NURSING AS AN ART, SCIENCE AND > Client - Engages in the advice or

PROFESSION services of another who is qualified to

provide this service. Also Receivers of
> Nightingale = Using the environment to Health Care/Collaborators of health care.
assist him in his recovery
3 types of clients
> Henderson = Assist the individual in the 1. Individual
performance of those activities 2. Families
contributing to health or its recovery 3. Communities

CNA (Canadian Nurses Association) 4 areas of nursing practice

= Dynamic, caring, helping relationship to 1. Promoting health & wellness
achieve and obtain optimal health. 2. Preventing illness
3. Restoring health
DEFINITIONS of CNA 4. Care of the dying (not enhance)

1. - Nursing is caring WELLNESS - a state of well-being.

2. - Nursing is an art Engaging in attitudes and behaviour that
3. - Nursing is a science enhance the quality of life.
4. - Nursing is client-centered
Goal of Illness - to maintain optimal health
5. - Nursing is holistic
by preventing disease.
6. - Nursing is adaptive
7. - Nursing is concerned with health Illness Nursing activities include:
promotion, health maintenance, 1. Immunization
and health restoration. 2. Prenatal and infant care
3. prevent STD
ANA (American Nurses Association)
= Direct, goal-oriented, and adaptable to General Nursing activities include:
the needs of the individual. 1. Providing direct care
2. Performing diagnostic
DEFINTIONS of ANA
3. Consulting
1. 1980, "nursing is the diagnosis and 4. Teaching Client
treatment of human responses to 5. Rehabilitating
actual or potential health 6. Care of the Dying
problems"
1. Care of the Dying
> Consumer - an individual, group of Involves comforting and caring for
people or a community that uses a service people of all ages who are dying.
or community. (Use health care product or 2. Rehabilitating
service). optimal functional level following
physical or mental illness, injury or
Recipients of Nursing - sometimes chemical addiction.
patients and sometimes clients. 3. Teaching Clients
about recovery activities, such as
> Patient - who is waiting or undergoing exercises that will accelerate
medical treatment and care. recovery after a stroke.
- "to suffer" or "to bear"
 4. Consulting persons, other health professionals, and
with other healthcare professionals people in the community.
about client problems.
5. Provide Direct Care c. Teacher
Administer medications, baths,
specific procedures and the nurse helps clients learn about their
treatments. health and the health care procedures
6. Perform diagnostic they need to perform to restore or
measure blood pressure and maintain their health.
examine feces.
d. Manager
Settings for Nursing
manages the nursing care of individuals,
1. Client Homes
families, and communities. Delegates
2. Hospitals
nursing activities to other nurses, and
3. Community Agencies
supervises and evaluates their
4. Ambulatory clinic
performances.
5. Long-term care
6. Nursing practice centers. > MANAGING - requires knowledge
about organizational structure and
Standards of Clinical Nursing Practice
dynamics, authority and accountability,
ANA Assessment - the nurse collects
leadership, delegation and supervision
patient health data.
and evaluation.
ANA Diagnosis - Analyzes the
assessment data in determining diagnosis. > Nurse Case Manager - work with the
ANA Outcome Identification - The nurse multidisciplinary health care team to
identifies expected outcomes measure the effectiveness of the case
individualized to the patient. management plan and to monitor
ANA Planning - the nurse develops a outcomes.
plan of care that prescribes interventions
to attain expected outcome. e. Research consumer
ANA Implementation - the nurse
implements the interventions identified in use research to improve client care.
the plan of care.
ANA Evaluation - the nurse evaluates the Expanded career roles: Nurse practitioner,
patients progress towards attainment of clinical nurse specialist, nurse
outcome. anaesthetist, nurse midwife, nurse
researcher, nurse administrator, nurse
a. Caregiver educator, nurse entrepreneur, forensic
nurse
encompasses the physical, psychosocial,
developmental, cultural and spiritual level. 1. Profession - defined as an
May provide care directly or delegate it to occupation that requires extensive
other caregivers. education or calling that requires
special knowledge, skill, and
b. Communicator preparation
2. Professionalism - professional
integral to all nursing roles. Nurses character, spirit, or methods. Set of
communicate with the client, support
 attributes, a way life that implies
responsibility and commitment.
3. Professionalization - the process
of becoming professional, that is,
of acquiring characteristics
considered to be professional.

