Fundamentals of Nursing PDF

# TOP RANK REVIEW ACADEMY - NURSING MODULE ## Fundamentals of Nursing ### Definitions of Nursing - **American Nursing Association (2003)** - Nursing is the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the d...

# TOP RANK REVIEW ACADEMY - NURSING MODULE ## Fundamentals of Nursing ### Definitions of Nursing - **American Nursing Association (2003)** - Nursing is the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations. - **Florence Nightingale** - Act of utilizing the environment of the patient to assist him in his recovery. - **Virginia Henderson** - The unique function of the nurse is to assist the individual, sick or well, in the performance of those activities contributing to health or its recovery (or to a peaceful death) that he would perform unaided if he had the necessary strength, will, or knowledge, and to do this in such a way as to help him gain independence as rapidly as possible. ### Nursing Theories and Conceptual Framework - **Florence Nightingale (1820-1910)** - Considered the first nursing theorist and earned the title "Nursing with a Lamp" - **Environmental Theory** - Five environmental factors: - Pure/fresh air - Pure water - Efficient drainage - Cleanliness - Light (direct sunlight) - Deficiencies in these five factors produce lack of health or illness. - Stressed the importance of keeping the client warm, maintaining a noise-free environment, attending to the client's diet. - **Virginia Henderson** - **The Nature of Nursing Model** - Conceptualizes the nurse's role as assisting sick or healthy individuals to gain independence in meeting the 14 Fundamental Needs: - Breathing normally - Eating and drinking adequately - Eliminating body wastes - Moving and maintaining a desirable position - Sleeping and resting - Selecting suitable clothes - Maintaining body temperature - Keeping the body clean and well-groomed - Avoiding dangers and injuring others - Communicating with others - Worshipping according to one's faith - Working in such a way that one feels a sense of accomplishment - Participating in various recreation - Learning, discovering, or satisfying the curiosity that leads to normal development and health - **Faye Glenn Abdellah** - **Patient-Centered Approaches to Nursing Model** - Identifies 21 nursing problems. - Defines nursing as a service to individuals and families. - Conceptualizes nursing as an art and science that molds the attitudes, intellectual competencies and technical skills of the individual nurse into the desire and ability to help people, sick or well, and cope with their needs. - **Dorothy E. Johnson** - **Behavioral System Model** - Each person as a behavioral system is composed of 7 subsystems: - Injective - Eliminative - Affiliative - Aggressive - Dependence - Achievement - Sexual and role identity - **Imogene King** - **Goal Attainment Theory** - Viewed nursing as an interaction process between patient and nurse that lead to goal attainment. - Patient has 3 interacting systems: - Operational system (individuals) - Interpersonal system (nurse-patient) - Social system (health care system) - **Madeleine Leininger** - **Transcultural Nursing Model (Cultural Care Diversity and Universality Theory)** - Emphasizes that human caring, although universal, varies among cultures in its expressions, process and patterns; it is largely culturally derived. - Presents 3 intervention modes: - Culture care preservation and maintenance - Culture care accommodation, negotiation, or both - Culture care restructuring and repatterning - **Myra Estrin Levine** - **Four Conservation Principles** - Proposed principles which are concerned with the unity and integrity of the individuals. - Conservation of energy - Conservation of structural integrity - Conservation of personal integrity - Conservation of social integrity - **Betty Neuman** - **Health Care System Model** - Asserted that nursing is a unique profession in that it is concerned with all the variables affecting the individuals' response to stress, which are intrapersonal stressors (within the individual), interpersonal (occurs between individuals), and extrapersonal (outside the person) in nature. - Nursing interventions focus on retaining or maintaining system stability. - **Dorothea Orem** - **Self-care and Self-care deficit Nursing Theory** - Defines self-care as performing activities independently by individual throughout life to promote and maintain personal well-being. - Identifies 3 types of nursing systems: - Wholly Compensatory - for individuals who are unable to control and monitor their environment and process information. - Partly Compensatory - designed for individuals who are unable to perform some, but not all, self-care activities. - Supportive-Educative - for clients who need to learn to perform self-care measures and need assistance to do so. - **Hildegard Peplau** - **Psychodynamic (Interpersonal Relations) Model** - Use of therapeutic relationship between nurse and the client - 4 phases: - Orientation - Identification - Exploitation - Resolution - **Martha Rogers** - **Science of Unitary