Aspects of Care and Delivery Full Notes PDF

Aspects of Care and Delivery Full notes:\ Topics 1: Nurse-Patient Communication **Aims of therapeutic communication within the health care context include:** Establishing a trusting & respectful relationship Transmitting & sharing information Exchanging ideas & understanding perceptions...

Aspects of Care and Delivery Full notes:\ Topics 1: Nurse-Patient Communication **Aims of therapeutic communication within the health care context include:** Establishing a trusting & respectful relationship Transmitting & sharing information Exchanging ideas & understanding perceptions Creating a platform for renewed understanding Enhancing understanding of attitudes, ideas & beliefs Achieving mutually acceptable goals for discourse, interventions & therapy **Communication Theory:** Communication is about interacting with people and therefore is at the core of nursing. For nursing to be effective and therapeutic the communication skills used by nurses need to be patient-centred. Continuous awareness by nurses as individuals about their interaction with others enhances therapeutic relationships **Concepts of Communication** Communication has been described as being both a simple and a complex process (Rosengren, 2000) Linear method (Miller & Nicholson, 1976) Sender Message Receiver **Concepts of Communication: Linear Model** Assumptions made by the linear Model: The sender is responsible for the verbal & non-verbal communication being sent The sender knows that the receiver interpreted the message accurately through feedback The sender is very clear about the purpose of the message The receiver is very open-minded and willing to participate in the interaction Does not take into account intrinsic factors including personal & professional aspects of both the sender & the receiver -- ex: values, beliefs, culture, goals, role & knowledge/education Does not take into account extrinsic factors that related to the immediate physical environment (noise) & the communication medium being used ex: written, verbal. **Concepts of Communication: Circular Model** Circular transactional model of communication: Two way process - rather an ongoing dynamic process that is inherently complex Takes place within a context of a relationship Acknowledges the intrinsic and extrinsic factors Feedback is fundamental **Concepts of Communication** DeVito (2002) described 4 types of noise: Physical Physiological Psychological Semantic **Purpose of Communication** Related to [Subject:] Conveying a message Related to [Self:] Satisfying personal needs Related to [Others:] Influencing others, establishing and maintaining relationships, play and entertainment **Levels of Communication** Cliché (ritual conversation) Gossip (Reporting facts or events, Narrating about others) Discussing Ideas (sharing of thoughts, judgements, decisions,) Sharing Feelings Peak Communication (Intimacy, total openness, honesty, experience of union, transparency) **'The comforting Interaction-Relationship Model'** Nursing actions:\ Comforting strategies Styles of care Nursing patterns of relating Patient actions Signals of discomfort Indices of distress Patterns of relating to a nurse **Blocks to communication can arise from many differences in individuals such as:** € Authority € Power € Language € Ability & Disability € Personality € Background € Gender € Health € Age € Race € Socio-economic group **Barriers within the patient** Lack of motivation towards being healthy Depends on a person's belief about the cause of illness or health and well-being Requires an understanding about how individuals perceive health status through cognitive-perceptual factors such as self-efficacy, control over health, benefits & barriers to health (health belief model). **Barriers within the nurse** Lack of active listening While the nurse may appear to be listening, adjunct non-verbal behaviour that support active listening may give conflicting messages Language Communication filter **Transference:** when patients unconsciously project seemingly inappropriate feelings/attitudes towards others that are based on previous experiences **Countertransference**: the nurse's conscious or unconscious response to the patient based on the patient's inappropriate feelings/attitudes towards them **Defense Mechanisms:\ Rationalization** -- defending behaviour with reasons that may be illegitimate ** Regression** -- reverting to behaviour associated with childhood ** Repression** -- suppressing emotions ** Denial** -- refusing to accept events ** Identification** -- taking on the characteristics of other **Projection --** projecting one's own undesirable traits on others Topic 3: **Ethics in Nursing:** **Defining Ethics:\ **♣Moral principles that govern how the person behave ♣Pertains to the right and wrong of actions ♣Encompasses the decision-making process of determining the ultimate consequences of those actions **Ethics in Health care** Healthcare workers need: To recognize dilemmas To make good judgements Come to decisions based on their values while keeping in mind the laws and policies that regulate them **Ethical Principles:\ **♣ Autonomy\* ♣ Justice\* ♣ Beneficence\* ♣ Nonmaleficence\* ♣ Fidelity ♣ Veracity ♣ Accountability **Autonomy:** **The patients' right to exercise control over what happens to them.** The right to choose/refuse treatment, where the patient has the mental capacity to take such decisions. Informed Consent- **Communication over what needs to happen whereby the patient authorizes the healthcare worker to proceed with the agreed treatment, or otherwise.