HEALTH

– Basic needs may be physiologic,

psychologic, social or spiritual.
Needs must be satisfied if a person
❖ (by WHO) is a state of complete physical, is to carry on activities of life.
mental and social well-being and not merely Health problems manifest
the absence of disease or infirmity. themselves differently in each
individual. Health problem is an
On a Personal level, health is defined according to: abnormal process in which the
1. how the person feels person’s level of functioning is
2. whether there is absence or presence of changed compared with a previous
symptoms of illness level. It is highly subjective, only the
3. ability of the individual to carry out individual person can say he or she
activities is ill. It is also synonymous with
disease & may or may not be
THEORETICAL CONCEPTS related to disease.
RELATED TO HEALTH Factors that Influence Illness
1. Health is a continually changing 1. Self-perception
phenomenon 2. Others’ perceptions
- It moves on a continuum and changes may 3. Effects of changes in body structure &
be gradual or abrupt. The level of health function
attainable depends on adaptive energy, 4. Effects of changes on roles &
genetic, and environmental factors. relationships
• Variety of stresses affect physical, 5. Cultural & spiritual values & beliefs
emotional and social health
- It may be internal or external. It may be Types of Illness
detrimental or beneficial to life. The Acute
sources of stress vary widely for different
individuals at different times. Tolerance - illness is typically characterized by rapid
for stress is different in each individuals. onset of symptoms of relatively short
• The ability to maintain a high level of duration. Their symptoms may appear
wellness is affected by an individual’s abruptly and subside quickly. It may or
ideas, attitudes, and knowledge relative to may not require intervention depending
maintenance & promotion of health. on the cause
• The environment requires continual
adaptations on a conscious and Chronic
unconscious level. – illness is one that lasts for an extended
- Adaptation depends on the nature of period, usually 6 months or longer, and
stress Success of adaptation will often for the person’s life. It may have a
determine nature & degree of assistance slow onset and often have periods
required to maintain equilibrium of remission (symptoms
• Individual reacts as a unified whole to disappear) or exacerbation (the symptoms
stress affecting any aspect of health. reappear)
– Individual is an open
system. Individual is made of many
interrelated subsystems.

2. Client needs to determine necessary care

NCM103A_F Fundamentals of Nursing Practice

STAGES OF HEALTH-SEEKING Factors Influencing the Delivery of
Health Care
BEHAVIOR by Igun
1. Cost has been a driving force for change in
the health care system as evidenced by
Stage 1: Symptom Experiences the strength and numbers of managed
Stage 2: Self-treatment or Self-medication care plans, increased use of outpatient
Stage 3: Communication to Others treatment, and shortened hospital stays
Stage 4: Assessment of Symptoms (Bodenheimer, 2005).
Stage 5: Sick-role Assumption 2. Access to health care services has a
Stage 6: Concern serious impact on the functioning of the
Stage 7: Efficacy of treatment health care system. As
Stage 8: Selection of treatment a result of the cost, health care for
Stage 9: Treatment many people is crisis-oriented and
Stage 10: Assessment of Effectiveness of fragmented.
Treatment 3. Safety and quality
Stage 11: Recovery and Rehabilitation are frequently compromised by inappropr
iate substitution of unqualified personnel
Health Care Delivery for registered nurses in direct care of
clients.
System (HDS)
described as the organized response of a
❖
society to the health problems of its
NURSING AS A PROFESSION
population (Van der Zee et al., 2004).
What is a profession?
Health Care System JOB
❖ the organization of people, institutions, – a group of positions that are similar in
and resources that deliver health care nature & level of skill that can be carried
services to meet the health needs target out by one or more individuals.
populations.
OCCUPATION
TYPES OF HEALTH CARE SERVICES – a group of jobs that are similar in type of
work and that are usually found
throughout an industry or work
❖ LEVELS OF PREVENTION environment.

1. Primary: Health Promotion and Disease PROFESSION

Prevention – a type of occupation that meets certain
– Ex. Immunization/Vaccination, criteria that raise it to a level above that of
Smoking cessation, Teaching an occupation.
2. Secondary: Diagnosis and Early Treatment
– Ex. Screenings such as CRITERIA OF A PROFESSION
Mammograms, PAP tests, Mantoux 1. Body of Knowledge
3. Tertiary: Rehabilitation, Health restoration 2. Ongoing Research
& Palliative Care 3. Service Orientation
– Ex. Rehabilitation after a Stroke 4. Specialized Education
Injury. 5. Code of Ethics
6. Autonomy
7. Professional Organization

NCM103A_F Fundamentals of Nursing Practice

All professions are occupations but not all – Responsible for the holistic care of
occupations are professions. patients, which encompasses the
psychosocial, developmental, cultural,
PROFESSIONALISM and spiritual needs of the individual.
– set of attributes, a way of life that implies
responsibility and commitment. ✓ Clinical Decision Maker
– Utilizes critical thinking skills and the
PROFESSIONALIZATION: nursing process
– process of acquiring characteristics of – Nursing Process: Assessment, Diagnosis,
professional. Planning, Implementation, Evaluation

QUALIFICATIONS & ABILITIES ✓ Client Advocate

OF A PROFESSIONAL NURSE – Nurse protects the clients human and
legal rights
1. PROFESSIONAL PREPARATION – Providing information to assist in
decision making
Nurse must: – Nurse considers Patient’s Bill of Rights
1. have a Bachelor of Science degree in
Nursing ✓ Rehabilitator Role
2. have a license to practice nursing in
– Assist client to return to optimal level of
the country
functioning
3. be physically and mentally fit
– Nurse helps client to adapt physically and
emotionally to changes in lifestyle, body
2. PERSONAL QUALITIES & PROFESSIONAL image
PROFICIENCIES OF A NURSE
1. Has interest & willingness to work & ✓ Comforter Role
learn with individuals/ groups in a
– Caring for client as a human being
variety of settings
– Role is traditional to nursing
2. Has a warm personality, a well-
– Care is directed to the whole person, not
balanced emotional condition &
just a body part
concern for people.
– Demonstration of care and concern
3. Is resourceful & creative
4. Has the capacity & ability to work
cooperatively with others ✓ Communicator Role
– Role is central to all other roles
3. HAS THE INITIATIVE TO IMPROVE SELF & – Involves communication with client,
SERVICE family, healthcare team members,
5. Has competence in performing work resource people, and the community
through the use of the nursing process – Without clear, concise communication it
6. 7. Has the skill in decision-making, will be difficult to give effective care
communicating, and relating to others
7. Must be research- oriented ✓ Teacher/Educator Role
8. Does active participation in issues – Explains concepts and facts about health,
confronting nurses & the nursing demonstrates procedures, reinforces
profession learning, determines understanding, and
evaluates progress of learning
ROLES BASIC TO NURSING CARE – Unplanned or informal education
– Planned or formal education
✓ Caregiver Role

NCM103A_F Fundamentals of Nursing Practice

 ✓ Allowed to have two days off, sick leaves,
FIELDS OF NURSING holidays and vacations with pay
✓ Disadvantages of Hospital Nursing
1. HOSPITAL NURSING ✓ Possibility of understaffing due to limited
❖ is a field of nursing that is devoted
budget.
primarily to the rendering of all of the
✓ Lesser time to improve nursing skills due
basic components of comprehensive
to bulk of work
patient care & family health nursing care
✓ More administrative problems
in hospitals and related health care
✓ Nurses usually feel burned-out and
facilities.
overworked
Positions Occupied by Nurses in Hospitals:
1. Staff nurse 2. COMMUNITY HEALTH NURSING
2. Head nurse / Charge Nurse ❖ field of nursing whose focus of care is
3. Nurse Supervisor Health Education, Prevention of
4. Assistant Nurse Director or Assistant illnesses/diseases, Treatment and care
Chief Nurse of the family’s and community’s health
5. Nurse Director or Chief Nurse problems.

MAIN RESPONSIBILITIES OF THE Advantages of Community Health Nursing

✓ Health conditions of the community can
HOSPITAL NURSE easily be monitored by the nurse.
✓ It maximizes the effort of the nurse to
➢ PROVIDES BEDSIDE CARE improvise, coordinate, and appreciate the
– performs nursing measures that will role in nation-building
meet the patient’s physical, emotional,
social and spiritual health needs Disadvantages of Community Health
➢ GIVES HEALTH EDUCATION Nursing
– teaches patients in all phases of care - ✓ Limited to exposure to chronic &
the acutely ill, the convalescing and communicable diseases
ambulatory patients ✓ More hazards are present
➢ CONDUCTS ASSESSMENT ✓ No fixed working hours
– uses the nursing process ✓ Unglamorous
➢ DOES COORDINATING AND ✓ Facilities and development of skills are
COLLABORATING ACTIVITIES limited
➢ MAINTAINS HOSPITAL SAFETY ✓ Nurse must be outgoing not an introvert
➢ INITIATES DISCHARGE PLANNING
– helps the family plan for patient’s health ➢ SCHOOL HEALTH NURSING
care needs when he returns home
➢ SPECIALIZES IN VARIETY OF AREAS ❖ A specialized practice of professional
nursing that advances the well-
being, academic success, and life-long
Advantages of Hospital Nursing
achievement of students.
✓ Presence of supervisors when the need
for consultation arises Responsibilities of the School Nurse
✓ Kept updated with new trends in ✓ organizes, implements & evaluates the
medicine and nursing school health programs
✓ More staff development programs are ✓ promotes health & safety in the school
available environment
✓ Opportunity to work in different areas ✓ intervene with actual & potential health
problems
NCM103A_F Fundamentals of Nursing Practice
 ✓ actively collaborates with other personnel
& agencies Categories of Private Duty Nurse Practitioners
✓ loves children and should be able to work 1. General Private Duty Nurse
well with them. – provides basic nursing to any type of
patient and his family
➢ OCCUPATIONAL HEALTH NURSING 2. Private Duty Nurse Specialist
❖ It is a specialty practice that provides for
& delivers health & safety programs &
services to workers, worker populations Advantages of Private Duty Nursing
and community groups. ✓ Has opportunities to make real friends
through close association with the family
1958 – INDUSTRIAL NURSING was changed to and patient.
OCCUPATIONAL HEALTH NURSING to reflect the ✓ Has the chance to travel and see the world
broader and changing scope of practice within ✓ Owns time, adjusts work and private life
the specialty. ✓ Has the chance to be updated with new
knowledge or procedures
Advantages of Occupational Health ✓ Can give the best care and see its results.
Nursing
✓ Nurse practices autonomy Disadvantages
✓ Goes off-duty on weekends ✓ Patient can become dependent on the
nurse
Disadvantages ✓ less replacement for holidays / vacations
✓ Nurse must be fully aware of his/her legal ✓ less hospital personnel friends
responsibilities as he gives immediate ✓ less assistance from the HN
care to patients with serious injuries ✓ poor participation in professional
✓ Nurses usually bargain individually for activities
their salaries. Pay is less than hospital ✓ no retirement, insurance and medical
pay. benefits

