UNIT 1: Nursing as a Profession

Lesson 1: Introduction
Intended Learning Outcomes
At the end of the unit, you are expected to:
1. Describe the value of what is nursing as a profession in
rendering care to the patients in the near future.

Introduction
Today, nursing emerged as a learned profession that is both a science
and an art that brings knowledge, leadership, spirit, and vital expertise to
expanding roles that afford increased participation, responsibility, and
rewards.
Nursing has been called the oldest of the arts and the youngest of the
professions.
The unique function of the nurse is to assist the individual, sick, or well,
in the performance of those activities contributing to health or its recovery
or to peaceful death, thus he would perform unaided, if he had the necessary
strength, will and knowledge and to do as rapidly as possible (Henderson,
1958).
The unit will focus on what is nursing as a profession.
Please proceed immediately to the “Unlocking of Difficulties” part
since the first lesson is also definition of essential terms.

Unlocking of Difficulties
To attend the following intended learning outcomes for the first lesson
of the course, you need to fully understand the following essential terms that
will be laid down in the succeeding pages.

Key Terms
▪ Nurse – evolve from Latin word nutrix, which means to nourish or to
cherish.
▪ Nursing – is the diagnosis and treatment of human responses to actual or
potential health problems.
▪ Profession – relating to work that needs special skills and qualifications.
▪ Human response – is a complex phenomenon that encompasses the
physical, social, emotional and spiritual aspects of being.

1
Lecture Notes
Nursing as a profession, is committed to recognize its own
unparalleled body of knowledge vital to nursing practice – nursing science.
As a science, nursing is based on the theory of what nursing is, what nurses
do, and why. Nursing is a unique discipline and is separate from medicine. It
has its own body of knowledge on which delivery of care is based.

The Nursing Profession

(Source: https://www.youtube.com/watch?v=pqBBimkJI2s. Retrieved on
January 16, 2021)
The nurse is prepared and authorized (1) to engage in the general
scope of nursing practice, including the promotion of health, prevention of
illness, and care of physically ill, mentally ill, and disabled people of all ages
and in all health care and other community settings; (2) to carry out health
care teaching; (3) to participate fully as a member of the health care team;
(4) to supervise and train nursing and health care auxiliaries; and (5) to be
involved in research. (ICN, 1987)
Characteristics:
In general, a profession is characterized by the use of standardized
knowledge that has three components: (1) an action taken based on
underlying basic knowledge or discipline, (2) practical knowledge to solve
every day’s problems, and (3) the knowledge based on skills and attitudes to
serve to the clients.
The characteristics of the nursing profession list them as:
1. Strong commitment
2. Long-term and regular education
3. Special body of knowledge and skills, ethics, autonomy, power for
standard service, valuing and
4. Existence of professional associations.

2
Human Responses:
The alleviation of suffering through the diagnosis and treatment of human
responses to health issues is an essential function of nursing as defined by
the American Nurses Association.
Essential Nursing Values/Core Values of Professional Nursing:
1. Altruism – selflessness; the nurse shows concern for the welfare and well-
being of patients, family, significant others. other nurses, and other health
care providers.
2. Autonomy – self-determination; the nurse respects patient’s rights to
make decisions about their health care.
3. Human dignity – respect for uniqueness; the nurse values and respects all
patients and colleagues.
4. Integrity – acting in accordance with an appropriate code of ethics and
accepted standards of practice; the nurse is honest and provides care
based on ethical principles.
5. Social justice – fairness; the nurse gives fair treatment regardless of
economic status, race, ethnicity, age, citizenship, disability or sexual
orientation.
Personal Values:
Values can be influenced from society and individual subgroups, and
some or all of these can be internalized as personal values. Societal values
are needed to feel accepted and people need such to have a sense of
individuality.
These are broad desirable goals that motivate people’s actions and
serve as guiding principles in their lives; are desirable to an individual and
represent what is important to someone.
Professional Values:
These are acquired during socialization into nursing from codes of
ethics, experiences, mentors and peers.
These are the guiding beliefs and principles that influence your work
behavior.

3
Criteria of Nursing Profession:
There are 6 criteria of nursing profession that are essential concepts
for nursing practice and a nurse must need to remember. As nursing is
gaining recognition as a profession meaning it is generally different from
other kinds of occupation as it requires extensive education or a calling that
requires special knowledge.
1. Distinct identity and subculture
Distinct identity and subculture is the first criteria meaning that the
members of a profession have a common identity and subculture.
2. Body of knowledge
The nursing profession's body of knowledge is generated through
research and theory building, and is rapidly accumulating.
3. Altruism/Service orientation
Altruism is defined as an orientation towards service. Members of the
profession are motivated by altruism and work for the good of the society.
4. Code of ethics
Like other professions, the nursing profession has its own code of
ethics which articulates its social responsibility and serves as a guide for its
members. Nursing has developed its own code of ethics and in most
instances has set up means to monitor the professional behaviour of its
members.
5. Autonomy
Professional autonomy means self-regulation, self-governing or self-
directing. A profession is autonomous if it regulates itself and sets standards
for its members. Providing autonomy is one of the purposes of a professional
association. To practitioners of nursing, autonomy means independence at
work, responsibility, and accountability for one’s action. Autonomy is more
easily achieved and maintained from a position of authority.
6. Professional organization
The nursing profession has its own organization. The American Nurses
Association is a professional organization that “advances the nursing
profession by fostering high standards of nursing practice, promoting the
economic and general welfare of nurses in the workplace.

4
7. Ongoing research
Increasing research in nursing is contributing to nursing practice. Most
early research was directed at the study of nursing education. In 1960’s
studies were often related to the nature of the knowledge base underlying
nursing practice. Since the 1970’s, nursing research has focused on practice-
related issues.

Focus Questions
Guide questions for Unit 1.1 discussions. Write your answer in a short bond
paper and submit it next week via Messenger. Basis for the grading will be
based on the given rubrics via Messenger.
1. Explain the difference between personal values and professional
values? Discuss briefly in one to two sentences only.

Related Readings
Please refer to this link for the add-on discussion.
http://nursingclient.blogspot.com/2013/08/criteria-of-nursing-
profession.html

Learning Activities
Activity 1. Write your answer in a short bond paper and submit it next week
via Messenger. Basis for the grading will be based on the given rubrics via
Messenger.
1. Discuss briefly in one to two sentences the importance of observing
the values of a nurse in patient’s care?

5
Lesson 2: History of Nursing
Intended Learning Outcomes
At the end of the unit, you are expected to:
1. Relate the history of nursing as it will be applied in rendering
care to the patients.

Introduction
Nursing is a profession within the health care sector that is focused on
the care of individuals, families and communities so they may attain,
maintain, or recover optimal health and quality of life (Coulehan, 2005).
Nurses provide care both interdependently, for example with
physicians, and independently as nursing professionals.
The unit will focus on the history of nursing.
Please proceed immediately to the “Unlocking of Difficulties” part
since the first lesson is also definition of essential terms.

Unlocking of Difficulties
To attend the following intended learning outcomes for the first lesson
of the course, you need to fully understand the following essential terms that
will be laid down in the succeeding pages.

Key Terms
▪ History – is the study of the past; chronological record of significant past
events.
▪ Griffith’s report – they are concerned with levels of service quality of
product, meeting budgets, cost improvement, productivity, motivating and
rewarding staff.
▪ UKCC – (United Kingdom Central Council) is the regulatory body for nursing,
midwifery and health visiting. Its duty is to establish and improve standards
of nursing, midwifery and health visiting care in order to serve and protect
the public.

6
Lecture Notes
Introduction to History of Nursing
“I attribute my success to this – I never gave or took any excuse”
- Florence Nightingale
Nurse, Writer and Statistician
NURSING is varied as the people who practice it; and is dynamic and
diverse as a kaleidoscope of ethnic, cultural and religious manifestations of
people who receive nursing care.
What is Nursing?
According to American Nursing Association (ANA), Nursing is the
diagnosis and treatment of human responses to actual or potential health
problems.
As defined by the International council of Nurses (ICN), Nursing
encompasses autonomous and collaborative care of individuals of all ages,
families, groups, and communities, sick or well and in all settings.
History of Nursing
Although the origins of nursing predate the mid-19th century, the
history of professional nursing traditionally begins with Florence Nightingale.
Nightingale, the well-educated daughter of wealthy British parents, defied
social conventions and decided to become a nurse. The nursing of strangers,
either in hospitals or in their homes, was not then seen as a respectable
career for well-bred ladies, who, if they wished to nurse, were expected to
do so only for sick family and intimate friends. In a radical departure from
these views, Nightingale believed that well-educated women, using scientific
principles and informed education about healthy lifestyles, could
dramatically improve the care of sick patients. Moreover, she believed that
nursing provided an ideal independent calling full of intellectual and social
freedom for women, who at that time had few other career options.
The major events in the evolution of nursing are as follows:
1700 - Care was largely carried out in people’s home by lay people.
1800 - Foundation of the Royal College of Surgeon led to a closer relationship
between medical education and hospitals.
1834 - Poor Law Amendment Act
1854-1856 - Florence Nightingale described as the first research nurse
7
1858 – Improvement of standards
1860 – Florence nightingale founded the first nursing training school.
Attitudes towards the poor changed, poverty implied sickness
1914-1918 – World War 1
1919- Nurses Act
1920 – General Nursing Council was established
1939-1945 – World War 2
1943 – Recruitment of nurses remained a problem
1960 – More policy decisions for nurses
1979 – Nurses, Midwives and Health Visitors Act
1983 – Griffiths report
1986 – Project 2000
1989 – Review of pay scales
1990 – Working for patients; purchaser/ provider
1997-1999 – The new NHS: modern dependable (DH 1997). A first-class
service quality in the new NHS (DH 1998a) making a difference (NHS
Executive 1999). Fitness for practice (UKCC 1999)
2000 – The NHS plan (DH 2000)
2002 – UKCC becomes Nursing and Midwifery Council (NMC)
2004 – Agenda for change
2005 – Reduction in junior doctor’s hours; review of nurses’ roles
2006 – Reorganization of NHS structures. Some NHS trusts report financial
overspends (Brooker & Waugh, 2007).

8
 Florence Nightingale at the Barrack Hospital in Scutari (Üsküdar), writing
letters for wounded soldiers of the Crimean War, 1855.
(Source: https://www.britannica.com/biography/Florence-Nightingale. Retrieved June
24, 2021)

Nightingale’s achievements overshadowed other ways to nurse the

sick. For centuries, most nursing of the sick had taken place at home and had
been the responsibility of families, friends, and respected community
members with reputations as effective healers. During epidemics, such as
cholera, typhus, and smallpox, men took on active nursing roles. For
example, Stephen Girard, a wealthy French-born banker, won the hearts of
citizens of his adopted city of Philadelphia for his courageous and
compassionate nursing of the victims of the 1793 yellow fever epidemic.

Stephen Girard, lithograph by A. Newsam after a portrait by B. Otis

Courtesy of the Library of Congress, Washington, D.C.
(Source: https://www.britannica.com/biography/Stephen-Girard. Retrieved June 24,
2021)

9
Urbanization and industrialization - those without families to care for them
found themselves in hospitals with the quality of nursing care.
Women from religious nursing orders - known for the quality of the nursing
care they provided in the hospitals they established.
Other hospitals - depended on recovering patients or hired men and women
for the nursing care of patients.
Late 19th century - Hospital-based nursing care became a problem when
changes in medical practices and treatments required competent nurses.
Trained nurse – a new health care professional that resulted from the
convergence of hospitals’ needs, physicians’ wishes, and women’s desire for
meaningful work.
Hospital-based training model - established own training schools for nurses.
- students provided the hospital with two or three years of skilled
free nursing care instead of lectures and clinical instructions.
- bound the education of nurses to hospitals rather than colleges.
- reinforced segregation in society and in health care system
(could seek training only in schools).
- maintained the aseptic and infection-control protocols
- established an orderly, routine, and systemized environment
within which patients healed
Early 20th century – “germ theory” of disease (the knowledge that many
illnesses were caused by bacteria) caused considerable alarm in countries
around the world.
- Teaching methods of preventing the spread of diseases, such as
tuberculosis, pneumonia, and influenza.
- Nurses cared for infected patients in the patients’ homes and
taught families and communities the measures necessary to
prevent spreading the infection.
- dramatic decline in the mortality and morbidity rates from
infectious diseases for children and adults.
- independent contractors called private-duty nurses cared for
sick individuals in their homes.
- 20th century - establishment of professional associations to set
standards in differentiating the work of trained nurses from
both assistive-nursing personnel and untrained nurses.
- Sought licensing protection for the practice of registered
nursing

10
 - collective bargaining and labour organizations to assist them in
asserting their and their patients’ rights to improve conditions
and make quality nursing care possible.

World War II: poster U.S. Army Nurse Corps poster from World War II
reading “More nurses are needed! All women can help—learn how you can
aid in army hospitals.” National Library of Medicine, Bethesda, Md.
(Source: https://www.britannica.com/science/nursing. Retrieved June 24, 2021)

Second half of the 20th century - innovative reorganizations of their patterns

of care and started grouping their most critically ill patients together to
provide more effective use of modern technology; responsibility of one nurse
for one patient.
- Advocated healthy and safe environments. The international
scope of nursing is supported by the World Health Organization
(WHO), which recognizes nursing as the backbone of most
health care systems around the world.
Modern nursing
Florence Nightingale was a nurse who tended to injured soldiers in the
Crimean War in the 1850s and played a significant role in changing the nature
of the nursing profession in the 19th century.

11
 Florence Nightingale
(Source: https://www.myamericannurse.com/reflections-on-nightingale-in-the-year-of-
the-nurse/. Retrieved June 24, 2021)

Different Fields of Nursing:

They use the title Private Duty nurse, Private Nurse Practitioner,
Special Duty Nurse or Private Duty Nurse Specialist. A private duty nurse is a
registered nurse who undertakes to give comprehensive nursing care to a
client on a one-to-one ratio.
The four fields of nursing are:
 adult nursing.

 children's nursing.
 learning disability nursing.
 mental health nursing.
Focus Questions
Guide questions for Unit 1.2 discussions. Write your answer in a short bond
paper and submit it next week via Messenger. Basis for the grading will be
based on the given rubrics via Messenger.
1. What is the impact of the history of nursing in rendering nursing care
to the patients? Discuss briefly in one to two sentences only.

12
Related Readings
Please refer to this link for the add-on discussion.
https://www.news-medical.net/health/History-of-Nursing.aspx

Learning Activities
Activity 1. Write your answer in a short bond paper and submit it next week
via Messenger. Basis for the grading will be based on the given rubrics via
Messenger.
1. Discuss briefly in one to two sentences by citing an example how are
you going to apply the history of nursing in dealing with patients?

UNIT 2: Nursing As An Art – Caring, Communicating,

Teaching
Intended Learning Outcomes
At the end of the unit, you are expected to:
1. Describe that nursing is an art by showing caring, good
communicating, excellent teachings.

Introduction
Nursing is widely considered as an art and a science, wherein caring
forms the theoretical framework of nursing. Nursing and caring are grounded
in a relational understanding, unity, and connection between the
professional nurse and the patient. Task-oriented approaches challenge
nurses in keeping care in nursing.
Nursing can be expressed as both a science and an art. Nursing has to
embrace both science and art of the practice. The skill, knowledge and
judgment that must be exercised by nurses are what are constituted as
an art form, because of the level of control involved with the practice.
Nursing is widely considered as an art and a science, wherein caring
forms the theoretical framework of nursing. Nursing and caring are grounded
in a relational understanding, unity, and connection between the
professional nurse and the patient. Task-oriented approaches challenge
nurses in keeping care in nursing. This challenge is ongoing as professional
nurses strive to maintain the concept, art, and act of caring as the moral
center of the nursing profession.
The unit will focus on the client in the context of nursing as an art.

13
 Please proceed immediately to the “Unlocking of Difficulties” part
since the first lesson is also definition of essential terms.

Unlocking of Difficulties
To attend the following intended learning outcomes for the first lesson
of the course, you need to fully understand the following essential terms that
will be laid down in the succeeding pages.

Key Terms
▪ Health promotion – is the process of enabling people to increase control
over, and to improve their health and its determinants, and thereby
improve the health.
▪ Prevention – the keeping of something (such as an illness or injury) from
happening.
▪ Caritas – unconditional love
▪ Communication - is the exchange of information, thoughts, and feelings
among people using speech or other means. The patient conveys their fears
and concerns to their nurse to help them make a correct diagnosis.

Lecture Notes

Caring: The Art of Nursing

(https://i.pinimg.com/originals/50/6b/cc/506bcc142f037afdd21661bd96ecd939.jpg.
Retrieved on January 18, 2021)

A. Caring
Keeping the care in nursing involves the application of art and science
through theoretical concepts, scientific research, conscious commitment to
the art of caring as an identity of nursing, and purposeful efforts to include
caring behaviors during each nurse-patient interaction.

14
1. Jean Watson’s Theory of Human Caring and Nursing: Human Science and
Human Care (1979 – 1985)
“Caring in nursing conveys physical acts, but embraces the
“mindbodyspirit” as it reclaims the embodied spirit as its focus of
attention. It suggests a methodology through both arts and aesthetics,
of being as well as knowing and doing. It concerns itself with the art of
being human. It calls forth from the practitioner an authentic
presencing of being in the caring moment, carrying an intentional
caring-healing consciousness…Nursing becomes a metaphor, for the
sacred feminine archetypal energy, now critical to the healing needed
in modern Western nursing and medicine” (Watson, 1999).

Jean Watson
(Source: https://www.pinterest.com/pin/424956914832773267/. Retrieved on
September 06, 2020)

1. Caring can be effectively demonstrated and practiced only

interpersonally.
2. Caring consists of carative factors that result in the satisfaction of
certain human needs.
3. Effective caring promotes health and and individual or family
growth.
4. Caring responses accept person not what he/she is now but as what
she/he may become.
5. A caring environment is one that offers the development of
potential while allowing the person to choose the best action for
himself of herself at a given point in time.
6. Caring is more “healthogenic” than is curing. A science of caring is
complimentary to the science of curing.
7. The practice of caring is central to nursing.
Watson views “carative” (caring with love) factors as a guide for the
core of nursing. It originated from the term “caritas” which means
to cherish, appreciate, and give special attention.