** Communicate medical information and treatment options. Ex. Signing consent form for surgery. **Autonomy** **Truth-telling-**the nurse needs to communicate full information to the patient. Without this, there is no trust between the nurse and the patient. Providing full information, with tact and sensitivity, to patients who want to know should be standard. **Confidentiality-** The obligation not to disclose personal details and information without the patients' consent. **Justice** **To treat all patients fairly- not necessarily equal treatment but equality-equitable care.** Ex: minor vs intensive treatment Care should not be denied, restricted or provided in an inferior quality; irrespective of any characteristics like economic status, ethnicity, gender identity and expression or others **Beneficence** **To act in the patient's best interest** This includes: Prevent harm, i.e. remove conditions that will cause harm (ex the decision to amputate) Promote welfare ( ex encourage self-care ) Defend the right of the patient ( ex be the patient's adovate ) Nonmaleficence **Do the patient no harm** To be careful that by one's actions, healthcare workers are not causing any harm to patients Decisions whereby the result of the actions outweighs the burdens (side effects) of treatment/care -- choose the best course of action for the patient  **Creating and Maintaining boundaries in a professional relationship** **What are boundaries?** ♣ Boundaries mark the parameters of the professional relationship ♣ Create the space in which the nurse and the client can relate therapeutically ♣ Lines that help the client and the professional be safe **Boundary crossing/violations** - Abuse of power - Touch - Sexual exploitation - Dual roles-relative/neighbor - Meeting the clients at a social event ( wedding ) - Self-disclosure Red Flags for boundary crossings - Giving the client personal contact details - Telephone/Mobile number, - Facebook account - Home address - Giving special treatments - spending excessive amount of time with the client - giving late/early appointment - giving extra things to a particular client (preferential treatment) - Style of communication Use of words -- too familiar - Use of personal space -- too close/too far from client - Use of touch -- showing over friendly behavior - Shares off-work hours with the clients - Making appointment to meet clients - when you are off duty, - Visiting clients at their home - Spending your break time with a client - Attending client's personal events - A family event ( a wedding, baptism etc..) - The giving and receiving of gifts - Is concerned about personal appearance when with the client **The inability to differentiate a professional relationship from a social relationship** Some activities professionals do appear to be social in nature -- example talking while walking Clients often test our boundaries Clients bring with them a variety of experiences, Treatment needs of the client are what drive the therapeutic nurseclient relationship **Attempting to have personal needs met through the professional relationship** The professional who has a strong need to be liked and to gain approval is likely to pattern behaviour that satisfies this personal need Self-disclosure -- the meaning of self-disclosure Professional confuses his/her own need with the client's **What can help me keep an eye on my professional boundaries ?** ♣ Self-awareness and Self-Monitoring ♣ Peer Debriefing and Group Approach ♣ Supervision/Buddy system ♣ Staff Support ♣ Continuing education **Psychology and Nursing** **Aims and Objectives:** ν To explore a range of psychological perspectives & how each explain elements of human behaviour ν To demonstrate how psychology can enhance nursing practice **Definitions** 'Nursing is primarily assisting the individual in their performance of those activities contributing to health, or its recovery that they would perform unaided if they had the necessary strength, will or knowledge' 'Psychology is the scientific study of behaviour and mental processes. Behaviour includes all of our outward or overt actions and reactions, such as talking, facial expressions and movements. Mental processes refer to all the internal, covert activity of our minds, such as thinking feeling and remembering' **Psychology Perspectives** ν Biological ν Psychodynamic ν Behavioural ν Cognitive ν Humanistic **Biological Psychology** ν Suggests that biological function and structure determine behaviour ν Identify the following for behaviour and individual differences: \- Genes - Anatomical differences \- Development through the lifespan \- Biological systems such as the nervous & endocrine systems Identify that people develop through a sequence of maturational changes as the nervous and endocrine systems develop Nurses seek to understand behaviour from a biological basis -- the medical model -- BUT it is more useful to recognise that this is ONLY one component -- biological component - of the whole person **Psychodynamic psychology** The term psychodynamic implies that active forces within the personality motivate behaviour -- active forces are conflicts between the inner or unconscious and the conscious. Freud offers a psychodynamic theory of the mind, personality and its development, i.e. how the development of the mind (conscious/unconscious) determine the development of the personality of the individual and which is reflected in the individual's behaviour. **Psychodynamic Psychology** Freud developed a structure of the mind, which includes: ID Ego Superego **ID**- part of the personality or mind that the person is born with -- holds the sexual and aggressive instincts of the person and demands instant gratification. **Superego-**Uses guilt and pride to facilitate part of