Lecture in NCM 100

Course Name : FUNDAMENTALS OF NURSING PRACTICECourse Code : NCM 100Course Description: This course provides the students with the overview of nursing as a science, an art and a profession. It deals with the concept of man as a holistic being comprised of bio- psycho- socio and spiritual dimensions. It includes a discussion on the different roles of a nurse emphasizing health promotion, maintenance of health as well as prevention of illness utilizing the nursing process. It includes the basic nursing skills needed in the care of individual clients.

Course Credit : 3units lecture, 2units RLE (Skills Lab)Contact Hours/Sem: 54 hours lecture, 102 RLE hours Skills LabPre-requisite : General Chemistry, Theoretical Foundations of NursingCo-requisite: Anatomy & Physiology, Biochemistry

Placement : 1st Year, 2nd semesterCourse Objectives: At the end of the course and given actual or simulated situations/conditions, the student will be able to:

1. utilize the nursing process in the holistic care of client for the promotion and maintenance of health

1.1 Assess with the client his/her health status and risk factors affecting health

1.2 Identify actual wellness/at risk nursing diagnosis1.3 Plan with client appropriate interventions for the promotion

and maintenance of health

1.4 Implement with client appropriate interventions for the promotion and maintenance of health

1.5 Evaluate with client outcomes of a healthy status

2. ensure a well-organized recording and reporting system

3. observe bioethical principles and the core values (love of God, caring, love of country and of people)

4. relate effectively with clients, members of the health team and others in work situations related to nursing and health; and,

5. observe bioethical concepts/ principles and core values and nursing standards in the care of clients

Course Outline : I. Nursing as a ProfessionA. Profession1. Definition (p)2. Criteria (p15)

CRITERIA OF A PROFESSIONNursing is gaining recognition as a profession.

Profession- has been defined as an occupation that requires extensive education or a calling that requires extensive education or a calling that requires special knowledge, skills, and preparation. A profession is generally distinguished from other kinds of occupations by (a) its requirement of prolonged, specialized training to require a body of knowledge pertinent to the role to be performed; (b) an orientation of an individual toward service, either to a community or to an organization; (c) on going research; (d) a code of ethics; (e) autonomy; (f) a professional organization.

Two terms related to profession need to be differentiated: professionalism and professionalization.

Professionalism- refers to a professional character, spirit, or methods. It is a set of attributes, a way of life that implies responsibility and commitment.Nursing Professionalism owes much to the influence of Florence Nightingale.Professionalization- is the process of becoming professional, that is, of acquiring characteristics considered to be professional.

B. Nursing1. Definition 2. Characteristics 3. Focus: Human Responses4. Personal and professional qualities of a nurse

1. DefinitionCONTEMPORARY NURSING PRACTICE

An understanding of contemporary nursing practice includes a look at definitions of nursing, recipients of nursing, scope of nursing, settings for nursing practice, nurse practice acts, and current standards of clinical nursing practice.

Definition of Nursing:Florence Nightingale defined nursing nearly 150 years ago as “the act of utilizing the environment of the patient to assist him in his recovery “ (Nightingale, 1860-1969). Nightingale considered a clean, well ventilated and quiet environment essential for recovery. Often considered to be the first nurse theorist, Nightingale raised the status of nursing through education. Nurses were no longer untrained housekeepers but people educated in the care of the sick.

Virginia Henderson was one of the first modern nurses to define nursing. She wrote, “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 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” (Henderson, 1966, p3). Like Nightingale, Henderson described nursing in relation to the client and the client’s environment. Unlike Nightingale, Henderson saw the nurse as concerned with both healthy and ill individuals, acknowledged that nurses interact with clients even when recovery may not be feasible, and mentioned the teaching and advocacy roles of the nurse.

In the latter half of the 20th century, a number of nurse theorists developed their known theoretical definitions of nursing. Theoretical definitions are important because they go beyond the simplistic common definitions. They describe what nursing is and the interrelationship among nurses, nursing, the client, the environment, and the intended client outcome: health (see chapter 3).

Professional nursing associations have also examined nursing and developed their definitions of it.In 1973, The American Nurses Association (ANA) describe nursing practice as “direct, goal oriented, and adaptable to the needs of the individual, the family and community during health and illness (ANA, 1973, p2). In 1980, the ANA changed this definition of nursing to this: “Nursing is the diagnosis and treatment of human responses to actual or potential health problems” (ANA, 1980, p9). In 1995, the ANA recognized the influence and contribution of the science of caring to nursing philosophy and practice. Their most recent definition of professional nursing is much broader and states: “Nursing

is the protection, promotion, and optimization of health and abilities, preventions 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 (ANA, 2003, p6).

Research to explore the meaning of caring in nursing has been increasing. For example, Coffman (2004) conducted a metasynthesis of qualitative studies describing cultural caring in nursing practice. Likewise, Graber and Mitcham (2004) sought to identify actions, interventions and interpersonal relationships that demonstrated caring and compassion. Details about caring are discussed in chapter 25. See also Watson’s “Assumptions of Caring” Box 3-1 in chapter 3.

B. Nursing2. Characteristics Recipients of nursing are sometimes called consumers, sometimes patients, and sometimes clients. A consumer is an individual, a group of people, or a community that uses service or commodity. People who use health care products or services are consumers of health care.

A patient is a person who is waiting for or undergoing medical treatment and care. The word patient comes from Latin a word meaning, “to suffer or “to bear.” Traditionally, the person receiving health care has been called a patient. Usually people become patients when they seek assistance because of illness or surgery. Some nurses believe that the word patient implies passive acceptance of the decisions and care of health professionals. Additionally, with the emphasis on health promotion and prevention of illness, many recipients of nursing care are not ill. Moreover, nurses interact with family members and significant others to provide support, information and comfort in addition to caring for the patient.

