Theories of Nursing

Professor Aimee Tiotuico

Tuesday 3-6pmRoom301

The Reporters are:

• Ma. Carmina M. Guda

• Lee-ann P. Punla

Ma. Carmina Guda and Lee-ann Punla

Bachelor science of nursing 1st year 2009-2010

CONCEPTS RELATED TO MAN

Concepts related to Man 

Man has been viewed as a unique individual, however, never ending questions as to his existence is still over

the years. Why is he unique over the living organisms?

Why is he considered the highest form of animal?How does his system works?

These are the some questions commonly ASKEDSince man is our client it is therefore useful to

understand his NATURE for us to be able to interact with him effectively.

Like for instance Byrne and Thompson view man as an organism composed of diffent organ

system and each system is composed of organs each organ is made up of tissue cell, which is the

base unit and has its own structure as claimed by the Anatomist, as well as specific function as

claimed by the Physiologist, Immunologist.

Because of this structure, man now functions as a unified whole they termed this as the ATOMISTIC APPROACH

On the other hand they also studied man in all aspect of his behavior and his relationship with others in his environment and they term this the

HOLLISTIC APPROACH

(holistic view traces the patterns of man’s relationship with other beings within the society it views him as a whole biologic organism with interrelated and independent parts functioning to produce a particular behavior that is unacceptable or acceptable to him or to

society.)

External stimuli present in the environment pushes man to respond consciously or unconsciously as he interacts with it. In spite of the hardship

present around his environment due to several external forces, man was able to surpass all of the out of MOTIVATION

Which made him understand how events came into existence .Man claims that it comes naturally to him to suffer for those whom he loves and wishes to protect from pain and suffering to a higher place in

non-material reward and he has to have the Intellect to assist him in achieving higher type of motivation.

MAN IS ALSO CONSIDERED TO BE A PASSIVE ORGANISM governed by the stimuli supplied by the external environment meaning HE

DEPENDS SO MUCH from HIS ENVIRONMENT end he executes minimal efforts to mobilize his resources or he does not participate in any

activity to make him more functional.

MAN CAN ALSO BE CONSIDERED TO BE THE SOURCE of all ACTS and that he has the FREEDOM to choose.

With the different point of views of MAN, it does not mean to say that we have to choose and decide the best but rather we have to understand that the nature of man is very COMPLEX and as future health care providers we might encounter the

above characteristics, we have to be guided by these concepts as we perform our task and of course we have to establish good

working relationships for us to understand the nature of our client***MAN***

Man as a Biological, Sociological and Cultural well-being

Man as a biological being states that man responds to environmental stimuli as a particular unit be it a solitary cell a component organism or a member of a conglomerate of individuals.

Man is a living organism who from birth is destined to die until he does and he has to face forces in his environment continuously.

Because the cell organs and organ system are found within the individual they comprise the subordinate system of man..

The cell is the basic building block of structure of all form of plant and animal life. Each of these cell carries out exactly the precise and highly specialized functions.

The family ,community , and society are called his superordinate system because these provides man with the necessary framework of relationship which helps him cope with elements in his environment, his behavior is greatly influence by his relationships.

His mind and body operates as a whole. To appreciate this fully try to observe the body changes that occur within when you are frightened ,(noticed that your heart beats so fast, your blood pressure rises, your breathing becomes heavier, you seem become more alert,the temperature of your body also changes,and skin feels cold to touch in the face of danger.this simply shows that the effect of external stimuli to a particular system affects the others.

MAN AS A PSYCHO-SOCIAL BEING

Man is a unique irreplaceable individual one-time being in this worldTo be irreplaceable means that an entry cannot be exchanged for another. Even with the advances in technology where man can replace parts of the body through transplants or prothesis, making these transplants survive in their new location is still the unresolved problem of surgeons,the Human brain for instance can not be transplanted and there are no sufficient evidences at present to say that all organ transplant are successful wherein the dilemma is solved then man will become replaceable. Because man is a one time being in this world, when he dies,he ceases to exist.there is not a second chance for living what may be left of him to indicate His temporal presence will be a few momentous with some thoughtful person will remember to collect his memory.

Man the PSYCHOLOGICAL being is a capable of rational, logical thinking most of the time but can become irrational and illogical when provoked.His RATIONAL side makes him merciful, kind, and compassionate, while hisIRRATIONAL nature may make him commit criminal acts against another man.One may never admit that he has some degree of immaturity well within an outer shell of maturity.In some person this core may be very small so that their immaturity is hard to detect but in others***TRAVELbee*** the core is big and the degree of immaturity is easy to detect in the person’s manner, SPEECH THOUGHT.

Man needs to communicate with others because he derives comfort from this and can share his troubles with another human being. He is also capable of relating with others and

that from birth, he is endowed with the capacity to know,to like, to love, and to

respond to appreciate the uniqueness of others even how he perceives things and it is

for this reason why individuals have no common perception to a particular situation.

