Fundamentals
of Nursing
NUR 200
Through integration of the art and science of nursing, the
quality of care you provide meets the highest standards
and benefits patients and their families.
Nursing is an art and a science.
As an art, nursing involves learning to deliver care with
compassion, caring, and respect for each patient’s
dignity and individuality.
As a science, nursing practice is based on a body of
knowledge and evidence-based practices that are
continually changing with new discoveries and
innovations.
NURSING AS A PROFESSION
• The patient is the center of your practice. Depending
on the setting and situation, your patients may
include individuals, families, and/or communities.
• Patients have a wide variety of health care needs,
knowledge, experiences, vulnerabilities, and
expectations, but this is what makes nursing both
challenging and rewarding.
• Nursing is not simply a collection of specific skills,
and you are not simply a person trained to perform
specific tasks.
Science and Art of Nursing Practice
• Because nursing is both an art and a science,
nursing practice requires a blend of current
knowledge and practice standards with an insightful
and compassionate approach to your patients’ health
care needs.
• Clinical expertise takes time and commitment
• When you provide well–thought-out care with
compassion and caring, you provide each patient the
best of the science and art of nursing care.
Scope and Standards of Practice
• When giving care, it is essential to provide a
specified service according to standards of
practice and to follow a code of ethics.
• Professional practice includes knowledge
from social and behavioral sciences,
biological and physiological sciences, and
nursing theories.
According to the American Nurses Association,
ANA, 2021
Nursing incorporates the art and science of caring and
focuses on the protection, promotion, and optimization
of health and abilities; prevention of illness and injury;
facilitation of healing; and alleviation of suffering
through compassionate presence. Nursing is the
diagnosis and treatment of human response, and
advocacy in the care of individuals, families, groups,
communities, and populations in recognition of the
connection of all humanity.
According to the International Council of Nurses
(ICN), 2021
Nursing encompasses autonomous and collaborative
care of individuals of all ages, families, groups, and
communities, sick or well, and in all settings. Nursing
includes the promotion of health; prevention of illness;
and the care of ill, disabled, and dying people.
Advocacy, promotion of a safe environment, research,
participation in shaping health policy and in patient and
health systems management, and education are also
key nursing roles.
Code of Ethics. The nursing code of ethics is a
statement of philosophical ideals of right and
wrong that define the principles you will use
to provide care to your patients.
Professional Responsibilities and Roles
• Nurses provide care and comfort for patients
in all health care settings.
• Their concern for meeting patients’ needs
remains the same whether care focuses on
health promotion and illness prevention,
disease and symptom management, family
support, or end-of-life care
Professional Responsibilities and Roles
• Autonomy and Accountability. Autonomy is an
essential element of professional nursing that involves
the initiation of independent nursing interventions without
medical orders.
• Caregiver. As a caregiver you help patients maintain and
regain health, manage disease and symptoms, and
attain a maximal level of function and independence
through the healing process.
• Advocate. As a patient advocate you protect your
patient’s human and legal rights and provide assistance
in asserting those rights if the need arises.
Professional Responsibilities and Roles
• Educator. Your value as a patient educator is important to
your patients’ health and recovery. Your ability to teach
effectively improves patients’ knowledge, skills, self-care
activities, and ability to make informed decisions
• Communicator. An effective communicator is central to the
nurse patient relationship. It allows you to know your
patients, including their preferences, strengths, weaknesses,
and needs.
• Manager. Nurse managers direct groups of nurses by
establishing an environment for collaborative patient-
centered care and safe, evidence-based quality care with
positive patient outcomes.
Career Development
• Clinician. Most nurses provide direct (hands-on) patient
care in acute care settings.
• Advanced Practice Registered Nurses. The
advanced practice registered nurse (APRN) is the most
independently functioning nurse. An APRN has a
master’s degree or Doctor of Nursing Practice (DNP)
degree in nursing; advanced education in
pathophysiology, pharmacology, and physical
assessment; and certification and expertise in a
specialized area of practice.
• Advanced Practice Registered Nurses.
1.Clinical nurse specialist.
2.Nurse practitioner
3.Certified nurse-midwife.
4.Certified registered nurse anesthetist.
