3 | FUNDAMENTALS OF NURSING 1

NURSING AS A SCIENCE

1. 0 LEARNING OUTCOMES
At the end of this chapter, students will be able to:
 Differentiate problem solving process and nursing process
 Assess with the client (individual, family, population group, and/or
community), one’s health status/competence.
 Identify an appropriate nursing diagnosis for the client based on the
assessment data.
 Formulate with the client a plan of care to address health needs and
problems based on priorities.

1.1 INTRODUCTION

Nursing as a profession is evolving and becoming more complex. It is

expected that every nurse, may they be affiliated in a clinical setting, providing
care for the community, or even those engaged in academe and research, must
possess knowledge and skills required to provide the best possible care.
Is nursing an art or a science? This question arouses significant debates
whether the discipline is considered to be an art or a science. Nursing as an art
is the application of all nursing science. Nurses do not merely follow a set of
tasks during their duties, it comes with an intuition in understanding and
empathizing with the patients in order to meet their physical, emotional, and
psychological needs. Nursing is also considered a science as it is systematic
process and consists information of human beings and their interaction with the
environment which provides knowledge to nurses about the human health
process. The upcoming discussions will provide an insight on the concept of
nursing as a science.

1.2 TOPICS/DISCUSSION (with ACTIVITIES/ASSESSMENT)

PROBLEM SOLVING PROCESS

There are two types of problems, first is the actual health problem such
as the impact of illness of physiological, physical, safety, socialization, self-
concept and self-esteem, and self-actualization status of the clients, the second
is the potential health problem such as risk for possible complications, failure
or non-adherence to treatment or therapy, educational needs for information
and concern to develop health-oriented attitudes and skills.
An individual’s response is dynamic in nature and change, and as person
progresses along the health-illness continuum, nurses are the ones that assist
the person to solve any problems encountered.
Nursing students are expected to have a well-developed problem-solving
skill specially when working with patients on a daily basis. The process is
centered in identifying critical issues and identifying solutions.
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What exactly is problem solving process? It is a cyclical process that

involves:
 The systematic identification and definition of a problem by
looking into the true nature of the problem from different perspectives.
This can provide a broad view of the situation and helps nurses to remove
issues that are not relevant and focus on the root cause of the problem.
 Analysing the problem as to how it affects the current situation and the
people involved in that situation. This can help in determining the how the
problem developed and its gravity or impact to the situation.
 Generating solutions through brainstorming and listing of all possible
solutions to the identified problem. All generated ideas of solutions should
be considered at this stage and never be disregarded.
 Analysing and selecting the best solutions by investigating (listing all
advantages and disadvantages) of each potential solution. Determine the
possible short-term and long-term benefits of each solution and selecting
which of the solutions will help meet your goals based on careful
judgment.
 Implementing the solution by creating a plan of action. One must
determine the steps to move forward with the decision to implement the
solution by executing it to solve the problem.
 Evaluate the solution by careful monitoring and assessment of the
results of your solution. Judge the effectiveness of the solutions. This
phase helps to redefine and revise the problem-solving process if ever the
solutions fail to manage the problems effectively.

NURSING PROCESS

The nursing process is a subset of the problem-solving process and is the

systematic rational method of planning and providing individualized care. It uses
problem solving and decision-making skills. It requires nurses to use critical
thinking and clinical reasoning based on good judgment. Like any problem-
solving process, this approach is cyclical and dynamic in nature. The nursing
process will be discussed further in the following topics and consists the
following steps:
 Assessment
 Nursing diagnosis
 Planning
 Implementation
 Evaluation
Nurses utilize the systematic problem-solving approach on a daily basis in
order to solve the nursing as well as medical problems of the client. There are
prerequisites for the efficient use of nursing process and these are: 1 nurse’s
comprehensive knowledge base, 2 experience and skills in the field of practice,
and 3 professional commitments.
The following topics will discuss each of the stages in the nursing process
to solve the clients’ health problems. Nurses or even student nurses should
always apply this knowledge while on practice in any healthcare setting.
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 ASSESSMENT