15
 Nursing process contains the same steps as the scientific research
process.
1. Assessment – observation, ID, history of problem, formulation,
conceptualization of framework, hypothesis, defining variables.
2. Plan – how variables would be measured, conceptual design,
what data would be collected, how on whom
3. Intervention – implementation of the plan, collection of data
from subjects.
4. Evaluation – analysis of the data, examination of effects,
interpretation of results, generate additional hypothesis or
nursing theory.
Concepts include:
1. Personhood (human being) – viewed holistically (body, mind,
soul are interrelated). Each part reflection of the whole, yet
whole is greater than and different from the sum of parts;
valued person; soul fully participates in healing.
2. Healing space and environment – focused on stress, comfort,
privacy, safety and clean aesthetic surroundings: sacred space.
3. Health, Illness and Disease
4. Transpersonal Nursing-Caring-Healing
2. Patricia Benner’s The Primary of Caring Model (From Novice to Expert
Nursing Model)
“Nursing is an integrative science that studies the relationships
between mind, body and human worlds. It is concerned with far more
than the cognitive structure of formal mental properties, such as
attitudes and belief systems of the mind-brain, and the physiology and
pathophysiology of the body as a system of cells, tissues and organs.
Nursing is concerned with the social sentient body that dwells infinite
human worlds: that gets sick and recovers; that is altered during
illness, pain, and suffering; and that engages with the world differently
upon recovery” (Benner, 1999).

16
 Patricia Benner
(Source: https://www.educatingnurses.com/biography-of-patricia-benner/. Retrieved
on September 06, 2020)
Domains of Nursing Practice:
1. The Helping Role Domain – healing relationship, comfort measures,
active patient participation
2. The Teaching-coaching Function Domain – timing, readiness to
learn, lifestyle alterations
3. The Diagnostic and Patient-Monitoring Function Domain - ongoing
assessment and anticipation of outcomes
4. The Effective Management of Rapidly Changing Situations Domain
– match demands with resources available
5. The Administering and Monitoring Therapeutic Interventions and
Regimens Domain – preventing complications
6. The Monitoring and Ensuring the Quality of Health Care Practices
Domain – maintenance of safety, continuous quality improvement
7. The Organizational and Work-Role Competencies Domain – priority
setting, team building, coordinating, providing continuity.
3. Katie Eriksson’s Caritative Caring Theory
“Caritative caring means that we take “caritas” into use when caring
for the human being in health and suffering…. Caritative caring is a
manifestation of the love that “just exists”….Caring communion, true
caring, occurs when the one caring in a spirit of caritas alleviates the
suffering of the patient” (Eriksson, 1992).
“Nursing ethics are the ethical principles that guide a nurse’s decision-
making abilities”.
“Caritative caring consists of love and charity, which is also known as
“caritas”, and respect and reverence for human holiness and dignity”.
Suffering that occurs as a result of a lack of caritative care is a violation
of human dignity”.

17
 Katie Eriksson
(Source: https://nursekey.com/11-theory-of-caritative-caring/. Retrieved on September
06, 2020)

Eriksson emphasizes that caritative caring relates to the

innermost core of nursing. She distinguishes between caring nursing
and nursing care. She means that nursing care is based on the nursing
care process, and it represents good care only when it is based on the
innermost core of caring.

Major concepts:
 Caritas – unconditional love
 Caring communion – source of strength and meaning in caring
 The Act of Caring – caring elements ( faith, hope, love, tending,
playing,
 Caritative caring ethics – ethics of caring, determined by caritas
motive; guides work or decision
 Dignity – absolute dignity (through creation, unique human
being), relative dignity (influenced and formed through culture
and external contexts)
 Invitation – career welcomes the patient to the caring
communion
 Suffering – unique, isolated total experience, not synonymous
with pain; struggle between good and evil in a state of becoming
 Suffering r/t illness, to care, and to life – to illness (with illness
and tx), to care (caused by care or absence of caring; violation
of dignity), to life (being a patient, entire life of human being)
 Suffering of human being – patient from Latin word patiens
(suffering); suffering human being or who suffers and patiently
endures
 Reconciliation – drama of suffering (confirmed suffering and
given time and space to suffer and reach reconciliation); living

18
 with imperfection but seeing a way forward and meaning in
one’s suffering.
 Caring culture – based on cultural elements (traditions, rituals,
basic values), reverence, tending, cultivating, and caring.
 Human being – entity of body, soul, and spirit; constant
becoming, constantly in change; dependent on communion
 Nursing – basic motive of caring (love and charity); natural and
original
 Environment – human being innermost space and feels at home
 Health – soundness, freshness and well-being.
The Six C’s of Caring:
According to Sister Simone Roach, caring is the human mode of being.
1. Care
2. Compassion
3. Competence
4. Communication
5. Courage
6. Commitment
Caring for self and others:
1. We can’t share with others a resource that we lack ourselves. The critical
starting point is to take our own mental health temperature. How am I
doing? What will help me combat anxiety? Am I drinking, eating, or sleeping,
or crying too much? What do I need to do to stay connected?
2. Ask for help when you need it.
3. Ask others, “How are you?”
4. Look for the positive and say it aloud.
B. Communicating

Core Value of Nursing

(Source: https://www.goodwin.edu/enews/core-values-of-nursing/ Retrieved on January
18, 2021)

19
Communication Process:
The process of communication refers to the transmission or passage of
information or message from the sender through a selected channel to the
receiver overcoming barriers that affect its pace.
The 5 main processes are:
1. Sender
2. Transmission
3. Noise
4. Receiver
5. Feedback

The Process of Communication

(Source: https://courses.lumenlearning.com/wm-organizationalbehavior/chapter/the-
process-of-communication/ Retrieved on January 18, 2021)

Face-to-face communication involves a sender, a message, a receiver,

and a response/feedback. Communication is a two-way process involving the
sending and the receiving of the message. The purpose is to elicit a response,
the process is ongoing the receiver of the message, then becomes the sender
of a response, and the original sender then becomes the receiver.

How the Communication Process Impacts E-Learning

(Source: https://blogs.articulate.com/rapid-elearning/communication-process-impacts-e-
learning/. Retrieved on January 18, 2021)

20
Modes of Communication:
1. verbal communication – pace and intonation, simplicity, clarity and brevity,
timing and relevance, adaptability, credibility and humor.
2. nonverbal communication – personal appearance, posture and gait, facial
expression, gestures.
3. electronic communication – e-mail
Therapeutic Communication:

The Art of communication

(Source: https://www.trainingjournal.com/articles/feature/art-communication. Retrieved
on January 18, 2021)

It is a collection of techniques that prioritize the physical, mental, and

emotional well-being of patients.
It promotes understanding and can help establish a constructive
relationship between the nurse and the client. Compared to social relationship,
where there may not be a specific purpose/direction, therapeutic helping
relationship is client and goal-oriented.
Nurses need to respond not only to the content of a client’s verb al
message but also to the feelings expressed.
5 key characteristics:
1. Empathy
2. Respect
3. Genuineness
4. Concreteness
5. Confrontation

21
Therapeutic Communication Techniques:
1. Using silence
2. Accepting
3. Giving recognition
4. Offering self
5. Giving broad openings
6. Active listening
7. Seeking clarification
8. Placing the event in time or sequence
9. Making Observations
10. Encouraging descriptions of perceptions
11. Encouraging comparisons
12. Summarizing
13. Reflecting
14. Focusing
15. Confronting
16. Voicing doubt
17. Offering hope and humor
Barriers to Communication:

Barriers to Effective Communication

(Source: https://www.seekhle.com/2018/07/barriers-to-effective-communication.html.
Retrieved on January 18, 2021)

Nurses need to recognize barriers/non-therapeutic responses to

effective communication. Failing to listen, improperly decoding the client’s
intended message, and placing the nurse’s needs above the client’s needs are
major barriers to communication.
Non-therapeutic communication techniques:
1. Advising – telling the patient what he or she needs to do.
2. Disagreeing – opposing whatever the idea the patient has expressed.
3. Interpreting – telling the patient what they mean.

22
Communication and the Nursing Process:
Effective use of communication has been shown to benefit the nurse
relationship, contributing to overall well-being and accelerating the process of
treatment. It is therefore an essential aspect of the nursing process. In some
cases, it can even mean the difference between life and death.
C. Teaching

Teaching Nursing: The Art and Science

(Source: https://images-na.ssl-images-
amazon.com/images/I/41i%2B3QD5NyL._AC_UL320_SR246,320_.jpg. Retrieved on
January 18, 2021)

One of the most critical roles that nurses have in health

promotion and disease preventions is that of an educator. Nurses spend the
most time with the patients and provide anticipatory guidance about
immunizations, nutrition, dietary, medications, and safety.
Nursing education has significantly developed in response to the
changing needs, advances, priorities and expectations in health and
healthcare. Modern nursing education should enable the nurse
student/practitioner to acquire the knowledge, skills and behavior and meet
the present and future challenges.

What is Nursing?
(Source: https://www.nursingworld.org/practice-policy/workforce/what-is-nursing/.
Retrieved on January 18, 2021)

23
I. Health Promotion – is the process of enabling people to increase control
over, and to improve their health and its determinants, and thereby improve
the health.
Models of Health Promotion:
1. Biomedical model of health
 focuses on risk behaviors and healthy lifestyles
 emphasizes health education – changing knowledge, attitudes and
skills
 focuses on individual responsibility
 treats people in isolation of their environments

2. Social model of health

 addresses the broader determinants of health
 involves inter-sectoral collaboration
 acts to reduce social inequities
 empowers individuals and communities
 acts to enable access to health care

3. Ecological model of health

 acknowledges the reciprocal relationship between health-related
behaviors and the environments in which people live, work and play
(behavior does not occur in a vacuum)
 considers the environment is made up of different subsystems –
micro, meso, exo and macro
 emphasizes the relationships and dependencies between these
subsystems
 is comprehensive and multi-faceted, using a shared framework for
change at individual and environmental levels

II. Prevention of illness – is a procedure through which individuals, particularly

those with risk factors for a disease, are treated in order to prevent disease
from occurring. Treatment normally begins either before signs and symptoms
of the disease occur, or shortly thereafter.

Prevention and Response Protocol

(Source: http://www.thinglink.com/scene/1117259710404231172. Retrieved on January
18, 2021)
24
3 Levels of Preventive Care:
1. Primary prevention – aims to avoid the development of a disease/disability
in healthy individuals
2. Secondary prevention – is early disease detection, making it possible to
prevent the worsening of the disease and the emergence of symptoms, or
to minimize complications and limit disabilities before the disease
becomes severe. Secondary prevention also includes the detection of
disease in asymptomatic patients with screening or diagnostic testing and
preventing the spread of communicable disease.
3. Tertiary prevention - The goal of tertiary prevention is to reduce the
negative impact of an already-established disease by restoring function
and reducing disease-related complications. Tertiary prevention also aims
to improve the quality of life for people with disease.
III. Restoration of Health – is the act of restoring or the condition of being
restored as a returning to a normal or healthy condition.

Maintenance and Restoration of Health

(Source: https://www.dreamstime.com/maintenance-restoration-health-blood-
pressure-tests-image110078853. Retrieved on January 18, 2021.)

Focus Questions
Guide questions for Unit 1.3 discussions. Write your answer in a short bond
paper and submit it next week via Messenger. Basis for the grading will be
based on the given rubrics via Messenger.
1. Discuss briefly in one to two sentences by citing an example that a nurse
is showing the art of nursing in caring, communicating and teaching?

Related Readings
Please refer to this link for the add-on discussion.
https://pubmed.ncbi.nlm.nih.gov/19850178/#:~:text=Nursing%20is%20wid
ely%20considered%20as,in%20keeping%20care%20in%20nursing.
mics/blog-posts/17-therapeutic-communication-techniques/

25
http://makeitourbusiness.ca/blog/what-does-it-mean-be-culturally-
competent#:~:text=Cultural%20competence%20is%20the%20ability,p
ositive%20attitudes%20towards%20cultural%20differences

Learning Activities
Activity 1. Write your answer in a short bond paper and submit it next week
via Messenger. Basis for the grading will be based on the given rubrics via
Messenger.
1. Discuss briefly in one to two sentences by citing an exam when a nurse
fails to show the art of nursing in caring, communicating and teaching?

UNIT 3: Nursing as a Science

Lesson 1: Problem Solving Process
Intended Learning Outcomes
At the end of the unit, you are expected to:
1. Explain on how to apply nursing as a science in the problem-
solving process in rendering care to the patients in the near
future.

Introduction
Problem solving represents a higher level of cognitive function. A
systematic approach to problem solving makes it more likely that you will
find an appropriate solution. Effective problem solving involves evaluating
the solution over time to be sure that it is still effective.
Having solved a problem in a situation adds to your experience in your
practice and allow you to apply that knowledge in future.
The problem-solving process is the foundation of the nursing process.
For nursing practice, problem solving is presented in a nursing process
format (Kelley, 2016).
The unit will focus on what is nursing as a science – problem-solving
process.
Please proceed immediately to the “Unlocking of Difficulties” part since
the first lesson is also definition of essential terms.

26
Unlocking of Difficulties
To attend the following intended learning outcomes for the first lesson
of the course, you need to fully understand the following essential terms that
will be laid down in the succeeding pages.

Key Terms
▪ Problem solving – is a response given in an important and difficult situation,
where critical thinking is required for a solution.
▪ Clinical judgment - is a decision-making process to ascertain the right
nursing action to be implemented at the appropriate time in the client’s
care.

Lecture Notes

The Nursing Profession

(Source: https://www.youtube.com/watch?v=pqBBimkJI2s. Retrieved on January 16,
2021)

Problem solving is centered on your ability to identify critical issues

and create or identify solutions. Remember, problems are a part of everyday
life and your ability to resolve problems will have a positive influence on
your future.
It is a mental activity in which a problem is identified that represents
an unsteady state. The nurse has to gather data that clarifies the nature of
the problem and suggests possible solutions and chooses the best one to
implement and keeps/reserves other solutions in case that the first solution
is not effective. The nurse has to carefully monitor to make it sure that the
initial database and continued effectiveness returns to the client in a steady
state. Commonly used approaches to problem solving include trial and
error, intuition, and the research process.
1. Trial and error – number of approaches are tried until a solution is
found. It can be dangerous because the client may suffer harm if
carried out approach is not appropriate. It is safer to be used in home

27
 settings related to logistics, equipment, and client lifestyle (e.g.
colostomy irrigation using a bent coat hanger hung on the shower
curtain rod instead of lowered IV pole/stand).
2. Intuition – nurse’s inner sense; understanding or learning of things
without the conscious use of reasoning. By some people, it is viewed
as a form of guessing and therefore it is not appropriate but by some,
it is a legitimate aspect of a nursing judgment in the implementation
of care acquired through knowledge and experience.
Clinical judgment - is a decision-making process to ascertain the right
nursing action to be implemented at the appropriate time in the
client’s care.

Experience – important in improving intuition because rapidity of

the judgment depends on the nurse having seen similar client
situations many times before; not recommended for
novices/students.

2. Research process – is a formalized, logical, systematic approach to

problem solving; helps to identify evidence that supports effective
nursing care.

Making Decisions and Solving Problems

(Source: https://nursekey.com/making-decisions-and-solving-problems/. Retrieved on
February 21, 2021)

6 Steps of Problem Solving

Step 1: Identify and Define the Problem

It is not difficult to overlook the true problem in a situation and
focus your attention on issues that are not relevant. This is why it is
important that you look at the problem from different perspectives. This
provides a broad view of the situation that allows you to weed out factors
that are not important and identify the root cause of the problem.
28
Step 2: Analyze the Problem
Break down the problem to get an understanding of the problem.
Determine how the problem developed. Determine the impact of the
problem.

Problem Solving
(Source: https://www.edgt.com/products/?ID=343. Retrieved on February 21,
2021)

Step 3: Develop Solutions

Brainstorm and list all possible solutions that focus on resolving the
identified problem. Do not eliminate any possible solutions at this stage.

Step 4: Analyze and Select the Best Solution

List the advantages and disadvantages of each solution before
deciding on a course of action. Review the advantages and disadvantages
of each possible solution. Determine how the solution will resolve the
problem. What are the short-term and long-term disadvantages of each
solution? What are the possible short-term and long-term benefits of
each solution? Which solution will help you meet your goals?

Step 5: Implement the Solution

Create a plan of action. Decide how you will move forward with your
decision by determining the steps you must take to ensure that you move
forward with your solution. Now, execute your plan of action.

Step 6: Evaluate the Solution

Monitor your decision. Assess the results of your solution. Are you
satisfied with the results? Did your solution resolve the problem? Did it
produce a new problem? Do you have to modify your solution to achieve
better results? Are you closer to achieving your goal? What have you
learned?

29
 Problem Solving for Nurses
(Source: https://www.youtube.com/watch?v=IAOPad3Vhy8. Retrieved on February 21,
2021)

Problem Solving and Nursing Process

(Source: https://nursing-course.blogspot.com/2014/11/problem-solving-and-nursing-
process.html. Retrieved on February 20, 2021)

Nursing as a profession, is committed to recognize its own

unparalleled body of knowledge vital to nursing practice – nursing science.
As a science, nursing is based on the theory of what nursing is, what nurses
do, and why. Nursing is a unique discipline and is separate from medicine. It
has its own body of knowledge on which delivery of care is based.

Focus Questions
Guide questions for Unit 3.1 discussion. Write your answer in a short bond
paper and submit it next week via Messenger. Basis for the grading will be
based on the given rubrics via Messenger.
1. How are you going to apply the steps in problem solving? Discuss
briefly in one to two sentences only.

30
Related Readings
Please refer to this link for the add-on discussion.
http://nursingclient.blogspot.com/2013/08/criteria-of-nursing-
profession.html

Learning Activities
Activity 1. Write your answer in a short bond paper and submit it next week
via Messenger. Basis for the grading will be based on the given rubrics via
Messenger.
1. Discuss briefly in one to two sentences the importance of problem
solving in patient’s care?

Lesson 2: Critical Thinking and the Nursing Process

Intended Learning Outcomes
At the end of the unit, you are expected to:
1. Relate the important aspects of the critical thinking and the
nursing process.