3. INDEPENDENT NURSING PRACTICE 6. MILITARY NURSING

4. NURSING EDUCATION ➢ Navy Nursing
❖ FOCUS is to teach the knowledge and – nursing field that provides high-quality
skills that will enable a nurse to practice nursing care for sailors, marines and
professional nursing. service members - and their families -
wherever duty calls.
Positions of the Nurse:
➢ Army Nursing
1. Faculty/Clinical Instructors
– Nursing field whose mission is to provide
– for the Undergraduate & Graduate
responsive, innovative, and evidenced-
programs
based nursing care integrated on the
2. Level Chairpersons
Army Medical Team to enhance readiness,
3. Clinical Supervisor
preserve life and function, and promote
4. Administrative Officer
health and wellness for all those
5. Dean
entrusted to their care.
5. PRIVATE DUTY NURSING
➢ Air Force Nursing
❖ a field of nursing that provides a variety – also called Flight nursing or Aero-space
of services to patients, including nursing
companionship and bathing.
NCM103A_F Fundamentals of Nursing Practice
 – nurse is responsible for patients, military utilization of this knowledge in
or otherwise, who have been evacuated implementing independent and inter-
from battle areas to the nearest dependent nursing interventions”
installation for treatment. (Senate Bill 2720, 2016)

7. CLINIC NURSING APN Fields of Specialization:

✓ Nursing Informatics
❖ Nurse acts as a receptionist, assists in
✓ Renal Nursing
physical examinations, performs
✓ Oncology Nursing
laboratory examinations, do dressings,
✓ Nurse-Midwife
give injections, do referrals as well as give
✓ Nurse Anesthetist
health teachings.
✓ Gerontologic Nursing
❖ Must possess good assessment skills and
✓ Nurse Practitioner or Independent
excellent teaching & communication
Nurse Practitioner
skills, exhibit organizational & leadership
ability.
Reasons for the Amendment
8. ENTREPRENURIAL NURSING 1. It could be the answer to the
increasing number of unemployed
❖ Field of nursing that ventures into new nurses and dearth of physicians,
opportunities in the world of business especially in rural areas.
❖ Requires the nurse to be capable of 2. With the advanced skills and
planning, organizing, financing, and training, there could be an increase
operating his own business. in the morale and job satisfaction of
❖ Requires the nurse to work outside of an nurses.
organization 3. Professional autonomy will be
❖ Responsible for indirect processes of care observed.
in his roles

9. ADVANCED PRACTICE NURSING HISTORY OF NURSING

❖ History provides current nurses with the
❖ APN is an umbrella term for nurses who
have specialized education in the post- same intellectual and political tools that
graduate level. determined nursing pioneers applied to
shape nursing values & beliefs to the
❖ Registered Nurses who receive social context of their times. Nursing
specialized training that allows them to history is not an ornament to be displayed
practice independently or in partnership or anniversary days, nor does it consist of
with doctors.
only happy stories to be recalled and
❖ Nurses in this field must have acquired
retold on special occasions. Nursing
the
1. Expert knowledge base history is a vivid testimony, meant to
2. Complex decision-making skills incite, instruct and inspire today’s nurses
3. Clinical competencies for expanded as they bravely tread the winding path of
practice. a reinvented health care system.” -
American Association for the History of
Proposed revision of the Philippine Nursing Nursing (2007)
Practice Reform Act of 2011
– is a “nurse who acquired substantial
theoretical knowledge and decision- EARLY NURSING
making skills in the specialty area of
❖ EARLY CIVILIZATION
nursing practice and proficient clinical
NCM103A_F Fundamentals of Nursing Practice
 – Early mid-1800s, women (alcoholics &
• 4000 BC- Primitive care prostitutes) made beds, scrubbed floors,
– mothers-nurses worked with priests in & bathed the poor.
providing care for the sick
• BEFORE MID 1800 ❖ WAR & RELIGIOUS INFLUENCES
– without organization, education, social – India – only men were considered
status. “pure” enough to be nurses.
– Women stayed at home, reared children, – THEODORE FLIEDNER- revived the
were good housewives and caring Church Order of Deaconesses --
mothers. opened a small hospital and
• ANCIENT GREECE KAISERSWERTH training school in
– Built temples to honor HYGEIA, the Germany.
goddess of health
– Priestesses (who were not nurses) • NURSING & the CIVIL WAR
attended to those housed in the temples ➢ CRIMEAN WAR: (1854-1856)
• ROMAN EMPIRE – Sir Sidney Herbert of British War
– 3RD & 4TH Century – wealthy matrons Department asked FLORENCE
(FABIOLA) of the Roman Empire used NIGHTINGALE to recruit female
their wealth to provide houses of care & nurses, set up sanitation practices,
healing. performed a miracle: mortality rate in
– Caregivers had no formal training in BARRACK HOSPITAL in Scutari
therapeutic modalities and cared for the dropped from 42% to 2%.
sick as a religious duty.
➢ AMERICAN CIVIL WAR (1861-1865):
❖ MIDDLE AGES – Harriet Tubman and Sojourner
– Military, religious, and lay orders of Truth
men provided care. • provided care and safety to
– Knights Hospitallers, the Teutonic slaves who had to flee to the
Knights, the Teriaries, the Knights of North on the Underground
St. Lazarus, the Holy Order of the Holy Railroad.
Spirit, and the Hospital Brothers of St. – Mother Biekerdyke and Clara
Anthony built hospitals and provided Barton, Walt Whitman and Louisa
nursing care to their sick and injured May Alcott
comrades. • Authors who volunteered as
– In the rural parts of Eastern Roman nurses, cared for injured
Empire & the West --- nursing was soldiers in the military
viewed as a natural nurturing job for hospitals.
women. – Dorothea Dix
• Became the Union’s
• RENAISSANCE superintendent of Female
– The Protestant Reformation (AD 1500- Nurses in Army Hospital -
1700) dissolved Catholic hospitals in recruited and supervised
many European countries à the sick no nurses in the army hospital.
longer had institutional care.
• ENLIGHTENMENT & INDUSTRIAL World War 1 brought progress in healthcare esp.
REVOLUTION in the field of surgery.
– London - medical schools were founded
– France - barbers functioned as surgeons • WORLD WAR II
(leeching, enemas, extracting teeth) ➢ CADET NURSE CORPS
NCM103A_F Fundamentals of Nursing Practice
 – was established due to increased – Scientific and technological
casualties & acute shortage of development as well as social
caregivers. changes mark this period.
– “practical” nurses, aides, & technicians a. Health is perceived as a
à provided care under the instruction fundamental human right
& supervision of better prepared b. Nursing involvement in
nurses. community health
➢ The WOMEN’S MOVEMENT (1848) c. Technological advances –
– Women were not considered equal to disposable supplies and
men. Society did not value education equipment
for women. Women did not have the d. Expanded roles of nurses was
right to vote. In Mid-1900s, more developed
women were being accepted into e. WHO was established by the
colleges & universities. United Nations
f. Aerospace Nursing was
❖ NIGHTINGALE ERA developed
– In 1860, The Nightingale Training g. Use of atomic energies for
School of Nurses opened at St. medical diagnosis, treatment
Thomas Hospital in London. h. Computers were utilized-data
– The school served as a model for collection, teaching, diagnosis,
other training schools. Its graduates inventory, payrolls, record
traveled to other countries to keeping, billing.
manage hospitals and institute i. Use of sophisticated
nurse-training programs. equipment for diagnosis and
– Nightingale focus vision of nursing therapy.
Nightingale system was more on
developing the profession within
hospitals. Nurses should be taught in
HISTORY OF NURSING IN
hospitals associated with medical THE PHILIPPINES
schools and that the curriculum
should include both theory and Early Beliefs, Practices and Care of the Sick
practice.
– It was the 1st school of nursing that • Early Filipinos subscribed to
provided both theory-based superstitious belief and practices in
knowledge and clinical skill relation to health and sickness
building. Nursing evolved as an art • Diseases, their causes and treatment
and science. Formal nursing were associated with mysticism and
education and nursing service begun. superstitions
• Cause of disease was caused by
❖ PERIOD OF CONTEMPORARY NURSIING another person (an enemy of witch)
or evil spirits
– Licensure of nurses started.
• Persons suffering from diseases
– Specialization of Hospital and
without any identified cause were
diagnosis
believed bewitched by
– Training of Nurses in diploma
“mangkukulam”
program
• Difficult childbirth was attributed to
– Development of baccalaureate and
“nonos”
advance degree programs
• Evil spirits could be driven away by
persons with powers to expel demons

NCM103A_F Fundamentals of Nursing Practice

 • Belief in special gods of healing: – Need to establish nursing schools became
priest-physician, word doctors, urgent
herbolarios/herb doctors – Fast turnover of American doctors and
nurses à need to train Filipino women
Early Hospitals during the Spanish Regime to become nurses and establishment of
nursing schools all over the country
• Religious orders exerted efforts to – Nursing education in the Phil. à pioneered
care for the sick by building hospitals by & Mrs. Andrew Hall
in different parts of the Philippines: – Nursing training evolved from the
• Hospital Real de Manila apprenticeship system -the process of
• San Lazaro Hospital learning through physical integration
• Hospital de Indios into the practices associated with the
• Hospital de Aguas Santas subject, such as workplace training.
• San Juan de Dios Hospital
SCHOOLS OF NURSING IN THE PHILIPPINES
PROMINENT PERSONAGES 1. St. Paul’s Hospital School of Nursing,
INVOLVED DURING THE Intramuros Manila – 1900
2. Iloilo Mission Hospital Training School of
PHILIPPINE REVOLUTION Nursing – 1906
– current name – CPU College of Nursing
Josephine Bracken
3. St. Luke’s Hospital School of Nursing – 1907
– wife of Dr. Jose Rizal who installed a field
– opened after four years as a dispensary
hospital in an estate in Tejeros that
clinic.
provided nursing care to the wounded
4. Mary Johnston Hospital School of Nursing –
night and day.
1907
Rosa Sevilla de Alvaro
5. Philippine General Hospital School of Nursing
– converted their house into quarters for
– 1910
Filipino soldiers during the Phil-American
6. UST College of Nursing – 1877
War in 1899.
– 1st College of Nursing in the Philippines
Hilaria de Aguinaldo
7. MCU College of Nursing – June 1947
– –wife of Emilio Aguinaldo who organized
– 1st College that offered BSN – 4-year
the Filipino Red Cross.
program
Melchora Aquino (Tandang Sora)
8. UP College of Nursing – June 1948
– considered the first military nurse in the
9. FEU Institute of Nursing – June 1955
Phil.
10. UE College of Nursing – Oct 1958
– nursed the wounded Filipino soldiers,
– gave them shelter and food.
Captain Salomen FACTS ABOUT NURSIING IN THE PHILIPPINES
– a revolutionary leader in Nueva Ecija who • 1909
provided nursing care to the wounded – 3 females graduated as “qualified
when not in combat. medical-surgical nurses”
Agueda Kahabagan – Felipa de la Pena, Nicasia Cada, Dorotea
– revolutionary leader in Laguna who also Caldito
provided nursing services to her troops. • 1920
Trinidad Tecson (Ina ng Biak na Bato) – 1st board examination for nurses
– stayed in the hospital at Biac na Bato to – 93 candidates took the exam, 68 passed
care for the wounded soldiers. with the highest rating of 93.5% - Anna
– Spanish domination ended and American Dahlgren
occupation began

