Chapter 1

Nursing: An Art and a Science

Introduction

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 the 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.

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 this 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, or 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 (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 in that is concerned with all of the variables
affecting individuals response to stressors, which are intra-, inter-, and
extra personal in nature (Neuman).
 An external regulatory force that acts to preserve the organizations and
integration of the clients 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 person, 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 to 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, dominant domain that
distinguishes nursing from the other health disciplines. Care is the
essential human need, necessary for the health and survival of all
individuals. Acts of caring refer to the direct and indirect nurturing and
skillful activities, processes and decisions that assist people in ways
that emphatic ,compassionate, and supportive; and that are
dependent on the needs, problems and values of individual being
assisted (Leininger)
 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 five 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 other.
 Being with is being emotionally present to other.
 Doing for is doing for other as he or she would do for the self if it
were at all possible.
 Enabling is facilitating the others passage through life transitions
(e.g. birth and 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 is a nursing practice involves: providing presence, comforting listening,
knowing the client, spiritual caring and family care.
 Providing presence is when a nurse establishes reassuring presence,
eye contact, body language, voice tone, listening and having a positive
and encouraging attitude, act together to create openness and
understanding.
 Comforting involves the use of touch and the skillful and gentle
performance of nursing care procedures.
 Listening involves paying attention to an individual’s words and tone of
voice, and entering to his her frame of reference.
 Knowing the client is at the core of the process by which nurses make
clinical decisions. To know the client means that the nurse considers the
client as a unique individual.
 Spiritual caring offers a sense of interconnectedness intrapersonally
(with one self), interpersonally (with others and the environment) and
transpersonally (with the unseen god, or a higher power).
 Family care involves knowing of the family as thoroughly as one knows
the client. A nurse demonstrates caring by helping family members
become active participants in the client care.

Concepts of Profession by ( MarieJahoda)

 A profession is an organization of an occupational group based on the application

of special knowledge which establishes its own rules and standards for the
protection of the public and the professionals.
 A profession implies that the quality of the work done by its member is of greater
importance in its own eyes and the society than the economic rewards they earn.
 A profession serves all of society and not the specific interest of a group.
 The aims of profession are altruistic rather than materialistic.

The Characteristics and attributes of a professional person are as follows:

1. Is concerned with quality. He/she possesses competence to practice the

profession in terms of scientific knowledge, technological skills and desirable
attitudes and values.
2. Is self- directed, responsible, and accountable for his/her actions.
3. Is able to make independent and sound judgment including high moral judgment.
4. Is dedicated to the improvement of human life.
 5. Is committed to the spirit and inquiry. He/she demonstrates zest for continued
studies including research, which will steadily increase and improve knowledge,
skills and attitudes needed by the profession.

Nursing as a Profession

 Nursing is a profession. A profession possesses the following primary

characteristics:
1. Education. A profession requires an extended education of members, as well
as basic liberal foundation.
2. Theory. A profession has a theoretical body of knowledge leading defined
skills, abilities and norms.
3. Service. A profession provides basic service.
4. Autonomy. Members of a profession have autonomy in decision making and
in practiced.
5. Code of Ethics. The profession as a whole has a code of ethics for practiced.
A profession has sufficient self- impelling power to retain its members
throughout life. It must not be a mere steppingstone to other occupations.
6. Caring. The most unique characteristics of nursing as a profession is that, it
is a CARING profession.

 Flexner’s Criteria for a profession Compared with Nursing

Patterns of developing Profession Nursing profession

1 .Professional are basically intellectual Nurses are educated in institutions of higher learning and
function in a responsible and accountable manner. Critical
thinking is now being emphasized to a great extent at all
levels of nursing education.

2. Professions are based on a specific body of Nursing has identified and continues to develop its own
knowledge that can be learned. specific body of knowledge from which nursing practice
emerges. Application of theory derived from research
provides the rationales for action.

3. Professions are practical as well as theoretical.

Nursing professionals accept great responsibility for
providing for peoples healthcare needs. The profession
evolved in response to needs identified by society and is
guided by an ethical code.

4. Professional work can be taught professional

education Nurses are educated primarily in different types of degree
programs – baccalaureate degree and advanced nursing
degree programs (Master’s degree and Doctorate degree).

5 .Professions have strong internal organizations. The Philippine Nurses Association (PNA) and other bodies
 provide internal organization.

6 .Practitioners are guided by altruism

Many nurses enter the profession out of a desire to help
others.

 Professional Nursing is an art and a science, dominated by an ideal of service

in which certain principles are applied in the skillful care of the well and the ill,
and through relationship with the client/patient, significant others, and other
members of the health team.
 A professional nurse is one who has acquired the art and science of nursing
through her basic education ,who interprets her role in nursing in terms of the
social ends for which it exists- the health and welfare of society and who
continues to add to her knowledge, skills and attitudes through continuing
education and scientific inquiry (research) or the use of the results of such
inquiry.

The Qualifications and Abilities of a Professional Nurse as follows:

1. Has faith in the fundamental values that underlie the democratic way of life,
for example:
 Respect for human dignity
 Self – sacrifice for the common good.
 Strong sense of responsibility for sharing in the solution of the problems of
the society.
2. Has a sense of responsibility for understanding those with whom he/she
works or associates with through the use of the following skills:
 Utilizing relevant basics concepts of psychology.
 Working effectively through therapeutic relationship.
3. Has faith in the reality of spiritual and aesthetic values and awareness of
the value and the pleasure of self- development through the pursuit of
some aesthetic interests.
4. Has the basic knowledge, skills and attitude necessary to address present-
day social problems, realistic, incisive, and well organized thoughts
through the use critical thinking. Critical thinking is securing, appraising and
organizing evidence.

5. Has skill in using written and spoken language, both to develop own
thoughts and to communicate them to others.
6. Appreciates understands the importance of good health.
 7. Has emotional balance. Is able to maintain poise and composure in trying
situations.
8. Like hard work and possesses a capacity for it.
9. Appreciates high standards of workmanship.
10. Accepts and tries to understand people of all sorts, regardless of race,
religion and color.
11. Knows nursing thoroughly that every client will receive excellent care.

Personal Qualifications of a Nurse

 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 shapes the facets of the character.
 Every person must develop a personal philosophy of life and plan for
expanding his personal life.
 Theories of nursing can be taught, but not a philosophy of life or a
philosophy of service.
B. 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 will include
more than that which meet 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 ones abilities, desires, impulses, habits
and physical character into a harmonious whole.

How to develop ones personality:

1. Warmth of manner, a ready smile, sincere laugh, genuine

interest, in others.
2. Complete sincerity.
 3. Sympathetic grooming: neat hair style, appropriate dress,
sufficient make up and expressive hand; being never mindful of
the people who see you.

Components of good personality

 Personal Appearance
 Character
 Attitude
 Charm

1. Personal Appearance
Your appearance often reveals more about the real you than any words you may say.
Self – respect is the basis upon which personal appearance is established. It includes a
healthy body motivated by unselfishness and expressing graciousness: the components
of personal appearance are as follows: posture, grooming, dress and uniform
a. Posture
 It refers to the habitual or assumed positions of your body in standing, sitting
or moving about.
 Posture presents some clues to your personality.
 As a nurse, you must be responsible for practicing a physical regimen that
helps to develop and maintain good posture and physical fitness.
b. Grooming
 Your hair should truly ‘crown’ the features of your face in an attractive manner.
 Your hair should be neat, clean and well arranged.
 It also includes personal hygiene and cleanliness.
c. Dress and uniform
 Just as self- respect is evident in good posture and personal hygiene, so as it
is reflected in the care you exercise with regards to dressing.
Basic guides for personal dress

 Undergarments must be clean and properly fitted for body support.

 All articles of clothing should be neat, personable and trim, especially the ”give
away” articles such as the bra straps, the slip, the heels of the shoes.
 Street attire is expected to be appropriate and to give you a sense of security in
official or social situations.
 Your wardrobe may be limited, but planning it in basic colors and using
contrasting or blending hues can add greatly to its extensiveness.
 Accessories should match the attire and should be suitable to the occasion and to
your personality.
  Current fads and styles may have to be disregarded to accommodate your budget
or your body structure.

The Nurse’s Uniform

 They come in different colors, but irrespective color, the nurse’s distinctive
uniform identifies you as nurse to your patient and his family as well as your co-
workers.
 You must respect the Uniform. It is a part of the nurse’s public image.
 Wear the uniform only during working hours.
 It should not be worn in jewelry, except a school pin or name plate.

The Nurse’s Cap

 The style of the cap remains usually the same for a particular school.
 Like the uniform, wear it with respect and dignity.

Points to remember in wearing the nurse’s uniform:

 Every item comprising the uniform must be spotlessly clean, well fitting, and in
good repair.
 Shoes and hosiery worn with the uniform should provide for maximum comfort.
 Uniform designated for use in a given hospital area is worn only in the line of
duty and not to be worn outside the specified department.
 Modification of any authorized uniform to suit your individual preference is not
permitted by the dictates of both good taste and integrity.

2. Character

 Character refers to the moral values and beliefs that are used as guides to personal
behavior and actions.
 It is what a person is inside
 It is the development in proportion to emotional and intellectual growth and involves the
degree to which you understand, direct and channel your feelings.
 The practice of nursing utilizes ones love for fellowman. Charity is the greatest virtue
and serves as a foundation for a sense of values and the development of human
character.

THE NURSE IS BASICALLY A GOOD PERSON

Four virtues emanating from the practice of charity:
 Justice. The quality of being righteous, correct, fair, and impartial.
 Prudence. Permits us to live with good sense and perspective. Guides ones
choice of action here and now.
 Fortitude. Assists in the control of feelings, thoughts and emotions in the face of
difficulty.
 Temperance. Encourages constructive use of the pleasure of the sense.

Attributes of Character

 Honesty
 Loyalty
 Tolerance
 Judgement
 Reliability
 Motivation
 Resourcefulness
 Moderation

 Honesty
 Being truthful, trustworthy and upright in ones dealing with others as well as
refraining from lying, cheating and stealing.
 It demonstrated in terms of:
 Truthfulness. The quality of being in agreement with facts, reality and
experience.
 Honor. Making good on commitments.
 Integrity. Adhering to ones set of moral values.
 Evidences of honesty can be observed in the following :
 Care of materials.
 Recognition of authority.
 Obedience to rules, regulation and authority.
 Use of time in terms of punctuality in performing activities.
 Loyalty
 The feeling of confidence, trust and affection you have towards your family
and friends and toward those who have helped, guided and stood by you
as you proceeded towards your goals.
 E.g. speaking well about co – workers and the institution where you work.
 Tolerance
  It manifests itself in your recognition of the rights of others.
 It allows you to respect and accept others as fellow human beings entitled
to enjoy the same basic rights and privileges that you claim for yourself. It
is demonstrated in the practice of patience, a sense of humor, sympathy,
understanding and unselfishness.
 E.g. allowing an angry relative to verbalize his/her feelings.
 Judgment
 Sometimes referred to as “good sense “, it indicates one’s ability to use
one’s intellectual capacity to form sound opinions. Qualities involved in the
used of judgment are wisdom, discretion and tact.
 E.g. questioning an unclear doctor’s orders before acting.
 Reliability
 It is dependability and involve one’s use of sound judgment based upon
careful observation and an understanding of any given situation in which
one is required to act.
 E.g. performing one’s responsibilities thoroughly even beyond time of duty,
as necessary; reporting on duty even during holidays, floods, typhoons,
etc.