For these 3 reasons, nurses increasingly refer to recipients of health care as clients. A client is a person who engages the advice or services of another who is qualified to provide this service. The term client presents the receivers of health care as collaborators in the care, that is, as people who are also responsible for their own health. Thus, the health status of a client is a responsibility of the individual in collaboration with health professionals. In this book, client is the preferred term, although consumer and patient are used in some instances.

3. Focus: Human ResponsesScope of Nursing

Nurses provide care for 3 types of clients: individuals, families, and communities. Theoretical frameworks applications to these client types, as well as assessment of individual, family, and community health, are discussed in chapter 7 and 24.

Nursing practice involves 4 areas: promoting health and wellness, preventing illness, restoring health, and caring for the dying.

Promoting Health and WellnessWellness is a process that engages in activities and behaviors that enhance quality of life and maximize personal potential. Nurses promote wellness in clients who are both healthy and ill. This may involve individual and community activities to enhance healthy lifestyles, such as improving nutrition and physical fitness, preventing drug and alcohol misuse, restricting smoking, and preventing accidents and injury in the home and workplace. See chapter 16 for details.

Preventing IllnessThe goal of illness prevention programs is to maintain optimal health by preventing disease. Nursing activities that prevent illness include immunizations, prenatal and infant care, and prevention of sexually transmitted disease.

Restoring HealthRestoring health focuses on the ill client, and it extends from early detection of disease through helping the client during the recovery period. Nursing activities include the following:

Providing direct care to the ill person, such as administering medications, baths, and specific procedures and treatments.

Performing diagnostic and assessment procedures, such as measuring blood pressures and examining feces for occult blood.

Consulting with other health care professionals about client problems.

Teaching clients about recovery activities such as exercises that will accelerate recovery after a stroke.

Rehabilitating clients to their optimal functional level following physical or mental illness, injury, or chemical addiction.

Care for the DyingThis area of nursing practice involves comforting and caring for people of all ages who are dying. It includes helping support persons cope with death. Nurses carrying out these activities work in homes, hospitals, and extended care facilities. Some agencies called hospices, are specifically designed for this purpose.

4. Personal and professional qualities of a nurse

Personal Qualifications of a Nurse: (Udan) Philosophy of Life Good personality

A. Philosophy of Life It is concerned with those basic truths that contribute to personal

growth in a systematic fashion and with those principles that relate to the moral values that shape the facets of character.

Every person must develop a personal philosophy of life and plan for expanding his personal life.

Theories in nursing can be taught but not a philosophy of life or a philosophy of service.

B. A Good personality Personality consists of the distinctive individual qualities that

differentiate one person from another. It refers to the impression one makes on others which include

more than that which meets the eye. It consist of deeper traits which come from the heart and which

infiltrate the real person if one wishes to exert a magnetic influence on others.

It is a result of integrating one’s abilities, desires, impulses, habits and physical character into a harmonious whole.

How to Develop One’s Personality1. Warmth of manner, a ready smile, sincere laugh, genuine

interest on others.2. Complete sincerity.3. Sympathetic grooming: Neat hair style, appropriate dress,

sufficient make up, and expressive hands; being ever mindful of the people who see you.

Components of Good Personality Personal appearance-posture, grooming, dress and

uniform

Character-the practice of nursing utilizes one’s love for fellowman. Charity is the greatest virtue and serves as the foundation for a sense of values and the development of human character.

4 Virtues emanating from practice of Charity:1. Justice- being righteous, fair, correct and impartial2. Prudence-permits us to live with a good sense and perspective.

3. Fortitude-assists in the control of feelings, thoughts and emotions in the face of difficulty4. Temperance-encourages constructive

Attributes of Character:1. Honesty-truthful, trustworthy, and upright with one’s dealings

with others.Evidences of Honesty: care for materials, recognition of authority, obedience to rules and regulations, use of time in terms of punctuality in performing activities.2. Loyalty-feeling of confidence, trust and affection towards others.

Ex. Speaking well about co-workers and institution where you work

3. Tolerance-recognition of the rights of others. Ex. Allowing an angry relative to verbalize his or her feelings.

4. Judgment-ability to use one’s intellectual capacity to form sound opinions. Ex. Questioning an unclear doctor’s order.

5. Reliability- dependability and involves one’s use of sound judgment based upon a careful observation. Ex. Performing one’s responsibilities thoroughly even beyond time of duty as necessary.

6. Motivation-something that moves one to plan and accomplish specific things. Ex. Aiming to give the best quality of patient care at all times.

7. Resourcefulness-ability to recognize and deal promptly and effectively with difficulties or problems that arise. Ex. Using indigenous materials, articles in the absence of sophisticated ones.

8. Moderation-allows one to maintain harmony and balance among all the elements of one’s character and in one’s relationship with others by encouraging one to develop perspective and a sense of objectivity. Ex. Indulging in food, material goods, things which provides pleasure are in controlled matter.

Attitude-a manner of acting, thinking, or feeling that is indicated by one’s response toward another person, situation or experience. Eight (8) Be- Attitudes of a Nurse

Acceptance, Helpfulness, Friendliness, Firmness Permissiveness, Limit Setting, Sincerity, Competence

Charm-to influence the senses or the mind by some quality or attraction, delight.