NCM103A_F Fundamentals of Nursing Practice

• 1921 – The hospital was first known as the
– Filipino Nurses Association was Negros Occidental Provincial Hospital.
established (now PNA) as the National – It was renamed Western Visayas Regional
Organization of Filipino Nurses Hospital Corazon Locsin Montelibano
– PNA: 1st President – Rosario Delgado Memorial Regional Hospital
– Founder – Anastacia Giron-Tupas – There was a proliferation of private
✓ March 1, 1919 – 1st nursing nursing schools and colleges all over the
law was passed pursuant to Act country.
No. 2808 known as “An Act – The increase in the number of schools of
Regulating the Practice of nursing led to the development of the BSN
Nursing Profession in the Program.
Philippines” – This development made the Ministry of
✓ June 19, 1953 –enactment of Health decide on the cessation of the
Republic Act 877, known as the Graduate in Nursing (GN) program.
“Philippine Nursing Act” – In December 1982, E.O. No. 851 s. 1982,
✓ November 21, 1991 – approval Section 18 of the Ministry of Health
of Republic Act 7164 ordered for the phasing out of all schools of
✓ October 21, 2002 nursing connected with government
– RA 9173, known as the hospitals.
“Philippine Nursing Act – This move, on the part of the government,
of 2002” prompted CLMMH to tie up with La Salle
– now the prevailing law College.
regulating the practice of
nursing • CLMMH provided academic and clinical
• 17th Congress Senate Bill No. 2069 training whereas La Salle College
– COMPREHENSIVE NURSING LAW OF supplemented the general education
2018 requirements, the over-all academic
– Filed on October 10, 2018 by Binay, administration & granted the BSN degree
Maria Lourdes Nancy S. • Phase out plans at CLMMH were completed in
✓ SBN-2069 (as filed)
March 1984 and in June 1985 La Salle College
✓ 11/12/2018
took over sole academic administration &
– An act providing for a comprehensive operation of the Nursing Program.
nursing law towards quality health
system, repealing for this purpose – The takeover of La Salle of the Nursing
Republic Act No. 9173 otherwise known Program has been remarkable & smooth
as the Philippine Nursing Act of 2002. primarily because its entire faculty force
came from the CLMMH School of Nursing.
HISTORY OF THE USLS COLLEGE OF – In June 1988, the institution was
NURSING conferred a university status because of
the strength of its academic programs.
• 1946
– NEGROS OCCIDENTAL PROVINCIAL
HOSPITAL then became the CORAZON NURSING AS AN ART –
LOCSIN MONTELIBANO MEMORIAL
HOSPITAL SCHOOL OF NURSING CARING
• Nursing Department of USLS traces its
beginnings at the Corazon Locsin ❖ Caring is defined as sharing deep &
Montelibano Memorial Hospital School of genuine concern about the welfare of
Nursing. another person. Caring practice involves

NCM103A_F Fundamentals of Nursing Practice

 connection, mutual recognition, and 6. COMPORTMENT
involvement between nurse & client. – appropriate bearing, demeanor, dress,
and language that are in harmony with
What are the Caring Practice Models? a caring presence. Presenting oneself as
1. Culture Care Diversity & Universality - someone who respects others and
Leininger demands respect.
2. Theory of Human Care - Watson
3. Theory of Caritative Caring - Eriksson Maintaining Caring Practice
4. Core, Care, Cure - Hall 1. Caring for Self
5. Nursing as Caring - Boykin and – described as helping oneself grow and
Schoenhofer actualize one’s possibilities. (Mayeroff,
6. Theory of Caring - Swanson 1990)
7. Technological Nursing as Caring – – means nurturing oneself
Locsin – involves initiating & maintaining
behaviors that promote healthy living &
THE 6 C's of Caring well-being.
❖ by M.S. Roach (2013), Caring: The Human
Mode of Being
2. Caring as “Helping the Other Grow”

1. COMPASSION MAJOR INGREDIENTS OF CARING

– awareness of one’s relationship to 1. Knowing means understanding the other’s
others, sharing their joys, sorrows, pain, needs and how to respond to these needs.
and accomplishments. Participation in 2. Alternating rhythms signifies moving back
the experience of another. and forth between the immediate & long-
term meanings of behavior, considering the
2. COMPETENCE past.
– having the “knowledge, judgment, skills, 3. Patience enables the other to grow in his
energy, experience and motivation own way and time
required to respond adequately to the 4. Honesty includes awareness and openness to
demands of one’s professional one’s own feelings and a genuineness in
responsibilities. caring for the other.
5. Trust involves letting go, to allow the other
3. CONFIDENCE to grow in his own way & own time.
– comfort with self, client, and others that 6. Humility means acknowledging that there is
allows one to build trusting always more to learn, and that learning may
relationships. come from any source.
7. Hope is belief in the possibilities of the
4. CONSCIENCE other’s growth.
– morals, ethics, and an informed sense of 8. Courage is the sense of going into the
right or wrong. Awareness of personal unknown, informed by insight from past
responsibility. experience

5. COMMITMENT
– the deliberate choice to act in NURSING AS AN ART –
accordance with one’s desires as well as
obligations, resulting in investment of TEACHING
self in a task or cause.
❖ It is an active process in which one individual
shares information with others to provide
them with facts to make behavioral
NCM103A_F Fundamentals of Nursing Practice
 changes. Considered the hallmark of quality precedes disease or dysfunction and is
nursing care. It is a goal-directed process that applied to generally healthy individuals or
provides opportunity for learning. This groups.
addresses client’s need for information.
Teaching Role of the Nurse in Primary Prevention
Benefits of Patient Education
• Increased patient understanding - As educators, nurses offer information
• More active approach to healthcare and counseling to communities and
• Enhanced motivation and better populations that encourage positive health
outcomes behaviors.
• Improved healthcare system - Primary prevention is typically the most
economical method of health care.
FOCUS OF TEACHING
➢ Secondary prevention
✓ HEALTH PROMOTION
- It is an important component of nursing - Emphasizes on early detection of disease,
practice, it is defined as a way of thinking prompt intervention, and health
that revolves around a philosophy of maintenance for individuals experiencing
wholeness, wellness, and well-being. In health problems. Includes prevention of
teaching, it is a process of enabling people complications and disabilities.
to increase control over and to improve
their health. Teaching Role of the Nurse in Secondary
Prevention
Client Education Topics
- Educate patients to reduce and manage
• Parenting skills
controllable risks, modifying the
• Nutrition individuals’ lifestyle choices and using
• Exercise early detection methods to identify
• Family planning diseases in their beginning stages when
treatment may be more effective. Teach
✓ DISEASE PREVENTION clients about regular screenings,
- Defined as behavior motivated by a desire conducted by a preventative health care
to actively avoid illness, detect it early, or nurse.
maintain functioning within the
constraints of illness. In teaching, it ➢ Tertiary prevention
focuses on specific efforts aimed at
reducing the development and severity of - Begins after an illness, when a defect or
chronic diseases & other morbidities. disability is fixed, stabilized, or
determined to be irreversible. Focus and
Client Education Topics to rehabilitate individuals and restore
them to an optimum level of functioning
• Immunizations
within the constraints of the disability.
• Health Screenings
• Smoking cessation Teaching Role of the Nurse in Tertiary
• Breast self-examination Prevention
• Safety measures (e.g., car seats)
– Nurse helps patient make and execute
Levels of Prevention a care plan.
– Nurse encourages client to practice
➢ Primary prevention behavior modifications necessary to
improve conditions.
– Generalized health promotion and
specific protection against disease. It
NCM103A_F Fundamentals of Nursing Practice
 Nurse discusses methods of
–
minimizing negative effects of illness
NURSING AS AN ART –
and preventing future complications. COMMUNICATION
✓ HEALTH RESTORATION & Communication (INTERPERSONAL)
MAINTENANCE ❖ A two- way process involving the sending
– Health restoration – a process and the receiving of a message thereby
consisting of activities that help an ill exchanging information or feelings
client return to health. between 2 or more people.
– Health maintenance – defined as
behavior directed toward sustaining Communication in Nursing:
the current level of health. ❖ Process of transmitting thoughts, feelings,
Client Education Topics information and other verbal and non-
• Medication Information verbal behavior.
• Community Resources ❖ The vehicle for establishing a therapeutic
• Information about treatment relationship with a client. (Trusting
modalities relationship)

✓ REHABILITATION Critical skill to develop:

- the process of helping an individual • Nurses spend more time with
achieve the highest level of function, patients.
independence, and quality of life possible. • Nurses must be able to recognize
- Rehabilitation does not reverse or subtle cues from silent patients.
undo the damage caused by disease or • Integral part of helping relationships
trauma, but rather helps restore the
individual to optimal health, functioning,
and Main purpose of communication
- Emphasis of rehabilitation and functional
ability and the changes or adaptations a 1. Influence others - teaching, express
client needs in daily lifestyle. caring and comfort, influencing others
may be helpful or non-helpful.
2. Obtain information- assessment data,
ACUITY LEVEL OF RESTORATIVE CARE interview
CLIENTS
Acuity – term that classifies where the client is COMPONENTS OF THE COMMUNICATION
on the care continuum, from being highly PROCESS
dependent on complex nursing care to being 1. SENDER
independent in self-care at the other end of the • source-encoder; person or group who
continuum. convey messages.
Components of the Care Continuum: • person has a thought, idea, or emotion
to convey to another person.
1. Amount of nursing assistance needed to • messages stem from a person’s need
physically accomplish ADLs and mobility. to relate to others, create meaning &
2. Amount of education in self-care activities to understand various situations
that client and family need to assume the care • decides on what language and words
themselves. to use, arrange the words, tone and
gestures

NCM103A_F Fundamentals of Nursing Practice

2. MESSAGE • Ineffective communication - occurs
• are the thought, idea, or emotion one when receiver misinterprets the sent
person sends to another person. message
• it is the stimulus produced by the
sender 5. FEEDBACK OR RESPONSE
• alteration in the message depends on • the response from the receiver that
the person’s perception enables the sender to verify that the
• What is actually said or written message received was the message
sent.
3. CHANNEL • allows the sender to correct or reword
• medium through which a message is a message
transmitted.
• MAJOR CHANNELS: 6. INFLUENCES
✓ VISUAL - sight, observation, • they are the person’s frame of
perception - drawing, painting, reference
pictures • involves: culture, age, emotions,
✓ AUDITORY - spoken words and education, language and attention
cues, requires active listening -
singing
✓ KINESTHETIC - experiencing METHODS OF COMMUNICATION
situations, procedural touch,
caring touch - gestures (nodding, 1) Verbal Communication
tapping feet etc.), this involves • The use of words, either spoken or
feelings. written, to send a message.