Human Being** - Views the person as an irreducible whole; the whole being is greater than the sum of its parts. - According to Rogers, unitary man: - Is an irreducible, four-dimensional energy field by pattern - Manifests characteristics different from the sum of the parts - Interacts continuously and creatively with the environment - Behaves as a totality - As a sentient being, participates creatively in change. - **Sister Callista Roy** - **Adaptation Model** - Defines adaptation as the process and outcome whereby the thinking and feeling person uses conscious awareness and choice to create human and environmental integration. - Goal of the model is to enhance life processes through adaptation in four adaptive modes: - Physiologic Mode - Self-concept mode - Role-function mode - Interdependence Mode - **Lydia Hall** - **Care, Core, and Cure Model** - Care - nurturance and is exclusive to nursing. - Core - involves the therapeutic use of self and emphasizes the use of reflection. - Cure - focuses on nursing related to the physician's orders - **Ida Jean Orlando (1961)** - **The Dynamic Nurse-Patient Relationship Model** - Nurses provide direct assistance to meet an immediate need for help in order to avoid or alleviate distress or helplessness. - She advocated that the three elements composing the nursing situation are: - Client behavior - Nurse reaction - Nurse action - **Jean Watson (1979)** - **Human Caring Theory** - Practice of caring is central to nursing; it is the unifying focus for practice - Formation of humanistic-altruistic system of values - Instillation of faith and hope - Cultivation of sensitivity to one's self and others - Development of helping-trusting relationship - Promoting and accepting the expression of positive and negative feelings - Systematically using the scientific problem-solving method for decision making - Promoting transpersonal teaching-learning - Provision of a supportive, protective, and/or corrective mental, physical, societal, and spiritual environment - Assisting with gratification of human needs - Allowance for existential-phenomenological-spiritual forces - **Rosemarie Rizzo Parse** - **Human Becoming Theory** - Proposed 3 assumptions about human becoming: - Human becoming is freely choosing personal meaning in situations in the intersubjective process of relating value priorities. - Human becoming is co-creating rhythmic patterns or relating in a mutual process with the universe. - Human becoming is contrascending multidimensional with the emerging possibilities emphasizes how individuals choose and bear responsibility for patterns of personal health. ### Scope of Nursing Practice - **Promoting Health and Wellness** - A process that engages in activities and behaviors that enhance quality of life and maximize personal potential. - Activities that enhance healthy lifestyles: - Improving nutrition and physical fitness - Preventing drug and alcohol misuse - Restricting smoking - Preventing accidents and injury at home and workplace. - **Preventing Illness** - Goal of illness prevention program is to maintain optimal health by preventing disease which includes: - Immunizations - Prenatal and infant care - Prevention of STIs - **Restoring Health** - Focuses on the ill client and it extends from early detection of disease through helping the client during the recovery period. - Activities include: - Providing direct care to the ill client - Performing diagnostic and assessment procedures - Teaching clients about recovery activities - Rehabilitating clients to their optimal functional level. - **Caring for Dying** - Comforting and caring for people of all ages who are dying, which includes: - Helping clients live as comfortably as possible until death - Helping support persons to cope with death. ## Standard of Nursing Practice - **Assessment** - Collect comprehensive data pertinent to the patient's health or situation. - **Diagnosis** - Analyzes the assessment data to determine the diagnoses or the situation - **Outcome Identification** - Identifies expected outcomes for a plan individualized to the patient or the situation. - **Planning** - Develops a plan that prescribes strategies and alternatives to attain expected outcomes. - **Implementation** - Implements the identified plan. - **Evaluation** - Evaluates progress towards attainment of outcomes. - **Quality of Practice** - Systematically enhance the quality and effectiveness of nursing practice. - **Education** - Attains knowledge and competency that reflects current nursing practice. - **Professional Practice Evaluation** - Evaluate one's own practice in relation to professional practice standards and guidelines, relevant statutes, rules, and regulations. - **Collegiality** - Interacts with and contributes to the professional development of peers and colleagues. - **Collaboration** - Collaborates with patients, family, and others in the conduct of nursing practice. - **Ethics** - Integrates ethical provisions in all areas of practice. - **Research** - Integrates research findings into practice. - **Resource Utilization** - Considers