Fundamental of Nursing Theory PDF

Introduction Nursing is an art and a science. As a professional nurse you will learn to deliver care artfully with compassion, caring, and respect for each patient’s dignity and personhood. As a science, nursing practice is based on a body of knowledge that is continually changing with new disc...

Introduction Nursing is an art and a science. As a professional nurse you will learn to deliver care artfully with compassion, caring, and respect for each patient’s dignity and personhood. As a science, nursing practice is based on a body of knowledge that is continually changing with new discoveries and innovations. Definition of nursing. 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 responses; and advocacy in health care for individuals, families, communities, and populations. (ANA, 2018). Definition of a Nurse. The nurse is a person who has completed a program of basic, generalized nursing education and is authorized by the appropriate regulatory authority to practice nursing in his/her country. Aim of nursing: Four broad aims of nursing practice can be identified in the definitions of nursing: 1. To promote health 2. To prevent illness 3. To restore health 4. To facilitate coping with disability or death To meet these aims, the nurse uses knowledge, skills, and critical thinking to give care in a variety of traditional and expanding nursing roles. 3|Page The nursing profession and its characteristics: A variety of career opportunities are available in nursing, including clinical practice, education, research, management, administration, and even entrepreneurship. As a student it is important for you to understand the scope of professional nursing practice and how nursing influences the lives of your patients, their families, and their communities. The patient is the center of your practice. Types of standards for nursing » Standards of Practice. The nursing process is the foundation of clinical decision making and includes all significant actions taken by nurses in providing care to patients. ▪ Assessment: The registered nurse collects comprehensive data pertinent to the patient’s health and/or the situation. ▪ Diagnosis: The registered nurse analyzes the assessment data to determine the diagnoses or issues. ▪ Outcomes Identification: The registered nurse identifies expected outcomes for a plan individualized to the patient or the situation. ▪ Planning: The registered nurse develops a plan that prescribes strategies and alternatives to attain expected outcomes. ▪ Implementation: The registered nurse (RN) implements the identified plan. ▪ Evaluation: The nurse evaluates progress toward attainment of outcomes. 4|Page » Standards of Professional Performance: The American Nurses Association ANA Standards of Professional Performance describes a competent level of behavior in the professional role (ANA,2010). The standards provide a method to assure patients that they are receiving high-quality care. 1. Ethics: The registered nurse practices ethically. 2. Education: The registered nurse attains knowledge and competency that reflects current nursing practice. 3. Evidence-Based Practice and Research: The registered nurse integrates evidence and research findings into practice. 4. Quality of Practice: The registered nurse contributes to quality nursing practice. 5. Communication: The registered nurse communicates effectively in all areas of practice. 6. Leadership: The registered nurse demonstrates leadership in the professional practice setting and the profession. 7. Collaboration: The registered nurse collaborates with health care consumer, family, and others in the conduct of nursing practice. 8. Professional Practice Evaluation: The registered nurse evaluates her or his own nursing practice in relation to professional practice standards and guidelines, relevant statutes, rules, and regulations. 9. Resources: The registered nurse uses appropriate resources to plan and provide nursing services that are safe, effective, and financially responsible. 10. Environmental Health: The registered nurse practices in an environmentally safe and healthy manner. 5|Page The role of the nurse and its functions: Nurses provide care and comfort for patients in all health care settings and concern for meeting their patient’s needs. These roles are described as the following: - 1- Direct care provider/ caregiver: As a caregiver, the nurse integrates the roles of communicator, teacher, counselor, leader, researcher, advocate, and collaborator to meet physical, emotional, intellectual, sociocultural, and spiritual needs for all patients. 2- Communicator: The use of effective interpersonal and therapeutic communication skills to establish and maintain helping relationships with patients of all ages in a wide variety of healthcare settings. 3- Teacher/Educator: The use of communication skills to assess, implement, and evaluate individualized teaching plans to meet learning needs of patients and their families. 4- Counselor: The use of therapeutic interpersonal communication skills to provide information, make appropriate referrals, and facilitate the patient’s problem-solving and decision-making skills. 