 Motivation
 Something that moves one to plan and accomplish specific things; it is a
positive force that directs one’s personal actions to the fulfillment of desires
or drives that are referred to as basic human needs.
 E.g. aiming to give the best quality of patient care at all times.
 Resourcefulness
 Involves a person’s ability to recognize and deal promptly and effectively
with difficulties and problems that arise. It requires the utilization of
information available about a given situation and using it courageously,
sensibly and constructively in dealing with the situation.
 E.g. using indigenous materials/articles in the absence of sophisticated
ones.
 Moderation
 Allows one to maintain harmony and balance among all the elements of
one’s character and in one’s relationships with others by encouraging one to
develop perspective and a sense of objectivity.
 E.g. indulging in food, material goods, and other factors that provide
pleasure or enjoyment to the senses in controlled manner.

3. Attitude
A manner of acting, thinking, or feeling that is indicated by ones response toward
another person, situation or experience.

 Personality is shaped by one’s attitudes.

 It is a part of a pattern of personal behavior.
 It is based on opinions, viewpoints or feelings.
 It is a result of responses to specific experiences.
 It changes from time to time as additional knowledge is gained and one’s
understanding is broadened.
 A change in attitude results to a change in behavior.
 It develops from awareness of oneself in relation to individuals and situations.

Eight Be- Attitudes of a Nurse

 Acceptance.
 Acceptance of othersis indicative of self – maturity.
 Facing known and meeting the unknown of life with maximum comfort.
 Changing can be changed within one’s self.
 E.g. the nurse accepts the client as an individual and respecting his/her
culture.
 Helpfulness.
 Strong feelings toward helping others; giving others attention,
reassurance and a protective security in the storms of daily living.
 E.g. the nurse assists a weak client in feeding and performing hygienic
measures.
 Friendliness.
 Maybe active or passive, warmth of manner; pleasant interaction with
others.
 E.g. the nurse establishes rapport with the client and his/her family
 Firmness.
 Being alert to the actions of others in a positive, confident way, uses firm,
kind and immediate methods of approach.
  E.g. the nurse implements hospital rules and policies regarding visiting
hours, number of visitors at a time, use of telephone.
 Permissiveness.
 Understanding of motives and the feelings expressed in behavior weather
they are or not capable; loosening or tightening the reign of authority in the
interaction; flexibility in responses.
 E.g. the nurse allows the adolescent to wear his own clothing as he/she
requests, instead of the hospital gown.
 Limit Setting.
 Knowing the value of her influence; offering of praise or blame; limiting
what others may say or do.
 E.g. the nurse tells the client who keeps on throwing things that this
behavior is unacceptable.
 Sincerity.
 Acting naturally, recognizing one’s anger fears and other feelings.
 E.g. the nurse tells the clients who is crying because she lost her baby,
that she understands how she feels at this time. And the nurse holds the
client’s hand and stays with her.
 Competence
 Approaching problems intellectually rather than emotionally; displaying
knowledge and ability to deal with situations.
 E.g. the nurse stays with the client whose wound on the abdomen has
disrupted and reassures the client that help from a physician is being
sought for.

4. Charm
 To influence the senses or the mind by some quality or attraction; delight.
 Innate in one who has a depth of feeling and an outgoing manner.
 May be cultivated by a desire to serve and a deep love for fellow human beings.

To acquire charm, one needs to cultivate the following:

 Voice. Modulated with clear enunciation.

 Manner. Courteous, attentive, patient, receptive.
 Heart.Attempt never to show indifference or a callused manner. Be emphatic,
understanding and tolerant. Remember to say” thank you “ as this works miracles
in social harmony.
 Intelligence. Keep an active mind, recognize beauty, accept new ideas from
others, read and exchange opinions with others.
  Poise. Equanimity, calmness, composure, evenness of temper, self – control.

The requirements for development of poise are as follows:

A. Calmness and composure:

 Face reality.
 Avoid emotional flare-ups.
B. Control of temper
 Think before acting
 Avoid verbal and physical aggressiveness.

 Carper’s Patterns of knowing

In the Carper (1978) model, knowledge is developed through a four patterns of

knowing which are as follows:
1. Empiric knowing
2. Ethical knowing
3. Personal knowing
4. Aesthetic knowing

 Empirical knowing. Is based on the assumption that what is known is

accessible through the physical senses, particularly seeing, touching and
hearing, and as pattern of knowing draws on traditional ideas of science.
 Ethical knowing. Involves making moment – moment judgments about what
ought to be done, what is good, what is right, and what is responsible.
 Personal knowing. Concerns the inner experience of becoming holistic,
authentic self, capable of unifying the plural dimensions in which that self-
lives in an honest and open manner.
 Aesthetic (esthetic) knowing. Involves deep appreciation of the meaning of a
situation and calls forth, inner creative resources that transform experience
into what is not real, bringing to reality something that would not otherwise be
possible.

Overview of the ProfessionalNursing Practice

 Level of proficiency according to Patricia Benner

a. Novice. A beginning nursing student or any nurse entering a situation in which
he or she has had no previous experience.
b. Advanced beginner. The advanced beginner can demonstrate marginally
acceptable performance.
 c. Competent. Competence is reflected by the nurse who has been on the same
job for 2 to 3 years and consciously and deliberately plans nursing care in
terms of long – range goals.
d. Proficient. The proficient nurse perceives situations as a whole rather than in
terms of aspects and manages nursing care rather than performing tasks.
e. Expert. The expert nurse no longer relies on rules or guidelines to connect
understanding of a situation to an appropriate action.
f.

The Roles and functions of a Professional Nurse

 Care provider
 Communicator / helper
 Teacher
 Counselor
 Client advocate
 Change agent
 Leader
 Manager
 Researcher
 Case manager
 Collaborator

1. Care Provider. The nurse supports the client by attitudes and actions that show
concern for client welfare and acceptance of the client as a person. The nurse is
primarily concerned with the clients need.
2. Communicator/Helper. The nurse communicates with clients, support persons
and colleagues to facilitate all nursing actions.
3. Teacher. The nurse provides health teaching to effect behavior change with
focuses on acquiring new knowledge or technical skills.
4. Counselor. The nurse helps the client to recognize and cope with stressful
psycho logic or social problems, to develop improved personal relationships and
to promote personal growth.
5. Client advocate. The nurse promotes what is the best for the client, ensures that
the client’s needs are met, and protects the client’s rights.
 6. Change agent. The nurse initiates changes and assists the client make
modifications in the lifestyle to promote health.

7. Leader. The nurse through the process of interpersonal influences helps the
client make decisions in establishing and achieving goals to improve his well –
being.
8. Manager. The nurse plans, gives directions, develops staff, monitors operations,
gives reward fairly, and represents both staff members and administrations as
needed.
9. Researcher. The nurse participates in scientific investigation and uses research
findings in practice.
10. Case manager. The nurse coordinates the activities of other members of the
healthcare team, such as nutritionists and physical therapists, when managing a
group of client’s care.
11. Collaborator. The nurse works in a combined effort with all those involved in
care delivery, for a mutually acceptable plan to be obtained that will achieve
common goals.

 Scope of Nursing Practice Based on RA 9173.

REPUBLIC ACT NO. 9173

AN ACT PROVIDING FOR A MORE RESPONSIVE NURSING PROFFESION,

REPEALING FOR THE PURPOSE REPUBLIC ACT NO. 7164, OTHERWISE KNOWN
AS “THE PHILIPPINE NURSING ACT OF 1991” AND FOR OTHER PURPOSES

ARTICLE 1

TITLE

SECTION 1. TITLE – This act shall be knownas the “Philippine Nursing Act of
2002.”

Sec 2. Declaration of policy. – it is hereby declared the policy of the state to

assume responsibility for the protection and improvement of the nursing profession by
instituting measures that will result in relevant nursing education, humane working
conditions, better career prospects and a dignified existence for our Nurses.

The state hereby guarantees the delivery of quality basic health services through an
adequate nursing personnel system throughout the country.
 ARTICLE VI

Nursing Practice

Sec. 28. Scope of Nursing – a person shall be deemed to be practicing nursing within
the meaning of this act when he/she singly or in collaboration with another, initiates and
performs nursing services to individuals, families and communities in any health care
setting. It includes, but not limited to, nursing care during conception, labor, delivery,
infancy, childhood, toddler, pre-school, school age, adolescence, adulthood, and old
image.

(a) Provide nursing care through the utilization of the nursing processes.
(b) Establish linkages with community resources and coordination with the health
team.
(c) Provide health education to individuals, families and communities;
(d) Teach, guide and supervise students in nursing educations programs including
the administrations of nursing services in varied setting, such as hospital and
clinic; undertakes consultation service;
(e) Undertake nursing and health human resources development training and
research, which shall include, but not limited to, the development of advance
nursing practice;

Sec. 29. Qualifications of Nursing Service Administration. – a person occupying

supervisory or managerial positions requiring knowledge of nursing must:

(a) Be a registered nurse in the Philippines;

(b) Have at least two (2) years experience in general nursing service
administrations;
(c) Possesses degree of bachelor of science in nursing, with at least nine (9) units in
management and administration courses at the graduate level;
(d) Be a member of good standing of the accredited professional organization of
nurses;

Provided, that a person occupying the position of chief nurse or director of nursing
service shall, in addition to the foregoing qualifications, possess:
(1) At least five (5) years of experience in a supervisory or managerial position in
nursing
(2) A master’s degree major in nursing;

 Overview of the Code of Ethics for Nurses

 BOARD OF NURSING
Board Resolution No. 220
Series of 2004
PROMULGATION OF THE CODE OF ETHICS FOR REGISTERED NURSES

WHEREAS, the board of nursing has the power to promulgate a code of ethics
for registered nurses in coordination and consultation with the accredited
professional organization (Sec. 9, (g), Art. III of R.A. No. 9173, known as the
“Philippine Nursing Act of 2002);
WHEREAS, in the formulation of the Code of ethics for registered nurses, the
code of good Governance for the Professions in the Philippines was utilized as
the principal basis therefore: all the principles under the said code were adopted
and integrated into the Code of Ethics as they apply to The nursing profession;
WHEREAS, the promulgation of the said Code as a set of guidelines, regulations
or measures shall be subject to approval by the commission (Sec.9, Art. II of R.A
no. 9173);
WHEREAS. The board, after consultation on October 23, 2003 at Iloilo city with
the accredited professional organization of registered nurse, the Philippine
Nurses Association, Inc. (PNA), and other affiliate organizations of registered
Nurses, decided to adopt a new Code of Ethics under the afore- mentioned new
NOW, THEREFORE, the board hereby resolved, as it now resolves, to
promulgate the hereunder Code of Ethics for
Registered Nurses;

ARTICLE I
PREAMBLE
SECTION 1.
Health is the fundamental right of every individual. The Filipino registered nurse,
believing in the worth and dignity of each human being, recognizes the primary
responsibility to preserve health at all cost.

SECTION 2.
To assume this responsibility, registered nurses have to gain knowledge and
understanding of man’s cultural, social spiritual, physiological, psychological, and
ecological aspects of illness, utilizing the therapeutic process.
 SECTION 3.
The desire for the respect and confidence of clientele, colleagues, co- workers
and the members of the community provides the incentive to attain and maintain
the highest possible degree of ethical conduct.

