CHAPTER I - HISTORICAL AND CONTEMPORARY OTHER THEMES COMMON TO DEFINITIONS OF

NURSING PRACTICE NURSING:

FLORENCE NIGHTINGALE • Nursing is CARING.

• Nursing is an ART.
• Known during the Crimean war as the “Lady
• Nursing is a SCIENCE.
with the Lamp”
• Nursing is CLIENT-CENTERED.
• Recognized as nursing’s first scientist-theorist
• Nursing is HOLISTIC.
for her work “Notes on Nursing: What it is, and
What it is not.” • Nursing is ADAPTIVE.
• “Founder of Modern Nursing” • Nursing is concerned with HEALTH
PROMOTION, HEALTH MAINTENANCE &
CLARA BARTON HEALTH RESTORATION.
• Nursing is a HELPING PROFESSION
• School teacher who volunteered as a nurse
during the American civil war. RECIPIENTS OF NURSING
• Noted in her role for establishing American
Red Cross. • CONSUMERS
o individual, group of people or
• Pursued to ratify the Treaty of Geneva
community that uses a service or
LILIAN WALD commodity.
• PATIENT
• “Founder of Public Health Nursing.”
o from the Latin word patiens meaning to
• Founded the Henry Street Settlement and
“suffer or to bear”
Visiting Nurse Service
o traditionally known as someone
LAVINIA L. DOCK receiving health care.
• CLIENT
• a feminist, prolific writer, political activist, and o person who engages in the advice or
suffragette services of another who is qualified to
• Campaigned for legislation to allow nurses to provide this service.
control their profession.
SCOPE OF NURSING
MARGARET HIGGINS SANGER
1. Promoting health and wellness
• school nurse activist 2. Preventing illness
• founder of Planned Parenthood 3. Restoring health
• Opened the first birth-control clinic in Baltimore 4. Care of the dying
in 1916.
STANDARDS OF CLINICAL NURSING PRACTICE
MARY BRECKINRIDGE
I. STANDARDS OF CARE
• notable pioneer nurse who established the a. Assessment
Frontier Nursing Service b. Diagnosis
• Started one of the first midwifery training c. Outcome Identification
schools in the US d. Planning
e. Implementation
DEFINITIONS OF NURSING
f. Evaluation
FLORENCE NIGHTINGALE - act of utilizing the II. STANDARDS OF PROFESSIONAL
environment to assist the patient in his/her recovery PERFORMANCE
a. Quality of care
VIRGINIA HENDERSON - assist the individual, sick or
b. Performance appraisal
well
c. Education
CANADIAN NURSES ASSOCIATION - act of dynamic d. Collegiality
caring, helping relationship, in which the nurse assists e. Ethics
the clients to achieve and obtain optimal health. f. Collaboration
g. Research
AMERICAN NURSES ASSOCIATION - diagnosis and h. Resource utilization
treatment of human responses to actual or potential
health problems
ROLES AND FUNCTIONS OF A NURSE CHAPTER 2 – NURSING EDUCATION AND RESEARCH

• Caregiver TYPES OF EDUCATIONAL PROGRAMS IN NURSING

• Communicator
1. LICENSED PRACTICAL (VOCATIONAL) NURSING
• Teacher
PROGRAMS
• Client advocate
• Usually, last 9 to 12 months and
• Counsellor
provide both classroom and clinical
• Change agent experiences.
• Leader • At the end of the program, the graduate
• Manager takes the NCLEX-PN to obtain a license
• Case manager as a practical or vocational nurse.
• Research consumer 2. REGISTERED NURSING PROGRAMS
NURSING AS A PROFESSION • A diploma program usually 3 years in
duration.
PROFESSION • With longer hospital-based educational
programs that provide a rich clinical
• occupation that requires extensive education
or a calling that requires special K.S.P. experience for nursing students
3. ASSOCIATE NURSING PROGRAMS
(Knowledge, Skill and Preparation) It is highly
distinguished from any other kinds of • In the US, it is a 2-yr. education
occupations because: program for nursing students in
a. Its requirement of prolonged community colleges.
specialized training is pertinent to the • At the end of 2 years, the student was
role to be performed to be awarded an associate degree in
b. Orientation of an individual towards nursing and be eligible to take the state
service, either to a community or to an board examination for nurse licensure.
organization. • Degree awarded is ADN.
c. Ongoing research 4. BACCALAUREATE NURSING PROGRAMS
d. Code of ethics • 4 to 5 years in duration; but previously
e. Autonomy 5 years (3-yr. diploma program and
f. Professional organization additional 2 years in liberal arts)
• Degree awarded is BSN.
PROFESSIONALISM • NCLEX-RN.
• refers to professional character, spirits and GRADUATE NURSING EDUCATION
methods.
• a set of attributes or a way of life that implies ➢ continuing education after finishing a
responsibility and commitment. baccalaureate degree program