the personality or mind that the person is born with -- holds the sexual and aggressive instincts of the person and demands instant gratification. **Ego**- develops in childhood and fulfills a function of balancing the desires of the id with the social constraints of the world which are internalised by the superego The id and superego are largely unconscious and the ego is largely conscious. ν As with an iceberg, most of the personality lies beneath the surface and therefore cannot be seen. ν Freud suggests that children are born with the id but develop the ego and superego through psychosexual developmental stages. **Freud's stages of psychosexual developmeny are:** Oral: 0-18 months ν Anal: 18-36 months ν Phallic: 3-6 years ν Latent: 6 years to puberty ν Genital: puberty onwards Psychodynamic Psychology This perspectives offers nurses to look at behaviour that people demonstrate as a result of internal conflicts of the different component of the mind. It demonstrates how a person's childhood may have influenced their personality, that is in a state of movement and tension. It offers an approach for understanding reactions to health problems. Behavioral psychology ν This perspective is concerned with learning -- all behaviour, including personality, is learnt. ν Learning occurs on four processes -- four building blocks of learning, which are: 1\. Habituation: the acknowledgment that people 'get used to' or to accept elements in their environment. 2\. **Classical conditioning:** the training of reflexes by association -- Ivan Pavlov -- stimulus (food), reflexive response (salivation), conditioning (ringing bells). **Behavioral Psychology** 3\. Operant conditioning: if good things happen following a behaviour, the person will repeat the behaviour -- Skinner: learning can take place either within the 'teacher-student' format or by 'trial and error'; and in either situation, rewards or punishment influence learning. 4\. Social Learning Theory: learning can occur not only by habituation, association and reward but also by observing others' behaviour and imitating it -- acknowledges a cognitive element to learning -- Bandura -- five cognitive components that influence the likelihood of learning: Attention ν Memory ν Rehearsal and organisation of memory ν Imitation ν motivation **Cognitive psychology** Cognitive psychology offers a number of differing theories on HOW PEOPLE THINK. It is set on the behavioural perspective (stimulus-response), and tries to understand what happens between the stimulus and the response -- because there is on always a predictable automatic response to any given stimulus Information process approach, where thinking is conducted in a process -- simple or complicated. **It includes:** \- Set processing rules \- A storage facility for information (memory) \- A central processing unit which manipulates the information **Schema theory** -- a collection of information about a certain topic/area/thing -- fixed component and flexible component. Schemas can also be interrelated, so that thinking about one schema can lead to a memory of information in another schema **Cognitive development theory**: Piaget suggested that schemas are developed through a process of assimilation and accommodation. **Assimilation**: process of incorporating new information into existing schemas. **Accommodation:** occurs when new information cannot be assimilated, at which point a new schema needs to be developed P**iaget developed four stages of cognitive development:** 1\. Sensori-motor stage 0-2 years 2\. Pre-operational stage 2-7 years 3\. Concrete operations 7-12 years 4\. Formal operations 12 onwards **Cognitive psychology** has been influential in the development of health promotion, which is a crucial part of the nurse's role. Cognitive psychology offers an explanation for how people make decisions about their behaviour, including health behavior **Humanistic Psychology** Humanistic psychology has taken off from the behaviorists approach and the internal conflict focused on by the psychodynamic approach -- acknowledged that both learning and unconscious processes are important. It suggest that people are individuals -- whole beings -- with unique potential and each person moves towards self-actualisation to achieve potential, but unfavorable environments sometimes disrupts this **Humanistic psychology** -- underlying principles coming from a collection of diverse theories: ν The person is motivated to self-actualise -- they have the desire to achieve their potential ν The person is unique -- different ν The person has unique potential -- different set of abilities & have an individual sense of fulfillment ν People need positive regard to remain healthy **Topic 5:** **Multidisciplinary Care** **Definitions of terms:\ Interprofessiona**l: interactions between team members, not necessarily have different backgrounds but with same/joint goals in working together **Interdisciplinary/Multidisciplinary:** A team of individuals with different training background who share common objectives but make a different but complementary contribution **Intraprofessional:** different specialist groups but from one profession as with different nursing specialisations. **Interagency**: various agencies collaborating together, and within each agency there can be Inter/Intra-professional teams \- "an integrated team approach to health care in which medical and allied health care professionals consider all relevant treatment options and develop collaboratively an individual treatment plan for each patient" (NBCC, 2003).