* Channel should be appropriate for the

message METHODS OF VERBAL COMMUNICATION:
1) Speaking/ Listening
• for communication to take place, both
4. RECEIVER OR DECODER speaking & listening must occur
• interprets, sort out the meaning of the • simple - use of commonly understood
message words
• person or group to whom the message • clear - direct precisely what is meant
is sent • brevity -fewest words necessary
• components involved: • timing and relevance - be sensitive to
✓ physiological - sensory the needs and concerns of the patient,
dysfunction (eyes, ears, taste, nose avoid asking several questions at a
etc...), mental dullness time
✓ psychological - emotional
character - fear of expressing 2) Pace and Intonation
one's ideas to others, excitement, • the manner of speech modifies the
emotional instability feeling and impact of the message
✓ cognitive - thinking or social • rate of speech: indicates interest,
skills, trouble making decisions, anxiety, boredom, or fear.
reasoning, organization, insight • tone of voice: may be pleasant,
• Effective communication - meaning of sincere, sorrowful, sarcastic, joyful or
the decoded message matches the angry.
intent of the sender
3) Writing/ Reading
• the receiver reads the words.
NCM103A_F Fundamentals of Nursing Practice
 • reader must understand the words • stooped shoulders, downward-held
&then attach meaning to them. head & shuffling gait= convey low self-
Ex. Bad communication esteem, depression, lack of confidence
Nurse charts “Patient or apathy.
uncooperative”.
Good communication 4) Eye Contact
Nurse charts “Patient refused to eat lunch, • Generally interpreted as indicating
refused to get out of bed and sit in chair.” interest & attention
• Lack of eye contact = indicate
avoidance, disinterest or discomfort.
2) Non-verbal Communication or
5) Body Position
Body Language • crossed arms = indicate withdrawal or
• transmission of message without the cold behavior
use of words. • open position (arms held freely at the
• partly learned behavior partly sides) = receptive attitude
instinct.
• generally done unconsciously 6) Physical Appearance
• can either reinforce or contradict • clean, neat, appropriately dressed =
what is said verbally. conveys a positive image, knowledge,
• clarify any observation to validate & competence
❖ Essential skill to learn - observing and • dirty, sloppy or inappropriately
interpreting the client's non-verbal behavior • dressed =conveys the message of “I
don’t care how I look”.
WAYS OF COMMUNICATING NON-VERBALLY:
7) Touch
1) Gestures
• Touch is a simple yet powerful means
• often referred to as “talking with
of non-verbal communication
hands”
• may be used to clarify a verbal
PURPOSES OF TOUCH
message, to emphasize an idea, to hold
• Connects people
another’s attention, or to relieve
• Provides affirmation
stress.
(verification/confirmation)
• Sign language
• Gives reassurance hope &
• pacing back and forth, tapping of the
encouragement
hands and feet
• Shows warmth
• Communicates caring
2) Facial Expressions
• Provides stimulation
• some people have very expressive
(inspiration/motivation)
faces, others do not.
• Decreases loneliness
✓ big smile = happy
• Increases self esteem
✓ “curled up” nose = displeasure
✓ raised eyebrows?
GUIDELINES IN THE USE OF TOUCH AS A
✓ emoji's (part of conveying facial
MEANS OF COMMUNICATION BETWEEN
expressions in text messages)
NURSE AND PATIENT
3) Posture and Gait
• Exhibit ability and sureness when
• good posture, with head held up, & a
touching the patient or when
purposeful gait = self-confidence,
performing nursing procedure.
competence & positive self-image
NCM103A_F Fundamentals of Nursing Practice
 • Seek permission before touching the outcome for the client  “helping
client. relationship”
• Touching a client must bring about a ❖ Is safe, confidential, reliable, and
sense of security, rather than anxiety. consistent
❖ People usually need to deal with feelings
ELECTRONIC COMMUNICATION before they can cope with other matters,
❖ type of communication with the use of such as learning new skills or planning for
electronic devices. the future.

EXAMPLES OF ELECTRONIC COMMUNICATION GOALS OF THERAPEUTIC

DEVICES THAT CAN BE USED IN THE CARE OF COMMUNICATION
CLIENTS.
1. Develop trust.
1. telephone – simplest form of ✓ Introduce self & call client by name
telecommunication system ✓ Dress professionally &
2. cell phone – load information to be appropriately
synchronized with the hospital’s IT ✓ Show client that you are listening
system ✓ Be honest & keep your word
3. computers ✓ Show respect for client at all times
4. televisions
5. EMAILS 2. Obtain or provide information
✓ Identify the most important
USES OF ELECTRONIC COMMUNICATION IN need/s of the patient
HEALTH CARE
• Send requisitions to other depts. in 3. Explore feelings
the hospital ✓ Assess the patient’s perception of
• Show safe dosages & drug interactions the problem
in hospital pharmacies ✓ Facilitate the patient’s expression
• Aid physicians in diagnosing and of emotions
treating some conditions. ✓ Ask patient how they feel
• Online documentation of patient care generally, specific health concerns,
• Electronic medical records (EMR) why he feels that way
✓ Patient outcomes tend to improve
EMAILS - schedule and confirm appointments, when patients are well-informed
report lab results, conduct client education about their health and feel
empowered to make decisions
Disadvantages:
✓ Client's privacy, confidentiality and 4. Show caring
potential misuse of information ✓ Implement interventions designed
✓ Not all have access to computer to address the patient’s needs
✓ Sharing deep and genuine concern
THERAPEUTIC about the welfare of another
person
COMMUNICATION
ELEMENTS OF THERAPEUTIC
❖ Sometimes called “effective
COMMUNICATION
communication”
❖ A purposeful & goal-directed
➢ WARMTH - makes the patient feel
communication creating a beneficial
relaxed, welcomed & unjudged
NCM103A_F Fundamentals of Nursing Practice
 ➢ CARING - makes client feel important – Expected to be difficult & filled with
➢ GENUINENESS - builds a trusting ambivalence
relationship, honest with another – helpful for both nurse & client to
➢ EMPATHY - understanding client with express their feelings about
compassion termination openly and honestly.
➢ ACCEPTANCE & RESPECT - lets clients – feeling of loss in this stage is
know that they can be themselves, normal
comfortable
➢ SELF- DISCLOSURE - encourages a THERAPEUTIC COMMUNICATION
reciprocal trust between nurse and client TECHNIQUES
➢ ACTIVE LISTENING - pay attention/ give 1. Clarifying / validating
time, the MOST EFFECTIVE • A method of making the client’s broad
overall meaning of the message more
❖ be mindful, use all senses understandable.
• To clarify the message, the nurse can
PHASES OF A THERAPEUTIC RELATIONSHIP
restate the basic message or confess
1. Preinteraction phase (Planning Stage) confusion and ask the client to repeat
– Nurse has information about the or restate the message.
patient before the meeting (name, • Nurses can also clarify their own
age, address, medical history, social message with statements.
history) • Verify the meaning of specific words.
– Nurse may become anxious during
the planning stage 2. Open-ended questions
• Asking broad questions that lead or
2. Orientation phase (Introductory Phase) invite the client to explore thoughts or
– Nurse and client observes each feelings.
other and form judgments about • Open-ended questions specify only
each other’s behavior the topic to be discussed and invite
– Goal: develop trust and security answers that are longer than one or
within the N-P relationship two words.
– It sets the tone for the rest of the
relationship 3. Giving information
– Agree about - location, frequency • Providing, in a simple and direct
and length of meeting, purpose, manner, specific factual information
confidentiality, tasks, goals, the client may or may not request.
duration • When information is not known, the
nurse states this and indicates who
3. Working Phase has it or when the nurse will obtain it.
– Nurse & client begin to appreciate
each other’s uniqueness 4. Reflecting
– They begin to care about each other • Directing ideas, feelings, questions, or
– Nurse and patient accomplish tasks content back to clients to enable them
– Nurse helps the client to explore to explore their own ideas and
thoughts, feelings and action feelings about a situation.
– Nurse helps the client plan a
program for action 5. Paraphrasing/Restating
• Actively listening for the client’s basic
4. Termination phase message and then repeating those
thoughts and/or feelings. Because
tactile contacts vary considerably
NCM103A_F Fundamentals of Nursing Practice
 among individuals, families and 4. GIVING COMMON ADVICE – offering
cultures, the nurse must be sensitive personal rather than professional opinion.
to the differences in attitudes and Telling the client what he should do which
practices of clients and self. may not be an expert advice.
5. STEREOTYPING – categorizing the client
6. Summarizing & ignoring individual differences
• Stating the main points of a discussion 6. BELITTLING – conveying to the person
to clarify the relevant points that his thoughts or feelings really have
discussed. This technique is useful at no value
the end of an interview or to review a 7. BEING DEFENSIVE – attempt to protect
health teaching session. It often acts self or another person from negative
as an introduction to future care comments
planning. 8. PROBING – asking for information chiefly
out of curiosity rather than with the
7. Focusing intent to assist the client.
• Helping the client expand on and 9. CHANGING THE SUBJECT – directing the
develop a topic of importance. It is communication into areas of self-interest
important for the nurse to wait until rather than client’s concerns
the client finishes stating the main
concerns before attempting to focus. EFFECTIVE COMMUNICATION CAN RESULT
TO:
8. Silence
• accepting pauses or silences that may ✓ Collection of Assessment data
extend for several seconds or minutes ✓ Initiation / application of intervention
without interjecting any verbal ✓ Evaluation of outcomes of intervention
response. ✓ Initiation of changes that promotes Health
✓ Prevention of Legal Problems
9. Active listening
• The process of listening attentively
while someone else speaks, NURSING PROCESS
paraphrasing, and reflecting back
what is said and withholding WHAT IS THE NURSING PROCESS?
judgment and advice.
• LEAN FORWARD AND FACE THE • Is a systematic, rational method of
SPEAKER planning and providing individualized
nursing care.
• The client may be an individual, a
BARRIERS TO family, a community, or a group.

COMMUNICATION PURPOSE OF THE NURSING PROCESS:

1. CLICHÉS – phrases or statements used • To identify a client’s health status

without thinking of the impact on the • To identify actual or potential health
other person care problems or needs
2. FALSE REASSURANCE – assurances • To establish plans to meet the
which are not founded in reality. identified needs
3. JUDGMENTAL RESPONSES – giving • To deliver specific nursing
opinions based on the nurse’s personal interventions to meet those needs.
value system & imply right or wrong

NCM103A_F Fundamentals of Nursing Practice

CHARACTERISTICS OF THE NURSING WHY IS THERE A NEED OF THE NURSING
PROCESS: PROCESS?

