ed.). Boston: Pearson Education, Inc.
 NRG106 FUNDAMENTALS OF NURSING PRACTICE OUTLINE
NURSING PROGRAM: DAVAO DOCTORS COLLEGE

 Having the “knowledge, judgment, skills, energy, experience and motivation

required to respond adequately to the demands of one’s professional
responsibilities”
3. CONFIDENCE
 Comfort with self, client, and others that allows one to build trusting relationships.
4. CONSCIENCE
 Morals, ethics, and an informed sense of right and wrong. Awareness of personal
responsibility.
5. COMMITMENT
 The deliberate choice to act in accordance with one’s desires as well as
obligations, resulting in investment of self in a task or cause.
6. COMPORTMENT
 Appropriate bearing, demeanor, dress, and language that are in harmony with a
caring presence. Presenting oneself as someone who respects others and
demands respect.

TYPES OF KNOWLEDGE IN NURSING

Nursing involves different types of knowledge that are integrated to guide nursing practice. Nurses require
scientific competence (empirical knowledge), the therapeutic use of self (personal knowing), moral/ethical
awareness (ethical knowing), and creative action (aesthetic knowing). These four types of knowledge were
identified by Carper (2009) from her observations of nurses’ activities. An understanding of each type of
knowledge is important because
only by integrating all ways of knowing can the nurse develop a professional practice.

1. Nursing science / Empirical Knowing: The Science of Nursing

• Knowledge about the empirical world is systematically organized into laws and theories for
the purpose of describing, explaining, and predicting phenomena of special concern to the
discipline of nursing. Empirical knowing ranges from factual, observable phenomena (e.g.,
anatomy, physiology, chemistry) to theoretical analysis (e.g.developmental theory,
adaptation theory).
• Based on assumption that what is known is accessible through the physical senses
DOMINGO T.SO, JR., RN, MAN
Berman, A., Snyder, S. & Frandsen G. (2016). Kozier & Erb’s fundamentals of nursing: Concepts, process, and practice (10th ed.). Boston: Pearson Education, Inc.
 NRG106 FUNDAMENTALS OF NURSING PRACTICE OUTLINE
NURSING PROGRAM: DAVAO DOCTORS COLLEGE

 Seeing, touching, and hearing

 Reality exists and the truth about it can be understood
• Expressed in practice as SCIENTIFIC COMPETENCE
• SOURCES OF KNOWLEDGE:
 Research
 Theory
• Employ knowledge thru EBP (evidence-based practice)

2. Nursing Ethics / Ethical Knowing: The Moral Component

• Goals of nursing include the conservation of life, alleviation of suffering, and promotion of
health. Ethical knowing focuses on “matters of obligation or what ought to be done” and
goes beyond simply observing the nursing code of ethics. Nursing care involves a series of
deliberate actions or choices that are subject to the judgment of right or wrong.
Occasionally, the principles and norms that guide choices may be in conflict. The more
sensitive and knowledgeable the nurse is to these issues, the more “ethical” the nurse will
be.
• REQUIRES:
 Experiential knowledge of the social value
 Ethical reasoning
• FOCUS IS ON:
 Matters of obligation
- What ought to be done
 Right, wrong and responsibility
 Ethical code of nursing
 Confronting and resolving conflicting values, norms, interests, or principles
• SOURCE of ETHICAL KNOWING:
 Nursing Code of Ethics and professional standards
 Understanding of different philosophical positions

3. Nursing Aesthetics / Aesthetic Knowing: The Art of Nursing

• individual nurse through his or her creativity and style in meeting the needs of clients. The
nurse uses aesthetic knowing to provide care that is both effective and satisfying. Empathy,