Introduction
According to Scheffer and Rubenfeld (2010), critical thinking is a
metaphorical bridge between information and action. Critical thinking in
nursing involves habits of the mind and requires the implementation of
cognitive skills. Critical thinking cognitively fuels the intellectual artistic
activity of creativity. When nurses incorporate creativity, they are able to
find unique solutions to unique problems.
The unit will focus on Critical thinking and the nursing process.

Please proceed immediately to the “Unlocking of Difficulties” part

since the first lesson is also definition of essential terms.

31
Unlocking of Difficulties
To attend the following intended learning outcomes for the first lesson
of the course, you need to fully understand the following essential terms that
will be laid down in the succeeding pages.

Key Terms
▪ Critical thinking - is the process of intentional higher level thinking to define
a client’s problem, examine the evidence-based practice in caring for the
client, and make choices in the delivery of care.

Lecture Notes

The purpose of critical thinking is for the identification of client

problems and the implementation of interventions to promote effective care
outcomes. The process of providing feedback and reflection is vital to the
improvement of nursing practice. A study by Asselin (2011) revealed that
students who reflected on new knowledge developed new insights regarding
practice. The insights nurses acquired led to changes in their approach to
practice. According to Scheffer and Rubenfeld (2010), critical thinking is a
metaphorical bridge between information and action. Critical thinking in
nursing involves habits of the mind and requires the implementation of
cognitive skills.
10 habits of the mind (affective components):
1. confidence 6. intellectual integrity
2. contextual perspective 7. intuition
3. creativity 8. open-mindedness
4. flexibility 9. perseverance and
5. inquisitiveness 10. reflection
7 skills (cognitive components):
1. analyzing
2. applying standards
3. discriminating
4. information seeking
5. logical reasoning
6. predicting and
7. transforming knowledge

32
Nurses need to use all 17 critical thinking concepts in the identification
of nursing diagnosis.

Nurse uses other techniques to ensure effective problem solving and

decision making. These techniques include:
1. critical analysis – application of a set of questions to a particular
situation.
2. inductive and deductive reasoning – inductive (formed from a set of
facts/observations, e.g. dehydration), deductive (reasoning from
general premise to the specific conclusion, e.g. encourage child to eat
- children love peanut butter sandwich)
3. making valid inferences
4. differentiating facts from opinions
5. evaluating the credibility of information sources
6. clarifying concepts and
7. recognizing assumptions.
Differentiating Types of Statements
Statement Description Example
Facts Can be verified through Blood pressure is
investigation affected by blood
volume.
Inference Conclusions drawn from If blood volume is
the facts; going beyond decreased (e.g. in
facts to make a hemorrhagic shock), the
statement about BP will drop.
something not
currently known
Judgments Evaluation of facts or It is harmful to the
information that client’s health if the
reflects values or other blood pressure drops
criteria; a type of too low.
opinion
Opinions Beliefs formed over Nursing interventions
time, include can assist in
judgments that may fit maintaining the
facts or be erroneous. client’s BP within
normal limits.
th
Fundamentals of Nursing, 10 edition By Kozier and Erb, copyright 2016

33
Overview of the Nursing Process
Phase and Description Purpose Activities
Assessing – collecting, To establish a database Establish a database
organizing, validating, about the client’s • Obtain a nursing health
& documenting client response to health history.
data concerns to illness & • Conduct a physical
the ability to manage assessment.
health care needs • Review client records.
• Review nursing
literature.
• Consult support
persons.
• Consult health
professionals.
Update data as needed.
Organize data.
Validate data.
Communicate/document
data.
Diagnosing - To identify client Interpret and analyze
analyzing and strengths and health data:
synthesizing data problems that can be • Compare data against
prevented or resolved standards.
by collaborative and • Cluster or group data
independent nursing (generate tentative
interventions To hypotheses).
develop a list of nursing • Identify gaps and
and inconsistencies.
collaborative problems Determine client’s
strengths, risks, and
problems.
Formulate nursing
diagnoses and
collaborative problem
statements.
Document nursing
diagnoses on the care
plan.

34
 Planning - To develop an
Set priorities and
Determining how to individualized care plan
goals/outcomes in
prevent, reduce, or that specifies client collaboration with client.
resolve the identified goals/desired Write goals/desired
priority client outcomes, and related outcomes. Select nursing
problems; how to nursing interventions strategies/interventions.
support client Consult other health
strengths; and how to professionals. Write
implement nursing nursing interventions and
interventions in an nursing care plan.
organized, Communicate care plan to
individualized, and relevant health care
goal-directed manner providers.
Implementing - To assist the client to Reassess the client to
Carrying out (or meet desired goals/ update the database.
delegating) and outcomes; promote Determine the nurse’s
documenting the wellness; prevent need for assistance.
planned nursing illness and disease; Perform planned nursing
interventions restore health; and interventions.
facilitate coping with Communicate what
altered functioning nursing actions were
implemented:
• Document care and
client responses to care.
• Give verbal reports as
necessary
Evaluating - To determine whether Collaborate with client
Measuring the degree to continue, modify, or and collect data related to
to which terminate the plan of desired outcomes. Judge
goals/outcomes have care whether
been achieved and goals/outcomes have
identifying factors that been achieved. Relate
positively or negatively nursing actions to client
influence goal goals/outcomes. Make
achievement decisions about problem
status. Review and modify
the care plan as indicated
or terminate nursing care.
Document achievement
of
outcomes and
modification of the care
plan.
th
Fundamentals of Nursing, 10 edition By Kozier and Erb, copyright 2016

35
Example of Critical Thinking in the Nursing Process
Nursing Process Phase Critical Thinking Activities
Assessing Making reliable observations Distinguishing
relevant from irrelevant data Distinguishing
important from unimportant data Validating
data Organizing data Categorizing data
according to a framework Recognizing
assumptions Identifying gaps in the data
Diagnosing Finding patterns and relationships among
cues Making inferences Suspending judgment
when lacking data Stating the problem
Examining assumptions Comparing patterns
with norms Identifying factors
contributing to the problem
Planning Forming valid generalizations Transferring
knowledge from one situation to another
Developing evaluative criteria Hypothesizing
Making interdisciplinary connections
Prioritizing client problems Generalizing
principles from other sciences
Implementing Applying knowledge to perform
interventions Testing hypotheses
Evaluating Deciding whether hypotheses are correct
Making criterion-based evaluations
Fundamentals of Nursing, 10th edition By Kozier and Erb, copyright 2016

Critical Thinking, clinical reasoning, nursing process:

Assessing – gather subjective and objective data; identify the client’s
chief complaint.
Diagnosing – based on the data collected, identify a nursing diagnosis
form NANDA International; consult evidence practice literature.
Planning – goal development; recall nursing and health related
knowledge; consult with the primary care provider and client; review
outcomes of prior clinical situations.
Implementing – identify and implement interventions to assist in the
attainment of goals and resolution of the nursing diagnosis.
Evaluating – evaluate the client’s response to the care provided.

36
Types of Assessment:
Type Time Performed Purpose Example
Initial Performed withinTo establish a Nursing
assessment specified time after complete admission
admission to a healthdatabase for assessment
care agency problem
identification,
reference, and
future
comparison
Problem- Ongoing process To determine Hourly
focused integrated with the status of a assessment of
assessment nursing care specific problem client’s fluid
identified in an intake and
earlier urinary output in
assessment an ICU
Assessment of
client’s ability to
perform self-
care while
assisting a client
to bathe
Emergency During any To identify life- Rapid assessment
assessment physiological or threatening of an individual’s
psychological crisis problems To airway, breathing
of the client identify new or status, and
overlooked circulation
problems during a cardiac
arrest
Assessment of
suicidal
tendencies or
potential for
violence

37
 Time-lapsed Several months after To compare the Reassessment of
reassessment initial client’s current a client’s
assessment status to functional health
baseline data patterns in a
previously home care or
obtained outpatient
setting or, in a
hospital, at shift
change
Fundamentals of Nursing, 10th edition By Kozier and Erb, copyright 2016

Components of a Nursing Health History

1. Biographic Data - Client’s name, address, age, sex, marital status,
occupation, religious preference, health care financing, and usual
source of medical care
2. Chief Complaint or Reason for Visit - The answer given to the question
“What is troubling you?” or “Describe the reason you came to the
hospital or clinic today.” The chief complaint should be recorded in the
client’s own words.
3. History of Present Illness
• When the symptoms started
• Whether the onset of symptoms was sudden or gradual
• How often the problem occurs
• Exact location of the distress
• Character of the complaint (e.g., intensity of pain or quality of
sputum, emesis, or discharge)
• Activity in which the client was involved when the problem
occurred
• Phenomena or symptoms associated with the chief complaint
• Factors that aggravate or alleviate the problem
4. Past History
• Illnesses, such as chickenpox, mumps, measles, rubella (German
measles), rubeola (red measles), streptococcal infections, scarlet
fever, rheumatic fever, hepatitis, polio, and other significant
illnesses
• Immunizations and the date of the last tetanus shot
• Allergies to drugs, animals, insects, or other environmental agents,
the type of reaction that occurs, and how the reaction is treated
• Accidents and injuries: how, when, and where the incident

38
 occurred, type of injury, treatment received, and any
complications
• Hospitalization for serious illnesses: reasons for the
hospitalization, dates, surgery performed, course of recovery, and
any complications
• Medications: all currently used prescription, over-the-counter
medications, such as aspirin, nasal spray, vitamins, or laxatives,
and herbal supplements
5. Family History - To ascertain risk factors for certain diseases, the ages
of siblings, parents, and grandparents and their current state of health
or, if they are deceased, the cause of death are obtained. Particular
attention should be given to disorders such as heart disease, cancer,
diabetes, hypertension, obesity, allergies, arthritis, tuberculosis,
bleeding, alcoholism, and any mental health disorders.
6. Lifestyle
• Personal habits: the amount, frequency, and duration of substance
use (tobacco, alcohol, coffee, cola, tea, and illegal or recreational
drugs)
• Diet: description of a typical diet on a normal day or any special
diet, number of meals and snacks per day, who cooks and shops
for food, ethnic food patterns, and allergies
• Sleep patterns: usual daily sleep/wake times, difficulties sleeping,
and remedies used for difficulties
• Activities of daily living (ADLs): any difficulties experienced in the
basic activities of eating, grooming, dressing, elimination, and
locomotion
• Instrumental ADLs: any difficulties experienced in food
preparation, shopping, transportation, housekeeping, laundry, and
ability to use the telephone, handle finances, and manage
medications
• Recreation/hobbies: exercise activity and tolerance, hobbies and
other interests, and vacations
7. Social Data
• Family relationships/friendships: the client’s support system in
times of stress (who helps in time of need?), what effect the client’s
illness has on the family, and whether any family problems are
affecting the client
• Ethnic affiliation: health customs and beliefs; cultural practices
that may affect health care and recovery
• Educational history: data about the client’s highest level of

39
 education attained and any past difficulties with learning
• Occupational history: current employment status, the number of
days missed from work because of illness, any history of accidents
on the job, any occupational hazards with a potential for future
disease or accident, the client’s need to change jobs because of
past illness, the employment status of spouses or partners and the
way child care is handled, and the client’s overall satisfaction with
the work
• Economic status: information about how the client is paying for
medical care (including what kind of medical and hospitalization
coverage the client has) and whether the client’s illness presents
financial concerns
• Home and neighborhood conditions: home safety measures and
adjustments in physical facilities that may be required to help the
client manage a physical disability, activity intolerance, and
activities of daily living; the availability of neighborhood and
community services to meet the client’s needs.
8. Psychological Data
• Major stressors experienced and the client’s perception of them
• Usual coping pattern for a serious problem or a high level of stress
• Communication style: ability to verbalize appropriate emotion;
nonverbal communication—such as eye movements, gestures, use
of touch, and posture; interactions with support persons; and the
congruence of nonverbal behavior and verbal expression
9. Patterns of Health Care - All health care resources the client is
currently using and has used in the past. These include the primary
care provider, specialists (e.g., ophthalmologist or gynecologist),
dentist, folk practitioners (e.g., herbalist or curandero), health clinic,
or health center; whether the client considers the care being provided
adequate; and whether access to health care is a problem.

Examples of Subjective and Objective Data

Subjective Objective
“I feel weak all over when I exert “I feel weak all over when I exert
myself.” Blood pressure 90/50 myself.” Blood pressure 90/50
mmHg* Apical pulse 104 beats/min mmHg* Apical pulse 104 beats/min
Skin pale and diaphoretic Skin pale and diaphoretic

40
 Client states he has a cramping pain Vomited 100 mL green-tinged fluid
in his abdomen. States, “I feel sick to Abdomen firm and slightly distended
my stomach.” Active bowel sounds
auscultated in all four quadrants
“I’m short of breath.” Lung sounds clear bilaterally;
diminished in right lower lobe
Wife states: “He doesn’t seem so Client cried during interview
sad today.” (This is subjective and
secondary source data.)
“I would like to see the chaplain Holding open Bible Has small silver
before surgery.” cross on bedside table
*Blood pressure obtained using an external cuff and manometer may be
considered secondary or indirect data since it does not directly measure
the pressure within the arteries.
(Source: Fundamentals of Nursing, 10th edition By Kozier and Erb,
copyright 2016)

Using the Senses to Observe Client Data

Sense Example of Client Data
Vision Overall appearance (e.g., body size, general weight,
posture, grooming); signs of distress or discomfort;
facial and body gestures; skin color and lesions;
abnormalities of movement; nonverbal demeanor
(e.g., signs of anger or anxiety); religious or cultural
artifacts (e.g., books, icons, candles,
beads)
Smell Body or breath odors
Hearing Lung and heart sounds; bowel sounds; ability to
communicate; language spoken; ability to initiate
conversation; ability to respond when spoken to;
orientation to time, person, and place; thoughts and
feelings about self, others, and health status
Touch Skin temperature and moisture; muscle strength
(e.g., hand grip); pulse rate, rhythm, and volume;
palpable lesions (e.g., lumps, masses, nodules)
Fundamentals of Nursing, 10th edition By Kozier and Erb, copyright 2016

41
Stages of an Interview
1. The opening – the nurse establishes rapport and orients the
interviewee.
2. The body – client feels comfortably while communicates what he/she
thinks, feels, knows, & perceives in response to questions from the
nurse using communication techniques.
3. The closing – the nurse terminates the interview, or client terminates
it (not give any more information/unable to offer more information r/t
fatigue; important for maintaining rapport & trust & for future
interactions.

Examining
The physical examination is carried out systematically. It may be
organized according to the examiner’s preference, in a head-to-toe
approach or a body systems approach. Usually, the nurse first records a
general impression about the client’s overall appearance and health
status: for example, age, body size, mental and nutritional status, speech,
and behavior. Then the nurse takes such measurements as vital signs,
height, and weight. The cephalocaudal or head-to-toe approach begins
the examination at the head; progresses to the neck, thorax, abdomen,
and extremities; and ends at the toes. The nurse using a body systems
approach investigates each system individually, that is, the respiratory
system, the circulatory system, the nervous system, and so on. During
the physical examination, the nurse assesses all body parts and compares
findings on each side of the body.

Diagnosing – nurse uses critical thinking skills to interpret assessment

data and identify client strengths and problems.
International recognition came with the First Canadian Conference in
Toronto in 1977 and the International Nursing Conference in May 1987
in Calgary, Alberta, Canada. In 1982, the conference group accepted the
name North American Nursing Diagnosis Association (NANDA),
recognizing the participation and contributions of nurses in the United
States and Canada. In 2002, the organization changed its name to NANDA
International to further reflect the worldwide interest in nursing
diagnosis.
The purpose of NANDA International is to define, refine, and promote a
taxonomy of nursing diagnostic terminology of general use to
professional nurses.
Taxonomy - is a classification system or set of categories arranged based
on a single principle or set of principles.
42
The group has currently approved more than 200 nursing diagnosis
labels for clinical use and testing.
Diagnosing – reasoning process
Diagnosis – statement conclusion regarding the nature of the
phenomenon. Diagnostic labels – standardized NANDA names for the
diagnoses
Nursing diagnosis – diagnostic label + etiology (cause) = client’s problem
statement
- According to NANDA, a clinical judgment
concerning a human response to health
conditions/life processes, or a vulnerability for
that response, by an individual, family, group, or
community.
- Judgment made only after thorough, systematic
data collection.
Kinds of nursing diagnosis:
1. Actual diagnosis – present at the time of nursing assessment; based on
the presence of associated s/sx (e.g. Ineffective Breathing Pattern,
Anxiety).
2. Health promotion diagnosis – client’s preparedness to implement
behaviors to improve their health condition (begin with the phrase
Readiness for Enhanced as in Readiness for Enhanced Nutrition).
3. Risk nursing diagnosis – clinical judgment that a problem does not
exist, but the presence of risk factors indicates that a problem is likely
to develop unless nurses intervene (e.g. diabetic or
immunocompromised client is at high risk – Risk for Infection).
4. Syndrome diagnosis – nurse’s clinical judgment to describe a cluster
of nursing diagnosis that have similar interventions
Qualifiers – word added to diagnostic statement, for example:
1. Deficient – inadequate in amount, quality, or degree, not sufficient;
incomplete
2. Impaired – made worse, weakened, damaged, reduced, deteriorated
3. Decreased – lesser in size, amount, degree
4. Ineffective – not producing the desired effect
5. Compromised – to make vulnerable to threat

43
 Components of Nursing Diagnosis:

Diagnosis Related Factors Defining

Characteristics
Activity Intolerance: Bed rest or immobility Verbal report of fatigue
insufficient Generalized weakness or weakness
physiological or Imbalance between Abnormal heart rate or
psychological energy oxygen supply/demand blood pressure
to endure or Sedentary lifestyle response to activity
complete required or
desired daily Electrocardiographic
activities changes reflecting
arrythmias or ischemia
Exertional discomfort
or dyspnea
Fundamentals of Nursing, 10th edition By Kozier and Erb, copyright 2016

Nursing Medical Collaborative

Diagnosis Diagnosis Problems
Example Activity Myocardial Potential
Intolerance r/t infarction complication
decreased cardiac myocardial
output infarction:
congestive heart
failure
Description Describe human Describe disease Involve human
responses to and pathology, responses–
disease process do not consider mainly
or health other human physiological
problem; consist responses, complications of
of a one-two, or usually consist of disease, tests, or
three-part not more than treatments,
statement, three words consist of a two-
usually including part statement
problem and of situation/
etiology pathophysiology
and the potential
complication

44
 Orientation & Oriented to the Oriented to Oriented to
responsibility for individual; nurses pathology; pathophysiology;
diagnosing responsible for physician nurses
diagnosing responsible for responsible for
diagnosing; diagnosing
diagnosis not
within the scope
of nursing
practice
Nursing focus Treat & prevent Implement Prevent and
medical orders monitor for
for treatment onset or status of
and monitor condition
status of
condition
Nursing actions Independent Dependent Some
(primarily) independent
actions, but
primarily for
monitoring and
preventing
Duration Can change Remains the same Present when
frequently while disease or
disease is situation is
present present
Classification Classification Well-developed No universally
system system is classification accepted
developed and system accepted classification
being used but is by the medical system
not universally profession
accepted
Fundamentals of Nursing, 10th edition By Kozier and Erb, copyright 2016

Basic two-part statements:

1. Problem (P): statement of the client’s response (NANDA label)
2. Etiology (E): factors contributing to or probable causes of the
responses. This format is joined by the words related to (implies
relationship) than due to.