Career Development
• Nurse Educator. A nurse educator works primarily in schools
of nursing, staff development departments of health care
agencies, and patient education departments. Nurse
educators need experience in clinical practice to provide them
with practical skills and theoretical knowledge.
• Nurse Administrator. A nurse administrator is responsible for
management of the nursing staff in a health care agency.
• Nurse Researcher. The nurse researcher conducts evidence-
based practice, performance improvement, and research to
improve nursing care and further define and expand the scope
of nursing practice.
HISTORICAL INFLUENCES
• Knowledge of the history of the nursing profession increases your
understanding of the social and intellectual origins of the
discipline.
• Florence Nightingale. She established the first nursing
philosophy based on health maintenance and restoration.
Nightingale was the first practicing nurse epidemiologist.
• Her statistical analyses connected poor sanitation with the incidence of
cholera and dysentery. She volunteered during the Crimean War in 1853 and
traveled the battlefield hospitals at night, carrying her lamp; thus, she was
known as the “lady with the lamp.” The sanitary, nutritional, and basic
conditions in the battlefield hospitals were poor, and she was asked to ensure
the quality of sanitation facilities. As a result of her actions, the mortality rate
at the Barracks Hospital in Scutari, Turkey, was reduced from 42.7% to 2.2%
in 6 months (Donahue, 2011).
HISTORICAL INFLUENCES
• The Civil War to the Beginning of the Twentieth Century.
1.Clara Barton founded the American Red Cross.
2.Dorothea Lynde Dix, Mary Ann Ball (Mother Bickerdyke), and
Harriet Tubman were key figures.
3.Dix and Bickerdyke organized hospitals, ambulances, and cared for
wounded soldiers.
4.Harriet Tubman was active in the Underground Railroad.
• Mary Mahoney: First professionally educated African-American
nurse. Advocated for cultural diversity and respect in nursing.
• Isabel Hampton Robb: Helped found the Nurses’ Associated
Alumnae of the United States and Canada in 1896 (later ANA). o
Authored nursing textbooks and co-founded the American Journal of
Nursing.
HISTORICAL INFLUENCES
• Lillian Wald and Mary Brewster: Opened the Henry Street
Settlement in 1893, focusing on health needs of the poor in NYC.
• Early 20th Century: Movement towards scientific, research-based
nursing knowledge. Mary Adelaide Nutting became the first nursing
professor at Columbia Teachers College in 1906.
• Magnet Recognition Program. Creation of specialty-nursing
organizations like the American Association of Critical Care Nurses,
AORN, INS, and ENA. ANA established the Center for Ethics and
Human Rights in 1990.
• 21st Century Challenges: o Adapting nursing practice and curricula
for aging populations, cultural diversity, bioterrorism, emerging
infections, and disaster management. o Advances in technology,
informatics, and the high acuity of patient care.
Contemporary Influences on Nursing:
• Importance of Nurses' Self-Care
o Nursing is physically and emotionally demanding, requiring self-care to
maintain compassionate care for others.
o Prolonged exposure to grief and loss can lead to compassion fatigue,
characterized by burnout and secondary traumatic stress.
o Compassion fatigue results from prolonged emotional involvement
without improved patient outcomes.
o Burnout arises when demands exceed available resources, causing
physical and mental exhaustion.
o Early recognition programs and supportive work environments can
help manage compassion fatigue.
o Resiliency skills are essential for managing stress, conflict, and
building support among colleagues.
Contemporary Influences on Nursing:
• Health Care Reform and Costs
•o Health care reform emphasizes health promotion,
disease prevention, and community-based care.
• o Nurses will need to adapt to changes by improving
resource management and patient discharge
processes.
•o Rising health care costs require nurses to deliver
quality care efficiently and economically.
Contemporary Influences on Nursing:
• Demographic Changes
•o The population is aging and becoming more
diverse, increasing the demand for expanded
health care resources.
• o By 2030, all baby boomers will be over 65, and
by 2044, more than half of the U.S. population
will be part of a minority group.
• o There's a shift from rural to urban areas, with
more people living with chronic illnesses and
seeking community-based care.
Contemporary Influences on Nursing:
• Medically Underserved
•o Factors such as unemployment, underemployment, mental
illness, homelessness, and rising health care costs contribute to
the medically underserved population.