- Important multidisciplinary care encompasses: A shared, collaborative, group decision-making approach A focus on continuity of care Development of pathways and protocols for treatment and care Development of appropriate referral networks, including appropriate referral pathways to meet psychosocial needs Development of team protocols and guidance Development of multidisciplinary team meeting audit mechanisms Consumers/patients: Are aware that care is managed in this manner Understand the process, know that they will be informed about the treatment and care recommendations and will be involved in decision making. **Multidisciplinary Team:**\ Multidisciplinary teams comprise health care practitioners required for all treatment and care decisions in a particular tumour stream Team members may be from the primary, community and acute sectors, public and private sector and may be from several health, social and educational services **Multidisciplinary Clinic** A multidisciplinary clinic is held in a setting such as an outpatient clinic or within a primary health care setting, where several clinicians/health practitioners are available for a patient to see at one visit. Multidisciplinary clinics and meetings may be linked, where a clinic may precede or follow a multidisciplinary meeting **Integrated Multidisciplinary care** Integrated multidisciplinary care refers to a system which links teams to ensure that all health professionals involved in the care of a patient can participate in the planning of their care. This includes linkage of the primary and community sector through the entire pathway to follow up and palliative care smaller teams to larger centres teams to specialist centres **Descriptions of multi- & interdisciplinary team approach - Management & organisation of Rx** **[Multidisciplinary Team]** The physician compiles a therapy plan and coordinates the therapists (hierarchically). Each professional group does their job in accordance with their standards (additive). The professionals work parallel and independently of each other. Each therapist sets his or her own treatment goals for patients or receives them from the physician as a guideline **[Interdisciplinary Team]** The physician and other professionals work together in a team. There is a high level of cooperation, integration & participation. The treatment arrangements and decisions are collaboratively agreed by the team members. Treatment goals are also determined together as a team, & are obligatory for all team members. Modifications of the treatment goals or plans must discussed & decided in the team **Descriptions of multi- & interdisciplinary team approach - Structure of communication & cooperation** **[Multidisciplinary Team]**... is bilateral and occasionally multilateral: The physician and other therapists come to an agreement bilaterally. Multilateral team meetings take place as required, especially for problem cases. **[Interdisciplinary Team]**... is permanently multilateral: All the professionals work together permanently as a team. Team meetings to discuss the treatment of all patients take place regularly. Communication is continuous and multilateral. **Multi/interdisciplinary teams: Why?** An approach to meet the high demands of patient To best utilize resources Provides care on an individual plan: holistic health care Provide a comprehensive assessment through professionals' individual expertise and in consultation with one another The team approach promotes coordination and communication The team approach offers the patient a one stop effort as opposed to many separate evaluations, interpretations and plans Any differences in opinion or approach to care can be discussed and resolved as a group among the professionals while keeping the patient the centre of care The professionals within teams can change from case to case depending on diagnosis and social or personal situation of patient. **Benefits to professionals** The opportunity to enhance the professional skills & knowledge of individual team members by providing a forum for learning more about strategies, resources and approaches used by various disciplines It is a built-in consultation component Provides ongoing support which can be invaluable particularly in difficult situations **Difficulties faced by professionals** Can be complicated to coordinate schedules and response in busy health professionals who need to participate in a number of cases It can be costly to spend time meeting Can create conflict unless there is effective management and mutual respect Role confusion Patients and family knows that every professional knows what the other is doing Patient is not responsible to deliver information, which himself might have not understand Patient and family receives continual support and care on a multifactoral level **What makes teams work?** Evolution of a shared team culture Open communication Mutual respect for all practitioners Equal value for each other's contribution Understanding each other's contribution of care and expertise Nurturing of group process **Factors enhancing success** Good communication skills Clear focus with a discrete are of practice expertise Responsiveness to requests Not abusive of one's authorative power Credibility Hard working Able to command and exercise mutual respect for others Awaits for invitation to participate rather than taking over situations Able to demonstrate clear areas of practice that complement rather than compete with the activities of others **Factors enhancing tension in teams** Conveying contradictory messages Unclear role boundaries/role confusion Unclear role responsibilities Philosophical disagreement about the underpinning rationale for the team Bypassing immediate resources/expertise within the team **Who are the professionals** The