Introduction to Nursing Theory Theory organized system of accepted knowledge that is composed of concepts, propositions, definitions and assumptions intended to explain a set of fact, event or phenomena

Concept defined as an idea formulated by the mind or an experience perceived and observed (e.g. justice, love, war, and disease).

Proposition explains relationships of different concepts. Definition composed of various descriptions which convey a general meaning and reduces the vagueness in understanding a set of concepts.

Assumption a statement that specifies the relationship or connection of factual concepts or phenomena.

Nursing Theory group of interrelated concepts that are developed from various studies of disciplines and related experiences. This aims to view the essence of nursing careComponents of a Theory (Barnum 1994) Context resembles the environment to which nursing act takes place

Content subject of the theory

Process method by which nurse acts in using nursing theoryDefinition of Nursing

ANA Nursing is the diagnosis and treatment of human responses to actual or potential health problems.

International Council of Nurses (ICN) Nursing encompasses autonomous and collaborative care of individuals of all ages, families, groups and communities, sick or well and in all settings. Nursing includes the promotion of health, prevention of illness, and the care of ill, disabled and dying people. Advocacy, promotion of a safe environment, research, participation in shaping health policy and in patient and health system management and education are also key nursing roles.

Henderson To assist in the performance of activities, contributing to health, its recovery or peaceful death that clients will perform unaided, if they had the necessary will, strength or knowledge.

ADPCN Nursing is a dynamic discipline. It is an art and a science of caring for individuals, families, group, and communities geared toward promotion and restoration of health, prevention of illness, alleviation of suffering and assisting clients to face death with dignity and peace. It is focused on assisting the client as he or she responds to health-illness situations, utilizing the nursing process and guided by ethico-legal moral principles.

Nursing Paradigms Patterns or models used to show a clear relationship among the existing theoretical works in nursing.

Person The recipient of nursing care like individuals, families and communities.

Environment The external and internal aspects of life that influence the person

Health The holistic level of wellness that the person experiences.

Nursing The interventions of the nurse rendering care in support of, or in cooperation with the client.

Different types of theories Descriptive/Factor-Isolating Theories To know the properties and workings of a discipline

Explanatory/ Factor-Relating Theories to examine how properties relate and thus affect the discipline

Predictive/Situation-Relating Theories To calculate the relationships between properties and how they occur

Prescriptive/Situation Producing Theories To identify under which conditions relationships occurConcepts Building blocks of theory

Abstract concepts indirectly observed or intangible. It is independent of time and place.

Concrete concepts directly observed or tangible

Theoretical models or frameworks Highly established set of concepts that are testable.

Conceptual models or frameworks Representations of an idea or body of knowledge based on the own understanding or perception of a person or researcher on a certain topic, phenomena or theory.

Steps in Scientific Method:

1. Observation2. Gathering Information/Data3. Forming Hypothesis4. Experimental Investigation5. Conclusion or Theoretical ExplanationPhenomenon Can be defined as sets of empirical data or experience that can be physically observed or tangible such as crying or grimacing when in pain.

Deduction From specific concepts to general conclusion

Induction From general conclusion to specific details

Florence Nightingale (Environmental Theory)

Born on May 12, 1820

The Lady with the Lamp

Notes on Nursing provides essential principles for rendering and implementing an efficient and effective nursing care. Nurses should perform tasks to and for the patient as well as control the patients environment to facilitate easy recovery

Health is being well and using every power that a person has to the fullest extent

Nurse it the one in control of patients environment

Nightingales Environmental Theory

Nightingales CanonsNursing Process and Thought

Ventilation and warmth Check patients body temp, room temp, ventilation and foul odors

Create a plan to keep the room well-ventilated and free of odor while maintaining the patients body temp

Light Check room for adequate light. Sunlight is beneficial to the patient

Create and implement adequate light in the room without placing the patient in direct light

Cleanliness Check room for dust, dampness and dirt

Keep room free from dust, dirt and dampness

Health of Houses Check surrounding environment for fresh air, pure water, drainage, cleanliness and light.