45
Constipation related to prolonged laxative use
Anxiety related to (r/t) threat to physiological integrity: possible cancer
diagnosis

Basic three-part statements:

1. Problem (P): statement of the client’s response (NANDA label)
2. Etiology (E): factors contributing to or probable causes of the
responses.
3. Signs and symptoms (S): defining characteristics manifested by the
client. This format cannot be used for risk diagnoses because the client
does not have signs and symptoms of the diagnosis.
Situational Low Self-Esteem related to (r/t) feelings of rejection by
husband as manifested by (a.m.b.) hypersensitivity to criticism, states “I
don’t know if I can manage by myself” and rejects positive feedback

One-part Statements
1. Problem (P): statement of the client’s response (NANDA label) only. It
is used for health promotion and syndrome nursing diagnoses only.
Health promotion diagnoses - Readiness for Enhanced Parenting
(Readiness for Enhanced followed by the desired higher level of
wellness)
Syndrome diagnoses – diagnosis associated with a cluster of other
diagnoses.

Risk for Disuse Syndrome (for long-term bedridden clients)

1. Impaired Physical Mobility
2. Risk for Impaired Tissue Integrity
3. Risk for Activity Intolerance
4. Risk for Constipation
5. Risk for Infection
6. Risk for Injury
7. Risk for Powerlessness
8. Impaired Gas Exchange
Guidelines for Writing a Nursing Diagnostic Statement (to be sent via
messenger)

The organizing principles for the NANDA Taxonomy II are the seven axes:
diagnostic concept, subject of diagnosis, judgment, location, age, time,
and status of diagnosis.

46
Planning - is a deliberative, systematic phase of the nursing process that
involves decision making and problem solving; begins with the first client
contact and continues until the nurse–client relationship ends, usually
when the client is discharged from the health care agency
Nursing intervention - any treatment, based upon clinical judgment and
knowledge, that a nurse performs to enhance patient/client outcomes.
Although planning is basically the nurse’s responsibility, input from the
client and support persons is essential if a plan is to be effective. Nurses
do not plan for the client, but encourage the client to participate actively
to the extent possible. In a home setting, the client’s support people and
caregivers are the ones who implement the plan of care; thus, its
effectiveness depends largely on them.

Types of planning:
1. Initial Planning - The nurse who performs the admission assessment
usually develops the initial comprehensive plan of care. This nurse has
the benefit of seeing the client’s body language and can also gather
some intuitive kinds of information that are not available solely from
the written database. Planning should be initiated as soon as possible
after the initial assessment.
2. Ongoing Planning - All nurses who work with the client do ongoing
planning. As nurses obtain new information and evaluate the client’s
responses to care, they can individualize the initial care plan further.
Ongoing planning also occurs at the beginning of a shift as the nurse
plans the care to be given that day. Using ongoing assessment data, the
nurse carries out daily planning for the following purposes: 1. To
determine whether the client’s health status has changed 2. To set
priorities for the client’s care during the shift 3. To decide which
problems to focus on during the shift 4. To coordinate the nurse’s
activities so that more than one problem can be addressed at each
client contact.
3. Discharge Planning - the process of anticipating and planning for needs
after discharge, is a crucial part of a comprehensive health care plan
and should be addressed in each client’s care plan. Because the
average stay of clients in acute care hospitals has become shorter,
people are sometimes discharged still needing care. Although many
clients are discharged to other agencies (e.g., long-term care facilities),
such care is increasingly being delivered in the home. Effective
discharge planning begins at first client contact and involves
comprehensive and ongoing assessment to obtain information about

47
 the client’s ongoing needs.
Developing Nursing Care Plan
Informal nursing care plan - is a strategy for action that exists in the
nurse’s mind. For example, the nurse may think, “Mrs. Phan is very tired.
I will need to reinforce her teaching after she is rested.”

Formal nursing care plan - is a written or computerized guide that

organizes information about the client’s care. The most obvious benefit
of a formal written care plan is that it provides for continuity of care.

Standardized care plan - is a formal plan that specifies the nursing care
for groups of clients with common needs (e.g., all clients with myocardial
infarction).

Individualized care plan - is tailored to meet the unique needs of a

specific client—needs that are not addressed by the standardized plan.
It is important for all caregivers to work toward the same outcomes and,
if available, use approaches shown to be effective with a particular client.
Care plan include the actions nurses must take to address the client’s
nursing diagnoses and produce the desired outcomes. The nurse begins
the plan when the client is admitted to the agency and updates it
throughout the client’s stay in response to changes in the client’s
condition and evaluations of goal achievement.
During the planning phase, the nurse must (a) decide which of the client’s
problems need individualized plans and which problems can be
addressed by standardized plans and routine care, and (b) write
individualized desired outcomes and nursing interventions for client
problems that require nursing attention beyond preplanned, routine
care.

The complete plan of care for a client is made up of several different

documents. Some documents describe the routine care needed to meet
basic needs (e.g., bathing, nutrition), and others address the client’s
nursing diagnoses and collaborative problems. There may also be
documents that specify the nurse’s responsibilities in carrying out the
medical plan of care (e.g., keeping the client from eating or drinking
before surgery; scheduling laboratory test). A complete plan of care
integrates dependent and independent nursing functions into a
meaningful whole and provides a central source of client information.
Standing order - is a written document about policies, rules, regulations,
or orders regarding client care.

48
Guidelines for Writing Nursing Care Plans:
1. Date and sign the plan.
2. Use category headings - “Nursing Diagnoses,” “Goals/Desired
Outcomes,” “Nursing Interventions,
3. Use standardized/approved medical or English symbols and key
words rather than complete sentences to communicate your ideas
unless agency policy dictates otherwise
4. Be specific.
5. Refer to procedure books or other sources of information rather than
including all the steps on a written plan
6. Tailor the plan to the unique characteristics of the client by ensuring
that the client’s choices, such as preferences about the times of care
and the methods used, are included.
7. Ensure that the nursing plan incorporates preventive and health
maintenance aspects as well as restorative ones.
8. Ensure that the plan contains ongoing assessment of the client (e.g.,
“Inspect incision q8h”).
9. Include collaborative and coordination activities in the plan.
10. Include plans for the client’s discharge and home care needs.
The Planning Process:
• Setting priorities
• Establishing client goals/desired outcomes – short-term & long-term
goals
• Selecting nursing interventions and activities – independent,
dependent, collaborative
• Writing individualized nursing interventions on care plans.
The Nursing Outcomes Classifications:
Standardized or common nursing language is required in all phases
of the nursing process if nursing data are to be included in computerized
databases that are analyzed and used in nursing practice. Nurse leaders
and researchers have been working since 1991 to develop a taxonomy,
the Nursing Outcomes Classification (NOC), for describing client
outcomes that respond to nursing interventions. In the taxonomy, over
385 outcomes belong to one of seven domains (e.g., physiological health
or family health) and a class within the domain (e.g., nutrition under
physiological health or family well-being under family health).

49
The Nursing Interventions Classifications:
In addition to the efforts of NANDA to standardize the language for
describing problems that require nursing care and to create a taxonomy
of standardized client outcome labels, nurse researchers also recognized
the need for a standardized language to describe the interventions that
nurses perform. A taxonomy of nursing interventions referred to as the
Nursing Interventions Classification (NIC) taxonomy, developed by the
Iowa Intervention Project, was first published in 1992 and has been
updated every 4 years since then. This taxonomy consists of three levels:
level 1, domains; level 2, classes; and level 3, interventions. More than
542 interventions (level 3) have been developed. Similar to NANDA
diagnoses, each broadly stated intervention includes a label (name), a
definition, and a list of activities that outlines the key actions of nurses in
carrying out the intervention. For example, the level 3 intervention
Touch is one of several interventions developed within the Behavioral
domain and its class entitled Coping Assistance.

Implementing and Evaluating

Implementing - action phase in which the nurse performs the nursing
interventions. Using Nursing Interventions Classification (NIC)
terminology, implementing consists of doing and documenting the
activities that are the specific nursing actions needed to carry out the
interventions.
The nurse performs or delegates the nursing activities for the
interventions that were developed in the planning step and then
concludes the implementing step by recording nursing activities and the
resulting client responses.

Implementing skills:
1. cognitive skills (intellectual skills) – problem solving, decision-making,
critical thinking, clinical reasoning, creativity.
2. interpersonal skills – all of the activities verbally & non-verbally.
3. technical skills – purposeful “hands-on” skills – manipulating
equipment, rendering nursing procedures.
Process of implementing:
1. Reassessing the client
2. Determining the nurse’s need for assistance
3. Implementing the nursing interventions
4. Supervising the delegated care
5. Documenting nursing activities.
50
Evaluating - is a planned, ongoing, purposeful activity in which clients and
health care professionals determine (a) the client’s progress toward
achievement of goals/ outcomes and (b) the effectiveness of the nursing
care plan. Evaluation is an important aspect of the nursing process
because conclusions drawn from the evaluation determine whether the
nursing interventions should be terminated, continued, or changed.
Evaluation is the sixth standard of the ANA Standards of Practice and
states that “The registered nurse evaluates progress towards attainment
of outcome.”

Process of Evaluating Client Responses:

5 components:
1. Collecting data related to the desired outcomes (NOC indicators)
2. Comparing the data with desired outcomes
3. Relating nursing activities to outcomes
4. Drawing conclusions about problem status
5. Continuing, modifying, or terminating the nursing care plan
Evaluation Checklist
(to be sent via Messenger)

Documentation and Reporting

Discussion - is an informal oral consideration of a subject by two or more
health care personnel to identify a problem or establish strategies to
resolve a problem.
Report – is oral, written, or computer-based communication intended to
convey information to others. For instance, nurses always report on
clients at the end of a hospital work shift.
Record/chart/client record - is a formal, legal document that provides
evidence of a client’s care and can be written or computer based.
Recording/charting/documenting - the process of making an entry on a
client record

Ethical & Legal Considerations

Ensuring confidentiality of computer records
1. A personal password is required to enter and sign off computer files.
Do not share this password with anyone, including other health team
members.
2. After logging on, never leave a computer terminal unattended.
3. Do not leave client information displayed on the monitor where
others may see it.

51
4. Shred all unneeded computer-generated worksheets.
5. Know the facility’s policy and procedure for correcting an entry error.
6. Follow agency procedures for documenting sensitive material, such
as a diagnosis of AIDS.
7. Information technology (IT) personnel must install a firewall to protect
the server from unauthorized access.

Purposes of Client Records

Client’s records are kept for a number of purposes:
1. Communication
2. Planning client care
3. Auditing health agencies
4. Research
5. Education
6. Reimbursement
7. Legal documentation and
8. Health care analysis.
Documentation Systems
1. Source-oriented record – narrative charting
2. Problem-oriented medical record – has 4 components: database,
problem list, plan of care, progress notes – SOAP (subjective data,
objective data, assessment, planning)
3. Problems, interventions, evaluation (PIE) model – problem,
interventions and evaluation
4. Focus charting – to make the client and client concerns and strengths
the focus of care; D – ata, A – ction, R – esponse.
Date/Hour Focus Progress Notes
2/11/15 Pain D: Guarding
0900 abdominal
incision.
Facial grimacing
Rates pain at “8” on
scale of 0 – 10.
A: Administered
morphine sulfate 4
mg
IV

52
 0930 R: Rates pain at “1.”
States
willing to
ambulate.

5. Charting by exception (CBE) – only abnormal/significant findings/

exceptions to norms are recorded; 3 key elements: flow sheets,
standards of nursing care, bedside access to chart forms.
6. Computerized documentation
7. Case management
These documentation systems can be implemented using the traditional
paper forms or with EHRs.

Kardex - is a widely used, concise method of organizing and recording

data about a client, making information quickly accessible to all health
professionals. The system consists of a series of cards kept in a portable
index file or on computer-generated forms. The card for a particular
client can be quickly accessed to reveal specific data.

Practice Guidelines in Documentation

DO
1. Chart a change in a client’s condition and show that follow-up actions
were taken.
2. Read the nurses’ notes prior to care to determine if there has been a
change in the client’s condition.
3. Be timely. A late entry is better than no entry; however, the longer
the period of time between actual care and charting, the greater the
suspicion.
4. Use objective, specific, and factual descriptions.
5. Correct charting errors.
6. Chart all teaching.
7. Record the client’s actual words by putting quotes around the words.
8. Chart the client’s response to interventions.
9. Review your notes—are they clear and do they reflect what you want
to say?

DON’T
1. Leave a blank space for a colleague to chart later.
2. Chart in advance of the event (e.g., procedure, medication).
3. Use vague terms (e.g., “appears to be comfortable,” “had a good
night”).
53
 4. Chart for someone else.
5. Record “patient” or “client” because it is their chart.
6. Alter a record even if requested by a superior or a primary care
provider.
7. Record assumptions or words reflecting bias (e.g., “complainer,”
“disagreeable”).
Client’s records are legal documents that provide evidence of a client’s
care.

Focus Questions
Guide questions for Unit 3.2 discussion. Write your answer in a short bond
paper and submit it next week via Messenger. Basis for the grading will be
based on the given rubrics via Messenger.
1. How can you apply critical thinking in the nursing process? Discuss
briefly in one to two sentences only.

Related Readings
Please refer to this link for the add-on discussion.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4216424/#:~:text=Critical
%20thinking%20is%20applied%20by,efficient%20and%20skillful%20n
ursing%20intervention.

Learning Activities
Activity 1. Write your answer in a short bond paper and submit it next week
via Messenger. Basis for the grading will be based on the given rubrics via
Messenger.
1. Describe briefly in one to two sentences the nursing process applied
with critical thinking.

54
Lesson 3: Health and Illness
Intended Learning Outcomes
At the end of the unit, you are expected to:
1. Identify influences on client’s definitions of health, wellness, and
well- being.

Introduction
Nurses’ understanding of health and wellness largely determines the
scope and nature of nursing practice. Clients’ health beliefs influence their
health practices. Some people think of health and wellness (or well-being) as
the same thing or, at the very least, as accompanying one another. However,
health may not always accompany well-being: A person who has a terminal
illness may have a sense of well-being; conversely, another person may lack
a sense of well-being yet be in a state of good health. For many years, the
concept of disease was the yardstick by which health was measured. In the
late 19th century the “how” of disease (pathogenesis) was the major concern
of health professionals. The 20th century focused on finding cures for
diseases. Currently health care providers are increasing their emphasis on
promoting health and wellness in individuals, families, and communities
(Kozier, 2018).

Unlocking of Difficulties
To attend the following intended learning outcomes for the first lesson
of the course, you need to fully understand the following essential terms that
will be laid down in the succeeding pages.

Key Terms
▪ Health – state of being well and using every power the individual possesses
to the fullest extent.
▪ Wellness – state of well-being; self-responsibility
▪ well-being – subjective perception of vitality and feeling well
▪ Illness – highly personal state in which the person’s physical, emotional,
intellectual, social, developmental, or spiritual functioning is thought to be
diminished.
▪ Disease - alteration in body functions resulting in a reduction of capacities
or a shortening of the normal life span

55
Lecture Notes
Health, wellness, and well-being have many definitions and
interpretations. The nurse should be familiar with the most common aspects
of the concepts and consider how they may be individualized with specific
clients.
Health – traditionally defined as presence or absence of disease. Florence
Nightingale defined it as a state of being well and using every power the
individual possesses to the fullest extent. It is as well defined in terms of
role and performance.

Wellness – has 7 components according to Anspaugh, Hamrick, and

Rosato:
1. Environment
2. Social
3. Emotional
4. Physical
5. Spiritual
6. Intellectual
7. Occupational

The seven components overlap to some extent, and factors in one

component often directly affect factors in another. For example, a
person who learns to control daily stress levels from a physiological
perspective is also helping to maintain the emotional stamina needed to
cope with a crisis. Wellness involves working on all aspects of the model.

Well-being - can be described objectively, experienced, and measured

and can be plotted on a continuum; it is a component of health. Nurses
need to clarify their understanding of health, wellness, and well-being for
the following reasons:
1. Nurses’ definitions of health largely determine the scope and nature
of nursing practice.
2. People’s health beliefs influence their health practices.
Internal Variables:
1. Biologic dimension - Genetic makeup, sex, age, and developmental
level.
2. Psychological dimension – mind-body interactions and self-concept.
3. cognitive/intellectual dimension – lifestyle choices, spiritual and
religious beliefs.