PROFESSIONALIZATION REQUIREMENTS FOR ADMISSION IN GRADUATE

PROGRAMS
• process of being professional/acquiring
characteristics needed to be professional 1. Must hold a baccalaureate program
2. Must be a registered nurse.
SELECTED EXPANDED CAREER ROLES FOR NURSES 3. Must give evidence of scholastic ability.
4. Must demonstrate satisfactory achievement on
• Nurse practitioner
a qualifying examination.
• Clinical nurse specialist
5. Must have letters of recommendation.
• Nurse anesthetist
• Nurse midwife EXAMPLES OF GRADUATE PROGRAMS FOR NURSING
• Nurse researcher
MASTERS PROGRAMS
• Nurse administrator
• Nurse educator 1. Master of Arts in Nursing (MAN)
• Nurse entrepreneur 2. Master of Science in Nursing (MSN)
3. Master in Nursing (MN)
4. Master of Arts in Education (MaED)

DOCTORAL PROGRAM

1. Doctor of Philosophy in Nursing (PhD)

NURSING RESEARCH 3. FEASIBILITY
• pertains to the availability of the
➢ used to improve client care and enhance
material and human resources needed
nursing’s scientific knowledge base
to investigate a research problem or
2 MAJOR APPROACHES IN NURSING RESEARCH question.
4. DEPENDENT VARIABLE
1. QUANTITATIVE RESEARCH
• behavior, characteristic or outcome
• progresses to systematic logical steps that the researcher wishes to explain or
according to a specific plan to collect a predict.
numerical information, often under 5. INDEPENDENT VARIABLE
conditions of considerable control
• presumed cause of influence on the
analyzed using statistical procedures.
dependent variable
• uses POSITIVISM and is often viewed
6. POPULATION
as a “HARD-SCIENCE” that uses
• all the possible members of the group
deductive reasoning and measurable
who meet the criteria for the study.
human experience
7. SAMPLE
2. QUALITATIVE RESEARCH
• segment of the population from whom
• often associated with naturalistic
the data will be actually collected.
inquiry, which explores the subjective
8. RELIABILITY
and complex experiences of human
• degree of consistency with which an
beings.
instrument measures a concept or
• investigates through careful collection
variable.
and analysis of subjective and narrative
9. VALIDITY
materials.
• degree to which an instrument
• uses inductive form of reasoning
measures what it is supposed to
RIGHT OF HUMAN SUBJECTS measure.
10. OPERATIONAL DEFINITIONS
1. Right not to be harmed • definitions that specify the instruments
2. Right to full-disclosure or procedures by which concepts will
3. Right to self-determination be measured.
4. Right of privacy and confidentiality
CHAPTER 3 - NURSING THEORIES AND CONCEPTUAL
RESEARCH DESIGN FRAMEWORKS
➢ overall plan for answering the research THEORY
questions or testing the research hypothesis.
➢ supposition or system of ideas that is proposed
3 MAJOR TYPES OF RESEARCH DESIGN to explain a given phenomenon
1. EXPERIMENTAL DESIGN ➢ One that has been repeatedly tested or is
• investigator manipulates the widely accepted and can be used to make
independent variable by administering predictions about natural phenomena.
an experimental treatment to some (American Heritage Dictionary)
subjects. TERMS RELATED TO NURSING THEORY
2. QUASI-EXPERIMENTAL DESIGN
• investigator manipulates the CONCEPTS
independent variable but without ➢ building blocks of theories
either the randomization or control
that characterizes true experiments. CONCEPTUAL FRAMEWORK
3. NON-EXPERIMENTAL DESIGN
➢ group of related ideas, statements or concepts.
• the investigation does no manipulation
on the independent variable PARADIGM

OTHER RESEARCH TERMS TO REMEMBER ➢ refers to a pattern of shared understandings

and assumptions about reality and the world
1. SIGNIFICANCE
• with potential to contribute to nursing NURSING THEORIES
science
ENVIRONMENTAL THEORY
2. RESEARCH ABILITY
• means that the problem can be ➢ formulated by Florence Nightingale.
subjected to scientific investigations. ➢ the act of utilizing the environment of the
patient to assist him in his recovery.
 ➢ linked health with 5 environmental factors: III. Interacts continuously and creatively with the
o pure or fresh air environment.
o light, especially direct sunlight, IV. Behaves as a totality.
o efficient drainage, V. Participates creatively in change.
o pure water,
OREM’S SELF-CARE DEFICIT THEORY
o cleanliness.
➢ Formulated by Dorothea Orem which Includes 4
INTERPERSONAL RELATIONS MODEL
related concepts:
➢ introduced by Hildegard Peplau. 1. SELF-CARE
➢ states that the nurse-client relationships evolve • activities an individual performs
4 phases: independently throughout life to
1. ORIENTATION promote and maintain personal well-
• client seeks help, and nurse assists the being.
client to understand the problem and 2. SELF-CARE AGENCIES
the extent of the need for help. • individual’s ability to perform self-care
2. IDENTIFICATION activities.
• a phase where client assumes 3. SELF-CARE REQUISITES
dependence, interdependence and • also called “self-care needs”
independence in relation to the nurse. • measures or actions taken to provide
3. EXPLOITATION self-care.
• client derives full value from what the 4. THERAPEUTIC SELF-CARE DEMANDS
nurse offers through the relationship. • all self-care activities required to meet
4. RESOLUTION the known self-care demand
• old goals and needs are set aside and
new ones are adopted

HENDERSON’S 14 HUMAN FUNDAMENTAL NEEDS

➢ Given by Virginia Henderson.