• o This group faces challenges in accessing care due to
social, political, economic, and health literacy barriers.
•o Increasing numbers of underserved patients require
home-based palliative care services.
• o Low health literacy leads to less participation in medical
decision-making, affecting care outcomes.
Trends in Nursing: Summary
Dynamic Nature of Nursing
o Nursing evolves with societal changes, health care
priorities, technologies, and the profession itself.
o Current nursing philosophies have a holistic focus,
addressing the whole person in health, illness, family,
and community interactions.
o Increasing awareness of patient safety across all
care settings.
Trends in Nursing: Summary
Evidence-Based Practice (EBP)
o RNs must make sound clinical judgments based on
evidence, not just education or experience.
o The public is more informed about health care
needs, costs, and medical errors, emphasizing the
need for EBP.
Health care agencies adopt EBP to control costs,
reduce errors, and improve safety, with many hospitals
pursuing Magnet Recognition® for excellence in
nursing.
Trends in Nursing: Summary
Quality and Safety Education for Nurses
(QSEN)
o QSEN aims to prepare nurses with knowledge,
skills, and attitudes (KSAs) to improve health
care quality and safety.
o QSEN defines competencies in patient-
centered care, safety, and informatics for
prelicensure and graduate programs.
Trends in Nursing: Summary
Emerging Information Technologies
o Technologies like EHR, CPOE, and telehealth
improve care accuracy, patient data
management, and communication.
Nurses must understand these technologies to
guide patients and enhance care delivery.
Trends in Nursing: Summary
Genomics
o Genomics involves studying all genes and their
interactions, impacting health outcomes, quality,
safety, and costs.
o Nurses play a role in interpreting genomic tests,
identifying risk factors, and counseling patients,
maintaining confidentiality and cultural sensitivity.
Trends in Nursing: Summary
Public Perception of Nursing
o Nursing is essential for health care delivery, with
nurses constituting the largest group of health care
professionals.
Consumers access health care information through
platforms like Hospital Compare and HCAHPS,
making informed choices about care.
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Trends in Nursing: Summary
Nursing's Impact on Politics and Health Policy
o Nurses increasingly influence politics, advocating for
health care improvements and standards through
professional organizations.
o The ANA promotes high nursing standards,
professional development, and equitable health care
access.
Nurses can influence policy at all levels, contributing to
social needs and health care improvements through
active participation and advocacy.
Professional Registered Nurse Education
Prelicensure Education:
o Bachelor’s Degree (BSN/BScN/BN): 4-year program
covering sciences, nursing theory, social sciences,
arts, and humanities.
Graduate Education:
o Master’s Degree: Prepares nurses for roles such as
educators, administrators, and advanced practice
nurses (APRNs)
Professional Registered Nurse Education
o Doctoral Degrees:
§ Doctor of Nursing Science (DSN or DNSc):
Focuses on applying research in clinical practice.
§ Doctor of Philosophy (PhD): Emphasizes research
and theory development.
§ Doctor of Nursing Practice (DNP): A practice-
focused doctorate for APRNs, emphasizing
evidence-based practice.
Professional Registered Nurse Education
Continuing and In-Service Education:
o Continuing Education: Offered by various institutions,
updates nurses on the latest practices and technologies.
In-Service Education: Provided by healthcare agencies
to enhance skills and knowledge, often focused on
new technologies and safety practices.
Nursing Practice
Nurse Practice Acts (NPAs):
o Regulate the scope of nursing practice, ensuring public
safety and defining legal practice limits.
o State Boards of Nursing oversee NPAs, which vary slightly
by state.
Licensure and Certification:
o Licensure: All RN candidates must pass the NCLEX-RN,
with some state-specific requirements. For Philippine
Setting - PNLE
o Certification: Nurses can pursue specialty certifications,
requiring ongoing education and clinical practice.
Nursing Practice
Professional Nursing Organizations
· Address issues related to nursing practice and
offer specialty-focused support.
· Provide educational programs, publish journals,
and foster professional development.
· Student Organizations:
o National Student Nurses’ Association (NSNA) and
Canadian Nursing Students’ Association (CNSA)
support nursing students in career development and
licensure preparation.