56
Examples of Healthy Lifestyle Choices
 Regular exercise
 Weight control
 Avoidance of saturated fats
 Avoidance of excessive alcohol
 Abstaining from use of tobacco products
 Seat belt use
 Bike helmet use
 Immunization updates
 Regular dental checkups
 Regular health maintenance visits for screening examinations or
tests
External Variables:
1. Physical environment
2. Standards of living
3. Family and cultural beliefs and
4. Social support networks.
Health Belief Models
Several theories or models of health beliefs and behaviors have been
developed to help determine whether an individual is likely to participate
in disease prevention and health promotion activities. These models can
be useful tools in developing programs for helping people with healthier
lifestyles and more positive attitudes toward preventive health
measures.
1. Health Locus of Control Model
2. Rosenstock and Becker’s Health Belief Models
Illness - highly personal state in which the person’s physical, emotional,
intellectual, social, developmental, or spiritual functioning is thought to
be diminished.
Disease - alteration in body functions resulting in a reduction of capacities
or a shortening of the normal life span

Classification of Illness:
1. Acute illness - typically characterized by symptoms of relatively short
duration; symptoms often appear abruptly and subside quickly and,
depending on the cause, may or may not require intervention by health
care professionals; some are serious.
Examples: appendicitis may require surgical intervention), but many

57
 acute illnesses, such as colds, subside without medical intervention or
with the help of over-the-counter medications. Following an acute
illness, most people return to their normal level of wellness.
2. Chronic illness - lasts for an extended period, usually 6 months or
longer, and often for the person’s life; usually have a slow onset and
often have periods of remission, when the symptoms disappear, and
exacerbation, when the symptoms reappear.
Examples: arthritis, heart and lung diseases, and diabetes mellitus.
Nurses are involved in caring for chronically ill individuals of all ages in
all types of settings—homes, nursing homes, hospitals, clinics, and
other institutions.
Illness behavior - a coping mechanism, involves ways individuals
describe, monitor, and interpret their symptoms, take remedial actions,
and use the health care system.

5 stages of illness according to Suchman:

1. Symptom experiences
2. Assumption of the sick role
3. Medical care contact
4. Dependent client role and
5. Recovery or rehabilitation
Effects of Illness:
1. Impact on the client - may experience behavioral and emotional
changes, changes in self-concept and body image, and lifestyle
changes.
2. Impact on the family
• Role changes
• Task reassignments and increased demands on time
• Increased stress due to anxiety about the outcome of the illness for
the client and conflict about unaccustomed responsibilities
• Financial problems
• Loneliness as a result of separation and pending loss
• Change in social customs.

58
Focus Questions
Guide questions for Unit 3.3 discussions. Write your answer in a short bond
paper and submit it next week via Messenger. Basis for the grading will be
based on the given rubrics via Messenger.
1. Discuss briefly in one to two sentences by citing an example that a client
is showing understanding of his health status?

Related Readings
Please refer to this link for the add-on discussion.
https://www.euro.who.int/en/health-topics/Health-systems/public-health-
services/policy/the-10-essential-public-health-operations/epho5-
disease- prevention,-including-early-detection-of-illness2

Learning Activities
Activity 1. Write your answer in a short bond paper and submit it next week
via Messenger. Basis for the grading will be based on the given rubrics via
Messenger.
1. Discuss briefly in one to two sentences by citing an example that a client
is showing lack of understanding of his health status.

59
UNIT 4: Interventions for Health Promotion and Prevention
of Illness
Lesson 1: Health Promotion Models
Intended Learning Outcomes
At the end of the unit, you are expected to:
1. Differentiate health promotion from health protection or
illness prevention in rendering care to the patients in the near
future.

Introduction
The beliefs and values of each person and the support he or she
receives come in large part from the family and are reinforced by the
community. The reverse is also true—the health of a community is affected
by the beliefs, attitudes, and behaviors of the individuals in the community.
Health promotion is an important component of nursing practice. It is a way
of thinking that revolves around a philosophy of wholeness, wellness, and
well-being. In the past two decades, the public has become increasingly
aware of and interested in health promotion. (Kozier, 2018).
The unit will focus on the Interventions for Health Promotion and
Prevention of Illness.
Please proceed immediately to the “Unlocking of Difficulties” part
since the first lesson is also definition of essential terms.

Unlocking of Difficulties
To attend the following intended learning outcomes for the first lesson of the
course, you need to fully understand the following essential terms that will
be laid down in the succeeding pages.

Key Terms
▪ Health Promotion Model – describes the multidimensional nature of
persons as they interact within their environment to pursue health.
▪ Primary prevention – focuses on health promotion, protection against
specific health problems
▪ Secondary prevention – focuses on early identification of health problems
and prompt intervention to alleviate health problems.
▪ Tertiary prevention – focuses on restoration and rehabilitation.

60
Lecture Notes
Assessing and planning health care of the individual client is enhanced
when the nurse understands the concepts of individuality, holism,
homeostasis, and human needs.
The 3 levels of prevention:
1. Primary prevention – focuses on health promotion, protection against
specific health problems (e.g. immunization). Its purpose is to decrease
the risk or exposure of the individual or community to disease.
2. Secondary prevention – focuses on early identification of health problems
and (b) prompt intervention to alleviate health problems. Its goal is to
identify individuals in an early stage of a disease process and to limit future
disability.
3. Tertiary prevention - focuses on restoration and rehabilitation. Its goal is
to return the individual to an optimal level of functioning.
Examples of activities for each level of prevention. The three levels of
prevention may overlap in practice. For example, a client may have
experienced a heart attack, and a goal of secondary prevention is to limit
disability. The teaching (e.g., lifestyle changes) for the client’s rehabilitation
will be similar to the health education activities used for primary prevention
teaching.
The difficulty in separating the terms health promotion and disease
prevention/health protection lies in the fact that an activity may be carried
out for numerous reasons.
For example, a 40-year-old male may begin a program of walking 3
miles each day. If the goal of his program were to “decrease the risk of
cardiovascular disease,” then the activity would be considered disease
prevention or health protection. By contrast, if the motivation for his walking
regimen were to “increase his overall health and feeling of well-being,” then
the activity would be considered a health promotion behavior.
It is most helpful to think of health promotion and health protection
as being complementary processes because both affect quality of health.
Health promotion can be offered to all clients regardless of their health and
illness status or age. For example, weight-control measures can benefit both
overweight clients without disease and clients with cardiac or joint disease.

61
Differences Between Health Promotion and Health Protection
Health Promotion Health Protection
Not disease oriented Illness or injury specific
Motivated by personal, positive Motivated by “avoidance” of illness
“approach” to wellness
Seeks to expand positive Seeks to stop the potential for
health occurrence of insults to
health and well-being
Fundamentals of Nursing, 10th edition By Kozier and Erb, copyright 2016
Models of Health and Wellness:
1. Clinical Model – people are viewed as physiological system with related
functions, and health is identified by the absence of signs and symptoms
of disease/injury; considered the state of not being “sick.”; opposite of
health is disease/injury; medical practitioners utilized this in their focus
on the relief of sings & symptoms of disease and elimination of
malfunction and pain & absence of which means health is restored.
2. Role Performance Model – health is defined in terms of one’s ability to
fulfill societal roles, to perform his work even if they have clinical illness.
Example: A man who works all day at his job as expected is healthy even
though he is partially deaf.
3. Adaptation model – health is a creative process; disease is a failure in
adaptation/maladaptation & its aim is to restore one’s ability to adapt –
cope. Extreme good health is a flexible adaptation to & interaction with
the environment to maximum advantage. Sister Callista Roy’s Adaptation
Model views person as an adaptive system. The focus is stability
considering as well element of growth & change.
4. Eudaimonistic Model – embodies the interaction and interrelationships
among the physical, social, psychological & spiritual aspects of life &
environment. Illness is a condition that prevents self-acutalization.
Pender, Murdaugh, and Parsons (2011) consider health promotion to
be different from disease prevention or health protection. They define health
promotion as “behavior motivated by the desire to increase well-being and
actualize human health potential,” and disease prevention or health
protection as “behavior motivated by a desire to actively avoid illness, detect
it early, or maintain functioning within the constraints of illness.” The
individual’s underlying motivation for the behavior is the major difference.
Nola J. Pender's model focuses on three areas: individual
characteristics and experiences, behavior-specific cognitions and affect, and
behavioral outcomes.
62
 According to Margaret Newman, health is the expansion of
consciousness.
5. Agent-Host-Environment Model – has 3 dynamic interactive elements: a.)
agent – environmental factor/stressor, b.) host – person who may/may
not be at risk of acquiring the disease (family history, lifestyle), c.)
environment – all factors external to the host (climate, living conditions,
noise, economic level, interactions with others).
6. Health-Illness-Continua – person’s perceived level of wellness; health &
illness/disease can be viewed as the opposite ends of health continuum;
no distinct boundary across from health to illness or from illness back to
health.

Programs and Intervention:

1. General Wellness
2. Smoking Cessation
3. Exercise/Conditioning
4. Weight Control
5. Stress Management
6. Nutritional Awareness
7. Work Safety

The Nurse’s Role in Health Promotion:

1. Model healthy lifestyle behaviors and attitudes.
2. Facilitate client involvement in the assessment, implementation, and
evaluation of health goals.
3. Teach clients self-care strategies to enhance fitness, improve nutrition,
manage stress, and enhance relationships.
4. Assist individuals, families, and communities to increase their levels of
health.
5. Educate clients to be effective health care consumers.
6. Assist clients, families, and communities to develop and choose health-
promoting options.
7. Guide clients’ development in effective problem solving and decision
making.
8. Reinforce clients’ personal and family health-promoting behaviors.
9. Advocate in the community for changes that promote a healthy
environment.

63
 The decision to establish a health promotion program must be based
on the health needs of the people; also, specific health promotion goals
must be set. After the program is implemented, outcomes must be
evaluated.

Focus Questions
Guide questions for Unit 4.1 discussion. Write your answer in a short bond
paper and submit it next week via Messenger. Basis for the grading will be
based on the given rubrics via Messenger.
1. How are you going to differentiate health promotion from health
protection or illness prevention in rendering care to the patients in the
near future? Discuss briefly in one to two sentences only.

Related Readings
Please refer to this link for the add-on discussion.
https://currentnursing.com/nursing_theory/health_promotion_model.html
. Retrieved on February 27, 2021

Learning Activities
Activity 1. Write your answer in a short bond paper and submit it next week
via Messenger. Basis for the grading will be based on the given rubrics via
Messenger.
1. Discuss briefly in one to two sentences by illustrating an example of each
three levels of prevention.

64
Lesson 2: Health Promotion Across the Lifespan –
Intrauterine to Older Adult
Intended Learning Outcomes
At the end of the unit, you are expected to:
1. Describe health promotion essential to growth and
development across the lifespan

Introduction
It is important for nurses to understand normal growth and
development because it provides a framework for health assessment and
health promotion throughout the life span. For example, teaching, a major
nursing role, is more effective when the nurse incorporates growth and
development needs and concepts. The terms growth and development both
refer to dynamic processes. Often used interchangeably, these terms have
different meanings (Kozier, 2016).
The unit will focus on Health Promotion Across the Lifespan.
Please proceed immediately to the “Unlocking of Difficulties” part
since the first lesson is also definition of essential terms.

Unlocking of Difficulties
To attend the following intended learning outcomes for the first lesson of the
course, you need to fully understand the following essential terms that will
be laid down in the succeeding pages.
Key Terms
▪ Growth - is physical change and increase in size. It can be measured
quantitatively.
▪ Development - is an increase in the complexity of function and skill
progression.
▪ Genetics – is the study of heredity and the variation of inherited
characteristics.
▪ Temperament – is the features of a person that reflect an individual’s
emotional disposition, or the way he or she behaves, feels, and thinks.

65
Lecture Notes
The terms growth and development both refer to dynamic processes.
Often used interchangeably, these terms have different meanings. Growth is
physical change and increase in size. It can be measured quantitatively.
Indicators of growth include height, weight, bone size, and dentition. The
pattern of physiological growth is similar for all people. However, growth
rates vary during different stages of growth and development. The growth
rate is rapid during the prenatal, neonatal, infancy, and adolescent stages
and slows during childhood. Physical growth is minimal during adulthood.
Development is an increase in the complexity of function and skill
progression. It is the capacity and skill of a person to adapt to the
environment. Development is the behavioral aspect of growth (e.g., a person
develops the ability to walk, talk, run, and think). Growth and development
are independent, interrelated processes. For example, an infant’s muscles,
bones, and nervous system must grow to a certain point before the infant is
able to sit up, walk, or talk. Growth generally takes place during the first 20
years of life; development takes place during that time and also continues
after that point.
1. Intrauterine
- development lasts approximately 9 calendar months (10 lunar
months) or 38 to 40 weeks, depending on the method of calculation.
(A lunar month is 28 days.) If the time is calculated from the day of
conception, this stage of life is about 38 weeks or 91 ⁄2 lunar months.
If the time is calculated from the first day of the last menstrual period,
it is 10 lunar months or 40 weeks.
- divided into trimesters; has two phases – embryonic phase (1st
trimester) & fetal life (2nd & 3rd trimester).
- embryo or fetus relies on the maternal blood flow through the
placenta for survival needs; mother’s health is essential.

66
 Intrauterine Pregnancy
(Source: https://www.labtestsguide.com/intrauterine-pregnancy. Retrieved on March
01, 2021)

A. Oxygen
- to meet the demands, mother gradually increases her normal
blood flow by about 1/3 8 months.
- respiratory rate and cardiac output
- heart of the embryo lies outside its body & repositioned in the
chest early in the second trimester.
- fetal circulation travels from the placenta through two umbilical
arteries, which carry deoxygenated blood away from the fetus;
20 weeks the fetal heartbeat is audible through a fetoscope; the
heartbeat is audible as early as the 10th week if a Doppler
stethoscope with ultrasound is used.

A Midwife Checking a Belly with a Fetoscope

(Source: https://www.123rf.com/photo_6663143_a-midwife-checking-a-belly-with-a-
fetoscope.html. Retreived on March 01, 2021)

67
 B. Nutrition & Fluids
- obtains nutrients from placental circulation & by swallowing
amniotic fluid.
- mother eats a well-balanced diet containing sufficient
calories, adequate folic acid ((e.g., green leafy vegetables,
oranges, dried beans, breakfast cereal) one of the B vitamins,
(to prevent neural tube defects [e.g., spina bifida] in the
fetus) and nutrients to meet both her needs and those of the
fetus.
C. Sleep, Rest & Activity - fetus sleeps most of the time and develops
a pattern of sleep and wakefulness that usually persists after birth;
mother can feel fetal activity at about the fifth lunar month of
pregnancy.
D. Elimination - Throughout pregnancy, fetal feces are formed in the
intestines from swallowed amniotic fluid, but are normally not
excreted until after birth. Inadequate oxygenation of the fetus
during the third trimester can result in relaxation of the anal
sphincter and passage of feces into the amniotic fluid. Urine
normally is excreted into the amniotic fluid after the kidneys
mature (16 to 20 weeks).
E. Temperature Maintenance – amniotic fluid gives safe &
comfortable temperature; it increases when there is mother has
illness, exposed to hot whirlpool baths, saunas (birth defects);
subcutaneous fatty tissue is developed & stored to maintain body
temperature at birth.
F. Safety
- body systems form during embryonic period & is at risk of
damage from a teratogen (developmental abnormities);
nursing considerations: ask for possible pregnancy before
giving medications, & radiography
- smoking, alcohol & drugs, exposure to tobacco (preterm
births, stillbirth, miscarriage, LBW, FASD [Fetal Alcohol
Spectrum Disorders] - mental retardation]); affects CNS.
2. Neonates & Infants (birth to 1 year) – Neonates basic task is adjustment
to the environment outside the uterus, which requires breathing, sleeping,
sucking, eating, swallowing, digesting, and eliminating. Infants continue to
grow and develop rapidly during the first year, learning more skills as they
interact with their world. Infants undergo significant physiological changes
in weight, length, head growth, vision, hearing, smell, taste, touch,
reflexes, and motor development.
68
 Therapies for Neonates
(Source: https://www.outsourcing-pharma.com/Article/2018/07/17/How-to-promote-
new-therapies-for-neonates-through-education-and-extended-exclusivity. Retrieved on
March 01. 2021.)

Infancy, Definition, Characteristics

(Source: https://www.britannica.com/science/infancy. Retrieved on March 01, 2021)

A. Health Screening
- Physiological health assessment occurs immediately at birth.
Developmental assessment also begins at birth by using
standardized tests. Ongoing nursing assessments continue for the
promotion of wellness
- normal birth weight among Filipinos is 2.8 K to 3.0 K (6.0 lbs – 6.6
lbs); average birth weight for babies is around 7.5 lb (3.5 kg),
although between 5.5 lb (2.5 kg) and 10 lb (4.5 kg) is considered
normal. In general: Boys are usually a little heavier than girls. First
babies are usually lighter than later siblings; by 5 months doubles
the birth weight & by 1-year-old triples the birth weight.
- female babies are on average smaller than male babies; average
length of a European American newborn in the United States is
about 50 cm (20 in.); two recumbent lengths are the crown-to-
rump length (the sitting length) and the head-to-heel length
(from the top of the head to the base of the heels) - normally the
crown-torump length is approximately the same as the head
circumference. By 6 months, infants gain another 13.75 cm (5.5

69
 in.) of height. By 12 months they add another 7.5 cm (3 in.). The
rate of increase in height is largely influenced by the baby’s size
at birth and by nutrition.
- head & chest circumference – important for growth rate of skull
and brain; At birth the average infant’s head circumference is 35
cm (14 in.) and generally varies only 1 or 2 cm (0.5 in.). The chest
circumference of the newborn is usually less than the head
circumference by about 2.5 cm (1 in.). As the infant grows, the
chest circumference becomes larger than the head
circumference. At about 9 or 10 months, the head and chest
circumferences are about the same, and after 1 year of age the
chest circumference is larger.
Apgar Scoring System to Assess the Newborn
Score
Sign 0 1 2
1. Heart Rate Absent Slow (below 100 Above 100
beats/min beats/min
2. Respirations Absent Slow, irregular Regular rate,
crying
3. Muscle tone Flaccid Some flexion of Active
extremities movements
4.Reflex None Grimace Cries
irritability
5. Color Body pale, Body pink. For Body completely
cyanotic babies with dark pink, pink
skin (e.g., African mucous
American, some membranes in
Latino, American babies with dark
Indian), check skin
mucous
membranes;
extremities blue
Fundamentals of Nursing, 10th edition By Kozier and Erb, copyright 2016
A. Developmental Assessment Guidelines (Please refer on the References)
1. Physical Development
2. Motor Development
3. Sensory Development
4. Psychosocial Development
5. Development in ADL

70
 Newborn babies can be assessed immediately by means of the Apgar
scoring system. This system provides a numeric indicator of the baby’s
physiological capacities to adapt to extrauterine life. Each of five signs is
assigned a maximum score of 2, so that the maximum score achievable is 10.
A score under 7 suggests that the baby is having difficulty, and a score under
4 indicates that the baby’s condition is critical. Apgar scoring is usually carried
out 60 seconds after birth and is repeated in 5 minutes. Those with very low
scores require special resuscitative measures and care.
Examples of Motor and Social Development in Infancy
Age Motor Development Social Development
Newborn Turns head from side to side Displays displeasure by
when in a prone position. crying and satisfaction by
Grasps by reflex when soft vocalizations.
object is placed in palm of Attends to adult face and voice by
eye contact and quieting
hand.