1. Breathe normally.
2. Eat and drink adequately.
3. Eliminate body wastes.
4. Move and maintain desirable postures.
5. Sleep and rest.
6. Select suitable clothes-dress and undress.
7. Maintain body temperature within normal
range by adjusting clothing and modifying
environment ➢ Focus is to enhance the patient's ability for
8. Keep the body clean and well-groomed and self-care and extend this ability to care for their
protect the integument dependents (Orem, 2005).
9. Avoid dangers in the environment and avoid ➢ Stated that self-care deficit results when self-
injuring others care agency is not adequate to meet the
10. Communicate with others in expressing known self-care demand.
emotions, needs, fears, or opinions. ➢ EXPLAINS 5 WAYS OF HELPING/ASSISTING AN
11. Worship according to one's faith. INDIVIDUAL:
12. Work in such a way that there is a sense of 1. Acting or doing
accomplishment. 2. Guiding
13. Play or participate in various forms of 3. Teaching
recreation. 4. Supporting
14. Learn, discover, or satisfy the curiosity that 5. Providing an environment that promotes an
leads to normal development and health and individual’s abilities to meet current and future
use the available health facilities demands

ROGER’S SCIENCE OF UNITARY HUMAN BEINGS KING’S GOAL ATTAINMENT THEORY

➢ presented by Martha Rogers ➢ Presented by Imogene King.

➢ According to Rogers, unitary man is: ➢ Describes the nature of and standard for nurse-
I. An irreducible, 4-demensional energy field patient interactions that leads to goal-
identified by a pattern. attainment – that nurses purposefully interact
II. Manifests characteristics different from the sum and mutually set, explore, and agree to means
of its parts. to achieve goals.
 ➢ Represents outcomes. ➢ Effective caring promotes health and individual
or family growth.
NEUMAN’S SYSTEMS MODEL
➢ Caring responses accept person not only as he
➢ Given by Betty Neuman or she is now but as what he or she may
become.
➢ A caring environment is one that offers the
development of potential while allowing the
person to choose the best action for himself or
herself at a given point in time.
➢ Caring is more “healthogenic” than is curing. A
science of caring is complementary to the
science of curing.
➢ The practice of caring is central to nursing.

PARSE’S HUMAN BECOMING THEORY

➢ Given by Rosemarie Rizzo Parse.

➢ PROPOSED 3 ASSUMPTIONS FOR HUMAN
ROY’S ADAPTATION MODEL BECOMING:
1. Human becoming is freely choosing
➢ Formulated by Sister Callista Roy
personal meaning in situations in
➢ She defined ADAPTATION as process and
intersubjective processes of relating
outcome whereby the thinking feeling person
value priorities.
uses conscious awareness and choice to create
2. Human becoming is cocreating rhythmic
human and environmental integration.
patterns or relating in mutual process
➢ Focuses on the increasing complexity of person
with the universe.
and environment and self-organization, and on
3. Human becoming is contranscending
the relationship between and among the
multidimensionally with the emerging
persons, universe, and what can be considered
possibles
a supreme being or God.
➢ THE GOAL OF THIS MODEL IS TO ENHANCE LIFE
PROCESSES THROUGH ADAPTATION IN 4
ADAPTIVE MODES:
1. Physiologic mode
2. Self-concept mode
3. Role function mode
4. Interdependence mode

LEININGER’S CULTURAL CARE DIVERSITY AND

UNIVERSALITY THEORY

➢ Theorized by Madeleine Leininger

➢ States that CARE is the essence of nursing and
the dominant, distinctive and unifying feature
of nursing.
➢ She emphasized that human caring, although a
universal phenomenon, varies among cultures
in its expressions , processes, and patterns; it is
largely culturally-derived.

WATSON’S HUMAN CARING THEORY

➢ Given by Jean Watson.

➢ Believes that the practice of caring is central to
nursing: it is the unifying focus for practice.

