Republic of the Philippines

CE B U T E CHNOLOGI CA L U NI V E RSI T Y - M a i n Campus

in consortium with
CE B U CI T Y ME DI CA L CE NT ER
COL L E GE OF NURSI NG
Dionisio Jakosalem Street, 6000, Cebu City, Cebu
Website: http://www.ctu.edu.ph Email: [email protected]
Phone: +6332 – 316 1987 or 316 5128

NCM 124: FUNDAMENTALS OF NURSING PRACTICE

MODULE 1: Nursing as a Profession

Prepared by: Vianney Airess R. Rezaba, RN

OVERVIEW OF THE LESSON

Chapter 1 of Kozier & Erb’s Fundamentals of Nursing provides an overview of nursing as a
profession. It introduces key concepts that define nursing and its role in healthcare. Here’s an
overview based on the content of this chapter:
1. Definition of Nursing
a. Nursing is described as both an art and a science, combining knowledge, skills,
and compassion to provide care to individuals, families, and communities.
b. It involves the promotion of health, prevention of illness, and the care of individuals
who are ill, disabled, or in need of assistance in daily activities.
2. Nursing as a Profession
a. The chapter emphasizes that nursing is a professional discipline with a well-
defined body of knowledge, standards of practice, and a code of ethics.
b. It outlines the characteristics of a profession, including specialized education, a
service-oriented focus, autonomy, and a commitment to continuing education.
3. The Role of Nurses
a. Nurses serve a critical role in the healthcare system by delivering direct patient
care, educating patients and families, advocating for health and well-being, and
participating in health promotion and disease prevention efforts.
b. The role of the nurse also involves collaboration with other healthcare
professionals to ensure the best outcomes for patients.
4. Standards of Nursing Practice
a. The chapter introduces various standards and frameworks that guide nursing
practice, such as the Nurse Practice Acts, the Code of Ethics for Nurses, and the
Standards of Practice set by professional organizations.
b. These guidelines ensure that nurses provide safe, effective, and ethical care in
diverse healthcare settings.
5. Nursing Education
a. Education is a foundational component of nursing practice. Nurses must undergo
rigorous education, starting from diploma programs to associate, bachelor’s, and
advanced practice degrees.
b. Continuing education is also emphasized to keep nurses updated on new
healthcare practices and technologies.
6. Nursing Theories and Knowledge
a. The chapter highlights the importance of nursing theories and models that guide
nursing practice and help nurses deliver care in a thoughtful, systematic, and
evidence-based way.
b. Theories also help nurses understand patients’ needs from different perspectives
and shape the way nursing interventions are designed and implemented.
7. Professionalism in Nursing
a. Nurses are expected to demonstrate professionalism, including adherence to
ethical principles, commitment to patient advocacy, accountability, and respect for
cultural diversity.

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 Republic of the Philippines
CE B U T E CHNOLOGI CA L U NI V E RSI T Y - M a i n Campus
in consortium with
CE B U CI T Y ME DI CA L CE NT ER
COL L E GE OF NURSI NG
Dionisio Jakosalem Street, 6000, Cebu City, Cebu
Website: http://www.ctu.edu.ph Email: [email protected]
Phone: +6332 – 316 1987 or 316 5128

b. The chapter stresses the importance of a nurse’s personal and professional

growth to advance the profession and ensure high-quality care
8. Health and Wellness
a. The chapter touches on the importance of a holistic approach to patient care,
emphasizing physical, emotional, social, and spiritual aspects of health.
b. Nurses are taught to recognize the individual needs of patients and address them
with compassion and respect.
9. Nursing’s Contribution to Society
a. The role of nurses in improving the health of society is outlined, from clinical care
to community health initiatives.
b. Nurses contribute to social change, advocating for healthcare policies that
improve access to care and ensure better outcomes for vulnerable populations.

DESIRED LEARNING OUTCOMES

1. Define nursing and nursing as a profession
2. Distinguish the criteria of a profession
3. Identify the scope and characteristics of nursing
4. Describe the history of nursing and the development of modern nursing
5. Discuss the growth of professionalism in nursing
6. Recognize the different fields of nursing; and
7. Apply the appropriate communication skills needed in nursing

LESSON CONTENT
▪ DEFINITION OF NURSING
• According to Kozier & Erb’s Fundamentals of Nursing, nursing is defined
as “the protection, promotion, and optimization of health and
abilities, prevention of illness and injury, alleviation of suffering
through the diagnosis and treatment of human response, and
advocacy in the care of individuals, families, communities, and
populations.”
• This definition reflects nursing as both an art and a science,
encompassing a broad range of activities from direct patient care to
health promotion, prevention, and advocacy. Nurses are tasked with
supporting individuals through various stages of health and illness while
advocating for their well-being in diverse settings.
▪ NURSING AS A PROFESSION
• Defined as “a vocation requiring advanced training usually involving mental rather
than manual work”.
• Profession are those occupations possessing a particular combination of
characteristics generally considered to be the expertise, autonomy, commitment
and responsibility.
• A profession is an occupation based on specialized intellectual study and training;
its purpose is to supply skilled services with ethical components

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 Republic of the Philippines
CE B U T E CHNOLOGI CA L U NI V E RSI T Y - M a i n Campus
in consortium with
CE B U CI T Y ME DI CA L CE NT ER
COL L E GE OF NURSI NG
Dionisio Jakosalem Street, 6000, Cebu City, Cebu
Website: http://www.ctu.edu.ph Email: [email protected]
Phone: +6332 – 316 1987 or 316 5128

Profession Occupation
▪ College or University ▪ On the job training
▪ Prolonged education ▪ Length varies
▪ Mental creativity ▪ Manual work
▪ Decisions based on science/theories ▪ Guided decision making
▪ Values, beliefs and ethics integral part ▪ Values, beliefs and ethics NOT part of
in preparation the preparation
▪ Strong commitment ▪ Commitment may vary
▪ Autonomous ▪ Supervised
▪ Unlikely to change profession ▪ Often change jobs
▪ Commitment is greater than rewards ▪ Motivated by rewards
▪ Individual accountability ▪ Employer is primarily accountable

CRITERIA OF A PROFESSION
▪ Education
▪ Body of Knowledge
▪ Service Orientation
▪ Code of Ethics
▪ Professional Organization
▪ On-going Research
▪ Autonomy

• It is an important aspect of professional status. The American Nurses Association

recommends the baccalaureate degree as the entry level/ pre-requisite for master’s
degree.
• As a profession, nursing is establishing a well-defined body of knowledge and expertise.
A number of conceptual frameworks contribute to the knowledge base of nursing and
give direction to nursing practice, education and ongoing research.
• It differentiates nursing from an occupation pursued primarily for profit. Many
considered ALTRUISM (selfless concern for others) the hallmark of a profession.
Nursing has a tradition of service to others. This service, however, must be guided by
certain rules, policies and code of ethics. TODAY: NURSING is also an important
component of the health care delivery system.
• Last July 14, 2014, a new Code of Ethics for Filipino Nurse was adopted under RA 9173
and was promulgated by the BON. It contains 7 articles that embodies ethical principles
and guidelines to be observed. These are the STANDARDs of behaviors that govern
the practice. And we call the standards CODE OF ETHICS. The code serves to assist
nurses when conflict or disagreement arises about correct practice or behavior. The
code of ethics sets forth ideals of nursing conduct and provides a common foundation
for education. Although the code is not a law, sanctions can still be imposed against a
nurse who is found to be practicing outside the framework of the code.
• Operation under the umbrella of a professional organization differentiates a profession
from an occupation. F. 1960, studies were often related to nature of the knowledge base
underlying nursing practice, but since 1970 Focused on practice – related issues.
• 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
NURSING
▪ Florence Nightingale
• “The act of utilizing the environment of the patient to assist him in his recovery”