4 months Rolls over. Sits with support,

Babbles, laughs, and
holds head steady when exhibits increased response
sitting to verbal play.
6 months Lifts chest and shoulders off
Starts to imitate sounds.
table when prone, bearing Vocalizes one-syllable
weight on hands. sounds: “ma ma,” “da da.”
9 months Creeps and crawls. Uses Complies with simple verbal
pincer grasp with thumb commands. Displays fear of
and forefinger. being left alone (e.g., going
to bed). Waves “bye-bye.”
12 months Walks alone with help. Clings to mother in
Uses spoon to feed self. unfamiliar situations.
Demonstrates emotions
such as anger and affection.
Fundamentals of Nursing, 10th edition By Kozier and Erb, copyright 2016
B. Health Promotion Guidelines for Infants
HEALTH EXAMINATIONS
• Screening of newborns for hearing loss at 1 month of age, diagnosis by 3
months of age, with intervention and treatment by 6 months of age
(Russ, White, Dougherty, & Forsman, 2010)
• Physical exam at 2 weeks and at 2, 4, 6, 9, and 12 months

71
PROTECTIVE MEASURES
• Immunizations: diphtheria, tetanus, acellular pertussis (DTaP),
inactivated poliovirus vaccine (IPV), pneumococcal (PVC), Haemophilus
influenzae type B (HIB), hepatitis B (HepB), hepatitis A (HepA), rotavirus,
and influenza vaccines as recommended. Varicella and measles-mumps-
rubella (MMR) are not given before 12 months of age.
• Fluoride supplements for infants over 6 months of age if there is
inadequate water fluoridation (less than 0.3 parts per million)
• Screening for tuberculosis
• Screening for metabolic conditions including phenylketonuria (PKU)
• Prompt attention for illnesses
• Appropriate skin hygiene and clothing
INFANT SAFETY
• Importance of supervision
• Car seat, crib with a firm mattress, playpen, bath, and home environment
safety measures
• No stuffed animals, pillows, or blankets in the crib
• Position the infant on the back for sleep
• Feeding measures (e.g., avoid propping bottle)
• Provide toys with no small parts or sharp edges
• Eliminate toxins in the environment (e.g., tobacco, chemicals, radon,
lead, mercury)
• Use smoke and carbon monoxide (CO) detectors in home
NUTRITION
• Exclusive breast-feeding to 4 to 6 months
• Solid foods between 4 and 6 months
• Need for iron supplements at 4 to 6 months
• Continued breast-feeding to age 12 months
• Breast-feeding and bottle-feeding techniques
• Formula preparation
• Feeding schedule
ELIMINATION
• Characteristics and frequency of stool and urine elimination
• Diarrhea and its effects
REST/SLEEP
• Establish routine for sleep and rest patterns

72
SENSORY STIMULATION
• Touch: holding, cuddling, rocking
• Vision: colorful, moving toys
• Hearing: soothing voice tones, music, singing
• Play: toys appropriate for development
C. Infant Screening and Immunization

2019 Philippine Childhood Immunization Schedule

(Source: https://businessmirror.com.ph/2019/02/28/2019-philippine-childhood-
immunization-schedule-released/. Retrieved on March 01, 2021)

D. Infant’s Safety – place the baby in a safe place such as a crib or playpen
when you cannot hold him. Your baby may be able to crawl as early as 6
months. Use gates on stairways and close doors to keep your baby out of
rooms where he or she might get hurt. Install operable window guards on
all windows above the first floor. Sudden infant death syndrome (SIDS) is
one of the leading causes of death for infants in the United States and can
occur when infants are not placed in a safe sleeping position.
E. Chocking & Chemical Intoxication - Babies and young children are at high
risk of choking because they: have less practice controlling food in their
mouths, do not always chew food into small enough pieces, have small
airways, explore the world by putting small objects into their mouths. It is
prevented by always supervising young babies and children when they
are eating. Children explore their environment as part of their normal,
natural development. They learn about new things by playing with them –

73
 trying to open containers, mimicking what they see siblings or adults do –
and by putting things in their mouth. Swallowing a poisonous substance,
spilling it on the skin, spraying or splashing it in the eye or inhaling it can
all lead to poisoning. It is prevented by storing medicines, chemicals and
cleaners up in a locked cupboard.

3. Toddler (1 to 3 years old) - develop from having no voluntary control to

being able to walk and speak. They also learn to control their bladder and
bowels, and they acquire a wide variety of information about their
environment; are usually chubby with short legs and large head; have a
pronounced lumbar lordosis and a protruding abdomen. The abdominal
muscles develop gradually with growth, and the abdomen flattens.

Making Friends: Toddlers

(Source: https://raisingchildren.net.au/toddlers/behaviour/friends-siblings/toddlers-
making-friends. Retrieved on March 01, 2021)

A. Developmental Assessment Guidelines (Please refer on the References)

1. Physical Development
2. Motor Development
3. Psychosocial Development
4. Development in ADL

B. Health Promotion Guidelines for Toddlers

HEALTH EXAMINATIONS
• At 15 and 18 months and then as recommended by the primary care
provider
• Dental visits starting at age 3 or earlier

PROTECTIVE MEASURES
• Immunizations: continuing DTaP, IPV, pneumococcal, MMR, varicella,
Haemophilus influenzae type B, hepatitis B, hepatitis A, influenza, and
meningococcal vaccines as recommended
• Screenings for tuberculosis and lead poisoning

74
 • Fluoride supplements if there is inadequate water fluoridation (less
than 0.6 part per million)

TODDLER SAFETY
• Importance of constant supervision and teaching child to obey
commands
• Home environment safety measures (e.g., lock medicine cabinet)
• Outdoor safety measures (e.g., close supervision near water and on
sidewalks)
• Appropriate toys
• Eliminate toxins in environment (e.g., tobacco, pesticides, herbicides,
mercury, lead, arsenic in playground materials)
• Use smoke and carbon monoxide (CO) detectors in home

NUTRITION
• Importance of nutritious meals and snacks
• Teaching simple mealtime manners
• Dental care

ELIMINATION
• Toilet training techniques

REST/SLEEP
• Dealing with sleep disturbances

PLAY
• Providing adequate space and a variety of activities
• Encouraging regular, vigorous physical activity
• Toys that allow “acting on” behaviors and provide motor and sensory
stimulation

4. Pre-Schoolers (4 and 5 years)- physical growth slows, but control of the

body and coordination increase greatly. Preschoolers’ worlds get larger as
they meet relatives, friends, and neighbors. Growth and development in the
toddler and preschool years provide the basis for a child’s future health and
well-being.

75
 Child Development from 5 – 6 years
(Source: https://raisingchildren.net.au/school-age/development/development-
tracker/5-6-years. Retrieved on March 01, 2021)

A. Developmental Assessment Guidelines (Please refer on the References)

1. Physical Development
2. Motor Development
3. Psychosocial Development
4. Development in ADL

B. Health Promotion Guidelines for Preschoolers

HEALTH EXAMINATIONS
• Every 1 to 2 years

PROTECTIVE MEASURES
• Immunizations: continuing DTaP, IPV, MMR, hepatitis A and B,
pneumococcal, influenza, varicella, and other immunizations as
recommended
• Screenings for tuberculosis
• Vision and hearing screening
• Regular dental screenings and fluoride treatment if necessary

PRESCHOOLER SAFETY
• Educating child about simple safety rules (e.g., crossing the street)
• Teaching child to play safely (e.g., bicycle and playground safety) •
Educating to prevent poisoning; exposure to toxic materials

NUTRITION
• Importance of nutritious meals and snacks

ELIMINATION
• Teaching proper hygiene (e.g., washing hands after using bathroom)

76
REST/SLEEP
• Dealing with sleep disturbances (e.g., night terrors, sleepwalking)

PLAY
• Encouraging regular, vigorous physical activity
• Providing times for group play activities
• Teaching child simple games that require cooperation and interaction
• Providing toys and dress-ups for role-playing

5. School-Age Children (6 – 12 years) – onset of puberty; the average age of

onset of puberty is 10 for girls and 12 for boys, some people define the
school-age years as 6 to 10 for girls and 6 to 12 for boys. Skills learned during
this stage are particularly important in relation to work later in life and
willingness to try new tasks. In general, the period from 6 to 12 years is one
of significant growth.

School Age
(Source: http://interfaithkids.org/programs/school-age/. Retrieved on March 01, 2021)

A. Developmental Assessment Guidelines (Please refer on the References)

1. Physical Development
2. Motor Development
3. Psychosocial Development
4. Development in ADL

B. Health Promotion Guidelines for Preschoolers

HEALTH EXAMINATIONS
• Every 1 to 2 years

PROTECTIVE MEASURES
• Immunizations: continuing DTaP, IPV, MMR, hepatitis A and B,
pneumococcal, influenza, varicella, and other immunizations as
recommended
• Screenings for tuberculosis
77
 • Vision and hearing screening
• Regular dental screenings and fluoride treatment if necessary

PRESCHOOLER SAFETY
• Educating child about simple safety rules (e.g., crossing the street)
• Teaching child to play safely (e.g., bicycle and playground safety)
• Educating to prevent poisoning; exposure to toxic materials

NUTRITION
• Importance of nutritious meals and snacks

ELIMINATION
• Teaching proper hygiene (e.g., washing hands after using bathroom)

REST/SLEEP
• Dealing with sleep disturbances (e.g., night terrors, sleepwalking)

PLAY
• Encouraging regular, vigorous physical activity
• Providing times for group play activities
• Teaching child simple games that require cooperation and interaction
• Providing toys and dress-ups for role-playing

6. Adolescents (12 to 18 years)

- an individual becomes physically and psychologically mature and
acquires a personal identity. At the end of this critical period in
development, the individual should be ready to enter adulthood and
assume its responsibilities. The length of adolescence is culturally
determined to some extent. In North America, adolescence is longer
than in some cultures, extending to 18 or 20 years of age.
- Puberty is the first stage of adolescence in which sexual organs begin
to grow and mature; starts between 10 – 14 years (girls), 12 – 16 (boys)
- Menarche (onset of menstruation) occurs in girls.
- Ejaculation (expulsion of semen) occurs in boys.
- The adolescent period is often subdivided into three stages:
- Early adolescence lasts from ages 12 to 13
- Middle adolescence extends from 14 to 16 years
- Late adolescence extends from 17 to 18 or 20 years; more stable stage
than the other two; are involved mostly with planning their future and
economic independence.

78
 Adolescent Development and Participation
(Source: https://www.unicef.org/eca/what-we-do/adolescent-development-and-
participation. Retrieved on March 01, 2021)

A. Developmental Assessment Guidelines (Please refer on the References)

1. Physical Development
2. Psychosocial Development
3. Development in ADL

B. Health Promotion Guidelines for Adolescents

HEALTH EXAMINATIONS
• As recommended by the primary care provider

PROTECTIVE MEASURES
• Immunizations as recommended, such as adult tetanus-diphtheria
vaccine, MMR, pneumococcal, human papilloma virus (HPV), and
hepatitis B vaccine
• Screening for tuberculosis
• Periodic vision and hearing screenings
• Regular dental assessments
• Obtaining and providing accurate information about sexual issues
• Assessing for mental health status

ADOLESCENT SAFETY
• Adolescents taking responsibility for using motor vehicles safely (e.g.,
completing a driver’s education course, wearing seat belt and helmet)
• Making certain that proper precautions are taken during all athletic
activities (e.g., medical supervision, proper equipment)

79
 • Parents keeping lines of communication open and being alert to signs of
substance abuse and emotional disturbances in the adolescent

NUTRITION AND EXERCISE

• Importance of healthy snacks and appropriate patterns of food intake
and exercise
• Factors that may lead to nutritional problems (e.g., obesity, anorexia
nervosa, bulimia)
• Engaging in regular vigorous exercise, at least three times a week for 1
hour each time

SOCIAL INTERACTIONS
• Encouraging and facilitating adolescent success in school
• Encouraging adolescents to establish relationships that promote
discussion of feelings, concerns, and fears
• Parents encouraging adolescent peer group activities that promote
appropriate moral and spiritual values
• Parents acting as role models for appropriate social interactions
• Parents providing a comfortable home environment for appropriate
adolescent peer group activities
• Expecting adolescents to participate in and contribute to family activities

7. Young Adult (20 – 40 years)

- a person is considered an adult depends on how adulthood is
described in the social context of the individual, and this defining age
is changing. Legally, a person in the United States can vote at 18 years.
Since the passage of the National Minimum Drinking Age Act in 1984,
the legal age for alcohol consumption outside the home is 21 years,
making the 21st birthday an important developmental milestone in
the United States (Fromme, Wetherill, & Neal, 2010).
- Another criterion of adulthood is financial independence, which is also
highly variable. Some adolescents support themselves as early as 16
years of age, usually because of family circumstances. By contrast,
some adults are financially dependent on their families for many years,
for example, during prolonged periods of education. Adulthood may
also be indicated by moving away from home and establishing one’s
own living arrangements. Yet this independence also varies greatly.
Some adolescents leave home because of family problems.

80
 Young Adulthood
(Source: https://sites.google.com/site/howtopreventachildgonewild/social-
development/young-adulthood. Retrieved on March 01, 2021)

A. Developmental Assessment Guidelines (Please refer on the References)

1. Physical Development
2. Psychosocial Development
3. Development in ADL

B. Health Promotion Guidelines for Young Adults

HEALTH TESTS AND SCREENINGS

• Routine physical examination (every 1 to 3 years for females; every 5
years for males)
• Immunizations as recommended, such as tetanus-diphtheria boosters
every 10 years, meningococcal vaccine if not given in early adolescence,
hepatitis B vaccine
• HPV vaccine for women up to 26 years old who have not yet received or
completed the vaccine series (ACS, 2013c)
• Regular dental assessments (every 6 months)
• Periodic vision and hearing screenings
• Professional breast examination every 1 to 3 years
• Papanicolaou smear annually within 3 years of onset of sexual activity
• Testicular examination every year
• Screening for cardiovascular disease (e.g., cholesterol test every 5 years
if results are normal; blood pressure to detect hypertension; baseline
electrocardiogram at age 35)
• Tuberculosis skin test every 2 years
• Smoking: history and counseling, if needed

81
SAFETY
• Motor vehicle safety reinforcement (e.g., using designated drivers when
drinking, maintaining brakes and tires)
• Sun protection measures
• Workplace safety measures
• Water safety reinforcement (e.g., no diving in shallow water)

NUTRITION AND EXERCISE

• Importance of adequate iron intake in diet
• Nutritional and exercise factors that may lead to cardiovascular disease
(e.g., obesity, cholesterol and fat intake, lack of vigorous exercise)

SOCIAL INTERACTIONS
• Encouraging personal relationships that promote discussion of feelings,
concerns, and fears
• Setting short- and long-term goals for work and career choices

8. Middle-Aged Adults (40 – 65 years)

- the years of stability and consolidation. For most people, it is a time
when children have grown and moved away or are moving away from
home. Thus partners generally have more time for and with each other
and time to pursue interests they may have deferred for years.
- Maturity is the state of maximal function and integration, or the state
of being fully developed. Many other characteristics are generally
recognized as representative of maturity. Mature individuals are
guided by an underlying philosophy of life. They take many
perspectives into account and are tolerant of the views of others. A
comprehensive philosophy allows a person to make sense out of life
and thus helps that person maintain a sense of purpose and hope in
the face of human tragedies. Mature individuals are open to new
experiences and continued growth; they can tolerate ambiguity, are
flexible, and can adapt to change.
In addition, mature people have the quality of self-acceptance; they
are able to be reflective and insightful about life

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 Middle Age the ‘sweet spot for older adults to enhance heart function’
(Source: https://www.thestar.com/life/2018/02/05/middle-age-the-sweet-spot-for-
older-adults-to-enhance-heart-function.html. Retrieved on March 01, 2021)

A. Developmental Assessment Guidelines (Please refer on the References)

1. Physical Development
2. Psychosocial Development
3. Development in ADL

B. Health Promotion Guidelines for Middle-Aged Adults

HEALTH TESTS AND SCREENING

• Annual physical examination
• Immunizations as recommended, such as a tetanus booster every 10
years, and current recommendations for influenza vaccine
• Regular dental assessments (e.g., every 6 months)
• Tonometry for signs of glaucoma and other eye diseases every 2 to 3
years or annually if indicated
• Breast examination annually by primary care provider
• Testicular examination annually by primary care provider
• Screenings for cardiovascular disease (e.g., blood pressure
measurement; electrocardiogram and cholesterol test as directed by the
primary care provider)
• Screenings for colorectal, breast, cervical, uterine, and prostate cancer
• Screening for tuberculosis every 2 years
• Smoking: history and counseling, if needed

SAFETY
• Motor vehicle safety reinforcement, especially when driving at night
• Workplace safety measures

83
 • Home safety measures: keeping hallways and stairways lighted and
uncluttered, using smoke detectors, using nonskid mats and handrails in
the bathrooms

NUTRITION AND EXERCISE

• Importance of adequate protein, calcium, and vitamin D in diet
• Nutritional and exercise factors that may lead to cardiovascular disease
(e.g., obesity, cholesterol and fat intake, lack of vigorous exercise)
• An exercise program that emphasizes skill and coordination

SOCIAL INTERACTIONS
• The possibility of a midlife crisis: encourage discussion of feelings,
concerns, and fears
• Providing time to expand and review previous interests
• Retirement planning (financial and possible diversional activities), with
partner if appropriate

9. Elders/Older Adults (65 – onwards)

- with advancements in disease control, living conditions, and health
technology, people are living longer.
- Baby boomers is a term used to describe the people born from 1946
to 1964 that represented a large increase in the U.S. birthrate. Starting
in 2011 (and through 2030) they began to enter their senior years with
better education, higher household incomes, and very active lifestyles
compared to previous generations of seniors. They tend to be
informed consumers of health care and may research information on
the Internet prior to seeing a health care provider.