WATSON’S ASSUMPTIONS OF CARING:

➢ Caring can be effectively demonstrated and

practiced only interpersonally.
➢ Caring consists of carative factors that result in
the satisfaction of certain human needs.
CHAPTER 4 LEGAL ASPECTS IN NURSING NURSING PRACTICE ACTS

LAW • RA 9173 - PHILIPPINE NURSING ACT OF 2002

o law that regulates the nursing
• defined as “the sum total” of rules and
profession
regulations by which a society is governed.
CONTRACTUAL ARRANGEMENTS IN NURSING
FUNCTIONS OF LAW IN NURSING
• CONTRACTUAL OBLIGATIONS
1. Provides framework for establishing which
o refer to the nurse’s duty of care, that is,
nursing actions in the care of clients are legal.
to render care, established by the
2. It differentiates the nurse’s responsibilities
presence of an expressed or implied
from those of other health professionals.
contract.
3. It helps establish the boundaries of
• RESPONDEAT SUPERIOR OR “LET THE MASTER
independent nursing action.
ANSWER”
4. It assists in maintaining a standard of nursing
o a doctrine where the employer assumes
practice by making nurses accountable under
responsibility for the conduct of the
the law
servant (employee) and can also be
COMMONLY-USED TERMS IN LEGAL ASPECTS OF held responsible for the malpractice of
NURSING the employee.
• RES IPSA LOQUITUR OR “THE THING SPEAKS
• PLAINTIFF
FOR ITSELF”
o the one who claims that his/her legal
o Refers to situations when it's assumed
rights have been infringed
that a person's injury was caused by
• DEFENDANTS the negligent action of another party
o one or more persons or entities accused because the accident was the sort that
of infringement of rights. wouldn't occur unless someone was
• BURDEN OF PROOF negligent.
o the duty of proving an assertion or
wrongdoing. INFORMED CONSENT
• EXPERT WITNESS
• agreement by a client to accept a course of
o has special training, experience, or skill
treatment or a procedure after being provided
in relevant area
complete information.
o allowed by the court to offer an
opinion on some issue within their area GENERAL GUIDELINES THAT MUST BE DISCLOSED IN
of expertise AN INFORMED CONSENT
• CREDENTIALING
1. The purpose/s of the treatment
o process of determining and
2. What the client can expect to feel or experience
maintaining competence in the nursing
3. The intended benefits of the treatment
practice.
4. Possible risks or negative outcomes of the
• LICENSE
treatment
o a legal permit that a government
5. Advantages and disadvantages of possible
agency grants to individuals to engage
treatments (including no treatment)
in the practice of a profession
o to use a particular title. 2 TYPES OF CONSENT
• LIABILITY
1. EXPRESS CONSENT
o quality or state of being legally
o either oral or written agreement.
responsible for one’s obligations and
2. IMPLIED CONSENT
actions
o exists when the individual’s nonverbal
o to make financial restitution for
behavior indicates agreement.
wrongful acts.
• RIGHT Obtaining informed consent for specific medical and
o a privilege or fun given fundamental surgical treatments is the responsibility of the person
power to which an individual is entitled who is going to perform the procedure
unless it is revoked by law or given
MAJOR ELEMENTS OF INFORMED CONSENT
voluntarily.
• RESPONSIBILITY • It must be given voluntarily
o obligation associated with a right • It must be given by a client or individual with
the capacity and competence to understand
 • The client or individual must be given enough • FALSE IMPRISONMENT
information to be the ultimate decision-maker. o unjustifiable detention of a person
without legal warrant to confine the
EXCEPTIONS OF PEOPLE WHO CAN’T PROVIDE
person.
INFORMED CONSENT:
• INVASION OF PRIVACY
1. Minors o a direct wrong of personal nature.
2. Persons who are unconscious or injured in such • DEFAMATION
a way that they are unable to give consent. o a communication that is false, or made
3. Mentally-ill persons who have been judged by with a careless disregard for the truth,
professionals to be incompetent and results to the injury to the
reputation of the person.
AREAS OF POTENTIAL NURSING LIABILITY
EXAMPLES OF DEFAMATION:
• CRIME • LIBEL
o an act of committed violation of public o defamation by means of print,
law and punishable by fine or writing, or pictures.
imprisonment. • SLANDER
• FELONY o defamation by the spoken
o a crime of serious nature, such as word, stating unprivileged or
murder. false words by which a
• MANSLAUGHTER reputation is damaged
o second degree murder. UNPROFESSIONAL CONDUCT
• MISDEMEANOR
o offense of a less-serious nature • includes incompetence or gross negligence,
o usually-served by a fine or short-term conviction, for practicing without a license,
imprisonment or both. falsification of client records, and illegally
• TORTS obtaining, using, or possessing controlled
o civil wrong committed against a person substances.
or person’s property.
GOOD SAMARITAN ACTS
CLASSIFICATION OF TORTS
• laws designed to protect health-care providers
UNINTENTIONAL TORTS EXAMPLES who provide assistance at the scene of an
emergency against claims of malpractice
• NEGLIGENCE
o a misconduct or practice that is below GUIDELINES FOR NURSES IN RENDERING EMERGENCY
the standard expected of an ordinary, CARE
reasonable and prudent person.
• Limit actions to those normally considered first
• MALPRACTICE
aid, if possible.
o a professional negligence, that is,
• Do not perform actions that you do not know
negligence that occurred while the
how to do.
person was performing as a
• Offer assistance, but do not insist.
professional
• Have someone call or go for additional help.
6 ELEMENTS FOR NURSING MALPRACTICE TO BE • Do not leave the scene until the injured person
PROVEN leaves or another qualified person takes over.
• Do not accept any compensation
1. Duty
2. Breach of duty
3. Foreseeability
4. Causation
5. Harm or injury
6. Damages

INTENTIONAL TORTS EXAMPLES

• ASSAULT
o attempt or threat to touch another
person unjustifiably.
• BATTERY
o willful touching of a person that may or
may not cause harm.
CHAPTER 5 VALUES, ETHICS AND ADVOCACY BIOETHICS

VALUES • ethics applied to life.