Factors influencing Contemporary

nursing practice:

1. Economics

2. Consumer Demands

3. Family Structure

4. Science and Technology

5. Info and Telecommunication

6. Legislation

7. Demography
NURSING PROCESS : Promotes positive working atmosphere =
- A systematics, organised, rational collaboration
method of planning and providing : Helps nurse to define roles to those
individualised, humanistic nursing care. outside profession
: Job satisfaction
PURPOSES OF NURSING : Facilitates professional growth
- To identify health status : Avoidance of legal action
- To establish :Meeting standards of accredited hospitals
- To deliver specific nursing care.
PARTS OF NURSING PROCESS
CHARACTERISTICS: 1. ASSESSMENT
2. DIAGNOSING
1. Goal Oriented and Client-Centered 3. PLANNING
2. Cyclical, Dynamic rather than static 4. INTERVENTION
3. Plan of care organised according 5. EVALUATION
to client problems rather than
nursing goals.
4. Basis of prioritizing nursing =
ASSESSMENT
problems not goals Nursing activities:
5. Follow a logical sequence 0 Data Collection
6. Universally applicable 0 Data Organization
7. Interpersonal and collaborative 0 Data Validation
- W/ patients and relatives 0 Data Recording
- W/ colleagues and other (no conclusion is being made at this
healthcare phase)
8. Adaptation of Problem-Solving
PURPOSE
techniques and principles
- To create a data base of the client’s
9. Problem-oriented, flexible, open to
response to health and illness
new info
- To determine the nursing care needs of
10. Allows creativity of nurse and
the patient
patient.

BENEFITS: 4 TYPES OF ASSESSMENT

1. Initial Assessment
Concepts = Patient and nurse benefits = 2. Focus Assessment
patient has greater benefit 3. Emergency Assessment
CLIENT-CENTERED. 4. Time-Lapsed Assessment

: Improves quality of care 1. Initial Assessment

: Ensures continuity and appropriate level At specified time after admission
of care Done at Ward
: Facilitates client participation through To create a data base for problem
planning with patient identification and for reference and future
: Enables nurse to maximise resources comparison.
: Feedback allows nurse to evaluate care
: Serves as a framework for accountability
thru documentation
2. Focus Assessment Methods of Data Collection
Integrated throughout the nursing = Observing, Interviewing, Examining.
process
To identify problems overlooked 2 Aspects of Observation Process:
earlier and To determine the status of a 1 Noticing the stimuli
health problem. 2 Do an interpretation of the stimuli

3. Emergency Assessment Interviewing

During acute physiologic and 2 types of interview
psychologic crisis. Emergency, Anywhere, 1. Directive = Structured and close-ended
On Site questions for specific data
To identify life-threating condition When you need elicit specific data
FRAMEWORK: ABC - Airway, Breathing, and little time available
Circulation 2. Non-directive = Open-ended and lets
patient to volunteer info
4. Time-Lapsed Assessment
Several months after initial Types of Interview Questions
assessment 1. Open-Ended Questions = Not
To compare current status of answerable by yes or no. More for
patient with the base line data. explanation

2. Close-Ended Questions = Answerable

- Initial Output of Assessment =
by yes or no, leading questions and
Recorded Data
phrasing question suggests about the
answer the interviewer is expecting.
Types of Data
3. Neutral Questions = Phrasing allows
1. Subjective or Covert
the patient to answer w/ least pressure.
Felt by Patient, Symptoms and stated by
Not addressed to the patient personally.
patient.
General topic.
2. Objective or Overt
Planning the interview:
Measured by nurse, observable by 5
Concepts:
senses.
Before the interview = determine what you
Sources of Data
know and what you don’t know. An
1. Primary Source
interview is a planned convo w/ a purpose.
Patient himself except when:
Interviews are a two-way process.
Unconscious, Baby, Insane
PATIENT SHOULD BE comfortable and
2. Secondary Source available and must have 3-4 feet.
Patient’s record, healthcare members,
related journal, significant others, family, Stages of the Interview
person who brought the patient to 1. Opening Stage =
hospital. Concept = most important part of the
interview
3. Environment of the Patient Rationale = Sets the tone all throughout
Ex. Diabetes patient exhibits acetone the interview
breath = Assess for diabetic ketoacidosis.
2. Body of Interview = 2. High-Risk Nursing Diagnosis
Occurs when patient responds to - Diagnosis that a patient is more
questioning. vulnerable or susceptible compared
with others in the same situation.
3. Closing Stage
Using the summarising technique.
3. Possible Nursing
Validation of Data - Evidence of health problem but the
Act of double checking the data causes are not fully understood
- Option to indicate that some data are
Purpose of Data Validation = Correctness, present to confirm a diagnosis but are
Completeness, and Accuracy of data. insufficient as of this time.
GUIDELINES in validation
1. Compare subjective and objective 4. Wellness Nursing Diagnosis
2. Be Familiar with the word usage - Positive Statement and indicated a
3. Reassess/ double-check data which are healthy response
extremely abnormal
4. Data contains CUES and not Domains of Diagnosis: Only includes
INFERENCES health problems that a nurse is
5. Free of Biases capable and licensed to treat.
6.. Avoid jumping to conclusions.
Parts of a Nursing Diagnosis:
Data Recording:
1. Problem Statement
Completes the assessment phase.
2. Presumed Etiology
DATA = Initial Output
RECORDED DATA = Final Output
3. Defining Characteristics