ARTICLE II
REGISTERED NURSESAND PEOPLE
SECTION 4.
Ethical Principles
1. Values, customs, and spiritual beliefs held by individuals shall be respected.
2. Individual freedom to make rational and unconstrained decisions shall be
respected.
3. Personal information required in the process of giving nursing care shall be
held in strict confidence.
SECTION 5.
Guidelines to be observed:

Registered Nurses must:

a. Consider the individuality and totality of patients when they administer care.
b. Respect the spiritual beliefs and practices of patients regarding diet and
treatment.
c. Uphold the rights of individuals.
d. Take into consideration the culture and values of patients in providing nursing
care, however, in the event of conflicts, their welfare and safety must take
precedence.

ARTICLE III

REGISTERED NURSES AND PRACTICE

SECTION 6

Ethical Principles

1. Human life is inviolable.

2. Quality and excellence in the care of the patients are the goals of nursing
practice.
 3. Accurate documentation of actions and outcomes of delivered care is the
hallmark of nursing accountability.

SECTON 7.

Guidelines to be observed:

REGISTERED NURSES MUST:

a. Knows the definition and scope of nursing practice which are in the provisions of
R.A. No. 9173, known as the” Philippines Nursing Act of 2002” and board Res.
b. Be aware of their duties and responsibilities in the practiced of their professions
as de find in the” Philippine Nursing Act of 2002” and the IRR.
c. Acquire and develop the necessary competence in knowledge, skill, and attitudes
to effectively render appropriate nursing services through varied learning
situations.
d. If they are administrators, be responsible in providing favorable environment for
the growth and developments of registered nurses in their charge.
e. Be cognizant that professional programs for specialty certification by the BON
are accredited through the nursing specialty certification council (NSCC).
f. See to it that quality nursing care and practice meet the optimum standard of
safe nursing practice.
g. Insure that modification of practice shall consider the principles of safe nursing
practice.
h. If in position of authority in a work environment, be normally and legally
responsible for devising a system of minimizing occurrences of ineffective and
unlawful nursing practice.
i. Ensure that patients’ records shall be available only if they are to be issued to
those who are professionally and directly involved in their care and when they
are required by law.

SECTION 8
Ethical Principle

Registered Nurses are the advocates of the patients: that shall take appropriate steps to
safeguard their rights and privileges.

Guidelines to be observed:
REGISTERED Nurses must
a respect the “Patient’s Bill of Rights” in the delivery of nursing care
 b provide the patients or their families with all pertinent information except those
which may be deemed harmful to their well-being
c uphold the patients’ rights when conflict arises regarding management of their
care

SECTION 10
Ethical Principle

Registered Nurses are aware that their actions have professional, ethical, moral, and
legal dimensions. They strive to perform their work in the best interest of all
concerned.

SECTION 11
Guidelines to be observed:
REGISTERED Nurses must:
a Perform their professional duties in conformity with existing laws, rules,
regulations, measures, and generally accepted principles of moral conduct and
proper decorum.
b Not allow themselves to be used in advertisement that should demean the image
of the profession (i.e. indecent exposure, violation of dress code, seductive
behavior, etc.).
a. Decline any gift, favor or hospitality which might be interpreted as capitalizing on
patients.
b. Not demand and receive any commission, fee or emolument for recommending
or referring a patient to a physician, a co-nurse or or another health care worker;
not to pay any commission, fee or other compensations to the one referring or
recommending a patient to them for nursing care.
c. Avoid any abuse of the privilege relationship which exists with patients and of the
privilege access allowed to their property, residence or workplace.

ARTICLE IV
REGISTERED NURSES AND CO-WOKERS

SECTION 12
Ethical Principles
1. The Registered Nurse is in solidarity with other members of the healthcare team in
working for the patient’s best interest.
2. The Registered Nurse maintains collegial and collaborative working relationship with
colleagues and other health care providers.

SECTION 13
Guidelines to be observed:
REGISTERED Nurses must
a Maintain their professional role/identity while working with other members of the
health team.
b Conform with group activities as those of a health team should be based on
acceptable, ethico-legal standards.
c Contribute to the professional growth and development of other members of the
health team.
d Actively participate on professional organizations.
e Not act in any manner prejudicial to other professions.
f Honor and safeguard the reputation and dignity of the members of nursing and
other professions; refrain from making unfair and unwarranted comments or
criticisms on their competence, conduct, and procedures; or not do anything that
will bring discredit to a colleague and to any member of other professions.
g Respect the rights of their co-workers.
 ARTICLE V
REGISTERED NURSES, SOCIETY, AND ENVIRONMENT

SECTION 14
Ethical Principles
1 The preservation of life, respect for human rights, and promotion of healthy
environment shall be a commitment of a Registered Nurse.
2 The establishment of linkage with the public in promoting local, national, and
international efforts to meet health and social needs of the people as a contributing
member of society is a noble concern of a Registered Nurses.

SECTION 15
Guidelines to be observed:
REGISTERED Nurses must
a Be conscious of their obligations as citizens and, as such, be involved in
community concerns.
b Be equipped with knowledge of health resources within the community, and take
active roles in primary health care.
c Actively participate in programs, projects and activities that respond to the
problems of the society.
d Lead their lives in conformity with the principles of right conduct and proper
decorum.
e Project an image that will uplift the nursing profession at all times.

ARTIVLE VI
REGISTERED NURSES AND THE PROFESSION

SECTION 16
Ethical Principles:
1. Maintenance of loyalty to the nursing profession and preservation of its integrity are
ideal.
2. Compliance with the by-laws of the accredited professional organization (PNA), and
other professional organizations of which the Registered Nurse is a member is a
lofty duty.
3. Commitment to continual learning and active participation in the development and
growth of the profession are commendable obligations.
4. Contribution to the improvement of the socio-economic conditions and general
welfare of nurses through appropriate legislation is a practice and a visionary
mission.
SECTION 17
Guidelines to be observed:
Registered Nurses must
a Be members of the Accredited Professional Organization (PNA).
d. strictly adhere to the nursing standards.
e. Participate actively in the growth and development of the nursing profession.
f. Strive to secure equitable socio-economic and work conditions in nursing through
appropriate legislation and other means.
g. Assert for the implementation of labor and work standards.

ARTICLE VII
ADMINISTRATIVE PENALTIES, REPEALING CLAUSE, AND EFFECTIVITY

SECTION 18
The Certificate of Registration of Registered Nurse shall either be revoked or
suspended for violation of any provisions of this Code pursuant to Sec. 23 (f), Art. IV of
R.A. No. 9173 and Sec. 23 (f), Rule III of Board Res. No. 425, Series of 2003, the IRR.

SECTION 19
The Amended Code of Ethics promulgated pursuant to R.A. No. 877 and P.D. No. 223 is
accordingly repealed or superseded by the herein Code.

SECTION 20
The Code of Ethics for Nurses shall take effect after fifteen (15) days from its full and
complete publication in the Official Gazette or in any newspapers of general circulation.
 Done in the City of Manila, this 14th day of July, 2004

(original signed)
EUFEMIA F. OCTAVIANO
Chairman

(original signed) (original

signed)
REMEDIOS L. FERNANDEZ LETTY G. KUAN
Member Member

(original signed) (original signed)

ANESIA B. DIONISIO FLORENCE
C.CAWAON
Member Member
ATTESTED:

(original signed)
CARLOS G. ALMELOR
Secretary, Professional Regulatory Boards

APPROVED:

(original signed)
ANTONIETA FORTUNA-IBE
Chairperson

(original signed) (original signed)

AVELINA A. DELA REA LEONOR TRIPON-
ROSERO
Commissioner Commissioner

CERTIFICATION
This is to certify that in the formulation of the Code of Ethics for Registered
Nurses, the Code of Good Governance for the Professions in the Philippines was
utilized as the principal basis. All the principles under this Code are adopted and
integrated in the Code of Ethics as they apply to the nursing profession.

(original signed)
EUFEMIA F. OCTAVIANO
Chairman

(original signed) (original signed)

REMEDIOS L. FERNANDEZ ANESIA B.
DIONISIO
Member Member

(original signed) (original signed)

LETTY G. KUAN FLORENCE C.
CAWAON
Member Member
• Filipino Bill of Rights / Legal Aspects

THE 1987 CONSTITUTION

OF THE
REPUBLIC OF THE PHILIPPINES

ARTICLE III
BILL OF RIGHTS

Section 1. No person shall be deprived of life, liberty, or property without due process of
law, nor shall any person be denied the equal protection of the laws.

Section 2. The right of the people to be secure in their persons, houses, papers, and
effects against unreasonable searches and seizures of whatever nature and for any
purpose shall be inviolable, and no search warrant or warrant or arrest shall issue
except upon probable cause to be determined personally by the judge after examination
under oath or affirmation of the complaint and the witnesses he may produce, and
particularly describing the place to be searched and the persons or things to be seized.

Section 3. (1) The privacy of communication and correspondence shall be inviolable

except upon lawful order of the court, or when public safety or order requires others
otherwise, as prescribed by law.

(2) Any evidence obtained in violation of this or the preceding section shall be
inadmissible for any purpose in any proceeding.

Section 4. No law shall be passed abridging the freedom of speech, of expression, or of

the press or the right of the people peaceably to assemble and petition the government
for redress of grievances.

Section 5. No law shall be made respecting an establishment of religion, or prohibiting

the free exercise thereof. The free exercise and enjoyment of religious profession and
worship, without discrimination or preference, shall forever be allowed. No religious test
shall be required for the exercise of civil or political rights.

Section 6. The liberty of abode and of changing the same within the limits prescribed by
law shall not be impaired except upon lawful order of the court. Neither shall the right to
travel be impaired except in the interest of national security, public safety, or public
health, as may be provided by law.
Section 7. The right of the people to information on matters on public concern shall be
recognized. Access to official records, and to documents and papers, pertaining to
official acts, transactions, or decisions, as well as to government research data used as
basis for policy development, shall be afforded the citizen, subject to such limitations as
may be provided by law.

Section 8. The right of the people, including those employed in the public and private
sectors, to form unions, associations, or societies for purposes not contrary to law shall
not be abridged.

Section 9. Private property shall not be taken for public use without just compensation.

Section 10. No law impairing the obligation of contracts shall be passed.

Section 11. Free access to the courts and quasi-judicial bodies and adequate legal
assistance shall not be denied to any person by reason of poverty.

Section 12. (1) Any person under investigation for the commission of an offense shall
have the right to be informed of his right to remain silent and to have competent and
independent counsel preferably of his own choice. If the person cannot afford the
services of counsel, he must be provided with one. These rights cannot be waived
except in writing and in the presence of counsel.

(2) No torture, force, violence, threat, intimidation, or any other means which vitiate the
free shall be used against him. Secret detention places, solitary, incommunicado, or
other similar forms of detention are prohibited.

(3) Any confession or admission obtained in violation of this or Section 17 hereof shall
be inadmissible in evidence against him.

(4) The law shall provide for penal and civil sanctions for violations of this section as
well as compensation to the rehabilitation of victims of torture or similar practices, and
their families.

Section 13. All persons, except those charged with offenses punishable by reclusion
perpetuawhen evidence of guilt is strong, shall, before conviction, be bailable by
sufficient sureties, or be released on recognizance as may be provided by law. The right
to bail shall not be impaired even when the privilege of the writ of habeas corpus is
suspended. Excessive bail shall not be required.
Section 14. (1) No person shall be held to answer for a criminal offense without due
process of law.

(2) In all criminal prosecutions, the accused shall be presumed innocent until the
contrary is proved, and shall enjoy the right to be heard by himself and counsel, to be
informed of the nature and cause of the accusation against him, to have a speedy,
impartial, and public trial, and to meet the witnesses face to face, and to have
compulsory process to secure the attendance of the witnesses and the production of
evidence in his behalf. However, after arraignment, trial may proceed notwithstanding
the absence of the accused: Provided, that he has been duly notified and his failure to
appear is unjustifiable.