• freely-chosen, enduring beliefs or attitudes NURSING ETHICS

about the worth of a person, object, idea or
• refers to ethical issues that occur in the nursing
action.
practice.
VALUE SET
MORALITY
• small group of values held by an individual.
• refers to private, personal standards of what is
BELIEFS (OR OPINIONS) right and wrong in conduct, character and
attitude.
• are interpretations or conclusions that people
accept as true. UTILITARIANISM

ATTITUDES • views a good act that brings the best and least
harm to the greatest number of people.
• mental positions or feelings toward a person,
object, or idea MORAL PRINCIPLES

ESSENTIAL NURSING VALUES AND BEHAVIORS 1. AUTONOMY

o the right to make one’s own decisions.
• ALTRUISM
2. NONMALEFICENCE
o concern for the welfare and well-being
o the duty to “do no harm”.
of others.
3. BENEFICENCE
• AUTONOMY o means “doing good”.
o right to self-determination. 4. JUSTICE
• HUMAN DIGNITY o often referred to as “fairness”
o respect for the inherent worth and 5. FIDELITY
uniqueness of individuals and o to be faithful in agreements and
populations. promises.
• INTEGRITY 6. VERACITY
o acting in accordance with an o refers to telling the truth.
appropriate code of ethics and 7. ACCOUNTABILITY
accepted standards of practice. o answerable to one’s self and others for
• SOCIAL JUSTICE own actions.
o upholding moral, legal and humanistic 8. RESPONSIBILITY
principles o the specific accountability or liability
FOUR (4) IMPORTANT VALUES OF NURSING associated with the performance of
duties of a particular role.
1. Strong commitment to service.
2. Belief in the dignity and worth of each person. CODE OF ETHICS
3. Commitment to education. • formal statement of a group’s ideals and
4. Professional autonomy values
VALUES CLARIFICATION • as higher requirements than legal standards,
and is also a set of principles that:
• process by which people identify, examine, and o Shared by members of the group
develop their own individual values. o Reflects their moral judgments over
THE VALUING PROCESS time
o Serves as a standard for their
1. Choosing (Beliefs are chosen) professional actions
2. Prizing (Chosen beliefs are prized)
3. Acting (Chosen beliefs are enacted INTERNATIONAL COUNCIL OF NURSES’ CODE OF
ETHICS
ETHICS
• Part 1 – Preamble (states the 4 fundamental
• method or inquiry that helps people to responsibilities of the nurses)
understand the morality of human behavior. • Part 2 – The Code (states the 4 principal
• Practices or beliefs of a certain group. elements that outlines the standards of ethical
• Expected standards of moral behavior of a conduct.
particular group.
4 PRINCIPAL ELEMENTS IN ICN CODE OF ETHICS:

1. Nurses and the people

2. Nurses and practice
3. Nurses and the profession
4. Nurses and co-workers

THE PHILIPPINE PATIENTS’ BILL OF RIGHTS

• Right to humane care and treatment

• Right to informed consent
• Right to privacy and confidentiality
• Right to information
• Right to choose health-care provider and facility
• Right to self-determination
• Right to religious belief
• Right to medical records
• Right to leave
• Right to refuse in participating to medical
research
• Right to correspondence to receive visitors.
• Right to express grievances.
• Right to inform the patient about his/her rights
or obligations.

SPECIAL ETHICAL ISSUES

• AIDS (Acute immune deficiency syndrome)

• Abortion
• Organ transplantation
• Euthanasia
a. Passive euthanasia
b. Active euthanasia

ADVOCACY

• ADVOCATE
o one who expresses or defends the
cause of another.
• CLIENT ADVOCATE
o one who advocate for client’s rights
CHAPTER 6 HEALTHCARE DELIVERY SYSTEM • Pharmacist

HEALTHCARE SYSTEM • Physical therapist

• It is the totality of services offered by all health • Physician

disciplines.
• Physician assistant
• TYPES OF HEALTH CARE SERVICES:
• Podiatrist
1. Primary Prevention
• Respiratory therapist
2. Secondary Prevention
• Social worker
3. Tertiary Prevention
• Spiritual support person
TYPES OF HEALTHCARE AGENCIES AND SERVICES
• Unlicensed assistive personnel
• Public Health
FACTORS AFFECTING HEALTH CARE DELIVERY
• Physicians’ offices
• Increasing number of elderly
• Ambulatory care centers
• Advances in technology
• Occupational health clinics
• Economics
• Hospitals
• Women’s health
• Rural Care
• Uneven distribution of services
• Crisis centers
• Access to healthcare
• Mutual support and self-help groups
• The homeless and the poor
• Extended Care (long term) care facilities
• Demographic changes
• Hospice services

PROVIDERS OF HEALTH CARE

FRAMEWORKS FOR CARE
• Nurse
• Managed care – a healthcare system with goals
• Alternative care provider to provide cost-effective, quality care that focuses on the
decreased costs and improved outcomes for groups of
• Dentist
clients.
• Dietitianor Nutritionist
• Case management – range of models for
• Occupational therapist integrating healthcare services for individuals or groups.