Elders and Their Care Today

(Source: www.atrainceu.com. Retrieved on March 01, 2021)

84
A. Developmental Assessment Guidelines (Please refer on the References)
1. Physical Development
2. Psychosocial Development
3. Development in ADL

B. Health Promotion Guidelines for Older Adults

HEALTH TESTS AND SCREENING

• Total cholesterol and high-density lipoprotein measurement every 3 to 5
years until age 75
• Aspirin, 81 mg, daily, if in high-risk group
• Diabetes mellitus screen every 3 years, if in high-risk group
• Smoking cessation
• Screening mammogram every 1 to 2 years (women)
• Clinical breast exam annually (women)
• Pap smear annually if there is a history of risk factors (exposed to
diethylstilbestrol [DES] before birth, weakened immune system from HIV
infection, organ transplant, chemotherapy, or chronic steroid use),
abnormal smears or previous hysterectomy for malignancy (American
Cancer Society, 2012)
• Women 65 years and older who have had normal cervical results should
not be tested for cervical cancer. Women with a history of a serious
cervical pre-cancer should continue to be tested at least 20 years after
the diagnosis, even if testing continues past age 65 (American Cancer
Society, 2013).
• Annual digital rectal exam
• Annual prostate-specific antigen (PSA)
• Annual fecal occult blood test (FOBT)
• Sigmoidoscopy every 5 years; colonoscopy every 10 years
• Visual acuity screen annually
• Hearing screen annually
• Depression screen periodically
• Family violence screen periodically
• Height and weight measurements annually
• Sexually transmitted infection testing, if in high-risk group
• Annual flu vaccine if over age 65 or in high-risk group
• Pneumococcal vaccine at age 65 and every 10 years thereafter
• Single dose of shingles vaccine for adults 60 years of age or older
• Tetanus booster every 10 years

85
SAFETY
• Home safety measures to prevent falls, fire, burns, scalds, and
electrocution
• Working smoke detectors and carbon monoxide detectors in the home
• Motor vehicle safety reinforcement, especially when driving at night
• Older driver skills evaluation (some states require for license renewal)
• Precautions to prevent pedestrian accidents

NUTRITION AND EXERCISE

• Importance of a well-balanced diet with fewer calories to accommodate
lower metabolic rate and decreased physical activity
• Importance of sufficient amounts of vitamin D and calcium to prevent
osteoporosis
• Nutritional and exercise factors that may lead to cardiovascular disease
(e.g., obesity, cholesterol and fat intake, lack of exercise)
• Importance of 30 minutes of moderate physical activity daily; 20 minutes
of vigorous physical activity three times per week

ELIMINATION
• Importance of adequate roughage in the diet, adequate exercise, and at
least six 8-ounce glasses of fluid daily to prevent constipation

SOCIAL INTERACTIONS
• Encouraging intellectual and recreational pursuits
• Encouraging personal relationships that promote discussion of feelings,
concerns, and fears
• Assessment of risk factors for maltreatment
• Availability of social community centers and programs for seniors

Focus Questions
Guide questions for Unit 4.2 discussion. Write your answer in a short bond
paper and submit it next week via Messenger. Basis for the grading will be
based on the given rubrics via Messenger.
1. Identify one health concern of each life stages that you consider most
important. Discuss each briefly in one sentence.

86
Related Readings
Please refer to this link for the add-on discussion.
https://currentnursing.com/nursing_theory/health_promotion_model.html
. Retrieved on February 27, 2021
https://nhm.gov.in/New_Updates_2018/NHM_Components/Immunization
/report/National_%20Immunization_Schedule.pdf. Retrieved on March
01, 2021

Learning Activities
Activity 1. Write your answer in a short bond paper and submit it next week
via Messenger. Basis for the grading will be based on the given rubrics via
Messenger.
1. Identify one health promotion of each life stages that you consider most
important. Discuss each briefly in one sentence.

UNIT 5: Specific Health Promotion Guidelines

Intended Learning Outcomes
At the end of the unit, you are expected to:
1. Identify the different approaches of specific health promotion
guidelines as it will be applied in dealing with the patients in the
near future.

Introduction

Health promotion is a means of increasing individual and collective

participation in health action and strengthening programmes through the
integrative use of various methods. These methods are combined through
comprehensive approaches which ensure action at all levels of society,
leading to enhanced health impact. It is the process of enabling people to
increase control over their health and its determinants, and thereby improve
their health (WHO Ottawa Charter, 1986).
The unit will focus on the Specific Health Promotion Guidelines.
Please proceed immediately to the “Unlocking of Difficulties” part
since the first lesson is also definition of essential terms.

87
Unlocking of Difficulties
To attend the following intended learning outcomes for the first lesson
of the course, you need to fully understand the following essential terms that
will be laid down in the succeeding pages.
Key Terms
▪ Health Promotion – it is the process of enabling people to increase control
over their health and its determinants, and thereby improve their health.
▪ Mobility - the ability to move freely, easily, rhythmically, and purposefully
in the environment, is an essential part of living. People must move to
protect themselves from trauma and to meet their basic needs.
▪ Range of motion (ROM) - of a joint is the maximum movement that is
possible for that joint.
▪ Nutrition - is the sum of all the interactions between an organism and the
food it consumes.

Lecture Notes
The following are the specific health promotion guidelines:
I. Activity – Exercise Health Pattern

Fitness and Exercise for Kids (Source: https://encrypted-

tbn0.gstatic.com/images?q=tbn:ANd9GcQD7G4a6VeA9qlo4alTmtaaGlF4THh0tInoVA&us
qp=CAU. Retrieved on March 29, 2021)

Exercise can boost your memory and thinking skills

(Source: https://domf5oio6qrcr.cloudfront.net/media/content/images/cr/b21711d2-
0a7a-40ff-8dc7-87d24d9bf3b4.jpg. Retrieved on March 29, 2021)

88
 Exercising for Better Sleep
(Source: https://encrypted-
tbn0.gstatic.com/images?q=tbn:ANd9GcSOE8EUc0MqY50acS1rKNKWEJfPDS6eQoF4Mw
&usqp=CAU. Retrieved on March 29, 2021)

Exercise Health Benefits

(Source: https://encrypted-
tbn0.gstatic.com/images?q=tbn:ANd9GcSuQch7Gzq8sK_ClAVS0L9Br3mAwsc096uDzg&u
sqp=CAU. Retrieved on March 29, 2021)

Refers to a person’s routine of exercise, activity, leisure, and

recreation. It includes (a) activities of daily living (ADLs) that require energy
expenditure such as hygiene, dressing, cooking, shopping, eating, working,
and home maintenance, and (b) the type, quality, and quantity of exercise,
including sports. Evidence shows that habitual exercise can prevent and even
reverse many of the chronic diseases experienced by aging adults. A growing
body of research supports the preventive and therapeutic effects of exercise
for individuals with hypertension, osteoporosis, coronary heart disease,
mental health disorders, diabetes, cancer, arthritis, chronic fatigue
syndrome, fibromyalgia, menopause, urinary incontinence, and HIV/AIDS.
People must move to protect themselves from trauma and to meet their
basic needs.
For the types of joint movements and example of corresponding ADL,
kindly refer to the given reference.
Exercise: People participate in exercise programs to decrease risk
factors for chronic diseases and to increase their health and well-being.
Functional strength is another goal of exercise, and is defined as the ability
of the body to perform work. Activity tolerance is the type and amount of
89
exercise or ADLs an individual is able to perform without experiencing
adverse effects.
Guidelines and Minimal Requirements for Physical Activity
FREQUENCY AND DURATION
• Aerobic: Cumulative 30 minutes or more daily (can be divided
throughout the day) of “moderate intensity” movement as measured by
talk test and perceived exertion scale.
• Stretching: Should be added onto that minimum requirement so that all
parts of the body are stretched each day.
• Strength training: Should be added onto these minimum requirements
so that all muscle groups are addressed at least three times a week, with
a day of rest after training.
TYPE OF EXERCISE
• Aerobic: Elliptical exercisers, walking, biking, gardening, dancing, and
swimming are recommended for all individuals, including beginners and
older adults. Activities that are more strenuous include jogging, running,
Spinning®, power yoga, bouncing, boxing, and jumping rope.
• Stretching: Yoga, Pilates, qigong, and many other flexibility programs are
effective.
• Strength training: Resistance can be provided with weights, bands, balls,
apparatus, and body weight.
SAFETY
• Stress the importance of balance and prevention of falls, proper clothing
to ensure thermal safety, checking equipment for proper function,
wearing a helmet and other protective gear, using reflective devices at
night, and carrying identification and emergency information.
Benefits of Exercise:
1. Musculoskeletal System
- size, shape, tone, & strength of muscles (like the heart) are maintained
with mild exercise & increased with strenuous activities.
- joints receive nourishment, flexibility, stability, & ROM.
- reduces weakness, frailty, depression, and the risk and incidence of
falling in older adults.
- maintains balance between osteoblasts (bone-building cells) &
osteoclasts (bone-resorption & breakdown cells) and bone density &
strength through weight bearing exercises (swimming & bicycling).

90
2. Cardiovascular System
- American Heart Association (2013) – moderate physical activity for at
least 150 mins/week (walking a mile in 15 – 20 mins) increases heart
rate, muscle contraction, & blood supply through increased cardiac
output or vigorous activity for 75 mins/week.
- mediates harmful effects of stress.
- lowers systolic & diastolic blood pressure, improves oxygen uptake,
heart rate variability & circulation & self-reported stress reduction.
3. Respiratory System
- Ventilation & oxygen intake increase thereby improving gas exchange,
more toxins are eliminated with deeper breathing & problem solving
and emotional stability are enhanced due to increased oxygen to the
brain.
- prevents pooling of secretions in the bronchi and bronchioles,
decreasing breathing effort and risk of infection.
- improves stamina & immune function.
- COPD: walking, treadmill, stationary bike, stair climbing.
4. Gastrointestinal System
- improves appetite & peristalsis (gastrointestinal tract tone) relieving
constipation; improves symptoms of irritable bowel syndrome & other
digestive disorders.
- rowing, swimming, walking, and sit-ups.
5. Metabolic/Endocrine System
- increases metabolic rate resulting to increasing production of body
heat and waste products and calorie use.
- increases the use of triglycerides and fatty acids, resulting in a reduced
level of serum triglycerides, glycosylated hemoglobin (HgbA1C ) levels,
and cholesterol.
- weight loss and exercise stabilize blood sugar and make cells more
responsive to insulin.
6. Urinary System
- promotes efficient blood flow, the body excretes wastes more
effectively.
- prevents stasis (stagnation) of urine in the bladder decreasing the risk
for urinary tract infections (UTIs).

91
7. Immune System
- as gravity is enlisted with postural changes, lymph fluid is more
efficiently pumped from tissues into lymph capillaries and vessels
throughout the body.
- Circulation through lymph nodes improves destruction of pathogens
and removal of foreign antigens.
8. Psychoneurologic System
- mental/affective disorders (depression/chronic stress) affects desire
to move; chronic stress depletes the body’s energy reserves.
- individuals with eating disorders may exercise excessively to prevent
weight gain.
- increases levels of metabolites for neurotransmitters (norepinephrine
& serotonin)
- releases endogenous opioids, resulting to increase levels of
endorphins
- increases levels of oxygen to the brain & other body systems, inducing
euphoria
- through muscular exertion (especially with movement modalities such
as yoga and t’ai chi) the body releases stored stress associated with
accumulated emotional demands.
- improves quality of sleep for most individuals.
9. Cognitive function
- positive effects in decision-making and problem-solving processes,
planning, and paying attention (brain gym {educational kinesiology})
- helps with attention deficit disorder (ADD), attention
deficit/hyperactivity disorder (ADHD), learning disorders & mood
disorders.
- induces cells in the brain to strengthen and build neuronal
connections.
10. Spiritual Health
- yoga-style exercise improves the mind–body–spirit connection,
relationship with God, and physical well-being by establishing balance
in the internal and external environment;
- emphasis on breathing in is thought to soothe the nervous and
cardiorespiratory systems, promoting relaxation and preparedness for
a contemplative experience.
- relaxation response (RR), first described by Dr. Herbert Benson, is
beneficial for counteracting some of the harmful effects of stress on

92
 the body and mind (recitation of a word or phrase or prayer while
sitting quietly and relaxing your muscles).
- slowly walking a labyrinth (a circular mandala) can induce a meditative
state, decreasing heart and respiratory rates, lowering blood pressure,
and reducing insomnia. Many hospitals, hospices, and churches have
labyrinths in garden and atrium spaces.
NURSING MANAGEMENT
Assessment: Relative to a client’s activity and exercise should be routinely
addressed and includes a nursing history and a physical examination of body
alignment, gait, appearance and movement of joints, capabilities and
limitations for movement, muscle mass and strength, activity tolerance,
problems related to immobility, and physical fitness. The nurse collects
information from the client, from other nurses, and from the client’s records.
The examination and history are important sources of information about
disabilities affecting the client’s mobility and activity status, such as
contractures, edema, pain in the extremities, or generalized fatigue.
Nursing History: An activity and exercise history is usually part of the
comprehensive nursing history. Examples of interview questions to elicit
these data are shown in the accompanying Assessment Interview. If the
client indicates a recent pattern change or difficulties with mobility, a more
detailed history is required. This detailed history should include the specific
nature of the problem, when it first began, its frequency, its causes if known,
how the problem affects daily living, what the client is doing to cope with the
problem, and whether these methods have been effective.
Physical Examination: Conduct the physical examination focusing on activity
and exercise patterns. The exam includes assessment of body alignment,
gait, appearance and movement of joints, capabilities and limitations for
movement, muscle mass and strength, activity tolerance, and problems
related to immobility.
ASSESSMENT INTERVIEW Activity and Exercise
DAILY ACTIVITY LEVEL
• What activities do you carry out during a routine day?
• Are you able to carry out the following tasks independently?
a. Eating
b. Dressing and grooming
c. Bathing
d. Toileting
e. Ambulating

93
 f. Using a wheelchair
g. Transferring in and out of bed, bath, and car
h. Cooking
i. House cleaning
j. Shopping
• Where problems exist in your ability to carry out such tasks: a. Would you
rate yourself as partially or totally dependent? b. How is the task achieved
(by family, friend, agency, or use of specialized equipment)?
ACTIVITY TOLERANCE
• What types of activities make you tired?
• Do you ever experience dizziness, shortness of breath, marked increase in
respiratory rate, or other problems following mild or moderate activity?
EXERCISE
• What type of exercise do you carry out to enhance your physical fitness?
• What is the frequency and length of this exercise session?
• Do you believe exercise is beneficial to your health? Explain.
FACTORS AFFECTING MOBILITY
• Environmental factors. Do stairs, lack of railings or other assistive devices,
or an unsafe neighborhood impede your mobility or exercise regimen?
• Health problems. Do any of the following health problems affect your
muscle strength or endurance: heart disease, lung disease, stroke, cancer,
neuromuscular problems, musculoskeletal problems, visual or mental
impairments, trauma, or pain?
• Financial factors. Are your finances adequate to obtain equipment or other
aids that you require to enhance your mobility?
Assessing Problems of Immobility
Assessment Problem
Musculoskeletal System
Measure arm and leg Decreased circumference due to
circumferences. decreased muscle mass
Stiffness or pain in joints
Palpate and observe body joints. Decreased joint ROM, joint
Take goniometric measurements of contractures
joint ROM.
Cardiovascular System
Auscultate the heart. Increased heart rate
Measure blood pressure. Orthostatic hypotension

94
 Palpate and observe sacrum, legs, Peripheral dependent edema,
and feet. increased peripheral vein
engorgement
Palpate peripheral pulses. Weak peripheral pulses
Measure calf muscle Edema
circumferences.
Observe calf muscles for redness, Thrombophlebitis
tenderness, and swelling.
Respiratory System
Observe chest movements. Asymmetric chest movements,
dyspnea
Auscultate chest. Diminished breath sounds, crackles,
wheezes, and increased respiratory
rate
Metabolic System Weight loss due to muscle atrophy
Measure height and weight. and loss of subcutaneous fat
Palpate skin. Generalized edema due to low
blood protein levels
Urinary System
Measure fluid intake and output. Dehydration
Inspect urine. Cloudy, dark urine; high specific
gravity
Palpate urinary bladder. Distended urinary bladder due to
urinary retention
Gastrointestinal System
Observe stool. Hard, dry, small stool
Auscultate bowel sounds. Decreased bowel sounds due to
decreased intestinal motility
Integumentary System
Inspect skin. Break in skin integrity
Psychoneurologic System
Observe behaviors, affect, and Anger, flat affect, crying, confusion,
cognition. Monitor developmental anxiety, decline in cognitive
skills in children. function, or signs such as sleep and
appetite disturbances warrant
further evaluation
th
Fundamentals of Nursing, 10 edition By Kozier and Erb, copyright 2016

95
II. Nutritional-Metabolic Pattern

What Might be Missing From My Plate?

(Source: https://www.npr.org/sections/thesalt/2015/01/12/376172800/what-might-be-
missing-from-myplate-water. Retrieved on March 29, 2021.)