Noise Check noise level in the room and surroundings

Attempt to keep noise level in minimum

Bed and Bedding Check bed and bedding for dampness, wrinkles and soiling

Keep the bed dry, wrinkle-free and lowest height to ensure comfort

Personal Cleanliness Attempt to keep the patient dry and clean at all times

Frequent assessment of the patients skin is essential to maintain good skin integrity

Variety Attempt to accomplish variety in the room and with the client

This is done with cards, flowers, pictures and books. Also encourage friends or relatives to engage in stimulating activities

Chattering hopes and advices Avoid talking without giving advice that is without a fact Respect the patient as a person and avoid personal talk

Taking Food Check the diet of the patient. Note the amount of food and fluid ingested by the patient at every meal

Petty Management This ensures continuity of care Document the plan of care and evaluate the outcomes to ensure continuity

Observation of the Sick Observe and record anything about the patient Continue observation in the patients environment and make changes in the plan of care if needed

Hildegard Peplau (Interpersonal Relations Theory)

Psychiatric Nurse of the Century

Born on September 1, 1901

A man is an organism that lives in an unstable balance of a given system

Health symbolizes movement of the personality and other ongoing human processes that directs the person towards creative, constructive, productive and community living.

Nursing is a significant, therapeutic interpersonal process

Phases of Nurse-Patient Relationship

1. Orientation The initial interaction between the nurse and the patient wherein the latter has a felt need and expresses the desire for professional assistance. The nurse assists the patient in recognizing and understanding the patient experience

2. Identification The patient and the nurse explore the experience and the needs of the patient which leads to a feeling of relatedness

3. Exploitation The patient derives the full value of the relationship as he moves on from a dependent role to and independent one Power is shifted to the patient

4. Resolution The patient earns independence over his care as he gradually puts aside old goals.

Roles of Nurses in the Nurse-Patient Relationship:

1. Stranger Initial contact, the nurse and patient are strangers to each one another. This role coincides with Identification Phase

2. Resource Person The nurse provides specific answers to his queries which include health information, advices, and a simple explanation of the healthcare teams course of care

3. Teacher- The nurse assumes a teaching role as she gives much importance for self-care and in helping him understand the therapeutic plan.

4. Leader The nurse acts as a leader in behalf of the patients best interest and at the same time enable him to make decisions over his own care. This is achieved through cooperation and active participation.5. Surrogate The patients dependency for his care give the nurse a surrogate role. The nurse must assist the patient to make sure that her surrogate role is different and only temporary.

6. Counselor Has the greatest importance and emphasis in nursing. This role strengthens the nurse-patient relationship as the nurse becomes a listening friend, an understanding family member, and someone who gives sound and emphatic advises.

Virginia Henderson (14 Human Basic Needs)

First Lady of Nursing

First Truly International Nurse

Referred a person as patient

Person is an individual who requires assistance to achieve health and independence or in some cases, a peaceful death.

Mind and body of a person is inseparable

Health is a quality of life and is very basic for a person to function fully Health requires independence and interdependence

Health promotion is more important than care of the sick

Nurse function independently from the physician

Special role of a nurse is to help both sick and well individuals

Emphasized the need to view the patient and his family as a single unit

14 Basic Needs

1. Breathing Normally2. Eating and Drinking adequately3. Eliminating body wastes4. Moving and maintaining a desirable position5. Sleeping and Resting6. Selecting suitable clothes7. Maintaining normal body temperature by adjusting clothing and modifying the environment8. Keeping the body clean and well groomed to promote integument9. Avoiding dangers in the environment and avoiding injuring others10. Communicating with others in expressing emotions, needs, fears, or opinions11. Worshipping according to ones faith12. Working in such a way that one feels a sense of accomplishment13. Playing or participating in various forms of recreating14. Learning, discovering or satisfying the curiosity that leads to normal development and health, and using available health facilities.

Joyce Travelbee

(Human-to-Human Relationship Model) Person is defined as a human being, who is unique, irreplaceable individual who is in the continuous process of becoming, evolving, and changing.

Health is measured by subjective and objective health

Nursing is an interpersonal process

Human-to-Human Relationship Model

1. Original Encounter First impression by the nurse of the sick person and vice-versa. The nurse and patient see each other in stereotyped or traditional roles.2. Emerging Identities This phase is described by the nurse and patient perceiving each other as unique individuals.3. Empathy This phase is described as the ability to share in the persons experience.

4. Sympathy This happens when the nurse wants to lessen the cause of the patients suffering.

5. Rapport Described as nursing interventions that lessens the patients suffering.

Betty Neuman (System Model)

Main role of a nurse is to help a person adapt to environmental stimuli causing illnesses back to a state of wellness.

Nursing requires holistic approach, and approach that considers all factors affecting health.

A person is an open system that works together with other parts of its body as it interacts with the environment.

Health is dynamic in nature.

Environment can be an internal, external and created force that interacts with a persons state of health.

Stressors are tensions that produce alterations in the normal flow of the environment.