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 Republic of the Philippines
CE B U T E CHNOLOGI CA L U NI V E RSI T Y - M a i n Campus
in consortium with
CE B U CI T Y ME DI CA L CE NT ER
COL L E GE OF NURSI NG
Dionisio Jakosalem Street, 6000, Cebu City, Cebu
Website: http://www.ctu.edu.ph Email: [email protected]
Phone: +6332 – 316 1987 or 316 5128

▪ Virginia Henderson
• “The unique function of the nurse is to assist individual, sick or well, in the
performance of those activities contributing to health or its recovery or to peaceful
death that he would perform unaided if he had the necessary strength, will or
knowledge and to do this in such a way as to help him gain independence as
rapidly as possible.”
SCOPE OF NURSING
▪ Promoting health and wellness
• Wellness is a state of well-being. It means engaging in attitude and behavior that
enhance the quality of life and maximize personal potential. E.g. involve individual
and community activities to enhance a healthy lifestyle
▪ Preventing illness
• GOAL is illness prevention programs is to maintain optimal health by preventing
disease like immunization, prenatal and infant care, and prevention of STD.
▪ Restoring Health
• focuses on the ill client and it extends from early detection of the disease through
helping the client during the recovery period.
i. Providing direct care like medications, specific procedures and treatments
ii. Performing diagnostic and assessment procedures such as BP, V/S
iii. Consulting other health care professionals.
iv. Teaching the client about recovery activities e.g. exercises
v. Rehabilitating the client to their optimal functional level following physical
or mental illness, injury, or chemical addiction
▪ Care of the dying
• Provide physical comfort: Manage pain, symptoms (like nausea or difficulty
breathing), and ensure proper hygiene and positioning for comfort.
• Offer emotional and psychological support: Listen, provide empathy, and support
both the patient and their family through the process.
• Facilitate communication: Ensure open, honest discussions about the dying
process, respecting the patient’s and family’s wishes.
• Respect ethical and cultural needs: Honor the patient’s autonomy, cultural beliefs,
and advance directives.
• Collaborate with the healthcare team: Work with interdisciplinary team members
(e.g., doctors, chaplains, hospice care) to provide comprehensive support.

RECIPIENTS OF NURSING
1. Consumers - is an individual, a group of people or a community that uses a service or
commodity
2. Patient - a person who is waiting for or undergoing medical treatment and care. It comes
from a Latin word meaning “to suffer” or “to bear”
3. Client – is a person who engages the advice or services of another who is qualified to provide
this service

CHARACTERISTICS OF NURSING
✓ Nursing is caring
✓ Nursing involves close personal contact with the recipient of care

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 Republic of the Philippines
CE B U T E CHNOLOGI CA L U NI V E RSI T Y - M a i n Campus
in consortium with
CE B U CI T Y ME DI CA L CE NT ER
COL L E GE OF NURSI NG
Dionisio Jakosalem Street, 6000, Cebu City, Cebu
Website: http://www.ctu.edu.ph Email: [email protected]
Phone: +6332 – 316 1987 or 316 5128

✓ Nursing is concerned with services that take humans into account as physiological,
psychological and sociological organisms
✓ Nursing is committed to promoting individual, family, community and national health goals
in its best manner possible
✓ Nursing is committed to personalized services for all persons without regard to color,
creed, social, or economic status.
✓ Nursing is committed to involvement in ethical, legal, and political issues in the delivery of
health care
ATTRIBUTES/ QUALITIES OF A NURSE
1. Communication Skills
2. Emotional Stability
3. Empathy
4. Flexibility
5. Attention to Detail
6. Interpersonal Skills
7. Physical Endurance
8. Problem Solving Skills
9. Quick Response
10. Respect
HISTORY AND DEVELOPMENT OF MODERN NURSING
1. Nursing in Ancient Times
a. In some early cultures, the provision of nursing care was assigned to females
because women provided nurturing to their infants and it was assumed that
they could provide the same type of care to the sick and injured.
b. Treating the sick is nothings new. People have cared for the sick throughout
history, beginning the ancient times.
c. However, considering the long history of nursing, it was not until fairly recently
that nurses received a formal education. Over hundreds of years, nursing has
undergone an evolution, eventually transforming itself into the respected
profession we all know of today.
d. In other ancient societies, however men were designed to care for the sick,
because they were considered priests, spiritual guides or medicine men.
e. There was no formal education available in the primitive societies, so the
earliest nurses learned the tricks of the trade via oral traditions that were
passed down from generation to generation
f. They also learned how to nurse patients back to health through trial and error
and by observing others who cared for the sick.
g. 300 BC- the Egyptian healthcare system was the first to maintain medical
records
h. 1836- Deaconess Institute of Kaiserwerth, Germany was founded
i. 1860- establishment of the Nightingale Training School for Nurses at St.
Thomas Hospital in London, England
i. Egyptian society was the first to classify medications and develop plans
to maintain people’s health
ii. Institute where Florence received her initial education in nursing. In the
Ancient Rome, during the Christian Era, deaconesses were selected
by the church to provide care for the sick. Deaconesses had some
education and were selected by the church’s bishop to visit and care

5
 Republic of the Philippines
CE B U T E CHNOLOGI CA L U NI V E RSI T Y - M a i n Campus
in consortium with
CE B U CI T Y ME DI CA L CE NT ER
COL L E GE OF NURSI NG
Dionisio Jakosalem Street, 6000, Cebu City, Cebu
Website: http://www.ctu.edu.ph Email: [email protected]
Phone: +6332 – 316 1987 or 316 5128

for the sick in their homes. PHOEBE is considered to be the first

“visiting nurse” who provided expert to nursing care.
iii. First organized program for training nurses
2. Nursing in Medieval Times
a. 1500-1700 – growing interest in science and technology led to advances in
medicine and public health.
b. Protestant Transformation- monasteries and convents were closed, lands were
seized. Common women who were too old or ill to find other jobs started caring
for the sick
i. Hospital in Protestant Europe, were no regular system of nursing
1. 1. At this time, the rich paid for their sick to be cared at home
while the poor had cared in the hospital. By the time, many poor
people arrived at the hospital very ill, so they often died in the
hospital being hospitalized had negative connotations for most
people, as hospitals were considered places where people went
to die.
2. Female practitioners cared for neighbors and family, but their
work in unpaid or unrecognized. But since only few hospitals in
Protestant Europe, in Catholic areas, the tradition of nursing
nuns continued and uninterrupted
3. Modern Nursing
a. Early 1900 – Modern Nursing began in Germany and Britain
i. British reformers advocated for the formation of groups of religious
women to staff existing in the hospitals
ii. two influential women in the field of nursing this time was ELIZABETH
FRY and FLORENCE NIGHTINGALE.
1. Elizabeth Fry
a. Founded the Protestant Sisters of Charity in 1840. -
English protestant sisterhood St. John’s House was
founded in 1848.
b. Members of this sisterhood received education in
nursing and observed patients at two London hospitals
c. These sisters live together as a community and
participated in a two year long nursing education
program They are required to work for St. John’s House
for 5 years in return for room and board plus a small
salary. They nursed for a few hours each day and spend
the rest of the time in prayer and religious instructions.
2. Florence Nightingale
a. A philanthropist from a wealthy English family who
studied nursing under the direction of Pastor Theodore
Fliedner, 1836 in Germany
b. Nightingale forever changed the practice of nursing
c. At the time, it was unusual for an upper-class woman to
care for the sick, but she felt a calling to serve humanity
d. When the Crimean war broke out in 1854, she appalled
to discover that the mortality rate of British troops was
41% and that the British army lacked nurses
e. Owing to Nightingale’s efforts, the number of deaths
among British soldiers decreased dramatically within
months  When Nightingale returned to England, she