• Cyclic and dynamic nature - Data from • The changing, expanding, more
each phase provide input into the next responsible role demands
phase. Findings from the evaluation knowledgeably planned, purposeful, &
phase feed back into assessment. accountable action by nurses.
Hence, the nursing process is a • Better prepared health professionals
regularly repeated event or sequence & more efficient use of health facilities
of events (a cycle) that is continuously can meet increasing demands for
changing (dynamic) rather than health care.
staying the same (static). • A decision-making process that
• Client centeredness - The nurse systematically selects & uses relevant
organizes the plan of care according to information is a requisite for
client problems rather than nursing individualized patient care
goals. In the assessment phase, the • The composite of cognitive, affective,
nurse collects data to determine the and activity components that is
client’s habits, routines, and needs, nursing can best be integrated by the
enabling the nurse to incorporate problem-solving process.
client routines into the care plan as • A sound basis for continual learning is
much as possible. necessary.
• Focus on problem solving – mental
activity in which a problem is HISTORICAL PERSPECTIVE OF THE NURSING
identified (unsteady state) and PROCESS
requires clarifying the nature of the
problem and suggesting possible • 1955 – term “nursing process” was
solutions. coined by Lydia Hall and Dorothy
• Decision making - Nurses can be Johnson.
highly creative in determining when • Orlando (1961) & Ernestein
and how to use data to make Weidenbach (1963) – were the first
decisions. user with the series of phases
• Interpersonal and collaborative style- describing the nursing process.
It requires the nurse to communicate • 1967 – nursing process was formally
directly and consistently with clients introduced as a tool for nursing
and families to meet their needs. It practice.
also requires that nurses collaborate,
as members of the health care team, in - Yura & Walsh identified 4 steps in the
a joint effort to provide quality client process:
care.
• Universal applicability - it is used as a Implementation was added
framework for nursing care in all
types of health care settings, with • Fry (1953) – first to introduce the
clients of all age groups. term nursing diagnosis.
• Use of critical thinking- requires the • Gebbie and Lavin (1974) – met with
nurse to think creatively, use the NANDA-I. Nursing diagnosis was
reflection, and engage in analytical added as a separate & distinct step in
thinking nursing process.
• Use of clinical reasoning - By reflecting • 1991 – ANA included outcome
the nurse determines whether the identification in the planning phase of
outcome of care was appropriate. the process.
NCM103A_F Fundamentals of Nursing Practice
PHASES (STEPS) IN THE NURSING PROCESS
– done several months after initial
A -assessment assessment to compare the client’s status
D- diagnosis (Nursing Diagnosis) to baseline data previously obtained.
P- planning – Functional health patterns of client in a
I - implementation home or long-term facility
E- evaluation
ASSESSMENT involves the following:
ASSESSMENT PHASE
Assessment • Collecting data
– Is the first step in the nursing process. • Organizing data
– Is the systematic & continuous collection, • Validating data
organization, validation and • Interpreting data
documentation of data or information • Documenting data
– Is carried out during all phases of the
nursing Process Collecting Data

Types of Assessment • Database – contains all the

information about a client
1. Initial Assessment
– performed within a specified time after – referred to as the baseline information of
admission to healthcare facility the client
– done to establish a complete database for – fundamental data in which the nurse
problem identification, reference & future builds client care.
comparison. – Includes the following:

Approaches to assessment: 1. nursing health history

2. physical examination
a. Head-to-toe approach
3. laboratory & diagnostic test results
b. Body systems approach
4. material contributed by other health
c. Combination approach
personnel
2. Problem-focused Assessment
• Sources of data:
A. Primary Source: Client is
– performed to determine status of a
major provider of
specific problem identified in an earlier
information about self.
assessment
B. Secondary Source:
– MIO
▪ Support people
– Self-care ability (improved or worsened)
▪ Health care
providers
3. Emergency Assessment
▪ Client records
▪ Relevant
– performed during physiologic or
literature
psychologic crisis of the client
▪ All sources other
– to identify life-threatening problems, new
than the client
or overlooked problems
– Rapid assessment of client during a
Types of Data
cardiac arrest
1. Subjective: referred to as symptoms or
4. Time-lapsed Reassessment
covert data
NCM103A_F Fundamentals of Nursing Practice
 – Data from client’s (and sometimes self perception and concept, role
family’s) point of view. relationship, sexuality, coping and
– Includes feelings, perceptions, and stress, and value belief systems.
concerns. Gordon uses the word pattern to
– Collected through interview. signify a sequence of recurring
behavior
2. Objective: Also called signs or overt data.
– Observable and measurable data obtained 2. Orem’s Self-care Model
through physical examination and
laboratory and diagnostic testing. • The model describes the client’s need
for adequate nutrition, normal
Methods of Collecting Data elimination, and adequate rest to
promote normal human functioning
1. Interview and development.
Initial Formal Interview – profile of the
client/health history
On-Going Interview – informally taken during 3. Roy’s Adaptation Model
N-P interaction
• Outlines the data to be collected
2. Observation according to the Roy adaptation
3. Physical examination model and classifies observable
– Inspection behavior into four categories:
– Palpation physiological, self-concept, role
– Percussion function, and interdependence
– Auscultation
ROY’S ADAPTIVE MODES
Organizing Data
1. Physiological needs
– Collected information must be organized
to be useful.
– Activity and rest
– Do screening & data clustering as a useful – Nutrition
way to identify significant and related – Elimination
information.
– Fluid and electrolytes
– Oxygenation
➢ Actual/ Abnormal findings – Protection
➢ Risk/ Related Factors – Regulation: temperature
➢ Strengths/weaknesses – Regulation: the senses
– Regulation: endocrine system

MODELS OR FRAMEWORKS USED IN 2. Self-concept

ORGANIZING DATA
– Physical self
1. Gordon’s 11 Functional Health Pattern – Personal self
Framework
3. Role function
• The eleven functional health patterns 4. Interdependence
are health perception and
management, nutritional, metabolic,
elimination, activity, sleep, cognitive,
NCM103A_F Fundamentals of Nursing Practice
Validating Data responses to actual or potential health
problems/life processes.
– “Double-checking” or verifying data to – statement of the client’s problem which
confirm that it is accurate and factual consists of the diagnostic label plus
– Usually done when discrepancies occur in etiology.
the data gathered in the interview and PE
NANDA - North American Nursing Diagnosis
➢ ensures that assessment data is complete Association (NANDA) - recognizing the
➢ ensures that objective & related subjective participation and contributions of nurses in the
data agree United States and Canada.
➢ additional important data may be gathered
➢ avoids jumping to conclusions ➢ The purpose of NANDA International is to
➢ differentiates between cues & inferences define, refine, and promote a taxonomy of
nursing diagnostic terminology of general
Documenting Data use to professional nurses

– Assessment data must be recorded and

reported. TYPES OF NURSING DIAGNOSES
– Accurate and complete recording of 1. Actual diagnosis – a client problem at
assessment data is essential for the time of assessment
communicating information to health care
team. Ex. Ineffective Breathing Pattern and Anxiety
2. Risk diagnosis – problem does not exist
NURSING DIAGNOSIS PHASE but the presence of risk factors indicates
– In this phase, nurses use critical thinking that a problem is likely to develop if
skills to interpret assessment data and unattended.
identify client strengths and problems. Ex. Risk for Infection
Diagnosing is a pivotal step in the nursing
process. Activities preceding this phase are 3. Wellness diagnosis – human responses
directed toward formulating the nursing to levels of wellness in an individual,
diagnoses family or community that have a
readiness for enhancement.

NURSING DIAGNOSIS Ex. Readiness for Enhanced Nutrition

Diagnosing – refers to the reasoning process

Diagnosis – statement or conclusion regarding ❖ Making a nursing diagnosis is the scientific
the nature of a phenomenon identification of the client’s needs. It
Diagnostic labels – standardized NANDA names requires:
for the diagnoses ✓ use of judgment
Etiology – causal relationship between the ✓ identification of stresses in the
problem & its related or risk factors external & internal environment
✓ awareness of client’s reactions to
– A medical diagnosis is a clinical judgment stress
by the physician that determines a
specific disease, condition or pathological NURSING DIAGNOSIS IS A ONE-, TWO- OR
state. THREE-PART STATEMENT
– A nursing diagnosis is a clinical judgment
about individual, family, or community

NCM103A_F Fundamentals of Nursing Practice

One-Part statement ***This format cannot be used in risk nsg. Dx

– consists of a NANDA label only • Risk for Falls as evidenced by muscle

weakness
Ex. • Risk for Injury as evidenced by altered
mobility
✓ Ineffective airway clearance • Risk for Infection as evidenced
✓ Acute pain by immunosuppression
✓ Impaired skin integrity
✓ Fluid volume deficit CHARACTERISTICS OF A NURSING DIAGNOSIS
✓ Impaired Gas exchange
✓ Hyperthermia 1. Clear & concise statement
✓ Sleep pattern disturbance 2. Specificity
3. Patient-centered data
Two-part statement (PE format) 4. Accuracy
5. No inclusion of medical data
– P - problem statement or diagnostic label 6. No inclusion of value judgment
(NANDA label) - describes the client’s 7. Supported by S/S within the database
response to an actual or potential health that reflect at least the major defining
problem or wellness condition. characteristics of that diagnosis
– E - etiology - the related cause or primary
factors contributing to the problem. PLANNING PHASE
– The two parts are joined by the words
related to Planning

Examples: – process of designing an action plan

through which lifestyle behaviors can be
✓ Ineffective Breathing Pattern related to prevented, reduced or eliminated.
pain – involves decision making and problem
✓ Anxiety related to stress solving.
✓ Acute Pain related to decreased – End product of the planning phase is the
myocardial flow NURSING CARE PLAN.
✓ Impaired Skin Integrity related to
pressure over bony prominence TYPES OF PLANNING
Basic three-part statement (PES format) ✓ Initial Planning: developing a preliminary
plan of care by the nurse who performs the
– Includes first two parts of Two-Part admission assessment.
Statement: the diagnostic label and the ✓ Ongoing Planning: continuous updating of
etiology. client’s plan of care. Nurse can individualize
– S – signs and symptoms or defining the initial plan further. Ongoing planning also
characteristics - subjective and objective occurs at the beginning of a shift as the nurse
data and clinical manifestations. plans the care to be given that day. Using
– Connects the two parts using as ongoing assessment data, the nurse carries
manifested by or evidenced by out daily planning for the following purposes:
Ex. Ineffective Breathing Pattern related to pain 1. To determine whether the client’s
as evidenced by pursed- lip breathing, reports of health status has changed
pain during inhalation, use of accessory muscles 2. To set priorities for the client’s care
to breathe during the shift
NCM103A_F Fundamentals of Nursing Practice
 3. To decide which problems to focus on Which of these problems is a priority?
during the shift
4. To coordinate the nurse’s activities so • Ineffective Airway Clearance (H)
that more than one problem can be • Deficient fluid volume (H)
addressed at each client contact. • Anxiety related to difficulty breathing
(M)
✓ Discharge Planning: Involves critical • Risk for interrupted family processes
anticipation and planning for client’s needs (L)
after discharge. • Impaired nutrition (L)
• Sleep pattern disturbance (L)
TASKS INVOLVED WITH PLANNING
Take note! Priorities change as the client’s
• Prioritizing list of nursing diagnoses. responses, problems, and therapies change.
• Identifying and writing client-
centered long- and short-term goals FORMULATING GOALS/ DESIRED OUTCOMES
and outcomes. Other terms used:
• Developing specific nursing
interventions. ✓ Objectives
• Recording entire nursing plan in ✓ Expected outcome
client’s record. ✓ Predicted outcome