5- Leader: The assertive, self-confident practice of nursing when providing care, effecting change, and functioning with groups. 6- Researcher: The participation in or conduct of research to increase knowledge in nursing and improve patient care. 7- Advocate: The protection of human or legal rights and the securing of care for all patients based on the belief that patients have the right to make informed decisions about their own health and lives. 6|Page 8- Collaborator: The effective use of skills in organization, communication, and advocacy to facilitate the functions of all members of the healthcare team as they provide patient care. The nurse carries out these roles in many different settings, with care increasingly provided in the home and in the community. Examples for providing patients are the following: Hospitals Ambulatory surgery centers Emergency helicopter services Clinics Homes Educational programs Public health offices Doctors’ offices Industry Long-term care facilities Mobile healthcare units Schools Offices Hospice Mental health facilities State health programs Skilled-care facilities Churches Prisons 7|Page  Ethics in nursing profession Introduction Ethical values are essential for any healthcare provider. Ethical values are universal rules of conduct that provide a practical basis for identifying what kinds of actions, intentions, and motives are valued. Definition of ethics: Ethics are moral principles that govern how the person or a group will behave or conduct themselves. Definition of nursing ethics: systematic rules or principles governing right conduct. Each nurse, is practiced with the responsibility to adhere to the standards of ethical practice and conduct set by the profession. Ethical principles: Ethical principles are the basis of all nursing practice and provide a framework to help the nurse in ethical decision making. The primary ethical principles include: ▪ Beneficence: Acting for the good and welfare of others and including such attributes as kindness and charity. ▪ Nonmaleficence: Acting in such a way as to prevent harm to others or to inflict the minimal harm possible. ▪ Autonomy: Recognizing the individual’s right to self-determination and decision-making. ▪ Justice: Acting in fairness to all individuals, treating others equally and showing all individuals the same degree of respect and concern. 8|Page  ▪ Veracity: Being truthful, trustworthy, and accurate in all interactions with others. ▪ Fidelity: Being loyal and faithful to individuals who place trust in the nurse. ▪ Integrity: Acting consistently with honesty and basing actions of moral standards. International Council of Nurses Code of Ethics Preamble The ICN Code of Ethics for Nurses has four principal elements that outline the standards of ethical conduct Elements of the Code 1. Nurses and People 1. The nurse’s primary professional responsibility is to people requiring nursing care. 2. In providing care, the nurse promotes an environment in which the human rights, values, customs and spiritual beliefs of the individual, family and community are respected. 2. Nurses and Practice ▪ The nurse carries personal responsibility and accountability for nursing practice, and for maintaining competence by continual learning. ▪ The nurse maintains a standard of personal health such that the ability to provide care is not compromised 3. Nurses and the Profession ▪ The nurse assumes the major role in determining and implementing acceptable standards of clinical nursing practice, management, research and education. 9|Page  ▪ The nurse is active in developing a core of research-based professional knowledge. 4. Nurses and Co-workers ▪ The nurse sustains a co-operative and respectful relationship with co- workers in nursing and other fields. ▪ The nurse takes appropriate action to safeguard individuals, families and communities when their health is endangered by a co-worker or any other person. 10 | P a g e  Patient Safety Safety, often defined as freedom from psychological and physical injury, is a basic human need. Health care provided in a safe manner and a safe community environment is essential for a patient’s survival and well- being. Definition of patient safety: The world health organization (WHO) defined patient safety as the prevention of errors and adverse effects to patients associated with health care. Purpose of patient safety: It aims to prevent and reduce risks, errors and harm that occur to patients during provision of health care. A cornerstone of the discipline is continuous improvement based on learning from errors and adverse events. Factors influencing patient safety ▪ Age and Development ▪ Lifestyle factors that place individuals at risk for injury include unsafe environments. ▪ Mobility and Health Status Alterations in mobility related to paralysis, muscle weakness, diminished balance, and lack of coordination place clients at risk for injury. ▪ Sensory Perceptual Alterations Accurate sensory perception of environmental stimuli is vital to safety. ▪ Emotional State states can alter the ability to perceive environmental hazards. 