professional is recognized as having a certain expertise that legitimates practitioner action usually bound by a code of ethics, standard education and a professional status (body) that regulates the profession **Physiotherapy** Physiotherapy, also known as physical therapy (PT), is a healthcare profession that focuses on restoring, maintaining, and maximizing physical strength, function, and overall well-being. It involves patient education, physical intervention and disease prevention **Physiotherapist** support people at all stages of life to recover from injury, reduce pain and stiffness, increase mobility and movement and maximise function and quality of life, incorporating physical, psychological, emotional and social wellbeing **Physiotherapy: Clinical settings** Hospitals - in outpatients, on medical and surgical wards and in specialised units such as intensive care, coronary care, burns and rehabilitation centres; assessing and treating a wide variety of muscle, joint and ligament problems as well as women's health, neurological, respiratory conditions and many more. Community and Primary Care Health Centres either in a dedicated Health Centres or visiting people in their homes, assessing and treating a wide variety of muscle, joint and ligament problems as well as women's health, neurological, respiratory conditions and many more. Giving treatment, advice and appliances to help improve independence; Schools - helping children achieve their full potential; Workplace - providing ergonomic assessments, preemployment screening, risk management and educating workers in correct lifting and handling techniques; **Radiography** Radiography is an imaging technique used to provide images of the tissues, organs and bones inside the human body. There are two types of radiographers: diagnostic and therapeutic. A diagnostic radiographer takes images of the insides of patients' bodies to diagnose injury, illness and disease. A therapeutic radiographer is an allied health professional who has undergone specific training to be able to deliver radiotherapy for patients undergoing treatment for cancer Radiographers operate the tools and equipment, whilst radiologists analyse and interpret the images, or treat patients with radioactive materials. Radiology is a branch of medicine and radiography is the type of technology radiologists employ to do their jobs X-rays -- to look through tissues to examine bones and cavities CT scan (computed tomography) -- provides views of cross-sections of the body MRI (magnetic resonance imaging) -- builds a 2D or 3D map of different tissues Ultrasound -- to check circulation and examine the organs Nuclear medicine imaging **Speech Language Pathology** SLPs work with people of all ages, from babies to adults. SLPs treat many types of communication and swallowing problems. Speech sounds - how we say sounds and put sounds together into words. Other words for these problems are articulation or phonological disorders, apraxia of speech, or dysarthria. Language --- how well we understand what we hear or read and how we use words to tell others what we are thinking. In adults this problem may be called aphasia. Literacy --- how well we read and write. People with speech and language disorders may also have trouble reading, spelling, and writing. Social communication --- how well we follow rules, like taking turns, how to talk to different people, or how close to stand to someone when talking. This is also called pragmatic Voice --- how our voices sound. We may sound hoarse, lose our voices easily, talk too loudly or through our noses, or be unable to make sounds. Fluency --- also called stuttering, is how well speech flows. Someone who stutters may repeat sounds, like t-t-t-table, use \"um\" or \"uh,\" or pause a lot when talking. Many young children will go through a time when they stutter, but most outgrow it. Cognitive-communication --- how well our minds work. Problems may involve memory, attention, problem solving, organization, and other thinking skills. Feeding and swallowing --- how well we suck, chew, and swallow food and liquid. A swallowing disorder may lead to poor nutrition, weight loss, and other health problems. This is also called dysphagia **Nutritionist** teaches others about general nutrition, food, and how what they eat affects their health Clinical nutritionists work with individuals or families in assessing, designing, and implementing dietary and nutritional strategies to improve their health. They may also be asked to address nutritional needs in people with specific medical issues like Hypertension, Diabetes, Obesity **Social work** Social work is a practice-based profession and an academic discipline that promotes social change and development, social cohesion, and the empowerment and liberation of people. Principles of social justice, human rights, collective responsibility and respect for diversities are central to social work concerned with meeting the basic needs of individuals, families, groups, communities, and society as a whole to enhance their individual and collective well-being **What is nursing?