Depending on his inherent qualities, the environment he grew up with, the experience he has had,he will manage to rise above limitations of his human conditions. He needs to surpass whatever stress that comes along his way and he

needs to strengthen his relationships with other fellow human for him not to become restless, lonely and embittered

individual. He needs people or friends for survival.

MAN AS A SPIRITUAL BEING The Christian view of the worth of the human person is based on the biblical teaching that each human being is created by God in his own image and likeness, differing from the animals in the possession spiritual intelligence and free will. Although God produces the human body through the corporation of human parents, the creation of the human soul is a direct act of God, which calls each person into the existence in relation to God himself.In spite of biological origin and social associations, man as a complex organism has special abilities to go beyond the limits of his animal nature.ability to overcome the physical and social needs by going beyond what is expected of him is descriptive of man’s social nature.

The will and intellect assist him in moving beyond his limitations. The intellect allows man to look for the truth, it gives him the ability to perceive his surroundings or the forces within the outside him or to understand the meaning of events as they relate to him and to his loved onesThrough a firm resolution of mind , man accomplishes what he likes or fails to accomplish what he dislikes.

Man as a spiritual being needs the essential freedom of the human spirit. To achieve this freedom he continuously struggles for it and the struggles is made doubly difficult when his coping skills is not effective or when something is wrong with his system. the intellect helps him understand that failure to cope up is a natural phenomenon that befalls anyone when his body resistance is low or when his body organs decline in function due to old age or to some disorder. It is the intellect that helps him find the truth of his illness and probably accept the fact that it is God’s punishment for his sins.

Basic RightsBasic Rights

Protecting the Rights of Human Subjects

 

Because nursing research usually focuses on humans, a major nursing responsibility is to be aware of and to advocate on behalf of clients’ rights. All clients must be informed and understand the consequences of consenting to serve as research subjects. The client needs to be able to assess

whether an appropriate balance exists between the risks of participating in a study and the potential benefits, either to

the client or to the development of knowledge.

Right Not to Be Harmed

The Department of Health and Human Services defines risk of harm to a research subject as exposure to the possibility of injury going beyond

everyday situations. The risk can be physical, emotional, legal, financial, or social. For instance, with holding standard care from a client in labor for the purpose of studying the course of natural childbirth clearly poses a

potential physical danger. Risks can be less overt and involve psycho logic factors, such as exposure to stress or anxiety, or social factors, such as loss

of confidentiality or loss of privacy.

Right to Full Disclosure

Even thought it may be possible to collect data about a client as part of everyday care without the client’s

particular knowledge or consent, to do so is considered unethical. Full disclosure is a basic right. It means that deception, either by withholding information about a

client’s participation in a study or by giving the client false or misleading information about what participating in the

study will involve, must not occur.

Right of Self-Determination

Many clients in dependent positions, such as people in nursing homes, feel pressured to participate in studies. They feel that they must please the

doctors and nurses who is responsible for their treatment and care. The right of self-determination means that the subject should feel free from

constraints, coercion, or any undue influence to participate in study. Masked inducements, for instance, suggesting to potential participants that by taking

part in the study they might become famous, make an important contribution to science, or receive special attention, must be strictly avoided.

Nurse must be assertive in advocating for this essential right.

Right of Privacy and Confidentiality

Privacy enables a client to participate without worrying about late embarrassment. The anonymity of a study participant is ensured if

even the investigator cannot link specific subject information a subject relates will not be made public or available to others

without the subject’s consent. Investigators must inform research subject about the measures that provide for these right, such

measures may include the use of pseudonyms or code numbers or reporting only aggregate or group data in published research.

Self-actualization - When the need for self esteem is satisfied, the individual strives for self-actualization, the innate need to develop one's maximum potential and realize one's abilities and qualitiesSelf esteem - The individual needs both self esteem (i.e., feelings of independence, competence, and self-respect) and esteem from others (i.e,. recognition, respect, and appreciation).Love and belonging - The third level of needs includes giving and receiving affection, attaining a place in a group and maintaining the feeling of belonging.

- Safety and security -The need for safety has both physical and psycho logic aspects. The person needs to feel safe ,both in the physical envi. and in relationships

Maslow’s heirarchy of needs

- Physiologic -

ROLE IN SAFEGUARDING the following RIGHTS:

• Right to be harmed

The department of Health and Human Service define risk of him to a research subject as exposure to the possibility of injury going beyond everyday situations.

• Risk can be: -Physical -Emotional -Legal -Financial -Social

*For instance,with hading standard care from a client in labor for the purpose I studying the course of natural childbirth clearly poses a potential physiacal danger.

• *Risks can be less overt and involve psychologist factor, such as exposure to stress or anxiety or social factor , such as loss of confidentiality or logs of privacy.