USDA Food: My Plate

(Source: https://www.enchantedlearning.com/food/foodplate/. Retrieved on March 29,
2021)

Nutrition is what a person eats and how the body uses it.
Nutrition is the science of food and its relationship to health – how the
human body uses food and processes the nutrients it contains to enable the
body to perform functions (i.e. the heart to beat, the lungs to breathe, the
kidneys to filter blood, the brain to think etc.).
Nutrients are organic and inorganic substances found in foods that are
required for body functioning. Adequate food intake consists of a balance of

96
nutrients: water, carbohydrates, proteins, fats, vitamins, and minerals. Foods
differ greatly in their nutritive value (the nutrient content of a specified
amount of food), and no one food provides all essential nutrients. Nutrients
have three major functions:
1. providing energy for body processes and movement,
2. providing structural material for body tissues, and
3. regulating body processes

Gordon’s 11 Functional Health Patterns

(Source: https://2.bp.blogspot.com/-tCI-
QXxbZak/XNRnGlXCsyI/AAAAAAAAAxg/IuRNaygRw7YeMmXvRxyljJlMeduWslsjwCLcBGA
s/s640/Gordon%2BFunctional%2BHealth%2BPatterns.jpg. Retrieved on March 29, 2021)

Health promotion and disease prevention (HPDP) play a vital role in

avoiding disease, delaying onset of signs and symptoms of disease,
preventing premature death, promoting quality of life and decreasing
economic liability on the healthcare system.

97
 Good nutrition, physical activity, and a healthy body weight are
essential parts of a person's overall health and well-being. Together, these
can help decrease a person's risk of developing serious health conditions,
such as high blood pressure, high cholesterol, diabetes, heart disease, stroke,
and cancer.
The six classes of nutrients are: carbohydrates, proteins, fats,
vitamins, minerals and water.
The principles of nutrition are:
 Water is your friend. The majority of people only really drink water when
they're thirsty – It flushes out horrible toxins, enhances mood, helps with
digestion, relieves tiredness, aids weight loss.
 Ban processed foods – contains harmful ingredients.
 More can sometimes be less – have 3 meals and avoid starving by eating
small snacks in between meals to control portion sizes and eat less.
 Havea well-balanced breakfast – it is the most important meal of the day
and boosts metabolism.
 Add fruit or veggies to your meals – reduces risk of heart disease (heart
attack, stroke), protects certain types of cancers, naturally low on fat, are
filling but low carb, high in fiber good for bowel elimination.

Energy balance is important. When you consume too

much energy and burn too little, your body stores that excess energy as body
fat. And being overweight increases your risk for several cancers, including
colon, pancreatic, endometrial and post-menopausal breast cancer.
Energy nutrients are carbohydrates, proteins, and fats. The nutrients
that provide energy are commonly referred to as macronutrients
(carbohydrates, lipids, and proteins).
Carbohydrates and proteins provide a similar amount of energy per
gram of food. Lipids are a concentrated source of energy and provide almost
twice the amount of energy than that supplied by proteins and
carbohydrates.
The United States government states that the average man needs
2,700 kcal per day and the average woman needs 2,200 kcal per day. Not
everybody needs the same number of calories each day. People have
different metabolisms that burn energy at different rates, and some people
have more active lifestyles than others.
Regulatory nutrients are vitamins and minerals.

98
Recommended Dietary Allowance or Adequate Intake:
1. Copper – 900 mcg/day
2. Fluoride – Men: 4 mg/day, Women: 3 mg/day
3. Folic Acid (Folate) – 400 mcg/day
4. Iodine – 150 mcg/day
(For further details, please refer to the Related Readings reference).
Food Guide Pyramid

Food Guide Pyramid

(Sources: https://www.pinterest.ph/pin/469500329877928511/. Retrieved on March
29, 2021)

The Filipino Pyramid Food Guide

(https://www.researchgate.net/figure/The-Filipino-Pyramid-Food-Guide-developed-by-
S-S-Orbeta-and-the-Food-Nutrition-and_fig1_274266454. Retrieved on March 29, 2021)

99
 Recommended Dietary Allowance (RDA): average daily level of intake
sufficient to meet the nutrient requirements of nearly all (97%-98%) healthy
people.

Recommended Dietary Allowance – an overview

(Source: https://ars.els-cdn.com/content/image/3-s2.0-B9780123849472000088-
f00008-02-9780123849472.jpg. Retrieved on March 29, 2021)

Recommended Dietary Allowance

(Source: https://www.time-to-run.com/nutrition/rda.htm. Retrieved on March 29,
2021)

100
Dietary Recommendation
Key facts according to World Health Organization
 A healthy diet helps to protect against malnutrition in all its forms, as
well as non-communicable diseases (NCDs), including such as
diabetes, heart disease, stroke and cancer.
 Unhealthy diet and lack of physical activity are leading global risks to
health.
 Healthy dietary practices start early in life – breastfeeding fosters
healthy growth and improves cognitive development, and may have
longer term health benefits such as reducing the risk of becoming
overweight or obese and developing NCDs later in life.
 Energy intake (calories) should be in balance with energy expenditure.
To avoid unhealthy weight gain, total fat should not exceed 30% of
total energy intake (1, 2, 3). Intake of saturated fats should be less than
10% of total energy intake, and intake of trans-fats less than 1% of
total energy intake, with a shift in fat consumption away from
saturated fats and trans-fats to unsaturated fats (3), and towards the
goal of eliminating industrially-produced trans-fats (4, 5, 6).
 Limiting intake of free sugars to less than 10% of total energy intake
(2, 7) is part of a healthy diet. A further reduction to less than 5% of
total energy intake is suggested for additional health benefits (7).
 Keeping salt intake to less than 5 g per day (equivalent to sodium
intake of less than 2 g per day) helps to prevent hypertension, and
reduces the risk of heart disease and stroke in the adult population (8).
 WHO Member States have agreed to reduce the global population’s
intake of salt by 30% by 2025; they have also agreed to halt the rise in
diabetes and obesity in adults and adolescents as well as in childhood
overweight by 2025 (9, 10).

Overview

Consuming a healthy diet throughout the life-course helps to prevent

malnutrition in all its forms as well as a range of noncommunicable diseases
(NCDs) and conditions. However, increased production of processed foods,
rapid urbanization and changing lifestyles have led to a shift in dietary
patterns. People are now consuming more foods high in energy, fats, free
sugars and salt/sodium, and many people do not eat enough fruit, vegetables
and other dietary fibre such as whole grains.

101
 The exact make-up of a diversified, balanced and healthy diet will vary
depending on individual characteristics (e.g. age, gender, lifestyle and degree
of physical activity), cultural context, locally available foods and dietary
customs. However, the basic principles of what constitutes a healthy diet
remain the same.

For adults

A healthy diet includes the following:

 Fruit, vegetables, legumes (e.g. lentils and beans), nuts and whole
grains (e.g. unprocessed maize, millet, oats, wheat and brown rice).
 At least 400 g (i.e. five portions) of fruit and vegetables per day (2),
excluding potatoes, sweet potatoes, cassava and other starchy roots.
 Less than 10% of total energy intake from free sugars (2, 7), which is
equivalent to 50 g (or about 12 level teaspoons) for a person of healthy
body weight consuming about 2000 calories per day, but ideally is less
than 5% of total energy intake for additional health benefits (7). Free
sugars are all sugars added to foods or drinks by the manufacturer,
cook or consumer, as well as sugars naturally present in honey, syrups,
fruit juices and fruit juice concentrates.
 Less than 30% of total energy intake from fats (1, 2, 3). Unsaturated
fats (found in fish, avocado and nuts, and in sunflower, soybean,
canola and olive oils) are preferable to saturated fats (found in fatty
meat, butter, palm and coconut oil, cream, cheese, ghee and lard)
and trans-fats of all kinds, including both industrially-produced trans-
fats (found in baked and fried foods, and pre-packaged snacks and
foods, such as frozen pizza, pies, cookies, biscuits, wafers, and cooking
oils and spreads) and ruminant trans-fats (found in meat and dairy
foods from ruminant animals, such as cows, sheep, goats and camels).
It is suggested that the intake of saturated fats be reduced to less than
10% of total energy intake and trans-fats to less than 1% of total
energy intake (5). In particular, industrially-produced trans-fats are
not part of a healthy diet and should be avoided (4, 6).
 Less than 5g of salt (equivalent to about one teaspoon) per
day (8). Salt should be iodized.

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For infants and young children

In the first 2 years of a child’s life, optimal nutrition fosters healthy

growth and improves cognitive development. It also reduces the risk of
becoming overweight or obese and developing NCDs later in life.

Advice on a healthy diet for infants and children is similar to that for
adults, but the following elements are also important:

 Infants should be breastfed exclusively during the first 6 months of life.

 Infants should be breastfed continuously until 2 years of age and
beyond.
 From 6 months of age, breast milk should be complemented with a
variety of adequate, safe and nutrient-dense foods. Salt and sugars
should not be added to complementary foods.

Food Labeling
There are five pieces of information that are required on all food labels with
few exceptions:
1. a statement of identity
2. a net weight or contents statement
3. the Nutrition Facts panel
4. an ingredients statement and
5. a statement that gives the name and place of business of the product's
manufacturer, packer, or distributor.

Nutrition Expert Says New Food Label is a ‘Win” for Consumers

(Source: https://www.ksre.k-state.edu/news/stories/2020/07/nutrition-label-helps-
consumers-eat-healthy.html. Retrieved on March 29, 2021)

103
 Changes to the Nutrition Facts Label I FDA
(https://www.fda.gov/files/NFL-NewLabel-900x900_0.png. Retrieved on March 29,
2021)

Factors affecting nutrient requirements

1. Genetics and gender.
2. Dietary energy concentration.
3. Environmental temperature.
4. Health status.
5. Stocking density.
6. Feeding strategy and degree of competition for feed.
7. Variability of nutrient content and availability in ingredients.
8. Presence of molds, toxins, or anti-nutritional factors in the diet.
III. Elimination Pattern
Elimination patterns describe the regulation, control, and removal of
by-products and wastes in the body. The term usually refers to the
movement of feces or urine from the body. Common digestive problems
include: constipation, diarrhea, gas, heartburn (acid reflux), nausea and
vomiting, intestinal cramps.
Factors affecting bowel elimination:
1. Age 5. Physical activity
2. Infection 6. Psychological factors
3. Diet 7. Personal habits
4. Fluid intake

104
For better digestive health:
1. Eat a high-fiber diet.
2. Be sure you're getting both soluble and insoluble fiber.
3. Minimize your intake of foods high in fat.
4. Select lean meats.
5. Add probiotics to your diet.
6. Follow a regular eating schedule.
7. Drink plenty of water.
For illness prevention, eat more frequent meals to help boost metabolism
and keep you from overeating.
Factors affecting fluid and electrolyte balance:
The 3 hormones that regulates fluid and electrolyte balance are:
1. antidiuretic hormone – from the pituitary gland
2. aldosterone – from the adrenal cortex
3. atrial natriuretic peptide – from the heart
The 3 major electrolytes are:
1. sodium
2. potassium
3. chloride
The electrolytes needed are:
1. sodium
2. potassium
3. chloride
4. calcium
5. bicarbonate
6. magnesium and
7. phosphate
The levels of electrolytes in the body can become too low or too high when
the amount of water in the body changes.
The kidneys help maintain electrolyte concentrations by
filtering electrolytes and water from blood, returning some to the blood, and
excreting any excess into the urine. Thus, the kidneys
help maintain a balance between daily consumption and excretion
of electrolytes and water.

105
Normal Electrolyte Values for Adults
Venous Blood
Sodium 135–145 mEq/L
Potassium 3.5–5.0 mEq/L
Chloride 95–108 mEq/L
Calcium, total 4.5–5.5 mEq/L or 8.5–10.5 mg/dL
Calcium, ionized 56% of total calcium (2.5 mEq/L or
4.0–5.0 mg/dL)
Magnesium 1.5–2.5 mEq/L or 1.6–2.5 mg/dL
Phosphate (phosphorus) 1.8–2.6 mEq/L or 2.5–4.5 mg/dL
Serum osmolality 280–300 mOsm/kg water
Fundamentals of Nursing, 10th edition By Kozier and Erb, copyright 2016
Normal Values of Arterial Blood Gases

Fundamentals of Nursing, 10th edition By Kozier and Erb, copyright 2016

106
Selected Intravenous Solutions

Fundamentals of Nursing, 10th edition By Kozier and Erb, copyright 2016

Commonly Use Venipuncture Sites

Fundamentals of Nursing, 10th Edition By Kozier and Erb, Copyright 2016

Healthy ways to strengthen the immune system
1. Don't smoke.
2. Eat a diet high in fruits and vegetables.
3. Exercise regularly.
4. Maintain a healthy weight.
5. If you drink alcohol, drink only in moderation.
6. Get adequate sleep.

107
7. Take steps to avoid infection, such as washing your hands frequently and
cooking meats thoroughly.
Universal precautions is an approach to infection control to treat all
human blood and certain human body fluids as if they were known to be
infectious for HIV, HBV and other bloodborne pathogens.
Standard Precautions are:
1. Hand hygiene.
2. Use of personal protective equipment (e.g., gloves, masks, eyewear).
3. Respiratory hygiene / cough etiquette.
4. Sharps safety (engineering and work practice controls).
5. Safe injection practices (i.e., aseptic technique for parenteral
medications).
6. Sterile instruments and devices.
7. Education

Cellular aberrations
Aberration – Something that deviates from the normal way.
Neoplasia/Tumor – an abnormal mass of tissue the growth of which exceeds
its uncoordinated with that of the normal tissues and persists in the same
excessive manner after the cessation of the stimuli which evoked the change.
Cancer is identified by aberrations in cellular structure and cellular function.
Gross morphological changes are evident in both the cellular and nuclear
membranes in tumor cells. The progression of many cancers has been traced
to a succession of genetic mutations that ultimately result in altered protein
function.

IV. Cognitive- Perceptual Pattern

Perception and Coordination - Without proper perception, there
cannot be proper coordination. Perception and coordination helps in
processing, integrating, organization and filtering of sensory information
from all over the body.
1. Neurologic (Brain) Function - The brain controls thoughts, memory and
speech, arm and leg movements and the function of many organs within
the body. It also determines how people respond to stressful situations
(i.e. writing of an exam, loss of a job, birth of a child, illness, etc.) by
regulating heart and breathing rates.
2. Visual (Eye) Function - When light hits the retina (a light-sensitive layer of
tissue at the back of the eye), special cells called photoreceptors turn the

108
 light into electrical signals. These electrical signals travel from the retina
through the optic nerve to the brain. Then the brain turns the signals into
the images you see.
3. Auditory (Ear) Function - The ears are organs that provide two main
functions — hearing and balance — that depend on specialized receptors
called hair cells.
4. Coordination - the organization of the different elements of a complex
body or activity so as to enable them to work together effectively.
Human Behavior Mental Health Concepts
Mental Health Promotion with Children and Adolescent
Common Childhood Problem
1. Death and grieving

Helping Your Toddler Cope with Grief and Death

(Source: https://zero-to-three.s3.amazonaws.com/images/4411/29d47370-993d-4d19-
995b-d65468998209-small.jpg?1586563486. Retrieved on March 29, 2021)

Children who are having serious problems with grief and loss may
show one or more of these signs: an extended period of depression in which
the child loses interest in daily activities and events. inability to sleep, loss of
appetite, prolonged fear of being alone, acting much younger for an
extended period.

109
2. Separation and Divorce

Importance of Co-parenting after a Separation or Divorce

(Source: https://guestngray.files.wordpress.com/2013/06/services.jpg. Retrieved on
March 29, 2021)

Children from divorced families may experience more externalizing

problems, such as conduct disorders, delinquency, and impulsive behavior
than kids from two-parent families. 7 In addition to increased behavior
problems, children may also experience more conflict with peers after
a divorce.
3. Sibling Relationship

Oh brother! Having a sibling makes boys selfless

(Source: https://encrypted-tbn0.gstatic.com/images?q=tbn:ANd9GcQiTAe_T-
eL9eHIzacvciKYt_2sQvYDoeY_Uw&usqp=CAU. Retrieved on March 29, 2021)

In particular, siblings play an important role in the development of

children's understanding of others' minds, namely their understanding of
emotions, thoughts, intentions and beliefs.

110
4. Physical fitness

Childhood Fitness Start Them Young

(Source: https://breakingmuscle.com/fitness/childhood-fitness-start-them-young.
Retrieved on March 29, 2021)

It promotes healthy growth and development. It helps build a

healthier body composition, stronger bones and muscles. It also improves
the child’ cardiovascular fitness. Physical activities help in the development
of better motor skill and in concentration and thinking skills.
- problems and struggles of youth nowadays to become physically fit
are boredom with exercise. lack of confidence in their ability to be physically
active (low self-efficacy) fear of being injured or having been injured
recently. lack of self-management skills, such as the ability to set personal
goals, monitor.
5. Adolescent Risk-Taking Behavior

Teens are Risk Junkies

(https://parenthetical.wisc.edu/wp-content/uploads/sites/1357/2014/06/risk_opt.png.
Retrieved on March 29, 2021)

Some of the most common adolescent high-risk behaviors include

sexual activity, substance abuse, cigarette smoking, preventable injury and
violence, including self-harm. The findings show that, relative to children and
adults, adolescents are less interested in information that would help them

111
to gauge the risks of their behavior. They are less motivated to seek out such
information and better able to tolerate a lack of knowledge.
Responding to Maintain Physiologic and Psychosocial Needs
1. Physiologic Needs
a. safety, infection control and hygiene
b. complementary and alternative modalities
c. comfort and sleep
d. skin integrity and wound care
2. Psychosocial Needs
a. spirituality
b. meeting needs r/t death and dying, grief and grieving
V. Sexuality-Reproductive Pattern
1. Personal Hygiene
2. Promotion of Health During Menstruation
3. Promotion of Health During Menopause
4. Sex Education
5. Birth Control Planning

Focus Questions
Guide questions for Unit 5.1 discussion. Write your answer in a short bond
paper and submit it next week via Messenger. Basis for the grading will be
based on the given rubrics via Messenger.
1. Choose one specific health promotion guideline for children and site
an example. Discuss briefly in one to two sentences only.

Related Readings
Please refer to this link for the add-on discussion.
https://www.vichealth.vic.gov.au/media-and-resources/vce-
resources/defining-health-promotion. Retrieved on March 28, 2021.
mins-and-supplements/vitamins-minerals-how-much-should-you-take.
Retrieved on March 29, 2021.

Learning Activities
Activity 1. Write your answer in a short bond paper and submit it next week
via Messenger. Basis for the grading will be based on the given rubrics via
Messenger.
1. Choose one specific health promotion guideline for adults and site an
example. Discuss briefly in one to two sentences only.

112
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