Fundamentals Of Nursing Practice Preliminary Lecture PDF

FUNDAMENTALS OF NURSING PRACTICE By: Sabrina P. Magañan, RN CONCEPT OF MAN, HEALTH & ILLNESS  The concept of “MAN” forms the first foundational component of nursing. Why do we need to understand MAN? To be able to provide individualized, holistic, humane,...

FUNDAMENTALS OF NURSING PRACTICE By: Sabrina P. Magañan, RN CONCEPT OF MAN, HEALTH & ILLNESS  The concept of “MAN” forms the first foundational component of nursing. Why do we need to understand MAN? To be able to provide individualized, holistic, humane, ethical, and quality nursing care CONCEPTS OF MAN ACCORDING TO NURSING THEORISTS Florence Nightingale referred to the person (Man) as a “patient” “Person is viewed holistically wherein the body, mind, and soul are interrelated” A person is a “unitary human being, a unified whole composed of parts which are interdependent and interrelated with each other. A person is a total being with universal, developmental needs and capable of continuous self-care.” Individuals are unique and holistic, of intrinsic worth and capable of rational thinking and decision making in most situations.  CONCEPTS OF MAN ACCORDING TO NURSING THEORISTS Man is a biopsychosocial and spiritual being who is in constant contact with the environment Person is a holistic being; wholeness is integrity Person is a developing organism that tries to reduce anxiety caused by needs A person is an individual requiring assistance to achieve health and independence or a peaceful death  CONCEPTS OF HEALTH ACCORDING TO NURSING THEORISTS Health is a fundamental right of every human being Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity (WHO, 1947) Health is maintained through prevention of disease by environmental control and social responsibility. Health is a state mutually exclusive of illness; a healthy state of mind & body Health is a state of well-being, is culturally defined, valued, and practiced.  CONCEPTS OF ILLNESS ACCORDING TO NURSING THEORISTS Illness is a personal state in which the person feels unhealthy Illness is a state in which person’s physical, emotional, intellectual, social, developmental or spiritual functioning is diminished or impaired compared with previous experience. Illness is not synonymous with disease DISEASE is an altercation in body functions resulting in reduction of capacities or a shortening of the normal life span.  COMMON CAUSES OF DISEASE Biologic Agents Inherited Genetic Defects Developmental Defects Physical Agents Chemical Agents Tissue response to irritation/injury Faulty chemical/metabolic process Emotional/Physical reaction to stress RISK FACTORS Is any situation, habit, social or environmental condition, physiological or psychological conditions, developmental or intellectual condition, or spiritual or other variable that increases the vulnerability of an individual or group to an disease or accident. Risk Factors of a disease are as follows: Genetic and Physiological Factors Age Environment Lifestyle  CLASSIFICATION OF DISEASES A. ACCORDING TO ETIOLOGIC FACTORS Heredity –due to defect of one or both parents which is transmitted to the offspring Congenital – due to the defect in the development, hereditary factors or prenatal infection present at birth Metabolic – due to disturbances in metabolism Deficiency – results from an inadequate intake or absorption of essential dietary factors Traumatic - due to injury  CLASSIFICATION OF DISEASES Allergic – due to abnormal response of the body to chemical or protein substances or to physical stimuli Neoplastic – Due to abnormal or uncontrolled growth of cells Idiopathic – Cause is unknown Degenerative – Associated with aging process Iatrogenic – results from the treatment of a disease  CLASSIFICATION OF DISEASES B. ACCORDING TO DURATION OR ONSET ACUTE ILLNESS – usually has a short duration and is severe. CHRONIC ILLNESS – Persistent, usually longer than 6 months and can also affect functioning in any dimension Remission – the disease is controlled Exacerbation – becomes more active again SUB-ACUTE – Symptoms are pronounce but more prolonged than in acute disease OTHER CLASSIFICATION OF DISEASES ORGANIC PANDEMIC FUNCTIONAL SPORADIC OCCUPATIONAL FAMILIAL VENEREAL EPIDEMIC ENDEMIC  FACTORS AND ISSUES AFFECTING HEALTH AND ILLNESS 1.INCOME AND SOCIAL STATUS – higher income and social status are linked to better health. The greater the gap, the greater the differences. 2.EDUCATION – low education levels are linked with poor health, more stress and lower self confidence 3.PHYSICAL ENVIRONMENT 4.SOCIAL SUPPORT NETWORKS – greater support from families, friends and communities 5.GENETICS – inheritance plays a part in determining lifespan, healthiness and the likelihood of developing certain illnesses.  FACTORS AND ISSUES AFFECTING HEALTH AND ILLNESS 6. PERSONAL BEHAVIOR AND COPING SKILLS – how we deal with life’s stresses and challenges all affect health 7. HEALTH SERVICES – access and use of services that prevent and treat disease influences health. 