DOMINGO T.SO, JR., RN, MAN

Berman, A., Snyder, S. & Frandsen G. (2016). Kozier & Erb’s fundamentals of nursing: Concepts, process, and practice (10th ed.). Boston: Pearson Education, Inc.
 NRG106 FUNDAMENTALS OF NURSING PRACTICE OUTLINE
NURSING PROGRAM: DAVAO DOCTORS COLLEGE

compassion, holism, and sensitivity are important modes in the aesthetic pattern of
knowing.
• Expressed through:
 Actions, bearing, conduct, attitudes, narratives and interactions
 Knowing what to do without conscious deliberation

• INVOLVES:
1. Deep appreciation of the meaning of a situation
2. Moves beyond the surface of a situation
3. Often shared without conscious exchange of words
4. Transformative art/acts
5. Brings together all the elements of a nursing care situation to create a meaningful
whole
6. Perceiving the nature of clinical situation & interpreting this information
7. To respond with skill action
8. Uses intuition & empathy

4. Personal Knowledge / Personal Knowing: The Therapeutic Use of Self

• Personal knowledge is concerned with the knowing, encountering, and actualizing of the
concrete, individual self. Because nursing is an interpersonal process, the nurse’s view of
self, as well as the client, is a critical factor in the therapeutic relationship. The nurse is aware
of his or her own attitudes and behavior and views the client as a unique individual who is
free to choose and create her or his own life. Personal knowing promotes wholeness and
integrity in the personal encounter, achieves engagement rather than detachment, and
denies the manipulative or impersonal approach.
• Acceptance of self that is grounded in self-knowledge & confidence
 Concerned with becoming self-aware
 Used in practice, when nurses engage in the therapeutic use of self
- Scientific confidence, moral/ethical practice, insight & experience in personal
knowing
• needs to be integrated with professional responsibilities
• comes to us through the process of observation, reflection, and self-actualization

DOMINGO T.SO, JR., RN, MAN

Berman, A., Snyder, S. & Frandsen G. (2016). Kozier & Erb’s fundamentals of nursing: Concepts, process, and practice (10th ed.). Boston: Pearson Education, Inc.
 NRG106 FUNDAMENTALS OF NURSING PRACTICE OUTLINE
NURSING PROGRAM: DAVAO DOCTORS COLLEGE

DEVELOPING WAYS OF KNOWING

The methods for developing each type of knowledge are unique (Chinn & Kramer, 2011). The methods that
are required for developing one pattern cannot be used to develop knowledge within through critical
reflection on one’s own actions and feelings in practice. Empirical knowing is gained from studying scientific
models and theories and from making objective observations. Ethical knowing involves confronting and
resolving conflicting values and beliefs. Aesthetic knowing arises from a deep appreciation of the
uniqueness of each individual and the meanings that individual ascribes to a given situation. The nurse who
practices effectively is able to integrate all types of knowledge to understand situations more holistically.

CARING ENCOUNTERS
Because caring is contextual, a nursing approach used with a client in one situation may be ineffective in
another. Caring responses are as varied as clients’ needs, environmental resources, and nurses’
imaginations. When clients perceive the encounter to be caring, their sense of dignity and self-worth is
increased, and feelings of connectedness are expressed. Common caring patterns include:
1. Knowing the Patient
 Personal knowledge of the client is a key in the caring relationship between nurse and
client. The nurse aims to know who the client is, in his or her uniqueness. This knowledge is
gained by observing and talking with the client and family while using effective listening and
communication skills. The nurse cannot remain detached, but must be actively engaged
with the client.
 nurse’s understanding of a specific patient
 selection of interventions
 Two elements that facilitate knowing:
- continuity of care
- clinical expertise
2. Providing Presence
 Establishment of a caring relationship depends on a moral commitment by the nurse and the
nurse’s ability to assess and realize another person’s state of being. Healing presence
requires an openness and consciousness of the self and the client. The nurse must create
some space for awareness by being truly present and focused on the moment. The nurse is
aware of his or her own thoughts and feelings, while also aware of an interconnectedness
with the client. Authentic presence involves empathy and openness to positive or negative