CHILD

A child (plural: children) is a human being between the stages of birth and puberty. The legal definition of "child" generally refers to a minor, otherwise

known as a person younger than the age of majority. "Child" may also describe a relationship with a parent or authority figure, or signify group membership in a clan, tribe, or religion; it can also signify being strongly affected by a specific time, place, or circumstance, as in "a child of nature" or "a child of the Sixties."

Definitions of stages of growth in childhood come from many sources. Theorists such as Jean Piaget, Lev Vygotsky, Lawrence Kohlberg, and Erik

Erikson have provided ways to understand development, and recent research has provided important information regarding the nature of development. In addition, stages of childhood are defined culturally by the social institutions,

customs, and laws that make up a society. For example, while researchers and professionals usually define the period of early childhood as birth to eight

years of age, others in the United States might consider age five a better end point because it coincides with entry into the cultural practice of formal

schooling.

There are three broad stages of development: early childhood,

middle childhood, and adolescence. The definitions of these stages are organized around the primary tasks of development in each stage, 

though the boundaries of these stages are malleable. Society's ideas about childhood shift over time, and research has led to new understandings of the 

development that takes place in each stage.

Definitions of stages of growth in childhood come from many sources. Theorists such as

Jean Piaget, Lev Vygotsky, Lawrence Kohlberg, and Erik Erikson have provided

ways to understand development, and recent research has provided important

information regarding the nature of development. In addition, stages of

childhood are defined culturally by the social institutions, customs, and laws that

make up a society. For example, while researchers and professionals usually define

the period of early childhood as birth to eight years of age, others in the United

States might consider age five a better end point because it coincides with entry into the cultural practice of formal schooling.

There are three broad stages of development: early childhood, middle

childhood, and adolescence. The definitions of these stages are organized

around the primary tasks of development in each stage, though the boundaries of

these stages are malleable. Society's ideas about childhood shift over time, and

research has led to new understandings of the development that takes place in each

stage.

From age’s three to five, growth in socioemotional skills includes the formation of peer relationships, gender identification, and

the development of a sense of right and wrong. Taking the perspective of another individual is difficult for young children, and events are often interpreted in all-or-nothing terms, with

the impact on the child being the fore-most concern. For example, at age five a child may expect others to share their

possessions freely but still be extremely possessive of a favorite toy. This creates no conflict of conscience, because fairness is

determined relative to the child's own interests. Between ages five and eight, children enter into a broader peer context and

develop enduring friendships. Social comparison is heightened at this time, and taking other people's perspective begins to play

a role in how children relate to people, including peers.

Implications for in-school learning. The time from birth to eight years is a critical period in the development of many foundational skills

in all areas of development. Increased awareness of, and ability to detect,

developmental delays in very young children has led to the creation of early intervention services that can reduce the need for special education placements when children reach

school age. For example, earlier detection of hearing deficits sometimes leads to correction

of problems before serious language impairments occur. Also, developmental delays caused by premature birth can be

addressed through appropriate therapies to help children function at the level of their

typically developing peers before they begin school.

An increased emphasis on early learning has also created pressure to prepare young children to enter school with as many prerequisite skills as possible. In 1994 federal legislation was passed in the United States creating Goals 2000, the first of which states that "All children will enter school ready to learn" (U.S. Department of Education, 1998). While the validity of this goal has been debated, the consequences have already been felt. One consequence is the use of standardized readiness assessments to determine class placement or retention in kindergarten. Another is the creation of transition classes (an extra year of schooling before either kindergarten or first grade). Finally, the increased attention on early childhood has led to renewed interest in preschool programs as a means to narrow the readiness gap between children whose families can provide quality early learning environments for them and those whose families cannot.

Judaism has always placed a high value on bearing and rearing children. The verse, "Be fruitful and multiply" (Gen. 1:28), was considered to be the

first commandment in the Bible. The Talmud asserts that one who is childless may be considered dead (Ned. 64b) and compares the

intentional avoidance of having children to murder (Yev. 63b). The commandment to be fruitful, however, devolves upon men only and is regarded as fulfilled once two boys or a boy and girl have been born. A man may marry a woman incapable of bearing children only if he has

already fulfilled his obligation or if he has another wife who is presumed fertile (Maim. Yad, Ishut 15:7). A couple that remains childless after ten

years of marriage is expected to divorce; if infertility is attributable to the woman she forfeits the basic compensation (but not any additional

compensation promised) guaranteed in her marriage contract (Ketubbah). If infertility is attributable to the husband, he must pay all benefits enumerated in the marriage contract (ibid. 15:8). In modern

times, divorce of this kind is extremely rare. One interpretation equates the biblical punishment of Karet, being "cut off," with Barrenness.

The filial obligations of children are recorded in the Pentateuch under the rubrics of honor (Ex. 20:12) and reverence (Lev. 19:3). Honor requires the provision of food, drink, and personal needs.