Stressors:

Intrapersonal occurs within the self ad comprises of man as a psychospiritual being Interpersonal occurs between one or more individual and consists of man as a social beingLines of Resistance

Lines of resistance act when the Normal Line of Defense is invaded by too much stressor, producing alterations in the clients health. It acts to facilitate coping to overcome the stressors that are present within the individual.

Normal Line of Defense

This must act in coordination with the normal wellness sate. It must reflect the actual range of responses that is normally acted by client in response to any stressorsFlexible Line of Defense

Flexible Line of defense serves as a boundary for the Normal Line of Defense to adjust to the situations that threaten the imbalance within the clients stability.

Reaction Outcomes or produced results of certain stressors and actions of the lines resistance of a client. It can be positive or negative depending on the degree of reaction the client produces to adjust and adapt with the situation.

Negentropy towards stability and wellness

Egentropy disorganization of the system producing illness.

Dorothy Johnson (Behavioral System Model)

A person has 2 major systems: the biological system and the behavioral system

The focus of medicine is in the biological system, while nursing is to behavioral system

Health is an elusive state that is affected by social, psychological, biological, and physiological factors

An individuals behavior is influenced by all the events in the environment

The primary goal of nursing is to cultivate the equilibrium within the individual, which allows for the practice of nursing with individuals at any point in the health-illness continuum.

Behavioral System Model

7 Behavioral Subsystems:

The Attachment or Affiliative Subsystem well-known as the earliest response system to expand in the individual.

The Dependency Subsystem is distinguished from the attachment or affiliative subsystem. Dependency behaviors are actions that trigger nurturing behaviors from other individuals in the environment.

The Ingestive Subsystem relates to the behaviors surrounding the ingestion of food. It is associated with biological system.

Eliminative Subsystem relates to behaviors surrounding the secretion of waste products from the body.

Sexual Subsystem imitates behaviors related to procreation or reproduction.

Aggressive Subsystem relates to behaviors concerned with defense and self-preservation.

Achievement Subsystem contains behaviors that attempt to control the environment.

Imogene King (Goal Attainment Theory)

A person exists in an open system as a spiritual being and rational thinker who makes choices, selects alternative courses of action, and has the ability to record their history through their own language and symbols, unique, holistic and have different needs, wants and goals. Health is the ability of a person to adjust to the stressors that the internal and external environment exposes to the client.

Environment is the process of balance involving internal and external interactions inside the social system.

Nursing is when the nurse interacts and communicates with the client

Interacting Systems Framework

Personal how the nurse views and integrates self based from personal goals and beliefs Interpersonal how the nurse interrelates with a co-worker or patient, particularly in the Nurse-Patient relationship Social How the nurse interacts with co-workers, superiors, subordinates and the client environment in general.Goal Attainment Theory

Action means of behavior or activities that are towards the accomplishment of a certain act. Reaction Is a form of reacting or a response to certain stimuli Interaction Any situation wherein the nurse relates and deals with a clientele or patient Open system absence of boundary existence, where a dynamic interaction between the internal and external environment can exchange information without barriers or hindrances.

Dorothea Orem (Self-Care Deficit Theory)

Human beings are very much different from other living things in terms of their capacity.

Supports the WHO definition of health as the state of physical, mental, and social well-being and not merely the absence of disease or infirmity.

Environment is an external source of influence in the internal interaction of a persons different aspects Nursing is helping clients to establish or identify ways to perform self-care activities.Self-Care is an activity that promotes a persons well-being. It is performed by persons who are aware of the time frames on behalf of maintaining life, continuing personal development and healthy functional living.

Self-Care Requisites are insights of actions or requirements that a person must be able to meet and perform in order to achieve well being.

Universal Self-Care Requisites There are universally se goals that must be undertaken in order for an individual to function in scope of a healthy living.

Developmental Self-Care Requisites

Provision of conditions that promote development

Engagement in self-development

Prevention of the effects of human conditions that threatens lifeHealth Deviation Requisites are required for a person to be considered as sick or ill. Disease affects the structures within the integral part of a person and its functioning.

Therapeutic Self-Care Demand These are summation of all activities needed to alleviate the existing disease or illness. Controlling or managing the factors will result to appropriate care of plan.

Self-Care Agency These are complex set of activities required to purposively regulate the actions needed for planning a care plan for a client.

Agent An agent is the individual who is engage in meeting the needs of a person.

Dependent Care Agent These are individuals who takes full responsibility of taking care of a person who are incapable of providing care for themselves or those who are living dependently with others aid

Nursing Agency Set of established capabilities of a nurse who can legitimately perform activities of care for a client.