PRIORITY SETTING
Why should there be goals?
Maslow’s Hierarchy of Needs - physiological
needs such as air, food, and water are basic to life • Provide direction for planning
and receive higher priority than the need for interventions.
security or activity. Growth needs, such as self- • Serve as criteria for evaluating client
esteem, are not perceived as “basic” in this progress.
framework. • Enable the client and nurse to determine
when the problem has been resolved.
– process of establishing a preferential • Help motivate the client & nurse by
sequence for addressing nursing providing a sense of achievement.
diagnoses and interventions. Deciding on
• Short-term outcome – statement written
which nsg. dx requires attention first,
in objective format demonstrating an
then 2nd…
expectation to be achieved in resolution
• Life-threatening problems – are of the nursing diagnosis in a short period
designated as high priority of time, usually in a few hours or days.
✓ impaired respiratory or cardiac function
• Long-term outcome – statement written
✓
in objective format demonstrating an
• Health-threatening problems – assigned expectation to be achieved in resolution
medium priority of the nursing diagnosis over a long
✓ acute illness, decreased coping ability period of time, usually over weeks or
✓ it may result in delay development or months.
cause destructive physical or emotional
changes. Objective Formulation
Objective must be SMART
• Low-priority – one that arises from normal
developmental needs or that which ✓ Specific
✓ requires minimal nursing support ✓ Measurable
✓ Attainable
NCM103A_F Fundamentals of Nursing Practice
 ✓ Realistic ❖ Dependent – activities carried out under the
✓ Time-bounded physician’s orders or supervision according
to specified routines.
Essential Components of Objectives
a) criterion of desired performance Includes: Providing medications, intravenous
– specify time or speed therapy, treatment, diet and activity, changing
b) subject – noun (usually the client) or part of a dressing, administering the medical orders,
client or attribute of the client assess the need for explaining.
c) task statement or verb-action the client
should perform ❖ Collaborative – actions the nurse carries out
d) conditions or modifiers (if necessary) in collaboration with other health team
members.
- explains the circumstances under which the
behavior is to be performed Includes: Overlapping responsibilities
EXAMPLE Identify whether the nursing actions are
independent, dependent or collaborative
Nursing Dx - Airway clearance, ineffective R/T
excessive mucus AEB dyspnea & presence of ✓ Reviewing and conveying abnormal
crackles & rhonchi laboratory results to physician (C)
Expected Outcome ✓ Assisting the client with oral care(I)
✓ Giving oral medication to client (D)
After 5 hours of nursing interventions, the client ✓ Referring client to dietician (C)
will be able to: ✓ Assessing pain level (I)
✓ Positioning client during mealtime (I)
1. Expectorate secretions with ease
2. Demonstrate reduction of noisy Criteria for Selecting Nursing Interventions
respirations
3. Sleep comfortably ✓ Safe & appropriate for client’s age, health
& condition
Nursing Interventions ✓ Achievable with the resources available.
✓ Congruent with client’s values, beliefs,
• A nursing intervention is an action and culture.
performed by the nurse that helps the ✓ Congruent with other therapies
client achieve the results specified by ✓ Based on nursing knowledge &
the goals and expected outcomes. experience or rationale
• Identified and written during the ✓ Within established standards of care by
planning step of the nursing process. laws, & policies set by the institution,
organization or country.
TYPES OF NURSING INTERVENTIONS
IMPLEMENTATION PHASE
❖ Independent – autonomous activities that
nurses are licensed to initiate on the basis of Implementation Phase
their knowledge & skills.
– Implementing consists of doing and
Includes: Physical care, ongoing assessment, documenting the activities that are the
emotional support, comfort, teaching, counseling, specific nursing actions needed to carry
environmental management out the interventions.

NCM103A_F Fundamentals of Nursing Practice

 – Nurse either performs or delegates the a) client’s progress towards achievement of
activities for the interventions that were desired outcomes
developed in the planning step.
b) effectiveness of the nursing care plan
SKILLS INVOLVED IN THE IMPLEMENTATION
PHASE:
RELATIONSHIP OF EVALUATION TO NURSING
• Cognitive skills - (intellectual skills) PROCESS
include problem solving, decision
Determine if goal/ desired outcome is
making, critical thinking, clinical
reasoning, and creativity.
• Interpersonal skills - all of the • met - discontinue the care for the problem
activities, verbal and non-verbal, identified
people use when interacting directly
with one another. The effectiveness of • partially met - problem has been
a nursing action often depends largely prevented but the risk factors are still
on the nurse’s ability to communicate present
with others. nursing activities: caring,
comforting, advocating, referring, ❖ keep the problem on the care plan. Not all
counseling, and supporting are just a outcomes were achieved,
few. Interpersonal skills include
conveying knowledge, attitudes, • not met – goal was not met
feelings, interest, and appreciation of
the client’s cultural values and ❖ interventions must be continued or revised
lifestyle.
• Technical skills - are purposeful
“hands-on” skills such as manipulating TYPES OF EVALUATION
equipment, giving injections,
Summative Evaluation
bandaging, moving, lifting, and
repositioning clients. These skills are
– takes place at the end of the learning
also called tasks, procedures, or
process to ascertain if the objectives have
psychomotor skills.
been achieved and competencies
developed.
Process of Implementing
– strives to assess the effectiveness of the
nursing actions performed
1. Reassessing the client
– focuses more on the desired outcome
2. Determining the nurse’s need for
assistance
Expected outcome:
3. Implementing the nursing interventions
4. Supervising delegated care • After 2 days of intervention, client will
5. Documenting nursing activities have productive cough.
Example of Summative evaluation:
EVALUATION STAGE
Goal met. Productive cough with moderate
Evaluation
amount of thick, yellow sputum.
– defined as a planned, ongoing, Formative Evaluation
purposeful activity in which clients &
healthcare professionals determine:

NCM103A_F Fundamentals of Nursing Practice

 – provides information about learning - complete & accurate information is vital to
needs of clients and where additional ensure that clients receive the care they
instruction is needed. require
– it is designed to monitor activities with ➢ Record - chart or client record
the purpose of improving the care plan. - formal, legal document that provides
evidence of a client’s care
Expected outcome: - can be written or computer-based
• After 48-72 hours, client’s lungs clear to ➢ Subjective Information/Subjective Data
auscultation. – also referred to as symptoms
Example of formative evaluation: – apparent only to the person affected and
can be described or verified only by that
Goal not met. Still with scattered inspiratory person.
crackles in the anterior & posterior chest. – include the client’s sensations, feelings,
values, beliefs, attitudes, and perception
of personal health status and life
The evaluation phase has five components: situation.
–
• Collecting data related to the desired ➢ Objective Information/Objective Data
outcomes – also referred to as signs or overt data, are
• Comparing the data with desired detectable by an observer or can be
outcomes measured or tested against an accepted
• Relating nursing activities to standard.
outcomes – They can be seen, heard, felt, or smelled
• Drawing conclusions about problem by the observer and they also include
status such data as blood pressure, level of pain,
• Continuing, modifying, or terminating and age.
the nursing care plan
Documentation
DOCUMENTATION It is defined as written evidence of:

❖ Effective communication among health ✓ interactions between and among health

professionals is vital to the quality of client professionals, clients, their families, and
care. Health personnel communicates health care organizations
through discussion, reporting, and recording. ✓ the administration of tests, procedures,
treatments, & client education
DEFINITION OF TERMS ✓ the results or client’s response to these
diagnostic tests & interventions
➢ Reporting - exchange of information about
clients among health team members, clients,
What is quality documentation?
and family members.
➢ Report - oral, written, or computer-based ❖ Quality documentation means that the
communication intended to convey elements of the nursing process are evident
information to others in the documentation.
➢ Recording - documenting information
relevant to the client’s health care QUALITY DOCUMENTATION INDICATORS:
management 1. Reflects the application of the nursing process
including:

NCM103A_F Fundamentals of Nursing Practice

 A. Assessment, interpretation of findings 7) Reimbursement
(analysis) and diagnosis, subjective and – helps a facility receive reimbursement
objective data. from the government (PhilHealth), for a
B. Plan of care which takes into account the facility to obtain payment.
clients’ needs, circumstances, preferences,
values, abilities and culture, and supports DOCUMENTATION SYSTEMS
the client in self-management of care
Source-Oriented Records
C. Implementation of intervention
D. Evaluation and modification of the care Each department have their own forms or
plan. sections in the client’s chat

2. Critical inquiry emphasizing critical thinking ✓ Admission sheet

and clinical judgment skills (e.g., identifying ✓ Physician’s notes
cause and effect relationships, and distinguishing ✓ Progress notes
between relevant and irrelevant data) ✓ Nurses’ notes
✓ It is convenient because care providers
3. Consultations and referrals, including
from each discipline can easily locate the
provider’s full name, designation, and
forms on which to record data and it is
organization.
easy to trace the information specific to
PURPOSES OF HEALTH CARE one’s discipline.
DOCUMENTATION Narrative Charting
1) Communication
– clearly communicate all important ✓ It is a traditional part of the source-
information regarding the client oriented record. It consists of written
notes that include routine care, normal
2) Education findings, and client problems.
– use documented data for learning and ✓ The narrative recording is being replaced
enhancing critical thinking for nursing by other systems, such as charting by
students provided confidentiality must be exception and focus charting.
strictly practiced. ✓ When using narrative charting, it is
important to organize the information in
3) Research a clear, coherent manner.
– Information contained in the client record
can be a valuable source of data for POMR (Problem-Oriented Medical Record)
research
✓ the data are arranged according to the
4) Legal and practice standards problems the client has rather than the
– failure to document can lead to clinical source of the information.
mishaps à malpractice cases
Advantages:
5) Planning client care
a. it encourages collaboration
– information in client records can help in
b. the problem list in the front of the chart
the treatment process as well as improve
alerts caregivers to the client’s needs and
the delivery of nursing care.
makes it easier to track the status of each
problem.
6) Auditing health agencies
– review of client records for quality
assurance purposes

NCM103A_F Fundamentals of Nursing Practice

Disadvantage: ✓ The advantages to this system are that it
eliminates lengthy, repetitive notes and it
a. caregivers differ in their ability to use the makes client changes in a condition more
required charting format obvious
b. it takes constant vigilance to maintain an
up-to-date problem list ISBARR
c. it is somewhat inefficient because
assessments and interventions that apply ✓ (Identify, Situation, Background,
to more than one problem must be Assessment, Recommendation, Readback)
repeated.
The POMR has four basic components: SOAPIE

• Database ✓ (Subjective data, Objective data,

• Problem list Assessment [Nsg Diagnosis], Plan,
Intervention, Evaluation)
• Plan of care
• Progress notes Computerized Documentation

✓ Electronic health records (EHRs) are used

FDAR (Focus, Data, Action, Response)
to manage the huge volume of
information required in contemporary
– it is intended to make the client and client
health care
concerns and strengths the focus of care.
✓ Nurses use computers to store the client’s
It is a method of organizing health
database, add new data, create and revise
information in an individual's record.
care plans, and document client progress
– Focus Charting is a systematic approach
✓ Multiple flow sheets are not needed in
to documentation.
computerized record systems because
information can be easily retrieved in a
➢ The focus may be a condition, a nursing
variety of formats.
diagnosis, a behavior, a sign or symptom, an
✓ The computerization of clinical records
acute change in the client’s condition, or a
has made it possible to transmit
client's strength.
information from one care setting to
➢ The data category reflects the assessment
another
phase of the nursing process and consists of
observations of client status and behaviors,
including data from flow sheets REPORTING
➢ The action category reflects planning and
implementation and includes immediate and • Change of Shift Report
future nursing actions. – meeting between healthcare providers at
➢ The response category reflects the the change of shift in which vital
evaluation phase of the nursing process and information about and responsibility for
describes the client’s response to any nursing the patient is provided from the off-going
and medical care. provider to the on-coming provider.