Reverence requires that the child not sit in his parent's seat or contradict him in conversation (Kid. 31b). The Bible (Deut. 21:18-21) even invoked the death penalty for the Rebellious Son who disregarded his parents and exhibited other extreme forms of anti-social behavior. The predominant opinion in the Talmud

claims that the Bible's intent was never actually to cause such a child to be executed but rather to express a value judgment upon such actions (San. 71a). However, a child is instructed to defy his parents should they order him to transgress the laws of Judaism.

A child born of an incestuous or adulterous relationship is designated a mamzer and may not marry into the community (Yev. 49a; see Illegitimacy). Such a child is still considered a Jew, however, and is permitted to marry another mamzer. The Talmud further states that a mamzer who is a Torah scholar is to be accorded higher honor than an uneducated High Priest (Hor. 3:8). There is no legal stigma attached to children born out of wedlock.In practice, the Jewish household has traditionally revolved around the bearing and rearing of children. Jewish parents the world over aspire to be blessed with God-fearing children and grandchildren and to be able to take pride in their offspring's accomplishments (see also Family; Mother; Parent and Child.)

Age of responsibilityPopulation aged under 15 years

in 2005The age at which children are

considered responsible for their own actions has also changed

over time, and this is reflected in the way they are treated in courts of law. In Roman times, children

were regarded as not culpable for crimes, a position later adopted by the Church. In the nineteenth century, children younger than seven years old were believed

incapable of crime. Children from the age of seven were considered

responsible for their actions. Therefore, they could face

criminal charges, be sent to adult prison, and be punished like

adults by whipping, branding or hanging.

In at least 25 countries of the world there is no specified age for compulsory education; at least 33 US States have no minimum age of employment and in 44 girls can be married

earlier than boys. In at least 125 countries children may be taken to court and risk imprisonment for criminal acts at an age between 7 and 15, often the age range for

compulsory education. Moreover, in the same country, it is not rare to find that children are legally obliged to go to school until they are 14 or 15 years old but a different law

allows them to work at an earlier age or to be married at the age of 12 or to be criminally responsible from the age of 7. Being aware of the legal situation of children around the

world is necessary for designing effective measures to improve it. Based on States Parties' reports under the Convention on the Rights of the Child (CRC) and therefore reflecting States' representations of their own practice, At what age? brings to light

problems that are not - but should be - effectively addressed: at what age do children become adults and lose their protection under the Convention on the Rights of the Child?

Children's right to education is currently under threat from early marriage, child labour and imprisonment; States have not adapted their legislation in favor of the right to

education, and they do not have agreed standards for the transition from childhood to adulthood either internationally or nationally. Often taken as the guarantor of childhood until 18, the Convention on the Rights of the Child in fact states in article 1 that: "a child

means every human being below the age of eighteen years unless, under the law applicable to the child, majority is attained earlier". The latter element, a limitation, substantially weakens the operative part of the article and provides justification for

differing interpretations and practice. It is an acknowledgment that not even the age of majority is the same in all countries.

elderly

ELDERLY

ELDERLY ELDERLY Elderly careElderly care or simply or simply eldercareeldercare is the fulfillment of the is the fulfillment of the special needs and requirements that special needs and requirements that are unique to are unique to senior citizenssenior citizens. This . This broad term encompasses such broad term encompasses such services as services as assisted livingassisted living, , adult day careadult day care, , long term carelong term care, , nursing homesnursing homes, , hospicehospice care, and In- care, and In-Home careHome care..The form of elder care provided varies The form of elder care provided varies greatly among countries and is greatly among countries and is changing rapidly. Even within the changing rapidly. Even within the same country, regional differences same country, regional differences exist with respect to the care for the exist with respect to the care for the elderly.elderly.Traditionally elder care has been the Traditionally elder care has been the responsibility of family members and responsibility of family members and was provided within the was provided within the extended familyextended family home. Increasingly in home. Increasingly in modern societies, elder care is now modern societies, elder care is now being provided by state or charitable being provided by state or charitable institutions. The reasons for this institutions. The reasons for this change include decreasing family size, change include decreasing family size, the greater the greater life expectancylife expectancy of elderly of elderly people, the geographical dispersion of people, the geographical dispersion of families, and the tendency for women families, and the tendency for women to be educated and work outside the to be educated and work outside the home. Although these changes have home. Although these changes have affected European and North American affected European and North American countries first, it is now increasingly countries first, it is now increasingly affecting Asian countries also.affecting Asian countries also.