factors related to safety, effectiveness, cost, and impact on practice on the planning and delivery of nursing services. - **Leadership** - Provides leadership in the professional practice setting and the profession. ## Roles and Functions of a Nurse - **Caregiver** - Encompasses activities that assist the client physically and psychologically while preserving the dignity of the client. - Nurse is primarily concerned with the client's needs. - **Communicator** - Communicates the identified problem of the client to other health care team. - **Teacher** - Nurse teaches the client about their health and procedures they need to perform to restore their health. - **Client Advocate** - Acts to protect the client. - Nurse assists clients in exercising their rights and helps them speak for themselves. - **Counselor** - Nurse provides emotional, intellectual, and psychological support. - **Change Agent** - Nurse assists clients to make modifications in their behavior. - **Leader** - Influences others to work together to accomplish a specific goal. - **Manager** - Nurse plans, gives direction, develops staff, monitors operations, gives rewards fairly and represents both staff members and administration as needed. - **Case Manager** - Works with the multidisciplinary health care team to measure the effectiveness of the case management plan and monitor outcomes. - **Researcher** - Nurse participates in scientific investigation and uses research findings to improve client care. - **Collaborator** - Nurse Works in combined effort with all those involved in care delivery. ## Expanded Career Roles for Nurses - **Nurse Practitioner** - Nurses who have advanced education & graduated from a nurse practitioner program. - Employed in health care agencies or community-based settings. - Deals with non-emergency acute or chronic illness & provide primary ambulatory care. - **Clinical Nurse Specialist** - Has an advanced degree or expertise and is considered to be an expert in a specialized area of practice (gerontology, oncology). - Provides direct client care, educates others, conducts research, and manages care. - **Certified Registered Nurse Anesthetist (CRNA)** - Completed advanced education in an accredited program in the anesthesiology. - Carries out pre-op and post-op visits and assessments. - Administers general anesthesia for surgery under the supervision of a physician prepared in anesthesiology. - Also assesses the postoperative status of clients. - **Nurse-Midwife** - RN who has completed a program in midwifery and gives prenatal & postnatal care and manages deliveries in normal pregnancies. - May also conduct pap smears, family planning and routine breast exams. - **Nurse Researcher** - Investigates nurse problems to improve nursing care and to refine and expand nursing knowledge. - Employed in academic institutions, teaching hospitals and research centers, and usually has advanced education at the doctorate level. - **Nurse Administrator** - Manages client care, including the delivery of nursing services. - Functions: - Budgeting - Staffing and planning programs - **Nurse Educator** - Responsible for classroom and clinical teaching. - **Nurse Entrepreneur** - Manages health-related businesses ## Patricia Benner's Stages of Nursing Expertise - **Stage I (Novice)** - No experience (student nurse) - Performance is limited, flexible, and governed by context-free rules and regulations rather than experience. - **Stage II (Advanced Beginner)** - Demonstrates marginally acceptable performance. - Recognizes meaningful "aspects" of a real situation. - Experienced enough real situations to make judgments about them. - **Stage III (Competent)** - 2-3 years of experience. - Demonstrates organizational and planning abilities. - Differentiates important factors from less important aspects of care. - Coordinates multiple complex care demands. - **Stage IV (Proficient)** - 3-5 years of experience. - Perceives situations as a whole rather than in terms of parts. - Uses maxims as guides for what to consider in a situation. - Has holistic understanding. - Focuses on long-term goals of the client, which improves decision-making actions. - **Stage V (Expert)** - No longer requires rules, guidelines, or maxims to connect an understanding of the situations to appropriate actions. - Performance is fluid, flexible, and highly proficient. - Inclined to take a certain action because "it feels right". ## Communication in Nursing - Interchange of information between two or more people: exchange of ideas and thoughts. - In addition, thoughts are conveyed to others not only by spoken or written words but also by gestures or body actions. - **Verbal Communication** uses spoken or written words. - **Non-verbal communication** uses gestures, facial expressions, posture/gait, body movements, physical appearance, eye contact and tone of voice. - **Components of communication** - **Sender** - is the person who encodes and delivers the message. - **Message** - the content of the communication, may contain verbal, nonverbal, and symbolic language. - **Receiver** - the person