• Paramedical technologist
• Patient-focused care – brings all services and PRIMARY CARE
care providers to the clients.
It is the provision of integrated, accessible healthcare by
• Differentiated practice – makes the best possible clinicians who are accountable for addressing a large
use of nursing personnel based on their educational majority of personal health services, developing a
preparation and resultant skill sets. sustained partnership with patients, and practicing in the
context of family and community. (IOM, 1194, p.15)
• Shared governance – focuses in encouraging
participation in decision-making at all levels of the COMMUNITY-BASED HEALTH CARE

organization.
A PHC system that provides health-related services

• Case method – or “total care”; here 1 nurse is within the context of people’s daily lives –that is, in places

assigned and is responsible for the comprehensive care where people spend their time, for example, in the

of a group of clients during an 8-12 hour shift. home, in shelters, in long-term care residences, at work,
in schools, in senior citizens’ centers, in ambulatory
• Functional Method – focuses on the jobs to be
settings, and in hospitals.
completed.
COLLABORATIVEHEALTHCARE
• Team nursing – delivery of an individualized
nursing care to clients by a team led by a professional Collaboration – a collegial working relationship with

nurse. another health care provider in the provision of patient

care.
• Primary Nursing – a system in which one nurse is
responsible for the total care of a number of clients 24/7. COMPETENCIES BASIC TO COLLABORATION:

➢ Communication

➢ Mutual respect and trust

CHAPTER 7 COMMUNITY-BASED NURSING & CARE ➢ Decision-making

CONTINUITY CONTINUITY OF CARE

PRIMARY HEALTHCARE It is the coordination of healthcare services by healthcare

Defined as essential health care based on practical, providers for clients moving from one healthcare setting

scientifically-sound and socially-acceptable methods and to another and between and among healthcare

technology made universally accessible to individuals professionals.

and families in the community, through their full To provide continuity of care, nurses need to accomplish
participation and at a cost that the community and the ff:
country can afford to maintain at every stage of their
➢ Initiate discharge planning for all clients, when
development in the spirit of SELF-RELIANCE & SELF-
they are admitted to any healthcare setting.
DETERMINATION. (WHO, 1978, P.35)
➢ Involve the client and the client’s family or Chapter 10 HEALTH, WELLNESS, AND ILLNESS
support persons in the planning process.
Definitions of Health
➢ Collaborate with other health care professionals
 Traditionally, it has been defined as the presence or
as needed.
absence of a disease.
DISCHARGE PLANNING  It is a state of well-being and using every power the
individual possesses to the fullest extent (F. Nightingale)
It is the process of preparing a client to leave one level of
 It is a state of complete physical, mental, and social
care for another within or outside the current healthcare
well-being, and not merely the absence of disease or
agency.
infirmity (WHO,1948)
Effective discharge planning involves:
 Ability to maintain roles. (T. Parsons, 1951)
1. Ongoing assessment to obtain client’s
WELLNESS
information about the client’s ongoing needs.
2. Statements of nursing diagnoses  Simply a state of well-being.

3. Plans to ensure the client’s and the caregivers’ BASIC CONCEPTS OF WELLNESS
needs are met.
1. Self-responsibility
REFERRALS 2. An ultimate goal

The REFERRAL PROCESS is a systematic problem-solving 3. A dynamic, growing process

approach that helps clients to use resources that meet 4. Daily decision-making in the areas of nutrition

their healthcare needs. 5. Stress management

6. Physical fitness
Home care referrals are often made before discharge for
7. Preventive health care
the ff. clients:
8. Emotional health and other aspects of health
➢ Elders 9. Whole being of the individual

➢ Children with complex conditions 7 COMPONENTS OF WELLNESS

➢ Frail persons who live alone 1. Physical

2. Social
➢ Those who lack or have a limited support system
3. Emotional
➢ Those having a caregiver whose health is failing 4. Intellectual

➢ Those whose home presents barriers to their 5. Spiritual

safety. 6. Occupational
7. Environmental

WELL-BEING
 It is a subjective perception of vitality and feeling
well…can be described objectively, experienced, and
measured. (Hood and Leddy, 2002, p.264)

MODELS OF HEALTH AND WELLNESS

CLINICAL MODEL

 People are viewed as physiologic systems with related

functions and health is identified by the absence of
signs of disease or injury.