8. GENDER – Men and women suffer from different type of diseases at different ages  HEALTH CARE DELIVERY SYSTEM The network of health facilities and personnel which carries out the task of rendering health care to the people. Philippine Health Care System is a complex set of organizations interacting to provide an array of health services. Health System comprises all organizations, institutions and resources devoted to producing actions whose primary intent is to improve health. Health is a basic human right guaranteed by the Philippine Constitution of 1987. The introduction of social health insurance administered by the Philippine Health Insurance Corporation (PhilHealth) since 1995 aimed to provide financial risk protection for the Filipino people. Health authorities in the Philippines are now focusing on the UN’s Sustainable Development Goal (SDG 3): good health and well-being Private health care companies have long played a major role in the health sector. In 2013, the Philippines introduced the Universal Health Care Act to ensure that all Filipinos, especially the poor receive health insurance coverage from PHIC. HMO’s are also rolling out micro-health plans that are targeted at the working poor. FOUR ESSENTIAL FUNCTIONS OF A HEALTH SYSTEM 1.SERVICE PROVISION 2.RESOURCE GENERATION 3.FINANCING 4.STEWARDSHIP  National TERTIARY HEALTH CARE Health Services Regional Health Service District Health Services SECONDARY HEALTH CARE Rural (Local Hospital Services) Rural Health Units PRIMARY HEALTH CARE Barangay Health Stations A PYRAMIDAL HEALTH CONCEPT OF NURSING Nursing is a caring profession. As a unique profession, it is practiced with an earnest concern for the art of care and the science of health. Through the years, the concept of nursing has been expanded and subsequently, the role of the nurse has become broader to meet the changing needs of the society. Likewise, career opportunities in nursing have greatly expanded. When we, nurses integrate the art and science of nursing into our practice, the quality of care we provide to our patients is at a level of excellence that benefits patients and their families.  PROFESSIONAL RESPONSIBILITIES AND ROLES BASIC TO NURSING CARE Autonomy & Change Agent Accountability Leader Caregiver Manager Communicator Researcher Educator Case Manager Advocate Collaborator Counselor Autonomy & Accountability Autonomy is an essential element of professional nursing that involves the initiation of independent nursing interventions without medical orders. With increased autonomy comes greater responsibility and accountability. Caregiver the nurse helps maintain and regain health, manage disease and symptoms, and attain a maximal level of function and independence through the healing process. Communicator Essential for all nursing roles and activities. Central to nurse- patient relationship Educator The nurse explains concepts and facts about health, describe the reason for routine care activities, demonstrate procedures such as self-care activities, reinforce learning or patient behavior, and evaluate the patient’s progress in learning. Advocate The nurse protects the patient’s human and legal rights and provides assistance in asserting their rights if the need arises. Counselor The nurse helps the patient to recognize and cope with stressful psychologic or social problems, to develop improved personal relationships and to promote personal growth. Change Agent The nurse initiates changes and assists the client make modifications in the lifestyle to promote health. Leader Helps the client make decisions in establishing and achieving goals to improve his well-being. Manager Plans, gives directions, develops staffs, monitors operations, gives rewards fairly and represents both staff members and administrations. Manages the nursing care of individuals, groups, families and communities. Researcher Participates in scientific investigation and uses research finding in practice. Case Manager Coordinates the activities of other members of the health care team when managing a group of client’s care. Collaborator The nurse works in a combined effort with all those involved in care delivery, for a mutually acceptable plan to be obtained that will achieve common goals. CONCEPT OF PROFESSION Nursing is a profession. It is not simply a collection of specific skills, and the nurse is not simply a person trained to perform specific tasks. A profession is an organization of an occupational group based on the application of special knowledge which establishes its own rules and standards for the protection of the public and the professionals. The aims of a profession are altruistic rather than materialistic.  