Charting by Exception • Incident Report

– or occurrence report, are used to
✓ it is a documentation system in which document any unusual occurrence or
only abnormal or significant findings or accident in the delivery of client care
exceptions to norms are recorded. EHR
(Electronic Health Record) • Referral System

NCM103A_F Fundamentals of Nursing Practice

 – A method by which the healthcare – provide information about the progress a
providers keep track of their patient client is making toward achieving the
referrals throughout the care continuum. desired outcome.
– The main goal is to improve and – the format varies depending on the
streamline communication among nurses, documentation system used by the
physicians, and other health providers healthcare facility.
involved in a patient's care.
• Discharge Summary
• Telephone Reports – made when the client is being discharged
– Health professionals frequently report or transferred to another institution.
about a client by telephone.
– The person receiving a telephone report FUNDAMENTAL RULES IN DOCUMENTATION
should document the date and time, the
name of the person giving the 1. Write legibly.
information, and the subject of the 2. Use proper spelling & grammar
information received, and sign the 3. Use authorized abbreviation
notation. 4. Use a permanent-ink pen preferably black.
5. Chart promptly
• Telephone Orders 6. Document in chronological order
– Primary care providers often give orders 7. Write in a complete but concise manner.
for a client by telephone. 8. Do not leave space between entries
– Many agencies allow only registered 9. Use quotation marks to indicate direct client
nurses to take telephone orders. responses.
– Once the order is written on the 10. Never change another person’s entry, even if
physician’s order form, the order must be incorrect.
countersigned by the primary care 11. Sign each entry with your full legal name and
provider title.
12. Follow the procedure in correcting erroneous
Hospital Records Used in entries per hospital protocol.
Documentation
✓ If an error is made while documenting,
use a single line to cross out the error.
• Admission Nursing Assessment
✓ Write the words “mistaken entry” over
– constitutes initial database, nursing.
the erroneous entry.
History, nursing. Assessment
✓ Sign the correction with your name and
the date & time.
• Nursing Care Plans
✓ Never use correction fluid, eraser tape,
• Kardex black marker, or scratch-out techniques
– consists of a series of cards kept in a that hide a documentation error.
portable index file or on computer-
generated forms 13. Document all telephone calls you receive that
are related to the client’s care
• Flow Sheets
– provide an easy-to-read record of the ✓ Record the order word-for-word on the
client’s condition doctor's order sheet or enter it into a
1. Graphic Record computer.
2. Intake and Output ✓ Note the date and time. On the next line,
3. Medication record write "telephone order."

• Progress Notes
NCM103A_F Fundamentals of Nursing Practice
 ✓ Read back the order and get – Record the time in the conventional 12-
confirmation from the person who gave hour manner or according to the 24-hour
the order. clock
✓ Then write the doctor's name, and sign
your name. • Timing
✓ Make sure the doctor countersigns the – Follow the agency’s policy about the
order within the time limit set by the frequency of documenting, and adjust the
healthcare facility. frequency as a client’s condition indicates.

REMEMBER!!! • Legibility
– All entries must be legible and easy to
• Documentation should paint the entire read to prevent interpretation errors.
picture of the client and the care provided
from the time the client entered the • Permanence
healthcare system until his or her discharge. – All entries on the client’s record are made
• Vague or opinionated documentation can in dark ink so that the record is
interfere with the continuity of care and permanent and changes can be identified.
misrepresent the assessment findings.
• “If it wasn’t documented. It wasn’t done.” • Accepted Terminology
– Abbreviations are used because they are
short, convenient, and easy to use.
❖ Disruptive and agitated behavior • Correct Spelling
– It is essential for accuracy in a recording.
The client is yelling and pacing in the hallway – If unsure how to spell a word, look it up in
a dictionary or other resource book.
❖ The client appears in pain
• Signature
The client grimaces when moved from back-to-
– Each recording on the nurses’ notes is
side
signed by the nurse making it.
❖ Client is non-compliant – The signature includes the name and title

The client said he does not want to take his • Accuracy

medication as it makes him feel nauseous – The client’s name and identifying
❖ The client is a fall risk information should be stamped or written
on each page of the clinical record.
The client said he does not want to take his
medication as it makes him feel nauseous • Sequence
– Document events in the order in which
GENERAL GUIDELINES FOR REPORTING they
A client’s record is considered a legal document
and may be used as a piece of evidence in court, • Appropriateness
health care personnel must not only maintain the – Record only information that pertains to
confidentiality of the record but should also meet the client’s health problems and care.
legal standards in the process of recording.
• Complete and Concise
• Date and Time – The information that is recorded needs to
– Document the date and time of each be complete and helpful to the client and
recording. health care professionals.

NCM103A_F Fundamentals of Nursing Practice

 – Recordings need to be brief as well as Accountability is an essential concept of
complete to save time in communication. professional nursing practice and the law.

• Legal Prudence Knowledge of laws that regulate and affect

– Accurate and complete documentation nursing practice is needed for two reasons:
should give legal protection to the nurse,
the client’s other caregivers, the health 1. To ensure that the nurse’s decisions
care facility, and the client. and actions are consistent with
current legal principles.
2. To protect the nurse from liability.
ETHICAL AND LEGAL CONSIDERATIONS
THE PHILIPPINE NURSING LAW OF 2002:
According to the American Nurses Association RA 9173
Code of Ethics (2001) “. . . the nurse has a duty to
maintain the confidentiality of all patient
information”). The client’s record is also ❖ AN ACT PROVIDING FOR A MORE
protected legally as a private record of the RESPONSIVE NURSING PROFESSION,
client’s care. Access to the record is restricted to REPEALING FOR THE PURPOSE REPUBLIC
health professionals involved in giving care to ACT NO. 7164, OTHERWISE KNOWN AS “THE
the client. The institution or agency is the PHILIPPINE NURSING ACT OF 1991” AND
rightful owner of the client’s record. This does FOR OTHER PURPOSES
not, however, exclude the client’s rights to the
same records. October 21, 2002 – it was signed into law by
President Gloria Macapagal Arroyo as Republic
(Table below is copied from Fundamentals of Act 9173 otherwise known as "Philippine
Nursing by Berman, Snyder, and Frandsen) Nursing Act of 2002"

ETHICO-MORAL& LEGAL
CONSIDERATIONS in the PRACTICE of
NURSING

❖ It is the application and interpretation of

regulations, laws, and principles of law to the
profession of nursing.
❖ Nursing is regulated by law because the
practice of nursing exposes individuals to
possible risks, especially if nurses are not
adequately prepared for the practice of
nursing. Therefore, nurses must meet various
requirements to practice.

LEGAL ASPECTS OF NURSING

ETHICO-MORAL & LEGAL CONSIDERATIONS
in the PRACTICE of NURSING
ARTICLE VI
Nursing practice is governed by many legal
concepts. Nurses need to know the basics of legal NURSING PRACTICE
concepts because nurses are accountable for
their professional judgments and actions. SEC. 28. Scope of Nursing. — A person shall be
deemed to be practicing nursing within the
NCM103A_F Fundamentals of Nursing Practice
meaning of this Act when he/she singly or in – strengthening its role in decision-making
collaboration with another, initiates and processes
performs nursing services to individuals,
families, and communities in any health care c. additional educational requirements for
setting. It includes, but is not limited to, nursing different levels of nursing practice
care during conception, labor, delivery, infancy,
childhood, toddler, pre-school, school age, CODE OF ETHICS FOR NURSES IN THE
adolescence, adulthood, and old age. As PHILIPPINES
independent practitioners, nurses are primarily
responsible for the promotion of health and • Ethics
prevention of illness. As members of the health – Is the science of morals, the area of
team, nurses shall collaborate with other health philosophical study involved in
care providers for the curative, preventive, and systematizing, defending, and
rehabilitative aspects of care, restoration of recommending concepts of right and
health, alleviation of suffering, and when wrong behavior
recovery is not possible, towards a peaceful – It examines human acts to determine
death. what is right or wrong, what is good or
bad, or what ought to be in a given
It shall be the duty of the nurse to: situation.
1. Provide nursing care through the
utilization of the nursing process.
2. Establish linkages with community • Autonomy
resources and coordination with the – patients can make independent decisions.
health team – recognizing each patient’s right to self-
3. Provide health education to determination and decision-making.
individuals, families, and
communities.
• Beneficence
4. Teach, guide, and supervise students
– is acting for the good and welfare of
in nursing education programs
others
including the administration of
– is defined as kindness and charity
nursing services in varied settings;
undertake consultation services,
• Justice
engage in activities that use the
– is that there should be an element of
knowledge and decision-making skills
fairness in all medical and nursing
of a registered nurse.
decisions and care.
5. Undertake nursing and health human
resources development training and
• Nonmaleficence
research to the development of
– is to do no harm
advanced nursing practice.