Section 15. The privilege of the writ of habeas corpus shall not be suspended except in
cases of invasion or rebellion, when the public safety requires it.

Section 16. All persons shall have the right to a speedy disposition of their cases before
all judicial, quasi-judicial, or administrative bodies.

Section 17. No person shall be compelled to be a witness against himself.

Section 18. (1) No person shall be detained solely by reason of his political beliefs and
aspirations.

(2) No involuntary servitude in any form shall exist except as a punishment for a crime
whereof the party shall have been duly convicted.

Section 19. (1) Excessive fines shall not be imposed, nor cruel, degrading or inhuman
punishment inflicted. Neither shall death penalty be imposed, unless, for compelling
reasons involving heinous crimes, the Congress hereafter provides for it. Any death
penalty already imposed shall be reduced to reclusion perpetua.

(2) The employment of physical, psychological, or degrading punishment against any

prisoner or detainee or the use of substandard or inadequate penal facilities under
subhuman conditions shall be dealt with by law.

Section 20. No person shall be imprisoned for debt or non-payment of a poll tax.

Section 21. No person shall be put twice in jeopardy of the punishment for the same
offense. If an act is punished by a law and an ordinance, conviction or acquittal under
either shall constitute a bar to another prosecution for the same act.
 Section 22. No ex post facto law or bill of attainder shall be enacted.
 Professional / Legal / Moral Accountability and Responsibility (As adopted from
CHED Memorandum No.5 series of 2008, Article IV. Competency standards Sec.

Keys Area of Core Competency Indicators

Responsibilit
y
A. Self and Core Competency 1:  Identifies the health needs of
Quality Demonstrates the patients/ groups
Nursing Knowledge base on  Explains the health status of the
Care The health/ illness patients/ groups
status of individual/
groups

Core Competency 2:  Identifies the problem

Provide sound  Gathers data related to the problem
decision making in the  Analyses the data gathered
care of individuals/  Select appropriate action
groups considering  Monitors the progress of the action
their beliefs and
values
Core Competency 3:  Performs age - specific safety
Promotes safety and comfort and Measures in all
privacy  Aspects of patient care
of patients  Performs age – specific comfort
measures in
 All aspect of patient care
 Performs age – specific
Measures to insure
 Privacy in all aspects of patient care

Core Competency 4:  Identifies the priority needs of patients

Sets priorities in  Analyses the needs of the patients
Nursing care base on  Determines appropriate
Patient’s needs  Nursing care to be provided
Core Competency 5:  Refers identified problem to
Ensures continuity of appropriate individuals /
Care agencies
 Establishes means of providing
continuous patient care

Core Competency 6:  Comforts to the 10 golden

Administers Rules in medication
medications and other Administration and health
health therapeutics
 Therapeutics
Core Competency 7:  Obtains consent
Utilizes the nursing  Completes appropriate
Process as framework Assessment techniques
For nursing  Performs appropriate
assessment techniques
7.1 Performs  Obtains comprehensive client
Comprehensive and Information
Systematic nursing  Maintains privacy and
Assessment Confidentiality
 Identifies health needs
7.2 Formulates a plan  Includes patient and his family
of care in in care planning
collaboration with  States expected outcomes of
patients and other Nursing intervention
members of the health  Develops comprehensive
team Patient care plan
 Accomplishes patient centered
Discharged plan

7.3 Implements  Explains interventions to

planned nursing care Patients and his family before
to achieve identified  Carrying them out
outcomes  Implements nursing
intervention that is safe and
Comfortable
 Acts according to clients’
Health condition and needs
 Performs nursing activities
Effectively and in timely
Manner
7.4 Evaluates  Monitors effectiveness of
progress toward Nursing interventions
expected outcomes  Revises care plan when
Necessary

B. Core Competency 1:  Identifiedtakes or activities

Management Organizes work load That needs to be accomplished
of To facilitate patient  Plants the performance of tasks
Resources Care Or activities base on priorities
and  Finishes work assignment on
Environment Time
Core Competency 2:  Determines the resources
Utilizes resources to needed to deliver patient care
support patient care  Controls the use of supplies
and equipment
Core Competency 3:  Checks proper functioning of
Ensures functioning of equipment
 Core Competency 2:  Considers nature of learning in
Develops health relation to: social, cultural,
education plan based political, economic,
on assessed and educational and religious
anticipated needs factors.

Core Competency 3:  Involves the patient, family,

Develops learning significant others and other
materials for health resources
Resources  Refers malfunctioning
education
 Formulates
equipment to a comprehensive
appropriate unit
Core Competency 4:  Establishes
health educationmechanism
plan with theto
Checks proper following components:
ensure proper functioning of
Functioning of objectives
equipment, content, the
Equipment  allotment,
Determines teaching tasks learningand
resources
procedures thatand can
evaluation
be safelyparameters
 Assign tothe
Provides other feedback
member of to
The team.
finalize the plan
 Verifies the competency of the
Core Competency 3:  Staff prior to delegating tasks
 Provides for a conducive
Core Competency
Implements 5:
the health  Observed proper disposal of
Maintains aplan
safe learning situation in terms of
education wastes
Environment time and place
 Adheres to policies,
 Considers
procedures client
and and family’s
protocols on
preparedness
prevention and control of infection
 Utilizes
Definesappropriate
steps to followstrategies
in case
 of fire, earthquake,
Provides and other
reassuring presence
emergency
through situations.
active listening,
C. health Core Competency 1:  touch, facial expressioninformation
Obtains learning and
Education Assesses the learning through
gestures interview,
needs of the patient  observation
Monitors andand
client validation
family’s
and family  Defines relevant information
responses to health education
Core Competency 5:  Completes assessment records
 Utilizes evaluation parameters
Evaluates the Appropriately
 Documents outcome
Identifies priority of care
needs
outcome of health
education  Revises health education plan
when necessary
D. Legal Core Competency 1:  Fulfills legal requirements in
Responsibility adheres to practices nursing practice
in accordance with the
 Holds current professional license
nursing law and other
relevant legislation  Acts in accordance with the
including contracts, terms of contend contract of
informed consent. employment and other rules
 and regulations
 Complies with required
continuing professional
education
 Confirms information given by
the doctor for informed consent
 Secures waiver of
responsibility for refusal to
undergo treatment or procedure
 Checks the completeness of
informed consent and other
legal forms
Core Competency 2:  Articulates the vision, mission
Adheres to of the institution where one belongs
Organizational policies  Acts in accordance with one established
and procedures, local Norms of conduct of the
and national institution/ organization
Core Competency 3:  Utilizes appropriate patient
Documents care care according or report.
rendered to patients  Accomplishes accurate
documentation in all matters
concerning patient care in
accordance to the standards of
nursing practice.
E. Ethico – Moral Core Competency 1:  Renders nursing care
Responsibility Respect the rights of consistent with the patient’s
individual / groups bill of rights: (i.e. confidentially
of information, privacy, etc.)
Core competency 2:  Meets nursing accountability
accepts responsibility requirements as embodied in
and accountability for the job description
own decision and  Justifies bases for nursing
actions. actions and judgement
 Projects a positive image of
the profession.

Core Competency 3:  Adheres to the cord of ethics

Adheres to the for nurses and abides by its
National and provision
International code of  Reports unethical and immoral
Ethics for nurses incidents to proper authorities
F. personal Core Competency 1:  Verbalizes strengths,
and Identifies own learning weaknesses, limitations
Professional Needs  Determines personal and
Development professional goals and
aspirations
Core Competency 2:  Participates in formal and non –
Pursues continuing formal
Education education
 Applies learned information
for the improvement of care
Core Competency 3:  Participates activity in
 Gets involves in professional, social, civic, and
professional religious activities
organization and  Maintains membership to
civic activities professional organizations
 Support activities related to
nursing and health issues
Core Competency 4:  Demonstrates good manners
Projects a and right conduct at all times
professional image of  Dresses appropriately
the nurse  Demonstrates congruence of
words and action
 Behaves appropriately at all times
Core Competency 5:  Listens to suggestions and
Possesses positive recommendations
attitude towards change  Tries new performance
and criticism. against standards of practice
 Adapts to changes willingly.
Core competency 6:  Assesses own performance
Performs function against standards of practice
according to  Sets attainable objectives to
professional enhance nursing knowledge
standards and skills
 Explains current nursing
practices, when situation call

For it
G. Quality Core Competency 1:  Demonstrate knowledge of
Improvement Gathers data for method appropriate for the
Quality improvement clinical problems identified
 Detects variation in the vital signs of
the patient from day to day
 Reports necessary elements at
the bedside to improve
patient stay at hospital
 Solicits feedback from patient
 and significant others
 regarding care rendered
Core Competency 2:  Contributes relevant
Participates in nursing information about patient
Audits and rounds condition as well as unit
condition and patient current reactions
 Shares with the team current
information regarding
particular patients condition
 Documents and records all
nursing care and action
 Performs daily check of
patients record / condition
 Completes patients records
 Actively contribute relevant
information of patients during
rounds thru readings and
sharing with others
Core Competency 3:  Documents observed variance
Identifies and reports regarding patient care and
Variances submits to appropriate group
within 24 hours
 Identifies actual and potential
variance to patient care
 Reports actual and potential

36
variance to patient care
 Submits reports to appropriate
groups within 24 hours
Core Competency 4:  Gives appropriate suggestions
Recommend solutions on corrective and preventive measures
To identified problems  Communicates and discusses
with appropriate groups.
 Gives an objective and accurate
report on what was observed rather
than an interpretation of the event.
H. Research Core Competency 1:  Able to identify researchable
Gather data using problems regarding patient
Different methodologies care and community heath
 Identify appropriate methods
of research for a particular
patient / community problem
 Combines quantitative and
qualitative nursing design thru
simple explanation on the
phenomena observed
 Analyses data gathered
Core Competency 2:  Base on the analysis of data
Recommends actions for gathered, recommends
Implementation particular solutions appropriate
for the problem
Core Competency 3:  Able to talk about the results
 Disseminates results of of the findings to colleagues /
Research findings patients / family and to others
 Endeavors to publish research
 Submits research finding to
own agencies and others as
 appropriate
Core Competency 4:  Utilizes findings in research in
Applies research findings the provision of the nursing care
In nursing practice to individuals / groups / communities
 Makes use of evidence – based
nursing to ameliorate nursing

Practice.

Records Core Competency 1: Completes updated

1. 
Management Maintains accurate and documentation of patient
updated documentation care
of patient care

Core Competency 2: Utilizes a records system ex.