CRITERIA OF A PROFESSION EDUCATION – A profession requires an extended education of its members, as well as basic liberal foundation. THEORY – A profession has a theoretical body of knowledge leading to defined skills, abilities and norms. SERVICE – A profession provides basic service. AUTONOMY – Members of a profession have autonomy in decision making and in practice. CODE OF ETHICS – The profession as a whole has a code of ethics for practice. CARING – The most unique characteristics of nursing as a profession  PROFESSIONAL QUALITIES OF A NURSE Has faith in the fundamental values that underlie the democratic way of life. Has a sense of responsibility for understanding those with whom he/she works or associates with. Has the basic knowledge, skills and attitudes necessary to address present – day social problems, realistic, incisive and well-organized thoughts through the use of critical thinking. Has skill in using written and spoken language, both to develop own thoughts and to communicate them to others.  PROFESSIONAL QUALITIES OF A NURSE Appreciates and understands the importance of good health. Has emotional balance. Likes hard work and possesses a capacity for it. Appreciates high standards of workmanship. Accepts and tries to understand people of all sorts, regardless of race, religion and color. Knows nursing so thoroughly that every client will receive excellent care.  PERSONAL QUALITIES OF A NURSE Philosophy of Life It is concerned with those basic truths that contribute to personal growth in a systematic fashion and with those principles that relate to the moral values that shapes the facets of the character. Good Personality  Personal Appearance  Character  Attitude  Charm  CAREER DEVELOPMENT: FIELDS OF NURSING 1.PROVIDER OF CARE Most nurses provide direct patient care in an acute care setting. 2. INSTITUTIONAL NURSING (Hospital Staff Nursing) Provides direct client care, using the nursing process and critical thinking skills. 3. INDEPENDENT NURSING PRACTICE/APRN Involves advanced nursing practice, and requires a Master’s Degree in Nursing, advanced education in Pharmacology and physical assessment, and certification and expertise in a specialized area of practice. 4 Core roles of APRN 1. CNS 3.CNM 2. CNP 4. CRNA 4. COMMUNITY HEALTH NURSING Is a nursing approach that merges knowledge from the public health sciences with professional nursing theories to safeguard and improve the health of populations in the community 5. 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. 6.NURSE ADMINISTRATOR Manages patient care and the delivery of specific nursing services within a health care agency. Nursing administration begins with positions such as clinical care coordinators. 7. NURSE RESEARCHER Is responsible for the continued development and refinement of nursing knowledge and practice through the investigation of nursing problems.  HISTORY OF NURSING IN THE PHILIPPINES  THE EARLIEST HOSPITALS ESTABLISHED Hospital Real de Manila (1577) established mainly to care for the Spanish King’s soldiers, but also admitted Spanish civilians; founded by Governor Francisco de Sande. San Lazaro Hospital (1578) Founded by Brother Juan Clemente and was administered for many years by the Hospitalliers of San Juan de Dios; built exclusively for patients with leprosy. Hospital de Indio (1586) Established by the Franciscan Order; service was in general supported by alms and contributions from charitable person. Hospital de Aguas Santas (1590) Established in Laguna; near a medical spring, founded by Brother J. Bautista of the Franciscan Order. San Juan de Dios Hospital (1596) Founded by the Brotherhood of Misericordia and administered by the Hospitalliers of San Juan de Dios; rendered general health service to the public. NURSING DURING THE PHILIPPINE REVOLUTION 1.Josephine Bracken Wife of Jose Rizal. Installed a field hospital in an estate house in Tejeros: provided nursing care to the wounded night and day. 2.Rosa Sevilla de Alvero Converted their house into quarters for Filipino Soldiers, during the Philippine-American War that broke out in 1899. 3.Doña Hilaria de Aguinaldo Wife of Emilio Aguinaldo, organized the Philippine Red Cross under the inspiration of Apolinario Mabini. 4.Doña Maria Agoncillo de Aguinaldo Wife of Emilio Aguinaldo; provided nursing care to Filipino soldiers during the revolution. President of the Filipino Red Cross Branch in Batangas. NURSING DURING THE PHILIPPINE REVOLUTION 5. Melchora Aquino (Tandang Sora) Nursed the wounded Filipino soldiers and gave them shelter and food. 6. Capitan Salome A revolutionary leader in Nueva Ecija; provided nursing care to the wounded when not in combat. 7. Agueda Kahabagan Revolutionary Leader in Laguna, also provided nursing services to her troops. 