11 | P a g e  ▪ Ability to Communicate Individuals with diminished ability to receive and convey information are at risk for injury. ▪ Environmental Factors Client safety is affected by the healthcare setting. ▪ Cognitive Awareness is the ability to perceive environmental stimuli and body reactions and to respond appropriately through thought and action. The Joint Commission National Patient Safety Goals Effective January 2023 for the Hospital Program Goal: Improve the accuracy of patient identification. ▪ Use at least two patient identifiers when administering medications, blood, or blood components; when collecting blood samples and other specimens for clinical testing; and when providing treatments or procedures. Goal: Improve the effectiveness of communication among caregivers. ▪ Report critical results of tests and diagnostic procedures on a timely basis. Goal: Improve the safety of using medications. ▪ Label all medications, medication containers, and other solutions on and off the sterile field in perioperative and other procedural settings. ▪ Reduce the likelihood of patient harm associated with the use of anticoagulant therapy. ▪ Maintain and communicate accurate patient medication information. 12 | P a g e Goal: Reduce patient harm associated with clinical alarm systems. ▪ Improve the safety of clinical alarm systems. Goal: Reduce the risk of health care-associated infections. ▪ Comply with either the current Centers for Disease Control and Prevention (CDC) hand hygiene guidelines or the current World Health Organization (WHO) hand hygiene guidelines. ▪ Implement evidence-based practices to prevent healthcare associated infections due to multidrug-resistant organisms in acute care hospitals and in nursing care centers. ▪ Implement evidence-based practices to prevent central line–associated bloodstream infections (CLABSI). ▪ Implement evidence-based practices for preventing surgical site infections. ▪ Implement evidence-based practices to prevent indwelling catheter- associated urinary tract infections (CAUTI). Goal: Reduce the risk of patient harm resulting from falls. ▪ Reduce the risk of falls. Goal: Prevent health care-associated pressure ulcers (decubitus ulcers). ▪ Assess and periodically reassess each patient’s and resident’s risk for developing a pressure ulcer and take action to address any identified risks. 13 | P a g e Goal: The organization identifies safety risks inherent in its patient population. ▪ Reduce the risk for suicide. ▪ Identify risks associated with home oxygen therapy, such as home fires. Goal: Improve health care equity. ▪ Improving health care equity for the organization’s patients is a quality and safety priority. Goal: Universal Protocol for Preventing Wrong Site, Wrong Procedure, Wrong Person Surgery ▪ Conduct a preprocedural verification process. ▪ Mark the procedure site. ▪ A time-out is performed before the procedure. 14 | P a g e  Health and Illness Concept Definition of Health Defining health is difficult. The World Health Organization (WHO) defines health as a “state of complete physical, mental, and social wellbeing, not merely the absence of disease or infirmity” (WHO, 1947). Definition of Illness o Illness is a state in which a person’s physical, emotional, intellectual, social, developmental, or spiritual functioning is diminished or impaired. o Cancer is a disease process, but one patient with leukemia who is responding to treatment may continue to function as usual, whereas another patient with breast cancer who is preparing for surgery may be affected in dimensions other than the physical. Acute and Chronic Illness Both acute and chronic illnesses have the potential to be life threatening. An acute illness is usually reversible, has a short duration, and is often severe. The symptoms appear abruptly, are intense, and often subside after a relatively short period. A chronic illness persists, usually longer than 6 months, is irreversible, and affects functioning in one or more systems. 15 | P a g e Characteristics of Acute and Chronic Illness Description Characteristics Acute Illness ▪ Usually, self-limiting Diseases that have a rapid onset and a short duration. ▪ Responds readily to treatment Examples: colds, influenza, acute ▪ Complications infrequent gastroenteritis ▪ After illness, return to previous level of functioning Chronic Illness ▪ Permanent impairments or deviations Diseases that are prolonged, do from normal. not resolve spontaneously, and are ▪ Irreversible pathologic changes rarely cured completely. ▪ Residual disability Examples: Alzheimer’s disease, ▪ Special rehabilitation required Arthritis, Cancer ▪ Need for long-term medical and/or nursing management Variables Influencing Health and Illness 1. Internal Variables ▪ Developmental Stage. A person’s thought and behavior patterns change throughout life. ▪ Intellectual Background. A person’s beliefs, knowledge, or incorrect information about body functions and illnesses, educational background, traditions, and past experiences. ▪ Perception of Functioning. The way people perceive their physical functioning affects health beliefs and practices. ▪ Emotional Factors. The