DOMINGO T.SO, JR., RN, MAN

Berman, A., Snyder, S. & Frandsen G. (2016). Kozier & Erb’s fundamentals of nursing: Concepts, process, and practice (10th ed.). Boston: Pearson Education, Inc.
 NRG106 FUNDAMENTALS OF NURSING PRACTICE OUTLINE
NURSING PROGRAM: DAVAO DOCTORS COLLEGE

feelings, nonpossessive warmth, a relaxed posture, and facial expressions that are congruent
with other communications (Jesse, 2010).
 person-to-person encounter conveying a closeness and sense of caring
 “being there” and “being with.”
3. Touch
 use of touch is one comforting approach that reaches out to patients to communicate
concern and support
 involves contact and noncontact touch
4. Listening
 Necessary for meaningful interactions with patients
 present and engages the patient in a nonjudgmental and accepting manner
 True listening leads to truly knowing and responding to what really matters to the patient
and family
5. Empowering the client
 Through knowing the client and engaging in a mutual relationship, the nurse is able to identify
and build on client/family strengths. This empowering relationship includes mutual respect,
trust, and confidence in the other’s abilities and motives.
 freedom to choose where and when one has treatment
 implies that patients should retain autonomy and responsibility for decision-making during
their treatment
 The caring behavior of enabling is defined as “facilitating the other’s passage through life
transitions and unfamiliar events”. Enabling also includes coaching, informing, explaining,
supporting, assisting, guiding, focusing, and validating.
6. Compassion
 Universally, clients equate compassion with caring. The caring nurse is described as warm and empathetic, compassionate and

concerned. To demonstrate empathy, the nurse must be able to identify with the client,
appreciating the pain and discomfort of illness, or imagine “walking in his shoes” in regard to
some part of the client’s life experience. Like empathy, compassion involves participating in
the client’s experience, with sensitivity to the person’s pain or discomfort, and a willingness
to share in their experience. Compassion is given as part of the caring relationship, as the
nurse shares the client’s joys, sorrows, pain, and accomplishments. Compassion requires
courage and openness, as the nurse experiences his or her own humanness and
interconnectedness with the client (Boykin & Schoenhofer, 2013).
DOMINGO T.SO, JR., RN, MAN
Berman, A., Snyder, S. & Frandsen G. (2016). Kozier & Erb’s fundamentals of nursing: Concepts, process, and practice (10th ed.). Boston: Pearson Education, Inc.
 NRG106 FUNDAMENTALS OF NURSING PRACTICE OUTLINE
NURSING PROGRAM: DAVAO DOCTORS COLLEGE

 intelligent kindness
 central to how people perceive their care
 How care is given through relationships based on empathy, respect and dignity
7. Competence
 The competent nurse employs the necessary knowledge, judgment, skills, and motivation to
respond adequately to the client’s needs. Just as competence without compassion is cold
and inhumane, compassion without competence is meaningless and dangerous. The nurse
is able to provide the necessary care while guiding the client and family through the
process. The nurse’s abilities to assess, plan, implement, and evaluate a plan of care are
focused on meeting the client and family needs.
 ability to understand an individual’s health and social needs
 Expertise
- clinical and technical knowledge to deliver effective care and treatments

MAINTAINING CARING PRACTICE

The concept of caring for self seems almost foreign to many nurses and students of nursing because of the
professional emphasis on meeting others’ needs. as nurses take on multiple commitments to family, work,
school, and community, they risk exhaustion, burnout, and stress. Despite these challenges, nurses must
attend to their own needs, because caring for self is central to caring for others.