To acquire charm, one needs to cultivate the following:1. Voice- modulated, with clear enunciation2. Manner-courteous, attentive, patient, receptive

3. Heart-attempt never to show indifference or a callused manner. Know how to say thank you.

4. Intelligence-keep an active mind, recognize beauty, accept new ideas from others, read and exchange opinions with others.

5. Poise-equanimity, calmness, composure, evenness of temper, self-control.

Calmness and composure- Face reality, avoid emotional flare ups. Control temper-Think before acting, avoid verbal and physical aggressiveness.

ROLES AND FUNCTIONS OF THE NURSENurses assume a number of roles when they provide care to clients. Nurses often carry out these roles concurrently, not exclusively of one another. For example the nurse may act as counselor while providing physical care and teaching aspects of the particular environment.

CaregiverThe caregiver role has traditionally included those activities that assist the client physically and psychologically while preserving the client’s dignity. The required nursing actions may involve full care for the completely dependent client, partial care for the partially dependent client, and supportive-educative care for to assist clients in attaining their highest possible level of health and wellness. Caregiving encompasses the physical, psychosocial, developmental, cultural, and spiritual levels. The nursing process provides nurses with a framework for providing care (see chapters 10-14). A nurse may provide care directly or delegate it to other caregivers.

CommunicatorCommunication is integral to all nursing roles. Nurses communicate with the client, support persons, other health professionals, and people in the community.In the role of communicator, nurses identify client problems and then communicate this verbally or in writing to other members of the health team. The quality of a nurse’s communication is an important factor in nursing care. The nurse must be able to communicate clearly and accurately in order for client’s health care needs be met. (See chapters 15 and 26)

TeacherAs a teacher, the nurse helps clients learn about their health and the health care procedures they need to perform to restore or maintain their health. The nurse assesses the client’s learning needs and readiness to learn, sets specific learning goals in conjunction with the client, enacts teaching strategies, and measures learning. Nurses also

teach unlicensed assistive personnel (UAP) to whom they delegate care, and they share their expertise with other nurses and health professionals. See chapter 27 for additional details about teaching/learning process.

Client AdvocateA client advocate acts to protect the client. In this role the nurse may represent the client’s needs and wishes to other health professionals, such as relaying the client’s wishes for information to the physician. They also assist clients in exercising their rights and help them speak up for themselves. (see chapter 5).

CounselorCounseling is the process of helping a client to recognize and cope with stressful psychologic and or social problems, to develop improved interpersonal relationships, and to promote personal growth. It involves providing emotional, intellectual, and psychologic support. The nurse counsels primarily healthy individuals with normal adjustment difficulties and focuses on helping the person develop new attitudes, feelings and behaviors, by encouraging the client to look at alternative behaviors, recognize the choices and develop a sense of control.

Change AgentThe nurse as a change agent when assisting clients to make modifications in their behavior. Nurses also often act to make changes in a system, such as clinical care, if it is not helping a client return to health. Nurses are continually dealing with change in the health care system. Technological change, change in the age of the client population and changes in medications are just a few of the changes nurses deal with daily. See chapter 28 for additional information about change.

LeaderA leader influences others to work together to accomplish a specific goal. The leader role can be employed at different levels: individual client, family, groups of clients, colleagues or the community. Effective leadership is a learned process requiring an understanding of the needs and goals that motivate people, the knowledge to apply the leadership skills and the interpersonal skills to influence others. The leadership role of the nurse is discussed in Chapter 28.

ManagerThe nurse manages the nursing care of individuals, families, and communities. The nurse manager also delegates nursing activities to

ancillary workers and other nurses, and supervises and evaluates their performance. Managing requires knowledge about organizational structure and dynamics, authority and accountability, leadership, change theory, advocacy, delegation and supervision and evaluation. See chapter 28.

Case ManagerNurse case managers work with the multidisciplinary health care team to measure the effectiveness of the case management plan and to monitor outcomes. Each agency or unit specifies the role of the nurse case manager. In some institutions , the case manager works with primary or staff nurses to oversee the care of a specific case load. In other agencies, the case manager is the primary nurse or provides some level of direct care to the client and family. Insurance companies have also developed a number of roles for nurse case managers, and responsibilities may vary from managing acute hospitalizations to managing high-cost clients or case types. Regardless of the setting, case managers help ensure the care is oriented to the client, while controlling costs.

Research ConsumerNurses often use research to improve client care. In a clinical area, nurses need to (a)have some awareness of the process and language of research, (b)be sensitive to issues related to protecting the rights of human subjects, (c) participate in the identification of significant researchable problems, and (d) be a discriminating consumer of research findings.

Expanded Career RolesNurses are fulfilling expanded career roles, such as those of nurse practitioner, clinical nurse specialist, nurse midwife, nurse educator, nurse researcher, and nurse anesthetist, all of which allow greater independence and autonomy. see box 1-2.

Selected Expanded Career Roles for Nurses

NURSE PRACTITIONERA nurse who has an advanced education and is a graduate of a nurse practitioner program. These nurses are certified by the American Nurse Credentialing Center in areas such as adult nurse practitioner, school nurse practitioner, pediatric nurse practitioner, or gerontology nurse practitioner. They are employed in health care agencies or community-based settings. They usually deal with non-emergency acute or chronic illness and provide primary ambulatory care.CLINICAL NURSE SPECIALIST

A nurse who has an advanced degree or expertise and is considered to be an expert in a specialized area of practice (eg, gerontology, oncology). The nurse provides direct client care, educates others, consults, conducts research and manages care. The American Nurses Credentialing Center provides national certification of clinical specialists.