6
 Republic of the Philippines
CE B U T E CHNOLOGI CA L U NI V E RSI T Y - M a i n Campus
in consortium with
CE B U CI T Y ME DI CA L CE NT ER
COL L E GE OF NURSI NG
Dionisio Jakosalem Street, 6000, Cebu City, Cebu
Website: http://www.ctu.edu.ph Email: [email protected]
Phone: +6332 – 316 1987 or 316 5128

was hailed a heroine. She then established the

Nightingale School of Nursing at St. Thomas Hospital in
London, offering education for professional nurses.
f. Late 1900- nursing professionalized rapidly in the United
States.
i. Women who had served as nurses in the Civil
War realized the importance of a formal nursing
education and played a crucial role in
establishing the first nurse training school
ii. Hospitals began setting up nursing schools that
attracted women both working class and middle-
class backgrounds
g. The first permanent school of nursing founded in the
United States was the nurse training school at the
Women’s Hospital in Philadelphia, which was
established in 1872.
h. Number of graduates grew rapidly by the end of 1960’s
i. Graduate nursing programs focusing on clinical
specialties laid the basis for the expansion of advanced
nursing practice
iii. Note: Traditional nursing role has always entailed humanistic caring,
nurturing, comforting and supporting.
HISTORY OF NURSING IN THE PHILIPPINES
1. Early Philippines
a. Early beliefs of health and illness in the Philippines were in conjunction with beliefs
of mysticism and superstitions
b. The cause of a disease was believed to be due to either another person, whom
which was an enemy, or a witch or evil spirits.
c. Filipinos were careful not to upset other people or the evil spirits for the good of
their health.
d. These evil spirits could be driven away by persons with power to banish demons.
The individuals who were known to rid of demons were either priests or herb
doctors.
e. Filipinos who became sick were usually cared for by the female family members
or friends in the home.
2. Spanish colonial rule
a. During Spain's colonial rule (1521-1898) the Philippine education system offered
distinct and unequal opportunities for Filipinos based on gender. An example of
this sexism was allowing only limited numbers of females receive primary
education in Spanish charitable institutions.
b. Without an education, women were unable to gain much knowledge or power.
c. The knowledge of caring for others came from family members and personal
experience with the sick. Nursing other individuals was seen as a task not a job or
a profession.
d. During the Spanish regime many specialized hospitals were established to care
for Spanish king’s soldiers and civilians.
e. To many elite Filipinos the Spanish colonial hospitals were places where those
who were not so fortunate to have homes, spent their last days until death
3. Philippine revolution

7
 Republic of the Philippines
CE B U T E CHNOLOGI CA L U NI V E RSI T Y - M a i n Campus
in consortium with
CE B U CI T Y ME DI CA L CE NT ER
COL L E GE OF NURSI NG
Dionisio Jakosalem Street, 6000, Cebu City, Cebu
Website: http://www.ctu.edu.ph Email: [email protected]
Phone: +6332 – 316 1987 or 316 5128

a. At the time of the Philippine Revolution many women transformed their homes into
quarters to nurse Filipino soldiers and revolutionaries.
b. One of these women was Melchora Aquino, also known as the Mother of the
Philippine revolution. In her old age of about 80, Aquino was a supporter of the
revolution by providing food and shelter to the revolutionists.
c. In addition, she provided care for those who became sick or wounded.
d. However, a few days after the revolution began, Aquino was arrested by the
Spaniards for providing care to the rebels.
e. In her strong will to not reveal any information to the Spanish about the location of
the rebel leader, Aquino was deported to Guam in the Marianas.
f. After six years of being exiled, the Mother of the Philippine revolution was able to
return in 1903, when the Philippines finally gained independence from the
Americans.
g. Aquino’s work caring for the ill and the wounded during the revolution has brought
comparisons to the British Florence Nightingale.
h. Both these women cared for soldiers during war and paved the way for nursing
practice
4. American colonial rule
a. Although the Philippines had gained independence from Spain, the United States
began to instil their power upon the islands and this broke out in conflict between
the Filipinos and the Americans.
b. It was the start of the Philippine-American War.
c. The presence of Americans played a vital role in influencing the development of
nursing into a profession.
d. Nurses and missionaries from the United States came to act as nurse mentors for
the Filipina women.
e. Nursing education, like teaching and missionary work in the Philippines provided
white American women with a sense of purpose in the colony.
f. This influence then continued with the building of many hospitals where American
nurses took charge and Filipina women began to learn under careful eye.
g. The time that the Philippines gained their independence from US colonial rule in
1946, the nursing profession continued to grow with the development of more
nursing schools and the growth of Filipinas seeking the title of a nurse.
h. While taking advantage of these learning opportunities Filipinos began to learn
more about the United States and the opportunities that the country could hold for
them, such as extending their education and increased pay.
i. This began the migration of nurses to the United States.
j. As individuals began travelling to and from United States, the stories they brought
home began to spark the interest of others to follow.
5. Post-colonial Philippines
a. After World War II, when Manuel Roxas assumed the presidency of the Republic
of the Philippines on July 4, 1946, it officially marked the end of the colonialism
between the United States and the Philippines.
b. Like much of the rest of the world, the Philippine islands were in ruins and Roxas
was determined to rebuild his country. He made it clear to his constituents that the
new government was still going to rely heavily on US financial support in order to
rehabilitate its national economy.
c. Roxas’ first attempts to balance the Philippines budget included collecting unpaid
taxes, reducing expenses and promoting foreign trade. Forms of foreign trade
would include the exportation of Filipino nurses.