Nursing Design These are professional functions that must be performed by the nurse in order to meet clients need. It serves as a guideline of needed and foreseen results.

Faye Glenn Abdellah (21 Nursing Problems)

Individuals are beneficiaries of care Health is the center and purpose of nursing services

Core of nursing is the individual

Nursing is an all-inclusive service that is based on the disciplines of art and science that serves individuals, sick or well, copes with their health needs.

21 Nursing Problems

Overt- obvious or can be seen

Covert unseen or masked one

1. To promote good hygiene and physical comfort

2. To promote optimal activity, exercise, rest, and sleep

3. To promote safety through prevention of accidents, injury, or other trauma and through the prevention of the spread of infection

4. To maintain good body mechanics and prevent and correct deformities

5. To facilitate the maintenance of a supply of oxygen to all body cells

6. To facilitate the maintenance of nutrition of all body cells

7. To facilitate the maintenance of elimination

8. To facilitate the maintenance of fluid and electrolyte balance

9. To recognize the physiologic responses of the body to disease conditions

10. To facilitate the maintenance of regulatory mechanisms and functions

11. To facilitate the maintenance of sensory function

12. To identify and accept positive and negative expressions, feelings, and reactions

13. To identify and accept the interrelatedness of emotions and organic illness

14. To facilitate the maintenance of effective verbal and nonverbal communication

15. To promote the development of productive interpersonal relationships

16. To facilitate progress toward achievement of personal spiritual goals

17. To create and maintain a therapeutic environment

18. To facilitate awareness of self as an individual with varying physical, emotional, and developmental needs

19. To accept the optimum possible goals in light of physical and emotional limitations

20. To use community resources as an aid in resolving problems arising from illness

21. To understand the role of social problems as influencing factors in the cause of illness

Sister Callista Roy (Adaptation Model)

A person is a biopsychosocial being in constant interaction with a changing environment. The person is an open, adaptive system who uses coping skills to deal with stressors. Environments are conditions, circumstances and influence that surround and affect the development and behavior of the person.

Health is the process of being and becoming an integrated and whole person.

Nursing is the science and practice that expands adaptive abilities and enhances person and environment transformation.Adaptation

Adaptation is the process and outcome whereby thinking and feeling persons as individuals or in groups use conscious awareness and choice to create human and environmental integration.

Internal ProcessesRegulator

The regulator subsystem is a persons physiological coping mechanism. Its the bodys attempt to adapt via regulation of our bodily processes, including neurochemical, and endocrine systems.

Cognator

The cognator subsystem is a persons mental coping mechanism. A person uses his brain to cope via self-concept, interdependence, and role function adaptive modes.

Four Adaptive Modes

The four adaptive modes of the subsystem are how the regulator and cognator mechanisms are manifested; in other words, they are the external expressions of the above and internal processes.

Physiological-Physical Mode

Physical and chemical processes involved in the function and activities of living organisms. These are the actual processes put in motion by the regulator subsystem.

The basic need of this mode is composed of the needs associated with oxygenation, nutrition, elimination, activity and rest, and protection. The complex processes of this mode are associated with the senses, fluid and electrolytes, neurologic function, and endocrine function.

Self-Concept Group Identity Mode

In this mode, the goal of coping is to have a sense of unity, meaning the purposefulness in the universe, as well as a sense of identity integrity. This includes body image and self-ideals.

Role Function Mode

This mode focuses on the primary, secondary and tertiary roles that a person occupies in society, and knowing where he or she stands as a member of society.

Interdependence Mode

This mode focuses on attaining relational integrity through the giving and receiving of love, respect and value. This is achieved with effective communication and relations.

Levels of Adaptation

Integrated Process

The various modes and subsystems meet the needs of the environment. These are usually stable processes (e.g., breathing, spiritual realization, successful relationship).

Compensatory Process

The cognator and regulator are challenged by the needs of the environment, but are working to meet the needs (e.g., grief, starting with a new job, compensatory breathing).

Compromised Process

The modes and subsystems are not adequately meeting the environmental challenge (e.g., hypoxia, unresolved loss, abusive relationships).

Six-Step Nursing Process

A nurses role in the Adaptation Model is to manipulate stimuli by removing, decreasing, increasing or altering stimuli so that the patient

Madeleine Leininger (Transcultural Theory in Nursing)

Creator of the Transcultural Subfield of Nursing

Humans are caring and capable of being concerned about the desires, welfare, and continued existence of others.