patient’s degree of stress, depression, or fear can influence health beliefs and practices. ▪ Spiritual Factors. Spirituality including the values and beliefs exercised, the relationships established with family and friends, and the ability to find hope and meaning in life. 16 | P a g e 2. External Variables ▪ Family Practices. The way that patients’ families use health care services generally affects their health practices. Their perceptions of the seriousness of diseases and their history of preventive care behaviors. ▪ Psychosocial and Socioeconomic Factors. Socioeconomic and psychosocial factors increase the risk for illness and influence the way that a person defines and reacts to illness. ▪ Cultural Background. Cultural background influences beliefs, values, and customs. Health Promotion, Wellness, and Illness Prevention ▪ Health promotion activities such as routine exercise and good nutrition help patients maintain or enhance their present levels of health. ▪ Wellness education teaches people how to care for themselves in a healthy way and includes topics such as physical awareness, stress management, and self-responsibility. ▪ Illness prevention activities such as immunization programs protect patients from actual or potential threats to health. Levels of Preventive Care 1. Primary Prevention. Primary prevention is true prevention; it precedes disease or dysfunction and is applied to patients considered physically and emotionally healthy. Primary prevention aimed at health promotion includes health education programs, immunizations, nutritional programs, and physical fitness activities. 17 | P a g e 2. Secondary Prevention Secondary prevention focuses on individuals who are experiencing health problems or illnesses and are at risk for developing complications or worsening conditions. Activities are directed at diagnosis and prompt intervention, thereby reducing severity and enabling the patient to return to a normal level of health as early as possible. 3. Tertiary Prevention Occurs when a defect or disability is permanent and irreversible. It involves minimizing the effects of a long-term disease or a disability by interventions directed at preventing complications and deterioration. Activities are directed at rehabilitation rather than diagnosis and treatment. ▪ For example, a patient with a spinal cord injury undergoes rehabilitation to learn how to use a wheelchair and perform activities of daily living independently. Care at this level helps patients achieve as high a level of functioning as possible, despite the limitations caused by illness or impairment. 18 | P a g e  Students’ self-assessment Circle the letter that corresponds to the best answer for each question. Immunizing children against measles is an example of which of the following levels of preventive care? a. Primary b. Secondary c. Tertiary Referring an HIV-positive patient to a local support group is an example of which of the following levels of preventive care? a. Primary b. Secondary c. Tertiary Which of the following guidelines was developed by the American Hospital Association to enumerate the rights and responsibilities of patients while receiving hospital care? a. Code of Ethics b. Patient Bill of Rights c. Biomedical ethics d. Hospital patient advocacy 1. Mention Factors influencing patient safety 2. Enumerate The role of the nurse and its functions. 3. differentiate between Characteristics of Acute and Chronic Illness 19 | P a g e  References 1. American Nurses Association. (2021). Nursing: Scope and standards of practice (4th ed.). Silver Spring, MD: Author. 2. Chaet, D. (2016). The AMA Code of Medical Ethics’ opinions on ethics committees and consultations. AMA Journal of Ethics, 18, 499–500. doi:10.1001/journal of ethics. 3. Joint Commission. (2023). Hospital national patient safety goals. Hospital National Patient Safety Goals 2023. Available at: http://www.jointcommission.org. 4. Kozier, B. (2022). Fundamentals of nursing: concepts, process and practice. Eleventh edition. Pearson education. 5. Perry, A. G., & Potter, P. A. (2021). Fundamentals of nursing. tenth edition St. Louis, Elsevier Inc. [ 20 | P a g e  Chapter Two (Communication) ) Learning objective At the end student will be able to: Identify the communication Describe the components of the communication process Discuss the mods (forms) of communication Categories the levels of communication Describe factors influencing the communication process Discuss therapeutic communication technique 21 | P a g e  Introduction Communication is a critical skill for nursing. It is the process by which humans meet their survival needs, build relationships, and experience emotions. In nursing, communication is a dynamic process used to gather assessment data, to teach and persuade, and to express caring and comfort. It is an integral part of the helping relationship. Definition of communication Communication is the process of exchanging information and generating and transmitting meanings between two or more people. It is the foundation of society and the most primary aspect of a nurse patient interaction. Basic components of the communication process The communication process is initiated based on a stimulus; in this case a patient need that must be addressed. The need might be due to a patient’s discomfort or desire for information or to address any uncertainty the patient might be experiencing. 