who receives and decodes the message - **Channel** - means of conveying and receiving messages through visual, auditory, and tactile senses. - **Response/feedback** - message returned by the receiver to the sender. ## Characteristics of Communication - **Simplicity** - use of commonly understood words. - **Pace and Intonation** - modifies the feeling and the impact of the message. - **Clarity and Brevity** - a message that is direct and simple. - **Timing and Relevance** - require choice of time and consideration of client's interest and concern. - **Adaptability** - message needs to be altered in accordance with behavioral cues from the client. - **Credibility** - means worthiness of belief, trustworthiness, and reliability - **Humor** - used to help clients adjust to difficult and painful situations. ## Documentation - Written or computer-based. - Served as a permanent record of client's information and progress care. - Formal, legal document that provides evidence of a client's care. ## Purposes of Documentation - Planning client care - Communication - For legal documents purposes - For research - For education - Reimbursement - For statistics, reporting, epidemiology - Auditing health agencies - Health care analysis ## Types of Records - **Source-Oriented Medical Record (Traditional Client Record/ SOMR)** - Each person or department makes notations in a separate section/s of client's chart. - Specific information is easier to locate - Components of SOMR - Admission sheet - Face sheet - Medical history and physical examination and sheet - Diagnostic finding sheet - TPR graphic sheet - Doctor's treatment and order sheet - Therapeutic sheet - Special flow sheet - Medication record - Nurses notes - Client discharge plan and referral summary - Initial nursing assessment. - **Problem-Oriented Medical Record** - Data about the client is recorded and arranged according to the sources of the information. - Records integrate all data about the problem, gathered by members of the health team. - **4 Basic Components of POMR** - **Database** - contains all information from the patient when he first entered the agency. It includes nursing assessment, physician's history, social and family data, results of physician's examination. - **Problem Lists** - contains all the aspects of the person's life requiring health care. - Kept in front of the chart - Problems are listed in the order, which they are identified. - Continually updated as new problems are identified and others are resolved. - **Initial list of orders or plan of care** - made with reference to the active problems and are generated by the person who lists the problem. - **Progress Notes** - which includes nurses' narrative notes (SOAPIE, SOAPIE, SOAPIER) - **KARDEX** - Provides a concise method of organizing and recording data about the client, making information readily accessible to all members of the health care team. - May be written in a pencil to ease in recording frequent change in details of client care. - A series to flip cards usually kept in portable file. ## General Guidelines for Recording - **Date and Time** - For legal reasons and client's safety. - Record the time in conventional manner (ex. 9:00 am or 3:15 pm) or according to 24-hour clock (military time) to avoid confusion about whether time was am or pm. - **Timing** - Adjust the frequency as per client's condition indicates - No recording should be done BEFORE providing nursing care. - Documenting should be done as soon as possible after assessment/intervention - **Legibility** - All entries must be easy to read to prevent interpretation errors. - **Permanence** - Records are made in dark permanent ink. - **Use of accepted terminology** - Use only commonly accepted abbreviation, symbols and terms that are specified by the agency. - **Correct Spelling** - Is essential for accuracy in recording. - If unsure how to spell, look it up in a dictionary or other resource book. - **Signature** - Each recording in nursing notes is signed by the nurse making it. - Include name and title (ex. Ralf Jake M. Faustino RN). - **Accuracy** - Clients' names should be written on each page of the clinical record. - Accurate notations consist of facts/observations rather than opinions or interpretation. - *e.g. Fact: "Client refused medication"* - *e.g. Opinion: "Client was uncooperative"* - When recording a mistake is made, draw a line through it and write the words "mistaken entry" (avoid writing the word error) above or next to the original entry with your initials or name. - Do not erase, blot out, or use correction fluid. - Write every line but not between lines. - If a blank appears in the notation, draw a through the blank space and sign the notation. - **Sequence** - Document events in the order in which they occur. - **Appropriateness** - Record only information that pertains to the client's health problems and care. - Recording irrelevant information may be considered an invasion of the client's privacy. - **Completeness** - Information needs to be complete and helpful to the client and health care professionals. - Care