NURSE ANESTHETISTA nurse who has completed advanced education in an accredited program in anesthesiology. The nurse anesthetist carries out preoperative visits and assessments, and administer general anesthetics for surgery under the supervision of a physician prepared in anesthesiology. The nurse anesthetist also assess the post operative status of clients.

NURSE MIDWIFEAn RN who has completed a program in midwifery and is certified by the American College of Nurse Midwives. The nurse gives prenatal and postnatal care and manages deliveries in normal pregnancies. The midwife practices in association with health care agency and can obtain medical services if complications occur. The nurse midwife may also conduct routine Papanicolaou smears, family planning and routine breast examinations.

NURSE RESEARCHERNurse researcher investigates nursing problems to improve nursing care and to refine and expand nursing knowledge. They are employed in academic institutions, teaching hospitals and research centers such as the National Institute for Nursing Research in Bethesda, Maryland. Nurse researchers usually have advanced education at the doctoral level.

NURSE ADMINISTRATORThe nurse administrator manages client care, including the delivery of nursing services. The administrator may have a middle management position such as head nurse or supervisor; or a more senior management position, such as director of nursing services. The functions of nurse administrators include budgeting, staffing, and planning programs. The educational preparation for nurse administrator positions is at least a baccalaureate degree in nursing and frequently a master’s or doctoral degree.

NURSE EDUCATORNurse educator are employed in nursing programs, at educational institutions, and in hospital staff education. The nurse educator usually has a baccalaureate degree or more advanced preparation and

frequently has expertise in a particular area of practice. The nurse educator is responsible for classroom and often clinical teaching.

NURSE ENTREPRENEURA nurse who has usually has an advanced degree and manages health related business. The nurse may be involved in education, consultation or research, for example.

C. History of Nursing 1. In the world (p5-11)

Evolution of Nursing Practice• Women’s roles and statusFrom the beginning women, cared for infants and children; thus nursing could be said to have its roots in “the home.” Care provided is focused on physical maintenance and comfort.• Religious (Christian) valuesThe Christian value of “Love thy neighbor as thyself” and Christ’s parable of the Good Samaritan that had a significant impact on the development of Western Nursing. Fabiola, a wealthy matron of the Roman Empire converted to Christianity, used his wealth to provide houses of care and healing for the sick, the poor and the homeless. Knights of Saint Lazarus, these brothers in arms provided nursing care to their sick and injured comrades. They also built hospitals, and dedicated themselves to the care of people with leprosy, syphilis and chronic skin conditions.• WarHarriet Tubman was known as “the Moses of her people” for her work with the Underground Railroad, during the civil war, (1861-1865) she nursed the sick and suffering of her own race.

Sojourner Truth (1797-1883) a preacher, women’s rights advocate, was a nurse for over 4 years during the civil war and worked as a nurse and counselor for the Freedmen’s Relief Association after the war.

Dorothea Dix (1802-1887)Was the Union’s superintendent of Female Nurses during the civil war.

A monument erected in 1938 and rededicated in1971 to commemorate devoted service to country and humanity by army, navy, and air force nurses.

• Societal attitudes• Visionary nursing leadershipFlorence Nightingale (1820-1910)-considered the founder of modern nursing, Florence was influential in developing nursing education, practice and administration. Her publication notes on Nursing: What It Is and What It Is Not, first published in England in 1859, and in U.S. in 1860, was intended for all women. She believed that she was “called by God to help others.. and to improve the well being of mankind.”

Clara Barton (1812-1912)-organized the American Red Cross, which linked with the International Red Cross. She persuaded the Congress in 1882 to ratify the Treaty of Geneva, so that the Red Cross could perform humanitarian efforts in time of peace.

Linda Richards (1841-1930) was America’s first trained nurse. Known for introducing nurse’s notes and doctor’s orders.

Mary Mahoney (1845-1926) was the first African American trained nurse. She worked for the acceptance of African Americans in nursing and for the promotion of equal opportunities.

Lilian Wald (1867-1940) the first to offer trained nursing services to the poor in New York slums.

Lavinia L. Dock (1858-1956) she campaigned for legislation to allow nurses rather than physicians to control their profession.

Margaret Higgins Sanger (1879-1966) founder of Planned Parenthood.

Mary Breckinridge ( 1881-1965) a nurse who practiced midwifery in England, Australia, and New Zealand, founded the Frontier Nursing Service in Kentucky in 1925 to provide family-centered primary health care to rural populations.

History of Nursing2. In the Philippines (include the history of own nursing school )Early Beliefs and Practice

Diseases and their causes and treatment were shrouded with mysticism and superstitions.

1. Beliefs about causation of disease:a. Another person (an enemy or a witch)b. Evil spirits

2. People believed that evil spirits could be driven away by persons with powers to expel demons.

3. People believed in special gods of healing, with the priest-physicians called “word doctors” as intermediary. If they used leaves or roots, they were called herb doctors (“Herbolarios).

Early Care of the SickThe early Filipinos subscribed to superstitious beliefs and practices in relation to health and sickness. Herbmen were called “Herbicheros,” meaning one who practiced witch craft. Persons suffering from diseases without any identified cause were believed to be bewitched by the “mangkukulam” or “mangagaway.” Difficult childbirth and some diseases (called “pamao”) were attributed to “nonos.” Midwife assisted in childbirth. During labor, the “mabuting hilot” (good midwife) was called in. if the birth became difficult, witches were supposed to be the cause. To disperse their influence, gunpowder was exploded from a bamboo cane close to the head of the sufferer.

Health Care During the Spanish RegimeThe religious orders exerted their efforts to care for the sick by building hospitals in the different parts of the Philippines.