In most western countries, elder care facilities are In most western countries, elder care facilities are freestanding freestanding assisted livingassisted living facilities, facilities, nursing homesnursing homes, , and continuing care retirement communities (CCRCs).and continuing care retirement communities (CCRCs).In the In the United StatesUnited States, most of the large multi-facility , most of the large multi-facility providers are publicly owned and managed as for-profit providers are publicly owned and managed as for-profit businesses. There are exceptions; the largest operator in businesses. There are exceptions; the largest operator in the US is the Evangelical Lutheran Good Samaritan the US is the Evangelical Lutheran Good Samaritan Society, a not-for-profit organization that manages 6,531 Society, a not-for-profit organization that manages 6,531 beds in 22 states, according to a 1995 study by the beds in 22 states, according to a 1995 study by the American Health Care AssociationAmerican Health Care Association..In In CanadaCanada, such privately-run for-profit facilities also , such privately-run for-profit facilities also exist, but they must compete with government-funded exist, but they must compete with government-funded public facilities run by each province's or territory's public facilities run by each province's or territory's Ministry of Health. In these care homes, elderly Ministry of Health. In these care homes, elderly Canadians pay for their care on a sliding scale based on Canadians pay for their care on a sliding scale based on annual income.annual income.Given the choice, most elders would prefer to continue Given the choice, most elders would prefer to continue to live in their own homes (to live in their own homes (aging in placeaging in place). ). Unfortunately the majority of elderly people gradually Unfortunately the majority of elderly people gradually lose functioning ability and require either additional lose functioning ability and require either additional assistance in the home or a move to an eldercare assistance in the home or a move to an eldercare facility. The adult children of these elders often face a facility. The adult children of these elders often face a difficult challenge in helping their parents make the right difficult challenge in helping their parents make the right choices. One relatively new service that can help keep choices. One relatively new service that can help keep the elderly in their homes longer is "respite care".This the elderly in their homes longer is "respite care".This type of care allows caregivers the opportunity to go on type of care allows caregivers the opportunity to go on vacation or a business trip and know that their elder has vacation or a business trip and know that their elder has good quality temporary care, for without this help the good quality temporary care, for without this help the elder might have to move permanently to an outside elder might have to move permanently to an outside facility. Some United States companies, like Senior facility. Some United States companies, like Senior Helpers, Helpers, Home Instead Senior CareHome Instead Senior Care, Visiting Angels, All , Visiting Angels, All Valley Home Care, and Comfort Keepers, offer long-Valley Home Care, and Comfort Keepers, offer long-term, in-home care for seniors.term, in-home care for seniors.A distinction is generally made between medical and A distinction is generally made between medical and non-medical care, and the latter is much less likely to be non-medical care, and the latter is much less likely to be covered by insurance or public funds. In the US, 86% of covered by insurance or public funds. In the US, 86% of the one the one

million or so residents in assisted living facilities pay for care million or so residents in assisted living facilities pay for care out of their own funds. The rest get help from family and out of their own funds. The rest get help from family and friends and from state agencies. friends and from state agencies. MedicareMedicare does not pay does not pay unless skilled-nursing care is needed and given in certified unless skilled-nursing care is needed and given in certified skilled nursing facilities or by a skilled nursing agency in the skilled nursing facilities or by a skilled nursing agency in the home. Assisted living facilities usually do not meet Medicare's home. Assisted living facilities usually do not meet Medicare's requirements. However, Medicare does pay for some skilled requirements. However, Medicare does pay for some skilled care if the elderly person meets the requirements for the care if the elderly person meets the requirements for the Medicare home health benefitMedicare home health benefit. . Thirty-two U.S. states pay for care in Thirty-two U.S. states pay for care in assisted livingassisted living facilities facilities through their through their MedicaidMedicaid waiver programs. Similarly, in the waiver programs. Similarly, in the United KingdomUnited Kingdom the the National Health ServiceNational Health Service provides medical provides medical care for the elderly, as for all, free at the point of use, but care for the elderly, as for all, free at the point of use, but social care is only paid for by public authorities when a social care is only paid for by public authorities when a person has exhausted their private resources.person has exhausted their private resources.Elderly care emphasizes the social and personal requirements Elderly care emphasizes the social and personal requirements of of senior citizenssenior citizens who need some assistance with daily who need some assistance with daily activities and health care, but who desire to age with dignity. activities and health care, but who desire to age with dignity. It is an important distinction, in that the design of housing, It is an important distinction, in that the design of housing, services, activities, employee training and such should be services, activities, employee training and such should be truly customer-centered.truly customer-centered.However, elderly care is focused on satisfying the However, elderly care is focused on satisfying the expectations of two tiers of customers: the resident customer expectations of two tiers of customers: the resident customer and the purchasing customer, who are often not identical, and the purchasing customer, who are often not identical, since relatives or public authorities rather than the resident since relatives or public authorities rather than the resident may be providing the cost of care. Where residents are may be providing the cost of care. Where residents are confused or have communication difficulties, it may be very confused or have communication difficulties, it may be very difficult for relatives or other concerned parties to be sure of difficult for relatives or other concerned parties to be sure of the standard of care being given, and the possibility of the standard of care being given, and the possibility of elder abuseelder abuse is a continuing source of concern. The Adult is a continuing source of concern. The Adult Protective Services Agency — a component of the human Protective Services Agency — a component of the human service agency in most states — is typically responsible for service agency in most states — is typically responsible for investigating reports of domestic elder abuse and providing investigating reports of domestic elder abuse and providing families with help and guidance. Other professionals who may families with help and guidance. Other professionals who may be able to help include doctors or nurses, police officers, be able to help include doctors or nurses, police officers, lawyers, and social workers.lawyers, and social workers.