1. CARING FOR SELF

Mayeroff (1990) describes caring for self as helping oneself grow and actualize one’s possibilities.
Self-care, when defined as responding to one’s own needs to grow, is the opposite of the self-
complacency that often accompanies egocentricity. Caring for self means taking the time to nurture
oneself. This involves initiating and maintaining behaviors that promote healthy living and well-being.
Although different activities may be helpful to different people.
• A healthy lifestyle (e.g., nutrition, activity and exercise, recreation)
- nutrition and exercise, and to avoid unhealthy lifestyle practices
- Keywords for a healthy lifestyle are balance and moderation.
- supplemented by regular physical examinations and health screenings
o NUTRITION
- Healthy eating

DOMINGO T.SO, JR., RN, MAN

Berman, A., Snyder, S. & Frandsen G. (2016). Kozier & Erb’s fundamentals of nursing: Concepts, process, and practice (10th ed.). Boston: Pearson Education, Inc.
 NRG106 FUNDAMENTALS OF NURSING PRACTICE OUTLINE
NURSING PROGRAM: DAVAO DOCTORS COLLEGE

- A nutritionally balanced eating plan provides energy, builds endurance to carry out
daily activities, and reduces the risk for certain health problems.
- select a variety of foods, to eat regular meals, and to eat the correct amount to
maintain a healthy weight

o ACTIVITY AND EXERCISE

- recognized as a lifetime endeavor that is essential for energetic, active, and healthy
living
- Benefits of exercise linked to many physiological and psychological responses, from a
reduced feeling of stress to an increased sense of well-being
- American Heart Association (2013) guidelines recommend that healthy adults,
ages 18 to 65 years, engage in the following activities to promote and maintain
health:
o At least 30 minutes of moderate-intensity aerobic activity at least 5 days
per week for a total of 150 minutes
OR
o At least 25 minutes of vigorous aerobic activity at least 3 days per week
for a total of 75 minutes; or a combination of the two
AND
o Moderate to high-intensity muscle-strengthening activity at least 2 or more
days per week for additional health benefits.
o RECREATION
- Self-care also includes taking time to do the things that bring joy and stimulate
creativity
- Nurses need to reward themselves, to experience spontaneity, and even to take
downtime or time to do nothing.

o AVOIDING UNHEALTHY PATTERNS

- avoiding activities or thought patterns that contribute to negative health outcomes.
Negative thinking can create a stress response with all its physiological, mental, and
emotional outcomes

DOMINGO T.SO, JR., RN, MAN

Berman, A., Snyder, S. & Frandsen G. (2016). Kozier & Erb’s fundamentals of nursing: Concepts, process, and practice (10th ed.). Boston: Pearson Education, Inc.
 NRG106 FUNDAMENTALS OF NURSING PRACTICE OUTLINE
NURSING PROGRAM: DAVAO DOCTORS COLLEGE

• Mind-body therapies (e.g., guided imagery, meditation, yoga).

- The interconnectedness of the mind and body is the basis for complementary therapies.
Imagery, meditation, storytelling, music therapy, and yoga are examples of
complementary therapies that bring balance to thoughts and emotions. The practice of
one or more mind-body therapies is an effective self-care strategy to help restore peace
and balance

Self-care focuses on the care of the self in the deepest sense. Self-awareness and self-esteem are
intimately connected to self-care. Each person is unique and possesses individual strengths and
weaknesses. Self-care practices are intentionally created by the self and vigilantly maintained. This is a
lifelong unfolding process, leading to wholeness that comes from and contributes to self-esteem.

2. REFLECTION ON PRACTICE
Critical thinking, self-analysis, and reflection are required in order to learn from one’s experience. The
student develops as a practitioner by thinking about how values and standards guide practical experience.
Reflection is thinking from a critical point of view, analyzing why one acted in a certain way, and assessing
the results of one’s actions. To develop oneself as a caring practitioner, reflection on practice must be
personal and meaningful.
Reflective practice is a method of self-examination that involves thinking back over what happened in a
nursing situation. It involves the whole person, including one’s emotions. Reflective practice includes
becoming aware of how one feels about oneself and recognizing how one thinks and acts. Reflective
practice requires discipline, action, openness, and trust. It is a form of self-evaluation.

DOMINGO T.SO, JR., RN, MAN

Berman, A., Snyder, S. & Frandsen G. (2016). Kozier & Erb’s fundamentals of nursing: Concepts, process, and practice (10th ed.). Boston: Pearson Education, Inc.