The Earliest Hospitals Established were the following:1. Hospital Real de Manila (1577). It was established mainly to care

for the Spanish civilians founded by Gov. Francisco de Sande.2. 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.

3. Hospital de Indio (1586). Established by the Franciscan Order, service was in general supported by alms and contributions from charitable persons.

4. Hospital de Aguas Santas (1590). Established in Laguna, near medicinal spring, founded by Brother J. Bautista of the Franciscan Order.

5. San Juan de Dios Hospital (1596). Founded by the Brotherhood of Misericordia and administered by the Hospitalliers of San Juan de Dios; support was derived from alms and rents, rendered general health service to the public.

Nursing During the Philippine RevolutionThe prominent persons involved in nursing works were:

1. Josephine Bracken, wife of Jose Rizal. Installed a field hospital in estate house in Tejeros: provided nursing care to wounded night and day.

2. Rosa Sevilla de Alvero. Converted their house into quarters for the wounded soldiers, during the Philippine-American war that broke out in 1899.

3. Dona Hilaria de Agulnaldo. Wife of Emilio Aguinaldo organized Filipino Red Cross under the inspiration of Apoloinario Mabini.

4. 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.

5. Melchora Aquino (Tandang Sora). Nursed the wounded Filipino soldiers and gave them shelter and food.

6. Capitan Salome. A revolutionary leader in Nueva Ecija, provided nursing care to the wounded when not in combat.

7. Agueda Kahabagan. Revolutionary leader in Laguna, also provided nursing services to her troops.

8. Trinidad Tecson. “Ina ng Biac na Bato,” stayed in the hospital at Biac na Bato to care for the wounded soldiers.

Filipino Red Cross Malolos, Bulacan was the location of the national

headquarters. Established branches in the provinces.

Functions of Filipino Red Cross:1. Collection of war funds and materials through concerts, charity,

bazaars, and voluntary contributions.2. Provision of nursing care to wounded Filipino soldiers.

Requirements for Membership:1. At least 14 years old, age requirement for officer was 25 years

old.2. Of sound reputation.

Hospitals and Schools of Nursing

1. Iloilo Mission Hospital School of Nursing (Iloilo City,1906).It was run by the Baptist Foreign Mission Society of America. Miss

Rose Nicolet, a graduate of New England Hospital for Women and Children in Boston, Massachusetts, was the first superintendent for nurses. It moved to its present location in Jaro Road, Iloilo City in 1929. Miss Flora Ernst, an American nurse, took charge of the school in 1942. In March 1944, 22 nurses graduated, in April, 1944 graduate nurses took the first Nurses Board Examination at the Iloilo Mission Hospital.

2. St. Paul’s Hospital School of Nursing (Manila, 1907).The hospital was established by the Archbishop of Manila, the

most reverend Jeremiah Harty under the supervision of the Sisters of St. Paul de Chartres. It was located in Intramuros and it provided general hospital services. It had a free dispensary and dental clinic. It opened its training school for nurses in 1908, with Rev. Mother Melanie as superintendent and Miss E. Chambers as principal.

3. Philippine General Hospital School of Nursing (1907).The Philippine General Hospital began in 1901 as a small

dispensary mainly for “Civil Officers and Employees” in the city of Manila. It later grew into Civil Hospital.

In 1906, Mrs. Mary Coleman Masters an educator advocated for idea of training Filipino girls for the profession of nursing, she opened a dormitory for girls enrolled at the Philippine Normal Hall and the University of the Philippines.

In 1907, with the support of Governor General Forbes and the Director of Health among others, she opened classes in nursing under the auspices of the Bureau of Education. Julia Nichols and Charlotte Clayton taught the students nursing subjects. American physicians also served as lecturers.

In 1910, Act No. 1976 modified the organization of the school placing it under the supervision of the Director of Health. The City Hospital was abolished; the Philippine General Hospital was established.

When she became chief nurse, Elsie McCloskey Gaches introduced several improvements in the school. The course was made attractive and more practical. Anastacia Giron Tupas, the first Filipino to occupy the position of chief nurse and superintendent in the Philippines, succeeded her.

4. St. Luke’s Hospital School of Nursing (Quezon City).The Hospital is Episcopalian institution. In 1907, the school

opened with 3 Filipino girls admitted. These girls had their first year in combined classes with the Philippine General Hospital School of Nursing and St. Paul’s Hospital School of Nursing. Miss Helen Hicks was the first principal. Mrs. Vitaliana Beltran was the first Filipino superintendent for nurses. Dr. Jose Flores was the first Filipino medical director of the hospital.

Note: In the period of organization between 1907 and 1910, the first year nursing students of the Philippine General Hospital had a common first year course. This was known as the Central School idea in nursing education.The 3 schools selected their own students based on the following requirements:

1. Educational preparation, at least completion of 7th grade.2. Sound physical and mental health.3. Good moral character.4. Good family and social standing.5. Recommendations from 3 different persons well known in the

community.The 3 groups of students from these schools were later fused in one class, lived in the same dormitory, and received the same instruction in anatomy and physiology, massage, practical nursing, material medica, bacteriology and English.

5. Mary Johnston Hospital and School of Nursing (Manila,1907).It started as a small dispensary on Calle Cervantes (Now Avenida

Rizal). It was called Bethany Dispensary and was funded by the Methodist Mission for the relief of suffering among women and children. In 1907, Sr. Rebecca Parish, together with the registered nurses Rose Dudley and Gertrude Dreisback, organized the Mary Johnston School of Nursing. In 1908, Mr. D.S.B. Johnston of Minnesota donated as a memorial to his wife $12,500.00 for a hospital building. At the outbreak of World War II, it became an emergency hospital where the wounded were treated. It was allowed to operate as a hospital even during Japanese occupation. It was burned down in 1945, it was reconstructed through contributions of Methodist Church in America. It reopened in 1947 at the Harris Memorial. Miss Librada Javalera was the first Filipino director of the school.