8. Trinidad Tecson “Ina ng Biac na Bato”, stayed in the hospital at Biac na Bsto to care for the wounded soldiers  FIRST HOSPITALS AND SCHOOLS OF NURSING 1. Iloilo Mission Hospital School of Nursing (Iloilo City, 1906) 2. St. Paul ‘s Hospital School of Nursing (Manila, 1907) 3. Philippine General Hospital School of Nursing (1907) 4. St. Lukes Hospital of Nursing 5. Mary Johnston Hospital and School of Nursing (Manila, 1907) 6. Philippine Christian Mission Institute Schools of Nursing 7. San Juan de Dios Hospital School of Nursing (Manila, 1913) 8. Emmanuel Hospital School of Nursing (Capiz, 1913) 9. Southern Islands Hospital School of Nursing (Cebu, 1918)  OTHER SCHOOLS OF NURSING 1. Zamboanga General Hospital School of Nursing (1921) 2. Chinese General Hospital School of Nursing (1921) 3. Baguio General Hospital School of Nursing (1923) 4. Manila Sanitarium and Hospital School of Nursing (1930) 5. St. Paul’s School of Nursing in Iloilo City (1946) 6. North General Hospital and School of Nursing (1946) 7. Silliman University School of Nursing (1947) FIRST COLLEGES OF NURSING IN THE PHILIPPINES 1.University of Santo Tomas College of Nursing (1946) 2.Manila Central University College of Nursing (1947) 3.University of the Philippines College of Nursing (1948) NURSING LEADERS IN THE PHILIPPINES 1.Anastacia Giron-Tupas First Filipino nurse to hold the position of Chief Nurse Superintendent ; Founder of the Philippine Nurses Association 2.Cesaria Tan First Filipino to receive a Masters Degree in Nursing aboard. 3.Socorro Sirilan Pioneered in Hospital Social Service in San Lazaro Hospital NURSING LEADERS IN THE PHILIPPINES 4. Rosa Militar A pioneer in school health education. 5.Sor Ricarda Mendoza A pioneer in nursing education. 6.Socorro Diaz First editor of PNA magazine called ‘The Message” 7.Conchita Ruiz First full-time editor of the newly named PNA magazine “The Filipino Nurse” 8.Loreto Tupaz “Dean of the Philippine Nursing”; Florence Nightingale of Iloilo NURSING AS AN ART  A. CARING Caring is the unique characteristic of the nursing profession. Caring and knowledge are the core of nursing, with caring being a key component of what a nurse brings to a patient experience. When nurses engage patients in a caring and compassionate manner, they learn that the therapeutic gain in caring makes enormous contributions to the health and well-being of the patients. CARING PRACTICE MODELS LEININGER’S TRANSCULTURAL CARING Describes the concept of care as the essence and central, unifying, and dominant domain that distinguishes nurses from other health disciplines. Care is an essential human need , necessary for the health and survival of all individuals. Caring is very personal; thus its expression differs for each patient. For caring to be effective, nurses need to learn culturally specific behaviors and words that reflect human caring in different cultures to identify and meet the needs of all patients. WATSONS TRANSPERSONAL CARING Caring is a central focus of nursing and it is integral to maintain the ethical and philosophical roots of the profession. Watsons theory of caring is a holistic model for nursing that suggests that a conscious intention to care promotes healing and wholeness. When the nurse focuses on transpersonal caring, he or she looks for deeper sources of inner healing to protect, enhance, and preserve a person’s dignity, humanity, wholeness, and inner harmony.  THE 6 C’S OF CARING CARE COMPASSION COMPETENCE COMMUNICATION COURAGE COMMITMENT CARE Care is our core business and that of our organizations, and the care we deliver helps the individual person and improves the health of the whole community. Caring defines us and our work. COMPASSION Compassion is how care is given through relationship based on empathy, respect, and dignity. It can also be described as intelligent kindness, and is central to how people perceive their care. COMPETENCE Competence means all those in caring roles must have the ability to understand an individual’s health and social needs and the expertise, clinical and technical knowledge to deliver effective care and treatment based on research and evidence. COMMUNICATION Communication is central to successful caring relationships and to effective team working. Listening is as important as what we say and do and essential for “no decision about me without me”. Communication is the key to a good workplace with benefits for those in our care and staff alike. COURAGE Courage enables us to do the right thing for the people we care for, to speak up when we have concerns and to have the personal strength and vision to innovate and to embrace new ways of working. COMMITMENT A commitment to our patients and populations is a cornerstone of what we do. We need to build on our commitment to improve the care and experience of our patients, to take action to make this vision and strategy a reality for all and meet the health care and support challenges ahead  CARING FOR SELF AND OTHERS Caring is one of those human behaviors that we can give and receive. Whether you are giving or receiving care, the value of caring in your nursing practice benefits your patients, your colleagues and your health care agency. Caring in nursing practice involves: Providing presence Touching or comforting Listening Knowing the patient Spiritual Caring Relieving Symptoms and suffering Family Care  B. COMMUNICATING Communication is a process in which people affect one another through exchange of information, ideas, and feelings. It is lifelong learning process. Nurses communicate with patients and families to develop relationships. Nurses need to communicate information about patients accurately, timely, in an effective manner.  