that is omitted because of client's refusal of treatment must also be recorded. Document what and why it is omitted and who was notified. - **Conciseness** - Recording needs to be brief as well as completed to save time in communication. - **Legal Prudence** - Accurate and complete documentation should be a legal protection to the client and health care team. - **Confidentiality** - Only the health professionals who participate in the care of the client are allowed to read the chart. ## Reporting - Takes place when two or more people share information about client care, either face-to-face or via telephone. - **Types of Reporting** - **Change-of-shifts report or endorsement** - For continuity of care of clients by providing quick summary of health care needs and details of care to be given. - It is not merely reciting the content of the KARDEX. - **Telephone Reports** - Provide clear, accurate and concise information: - Date and time - Name of the person giving the information - Subject of information received - Name and signature of the receiver. - Person receiving the information should repeat it back to the sender to ensure accuracy. - **Telephone Orders** - Only RN's may receive telephone orders. - Another RN should listen in another telephone line to countercheck the details. - Write the date and time the telephone order was received. - Write the complete order and read it back. - Question primary care provider about any order that is unusual or contraindicated to client's condition. - **Transfer Report** - Done when transferring a client to another unit. ## Nursing Process - To identify client's health status - **Purposes of nursing process** - Actual health problem - Potential health problems or needs - To establish plans to meet identified needs - To deliver specific nursing care and improve the quality of care. ## Characteristics of Nursing Care - **Cyclical (regularly repeated events) & Dynamic (continuously changing)** - **Client-centered** - organizes the plan or care according to the client's problems rather than nursing goals. - **Focused on Problem Solving** - nursing process is directed towards the client's responses to disease and illness. - **Decision making** - involved in every phase of nursing process. - **Interpersonal and Collaborative** - Communicates with the client and family. - Collaborates with other members of the health care team - **Universally applicable** - used in all types of health care settings with clients of all age groups. - **Nurses must use a variety of critical thinking skills to carry out the nursing process.** ## Components of the Nursing Process (ADPIE) <start_of_image> Areas include: - **Assessment** - **Diagnosis** - **Planning** - **Implementation** - **Evaluation** ### Assessment - Assessment is a systematic and continuous collection, organization, validation, and documentation of data about the client's health status. - **Purpose:** Establish a database. - **Activities During Assessment** - **Data Collection** - Gathering information about the client, considering the physical, psychological, emotional, social-cultural, and spiritual factors that may affect his/her health status. - **Sources of data** - **Primary** - **Secondary** - Support people (family members, friends, and caregivers who know the client well). - Client records: - Medical records - past and present health and illness patterns - Records of therapies: social workers, nutritionists, dieticians, physical therapists - Laboratory records - Health care professionals - Literature - **Data Collection Methods** - **Observing** - gathers data by using the senses. - 2 aspects: - Noticing the data - Selecting, organizing, and interpreting data. - **Interviewing** - is a planned communication or a conversation with a purpose. - 2 approaches: - **Directive** - Highly structured and elicits specific information. - Uses closed-ended questions (YES/NO) - The nurse establishes the purposes and controls the interview. - Used when you need to elicit specific data. - Used in emergency situations. - **Non-directive (rapport-building)** - Nurse allows the client to control the purpose, subject matter, and pacing. - Uses more open-ended questions. - Advantage: allows the patient to explain certain information - Stages of Interview - **The Opening** - Most important - Establish rapport - Orientation - **The Body** - the client communicates what he or she thinks, feels, and perceives in response to the question. - **The Closing** - termination of the interview. - **Data Organization** - Clustering/organizing of facts into groups of information. - Nurse uses a written/computerized data systematically. - **Validating Data** - Double checking or verifying data to confirm that is accurate and factual. - **Documenting Data** - Accurate documentation is essential and should include all data collected about the client's health status. - **4 Types of Assessment** - **Initial Assessment** - Perform within the specified time after admission. - Main purpose is to create a database for problem identification reference and future