ROLE PERFORMANCE MODEL AGENT-HOST ENVIRONMENT MODEL

 Here, health is defined in the individual’s ability to  Also called the ecologic model.

fulfill societal roles, that is, to perform work.  Used primarily in predicting illness rather than in

 According to this model, people who can fulfill their promoting wellness. It has 3 dynamic interactive

roles are healthy even if they appear clinically-ill. elements: AGENT, HOST, ENVIRONMENT.

ADAPTIVE MODEL

 The focus is ADAPTATION.

 In this model, health is a creative process; disease is a

failure in adaptation or maladaptation.

EUDEMONISTIC MODEL
HEALTH-ILLNESS CONTINUA
 Health is seen as a condition of actualization or
 Health and illness or disease can be viewed as
realization of a person’s potential.
opposite ends of a healthcontinuum.
 In this model, highest aspiration is actualization;
 Used to measure a person’s perceived level of
illness is a condition that prevents self-actualization.
wellness.

 Ex. 1. Dunn’s high-level wellness grid 2. Travis’s illness-

wellness continuum

DUNN’S HIGH-LEVEL WELLNESS GRID

 HEALTH LOCUS OF CONTROL MODEL

 Locus of control – a concept from social learning

theory that nurses can use to determine whether clients
are likely to take action regarding health.

ROSENSTOCK’S AND BECKER’S HEALTH BELIEF MODELS

 Rosenstock proposed a health belief model intended

to predict which individuals would or would not use
TRAVIS’S ILLNESS-WELLNESS CONTINUUM
preventive measures as screening for early detection of
cancer.
 Becker modified the health belief model to include
these components: individual perceptions, modifying
factors, and variables likely to affect after initiating
action.

Individual perceptions
DIFFERENTIATING HEALTH STATUS, BELIEFS, AND
 Perceived susceptibility
BEHAVIOR
 Perceived seriousness
 Health status – state of health of an individual at a  Perceived threat
given time.
Modifying factors
 Health beliefs – concepts about health that an
individual believes is true.  Factors that modify a person’s perceptions include the

 Health behaviors – the actions people take to following:

understand their health state, maintain an optimal state

1. Demographic variables
of health, prevent illness and injury, and reach their
2. Sociopsychologic variables
maximum physical and mental potential.
3. Structural variables

VARIABLES INFLUENCING HEALTH STATUS, BELIEFS, AND 4. Cues to action

PRACTICES
Likelihood of action

Internal variables - Include biologic, psychologic, and

 Perceived benefits of the action
cognitive dimensions. - Described as “nonmodifiable”
 Perceived barriers to action
External variables - Includes the physical environment,
standards of living, family and cultural beliefs, and social ADHERENCE - Extent to which an individual’s behavior

support networks. (for example, taking medications, following diets or

making lifestyle changes) coincides with medical or
HEALTH BELIEF MODELS
health advice.
 Factors influencing adherence reduction of capacities or shortening of the normal life
span.
 Client motivation to become well
 Degree of lifestyle change necessary CLASSIFICATION OF ILLNESS

 Perceived severity of the healthcare problem

 Acute illness – typically characterized by severe
 Value placed on reducing the threat of illness
symptoms of relatively short duration; symptoms
 Difficulty in understanding and performing specific
appear abruptly and disappears quickly, depending on
behaviors
the cause, and may or may not require help from health
 Degree of inconvenience of the illness itself or of the professionals.
regimen
 Chronic illness – lasts for an extended period, usually
 Beliefs that the prescribed therapy or regimen will or 6 months or longer, and often, for the person’s life.
will not help.
TERMS RELATED TO ILLNESS & DISEASE
 Complexity, side-effects and duration of therapy.
 Specific cultural heritage that make adherence  Remission – symptoms disappear.
difficult.  Exacerbation – symptoms reappear.
 Degree of satisfaction and quality and type of  Illness behavior – a coping mechanism that involves
relationship with the health care providers. ways in which individuals describe, monitor, and
 Overall cost of prescribed therapy. interpret their symptoms, take remedial actions, and
use the health care system.
When a nurse identifies nonadherence, it is important
to take the ff. steps: 5 STAGES OF ILLNESS ACCORDING TO SUCHMAN

 Establish why the client is not following the regimen. 1. Symptom experiences
 Demonstrate caring. 2. Assumption of the sick role
 Encourage healthy behaviors through positive 3. Medical care contact
reinforcement. 4. Dependent client role

 Use aids to reinforce teaching. 5. Recovery or rehabilitation.