DIAGNOSIS Example of Nursing Diagnosis =

Fluid Volume Deficit, related to
Activities: frequent loss of bowel movement as
- Sorting, clustering, analysing, and evidenced by decreased skin turgor.
interpreting data.
Advantages ofUsing a Standardised
Concept: Diagnostic Terminology
Nursing Diagnosis = Final Output - Provide professional accountability
and autonomy by defining and
Different Types of Nursing describing the independent areas of
Diagnosis practice
- Provides effective vehicle of
1. Actual Nursing Diagnosis communication
- Present time statement - Provides an organising principle for
- Clinical judgement that the nurse has meaningful research
validated because of the presence of - Facilitates continuity and
major defining characteristics. individualised care.
PLANNING Guidelines for Implementation
1. Should be based on scientific
Concept: Determining ahead of time knowledge, research, and professional
and forecasting a course of action. standards of practice.
- For plans to be effective, involve the 2. Should be adapted to the individual
patient and the family. patient
3. Should always be safe
Nursing Care Plan - Final output 4. Holistic
5. Should be accompanied by support,
Types of Planning
comfort and teaching.
1. Initial Planning
Done by Nurse, at specified time upon
or after admission of the patient. EVALUATION
Purpose - Determine client’s progress,
2. On-going Planning the effectiveness of the care plan,
Done by all nurses who worked w/ the determine to what extent the nursing
patient, patient himself, the family, goals have been met.
Nurse
Importance - Continued, Modified,
3. Discharge Planning Discontinued.
Purpose - ensure the continuity of care
Activities =
1. Identify the outcome criteria to be
Characteristics of Planning Process used as measurement
S - Specific 2. Gather info relevant to the outcome
M - Measurable criteria
A - Attainable 3. Compare info with the criteria
R - Realistic 4. Assess the reasons for the outcome
T - Time-bounded 5. Revise the nursing care plan as
needed
IMPLEMENTATION
Activities - Reassess the patient (To Types of Evaluation
determine if the procedure is still 1. On-Going = Done during after the
needed). intervention.
- Determine the need for Importance = allows the nurse to
nursing assistance, and implement the decide and make on-the-spot
nursing strategies. modifications in an intervention.
- Communicate the procedure
performed by documenting the 2. Intermittend Evaluation = A
procedure. specified time
- Understand the orders (verify Purpose = Shows the extent of the
Physician’s Order) progress
-Encourage patient to Importance = To correct deficiencies
participate actively. and modify the NCP.
3. Terminal Evaluation = Immediately
before discharge
Importance = States the status of a
health problem at the time of
discharge. MET, PARTIALLY MET,
UNMET.
THERAPEUTIC COMMUNICATION 5. Using touch
6. Restating or paraphrasing
Principles or Characteristic: 7. Seeking clarification
1. Patient - primary focus 8. Offering self
2. Professional attitude - sets the tone 9. Perception checking or
of therapeutic relationship seeking consensual validation
3. Self-disclosure cautiously only for 10. Giving information
therapeutic purposes 11. Acknowledging
4. Avoid social relationship w patient 12. Presenting reality
5. Maintain patient confidentiality 13. Clarifying time and
sequence
Goal:
14. Reflecting
1. Establish therapeutic nurse-patient
15. Focusing
relationship
16. Summarizing
2. Identify patient’s needs
●
3. Assess the patient’s perception of
problem
4. Facilitate the patient’s expression
5. Implement intervention designed to
address the patient’s needs
6. Assess patient’s intellect
competence to determine the level of
understanding
7. IMplement intervention
8. Maintain a non judgemental attitude.
9. Avoid giving advice
10. Guide the patient to interpret
experience

ACTIVE LISTENING
S - Sit facing the client
O - Open posture
L - Lean forward toward client
E - Establish eye contact
R - Relax

TECHNIQUES:

●
1. Using silence
2. Provide general leads
3. Being specific and tentative =
Rating pain and are you in
pain?
4. Using open ended questions