6. Philippine Christian Mission Institute Schools of nursingThe United Christian Missionary Society of Indianapolis, Indiana,

a Protestant organization of the Disciples of Christ, operated 3 schools of nursing:

Slallie Long Read Memorial Hospital School of Nursing (Laoag, Ilocos Norte, 1903).

Mary Chiles Hospital of Nursing (Manila, 1911). The hospital was established by Dr. W.N. Lemon in a small house on Azcarraga Smapaloc Manila.

Frank Dunn Memorial Hospital (Vigan, Ilocos Sur, 1912).7. San Juan de Dios Hospital School of Nursing (manila

1913).8. Emmanuel Hospital School of Nursing (Capiz, 1913).9. Southern Islands Hospital of Nursing (Cebu, 1918).10. Other Schools of Nursing Established were as

follows:

Zamboanga General Hospital School of Nursing (1921).

Chinese General Hospital School of Nursing (1921.) Baguio General Hospital School of Nursing (1923). Manila Sanitarium and Hospital School of Nursing (1930). St. Paul’s School of Nursing in Iloilo City (1946). North General Hospital and School of Nursing (1946). Siliman University School of Nursing (1947).

The First Colleges of Nursing in the Philippines

1. University of Santo Tomas College of Nursing (1946).2. Manila Central University College of Nursing (1947).3. University of the Philippines College of Nursing (1948).

Nursing Leaders in the Philippines1. Anastacia Giron Tupaz2. Cesaria Tan. 3. Socorro Sirilan.4. Rosa Militar.5. Sor Ricarda Mendoza.6. Socorro Diaz. 7. Conchita Ruiz.8. Loreta Tupaz

Health and Nursing Organizations

Early Institutions for child welfare:1. Hospicio de San Jose (Manila 1782)2. Asylum of San Jose (Cebu)3. Asylum of Looban (Manila)4. Colegio de Santa Isabel (Naga City) Took care of poor girls.5. Gota de Leche (Manila 1907). Milk station. Its objective was to

promote health in infants through proper feeding.6. Liga Nacional Filipiniana para la Protection de la Primera infancia.

Worked for the passess of child welfare legislations.7. Public Welfare Board. Took over the work of the Liga in 1915,

conducted a systematic campaign on child hygiene in 1917.

Nursing Organizations:1. Philippine Nurses Association. This is the national organization of

Filipino nurses.2. National League of Nurses. The association of nurses employed

in Department of Health.3. Catholic Nurses Guild of the Philippines4. Others: ORNAP, MCNAP, IRNOP etc.

D. Development of modern nursingII. Nursing as an Art1. Definition of ArtsIntroduction: Nursing is a caring profession. as a unique profession, it is practiced with an earnest concern for the art of care and the science of health. The profession involves a humanistic blend of scientific knowledge, and holistic nursing practice.

Nursing- what it is today is the result of changes in scientific, technological, political, social and economic climate. Through the years the concept of nursing has been expanded and subsequently, the role of the nurse has become broader to meet the changing needs of the society. Likewise, career opportunities in nursing have greatly expanded.

2. Why is nursing an art?

3. Concepts related to the art of nursing

Concepts of Nursing and Caring The four major concepts in nursing theories are the person,

environment, health and nursing. The act of utilizing the environment of the patient to assist him in

his recovery (Nightingale). The unique function of the nurse is to assist the individuals, sick

or well in the performance of those activities contributing to the health or its recovery (or to peaceful death) that he would perform unaided if he had the necessary strength, will and knowledge, and to do this in such a way as to help him gain independence as rapidly as possible (Henderson).

A humanistic science dedicated to compassionate concern with maintaining and promoting health and preventing illness and caring for and rehabilitating the sick and disabled (Rogers).

A theoretical system of knowledge that prescribes a process of analysis and action related to the care of the ill person (Roy).

A helping or assisting service to persons who are wholly or partly dependent- infants, children and adults- when they, their parents and guardians or other adults responsible for their care are no longer able to give or supervise their care (Orem).

A helping profession that assists individuals and groups in society to attain, maintain and restore health. If this is not possible, nurses help individuals die with dignity (King).

A unique profession is that it is concerned with all of the variable affecting an individual’s response to stressors, which are intra, inter, and extra personal in nature (Neuman).

An external regulatory force that acts to preserve the organization and integration of the client’s behavior at an optimal level under those conditions in which the behavior constitute a threat to physical or social health or in which illness is found (Johnson).

Caring means that persons, events, projects, and things matter to people. It is a word of being connected. It also reveals what is stressful and the available options for coping. “Caring creates possibility.” As an inherent feature of nursing practice, caring enables nurses help clients to recover in the face of illness, to give meaning to that illness and to maintain or reestablish connection (Benner).

Caring is the essence and central unifying and dominant domain that distinguishes nursing from the other health disciplines. Care is an essential human needs, necessary for the health and survival of all individuals. Acts of caring refer to the direct and indirect nurturant and skillful activities, processes, and decisions that assist people in ways that are empathic, compassionate and supportive; and that are dependent on the needs, problems and values of the individual being assisted (Leiniger).