The first phase of the nursing process focused on collecting, organizing,

validating, and documenting data for the purpose of obtaining a database of the
client through history taking, conducting physical assessment, review of client’s
past health records, and consulting support persons and health professionals.
Remember that assessment is a continuous process wherein nurses can identify
the human response patterns or functional health status of the clients. Steps in
assessment are the following:

Collection of Data

Data collection should be systematic and continuous to identify any

changes in the client’s health status. Activities in the collection of data:
1. Identify the client by name, age, gender, address, doctor-in-charge, and
registration.
2. Collect data as current and past health history of illness, family history of
illness, psychosocial patterns.
3. Use primary and secondary sources in obtaining pertinent data.
4. Use different methods or techniques in data collection such as
observations and physical examinations using the senses, interviewing the
client and support persons, and clinical and laboratory examination and
reports.
5. Clarify doubts and validate subjective data by secondary sources and
objective data.

Organization of Data

When you have obtained a comprehensive information about your client,

you need to organize the data in a meaningful manner as current and historical,
subjective and objective data, and primary and secondary sources of data.

Documentation of Data

After organizing the collected data, it is important to complete the

assessment with accurate documentation. Always remember that data should
be accurately collected, organized, and documented. Some of the essential
elements of an accurate documentation are listed below.

Characteristics:
1. Documents must be accessible to different team members.
2. A well-documented data must provide a baseline information, prevent
gaps, and with minimal repetitions.
3. Facilitate delivery of quality care allow the nurse to validate clarify and
update data.
4. Assured evaluation of individualized care, assist in demonstrating
compliance with the accepted standards (useful in audits)
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5. Create permanent legal record which can be used to protect the client,
health care providers, and the agency.
6. Provide foundation for nursing research.

Guidelines for Documentation of Client Data:

1. Entries are written objectively without bias and value judgment or
personal opinions.
2. Support data with objective observations.
3. Always be specific and always avoid generalizations.
4. Describe findings as thoroughly as possible.
5. Write or print legibly in non-erasable ink, avoid erasing, crossing out, and
overwriting entries.
6. Use correct grammar, spelling, and abbreviations while avoiding slang,
label and short forms.
7. Feed the organized data into the computer as per agency policy

 NURSING DIAGNOSIS

The second phase of the nursing process which formally began in 1973 to
identify the role of the nurse in the ambulatory setting. In 1987 the International
Nursing Conference was named North American Nursing Diagnosis Association
(NANDA), the purpose of which is to define and promote a taxonomy of nursing
diagnostic terminology for general use by professional nurses.
A nursing diagnosis is a clinical judgment in terms of responses to actual
and potential health problems or life processes of an individual, family,
population group or community (physical, sociocultural, psychological, and
spiritual responses to an illness or health problem). It provides the basis for the
selection of interventions to achieve a positive outcome for which a nurse is
responsible.

Types of Diagnosis:

 Actual diagnosis which is present at the time of diagnosis

 Health promotion diagnosis which refers to the readiness to improve
health status
 Risk nursing diagnosis, problem does not exist but there are possible risks

What are the steps in creating a nursing diagnosis?

Classification, Analysis, and Interpretation of Data

1. Classify the raw data by sorting out information into specific categories
such as
 Signs and symptoms related to specific systems
 Signs and symptoms that need immediate attention
 Patterns (human response/functional health)
 Spiritual history
 Abilities and strengths
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 Deficits
2. Analyse and interpret data to obtain cues. Cues are nurses’ perception of
obtained information. Make judgment or conclusions based upon cluster of
cues.

Identification of the Problem: Actual or Potential

1. Identify actual and potential problems

2. Identify the problem that needs to be solved/changed and its etiology or
related factors that may suggest intervention.

Validation

1. Verify the accuracy of validated interpretation of data using reflective

statements when talking to the client.
2. Validate information or clarify doubts with other members of the health
care team, medical records, or references sources.