8
 Republic of the Philippines
CE B U T E CHNOLOGI CA L U NI V E RSI T Y - M a i n Campus
in consortium with
CE B U CI T Y ME DI CA L CE NT ER
COL L E GE OF NURSI NG
Dionisio Jakosalem Street, 6000, Cebu City, Cebu
Website: http://www.ctu.edu.ph Email: [email protected]
Phone: +6332 – 316 1987 or 316 5128

d. Already trained by Americans, Filipino nurses were the perfect candidates to assist
the United States and other countries experiencing post World War II shortages.
e. At the time in the Philippines there was also rumor of nursing shortage however it
was questioned to be true do to the expanding health programs, inefficient use of
nurses’ time and skills and loss of qualified nurses to other countries.
f. By the mid-1960s, Filipino nurses were entering the United States by the
thousands.
g. The benefit to the travelling nurses was that they were able to make nearly 20
times as much as they were earning back home.
h. Part of this money would be sent back to their families as remittance and this
remittance would in turn assist in boosting the Philippine economy.
i. The negative effects of the high exportation rate was that the nurses were adding
to their own country’s nursing shortage problem.
j. As well the Philippines faced losing one of its greatest sources of social capital,
which are educated workers.
k. The negative effects are also seen in the United States as American salaries
decrease because Philippine nurses that newly arrive would work the same job at
a lower wage.
6. Today
a. The Philippines is the leader in exporting nurses to meet the demands of the United
States and other developed nations.
b. It has been argued however, that The Philippines' persistent production of nurses
for the global market is a state strategy to develop an export industry for economic
development.
c. Things such as immigration services and nursing licensing authorities encourage
the production of nurses for export
CTU-CCMC-CN
➢ Vision
o CTU: A premier, multidisciplinary-technological university
o CCMC-CN: To prepare nursing students to become globally competitive nurses
➢ Mission
o CTU: A premier, multidisciplinary-technological university
o CCMC-CN: The University shall primarily provide leading-edge degree programs,
innovative professional, entrepreneurial, and technical instruction as well as
research, extension and resource generation programs that address both the
needs of the region and the nation in the context of the global knowledge economy,
Fifth Industrial Revolution and sustainability.
CTU-CCMC-CN HISTORY

• Cebu City Hospital School of Nursing was established by the Cebu City
Government through Ordinance No. 679 by the Cebu City Council on May 21, 1970
and approved by the City Mayor on June 4, 1970
• offering a 3-year Graduate in Nursing Program
• The GN Program was phased out effective S.Y.1978-1979 in favor of the Bachelor
of Science in Nursing
• Cebu State College-Cebu City Medical Center College of Nursing was named
under Ordinance 1041 passed by City Council 1979 effective S.Y. 1984-1985
through DECS Order No. 9, s. 1984.

9
 Republic of the Philippines
CE B U T E CHNOLOGI CA L U NI V E RSI T Y - M a i n Campus
in consortium with
CE B U CI T Y ME DI CA L CE NT ER
COL L E GE OF NURSI NG
Dionisio Jakosalem Street, 6000, Cebu City, Cebu
Website: http://www.ctu.edu.ph Email: [email protected]
Phone: +6332 – 316 1987 or 316 5128

• Effective S.Y. 1991-1992, the tie-up agreement was transferred with same
curricular program to Cebu State College of Science and Technology
• November 10, 2009, under Republic Act No. 9744 Converting Cebu State College
of Science and Technology in state university to be known as CEBU
TECHNOLOGICAL UNIVERSITY.
FACTORS AFFECTING THE NURSING SHORTAGES
1. Aging Nurse Workforce
2. Aging of Nursing Faculty
3. Reduced Entry of Younger People into Nursing
4. Aging Population
5. Increased Demand for Nurses
6. Workplace Issues

• Aging
o Number of nurses under 30 decreasing
o Number of nurses ages 40-49 increasing with 40% older than 50 by 2010
o New graduates entering workforce at an older age and will have fewer years
to work
• As nursing faculty retire, nursing programs may have fewer faculty to educate future
nurses.
• Reduction in nursing programs enrolment
• Individuals 65 and older to double between 2000 and 2030., Increasing health care
needs of aging population.
• Increased acuity of hospitals clients requiring skilled and specialized nurses. Shorter
hospital stays resulting in transfer of clients to long term care and community settings,
creating increased demand for nurses in the community
• Inadequate staffing, heavy workloads, increased use of overtime, lack of sufficient
support staff, inadequate wage, difficulty recruiting and retaining nurses.
COLLECTING BARGAINING

• More nurses are using collective bargaining to deal with their concerns.
• The ANA participates in collective bargaining on behalf of nurses through its economic
and general welfare programs.
• Today, some nurses are joining other Labor organizations that represent them at the
bargaining table.
• Nurses have gone on strike over economic concerns and over issues about safe care
for clients and safety for themselves.
NURSING ASSOCIATIONS
International
a. American Nurses Association
i. “To foster high standards of nursing practice and to promote the
educational and professional advancement of nurses so that all people may
have better nursing care.”
b. National League of Nursing:
i. Formed in 1952 is an organization of both individuals and agencies
ii. Objective
1. To foster the development and improvement of all nursing services
and nursing education

10
 Republic of the Philippines
CE B U T E CHNOLOGI CA L U NI V E RSI T Y - M a i n Campus
in consortium with
CE B U CI T Y ME DI CA L CE NT ER
COL L E GE OF NURSI NG
Dionisio Jakosalem Street, 6000, Cebu City, Cebu
Website: http://www.ctu.edu.ph Email: [email protected]
Phone: +6332 – 316 1987 or 316 5128

c. International Council of Nurses

i. Established in 1899
ii. Nurses from U.S., Great Britain, and Canada are the founding members.
iii. It provides an organization through which member national associations
can work together for the mission of representing worldwide, advancing the
profession and influencing health policy.
d. National Student Nurse’s Association
i. Formed in 1953 and is the official pre-professional organizations of nursing
students.
BENNER’S STAGES OF NURSING EXPERTISE

• Stage I: Novice
o No experience (nursing students) performance is limited inflexible, and governed
by context-free rules and regulations rather than experience)
• Stage II: Advanced Beginner
o Demonstrates marginally acceptable performance. Recognizes the meaningful
“aspects” of a real situation. Has experienced enough real situation to make
judgements about them.
• Stage III: Competent
o Has 2 -3 years’ experience. Demonstrates organizational and planning abilities.
Differentiated important factors from less important aspects of care. Coordinates
multiple complex care demands
• Stage IV: Proficient
o Has 3-5 years of experience. Perceives situations as whole rather than in terms of
parts as in Stage II. Uses maxims as guides for what to consider in a situation. Has
holistic understanding of the client, which improves decision making. Focuses on
long term goal.
• Stage V: Expert
o Performance is fluid, flexible and highly proficient, no longer requires rules,
guidelines, or maxims to connect an understanding of the situation to appropriate
action. Demonstrates highly skilled, intuitive and analytic ability in new situations.
Is inclined to take a certain action because it felt right

ROLE AND RESPONSIBILITIES OF A PROFESSIONAL NURSE

1. Caregiver
a. Has traditionally included those activities that assist the client physically and
psychologically while preserving the client’s dignity
2. Communicator
a. Communication is integral to all nursing roles. Nurses communicates with the
client, S.O., other health professionals, and people in the community. Role of a
communicator: nurses identify client problems and then communicates these
verbally or in writing to the other members of the healthcare team. Must
communicate clearly and accurately.
3. Teacher
a. As a teacher, the nurse helps client learn about their health and the health care
procedures they need to perform to restore or maintain their health. The nurse
assesses the client’s learning needs and readiness to learn, sets specific learning
goals. Teaches unlicensed assistive personnel to whom they delegate care, and
they share their expertise with other nurses and health professions