LEVELS OF COMMUNICATION 1.INTRAPERSONAL COMMUNICATION “self-talk” 2.INTERPERSONAL COMMUNICATION “one-on-one interaction” 3.SMALL GROUP COMMUNICATION 4.PUBLIC COMMUNICATION “audience” 5.ELECTRONIC COMMUNICATION MODES OR FORMS OF COMMUNICATION I.VERBAL II.NON-VERBAL  VERBAL COMMUNICATION Uses spoken or written words. Conveys specific meaning through a combination of words Aspects of Verbal communication: - Vocabulary - Intonation - Clarity & Brevity - Pacing - Timing & Relevance  NON-VERBAL COMMUNICATION Includes the five senses and everything that does not involve spoken or written word. Aspects of Non Verbal Communication - Personal Appearance - Posture & Gait - Facial Expressions - Eye Contact - Gestures - Sounds - Territoriality & Personal Space  THERAPEUTIC COMMUNICATION Therapeutic communication techniques are specific response that encourage the experience of feelings and ideas and convey acceptance and respect. - Active Listening -Sharing observations - Sharing Empathy - Sharing Hope - Sharing Humor - Sharing feelings - Using Touch - Using Silence - Providing Information - Clarifying - Focusing - Paraphrasing -Validation - Asking Relevant Questions - Summarizing - Self-Disclosure - Confrontation  HELPING RELATIONSHIP Communication is a basic component of human relationships and nurse-patient relationships Effective communication is reciprocal interaction. Trust is the foundation of a positive nurse- patient relationship. A non judgmental acceptance of the patient is an important characteristic of the relationship. PHASES OF HELPING RELATIONSHIP 1.PREORIENTATION PHASE 2.ORIENTATION PHASE 3.WORKING PHASE 4.TERMINATION PHASE  PREORIENTATION Before meeting the patient Review available data including the medical and nursing history. Talk to other caregivers who have information about patient. Anticipate health concern or issues that arise Identify a location and setting that fosters comfortable, private interaction Plan enough time for the initial interaction.  ORIENTATION PHASE When the nurse and the patient meet and get to know each other  Set the tone for the relationship by adopting a warm, empathetic, caring manner  Recognize that the initial relationship is often superficial, uncertain and tentative.  Expect the patient to test your competence and commitment  Closely observe the patient and expect to be closely observed by the patient  Begin to make inferences and form judgments about patient messages and behaviors.  Assess the patient’s health status.  Prioritize the patient’s problems  Clarify the patient’s and your roles  Form contracts with the patient that specify who will do that  Let the patient know when to expect the relationship to be determined.  WORKING PHASE When the nurse and the patient work together to solve problems and accomplish goals. Encourage and help the patient express feelings about his or her health. Provide information needed to understand and change behavior. Encourage and help the patient set goals. Take action to meet the goals set with the patient Use therapeutic communication skills to facilitate successful interactions.  C. TEACHING Patient education is one of the most important nursing interventions in any health care setting. The teaching-learning process empowers patients and usually enables them to achieve a higher level of wellness or to manage specific health care needs.  I. PROMOTION OF HEALTH & ILLNESS PREVENTION Involves providing information and skills to help patients adopt healthier behaviors. Promoting healthy behavior through education allows patients to assume more responsibility for their own health. Greater knowledge results in better health maintenance habits. When patients become more health conscious, they are more likely to seek early diagnosis of health problems.  II. RESTORATION OF HEALTH Injured or ill patients need information and skills to help them regain or maintain their levels of health. The family often is a vital part of patient’s return to health. Therefore, family caregivers usually require as much education as the patient, including information on how to perform skills within the home.  III. REHABILITATION New knowledge and skills are often necessary for patients to continue activities of daily living. The patient’s family needs to understand and accept many changes in the patient’s physical capabilities. The family’s ability to provide support results in part from education. Teach family members to help the patient with health care management. TEACHING A system of activities aimed to produce learning. Involves dynamic interaction between teacher and learner. Concept of imparting knowledge It consists of a conscious, deliberate set of actions that help individuals gain new knowledge, change attitudes, adopt new behaviors, or perform new skills. LEARNING Is the purposeful acquisition of new knowledge, attitudes, behaviors and skills through an experience or external stimulus It is process of both understanding and applying newly acquired concepts It is reflected by a change of behavior.