Improving mobility in the elderlyImproving mobility in the elderlyImpaired mobility is a major health concern for older adults, affecting Impaired mobility is a major health concern for older adults, affecting fifty percent of people over 85 and at least a quarter of those over fifty percent of people over 85 and at least a quarter of those over 75. As adults lose the ability to walk, to climb stairs, and to rise from 75. As adults lose the ability to walk, to climb stairs, and to rise from a chair, they become completely disabled. The problem cannot be a chair, they become completely disabled. The problem cannot be ignored because people over 65 constitute the fastest growing ignored because people over 65 constitute the fastest growing segment of the U.S. population.segment of the U.S. population.Therapy designed to improve mobility in elderly patients is usually Therapy designed to improve mobility in elderly patients is usually built around diagnosing and treating specific impairments, such as built around diagnosing and treating specific impairments, such as reduced strength or poor balance. It is appropriate to compare older reduced strength or poor balance. It is appropriate to compare older adults seeking to improve their mobility to athletes seeking to adults seeking to improve their mobility to athletes seeking to improve their split times. People in both groups perform best when improve their split times. People in both groups perform best when they measure their progress and work toward specific goals related they measure their progress and work toward specific goals related to to strengthstrength, , aerobic capacityaerobic capacity, and other physical qualities. Someone , and other physical qualities. Someone attempting to improve an older adult’s mobility must decide what attempting to improve an older adult’s mobility must decide what impairments to focus on, and in many cases, there is little scientific impairments to focus on, and in many cases, there is little scientific evidence to justify any of the options. Today, many caregivers evidence to justify any of the options. Today, many caregivers choose to focus on leg strength and balance. New research suggests choose to focus on leg strength and balance. New research suggests that limb that limb velocityvelocity and and core strengthcore strength may also be important factors in may also be important factors in mobility.mobility.

The family is one of the most important providers for the elderly. The family is one of the most important providers for the elderly. In fact, the majority of caregivers for the elderly are often In fact, the majority of caregivers for the elderly are often members of their own family, most often a daughter or a members of their own family, most often a daughter or a granddaughter. Family and friends can provide a home (i.e. have granddaughter. Family and friends can provide a home (i.e. have elderly relatives live with them), help with money and meet social elderly relatives live with them), help with money and meet social needs by visiting, taking them out on trips, etc.needs by visiting, taking them out on trips, etc. Declaring elderly incompetenceDeclaring elderly incompetenceIn almost all cases in which elderly persons are declared mentally In almost all cases in which elderly persons are declared mentally or physically incompetent to adequately take care of themselves, or physically incompetent to adequately take care of themselves, state laws require that a minimum of two doctors, or other health state laws require that a minimum of two doctors, or other health professionals, vouch for evidence of such incompetence. Only then professionals, vouch for evidence of such incompetence. Only then can legal supervision by a loved one or caretaker be initiated, can legal supervision by a loved one or caretaker be initiated, including power of attorney, guardianship and conservatorship. If including power of attorney, guardianship and conservatorship. If doctors' corroboration cannot be obtained by interested parties, doctors' corroboration cannot be obtained by interested parties, then other proof must be proffered to support the case for then other proof must be proffered to support the case for incompetence, including outstanding bills and financial debt, or incompetence, including outstanding bills and financial debt, or substandard living conditions that would be deemed unsafe or substandard living conditions that would be deemed unsafe or hazardous to the elderly person(s).hazardous to the elderly person(s).

 

PATIENT

 

A patient is any person who receives medical attention,

care, or treatment. The person is most often ill or

injured and in need of treatment by a physician or other medical professional, although one who is visiting

a physician for a routine check-up may also be viewed as a patient.

 

RECEPIENTS OF NURSING

the recipients of nursing are sometimes called the consumers, sometimes patients , and sometimes clients. A consumer is an individual , a group of people, or a community that uses a service or commodity. People who use health care products or services are consumers of healthcare.A patient is a person who is waiting for or undergoing medical treatment and care. The word patient comes from the Latin word meaning “to suffer “ or “to bear”. Traditionally , the person receiving health care has been called a patient. Usually people become patient when they seek assistance because of illness or for surgery.Some nurses believe that the word patients implies passive acceptance of the decision and care of health professionals.

 

Additionally, with the emphasis on health promotion and prevention of illness, many recipients of nursing care are not ill.Nurses interact with the family members and significant orders to provide support , information, and comfort in addition to caring for the patient.For these reasons nursing 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.Client is the proffered term , although consumer and patient are used in some instances.