Caring- healing is communicated through the consciousness of the nurse to the individual being cared for. Transpersonal caring expands the limits of openness and allows access to higher human spirit, thus expanding human consciousness (Watson).

Caring involves 5 processes: knowing, being with, doing for, enabling, and maintaining belief.

- Knowing is striving to understand an event as it has meaning in the life of the other

- Being with is being emotionally present to the other- Doing for is doing for the other as he or she would do for

the self if it were at all possible- Enabling is facilitating the other’s passage through life

transitions (e.g., birth, death) and unfamiliar events- Maintaining belief is sustaining faith in the other’s capacity

to get through an event or transition and face a future with meaning (Swanson).

Caring in nursing practice involves: providing presence, comforting, listening, knowing the client, spiritual caring and family care.

-Providing presence 4. Self-awareness/concept (Who am I?) P1003Self-concept is one’s mental image of oneself. A positive self concept is essential to a person’s mental and physical health. Individuals with positive self-concept are better able to develop and maintain interpersonal relationships and resist psychologic and physical illness.

An individual possessing strong self-concept should be better able to accept or adapt to changes that may occur over the lifespan. How one views oneself affect one’s interaction with others.

Nurses have a responsibility to assess clients for negative self-concept and to identify the possible causes in order to help them develop a more positive views of themselves. Individuals who have poor self-concept may express feelings of worthlessness, self-dislike, or even self-hatred. They may feel sad or hopeless, and may state they lack energy to perform even the simplest task.

Self-awareness refers to the relationship between one’s perception of himself or herself or others’ perceptions of him or her. Thus, a nurse who is very self-aware has perceptions that are very congruent. Becoming more self aware is a process that requires time and energy and is never complete. One important component of the process is introspection, which involves the nurse considering his or her own beliefs, attitudes, motivations, strengths and limitations (Donnelley, 2004). In addition to using individual reflective exercises, the nurse gains insight into the self, through working with other nurses who serve as mentors and by taking seriously and acting on the feedback obtained during regular performance reviews.

Once the nurse has developed a clear understanding and awareness of self, the nurse can respect and avoid projecting his or her own beliefs onto others. While in the caregiver role, the self-aware nurse is able to suspend judgment, and focus on the needs of the client, even if they differ from those of the nurse. When conflicts arise, the nurse can analyze his or her reactions through introspection and by asking:

“What is there in me that produces this kind of reaction in the client?”

“Why do I react this way (fear, anger, anxiety, annoyance, worry)?”

“Can I change the way I respond to this situation to affect the client’s reaction in a helpful way?”

5. Self enhancement (How do I become a better person?)P1011

6. Caring : An Integral Component of Nursing

7. Nursing – Client relationship (pp472)Nurse-Client Relationships

• Referred to as– Interpersonal relationship– Therapeutic relationship– Helping relationship

Keys to Helping Relationships• Development of trust and acceptance between nurse and client• Sincere interest in the client’s welfare

Four Phases of the Helping Relationship• Preinteraction • Introductory • Working (maintaining) • Termination

Preinteraction Phase• Reviews pertinent assessment data and knowledge• Considers potential areas of concern• Develops plans for interaction

Introductory Phase• Stage 1: Opening the relationship • Stage 2: Clarifying the problem• Stage 3: Structuring and formulating the contract

Working Phase• Stage 1: Exploring and understanding thoughts and feelings• Stage 2: Facilitating and taking actions

Termination Phase• Nurse and client accept feelings of loss• Client accepts end of relationship without feelings of anxiety or

dependence

Four Phases of the Helping Relationship• Termination Phase

– Nurse and client accept feelings of loss– Client accepts the end of the relationship without feelings

of anxiety or dependence

8. Therapeutic communication (Pp468, 183)Promotes understanding and can help establish a constructive

relationship between the nurse and the client. Unlike the social relationship, where there may not be a specific purpose or direction, the therapeutic helping relationship is client and goal directed.

Nurses need to respond not only to the content of a client’s verbal message nut also to the feelings expressed. It is important to understand how the client views the situation and feels about it before responding. The content of the client’s communication is the words or thoughts, as distinct from the feelings. Sometimes people can convey a thought in words while their emotions contradict the words, that is, words and feeling are incongruent. “I am glad he has left me; he was very cruel.” But the nurse observes a tears in her eyes. To respond to the client’s words, “You are pleased that he has left you.” To respond

to the client’s feelings, the nurse would need to acknowledge the tears in the client’s eyes, saying, for ex. “You seem saddened by all this.” Such response help client to focus on her feelings. In some instances, the nurse may need to know more about the client and her resources for coping with these feelings.

9. Focus of nursing

E. Growth of Professionalism1. Profession (p15-16) first page

a. Specialized educationSpecialized education is an important aspect of professional status. In modern times, the trend in education for the professions has shifted toward programs in colleges and universities. Many nursing educators believe that the undergraduate nursing curriculum should include liberal arts education in addition to the biologic and social sciences and the nursing discipline.

In the U.S. today, there are five means of entry into registered nursing: hospital diploma, associate degree, baccalaureate degree, master’s degree, and doctoral degree. These programs are discussed in chapter 2.

Associate degreeBecause ADN-prepared and BSN-prepared nurses currently function under the same practice acts, the need for differentiated competencies has been debated for years. Brady et al. (2001) pointed out that clear and specific information about the type of knowledge, skills and abilities of each type of nursing education program would “assure that the right nurse with the right competencies is in the right job at the right cost.”

The Pew Health Professionals Commission developed a set of competencies needed by all health professional groups for successful practice in the 21st century. In addition, the Pew Commission challenges nursing to address a number of issues, among them, to define the various competencies for each level.