Documentation of Diagnostic Statement

Formulate the nursing diagnosis using the following guidelines:

1. Write the first part of the statement which is the actual or potential health
problems in terms of client’s response rather than nursing need.
2. Use the term “related to” to connect the two parts of statement.
3. Write the related factor in terms that can be changed or modified through
specific nursing interventions.
4. Write the diagnosis in legally advisable terms.
5. Diagnosis should be written without value judgment and avoid using
words such as inadequate, poor, unhealthy in diagnostic statements.
6. Avoid reversing the parts of the statement. Always remember that the first
part is the human response/health pattern and the second part is the
etiology of the problem and its related factors.
7. Avoid using single cues in the first part of the statement.
8. Do not include medical diagnosis in the statements.
9. State the diagnosis clearly and concisely.
10. Validate the statement by verifying its accuracy whilst looking for
gaps in data, and misinterpretation of cues.
11. Always refer to the standardized classification of nursing diagnosis
which is based on the human response or functional health patterns.
12. Review, revise, and eliminate the diagnostic statements as per
change in client’s response/health status.

 PLANNING

The third phase of the nursing process which is a deliberate systematic

phase that uses problem solving and decision-making skills. This phase uses the
collected assessment data and nursing diagnostic statements to come up with
the goals and interventions needed to prevent, reduce, or eliminate the client’s
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problems. Planning should always be a joint effort between the client or patient,
support person, and other health professionals.

Types of Planning

 Initial planning which is done after and based on the initial assessment.
 Ongoing planning is done in the beginning of each shift, or when new info
is acquired and based on the patient’s response to care which allows the
plan care to be individualized.
 Discharge planning which is needed by the patient after discharge. It
begins as soon as the patient is admitted and requires comprehensive and
ongoing assessment.

Developing and Prioritizing Outcomes

1. Develop expected outcomes, goals or behavioural objectives for modifying

the human response. Outcomes are the possible solutions of client’s
problems.
2. Use the given guidelines for writing outcomes:
a. Outcomes should be related to the human response as identified
and stated in the first part of the nursing diagnosis.
b. Outcomes should be client centered preferably agreed upon by the
client and the nurse.
c. Outcomes are clear and concise.
d. Outcomes should be realistic in approach.
e. Outcomes should describe behaviour that is measurable and
observable.
f. Outcomes should be time-bounded (short or long term)
3. Organized expected outcomes depending on the client’s needs and
classify them into short and long terms.

Developing Interventions

1. Develop interventions or activities based on the related factors required to

assist the client in achieving the outcomes.
2. Predict or hypothesize any alternatives that may be helpful in achieving
the outcomes by applying scientific principles, knowledge of client’s
abilities, and similar past experiences.
3. Generate ideas and after gathering possible alternatives, each should be
judged in terms of its feasibility or probability of success. Then choose the
ones that are most appropriate for the client.
4. Ensure that interventions help promote, maintain, or restore client’s
health.

Always remember that interventions are:

 Independent/dependent in approach
 Consistent with the total plan of medical/nursing care
 Based on science
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 Individualized and client-centered

 Safe and provide therapeutic environment
 Inclusive of teaching-learning activities
 Effective in terms of resources

Documentation: Nursing Care Plan

1. Document the nursing diagnosis, outcomes, and planned interventions

based the client’s needs. NCPs are designed and directed to promote
quality nursing care by facilitating:
 Individualized care
 Continuity of care
 Communication
 Evaluation
2. Plan should be based on current data nursing diagnosis and interventions.
3. Use precise action verbs for specific interventions or activities which
should also be dated and signed by the nurse.
4. Frequently update the NCP.
5. Make use of standardized care plans or computerized plans per
agency/unit policy.