Records outcome of Kardex or hospital information

Patient care System (HIS)

Core Competency 3:  Observes confidentially and

Observes legal privacy of the patient’s records.
Imperative in record  Maintains an organized system
keeping of filling and keeping patients’
records in a designated area.
 Refrains from releasing
records and other information
without proper authority.
J. Communication Core Competency 1:  Creates trust and confidence
establishes rapport with  Listens attentively to client’s
patients, significant queries and requests
others and members of  Spends time with the client to
the health team facilitate conversation that
allows client to express concerns
Core Competency 2:  Interprets and validates
Identifies verbal and client’s body language and
non – verbal cues facial expressions
Core Competency 3:  Makes use of available visual
Utilizes formal and aids
Information channels
Core Competency 4:  Provides reassurance through
Response to needs of therapeutic, touch, warmth
individuals, family, group and comforting words of
and community Readily smiles
Core Competency 5:  Utilizes telephone, mobile
Uses appropriate phone, email and internet, and
information technology informatics
to facilitate  Identifies significant other so
communication that follow up care can be
 obtained
 Provides “ Holding’’ or
 Emergency numbers for
 services
K. Core competency 1:  Contributes to decision
Collaboration Establishes collaborative making regarding patients’
And Relationship with needs and concerns
Teamwork Colleagues and other  Participates actively in patient
Members of the health care management including audit
Team  Recommends appropriate intervention to
improve
patient care
 Respect the role of other
members of the health team
 Maintains good interpersonal relationship w
patients, colleagues and other members of
health team
Core Competency 2:  Refers patients to allied health team partner
Collaborates plan of care  Acts as liaison / advocate of the patient
With other members of  Prepares accurate documenta
The health team for efficient communication of services

Different Fields of Nursing

 Institutional Nursing (Hospital Staff Nursing)

The nurse provides direct client care, using the nursing process and critical thinking
skills. The focus is restorative and curative. The nurse provides education to the client
and family to promote health maintenance and self - care. In collaboration with other
health care team members, the nurse focuses on returning the client to his or her home
and usual state of health.
In the hospital, the nurse may choose to practice in a medical – surgical unit or
concentrate on a specific area of practice, such as critical care, pediatric
 Community Health Nursing / Nursing
Public Health Nursing focus requires understanding the needs of a population,
or a collection of individuals who have in common one or more personal or
environmental characteristics. Example of population may be high risk infants,
older adults, or cultural group such as Aetas, Mangyans, Manobos, ect.

A public health nursing professional must understand factors that

influencing the incidence of disease within populations, environmental factor
contributing to health and illness, and political process used to effect public
policy.
 Community Health Nursing is a nursing approach that merge knowledge from the
public health sciences with professional nursing theories to safeguard and
improve the health of populations in the community.

Community Health Nursing / Public Health Nursing may include school

Nursing and Industrial Nursing.

 Independent Nursing Practice

It involves advanced nursing practice, and requires a Master’s degree in
Nursing advanced education in pharmacology and physical assessment, and
certification and expertise in a specialized area of practice. It allow the nurse to
work in primary, acute, or restorative care setting.

 Nursing in Other Fields (Expanded Nursing Role)

a. Nursing Practitioner (NP)
Has advanced education (at least a Master’s degree in Nursing) and is a
graduate of nurse practitioner program.
Nurse practitioners function with more independence and autonomy that
other nurses. They are highly skilled in performing nursing assessments,
physical examination, counselling, teaching and treating minor health
problems. NPs have a specialist, e.g., obstetrics, pediatrics, or family care.

b. Clinical Nurse Specialist (CNS)

Has a master’s degree in Nursing and may have advanced experience
and expertise in a specialized are of practice (e.g., Gerontology, Pediatrics,
Critical Care, Oncology, Endocrinology, Cardiovascular Disease, or
Pulmonary Disease.)

c. Nursing midwife
Is educated in nursing and midwifery and is licensed to provide
independent care for women during normal pregnancy, labor and delivery.
d. Nurse Anesthetist
Provides general anesthesia for clients undergoing surgery under
the supervision of a physician prepared in anesthesiology. Nurse anesthetist
are RNs with advanced education in anesthesiology.

e. Nurse Researcher
Is responsible for the continued development and refinement of
nursing knowledge and practice through the investigation of nursing
problems. Nurse research have advanced education, usually at the doctorate
 level. They work in large teaching hospitals and research center, and also in
academic settings.

f. Nurse Administrator
Manages and control clients care. Nursing administrators are
responsible for specific nursing units and serve as liaisons between staff
members and directors or nursing. Education preparation for nurse
administrators requires advanced education.

g. Nurse Educator
Role can be develop in many setting including schools or nursing and
hospital staff development department. Advanced education in nursing is
required (at least master’s degree). Teaching the Master’s degree or
Doctorate degree in nursing requires a Doctorate degree.

Types of Nursing Educations

1. Independent or Nurse-initiated intervention. Are autonomous actions

based on scientific rationale that is executed to benefit the client in a
predicted way related to the nursing diagnosis and client-centeredgoals?
These can solve the client’s problems without consultation or collaboration
with physicians or other health care profession. E.g. the nurse gives health
teachings on the ill-effects of cigarette smoking alcohol abuse and drug
abuse.
2. Dependent or physician-initiated intervention. Are based on the
physician’s response to a medical diagnosis. The nurse intervenes by
carrying out physician’s written orders, but requires nursing judgment or
decision making. E.g. the nurse administers antibiotics to the client with
infection.
3. Interdependent or collaborative interventions. Are therapies that
require the knowledge, skill and expertise of multiple health care
professionals? E.g. the nurse assist the client in walking using crutches
after conferring with the physical therapies.

Nursing Care Delivery Models

 Total Patient Care

 Functional Nursing
  Team Nursing
 Primary Nursing
 Case Management

 Total Patient Care. A care delivery model where the registered nurse (RN) is
responsible for all aspects of one or more clients’ care.
 The nurse works directly with the client, family, physician, and health team
members.
 This model has a shift-based focus.
 The same nurse does not necessary care for the same client over time.
 For continuity of care, the staff needs to communicate clearly the client’s
needs to one another from shift to shift.
 Functional Nursing. This care delivery model involves the division of tasks, with
one nurse assuming responsibility for certain task (e.g. administration of
medications) while another nurse assumes responsibility for other (e.g. hygiene,
nursing therapies).
 Nurses tend to become highly competent with the tasks that are
repeatedly assigned to them.
 However, functional nursing id task focused, not client – focused. There is
absence of holistic view of clients, and there is great probability that care
becomes mechanical.
 Communication is not always clear since no one nurse is responsible for
the overall care of the client.
 Team Nursing. This model involves the delivery of nursing care by staff of
various educational preparations. An RN leads the team composed of other
RN’s, and assistive personnel (e.g. nurse assistants, health aides).
 The team members provide direct client care to group of clients under the
direction and coordination of the RN team leader.
 This model emphasizes collaboration that encourages each member of
the team to help others.
 In this model, RN and assistive personnel are often given client
assignments rather than nursing tasks.
 The team leader coordinates care of the team by communicating with the
physicians and other health care personnel and resolving the problems
met by team members.
 The team leader is responsible for coordinating each client’s nursing care
plan.
 Limitations of this model include:
  Risk if assistive personnel are not prepared to perform all care
required by a client.
 Problems may develop if the role of the RN versus that of assistive
personnel has not been clearly defined.
 Lack of time the team leader can spread with the clients.
 There may be no attempt to assign the same nurse to the same
client each day, causing lack of continuity of care.
 Primary Nursing. This model was developed with the aim of placing RN’s at the
bedside and improving the professional relationship between staff.
 An RN assumes responsibility for a caseload of client over time.
 The RN select the clients for his/her caseload and care for the same
clients during their hospitalization or stay in a health care setting.
 Primary nursing is a care delivery model designed to maintain continuity of
care across shifts, days or visits.
 Case Management. it is care delivery approach that coordinates and links health
care services to clients and their families.
 This involves a professional nurse assuming responsibility for client care
from admission through and following discharge.
 Clinicians, either as individuals or as part of collaborative group oversee
the management of case-type-based care (e.g. clients with specific
diagnosis).
Nursing Theories and Conceptual Framework
Florence Nightingale (mid-1800)
Developed and described the first theory of nursing. Notes on Nursing: What
it is, What it is Not. She focused on changing and manipulating the environment in order
to put the patient in the best possible conditions for nature to act.
She believed that in the nurturing environment, the body could repair itself.
Client’s environment is manipulated to include appropriate noise, nutrition, hygiene,
light, comfort, socialization and hope.
Virginia Henderson (1955)
Introduced The Nature of Nursing Model. She identified fourteen basic needs. She
postulated that the unique function of the nurse is to assist the clients, sick or well, in
the performance of those activities contributing health or its recovery, that clients would
perform unaided if they had the necessary strength, will or knowledge. She further
believed that nursing involves assisting the client in gaining independence as rapidly as
possible, or assisting him achieve peaceful death if recovery is no longer possible.
FayeAbdellah (1960)
Introduced Patient – Centered Approaches to Nursing Model. She identified twenty-one
nursing problems. She defined nursing as service to individuals and families; therefore
to society. Furthermore, she conceptualized nursing as an art and a science that molds
the attitudes, intellectual competencies and technical skills of the individual nurse into
the desire and ability to help people, sick or well, and cope with their health needs.
Dorothy E. Johnson (1960, 1980)
Conceptualized the Behavior System Model. According to Johnson, each person as a
behavioral system is composed of seven subsystems namely:
1. Ingestive. Taking in nourishment in socially and culturally acceptable ways.
2. Eliminative. Ridding the body of waste in socially and culturally acceptable ways.
3. Affiliative. Security seeking behavior.
4. Aggressive. Self – protective behavior.
5. Dependence. Nurturance – seeking behavior.
6. Achievement. Master of oneself and one’s environment according to internalized
standards of excellence.
7. Sexual and role identity behavior.

In addition, she viewed that each person strives to achieve balance and
stability both internally and externally and to function effectively by adjusting and
adapting to environmental force through learned patterns of response.
Furthermore, Johnson believed that the patient strives to become a person
whose behavior is commensurate with social demands; who is able to modify his
behavior in ways that support biological imperatives; who is able to benefit to the fullest
extend during illness from the health care professional’s knowledge and skills; and
whose behavior does not give evidence of unnecessary trauma as a consequence of
illness.
Imogene King (1971, 1981)
Postulated the Goal Attainment Theory. She described nursing as a helping profession
that assist individual and group in society to attain, maintain, and restore health. If this is
not possible, nurses help individuals to die with dignity.
In addition, King viewed nursing as an interaction process between client
and nurse whereby during perceiving, setting goals, and acting to them, transactions
occur and goals are achieved.
Madeleine Leininger (1978, 19 84)
Developed the Transcultural Nursing Model. She advocated that nursing is a humanistic
and scientific mode of helping a client through specific cultural caring processes
(cultural values, beliefs and practices) to improve or maintain a health condition.
Myra Levin (1973)
Described the Four Conservation Principles. She advocated that nursing is a human
interaction and proposed four conservation principles of nursing which are concerned
with the unity and integrity of the individual. The four conservation principles are as
follows:
1. Conservation of energy. The human body functions by utilizing energy. The
human body needs energy producing input (food, oxygen, fluids) to allow energy
utilizing as output.
2. Conservation of structural integrity. The human body has physical boundaries
(skin and mucous membrane) that must be maintained to facilitate health and
prevent harmful agents from entering the body.
3. Conservation of Personal Integrity. The nursing interventions are based on the
conservation of the individual client’s personality. Every individual has a sense of
identity, self worth and self esteem, which must be preserved and enhance by
nurses.
4. Conservation of Social integrity. The social integrity of the client reflects the
family and the community in which the client functions. Health care institutions
may separate individuals from their family.

Betty Neuman (1982, 1992)

Proposed the Health Care System Model. She asserted that nursing is a unique
profession in that it is concerned with all the variables affecting an individual’s
response to stresses, which are intra- (within the individual), inter-(between one or
more other people), and extrapersonal (ourside the individual) in nature. The
concern of nursing is to prevent stress invasion, to protect the client’s basic structure
and to obtain or maintain a maximum level of wellness. The nurse helps the client,
through primary, secondary and tertiary prevention modes, to adjust to
environmental stressors and maintain client stability.
Dorothy Orem(1970, 1985)
Developed the Self-Care and Self-Care Deficit Theory. She defined self-care as “the
practice of activities that individual initiate and perform on their own behalf in
maintaining life, health and well-being.” She conceptualized three nursing system as
follows:
1. Wholly Compensatory: when the nurse is expected to accomplish all the patient’s
therapeutic self-care or to compensate for the patient’s inability to engage in self
care or when the patient needs continuous guidance in self care;
2. Partially Compensatory: when both nurse and patient engage in meeting self
care needs;
3. Supportive-Educative: the system that require assistance in decision making,
behavior control and acquisition of knowledge and skills.