comparison. - **Problem-focused Assessment** - Integrated throughout the nursing process. - Purpose is to determine the status of a specific health problem (ex. Hydration status every 15 minutes). - **Emergency Assessment** - Done during an acute physiologic and psychologic crisis of the client - Purpose: identify life-threatening condition and to identify new or overlooked problems. - Framework and principle in emergency assessment: - A- Airway - B- Breathing - C- Circulation - Use either Maslow's Hierarchy of needs or ABC principles. - **Time-lapsed Assessment** - Done several months after the initial assessment. - Purpose: to compare clients' current status to baseline data (initial assessment) previously obtained. ## Diagnosis (2nd Phase of Nursing Process) - The process, which results to a diagnostic statement or nursing diagnosis. It is the clinical act of identifying problems. - **Purpose:** to identify the client's health care needs and to prepare a diagnostic statement. - **Activities During Diagnosing** - Organized clustering/grouping of data. - Compare data with standards (norm) - Analyze data after comparing with standards. - Identifying gaps & inconsistencies in data. - Determine the client's health problems, risks, and strengths. - Final output: Nursing Diagnosis statement. - **Nursing diagnosis** is a statement of the client's potential or actual alteration of health status. - It uses the critical-thinking skills of analysis and synthesis. - **Basic 2-part statements** - **Problem** (statement of the client's response). - **Etiology** (factors contributing to or probable causes of the responses). - The two parts are joined by the words "related to" (implies relationship). - e.g.: Constipation related to prolonged laxative use - e.g.: Ineffective breast feeding related to breast engorgement - **Basic 3-part statements** (PES format) - **Problem** - **Etiology** - **Signs and symptoms** (defining characteristics manifested by the client) - e.g. "Self-esteem is related to rejection by husband as manifested by hypersensitivity to criticism: states 'I don't know if I can manage by myself'" and rejects positive feedback. - **One-part statements** - Consists of NANDA label only. - e.g.: Rape-Trauma syndrome; Anticipatory grieving. - **Collaborative problems** - Suggested that all collaborative problems begin with diagnostic label "Potential Complications". - e.g.: Potential complications of head injury: Increased intracranial pressure. - **Purpose of NANDA** - To define, refine, and promote taxonomy (classification or system or set of categories arranged on the basis of a single principle or set of principles) of nursing diagnostic terminology of general use to professional nurses. - **Members** - Staff nurses - Clinical specialists - Faculty, directors of nursing - Deans, theorists, and researchers - **Types of Nursing Diagnosis** - **Actual Diagnosis** - Client problem that is present at the time of the nursing assessment (based on the presence of associated signs and symptoms). - e.g.: Ineffective breathing pattern; Anxiety - **Risk Nursing Diagnosis** - Clinical judgment that a problem does not exist, but the presence of risk factors indicates that a problem is likely to develop unless nurses intervene. - e.g.: Risk for Infection - **Wellness Diagnosis** - Describes human responses to levels of wellness in an individual, family, or community that have a readiness for enhancement. - e.g.: Readiness for enhanced spiritual well-being; Readiness for enhanced family coping - **Possible Nursing Diagnosis** - Evidence about a health problem is incomplete or unclear. - e.g.: Possible social isolation related to unknown etiology. - **Syndrome Diagnosis** - Associated with a cluster of other diagnoses. - e.g.: Risk for disuse syndrome; Impaired physical mobility; Risk for infection; Impaired gas exchange. ## Planning - Deliberative, systematic phase of nursing process that involves decision making and problem solving. - **Goal setting:** to have criteria for evaluation. - **For the goal to be useful during evaluation, it should be stated in BEHAVIORAL TERMS** - **To be effective, involve the patient and family.** - **Types of Planning** - **Initial Planning** - done by the nurse who performs the admission assessment. - **Ongoing Planning** - Done by all nurses who work with the client. - **Discharge planning** - Occurs at the beginning of a shift as the nurse plans the care to be given that day. - Process of anticipating and planning for needs after discharge, is a crucial part of comprehensive health care. - Begins at first client contact and involves comprehensive & ongoing assessment to obtain information about client's ongoing needs. - **The Planning Process** - Setting priorities - Establishing client goals/desired outcomes - Selecting nursing interventions - Writing individualized nursing interventions on care plans - **Guidelines for Writing Nursing Care Plans** - Date and sign the plan. - Use category headings. - Use standardized/approved medical or English symbols and key words rather than complete sentences to communicate your