 

HEALTH CARE PROVIDER

Nurses assume a number of roles when they provide care to clients . nurses often carry out these roles concurrently, not exclusively of one another. The nurse may act as a counselor while providing physical care and teaching aspects of that care. The roles required at a specific time depends on the needs of the client and aspects of the particular environment.

 

STANDARDS OF CARE  assessment  the nurse collects the patient health datadiagnosis

 the nurse analyzes the assessment data in determining diagnoses.outcome identification

 the nurse identifies expected outcomes individualized to the patient planning 

 the nurse develops a plan of care that prescribes interventions to attain expected outcomes.

implementation the nurse implements interventions identified in the plan care.

Evaluation The nurse evaluates evaluates the patient’s progress toward attainment of outcomes.

 

CAREGIVER        The 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 to assist clients in attaining their highest possible level of health and wellness. Caregiving compasses the physical, psychosocial, developmental, cultural, and spiritual levels.A nurse may provide care directly or delegate it to other caregivers.

COMMUNICATOR        Communication 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 the communicator , nurses identify client problems and then communicate these verbally on writing to other members of the health team.the nurse must be able to communicate clearly and accurately in order for a client’s health care needs to be met.

 

TEACHER          As a TEACHER a nurse helps the client learn about their health and the health care procedures they need to perform to restore or maintain their helath. Nurse’s assesses client’s learning needs and readiness to learn, sets specific learning goals in conjunction with the client, enact teaching strategies, and measures learning.

CLIENT ADVOCATE          Client advocate acts to protect the client. The nurse may represent the client’s needs and wishes to other health professional, such as relaying clients wishes for information to the physician, they assist clients in exercising their rights and help them speak up for themselves. 

 

COUNSELOR       Counseling is the process of helping a client to recognize and cope with stressful psychologic 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 health 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 choices, and develop a sense of control.  

CHANGE AGENT        Nurse acts as change agent when they assist others ,to make modifications on their behavior.nurses also often act to make changes in a system , such as clinical care if it is not helping a client to 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 their medications are just few of the changes nurses deal with the daily.

 

LEADER        A 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.

MANAGER        The 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.

 

CASE MANAGER

Nurse case manager work with the multidisciplinary health care team to measure the effectiveness of the case management plan to monitor outcomes. Each agency or units specifies the role of the nurse case manager. In some institutions, the case manager works with primary or staff nurses to over see the care of a specific caseload. 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 that care is oriented ti the client, while controlling costs.

 

RESEARCH CONSUMER Nurses often use research to improve client care. In a

clinical area, nurses need to have some awareness of the process and language of research. Be sensitive to issues

related to protecting the rights of the human subjects. Participate in the identification of significant researchable problems, and 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.

LEVELS OF CLIENTELE

Levels of clientLevels of client

IndividualIndividual Family Family Community Community

INDIVIDUAL

IndividualDimensions of individuality include the person's total character, self-identity, and perceptions. The person's total character encompasses behaviors, emotional state, attitudes, values, motives, abilities, habits, and appearances. The person self identity encompasses perception of self as a separate and distinct entity alone and in interactions with others. The person's perception encompass the way the person thinks, feels and act in any given situation.

Concept of Individuality•to help client attain, maintain, or regain an optimum level of health, nurses need to understand clients as individuals.

Concept of HolismNurses are concern with the individual as a whole, complete, or holistic person, not as an assembly of parts and processes. When applied in nursing, the concept of holism emphasizes that nurses must keep the whole person in mind and strive to understand how one area of concern relates to the whole person.

Concept of homeostatis

the concept of homeostatis was first introduced by Cannon (1939) to describe the relative constancy of the internal processes of the body, such as blood oxygen and carbon dioxide levels, bloods pressure, body temp., blood glucose, and fluid and electrolyte balance.

Physiologic Homeostatic•means that the internal environment of the body is relatively stable and constant.

Homeostatic mechanisms have 4 main characteristics

1-They are self-regulating2-They are compensatory3-They tend to be regulated by negative feedback systems. 4-They may require several feedback mechanism to correct only one physiologic imbalance.

:

FAMILYis a basic unit of societyIt consists of those individuals, male or female, youth or adult, legally or not legally related, genetically or not genetically related, who are considered by the others by the others to represent their significant persons

Function of the Family

the economic resources needed by the family are secured by adult members the family protects the physical health of its member by providing adequate nutrition and health care service

Nuclear Family- A family structure of parents and their offspring.

Extended family -The relatives of nuclear families, such as grandparents or aunts and uncles, compose.

Extended family -The relatives of nuclear families, such as grandparents or aunts and uncles, compose.

Types of Families in Today's Society

Traditional Family

is viewed as an autonomous unit in which both parents reside in the home with their children, the mother often assuming the nurturing role and the father providing the necessary economic resources

Two-Career Family

• In two-career (or dual career) families, both partners are employed.