11
 Republic of the Philippines
CE B U T E CHNOLOGI CA L U NI V E RSI T Y - M a i n Campus
in consortium with
CE B U CI T Y ME DI CA L CE NT ER
COL L E GE OF NURSI NG
Dionisio Jakosalem Street, 6000, Cebu City, Cebu
Website: http://www.ctu.edu.ph Email: [email protected]
Phone: +6332 – 316 1987 or 316 5128

4. Client Advocate
a. Acts to protect the client. The nurse may represent the client’s needs and wishes
to other health care team members like relaying information
5. Counsellor
a. Counselling is the process of helping a client to recognize and cope with stressful
psychologic or social problems to develop improved interpersonal relationships,
and to promote personal growth. It involves providing emotional, intellectual, and
psychologic support. Counsels primarily healthy individuals with normal
adjustment difficulties and focuses on helping the person to develop new attitudes,
feelings, and behavior by encouraging the client to look at alternative behaviors,
recognizes the choices and develop a sense of control.
6. Change Agent
a. Acts as a change agent when assisting others, that is, clients, to make
modifications in their own behavior. They also often act to make changes in the
system such as clinical care, technological care.
7. Leader
a. A leader influences other to work together to accomplish a specific goal. An
effective leadership is a learned process requiring an understanding of the needs
and goals that motivate people, the knowledge to apply the leadership skills and
the interpersonal skills to influence others
8. Manager
a. Manages the nursing care of the individuals, families and communities. The nurse-
manager also delegates nursing activities to ancillary workers and other nurses
and supervises and evaluates their performance.
9. Case Manager
a. Nurse case managers work with the multidisciplinary health care team to measure
the effectiveness of the case management plan and to monitor outcomes.
Regardless of the setting, case managers help ensure that care is oriented to the
client, while controlling costs.
10. Research Consumer
a. Nurses often use research to improve client care
11. Expanded Career Roles
a. Nurses are fulfilling expanded career roles, such as those of nurse midwife, nurse
educator, clinical nurse specialist, nurse practitioner, nurse researcher, and nurse
anesthetist, all of which allow greater independence and autonomy.

CARPER’S 4 PATTERNS OF KNOWING

• Carper's fundamental ways of knowing is a typology that attempts to classify the different
sources from which knowledge and beliefs in professional practice (originally specifically
nursing) can be or have been derived.
• It was proposed by Barbara A. Carper, a professor at the College of Nursing at Texas
Woman’s University, in 1978.
• Why develop patterns of knowing
o The aim of Carper’s theory was to:
▪ Formally express nursing knowledge
▪ Provide a professional and discipline identity
▪ Convey to others what nursing contributes to healthcare
▪ Create expert and effective nursing practice
• Knowing and knowledge

12
 Republic of the Philippines
CE B U T E CHNOLOGI CA L U NI V E RSI T Y - M a i n Campus
in consortium with
CE B U CI T Y ME DI CA L CE NT ER
COL L E GE OF NURSI NG
Dionisio Jakosalem Street, 6000, Cebu City, Cebu
Website: http://www.ctu.edu.ph Email: [email protected]
Phone: +6332 – 316 1987 or 316 5128

o Knowing refers to the way of perceiving and understanding self and the world
o Knowledge refers to knowing that is expressed in a form that can be shared and
communicated to others
• CARPER’S FOUR WAYS OF KNOWING
1. EMPIRICAL KNOWLEDGE
a. Involves use of data and scientific methods to analyze situations
i. Empirical knowledge comes through observation and
experimentation. It is the type of knowledge that is most
often associated with science. Empirical knowledge comes
through experience rather than deductive reasoning and
innate ideas.
ii. Empirical knowledge encompasses models of human
nature. It also includes behaviors and traits that particular
people have in common.
2. ESTHETIC KNOWLEDGE
a. Involves the beauty and our appreciation of it
i. Esthetic knowledge comes through our appreciation of
beauty. It can be as art, music, or nature. It is this type of
knowledge that helps us to find meaning in life.
ii. Carper’s Pattern of Knowing is a helpful way to think about
the different knowledge that nurses use in their everyday
practice.
3. PERSONAL KNOWING
a. Involves understanding of self and others
i. Personal knowledge comes through our own experiences.
It can be both positive and negative experiences. It is this
type of knowledge that helps us to decide based on our
personal values. Through personal knowing, we understand
self.
ii. Understanding self includes the knowledge that other
people have changing personalities. No single person has a
particular identity, it varies with time as people are
constantly becoming. Understanding self helps understand
what is right and wrong based on personal principles and
beliefs
4. ETHICAL KNOWING
a. Encompasses the understanding of right and wrong
i. Ethical knowledge comes through our understanding of right
and wrong. This type of knowledge is vital in making sure
that we act in a way that is morally correct.
ii. Ethical dilemmas on right and wrong are common in the day
and life of a nurse. A nurse can use the ethical knowledge
to make tough calls regarding patient care at work. Nurses
also face moral dilemmas where they may struggle to

13
 Republic of the Philippines
CE B U T E CHNOLOGI CA L U NI V E RSI T Y - M a i n Campus
in consortium with
CE B U CI T Y ME DI CA L CE NT ER
COL L E GE OF NURSI NG
Dionisio Jakosalem Street, 6000, Cebu City, Cebu
Website: http://www.ctu.edu.ph Email: [email protected]
Phone: +6332 – 316 1987 or 316 5128

SCOPE OF NURSING PRACTICE BASED ON RA 9173

Republic Act No. 9173, October 21, 2002
AN ACT PROVIDING FOR A MORE RESPONSIVE NURSING PROFESSION, REPEALING
FOR THE PURPOSE REPUBLIC ACT NO. 7164, OTHERWISE KNOWN AS "THE PHILIPPINE
NURSING ACT OF 1991" AND FOR OTHER PURPOSES
➢ ARTICLE I
o Section 1. Title. - This Act shall be known as the "Philippine Nursing Act of 2002."
➢ ARTICLE II
o Declaration of Policy
▪ Section 2. Declaration of Policy. – It is hereby declared the policy of the
State to assume responsibility for the protection and improvement of the
nursing profession by instituting measures that will result in relevant
nursing education, humane working conditions, better career prospects
and a dignified existence for our nurses.
• The State hereby guarantees the delivery of quality basic health
services through an adequate nursing personnel system throughout
the country.
Code of Ethics for Filipino Nurses
➢ What are CODES OF ETHICS?
o These are systematic guides for developing ethical behavior
o They answer normative questions of what beliefs and values should be normally
accepted
Code of Good Governance
➢ Promulgated by the Professional Regulation Commission, July 23, 2003
➢ States that:
o The hallmark of all professionals is their willingness to accept a set of professional
and ethical principles which they follow in the conduct of their daily lives.
o The acceptance of these principles requires the maintenance of a standard of
conduct higher than what is required by law.
o This code is adopted by the Professional Regulation Commission and the 42
Professional Regulatory Boards to cover an environment of good governance in
which all Filipino professionals shall perform their duties.
➢ General Principles
o Service to Others
o Integrity and Objectivity
o Professional Competence
o Solidarity and Teamwork
o Social and Civic Responsibility
o Global Competitiveness
o Equality of All Professions
➢ After consultation on October 23, 2003 at Iloilo City with the accredited professional
organization of registered nurses, the code was adopted under the Republic Act 9173 and
promulgated by the Board of Nursing under Resolution No. 220 Series of 2004 last July
14, 2004.
➢ Code of Ethics
o The ICN Code of Ethics for Nurses - revised in 2000, is a guide for action based
on social values and needs. The Code has served as the standard for nurses

14
 Republic of the Philippines
CE B U T E CHNOLOGI CA L U NI V E RSI T Y - M a i n Campus
in consortium with
CE B U CI T Y ME DI CA L CE NT ER
COL L E GE OF NURSI NG
Dionisio Jakosalem Street, 6000, Cebu City, Cebu
Website: http://www.ctu.edu.ph Email: [email protected]
Phone: +6332 – 316 1987 or 316 5128

worldwide since it was first adopted in 1953. The new version, revised for the first
time in 27 years, responds to the realities of nursing and health care in a changing
society.