Hildegard Peplau (1952)

 Introduced the Interpersonal Model. She defined nursing as an interpersonal
process of therapeutic interactions between an individual who is sick or in need of
health services and a nurse especially educated to recognize and respond to the
need for help.She identified four phases of the nurse-client relationship
namely:
1. Orientation: the nurse and the client initially do not know each other’s
goals and testing the role each will assume. The client attempts to identify
difficulties and the amount of nursing help that is needed;
2. Identification: the client responds to the professionals or the significant
others who can meet the identified needs. Both the client and the nurse
plan together an appropriate program to foster health;
3. Exploitation: the client utilizes all available resources to move toward a
goal of maximum health or functionality;
4. Resolution: refers to the termination phase of the nurse-client
relationship. It occurs when the client’s needs are met and he/she can
move toward a new goal. Peplau further assumed that nurse-client
relationship forters growth in b oth the client and the nurse.

Martha Rogers (1970)

Conceptualized the Science of Unitary Human Being. To Rogers, unitary
man is an energy field in constant interaction with the environment. She asserted
that human beings are more than and different from the sum of their part; the
distinctive properties of the whole are significantly different from those of its
parts. Furthermore, she believed that human being is characterized by the
capacity for abstraction and imagery, language and thought, sensation and
emotion.
Sister Callista Roy (1979,1984)
Presented the Adaptation Model. She viewed each person as a unified
biopsychosocial system in constant interaction with a changing environment.
She contended that the person as an adaptive system, functions as a whole
through interdependence of its parts. The system consist of input, control
processes, output and feedback. In addition, she advocated that all people have
certain needs which they endeavor to meet in order to maintain integrity. These
needs are divided into four different modes, the physiological, self concept, role
function, and interdependence. Accordingly Roy believed that adaptive human
behavior is directed as an attempt to maintain homeostasis or integrity of the
individual by conserving energy and promoting the survival, growth, reproduction
and mastery of human system.
Lydia Hall (1962)
Introduced the model on Nursing: what is it? , focusing on the notion that
centers around three components of CARE, CORE and CURE. Care represents
nurturance and is exclusive to nursing. Core involves the therapeutic use of self
and emphasizes the use of reflection. Cure focuses on nursing related to the
physician’s orders. Core and cure are shared with the other health care
providers.
Ida Jean Orlando (1961)
Conceptualized The Dynamic Nurse – Patient Relationship Model. She
believed that the nurse helps patients meet a perceived need that the patients
cannot meet for themselves. Orlando observed that the nurse provides direct
assistance to meet an immediate need for help in order to avoid or to alleviate
distress or helplessness. She emphasized the importance of validating the need
and evaluating care based on observable outcomes. She also indicated that
nursing actions can be automatic (those resulting from validating the need for
help, exploring the meaning of the need, and validating effectiveness of the
actions taken to meet the need). She also advocated that the three elements
composing nursing situation are: client behavior, nurse reaction and nurse action.
Ernestine Weidenbach (1964)
Developed the Clinical Nursing – A Helping Art Model. She advocated that
the nurse’s individual philosophy or central purpose lends credence to nursing
care. She believed that nurse meet the individual’s need for help through the
identification of the needs, administration of help, and validation that actions
were helpful. Components of clinical practice: Philosophy, purpose, practice and
an art.
Jean Watson (1979-1985)
Conceptualized the Human Caring Model (Nursing: Human Science and
Human Care). She emphasized that nursing is the application of the art and
human science through transpersonal caring transactions to help persons
achieve mind-body-soul harmony, which generates self – knowledge, self –
control, self – care, and self – healing.
Rosemarie Rizzo Parse (1981, 1992)
Introduced the theory of Human Becoming, she emphasized free choice or
personal meaning in relating value priorities , co – creating of rhythmical patterns,
in exchange with the environment , and contranscending in many dimensions as
 possibilities unfold. She also believed that each choice opens certain
opportunities while closing others.
JoycesTravelbee (1966, 1971)
She postulated the interpersonal aspects of nursing model. She
advocated that the goal of nursing is to assist individual or family meaning in
illness, or maintaining maximal degree of health. She further viewed that
interpersonal process is a human-to-human relationship formed during illness
and “experience of suffering”. She believed that a person is a unique,
irreplaceable individual who is in a continuous process of becoming, evolving
changing.
Josephine Paterson and Loretta Zderad (1976)
Provided the humanistic nursing practice theory. This is based on their
belief that nursing is an existential experience. Nursing is viewed as a lived
dialogue that involves the coming together of the nurse and the person to be
nursed. The essential characteristics of nursing is nurturance. Humanistic care
cannot take place without the authentic commitment of the nurse to being with
and the doing with client.
Hlelen Erickson, Evely Tomlin, and Mary Ann Swain (1983)
Developed modeling and role modeling theory. The focus of this theory is
on the person. The nurse models (assesses), role models (plans), and
intervenes in this interpersonal and interactive theory. They asserted that each
individual is unique, has some self-care knowledge, needs simultaneously to be
attached to and separate from others, and has adaptive potential.
Margaret Newman
Focused on health as expanding consciousness. She believed that
humans are unitary beings in whom disease is a manifestation of the pattern of
health. She defined consciousness as the information capability of the system
which is influenced by time, space and movement and is ever – expanding.
Change occurs through transformation. Nursing is involved with human beings
who have reached choice points and found that their old ways are no longer
effective. Caring is a moral imperative for nursing.
Patricia Benner and Judith Wrubel (1989)
Proposed the primacy of caring model. They believed that caring is central
to the essence of nursing. Caring creates the possibilities for coping and creates
possibilities for connecting with and concern for others.
 Anne Boykin and SavinaAchoenhofer
Presented the grand thory of nursing as caring. They believed that all
persons are caring, and nursing is a response to a unique social call. The focus
of nursing is on nurturing persons living and growing in caring in a manner that
specific to each nurse-nursed relationship or nursing situation. Each nursing
situation is original.

Moral Theories
Freud (1961)
Believed that the mechanism for right and wrong within the individual is the superego,
or conscience.He hypothesized that a child internalizes and adopts the moral
standard and character or character traits of the model parent through the process of
identification. The strength of the superego depends on the intensity of the child’s
feelings of aggression or attachment toward the model parent rather than on the actual
standards of the parents.
Erikson (1964)
Erikson’s theory on the development of virtues or unifying strengths of the ‘good man’
suggest that moral development continues throughout life. He believed tat if the conflicts
of each psychosocial development stages are favorably resolved, then an ‘ego-strength’
or virtue emerges.
Kohlberg
Suggested three level of moral development. He focuses on the reasons for the making
of decision, not on the moral of decision itself. At first level called the premoral or the
preconventional level, children are responsive to cultural rules and labels of good and
bad, right and wrong. However, children interpret these in terms of physical
consequences of their actions, i.e., punishment or reward.
Peter (1981)
Proposed a concept of rational morality based on principles. Moral development is
usually considered to involve three separate components: moral emotion, moral
judgment, and moral behavior. In addition Peter believed that the development of
character traits or virtues is an essential aspect of moral development. Also Peter
believed that some virtues can be described as habits because they are in some sense
automatic and therefore are performed habitually, such as politeness, chastity, tidiness,
thrift and honesty.
Schulman and Mekler (1985)
Believed that moral is measure if how people treat fellow humans and that a moral
child is one who strives to be kind and just. They believed that morality has two
components, namely:
1. The intention of the person acting must be good in the sense that the goal of the
act is the well-being of one or more people;
2. The person acting must be fair or just in the sense that the person considers the
rights of others without prejudice or favoritism. Furthermore, the aforementioned
author asserted that the theory of moral development is based on three
foundations, which they believed can be taught, as follows:
a. Internalizing parental standards of right and wrong.
b. Developing emphatic reactions.
c. Acquiring personal standards.

Gilligan (1982)
Including the concepts of caring and responsibility. She described three stages in the
process of developing an “ethic of care” which are as follows:
1. Caring for oneself.
2. Caring for others.
3. Caring for self and others.

She believed that women see morality in the integrity of relationships and caring.
For women, what is right is taking responsibility for others as self-chosen decision on
the other hand, men consider what is right to be what is just.
Spiritual theories
Fowler (1979)
Described that faith is a way of behaving. He developed a four-stage theory of faith
development based largely on his life experiences and the interpretation of those
experiences. These stages are as follows:
1. Experienced faith (infancy to early adolescence): experiences faith through
interaction with others who are living a particular faith tradition.
2. Affiliative faith (late adolescence): actively participates in activities that
doubting own faith, acquires a cognitive as well as affective faith.
3. Searching faith (young adulthood): through a process of questioning and
doubting own faith, acquires a cognitive as well as affective faith.
4. Owned faith (middle adulthood): puts faith into personal and social action and
is willing to stand up for what he/she believes even against the nurturing
community.
History of Nursing in the Philippines
Early Beliefs and Practices
Diseases and their causes and treatment were shrouded with mysticism and
superstitions.
1. Beliefs about causation of disease:
a. Another person (an enemy of 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-physician (called “word
doctors”) as intermediary. If they used leaves or roots, they where called herb
d0ctors (“Herbolarios”).

Early Care of the Sick

The early Filipino subscribed to superstitious beliefs and practices in relation to
health and sickness. Hebmen were called “Herbicheros,” meaning one who
practiced witchcraft. Person suffering from diseases without any identified causes
were believed to be betwitched by the “mangkukulam” or “mangagaway”. Difficult
childbirth and some diseases (called “pamao”) were attributed to “nonos”. Midwife
assisted in childbirth. During labor, the “ mabutinghilot” (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 Regime
The religious orders exerted their efforts to care for the sick by building hospitals in
the different parts of the Philippines.
The Early Hospital Established were the following:
1. Hospital Real de Manila (1577). It was established mainly to care for the
Spanish King’s soldier, but also admitted Spanish civilians; founded by Gov.
Francisco de Sande.
2. San Lazaro Hospital (1586). 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 contribution from charitable persons.
4. Hospital de AguasSantas (1590).Estabhished in Laguna; near a medical spring,
founded by Brother J. Bautista of the Franciscan Order.
5. San Juan Dios Hospital (1596). Founded by the Brotherhood of misericordia
and administered by the Hospitalliers of San Juan de Dios; support was derived
froem alms and rents; rendered general health service to the public.

Nursing During the Philippine Revolution

The prominent persons involved in nursing works were:
1. Josephine Bracken, wife of Jose Rizal. Installed a field hospital in an estate
house in Tejeros: provided nursing care to the wounded night and day.
2. Rosa SevillaAlvero. Converted their house into quarters for the Filipino soldiers,
during the Philippine-American War that broke out in 1899.
3. Dona Hillaria de Aguinaldo. Wife of Emillio Aguinaldo; organized the Filipino
Red Cross under the inspiration of ApolinarioMabini.
4. Dona Maria Agocillo 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 (TandangSora). 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. AguedaKahabagan. Revolutionary leader in Laguna, also provided nursing
service to her troops.
8. Trinidad Tecson. “Ina ngBiacnaBato”, stayed in the hospital at BiacnaBato to
care for the wounded soldiers.