Environment is the totality of an event, situation, or particular experience that gives meaning to human expressions, interpretations, and social interactions in particular physical, ecological, sociopolitical and/or cultural settings. Transcultural nursing is defined as a learned subfield or branch of nursing which focuses upon the comparative study and analysis of cultures with respect to nursing and health-illness caring practices, beliefs, and values with the goal to provide meaningful and efficacious nursing care services to people according to their cultural values and health-illness context.

Ethnonursing is the study of nursing care beliefs, values, and practices as cognitively perceived and known by a designated culture through their direct experience, beliefs, and value system (Leininger, 1979).

Nursing is defined as a learned humanistic and scientific profession and discipline which is focused on human care phenomena and activities in order to assist, support, facilitate, or enable individuals or groups to maintain or regain their well-being (or health) in culturally meaningful and beneficial ways, or to help people face handicaps or death.

Professional nursing care (caring) is defined as formal and cognitively learned professional care knowledge and practice skills obtained through educational institutions that are used to provide assistive, supportive, enabling, or facilitative acts to or for another individual or group in order to improve a human health condition (or well-being), disability, lifeway, or to work with dying clients.

Cultural congruent (nursing) care is defined as those cognitively based assistive, supportive, facilitative, or enabling acts or decisions that are tailor-made to fit with individual, group, or institutional cultural values, beliefs, and lifeways in order to provide or support meaningful, beneficial, and satisfying health care, or well-being services.

Health is a state of well-being that is culturally defined, valued, and practiced, and which reflects the ability of individuals (or groups) to perform their daily role activities in culturally expressed, beneficial, and patterned lifeways.

Human beings are believed to be caring and to be capable of being concerned about the needs, well-being, and survival of others. Leininger also indicates that nursing as a caring science should focus beyond traditional nurse-patient interactions and dyads to include families, groups, communities, total cultures, and institutions.

Society/environment is not terms that are defined by Leininger; she speaks instead of worldview, social structure, and environmental context.

Worldview is the way in which people look at the world, or at the universe, and form a picture or value stance about the world and their lives.

Cultural and social structure dimensions are defined as involving the dynamic patterns and features of interrelated structural and organizational factors of a particular culture (subculture or society) which includes religious, kinship (social), political (and legal), economic, educational, technologic and cultural values, ethnohistorical factors, and how these factors may be interrelated and function to influence human behavior in different environmental contexts.

Environmental context is the totality of an event, situation, or particular experience that gives meaning to human expressions, interpretations, and social interactions in particular physical, ecological, sociopolitical and/or cultural settings.

Culture is the learned, shared and transmitted values, beliefs, norms, and lifeways of a particular group that guides their thinking, decisions, and actions in patterned ways.

Culture care is defined as the subjectively and objectively learned and transmitted values, beliefs, and patterned lifeways that assist, support, facilitate, or enable another individual or group to maintain their well-being, health, improve their human condition and lifeway, or to deal with illness, handicaps or death.

Culture care diversity indicates the variabilities and/or differences in meanings, patterns, values, lifeways, or symbols of care within or between collectives that are related to assistive, supportive, or enabling human care expressions.

Culture care universality indicates the common, similar, or dominant uniform care meanings, pattern, values, lifeways or symbols that are manifest among many cultures and reflect assistive, supportive, facilitative, or enabling ways to help people.

Margaret Jean Watson (Philosophy and Science of Caring)

Society provides the values that determine how one should behave and what goals one should strive toward. Watson (1979) states:

Caring (and nursing) has existed in every society. Every society has had some people who have cared for others. A caring attitude is not transmitted from generation to generation by genes. It is transmitted by the culture of the profession as a unique way of coping with its environment.

Human being is a valued person to be cared for, respected, nurtured, understood, and assisted.

Health is the unity and harmony within the mind, body, and soul; health is associated with the degree of congruence between the self as perceived and the self as experienced.

Nursing is a human science of persons and human health illness experiences that are mediated by professional, personal, scientific, esthetic, and ethical human care transactions.

Actual caring occasion involves actions and choices by the nurse and the individual. The moment of coming together in a caring occasion presents the two persons with the opportunity to decide how to be in the relationship what to do with the moment.

The transpersonal concept is an intersubjective human-to-human relationship in which the nurse affects and is affected by the person of the other. Both are fully present in the moment and feel a union with the other; they share a phenomenal field that becomes part of the life story of both.