 IMPLEMENTATION

The fourth phase of the nursing process which is the initiation or carrying
out the plan of care for each client. All the previous steps of the process
contribute to the implementation phase. Specific nursing interventions or
activities are implemented to modify factors contributing to the client’s health
problems leading to the achievement of the specific outcomes.
There are certain skills that need to be utilized in the implementation
phase of the nursing process. Cognitive skills which include problem solving,
critical thinking, clinical reasoning, and creativity in order to provide the best
quality care possible. Interpersonal skills that include verbal and nonverbal
communication skills which is important in providing care and comfort,
advocating, referring, counselling, and supporting patients, and communicating
with other members of the health care team. And lastly, the technical skills or
the hands-on skills.
So, what exactly are the steps in the implementation phase?

Preparation

1. Review the nursing interventions identified in the planning phase.

2. Analyse the client’s potentials/abilities to determine the degree of
assistance required in implementing the interventions.
3. Recognize potential complications associated with specific nursing
activities.
4. Determine and provide necessary resources such as the personnel,
material, or equipment.
5. Prepare an environment conducive to the types of activities required.
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6. Identify legal and ethical concerns associated with intervention following

hospital policy.
7. Use appropriate nursing care approach/care delivery system to achieve
the outcomes.

Action/Interventions

1. Make a quick assessment of the client and environment just before

performing the intervention.
2. Carry out preventive, promotive, corrective (curative) rehabilitative or
palliative nursing actions to eliminate the related factors in nursing
diagnosis.
3. Recognize independent, interdependent, and dependent nursing
interventions or actions.
4. Use various opportunities for communicating, teaching, and supporting
clients.
5. Refer to nursing prescriptions/hospital or unit protocols/procedure
manual/nursing standards for carrying out appropriate nursing
interventions

Documentation

Lastly, document all implemented nursing actions accurately in the

appropriate chart or source notes such as the nurses’ notes, flow sheet, health
teaching records, or care plans.

 EVALUATION

Evaluation is a planned, ongoing, purposeful activity done during or after

an intervention. The last step of the nursing process and is an integral part of all
phases of nursing process and carried out at the end point to determine if:
 Client’s expected outcome is achieved or not
 The care plan is appropriate, realistic, current or in need of revision.

Gathering of Data/Reassessment

1. Collecting of objective and subjective data using different techniques for

the purpose of evaluation such as interviewing the client about pain relief,
physical examination, direct observations, and review of documents.
2. Assess the degree/intensity level of problem or health status after the
interventions.

Making Judgment and Revising the Plan

1. Analyse the information on clients’ current health status by:

 Making judgments (using critical thinking both inductive and
deductive reasoning)
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 Revising the diagnosis and care plan (if the outcome is not
achieved)

1.3 REFERENCES

Book References:

Berman, A., Snyder, S. and Frandsen, G., 2012. Kozier & Erb's Fundamentals of
Nursing: Concepts, Process, and Practice. 10th ed. New Jersey: Pearson
Education, Inc., pp.723-728, 1216-1226.

Online Sources:

Vega, Heather RN; Hayes, Kristy RN Blending the art and science of nursing.
Nursing: September 2019 - Volume 49 - Issue 9 - p 62-63 doi:
10.1097/01.NURSE.0000577752.54139.4e
https://studycorgi.com/nursing-as-a-combination-of-art-and-science/
#:~:text=Nursing%20is%20a%20science%20because,the%20well
%2Dbeing%20of%20patients.&text=Nursing%20as%20a%20science
%20consists,skill%2C%20awareness%2C%20and%20efficiency.
https://www.123helpme.com/essay/The-Nursing-Science-And-Science-Of-
Nursing-540980
https://egyankosh.ac.in/bitstream/123456789/32099/1/Unit-4.pdf
https://www.slideshare.net/drjayeshpatidar/problem-solving-61184805
https://nursing.lsuhsc.edu/AcademicSuccessProgram/
StrategiesProblemSolving.aspx

1.4 ACKNOWLEDGMENT
The images, tables, figures and information contained in this module were
taken from the references cited above.