COMMUNICATION

• the interchange of ideas or thoughts.

• Is any means of exchanging information or feelings between two or more people.
• It is the basic human relationship, including nursing
• The intent of any communication is to elicit a response.
Methods used are talking and listening, writing and reading, painting, singing, dancing,
storytelling. Thoughts are conveyed to others not only by spoken or written words but also by
gestures or body actions. Thus, communication is a process.
2 main purposes:
1. Influence others
2. To obtain information
a. The first encourages a sharing of information, thoughts or feelings
between two or more people
b. The latter hinders or blocks the transfer of information and feelings.

COMMUNICATION PROCESS

• The communication is the process of transmitting thoughts, feelings, facts, and other
information, includes verbal and non-verbal behavior. The communication process is built
on a trusting relationship with a client and support persons.
o Sender
▪ A person or group who wishes to convey a message to another, can be
considered the source
▪ encoder.
▪ The first component of the communication process
• Source: that the person or group sending the message must have
an idea or feeling that can be transmitted. Encoding involves the
selection of specific signs or symbols (codes) to transmit the
message
o 1. WHICH LANGUAGE AND WORDS TO USE
o 2. HOW TO ARRANGE THE WORDS
o 3. WHAT TONE AND GESTURES TO USE
o Message
▪ the 2nd component of the communication process.
▪ The body language that accompanies the words, and how the message is
transmitted.
▪ The message is the channel, and it can target any of the receiver’s senses.
▪ It is important for the channel to be appropriate for the message and it
should help make the intent of the message mire clear.
▪ Example: face – face, written communications, non-verbal: touch.
o Channel
▪ the medium through which the message is transmitted
▪ with 3 major communication channels.

15
 Republic of the Philippines
CE B U T E CHNOLOGI CA L U NI V E RSI T Y - M a i n Campus
in consortium with
CE B U CI T Y ME DI CA L CE NT ER
COL L E GE OF NURSI NG
Dionisio Jakosalem Street, 6000, Cebu City, Cebu
Website: http://www.ctu.edu.ph Email: [email protected]
Phone: +6332 – 316 1987 or 316 5128

• Visual
o consists of sight and observation
• Auditory
o consists of spoken words and cues
• Kinesthetic
o refers to experiencing sensations
o Receiver
▪ the third component, is the listener.
▪ Who must listen, observe, attend
▪ This person is the DECODER who must perceive what the sender intended
(interpretation).
▪ Perception uses all of the sense to receive verbal and nonverbal messages
o Response
▪ the fourth component of the communication process
▪ Is the message that the receiver returns to the sender. It is called
FEEDBACK that can be either verbal, nonverbal or both.
▪ Example of non-verbal: yawn or nod

LEVELS OF COMMUNICATION
1. Intrapersonal level
a. Consists of the messages one send to oneself, including self-talk or
communication with oneself. The result of this process is the individual’s unique
way of perceiving
2. Interpersonal level
a. Is the process that occurs between two people either in face-face encounters, over
the telephone or other communication media
3. Group level
a. Is the process that occurs between two people either in face-face encounters, over
the telephone or other communication media
MODES OF COMMUNICATION
1. Presentational mode
a. For example, students often prepare a travel brochure or poster about a city or
country where the target language is spoken.
b. The brochure or poster is the presentational mode.
2. Interpretive mode
a. The unit is not finished with the completion of the poster. What can the students
do to meet the criteria of the interpretative mode
b. They could read a travel brochure in the target language and check off statements
on a worksheet that are true about the place described in the brochure.
3. Interpersonal mode
a. the brochures or posters produced by the students could be the basis for a
discussion about what places the students would like to visit and why. Students
could sit in pairs to discuss.
b. The teacher can monitor the discussion while students could be asked to complete
a peer assessment sheet after time is up

16
 Republic of the Philippines
CE B U T E CHNOLOGI CA L U NI V E RSI T Y - M a i n Campus
in consortium with
CE B U CI T Y ME DI CA L CE NT ER
COL L E GE OF NURSI NG
Dionisio Jakosalem Street, 6000, Cebu City, Cebu
Website: http://www.ctu.edu.ph Email: [email protected]
Phone: +6332 – 316 1987 or 316 5128

LIFESPAN CONSIDERATIONS
➢ Infants
o they communicate through their senses.
o teach the parents the importance of touch.
o they respond best to a high pitched, soft or gentle one of voice and eye contact.
➢ Toddlers and Pre-schoolers
o allow time for them to complete verbalizing their thoughts without interruptions.
o provide a simple response to questions because they have short attention.
o drawing a picture can provide another way for the child to communicate.
➢ School-age Children
o talk to the child at his or her eyelevel to help decrease intimidation.
o include the child in the conversation when communicating with the parents.
➢ Adolescents
o Take time to build rapport with the adolescents
o Use active listening skills
o Project a non-judgmental attitude and nonreactive behaviors even when the
adolescent says disturbing remarks.

➢ Types of Communication
o There are three basic types of communication:
▪ Verbal
• Uses spoken words to communicate a message.
• Largely conscious because people chose the words they use
• The words used vary among individuals according to culture,
socioeconomic background, age, and education.
• Verbal communication is applicable to a wide range of situations,
ranging from informal office discussions to public speeches made
to thousands of people
▪ b. Non-verbal
• Personal appearance
• Posture and Gait
• Facial expression
• Gestures
• Also includes body language, gestures, facial expressions, and
even posture
• Sets the tone of a conversation and can seriously undermine the
message contained in your words if you are not careful to control it.
▪ c. Written
• Written communication is essential for communicating complicated
information, such as statistics or other data, that could not be easily
communicated through speech alone.
• When producing a piece of written communication, especially one
that is likely to be referred to over and over again, you need to plan
what you want to say carefully to ensure that all the relevant
information is accurately and clearly communicated.
▪ Written communication also allows information to be recorded so that it can
be referred to at a later date.