Filipino Red Cross

 Malolos, Bulacan was the location of the national headquarters.
 Established banches in the provinces.

Function 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 yaers old.
2. Of sound reputation.
Hospital and School of Nursing
1. Iloilo Mission Hospital School of Nursing (Iloilo City, 1906)
It was ran by the Baptist Foreign Mission Society of America. Miss Rose
Nicolet, z graduate of New England Hospital for Woman and Children in Boston,
Massachusetts, was the first superintendent for nurses.

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 service. It
had a free dispensary and dental clinic.

3. Philippine General Hospital School of Nursing (1907)

The Philippines General Hospital began 1901 as a small dispensary
mainly for “Civil Officers and Employees” in the City of Manila. It lately grew into
Civil Hospital.
In 1906, Mrs. Mary Coleman Masters, an educator advocated for idea of training
Filipino girls for the profession of nursing.
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 Nicholas and Charlotte Clayton taught the students
nursing subjects.
In 1910, Act No. 1976 modified the organization of the school, placing it
under the supervision of the Director of Health. The school became known as the
Philippine General Hospital School of nursing.
When she became chief nurse, Elsie McCloskey-Gachesintroduced
several improvements in the school. The course was made attractive and more
practical. AnastaciaGiron-Tupas, the first Filipino nurse to occupy the position of
chief nurse and superintend in the Philippines, succeeded her.

4. St. Luke’s Hospital School of Nursing (Quezon City, 1907)

The Hospital is an Episcopalian Institution. It began as a small dispensary in
1903. In 1907, the school opened with three Filipino girls admitted. These girls
has 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
of nurse.Dr. Jose Foreswas 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, St. Luke’s Hospital and St.
Paul’s Hospital had a common first year course. This was known as the Central
 School Idea in nursing education. The three schools selected their own
students, based on the following requirements:
 Education preparation, at least completion of seventh grade.
 Sound physical and mental health.
 Good moral character.
 Good family and social standing.
 Recommendations from three different persons well known in their community.
The three groups of students from these schools were later fused in on
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 Johnson Hospital and School of Nursing (Manila, 1907)

It started as a small dispensary of Calle Cervantes (now Avenida Rizal). It was
called Bethany Dispensary and was founded by the Methodist Mission for the
rekief of suffering among women and children. In 1907, Sr. Rebecca Parrish,
together with the registered nurse Rose Dudley and Gertrude Dreisback,
Organized the Mary Johnson School of Nursing. In 1908, Mr. D. S. B. Johnston
of Minnesota donated as s memorial to his wife $12,500.00 for a hospital
building. In 1911, the Philippine Assembly appropriated a monthly sum of
P500.00 for the hospital, in appreciation for its services during the cholera
epidemics in the previous years. Later, P11,000.00 was provided by the
assembly for the construction of a maternity and milk station and dispensary. At
the outbreak of World War II, it became an emergency hospital where the
wounded were treated. 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 Libra Javalerawas the first Filipino director of the school.

6. Philippine Christian Mission Institute School of Nursing

The United Christian Missionary Society of Indianapolis, Indiana, a Protestant
organization of the Disciple of Christ, operated three schools of nursing:
 Sallie Long Read Memorial Hospital School of Nursing (Laog,
IlocosNorte, 19030).
 Mary Chiles Hospital School of Nursing (Manila 1911). The hospital
was established by in Dr. W.N. Lemon in a small house on Azcarraga,
Sampaloc, Manila. In 1913, Miss Mary Chales of Independence,
Montana, donated a large sum of money with which the present building
at Gastambide was bought. The Tuason Annex was donated by Miss
Esperanza Tuazon, a Filipino Philantropist.
 Frank Dunn Memorial Hospital (Vigan, Ilocos Sur, 1912).
 7. San Juan de Dios Hospital School of Nursing (Manila, 1913)
In 1913, through the initiative of Dr. Benito Valdez, the Board of
Inspectors and the Executive Board of the Hospital passed a resolution to open
a school of nursing. The school is run by the Daughter of Charity since then.
Sister TacianaTrinaneswas the first directress of the school.
Dr. Gregorio Singian introduced the following reforms when he was
appointed medical director in 1920:
 The first six months of training was considered a trial period. Students
who incurred a failure in two or three subjects were dismissed.
 A separate building was provided for the library.
 A kitchen was constructed; classes for bacteriology and chemistry were
introduced.
 Laboratory classes for bacteriology and chemistry were introduced.
 Anatomic charts and specimens for experiments were acquired.
 A new spacious dormitory for students and nurses was built. In 1945,
during the fight in intramuros, the hospital was destroyed. It rebuilt at its
present site in Roxas Boulevard.

8. Emmanuel Hospital School of Nursing (Capiz,1913)

In 1913, the American Baptist Foreign Mission Society sent Dr. P.H.J.
Lerrigo to Capiz for the purpose of opening a hospital, Miss Rose Nicole
assisted him. The school offered a 3-year training course for an annual fee of
P100.00. Miss Ciara Paedrosawas the first Filipino principal.

9. Southern Islands Hospital School of Nursing (Cebu, 1918)

The hospital was established in 1911 under the Bureau of Health. The
School opened in 1918 with AnataciaGiron-Tupas, as the organizer, Miss
Visitacio Perez was the first principal.

10. Other School of Nursing established were as follows:

1. Zamboanga General Hospital School of Nursing (1921)
2. Chinese Genaral Hospital School of Nursing (1921)
3. Baguio General Hospital School of Nursing (1923)
4. Manila Sanitarium and Hospital School of Nursing (1930)
5. St. Paul’s School of Nursing in Iloilo City (1946)
6. North General Hospital and School of Nursing (1946)
7. Siliman University School of Nursing (1947)

The First Colleges of Nursing in the Philippines

1. University of Santo Tomas College of Nursing (1946)
 The college began as the UST School of Nursing Education on February 11,
1941. The school was unique since it operated as a separate entity from the
Santo Tomas University Hospital. The course of instruction were designed to
conform to the latest and most modern advances I nursing science and
education. At the same time, the ideals of Christian Charity Permeated this
course. In its first year of existence, its enrollees consisted of students from
different schools of nursing whose studies were interrupted by war.
2. Manila Central University College of Nursing (1947)
The MCU Hospital first offered the BSN course in 1947. It served as the
clinical field for practice. Miss Consuelo Gimeno was its first principal.
3. University of the Philippines College of Nursing (1948)
The idea of opening the college began in conference between Miss Julita and
then U.P. President Gozales. Nurse, who attended the biennial convention in
May, 1946 endorsed the idea. In April, 1948, the University Council approved the
curriculum, and the Board of Regents recognized the profession as having equal
standing as medicine, law, engineering.etc. Miss Sotejo was its first dean.
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)
5. Gota de Leche (Manila, 1907)
6. LigaNacionalFilipinianapara l Protection de la PrimeraInfancia.
7. Public Welfare Board.

Nursing Organizations:
1. Philippines Nurses Association. This is national organization of Filipino nurses.
2. National League of Nurses. The association of nurses employed in Department
of Health.
3. Catholic Nurses Guild of Philippines
4. Others: ORNAP, MCNAP, IRNOP etc.

History of Nursing in Other Lands

Period of Intuitive Nursing
Nursing in the Near East
 Babylonia
 Egypt
 Israel
Nursing in the Far East
  China
 India
Nursing in Ancient Greece
Nursing in Rome
Period of Apprentice
Nursing
Nursing in America
Period of Educated
Nursing
Period of Contemporary
Nursing

 Period of Intuitive Nursing

Intuitive Nursing was practiced since prehistoric times among primitive
tribes and lasted through the early Christian era. Nursing was untaught and
intuitive. It was performed out of compassion for others, out of the wish to help
others.

Beliefs and Practices of Prehistoric Man

1. He was Nomad. His philosophy of life was “the best for the most” and he was
ruled by the law of self-preservation.
2. Nursing was a function that belonged to women. They took good care of
the children, the sick and the aged.
3. he believed that the illness was caused by the invasion of the victim’s body by
evil spirit through the use of black magic or voodoo.
4. He believed that the medicine man called “shaman” or witch doctor had the
power to heal by using white magic. Among others, the shaman used
hypnosis, charms, dances, incantations, purgative, massage, fire, water and
herbs as means of driving illness from the victim. He also practiced
“trephining” (drilling a hole in the skull with a rock or stone without the
benefit of anesthesia as a last resort to drive evil spirits from the body of the
afflicted.

Nursing in the Near East

Beliefs and Practices
1. Man’s mode of living changed from nomadic style to an agrarian society an
urbsn community life.
2. Man developed a means of communication and the beginning of a body of
scientific knowledge.
3. Nursing remained the duty of slaves, wives, sisters or mothers.
 4. The care of the sick was still closely related to religion, superstition and
magic. Astrology and numerology were also used in medical practice.
5. The period saw the birth of three great religious ideologies: Judaism,
Christianity, and Islam.

Contributions to medicine and Nursing

a. Babylonia
Code of Hammurabi.Provided law that covered every facet of Babylonian life
including medical practice. The medical regulations established fees,
discouraged experimentation, recommended specific between the use of
charms, medications, or surgical procedures to cure the disease.

b. Egypt
 The Egyptians introduces the art of embalming which enhanced their
knowledge og human anatomy.
 They developed the ability to make keen observation and left a record
of 250 recognized diseases.
 There was no mention of nurses, hospitals or hospital personnel.
Slaves and patient’s families nurse the sick.
c. Israel
Moses is recognized as the “Father of Sanitation”. He wrote the five
books of the Old Testament which:
1. Emphasized the practice of hospitality to strangers and the act of charity
(Book of Genesis, Old Testament).
2. Promulgated law of control on the spread of communicable disease and
the ritual of circumcision of the male child(Book of Laviticus).
3. Referred to nurse as midwife, wet nurses or child’s nurse whose acts were
compassionate and tender (outpouring of maternal instincts).

Nursing in the Far East

a. China
 The people strongly believed in spirit and demons as seen in the practices
such as using girl’s clothes for male babies keep evils away from them.
 They practices ancestor worship which prohibited the dissection of dead
human body.
 They gave the worlds knowledge of material medica (pharmacology)
which prescribed methods of treating wounds, infections and muscular
afflictions.
  There was no mention of nursing in their records. It is assumed that the
care of the sick was done by female members of the household.
b. India
 Men of medicine built hospital, practiced an intuitive form of asepsis and
were proficient in the practice of medicine and surgery.
 Sushurutu made a list of function and qualifications of nurses. For the
first time in recorded history, there was a reference to the nurse’s taking
care of patients. These nurses were described as combination of physical
therapist and cook.

Nursing in Ancient Greece

 Nursing was the task of untrained slave.
 The Greeks introduced the caduceus, the insignia of the medical profession
today.
 Hippocrates, born in Greece, was given the title “Father of Scientific
Medicine”. He made a major advance in medicine by rejecting the belief that
diseases had supernatural causes. He also developed assessment standards for
clients, established overall medical standards, recognized a need for nurses.

Nursing in Rome
 The transition from pagan to Christian philosophy took place. There was a
contrast between the materialism of pagan society and the spiritual of the
converted Christians.
 The Romans attempted to maintain vigorous health, because illness was a sign
of weakness.
 Care of the ill was left to the slave or Greek physicians. Both groups looked upon
as inferior by Roman society.
 Fabiola was a worldly, beautiful Roman matron who was converted to
Christianity by her friends Marcella and Paula. With their help, she made her
home the first hospital in the Christian world.