Patricia Benner (Novice to Expert)

Skill Acquisition in Nursing

Stage 1 Novice: This would be a nursing student in his or her first year of clinical education; behavior in the clinical setting is very limited and inflexible. Novices have a very limited ability to predict what might happen in a particular patient situation. Signs and symptoms, such as change in mental status, can only be recognized after a novice nurse has had experience with patients with similar symptoms.

Stage 2 Advanced Beginner: Those are the new grads in their first jobs; nurses have had more experiences that enable them to recognize recurrent, meaningful components of a situation. They have the knowledge and the know-how but not enough in-depth experience.

Stage 3 Competent: These nurses lack the speed and flexibility of proficient nurses, but they have some mastery and can rely on advance planning and organizational skills. Competent nurses recognize patterns and nature of clinical situations more quickly and accurately than advanced beginners.

Stage 4 Proficient: At this level, nurses are capable to see situations as "wholes" rather than parts. Proficient nurses learn from experience what events typically occur and are able to modify plans in response to different events.

Stage 5 Expert: Nurses who are able to recognize demands and resources in situations and attain their goals. These nurses know what needs to be done. They no longer rely solely on rules to guide their actions under certain situations. They have an intuitive grasp of the situation based on their deep knowledge and experience. Focus is on the most relevant problems and not irrelevant ones. Analytical tools are used only when they have no experience with an event, or when events don't occur as expected.Historical Perspective in Nursing

I. Intuitive Nursing (Primitive Period; Ancient Civilization) It is practiced since prehistoric times among primitive tribes and lasted through the early Christian era

Ability to see something without reason

Spirit of nursing started

Based on Love, Instinct and Desire

Disease Oriented

Beliefs and Practices

People are nomads. Philosophy in life was the best for the most and was ruled by the Law of Self-Preservation.

Nursing was a function that belonged to women

Believed that illness is caused by evil spirits (voodoos)

Believed in medicine man (Shaman) who practices trephening.

Contributions of different civilization during the Intuitive Period1. Egypt Art of embalming

Recognition of 250 diseases2. China

Pharmacology (Materia Medica)

Use of Wax3. Babylonia

Code of Hammurabi4. India

Sushurutu Qualification of nurses

5. Israel

Moses is recognized as the Father of Sanitation Ritual Circumcision of a male child

6. Greek

Introduced caduceus, the insignia of medical profession today

Hippocrates was given the title of Father of Scientific Medicine

II. Apprentice Nursing

From the founding of the Religious orders in the 11th century up to 1836 with the establishment of the Kaiserwerth Institute for training of Deaconesses

Period of on-the-job training

Nursing performed without any formal education and by people who were directed by more experienced nurses

Important personalities in this period:

St. Clare-gave nursing care to the sick and the afflicted

St. Elizabeth of Hungary- Patrones of nurses

St. Catherine of Siena- First lady with a lamp

Dark period of Nursing

From the 17th century up to 19th century Nursing became the work of the least desirable of women

III. Educative Nursing

Began on June 15, 1860 when Florence Nightingale School of nursing opened St. Thomas Hospital in London

Development of nursing was strongly influenced by trends resulting from wars, from an arousal of social consciousness, from the increased educational opportunities offered to women

IV. Contemporary Nursing

Covers the period after the World War II to the present

Marked by scientific and technological developments as well as social changesHistory of Nursing in the Philippines

Hospital Real de Manila (1577) it was established mainly to care for the Spanish kings soldiers, but also admitted Spanish civilians; founded by Gov. Francisco de Sande.

San Lazaro Hospital (1578) founded by Brother Juan Clemente and was administered for many years by the Hospitalliers of San Juan de Dios; built exclusively for patients with leprosy.

Hospital de Indios (1586) established by the Franciscan Order; service was in general supported by alms and contributions from charitable persons.

Hospital de Aguas Santas (1590) established in Laguna; near a medicinal spring, founded by Brother J. Baustista of the Franciscan Order.

San Juan de Dios Hospital (1596) founded by the Brotherhood of Misericordia and administered by the Hopsitaliers of San Juan de Dios; support was delivered from alms and rents; rendered general health service to the public. Josephine Bracken, wife of Jose Rizal- installed a field hospital in an estate house in Tejeros; provided nursing care to the wounded night and day

Rosa Sevilla de Alvero- converted their house into quarters for the Filipino soldiers; during the Philippine-American War that broke out in 1899

Dona Hilaria de Aguinaldo- wife of Emilio Aguinaldo; organized that Filipino Red Cross under the inspiration of Mabini

Dona Maria Agoncillo de Aguinaldo- second wife of Emilio Aguinaldo; provided nursing care to Filipino soldiers during the revolution, President of the Filipino Red Cross branch in Batangas