17
 Republic of the Philippines
CE B U T E CHNOLOGI CA L U NI V E RSI T Y - M a i n Campus
in consortium with
CE B U CI T Y ME DI CA L CE NT ER
COL L E GE OF NURSI NG
Dionisio Jakosalem Street, 6000, Cebu City, Cebu
Website: http://www.ctu.edu.ph Email: [email protected]
Phone: +6332 – 316 1987 or 316 5128

➢ Therapeutic Communication
o Promotes understanding and can help establish a constructive relationship
between the nurse and the client.
o Nurses need to respond not only to the content of a client’s verbal message but
also to the feelings expressed.
o Attentive listening is listening actively, using all the senses as opposed to listening
passively with just the ear.
➢ Barriers to Communication
o Stereotyping
▪ offering generalized and oversimplified beliefs about groups of people that
are based on experience too limited to be valid.
▪ These responses categorize the clients and negate their uniqueness as
individuals.
• Example: “women are complainers”, “men don’t cry”
o Failure to listen, improperly decoding the client’s intended
message and placing the nurse needs first before the
client’s needs.
o Agreeing and disagreeing
▪ akin to judgmental responses, agreeing and disagreeing imply that the
client is either right or wrong and that the nurse is in a position to judge this.
▪ These responses deter clients from thinking through their position and may
cause the client to become defensive.
• Example:
o Client: “I don’t think that this medication will work for me.”
o Nurse: “this medication is very effective to all the patients”

o Being defensive
▪ attempting to protect a person or health care services from negative
comments.
▪ These responses prevent the client from expressing true concerns.
• Example: The nurse is saying “You have no right to complain”.
o Defensive responses protect the nurse from admitting
weaknesses in the health care services including personal
weaknesses.
• Example: “the night nurses must just sit around and talked.
o Nurse: “We literally run around on nights. You’re not the only
clients, you know”
o Challenging
▪ giving a response that makes the client prove their statements or point of
views.
▪ These responses indicate that the nurse is failing to consider the client’s
feelings, making the client feel it necessary to defend a position.
• Example: “I felt nauseated after that red pill”
o Nurse: “Surely you don’t think I gave you the wrong pill?”.
o Probing
▪ asking for information chiefly out of curiosity rather than with the intent to
assist the client
▪ These responses are considered prying and violate the client’s privacy.
▪ Asking “why” is often probing and places the client in a defensive position.
• Example: “I was robbed at the dark alley”
o Nurse: Why are you there on the first place?”

18
 Republic of the Philippines
CE B U T E CHNOLOGI CA L U NI V E RSI T Y - M a i n Campus
in consortium with
CE B U CI T Y ME DI CA L CE NT ER
COL L E GE OF NURSI NG
Dionisio Jakosalem Street, 6000, Cebu City, Cebu
Website: http://www.ctu.edu.ph Email: [email protected]
Phone: +6332 – 316 1987 or 316 5128

o Testing
▪ Asking questions that make the client admit to something
▪ These responses permit the client only limited answers and often meet the
nurse’s need rather than the client’s.
▪ Example: “Do you think I’m not busy?” forces the client to admit that the
nurse is really busy.
o Rejecting
▪ Refusing to discuss certain topics with the client.
▪ These responses often make client’s feel that the nurse is rejecting not only
their communication but also the clients themselves.
• Example: “I don’t want to discuss that. Let’s talk about.”
o Changing topics and subjects
▪ directing the communication into areas of self-interest rather than
considering the client’s concerns is often a self-protective response to a
topic that cause anxiety. These responses imply that what the nurse
considers important will be discussed and that the client’s should not
discuss certain topic.
o Unwanted reassurance
▪ using clichés or comforting statements of advice as a means to reassure
the client.
▪ These responses block the fears, feelings, and other thoughts of the client.
• Example: “I’m sure everything will turn out to be alright”
o Passing judgement
▪ Giving opinions and approving and disapproving responses moralizing or
implying one’s values.
▪ These responses imply that the client must think as the nurse thinks,
fostering client’s dependence.
• Example: That’s good. (bad)
o Giving common advice
▪ Telling the client what to do. These responses deny the client’s right to be
an equal partner.
▪ Note that giving expert rather than common advice is therapeutic.
THERAPEUTIC COMMUNICATION TECHNIQUES
➢ Using silence
o Accepting pauses or silence that may extend for several seconds or minutes
without interjecting any verbal response.
➢ Providing general leads
o Using statements or questions that encourage the client to verbalize and choose
topic of conversation and facilitate continued verbalization.
o Would it help to discuss your feeling?
➢ Being specific and tentative
o Making statements that are specific rather than general, and tentative rather than
absolute.
o Rate your pain on a scale 0-10, 0 as no pain and 10 as painful.
➢ Using open-ended questions
o Asking broad questions that lead or invite the client to explore, elaborate, clarify,
describe, compare or illustrate thoughts or feeling.
o Open-ended questions specify only the topic to be discussed and invite answers
that are longer than one or two words.
▪ Example: I’d like to hear more about that….

19
 Republic of the Philippines
CE B U T E CHNOLOGI CA L U NI V E RSI T Y - M a i n Campus
in consortium with
CE B U CI T Y ME DI CA L CE NT ER
COL L E GE OF NURSI NG
Dionisio Jakosalem Street, 6000, Cebu City, Cebu
Website: http://www.ctu.edu.ph Email: [email protected]
Phone: +6332 – 316 1987 or 316 5128

▪ You said you were frightened yesterday, how are you feeling right now?
➢ Using touch
o Providing appropriate forms of touch to reinforce caring feelings.
o Because tactile contacts vary among families, individual, and culture, the nurse
must be sensitive to the difference in attitudes and practices of clients and self.
➢ Restating or paraphrasing
o Actively listening for the client’s basic message and then repeating those thoughts
and feelings in similar words.
o This conveys that the nurse has listened and understood the client’s basic
message and also offers clients a clearer idea of what they have said.
▪ Example: I have trouble talking with strangers…. You find It difficult talking
to people you don’t now?
➢ Seeking clarification
o A method of making the client’s broad overall meaning of the message more
understandable. It is used when paraphrasing is difficult.
o Would you please say that again?
➢ Perception checking or seeking consensual validation
o A method similar to clarifying that verifies the meaning of specific words rather than
the overall meaning of a message
o Example: My husband never gives me any present…..
▪ You mean he has never given you a present for your birthday or Christmas?
Well not never, but he never thinks of giving me anything at any other
time…

➢ Offering self
o Suggesting one’s presence, interest or wish to understand the client without
making any demands or attaching conditions that the client must comply with to
receive the nurse’s attention
o I’ll stay with you until your daughter arrives
➢ Giving information
o Providing in a simple and direct manner specific, factual information the client may
or may not request. When information is not known, the nurse states this and
indicates who has it or when the nurse has obtained it.
▪ Example: I don’t know the answer to that, but I will find out from Mrs. King,
the nurse in charge.
➢ Acknowledging
o Giving recognition, in a non-judgmental way, of a change in behavior, an effort the
client has made, or a contribution to a communication.
o You washed and combed your hair today.
➢ Clarifying time and sequence
o Helping the client clarify an event, situation or happening relationship to time.
o I vomited this morning…. Was that after breakfast?
➢ Presenting reality
o Helping the client from differentiating from real to unreal
➢ Focusing
o Helping the client expand on and develop a topic of importance.
o It is important of the nurse to wait until the client finishes stating the main concern
before attempting to focus
o The focus may be an idea or a feeling, however, the nurse often emphasizes a
feeling to help the client recognize an emotion disguised behind words.
➢ Reflecting