** The use of clinical judgement in the provision of care to enable people to improve, maintain, or recover health, to cope with health problems, and to achieve the best possible quality of life, whatever their disease or disability, until death. (RCN 2003:3) **The nurse's role within an interdisciplinary team** Create links with other professionals who can provide ongoing support to the client Collaborate with other professionals in order to meet one's needs Provide information to clients about services available Provide knowledge about one's condition according to client's wishes Communicate effectively with other professionals and clients/family members Like other professionals the nurse need to use therapeutic skills (helping skills) to deal with client's concerns, issues, thoughts and emotions that may be influential on one's holistic wellbeing Practice within an ethical and legal framework; hence be aware of ethical and legal guidelines and procedures Liaise between acute and community health care services/professionals Use specific skills and knowledge depending on the area in which they are working; example nurse working within a wound care clinic needs to use specific skills and knowledge on wound management while the school nurse need to use skills related to child's and adolescent's health such as developmental issues, sex education and bullying Topic 6: **The concept of Care in Nursing** Caring is defined as a concept central to the practice of professional nursing (AACN, 1998) υ It is a core value that encompasses  Altruism  Autonomy  Human dignity  Integrity  Social justice **Caring Theories** υ The nursing caring theories provide a link between generic caring and the uniqueness of caring in nursing υ Generic care is a fundamental aspect of humans and may include assisting, supporting and facilitating others in such a way to improve their life υ The caring nurse own a set of learned actions, techniques and processes which are communicated to patients/clients. Watson's Human Caring Theory Leininger's Culture Care Diversity and Universality Theory Roach's Conceptualisation of Caring **Jean Watson's Theory of Human Caring** υ Proposes a philosophical approach to caring which reflects her existential (being), phenomenological (knowing), and spiritual influences υ Nursing centers around helping people to gain a higher degree of harmony within the mind, body and soul υ Caring is both an art and a science (humanistic-scientific combination) υ It can be demonstrated only through interpersonal relationships **Jean Watson's Theory of Human Caring** **10 carative factorts** υ Humanistic-altruistic system of values υ Faith-hope υ Sensitive to faith and others υ Helping-trusting, human care relationship υ Expressing positive and negative feelings υ Creative problem-solving caring process υ Transpersonal teaching-learning υ Supportive, protective and/or corrective mental, physical, societal and spiritual environment υ Human needs assistance υ Existential-phenomenological-spiritual factors **Madeleine Leininger's Theory of Culture Care** υ Caring and culture are inextricably linked υ Cultures vary in the way they perceive and practice care but the common factor is that they all aim to provide care -- diversity and universality υ There can be no cure without care, but there can be care without cure υ The goal of nursing should be to work towards an understanding of care and the values, health beliefs and lifestyles of different cultures **Caring includes** υ assistive υ supportive υ facilitative acts toward or for another individual or group with evident or anticipated needs. Caring serves to ameliorate or to improve human conditions or ways of living. Caring is essential to - human development, - growth, - survival. **Caring behaviors include:** - Comfort - Compassion - Concern - Coping behavior - Interest - Involvement - Health consultative acts - Health maintenance acts - Helping behaviours - Love - Nurturance - Presence - Protective behaviours - Restorative behaviours - Sharing - Stimulating behaviours - Stress alleviation - Tenderness - Touching - Trust **Simone Roach's Conceptualization of Caring** Caring is the human mode of being (humanistic perspective) υ Caring is not unique to nursing but unique in nursing **The main concepts of this theory are the attributes of caring ( The 5 C's)**  Compassion  Competence  Confidence  Conscience  Commitment **Simone Roach's Conceptualisation of Caring** **Compassion** A way of living born out of awareness of one's relationship to all human beings; a quality of presence which allows one to share with and make room for the other **Competence** The state of having the knowledge, judgment, skills, energy, experience & motivation required to respond adequately to the demands of one's professional responsibility **Confidence** The quality that fosters trusting relationships **Conscience** A state of moral awareness; directing one's behaviour according to the moral state **Commitment** A complex affective response characterised by a convergence between one's desires & one's obligations, & by a deliberative choice to act in accordance with them **What is an Art?** υ Composed of skills that require expertise for their competent education. υ It is the creative use of knowledge in service to others. υ Originally nursing considered as an 'art'. Called 'born nurses' (natural / untaught). Art improved by practice. Need little education as nurses only carry out doctors orders. **What is a Science** It requires systemized knowledge derived from observation, critical thinking, study and research. υ Nursing as a 'Science'...Gradually, as the body of scientific knowledge grew, nurses aware of the basic principles for practice. υ Nursing shares its 'science' from other disciplines.  υ "the science of nursing is the knowledge base for the care that is given, and the art of nursing is the skilled application of that knowledge to help others achieve maximum health and quality of life **Conclusion** : Nursing is indeed an art and science. Science helps to explain the work of a nurse, while art addresses the human connections, empathetic communication, and dedicated care and compassion that make nursing a critical element of healthcare.