ideas unless the agency policy dictates otherwise.. - Be specific. - Refer to procedure books or other sources of information rather than including all the steps on a written plan. - Tailor the plan to the unique characteristics of the client by ensuring that the client's choices such as preferences about the times of care and methods used are included. - Ensure that the nursing plan incorporates preventive and health maintenance aspects as well as restorative ones. - Ensure that the plan contains interventions for ongoing assessment. - Include collaborative and coordination activities in the plan. - Include plans for the client's discharge and home care needs. - **Characteristics of the Planning Process (CSMART)** - Client-centered - Specific - Measurable - Attainable - Realistic - Time bound ## Implementation - Doing and documenting the activities that are specific nursing actions needed to carry out the interventions (or nursing orders). - Reassessing the client before implementing an intervention. - Determining the nurse's need for assistance. - Implementing the nursing interventions. - Supervising the delegated care. - Documenting nursing activities. ## Requirements for Implementation - Adequate knowledge - Technical skills - Communication skills - Therapeutic use of self - Right attitude ## Evaluation - Collecting data, comparing data, and relating nursing activities to outcomes. - Drawing conclusions about problem status. - Continuing, modifying, or terminating the NCP (Nursing Care Plan). - **Types of Evaluation** - **On-going/Formative Evaluation** - Done during or immediately after the intervention. - Allows the nurse to decide and make on-the-spot modifications/s in an intervention. - **Intermittent Evaluation** - Done at a specified time & it shows the extent of progress of the patient. - Enables the nurse to correct deficiencies and modify the nursing care plan. - Importance: It determines whether the goals are met, partially met, or unmet. - When goals have been partially met or when goals have not been met, two conclusions may be drawn: - The care plan may need to be revised, since the problem is only partially resolved. - Or the care plan does not need revision, because the client merely needs more time to achieve the previously established goal(s). ## Concepts of Health and Illness - **Health** is a state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity (WHO). - **Health** is the ability to maintain homeostasis or dynamic equilibrium. Homeostasis is regulated by the negative feedback mechanism (Walter Cannon). ## Models of Health and Illness - **Travis's Illness-Wellness Continuum** - The illness-wellness continuum developed by Travis ranges from high-level wellness to premature death. - The model illustrates two arrows pointing in opposite directions and joined at a neutral point. - Movement to the right of the neutral point indicates increasing levels of health and well-being for an individual. This is achieved in three steps: - Awareness - Education - Growth - In contrast, movement to the left of the neutral point indicates progressively decreasing levels of health. - **Health Belief Model** - The model of Becker (1975) which describes the relationship between a person's belief and behavior. - Individual perceptions and modifying factors may influence health beliefs and preventive health behavior. - **Individual perceptions** include the following: - Perceive susceptibility to illness - Perceive seriousness of an illness - Perceive threat of an illness - **Modifying factors** including the following: - Demographic variables (age, sex, race, etc.) - Socio-psychologic variables (pressure from peers) - Structural variables (knowledge about the disease) - Cues to action (internal: fatigue; external: mass media) - **Smith's Model of Health** - **Clinical model** - identifies health as the absence of signs and symptoms of disease or injury. - **Role performance model** - health is identified in terms of individual's ability to perform his/her work. - **Adaptive model** - Health is a creative process; disease is a failure in adaptation; focuses on the ability of the person to cope. - **Eudemonistic model** - health is seen as a condition of actualization or realization of person's potential. - **Leavell and Clark's Agent-Host-Environmental Model (Ecologic Model)** - States that there are three interactive factors that affect health and illness. - **Agent** - any factor or stressor that can cause or lead to illness. - **Host** - person who may or may not be at risk of acquiring the disease. - **Environment** - any factor external to the host that may or may not predispose the person to the development of the disease. - **Illness** - is the state in which the person's physical, emotional, intellectual, social, developmental, or spiritual functioning is diminished or impaired compared with previous experiences. - **Disease** - an alteration in body functions resulting in reduction of capacities or a shortening of the normal life span. - **Common Causes of Disease** - Biologic agents (microorganisms). - Inherited