20
 Republic of the Philippines
CE B U T E CHNOLOGI CA L U NI V E RSI T Y - M a i n Campus
in consortium with
CE B U CI T Y ME DI CA L CE NT ER
COL L E GE OF NURSI NG
Dionisio Jakosalem Street, 6000, Cebu City, Cebu
Website: http://www.ctu.edu.ph Email: [email protected]
Phone: +6332 – 316 1987 or 316 5128

o
Directing ideas, feelings, questions or content back to the clients to enable them
to explore their own ideas and feelings about the situation
▪ Example: What can I do?. What do you think would be helpful?
➢ Summarizing and Planning
o Stating the main point of a discussion to clarify the relevant points discussed. This
technique is useful at the end of the interview or to review a health teaching
session.
▪ Example: In a few days I’ll review what you have learned about the actions
and effects of your medication
FACTORS INFLUENCING COMMUNICATION PROCESS
1. Development
a. Knowledge of the client’s developmental stage will allow the nurse to modify the
message accordingly
2. Gender
a. From early age females and males communicate differently. girls tend to use
language to seek confirmation, minimize differences, and establish intimacy. Boys-
use language to establish independence and negotiate status within the group.
These differences continue into adulthood so that the same communication may
be interpreted differently by a man and a woman
3. Values and perception
a. Values are the standards that influence behavior, and perceptions are the personal
view of an event. Because each person has unique personality traits, values, and
life experiences, each will perceive and interpret messages and experiences
differently.
4. Personal space - Is the distance people prefer in interaction with others.
a. Intimate: touching to 11/2 feet
i. communication is characterized by body contact heightened sensations of
body heat and smell, and vocalizations that are low and is frequently used
by a nurse. E.g. body positioning of the client.
b. Personal: 11/2 feet to 4 feet
i. is less overwhelming than intimate distance: voice tones are moderate;
body heat and smell are less noticed.
c. Social: 4 – 12 feet
i. characterized by a clear visual perception of the whole person and eye
contact is increased. Communication is more formal and is limited to seeing
and hearing.
d. Public: 12-15 feet
i. requires loud, clear vocalization with careful enunciation, although faces
and forms of people are seen at public distance individuality is lost
5. Territoriality
a. Is a concept of the space and things that an individual considers as belonging to
the self
6. Roles and relationship
a. The roles of the sender and receiver affect the communication process. Choices
of words, sentence structure and tone of voice vary considerably from role to role
7. Environment
a. People usually communicate most effectively in a comfortable environment.
8. Congruence

21
 Republic of the Philippines
CE B U T E CHNOLOGI CA L U NI V E RSI T Y - M a i n Campus
in consortium with
CE B U CI T Y ME DI CA L CE NT ER
COL L E GE OF NURSI NG
Dionisio Jakosalem Street, 6000, Cebu City, Cebu
Website: http://www.ctu.edu.ph Email: [email protected]
Phone: +6332 – 316 1987 or 316 5128

a. Congruent communication, the verbal and non-verbal aspect match. If there is

incongruence usually the nonverbal expression is usually the one with true
meaning
9. Interpersonal attitudes
a. Caring and warmth
b. Respect
c. Acceptance
Interpersonal attitudes convey beliefs thoughts and feelings about people and events.
I. Convey a feeling of emotional closeness, in contrast to an impersonal approach
II. An attitude that emphasizes the other person’s worth and individuality
III. Emphasizes neither approval or disapproval. The nurse is willingly receiving the client’s
honest feelings except if the client is harmful to self and others.

COMMUNICATING WITH VULNERABLE POPULATIONS

➢ Clients who are hearing impaired
o Determine if client reads lips. If so, face the client and reduce background noise to
a minimum.
o If client is using a hearing aid, check to see that it is in working condition.
o Always face the client.
o Speak at a normal pace in a normal tone of voice.
o Focus on a non-verbal cue of the client.
o Use gestures and facial expressions to reinforce verbal messages
o Provide pen and paper to facilitate communication if client is literate.
➢ Client who are visually impaired
o When speaking, always face them as if they were sighted.
o Follow the cues of the client in order to allow as much independence as possible
o Look directly at the client
o Speak in a normal tone of voice, it is demeaning to yell
o Ask permission before touching the client
o Orient the client to the immediate environment
➢ Client who are aphasic
o Assess the client’s usual method of communication, adapt the interaction to
accommodate the client’s abilities
o Use a written interview format, letter boards or yes or no cards
o Allow additional time for client’s responses
o Do not answer for the client
o Use closed (one-word response) questions when possible
o Repeat or rephrase the comment if client does not understand
o Speak directly to the client not to the intermediary
o To reinforce verbal message, use facial expressions, gestures, and voice tone.
➢ Unconscious clients
o Assume the client can hear
o Talk to the client in a normal tone of voice
o Engage in a Speak to the client before touching
o Use touch to communicate a sense of presence
o normal conversational topic as with any client. Use pictures and symbols
o Use closed rather than open ended questions
o Give the client time to respond

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 Republic of the Philippines
CE B U T E CHNOLOGI CA L U NI V E RSI T Y - M a i n Campus
in consortium with
CE B U CI T Y ME DI CA L CE NT ER
COL L E GE OF NURSI NG
Dionisio Jakosalem Street, 6000, Cebu City, Cebu
Website: http://www.ctu.edu.ph Email: [email protected]
Phone: +6332 – 316 1987 or 316 5128

➢ Confused client
o Maintain appropriate eye contact
o Keep background noise to a minimum
o Use simple, concrete words and sentences
➢ Angry clients
o Use caution when communicating with a client who has a history of violent
behaviour or poor impulse control
o Do not turn your back on a client. Arrange the setting so that the client is not
between you and the door to the room
o Focus on the client’s body language
o Be alert for physical indications of impending aggression, narrowed eyes, clenched
jaw, clenched fist, or a loud tone of voice
o Model the expected behaviour by lowering your tone of voice
o Stay within your client’s line of vision
o Do not use touch

GENERAL GUIDELINES
➢ Respecting our differences
o Culture influences the way a person processes information.
o To determine which channel: visual, auditory, or kinesthetics - is your dominant
mode.
o When talking to client with diverse cultures, it is especially important to attend to
non-verbal messages.
▪ Eye contacts, voice volume and tone, facial expressions and gestures can
be used to enhance communication with individual of every cultural
background

23
 Republic of the Philippines
CE B U T E CHNOLOGI CA L U NI V E RSI T Y - M a i n Campus
in consortium with
CE B U CI T Y ME DI CA L CE NT ER
COL L E GE OF NURSI NG
Dionisio Jakosalem Street, 6000, Cebu City, Cebu
Website: http://www.ctu.edu.ph Email: [email protected]
Phone: +6332 – 316 1987 or 316 5128

Learning Activity
In one long size of bond paper via pdf form, create an infographic about yourself akin to the roles
and responsibilities of a nurse. THERE ARE NO RULES, JUST BE CREATIVE AND FIT ALL
THE CONTENTS TOGETHER IN A SINGLE LONG SIZE BOND PAPER ONLY.
1. Infographic File Name: REZABA (just your family name)
2. In your google drive, make a folder indicating your section
a. Folder Name: 1A-LA1-Funda / 1B-LA1-Funda
b. And upload your infographic outputs afterward
3. Send it by section thru this email [email protected]
4. Deadline: January 31, 2025 8 pm
a. Late outputs: deduction of 5 points
b. No outputs: automatic 0 score

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