Baccalaureate Degree ProgramsBaccalaureate nursing programs are located in senior colleges and universities and are generally 4 years in length. The curricula offer courses in the liberal arts, sciences, humanities and nursing. Graduates

must fulfill both degree requirements of the college or university and the nursing program before being awarded a BSN.

Master’s ProgramThe major emphasis of the programs was to be research and specialization for teaching and administration. Master’s degree programs provide specialized knowledge and skills that enable nurses to assume advanced roles in practice, education, administration, and research.

Doctoral ProgramsContent and approach vary among doctoral programs. Some focus on the usual clinical areas, such as medical-surgical nursing, and others emphasize such nontraditional areas as transcultural nursing. some programs emphasize theory development, but ALL emphasize research.

b. Body of knowledgeAs a profession, nursing is establishing a well-defined body of knowledge and expertise. A number of nursing conceptual frameworks (discussed in chapter 3) contribute to the knowledge base of nursing and give direction to nursing practice, education and ongoing research.

c. Ethics nurses have traditionally placed a high value on the worth and dignity of others. The nursing profession requires integrity of its members; that is, a member is expected to do what is considered right regardless of the personal cost.

Ethical codes change as the needs and values of society change. Nursing has developed its own codes of ethics and in most instances has set up means to monitor the professional behavior of its members. See chapter 5.

Code of Ethics• Formal statement of a group’s ideals and values• Serves as a standard for professional actions• Provides ethical standards for professional behavior

Purposes of Professional Codes of Ethics• To inform the public about the minimum standards of the

profession• To help the public understand professional nursing conduct• To provide a sign of the profession’s commitment to the public

Common Ethical Issues• Issues in the care of HIV/AIDS clients• Abortions• Organ transplantation

• End-of-life decisions• Cost-containment issues (resource allocation)• Breaches of client confidentiality

d. AutonomyA profession is autonomous if it regulates itself and sets standards for its members. Providing autonomy is one of the purposes of a professional association. If nursing is to have professional status, it must function autonomously in the formation of policy and in the control of its activity. To be autonomous, a professional group must be granted legal authority to define the scope of its practice, describe its particular functions and roles, and determine its goal and responsibilities in delivery of its services.

To practitioners of nursing, autonomy means independence at work, responsibility and accountability for one’s actions. Autonomy is more easily achieved and maintained from a position of authority. Therefore, some nurses seek administrative positions rather than expanded clinical competence as a means to ensure their autonomy in the work place.

2. Carpers four patterns of knowing a. Nursing scienceb. Nursing ethicsc. Nursing estheticsd. Personal knowledge

F. Overview of the Professional Nursing Practice (p171. Level of Proficiency according to Benner (Novice, Beginner, Competent, Proficient, Expert)2. Roles and Responsibilities of a Professional nurse3. Scope of Nursing Practice based on RA 91734. Overview of the Code of Ethics for Nurses/Filipino Bill of Rights/Legal Aspects5. Professional/legal and moral accountability / responsibility

G. Different Fields in Nursing1. Institutional nursing (hospital staff nursing)2. Community health nursing (school nursing /industrial nursing/public health nursing)3. Independent nursing practice4. Nursing in education5. Nursing in other fields

H. Communication Skills

1. Effective communication2. Purposes of therapeutic communication3. Components of communication4. Criteria for effective verbal communication5. Guidelines for active & effective listening6. Guidelines for use of touch7. Developmental consideration in communication8. Communicating with people who area. Physically challengedb. Cognitively challengedc. Aggressive9. General guidelines for trans-cultural therapeutic communication

I. Nursing Process1. Assessment2. Nursing Diagnosis (as a concept and process)3. Planning (long-term, short-term, priority setting, formulation of objectives)4. Intervention (collaborative, independent nursing interventions)5. Evaluation (formative, summative)6. Documentation of plan of care /reporting

J. Health and Illness:1. Recall concepts learned about man as an individual and as a member of the family2. Define health, wellness and illness3. Explain the dimensions of wellness4. Discuss the Health-Illness Continuum5. Enumerate the stages of wellness and Illness6. Describe the three levels of Prevention

K. Levels of Care1. Health promotion2. Disease prevention3. Health maintenance4. Curative5. Rehabilitative

L. Basic Interventions to Maintain1. Healthy lifestyle,2. Oxygenation3. Fluid and electrolyte balance4. Nutrition5. Elimination6. Temperature regulation

7. Mobility and exercise8. Hygiene and comfort,9. Safety, security and privacy10.Psychosocial and Spiritual Concerns

M. Meeting needs related to death and dying/grief and grieving1. Concept of death and dying/grief and grieving2. Care of the terminally ill patients and their families .3. Post mortem care

III. Health and Illness:1. Recall concepts learned about man as an individual and as a member of the family2. Define Health, Wellness and Illness3. Explain the dimensions of wellness4. Discuss the Health-Illness Continuum5. Enumerate the stages of wellness and Illness6. Describe the three levels of Prevention

Guide for RLEProvides opportunity to demonstrate the various nursing procedureslearned.Provides opportunity to care for a healthy/well client.LaboratorySupplies and Equipment:Office Supplies such as:Hospital forms and logbookEquipment such as surgical instruments, hospital equipments like bedpan, urinal, surgical beds, stethoscope, non-mercurial BP apparatus, etc.Fixtures such as chart rack, medicine and treatment cards rackAudio visual equipments such as mannequin, models, videos, CD, etc.Appliances such as footstool, wheel chair, stretcher etc.Hospital linens