Melchora Aquino (Tandang Sora) nursed the wounded Filipino soldiers and gave them shelter and food

Capitan Salome a revolutionary leader in Nueva Ecija; provided nursing care to the wounded when not in combat

Agueda Kahabagan- revolutionary leader in Laguna, also provided nursing services to her troops

Trinidad Tecson (Ina ng Biak-na-Bato)- stayed in the hospital at Biak na Bato to care for wounded soldiers University of Santo Tomas-College of Nursing (1946)

In its first year of existence, its enrolees were consisted of students from different school of nursing whose studied were interrupted by the war. In 1947, the Bureau of Private Schools permitted UST to grant the title Graduate Nurse to the 21 students who were of advance standing from 1948 up to the present. The college has offered excellent education leading to a baccalaureate degree. Sor Taciana Trinanes was its first directress. Presently, Associate Professor Glenda A. Vargas, RN, MAN serves as its Dean. Manila Central University-College of Nursing (1947)

The MCU Hospital first offered BSN and Doctor of Medicine degrees in 1947 and served as the clinical field for practice. Miss Consuelo Gimeno was its first principal. Presently, Professor Lina A. Salarda, RN, MAN, EdD serves as its Dean.

University of the Philippines Manila-College of Nursing (1948)

The idea of opening the college began in a conference between Miss Julita Sotejo and UP President. In April 1948, the University Council approved the curriculum, and the Board of Regents recognized the profession as having an equal standing as Medicine, Engineering etc. Miss Julita Sotejo was its first dean. Presently, Professor Josefina A. Tuason, RN, MAN, DrPh is once more reappointed as the Dean of UP Manila College of Nursing.

Basic Nursing Procedures

Hand Washing

It is considered one of the most effective infection control measures.

It should be done before eating, after using the bedpan or toilet, after the hands have come in contact with body substances, and before and after giving care of any kind.

WHO recommends hand washing under a stream of water for 20 seconds using plain granule soap, soap filled sheets, or liquid soap.

CDC recommends using alcohol-based antiseptic hand rubs before and after giving care aside from hand washing.

Proper application of alcohol-based products includes the following steps:

1. Apply a palmful of the product to a cupped hand

2. Rub palms against palms

3. Interlace fingers palm to palm

4. Rub palms to back of hands

5. Rub each finger individually on all sides with the other hand

6. Continue until product is dry about 20-30 seconds.Purposes of Hand Washing:

1. To reduce the number of microorganisms on hands

2. To reduce the risk of transmission of microorganisms to clients

3. To reduce the risk of cross-contamination among clients

4. To reduce the risk of transmission of infectious organisms to oneself

Notes when doing Hand Washing:

Use warm water because warm water removes less of the protective oil of the skin.

Hold hands lower than elbows (Medical Hand washing)

For Surgical Hand Washing, hands should be higher than elbows

Water should flow from the least contaminated to the most contaminated.

Apply 2-4ml of liquid soap

Use firm, rubbing, and circular movements. This should be done for at least 15 seconds

Dry hands by patting Do not rub the hands.Bed Bath

Bathing removes accumulated oil, perspiration, dead skin cells, and some bacteria. Bathing also improves circulation

Rubbing should be done by long smooth strokes from the distal to proximal parts of extremities.

Types of cleaning bath: Complete bed bath the nurse washes the entire body of dependent client on bed Self-help bed bath clients confined to bed are able to bathe themselves with help from the nurse for washing the back and perhaps the feet. Partial bath (Abbreviated bath) Only parts of the clients body that might cause discomfort or odor, of neglected, are washed. The face, hands, axillae, perineal area, and back. Bag bath Commercially prepared product that contains 10-12 presoaked disposable washcloths that contain no-rinse cleanser solution. Warming time is 1 minute. Tub bath often preferred to bed baths because it is easier to wash and rinse in a tub. Sponge bath suggested to newborns. Temperature of cleansing bath should be 43-46 degrees Celsius or 110-115 degrees Fahrenheit. Therapeutic baths are given for physical effects, such as to soothe irritated skin or treat an area. Medications may be placed on water. Therapeutic bath s generally taken in a tub one-third or one-half full. Designated time is 20-30 minutes Temperature of therapeutic bath includes: 37.7C 46C (100F-115F) for adults and 40.5C (105F) for infants.Bed Shampoo and Hair Care

Each person has particular ways of caring for their hair Dark-skinned people need to oil their hair because it tends to be dry

A wide-toothed comb is usually used because finer combs pull and break the hair Lanugo are fine hair on the body of the fetus, also referred as down or woolly hair

Pubic hair usually appears in early puberty, followed in about 6 months by the growth of axillary hair

Alopecia is the medical term for hair loss

Dandruff is the diffuse scaling of the scalp

Ticks are small gray-brown parasites that bite into tissue and suck blood. They can also transmit diseases such as Lyme disease and Rocky Mountain spotted fever.