Single-Parent Family

•Approximately 50% of American children live in a single-parent home

Adolescent Family

•A growing proportion of infants are born each year to adolescent parents, especially those of minority cultural groups.

Faster Family

• children who can no longer live with their parents may require placement with family that has agreed to include them temporarily

Blended Family

•Existing family units who join together to form new families are known as blended, step, or reconstituted families.

Intergenerational Family

In some cultures, and as people live longer, more than two generations may live together

• .

Cohabiting Family

cohabiting (or communal) families consists of unrelated individuals or families who live under one roof.

Gay and Lesbian Family

Homosexual adults may form gay and lesbian families based on the same goals of caring and commitment seen in heterosexual relationships

• .

Single Adults Living Alone

•Individuals who live by themselves represent a significant portion of today's society

Communityis a collection of people who share some attribute of their lives can also be defined as social system in which the members interact formally or informally and form networks that operate for the benefit of all people in the community.

Community health nursing

•focuses on promoting and preserving the health of preserving the health of population groups.

Communication

The term communication has various meanings, depending on the context in which is used.is any means of exchanging information or feelings between two or more people.

The Communication Process

•Face-to-Face communication involves a sender, a messenger, a receiver, and a response, or feedback

Sendera person or group who wishes to convert a person or group who wishes to convert a message to another, can be considered a message to another, can be considered thethe sources-encoder. sources-encoder.the term suggests that the person or the term suggests that the person or group sending the message must have group sending the message must have an idea or reason for communicating an idea or reason for communicating (sources) and must put the idea or (sources) and must put the idea or feeling of into a form that can be feeling of into a form that can be transmittedtransmitted..

a person or group who wishes to convert a person or group who wishes to convert a message to another, can be considered a message to another, can be considered thethe sources-encoder. sources-encoder.the term suggests that the person or the term suggests that the person or group sending the message must have group sending the message must have an idea or reason for communicating an idea or reason for communicating (sources) and must put the idea or (sources) and must put the idea or feeling of into a form that can be feeling of into a form that can be transmittedtransmitted..

Encodinginvolves the selection of specific signs or symbols (codes) to transmit the message, such as which language and words use, how to arrange words to use ,and what tone of voice and gestures to use.

Message•what is actually said or written , the body language that accompanies the words, and hoe the message is transmitted.

Receiveris the listener, who must listen, is the listener, who must listen, observe, and attend. observe, and attend. decode - decode - means to relate the means to relate the message perceived to the message perceived to the receiver's storehouse of receiver's storehouse of knowledge and experience and knowledge and experience and to sort out the meaning of the to sort out the meaning of the message.message.

Responseis the message that the receiver returns to the sender.It is also called feedback.

Modes of communication

Verbal communication Nonverbal communication

Verbal communication

• uses the spoken or written word.

• is largely conscious because people choose the words they use.

*when choosing words to say or write ,

nurses need to consider* • (a) pace and intonation - The manner speech, as in the pace or rhythm

and intonation, will modify the feeling and impact of the message.

• (b) simplicity - simplicity includes the use of commonly understood words, brevity, and completeness.

• (c) clarity and brevity - a message that is direct and simple will be more effective.

• (d) timing and relevance - Nurses needs to be aware of both relevance and timing when communicating with clients.

• (e) adaptability- spoken message needs to be altered in accordance with behavioral cues from the client.

• (f) credibility- means worthiness of belief, trustworthiness, reliability

•

•

• (g) humor - the use of humor can be a positive and powerful tool in the nurse-client relationship, but it must be used with care

Nonverbal communication

• uses other form, such as gestures or facial expression, and touch

• is sometimes called body language

.• personal appearance - Cloth in an adornments

can be sources of info. about a person posture and gait-the way people walk and carry

themselves are often reliable indicators of self-concept, current mood, and health.

• facial expression - no part of the body is as expressive as the face.

-feeling of surprise, fear, anger, disgust, happiness, and sadness can be conveyed by facial expression

• Gestures - Hand and body gesture may emphasize and clarify the spoken word, or they may occur w/o words to indicate a particular feeling or to give a sign.

Therapeutic Communication

• Promotes understanding and can help establish a constructive relationship between the nurse and the client.

Attentive listening

• listening actively, using all he senses, as opposed to listening passively w/ just the ear.

Physical attending

• Egan(1998) has outline five specific ways to convey physical attending, which he defines as the manner of being present to another or being w another.

Barriers to communication

• Nurses needs to recognize barrier or non therapeutic responses to effective communication.

The Helping Relationship

• Nurse-client relationships are refer to by some as interpersonal relationship, by others as therapeutic relationships, and by still as helping relationships.

Phases of the Helping Relationship

• the helping relationship process can be described in terms of four sequential phases, each characterized by identifiable tasks and skills.