1. The sender or source (encoder) of the message is a person or group who initiates or begins the communication process. 2. The message is the actual communication product from the source It might be a speech, interview, conversation, chart, gesture memorandum, or nursing note. 3. The channel of communication is the medium the sender has selected to send the message. The channel might target any of the receiver’s senses. The message can be sent to the receiver through the following channels: ▪ Auditory—spoken words and cues ▪ Visual—sight, observations, and perception 22 | P a g e  ▪ Kinesthetic—touch Nurses use all three of these channels to communicate with patients and other health care providers. 4. The receiver (decoder) must translate and interpret the message sent and received. To be an effective communicator, the nurse needs to be considerate of the receiver, and select a message that appeals to the patient’s interests and that requires minimal effort and time to decode. 5. Confirmation of the message provides feedback (i.e., evidence) that the receiver has understood the intended message. Communication is a reciprocal process in which both the sender and the receiver of messages participate simultaneously. 23 | P a g e  The Mods (Forms) Of Communication The sending and receiving of messages is accomplished through verbal and nonverbal communication techniques. These can occur separately or simultaneously. 1. Verbal Communication - Verbal communication is an exchange of information using words including both the spoken and written word. Verbal communication depends on language, or a prescribed way of using words so that people can share information effectively. - Nurses use verbal communication extensively when providing patient care, including verbal interactions with patients and family giving oral reports to other nurses and health care providers developing nursing care plans, and evaluating patient progress. 2. Nonverbal Communication Nonverbal communication is the transmission of information without the use of words, also known as body language. It often helps nurses to understand subtle and hidden meanings in what the patient is saying verbally. The various forms of nonverbal communication follow. Touch Tactile sense has been studied seriously as a form of nonverbal communication only since the 1960s. Touch is a personal behavior and means different things to different people. Familial, regional, class, and cultural influences largely shape tactile experiences. 24 | P a g e  Eye Contact Communication often begins with eye contact. A glance, for example is often an attention-getting method to open conversation. In many cultures, eye contact suggests respect and a willingness to listen and to keep communication open. Facial Expressions The face is the most expressive part of the body. Examples of the various messages facial expressions convey are anger, joy, suspicion sadness, fear, and contempt. Posture The way a person holds the body carries nonverbal messages. People in good health and with a positive attitude usually hold their bodies in good alignment. Depressed or tired people are more likely to slouch Posture also often provides nonverbal clues concerning pain and physical limitations. General Physical Appearance Many illnesses cause at least some alterations in general physical appearance. Observing for changes in appearance is an important nursing responsibility for detecting illness or evaluating the effectiveness of care and therapy. Sounds. Sounds such as sighs, moans, groans, or sobs also communicate feelings and thoughts. They have several interpretations: moaning conveys pleasure or suffering, and crying communicates happiness, sadness, or anger. Validate nonverbal messages with the patient to interpret them accurately. 25 | P a g e 3. Electronic Communication - The Internet and a variety of social websites provide new and challenging opportunities for nurses to communicate and collaborate with other health care providers. - The challenges of using social media include protecting patient privacy and confidentiality and preventing unintended consequences for the employer or the nurse. Social Media Social media are web-based technologies that allow users to create share, and participate in dialogue in virtual communities and networks The availability of social media sites has dramatically changed communications among people, communities, and organizations social media networks allow nurses to share ideas, develop professional connections, access educational offerings and forums receive support, and investigate evidence-based practices. E-Mail and Text Messages E-mail and text messages are efficient means to communicate with staff members and, in some cases, patients. The risk for violating patient privacy and confidentiality exists any time a message is sent electronically. levels of