Lice are parasitic insects that infest mammals. Infestation with lice is called pediculosis.Kinds of Lice Pediculus capitis head louse Pediculus Corporis body louse Pediculus Pubis crab louseScabies

Contagious skin infestation by itch mite. Characteristic lesion is caused by burrowing of female mite Itching is more pronounce at nightHirsutism

Growth excessive body hairFunction of Brushing the Hair

Stimulates circulation of blood in the scalp

Distributes oil along the hair shaft

Helps arrange the hair

Notes when doing hair care and bed shampoo:

Hair is more easily combed when the patient is in sitting position

Water used for shampoo should be 40.5C (105F)

Massage the hair using the pads of fingertips

Bed making

.Purpose: 1. To provide clean and comfortable bed for the patient

2. To reduce the risk of infection by maintaining a clean environment

3. To prevent bed sores by ensuring there are no wrinkles to cause pressure pointsNotes when doing Bed Making:

Do not let your uniform touch the bed and the floor not to contaminate yourself.

Never throw soiled lines on the floor not to contaminate the floor.

Staying one side of the bed until one step completely made saves steps and time to do effectively and save the time. Unoccupied bed can be closed or open

Top covers of an open bed are folded back to make it easier for a client to get in

Materials used in Bed Making:

1. 2 flat sheets or one fitted and one flat sheet

2. Draw sheet

3. Blanket

4. Bed spread

5. Rubber Sheet

6. PillowcaseVital Signs

Vital signs include body temperature, pulse, respiration, and blood pressure

Pain is considered as the fifth vital sign

Body temperature reflects the balance between heat produced and heat loss

Core temperature is the temperature of the deep tissues of the body, such as abdominal cavity and pelvic cavity

Surface temperature is the temperature of the skin, the subcutaneous tissue, and fat.

Temperature

Processes of Heat Loss:

1. Convection The flow of heat from the body surface to cooler ambient air. "baby is wrapped with a blanket to protect them from cold"

2. Radiation The loss of heat from the body surface to cooler solid surface not in direct contact, but close. "Cribs are placed away from outside windows for this"

3. Evaporation The loss of heat that occurs when a liquid is converted to a vapor, "occurs by failure to dry a newborn after birth or slow drying after a bath

4. Conduction The loss of heat from the body to cooler surface in direct contact, newborn is placed in a warming crib to minimize heat lossMeasuring body temperature

The measurement of core body temperature may seem simple, but several issues affect the accuracy of the reading. These include the measurement site, the reliability of the instrument and user technique (Pusnik and Miklavec, 2009). Practitioners must understand the advantages and disadvantages associated with the chosen method so they can explain the procedure to patients and obtain valid consent (Nursing and Midwifery Council, 2008).

True core temperature readings can only be measured by invasive means, such as placing a temperature probe into the oesophagus, pulmonary artery or urinary bladder (Childs, 2011). It is not practical, nor indeed necessary, to use such sites and methods in all cases; they tend to be reserved for patients who are critically ill.

Non-invasive sites such as the rectum, oral cavity, axilla, temporal artery (forehead) and external auditory canal are accessible and are believed to provide the best estimation of the core temperature (Pusnik and Miklavec, 2009). The temperature measured between these sites can vary greatly, so the same site ought to be used consistently and recorded on the chart with the reading (Davie and Amoore, 2010).

1. Oral cavity

The oral cavity temperature is considered to be reliable when the thermometer is placed posteriorly into the sublingual pocket (Hamilton and Price, 2007). This landmark is close to the sublingual artery, so this site tracks changes in core body temperature (Dougherty and Lister, 2011).

Electronic or disposable chemical thermometers may be used. Chemical thermometers should be avoided if the patient is hypothermic (18 per minute and smoking (Dougherty and Lister, 2011). Oxygen therapy, particularly with high-flow rates, may influence temperature but this claim has been refuted by Stanhope (2006).

2. Tympanic temperature

The tympanic thermometer senses reflected infrared emissions from the tympanic membrane through a probe placed in the external auditory canal (Davie and Amoore, 2010). This method is quick (