Period of Apprentice Nursing

This period extends from the founding of religious nursing orders in the
Crusades, which began un the 11 th century and ended in 1836, when Pastor
Fliedner and his wife established the Kaiserwerth institute for the training of
Deaconenesses(a training school for nurses) in Germany.
It is called the period of “on the job” training. Nursing care was
performed without any formal education and by people who were directed by more
 experienced nurse. Religious orders of the Christian Church were responsible
for the development of this kind of nursing.
The Crusades
The crusades were Holy War waged in an attempt to recapture the Holy Land from
the Turks who denied Christ’s pilgrims permission to visit the Holy Sepulcher.
Military religious orders and Their Works.
1. Knight of St. John of Jerusalem, (Italia). Devoted to religious life and nursing.
Discipline was strict. It established an organization of ranks and advocated
principles of complete and unquestioned devotion to duty and traditional
obedience of superiors.
2. Teutonic Knight (German). Established tent hospitals for the wounded.
3. Knight of St. Lazarus.Was founded primarily for the nursing care of lepers in
Jerusalem after the Christians had conquered city.

The Alexian Brothers were members of a monastic order founded in 1348. They
established the Alexian Brother Hospital School of Nursing, the men in United
States, The school closed in 1969.

The Rise of Secular Orders

During this period, there was also the rise of Religious Orders for women.
Although Christianity promoted equality to all men, women were still
concentrated in their roles as wives and mothers. Only by entering a convent
that she could follow a career, obtain an education and perform acts of
charity that her taught would help her gain grace in heaven. Queens,
princesses and other ladies of royalty founded many religious orders.

Religious taboos and social restrictions influenced nursing at the time

of the religious Nursing Orders. Hospitals were poorly ventilated and the beds
were filthy. There was overcrowding of patient: three or four patients, regardless
of diagnosis or whether they are alive or dead, may have shared one bed.
Practice of environment sanitation and asepsis were non-existent. Orders nuns
prayed with and took good care of the sick; while the younger nuns washed
soiled lines, usually in the rivers.

Secular Orders Founded During the Period of The Crusade:

1. Order of St. Francis of Assisi (1200-present). Believed in devoting their
lives to poverty and service to the poor.
a. First Order. Founded by St. Francis Himself.
b. Second Order (Poor Clares). Founded by St. Clare of Assisi.
 c. Third Order (Tertiary Order). Composed of members who devoted their
name to performance of acts of mercy in their communities; most provided
nursing care in homes and hospitals.
2. The Beguines. Composed of lay nurses who devoted their lives to the
service of suffering humanity. It was founded in 1170 by a priest, Lambert Le
Bague.
3. The Oblates (12th century)
4. Benedictines
5. Ursulines
6. Augustians

Important Nursing Personages During the Period of Apprentice Nursing

1. St. Clare. Founded of the Second Order of St. Francis of Assisi; took vows of
poverty, obedience service and charity; gave nursing care to the sick and the
afflicted.
2. St. Elizabeth of Hungary. Known as the “Patroness of Nurses,” she
was the daughter of the Hungarian king. She lived her life frugally despite her
wealth. She used all her wealth to make the lives of the poor happy and
useful. She built hospitals for the sick and the needy. She fed the sick with her
own hands and made their beds. She provided for orphans and fed 300-900
persons daily at her gate. To avoid idleness, she employed those who were
able to work continually in her hospital and in the homes of the poor and to go
fishing in streams to help provide for the many sufferers.
3. St. Catherine of Selena. The first “Lady with Lamp”.She was 25th child of
humble Italian parents. She pledged her life to service at the age of seven
and was referred to as little saint. She was a hospital nurse, prophetess,
researcher and a reformer society and the church.

The world of nursing despite was and plagues made considerable

progress under the influence of Christianity. It may be said that nursing
owe its foundation to the work of benevolent men and women, the
crusades and the guilds. But this progress in nursing was brought to a halt
by industrial and political revolution and the Reformation in the 16 th
century. These left the world in the following situation:
1. The masses of the people huddled in slums as a result of famine, wars
and the introduction of machinery (industrial revolution).
2. Living in blighted slum areas, the people sank into brutal and immoral
way of life.
3. Ambition for power and the antagonism resulting from the attempts to
achieve this power replaced human empathy.
 4. Class lines could be bypassed in some parts of the world, and people
struggled against one another for power, wealth and leisure.
5. Skepticism was the result of political, intellectual and ideological
revolutions; everything in life had to be based upon scientific fact.
Nothing else was true.

In the 16th century, hospitals were established for the care of the sick. The
hospitals were gloomy, cheerless and airless. They were unsanitary. People
entered hospital only under compulsion or as last resort. There was little
employment and education was only for the rich and the titled. St. Vincent de
Paul seeing the pervading poverty and the generally poor health conditions
organized the group called “Le Charite” and the community of the Sisters of
Charity. The letter was composed of women who live uncloistered and were
dedicated to doing God’s work through caring for the sick, the poor, the
orphaned, and the windowed. Loise de Gras (nee Marillac) was the first
superior and co-founder of this order.
The Dark Period of Nursing
This extends from the 17th to the 19th century from the period of reformation until
the U.S Civil War. The religious upheaval led by Martin Luther destroyed the unity of
the Christian faith. The wrath of Protestantism swept away everything connected with
Roman Catholicism in school, orphanages and hospitals. Properties of hospitals and
schools were confiscated. Nurses fled for their lives. In England, hundreds of hospitals
were closed. There were no provision for the sick, no one to care for the sick. Nursing
became the work of the least desirable of women-women who took bribes from patients,
who stole the patient’s food and who used alcohol as a tranquilizer. They worked seven
days a week, slept in cubbyhole near them. These women were personified in a Charles
Dickens novel as SaireyGamp and BarsyPreg.
Several leaders sought to bring about reforms. Among them were:
1. John Howard. A prison reformer, helped improve the living conditions
in prisons and gave prisoners renewed hope.
2. Mother Mary Aikenhand. Established the Irish Sisters of Charity to
bring back into nursing the dedication of the early Christian era.
3. Pastor TheodoeFiledner and Frederika Munster Filedner
established the institute for the Training of Deaconesses at
Kaiserwerth, Germany (1836), the first organized training school for
nurses. Requirements for entering the school were
a. Character reference from clergyman.
b. A certificate of health from a physician.
c. Permission from their nearest relative.
Nursing in America
People began to settle in the North America continent, to seek for adventure, new
quests and new trade routes.
Mdme. Jeanne Mance was the first laywoman who worked as a nurse in North
America. She founded the Hotel Dieu of Montreal, a log cabin hospital.
1. Pre-Civil War Nursing
In the USA and Canada, religious nursing orders, both Catholic and
Protestant carried out nursing. Augustian nuns, Ursukine sisters, Deaconesses of
Kaiserswerth, Proterstant sisters of Charity and many other helped found and
staff hospitals.
Mrs.Elizabel Seton, an American, founded the sisters of Charity of
Emmitsberg, Maryland in 1809.

2. American Reforms in Nursing

a. The nurse’s Society of Philadephiaorganized a school of nursing under the
direction of Dr. Joseph Warrington in 1839. Nurses were trained on the job
and attended some preparatory courses.
b. Women’s Hospital in Philadelphia established a six-month course in
nursing to increase the nurse’s knowledge while they worked. They were
taught a minimum amount of medical and surgical nursing materiamedica and
diatetics.

3. Nursing During the Civil War

The American Medical Association during the Civil War created the
Committee on Training of Nurses. It was designated to study and make
recommendations with regards to the training of nurses. Doctors realized the
need for qualified nurses.

Some of the Important Personages at this time were:

a. Dorothea Lynde Dix. She established the Nurse Corps of the United
States Army. She directed the nursing of the injured.
b. Clara Barton. Founded the American Red Cross.

Period of Educated Nursing

This period began on June 15, 1860 when the Florence Nghtingale School of
Nursing opened at St. Thomas Hospital in London (St. Thomas Hospital School of
Nursing). The development of nursing during this period was strongly influenced by
trends resulting from wars, from an arousal of social consciousness, from the
emancipation of women and from the increased educational opportunities offered to
women.
Facts about Florence Nightingale
 Recognized as the “Mother of Modern Nursing”; she was also known as the
“Lady with a Lamp”.
 Born on May 12, 1820 in Florence Italy.
 Raised in England in an atmosphere of culture and affluence; learned languages,
literature, mathematics and social graces.
 Her education was rounded out by a continental tour.
 Not contented with the social custom imposed upon her as a Victorian Lady, she
developed her self-appointed goal: “To change the profile of nursing”.
 Compiled notes of her visits to hospitals, her observation of the sanitary facilities,
and social problems of the places she visited.
 Noted the need for preventive medicine and good nursing.
 Advocated for care of those afflicted with diseases causes by lack of hygienic
practices.
 At the age of 31, she overcame her family’s resistance to her ambitions. She
entered the Deoconess School at Kaiserworth.
 Worked as a superintendent for Gentlewomen during illness.
 Disapproved of the restrictions on admission of patients and considered this
unchristian and incompatible with health care.
 Upgraded the practice of nursing and made nursing an honorable profession for
gentlewomen.
 Led the nurses that took care of the wounded during the Crimean War.
 Put down her ideas in two published books: Notes on Nursing and Notes on
Hospitals.

Other Important Persons/Groups/Events During Period of Educated Nursing

1. Linda Richards. First graduated nurse in the US; graduated on September 1,
1872, from the New England Hospital for Women in Boston.
2. Dr. William Halstead. Designed the first rubber gloves.
3. Caroline Hampton Robb. The first to nurse to wear rubber gloves while working
as an operating room nurse.
4. Established of nursing organizations; contributed to the uplift of the nursing
profession.
5. Isabel Hampton Robb. The first principal of the John Hopkins Hospital School of
Nursing; the most influential in directing the development of nursing during this
period.
6. Clara Louise Maas. Engaged in medical research on yellow fever during the
Spanish-American War. She died of yellow fever.
 7. Development of private duty nursing, settlement house nursing (forerunner of
PHN); school nursing, government service of nurses, and prenatal and maternal
health nursing (1900-1912)
8. Age of specialization began in the first decade of the 20 th century.
9. Preparation of a standard curriculum based on educational objectives for schools
of nursing (1913-1937)
10. Edith Cavell. Known as “Mata Hari”, served the wounded soldier during World
War I. (both English and Russian soldier). This was why she was suspected as a
spy (“Mata Hari”). She was an English nurse. She has a monument in Russia, as
a recognition to her services.

Period of Contemporary Nursing

This cover the period after World War II to the present. Scientific and
technological developments as well as social changes mark this period.

Events and Trends

1. Establishment of the World Health Organization by the United Nation to assist in
fighting disease by providing health information and improving nutrition, living
standards, and environmental conditions of all people.
2. Use of atomic/nuclear energy for medical diagnosis and treatment.
3. Utilization of computers for collecting date, teaching, establishing diagnosis ,
maintaining inventory, making payrolls, record keeping, and billing.
4. Uses of sophisticated equipment for diagnosis and therapy.
5. The advent of space medicine also brought about the development of aerospace
nursing. Colonel Pearl Tucker developed a comprehensive one-year course to
prepare nurses for aerospace nursing at Cape Kennedy.
6. Health is perceived as fundamental human right.
7. Nursing involvement in community health is greatly intensified.
8. Technological advances, such as the development of disposable supplies and
equipment have relieved the nurse from numerous tedious tasks.
9. Development of the expanded role of the nurse. The nurse is constantly
assuming responsibilities in patient care which were formerly the sole prerogative
of the physician.