communication Throughout our lives and the lives of our patients, communication occurs at varying levels. Nurses engage in four levels of communication during practice: ▪ intrapersonal communication ▪ interpersonal communication, ▪ small-group communication, ▪ Public communication 26 | P a g e  Intrapersonal communication is a powerful form of communication that occurs within an individual. This level of communication is also called self-talk self- verbalization or inner thought People's thoughts strongly influence perceptions, feelings, behavior, and self-concept. Interpersonal communication is one-on-one interaction between a nurse and another person that often occurs face to face. It is the level most frequently used (in nursing situations and lies at the heart of nursing practice.) Small-group communication is an interaction that occurs when a small number of people meet. This type of communication is usually goal-directed and requires an understanding of group dynamics. Public communication is interaction with an audience. Nurses have opportunities to speak with groups of consumers about health-related topics, present scholarly work to colleagues at conferences, or lead classroom discussions with peers or students. Factors influencing the communication process Many factors influence the communication process. Some of these are development, gender, values and perceptions, personal space, territoriality, roles and relationships, environment, congruence, interpersonal attitudes, and boundaries. 27 | P a g e  Development Language, psychosocial, and intellectual development move through stages across the lifespan. Knowledge of patient’s developmental stage will allow the nurse to modify the message accordingly. Gender From an early age, females and males communicate differently. Girls tend to use language to seek confirmation, minimize differences, and establish intimacy. Boys use language to establish independence and negotiate status within a group. Values and Perceptions Values are the standards that influence behavior, and perceptions are the personal view of an event. Because each individual has unique personality traits, values, and life experiences, each will perceive and interpret messages and experiences differently. Personal Space Personal space is the distance people prefer in interactions with others 1. Intimate: 0 to 1 12 feet 2. Personal: 1 12 to 4 feet 3. Social: 4 to 12 feet 4. Public: 12 feet and beyond 28 | P a g e  Environment People usually communicate most effectively in a comfortable environment. Temperature extremes, excessive noise, and a poorly ventilated environment can all interfere with communication. Interpersonal Attitudes Attitudes convey beliefs, thoughts, and feelings about people and events. Attitudes are communicated convincingly and rapidly to others. Therapeutic communication technique Therapeutic Communication Techniques are specific responses that encourage the expression of feelings and ideas and convey acceptance and respect. 1. Active Listening. Active listening means being attentive to what a patient is saying both verbally and nonverbally. Active listening facilitates patient communication. 29 | P a g e 2. Sharing Observations. Nurses make observations by commenting on how the other person looks, sounds, or acts. 3. Sharing Empathy. Empathy is the ability to understand and accept another person's reality, accurately perceive feelings, and communicate this understanding to the other. 4. Sharing Hope. Nurses recognize that hope is essential for healing and learn to communicate a "sense of possibility" to others. 5. Sharing Humor. Humor is an important but often underused resource in nursing interactions. 6. Sharing Feelings. Emotions are subjective feelings that result from one's thoughts and perceptions. If individuals do not express feelings, stress and illness may worsen. 7. Using Touch. Touch is one of the most potent forms of communication. Historically physical touch played a central role in healing. 8. Using Silence. Silence prompts some people to talk. It allows a patient to think and gain insight. 9. Providing Information, providing relevant information tells other people what they need or want to know so they are able to make decisions, experience less anxiety, and feel safe and secure. 10.Clarifying. To check whether understanding is accurate, restate an unclear message to clarify the sender's meaning. 11.Focusing. Focusing centers on key elements or concepts of a message. If the conversation is vague or patients begin to repeat themselves, focusing is a useful technique. 30 | P a g e 12.Paraphrasing. Paraphrasing is restating another's message more briefly using one's own words. 13.Asking Relevant Questions. Nurses ask relevant questions to seek information needed for decision-making. Ask only one question at a time and fully explore one topic before moving to another area. 14.Summarizing. Summarizing is a concise review of key aspects of an interaction. It brings a sense of satisfaction and closure to an individual conversation and is especially helpful during the termination phase of a nurse-patient relationship. 31 | P a g e