R.A. 9173 – The Philippine Nursing Act of • Values

2002 – Values are enduring beliefs or attitudes
about the worth of a person, object, idea,
Amendments provided for: or action.
– Values are important because they
a. restructuring of scope & practice of nursing influence decisions and actions, including
– need for certification & specialization nurses’ ethical decision-making.
programs
b. expanding the powers of the BON
NCM103A_F Fundamentals of Nursing Practice
 ETHICS VS MORALS 2. Give clear instruction of what action
would be considered ethical or right
Morals refer mainly to guiding principles, in the given circumstance.
and ethics refer to specific rules and actions, or
behaviors. CODE OF ETHICS FOR FILIPINO
A moral precept is an idea or opinion that’s NURSES:
driven by a desire to be good. An ethical code is
a set of rules that defines allowable actions or – Board of Nursing has promulgated a Code of
correct behavior. Ethics for Registered Nurses in coordination
and consultation with the accredited
Ethical codes professional organization known as the
“Philippine Nursing Act of 2002”
✓ systematic guides for developing ethical – It consists of ethical principles and guidelines
behavior. to be observed
✓ provides direction for nurses to act
morally. Evolves around the following:
• Article II, Sec. 4 & 5 - Registered Nurse
Code of Good Governance
and People
The Code stated that good governance will
• Article III, Sec. 6 -11 Registered Nurses
promote and establish ethical awareness and
and Practice
competency among Filipino professionals to make
them accountable and fulfill their professional • Article IV, Sec. 12 & 13 Registered Nurses
obligation to clients. It also empowers and Co-workers
professionals not only to upgrade or improve their
technical and ethical proficiency but also to keep 1982 - Dean Emeritus Julita V. Sotejo
pace with modern trends and technology in their
respective professions. This assures high-quality, • chairman of the PNA Special
value-adding, and globally competitive Committee
professional services, and secures the public’s • developed a Code of Ethics for Filipino
safety and protection. nurses approved by the House of
Delegates of the PNA but not
CODE OF GOOD GOVERNANCE implemented

• Promulgated by the Board of Nursing October 25, 1990 - Code was approved by the
(BON) and the PRC general assembly of the PNA
• Underwent consultation with
accredited professional organizations October 23, 2013, Iloilo City - accredited
like the Philippine Nurses Association. professional organizations decided to adopt a
new Code of Ethics under the RA 9173.
CODE OF ETHICS
THE NATIONAL NURSING CORE
Serves as a guide for: COMPETENCY STANDARDS
(NNCCS)
1. Carrying out nursing responsibilities
which would tackle difficult issues and ❖ The development of the National Nursing
decisions that a profession might be Core Competency Standards (NNCCS) for
facing nursing practice started in 2001 through the
initiative of the Professional Regulation
Commission - Board of Nursing (PRC-BON)
which created a National Task Force for Core
NCM103A_F Fundamentals of Nursing Practice
 Competency Standards Development. The 3. The decrease in NLE national passing
project was completed in 2005. percentage has been noted.
• There are various contributory factors
January 2012 needed to be explored.
• a public hearing was conducted as 4. There was a need to strengthen the
comments, suggestions, and implementation of the curriculum and
recommendations were discussed. improve knowledge of the core competencies
and teaching methodology used in the
May 2012 competency-based approach by nursing
educators.
• the last phase of the refinement was 5. Many Nursing Practitioners are not aware of
done giving birth to the revised NCCS the expected core competencies
of Nursing Practice 6. The emphasis on the development of
international nursing competencies was
Legal Bases of Core Competency Standards noted.
Development
• ASEAN Nursing Core Competencies
• WHO Nursing of Curriculum
• RA 8981 (The PRC Modernization Act
Guidelines, Public Safety Guidelines,
of 2000), section 2)
and Patient Safety Guidelines
• RA 9173
• WP/SEAR (Western Pacific South East
R.A. 9173, Art.3, Sec.9, (c) Asian Regions) Core
Competency Standards
– states that the Board of Nursing shall • ICN Core Competency Standards
monitor & enforce quality standards of nursing
practice in the Philippines & exercise the powers 7. There have been significant milestones in the
necessary to ensure the maintenance of efficient, development of the Nursing Profession in the
ethical & technical, moral & professional Philippines
standards in the practice of nursing taking into
account the health needs of the nation. 2012 National Nursing Core Competency
Standards:
Local & International Developments in the
Nursing Profession that Contributed to the
1. BEGINNING NURSE’S ROLE ON CLIENT
Decision to Revisit the Core Competencies
CARE
1. The revised BSN Curriculum did not 2. BEGINNING NURSE’S ROLE ON
emphasize the following: MANAGEMENT AND LEADERSHIP
3. BEGINNING NURSE’S ROLE ON
• The need to incorporate competencies
RESEARCH
focusing on Health Promotion
• For CHN, the need to include
competencies on the care of the PATIENT’S BILL OF RIGHTS
family, population group and
“A patient's bill of rights is a list of guarantees for
community as a client, and public
those receiving medical care. It may take the form of
health care. a law or a non-binding declaration. Typically, a
• The need to include care of the older patient's bill of rights guarantees patients
person, disaster preparedness, etc. information, fair treatment, and autonomy over
medical decisions, among other rights”
2. Some indicators had broader scope
compared to the competencies

NCM103A_F Fundamentals of Nursing Practice

Patients' Rights: • Malpractice
– Implies the idea of improper or
1. Right to appropriate medical care and unskillful care of a patient by a
humane treatment nurse.
2. Right to informed consent
3. Right to privacy and confidentiality • Incompetence
4. Right to information. – Lack of ability, legal qualifications,
5. The right to choose a health care or fitness to discharge the required
provider and facility. duty
6. Right to self-determination
7. Right to religious beliefs DATA PRIVACY ACT
8. Right to medical records
9. Right to leave REPUBLIC ACT NO. 10173
10. Right to refuse participation in
medical research AN ACT PROTECTING INDIVIDUAL PERSONAL
11. Right to correspondence and receive INFORMATION IN INFORMATION AND
visitors COMMUNICATIONS SYSTEMS IN THE
12. Right to express grievances GOVERNMENT AND THE PRIVATE SECTOR,
13. Right to be informed of his rights and CREATING FOR THIS PURPOSE A NATIONAL
obligations as a patient PRIVACY COMMISSION, AND FOR OTHER
PURPOSES
RESPONSIBILITY AND ACCOUNTABILITY FOR Republic Act No. 10173, otherwise known as
THE PRACTICE OF PROFESSIONAL NURSING the Data Privacy Act is a law that seeks to
protect all forms of information, be it private,
✓ As nurses begin their professional personal, or sensitive. It is meant to cover both
obligations, their legal responsibilities natural and juridical persons involved in the
begin as well. processing of personal information.
✓ Nurses are enjoined to be familiar with
the Philippine Nursing Law, the standards What does this entail?
of care, and other laws which affect the
nursing practice and their code of ethics. 1. All personal information must be collected
for reasons that are specified, legitimate, and
• Standard of Conduct reasonable.
– Is a clearly defined, legal expectation 2. Personal information must be handled
to which nurses are held properly.
accountable 3. Personal information must be discarded in a
. way that does not make it visible and
• Professional Negligence accessible to unauthorized third parties.

– Refers to the commission or The PHIE (Philippine Health Information

omission of an act according to duty, Exchange) is an electronic health (eHealth)
that a reasonably prudent person in initiative of the Department of Health (DOH), the
the same or similar circumstance Department of Science and Technology (DOST),
would or would not do, and acting and the Philippine Health Insurance Corporation
or the non-acting of which is the (PhilHealth) that would ensure accurate and
proximate cause of injury to another timely health information exchange that can be
person or his property. instrumental in improving the services of these
three agencies as well as the other organizations
that could use the said data.

NCM103A_F Fundamentals of Nursing Practice

 INFORMED CONSENT 3. Patient Understanding
– education, language, or dialect
❖ It is an agreement by a client to accept a
course of treatment or a procedure after 4. Voluntariness
being provided complete information, – make an autonomous decision without
including benefits and risks of treatments, force or intimidation, and understands
alternatives to the treatment, and prognosis that he/she can withdraw consent
if not treated by a health care provider. anytime without consequence
❖ It is also defined as the patient's choice to 3 Major Elements:
have a treatment or procedure which is
based on their full understanding of the 1. The consent must be given
treatment or procedure, benefits of treatment voluntarily.
risks of treatment or procedure, and any 2. The consent must be given by a client
alternatives to the particular treatment or or individual with the capacity and
procedure. competence to understand.
❖ The goal of informed consent is to assure the 3. The client or individual must be given
client’s autonomy. enough information to be the ultimate
decision-maker.
2 TYPES OF CONSENT
NURSE’S ROLE
1. Express consent
– may take the form of either an oral or Nurses are often asked to obtain a signed
written agreement consent form. The nurse is not responsible for
– the more invasive a procedure or the explaining the procedure but for witnessing the
greater the potential risk for a client, the client’s signature on the form. The nurse’s
greater the need for written permission. signature confirms three things:

2. Implied Consent • The client gave consent voluntarily.

– exists when the individual’s nonverbal • The signature is authentic.
behavior indicates agreement • The client appears competent to give
– in a medical emergency when an consent.
individual cannot provide express
consent because of a physical condition. LEADERSHIP AND
Informed Consent MANAGEMENT
– The consent shall conform to the Across the healthcare continuum, regardless of
requirements or characteristics of valid our role or practice setting, each of us is viewed
informed consent which consist of the as a nurse leader. As nursing students, we are
following: taught we will lead colleagues from other
ancillary groups, oversee care teams and be
1. Competence accountable for patient care outcomes. Some
– of sound mind, at least 18 years old, and nurses spend years leading in an informal
not under the influence of drugs or liquor leadership capacity, while others take on formal
management and leadership roles.
2. Amount and Accuracy of Information
– relevant factual data about a procedure CONCEPT OF LEADERSHIP AND
and/or treatments, its benefits, risks, and MANAGEMENT
possible complications or outcomes

NCM103A_F Fundamentals of Nursing Practice

NURSE as a LEADER ✓ Managers are also responsible for the
development of licensed and unlicensed
✓ Influences others to work together to personnel within their workgroup.
accomplish a specific goal.
✓ Leaders are often visionary; they are LEVELS OF MANAGEMENT
informed, articulate, confident, and self-
aware. • First-level managers - responsible
✓ Leaders outstanding interpersonal skills for managing the work of non-
and are excellent listeners and managerial personnel and the day-to-
communicators. They have initiative and day activities of a specific work group
the ability and confidence to innovate or groups
change, motivate, facilitate, and mentor • Middle-level managers - supervise a
others. number of first-level managers and
✓ Nurse leaders participate in and guide are responsible for the activities in the
teams that assess the effectiveness of departments they supervise.
care, implement evidence-based practice • Upper-level (top-level) managers -
and construct process improvement are organizational executives who are
strategies. primarily responsible for establishing
✓ They may be employed in a variety of goals, and developing strategic plans
positions

NURSE as a MANAGER

✓ A manager is an employee of an
organization who is given authority,
power, and responsibility for planning,
organizing, coordinating, and directing
the work of others, and for establishing
and evaluating standards.
CONCEPTS AND PRINCIPLES OF
✓ Managers understand organizational PARTNERSHIP, COLLABORATION,
structure and culture. They control AND TEAMWORK
human, financial, and material resources.
✓ Managers set goals, make decisions, and • Teamwork
solve problems. They initiate and – in health, it is defined as two or more
implement change. people who interact interdependently
✓ Some nurses assume a position within the with a common purpose, working toward
organization as unit manager, supervisor, measurable goals that benefit from
or executive. leadership that maintains stability while
✓ As a manager, the nurse is responsible encouraging honest discussion and
for: problem-solving
a. efficiently accomplishing the goals • Interprofessional
of the organization – Relates to two or more professionals
b. using the organization’s resources collaborating towards a shared goal.
c. ensuring effective client care
d. ensuring compliance with • Collaboration
institutional, professional, – A mutually beneficial and well-defined
regulatory, and governmental relationship is entered into by two or
standards.

NCM103A_F Fundamentals of Nursing Practice

 more organizations to achieve common
goals.

• Group
– Is a collection of individuals each with
their own thoughts, ideas, abilities, and
objectives. (Humphries 1998)

• Team
– Is a group of people working together to
achieve common objectives and willing to
commit all their energies necessary to
make sure that the objectives are
achieved. (Humphries 1998).

• Dyad

– two individuals maintaining a

sociologically significant relationship

NCM103A_F Fundamentals of Nursing Practice