 Establish a therapeutic relationship of freedom,

mutual understanding, and mutual responsibility with
the client and the support persons.
CHAPTER 11 INDIVIDUAL, FAMILY, AND COMMUNITY
ILLNESS & DISEASE
HEALTH
 Illness – a highly personal state in which a person’s
CONCEPT OF INDIVIDUALITY
physical, emotional, intellectual, social, developmental
or spiritual functioning is thought to be diminished. • To help clients attain, maintain or regain an

 Disease – alteration in body functions resulting in optimal level of health, nurses need to
understand clients as INDIVIDUALS.
 CONCEPT OF HOLISM 4. A life experience that provides

• When applied in nursing, the concept of holism satisfactions

emphasizes that nurses must keep the whole FAMILY:

person in mind and strive to understand how
▪ Basic unit of society.
one area of concern relates to the whole
▪ It consists of those individuals, male or female,
person.
young or adult, legally or not legally related,
CONCEPT OF HOMEOSTASIS: genetically, or not genetically related, who are

▪ Introduced by Cannon (1939); describes the considered by others to represent their

relative constancy of the internal processes of significant persons.

the body. ▪ FAMILY-CENTERED NURSING – nursing that

▪ 4 main characteristics of physiologic considers the health of the family as a unit in

homeostasis: addition to the health of individual family

1. They are self-regulating. members.

2. They are compensatory. TYPES FO FAMILIES IN TODAY’S SOCIETY

3. They need to be regulated by negative
❖ Traditional family
feedback systems.
❖ Two-career family
4. They may require several feedback
❖ Single-parent family
mechanisms to correct only one physiologic
❖ Adolescent family
imbalance.
❖ Foster family
FEEDBACK: ❖ Blended family

▪ It is the mechanism by which some of the output ❖ Intragenerational family

of the system is returned to the input. ❖ Cohabiting family

▪ 2 types of feedback- ❖ Gay and lesbian family

Negative feedback – inhibits change. ❖ Single adults living alone

Positive feedback – stimulates change. NEEDS THEORIES:

PSYCHOLOGICAL HOMEOSTASIS: ▪ Human needs are ranked in an ascending scale

▪ Refers to emotional or psychologic balance according to how essential the needs are for

of a state of mental being. survival.

▪ Prerequisites to develop psychologic ▪ Ex. Abraham Maslow’s Hierarchy of Needs

homeostasis:
1. A stable physical environment
2. A stable psychologic environment
3. A social environment that includes
adults who are healthy role models.
 has difficulty taking the viewpoint
of others Classifies objects by a
single feature: e.g., groups
together all the red blocks
regardless of shape or all the
square blocks regardless of colour
Concrete Can think logically about objects
operational (7-11 and events Achieves conservation
years) of number (age 6), mass (age 7),
and weight (age 9) Classifies
KALISH’S HIERARCHY OF NEEDS: objects according to several
▪ He has adapted Maslow’s hierarchy of needs into features and can order them in
6 levels rather than 5. series along a single dimension
▪ He suggested another category known as such as size.
STIMULATION NEEDS. Formal operational Can think logically about abstract

DEVELOPMENTAL STAGE THEORIES: (11 years and up) propositions and test hypotheses
systemtically Becomes concerned
▪ It categorizes a person’s behaviors or tasks in
with the hypothetical, the future,
approximate age ranges or in terms that describe
and ideological problems
the features of an age group.
▪ Ex: Piaget’s stages of cognitive development
SYSTEM THEORIES:
STAGE CHARACTERISED BY
▪ It provides a way of examining interrelationships
Sensori-motor Differentiates self from objects
and deriving principles.
(Birth-2 yrs) Recognises self as agent of action
▪ The interrelatedness of all parts of the system is
and begins to act intentionally:
the basis for a nursing’s holistic view of the client.
e.g., pulls a string to set mobile in
motion or shakes a rattle to make STRUCTURAL-FUNCTIONAL THEORY:
a noise Achieves object ▪ Focuses on the family structure and function.
permanence: realises that things ▪ It addresses the membership of the family and
continue to exist even when no the relationships among family members.
longer present to the sense (pace
Bishop Berkeley)
Pre-operational (2-7 Learns to use language and to
years) represent objects by images and
words Thinking is still egocentric:
CHAPTER 12 CULTURE & HERITAGE • Race – classification of people according to
shared biologic characteristics, genetic markers
CULTURE
or features.
• It can be defined as the nonphysical traits, such
• Prejudice – negative belief or preference that is
as beliefs, values, and attitudes that are shared
generalized about a group and that leads to pre-
by a group of people and passed from one
judgment.
generation to the next. (Spector, 2000)
• Stereotyping – assuming that all members of a
• CULTURAL CARE NURSING – a concept that
culture or ethnic group are alike.
describes the provision of nursing care across
• Discrimination – the differential treatment of
cultural boundaries and that takes into account
individuals or groups based on different
the context in which the client lives and the
categories.
situations in which the client’s health problems
• Culture shock – a disorder that occurs in
arise.
response to transition from one cultural setting
HERITAGE to another.
Things passed down from previous generations. • Ethnicity – a group within the social system that
claims to possess variable traits such as common
Cultural care must be:
religion or language.
1. Culturally sensitive
• Religion – a system of beliefs, practices, ethical
2. Culturally appropriate values, about divine or superhuman powers
worshipped as the creator/ruler of the universe.
3. Culturally competent
• Socialization – process of being raised within a
CONCEPTS RELATED TO CULTURAL CARE NURSING culture and acquiring the characteristics of that
• Subculture – usually composed of people with a group.
distinct identity and yet are related to a larger
HEALTH BELIEFS AND PRACTICES
cultural group.
• Magico-religious health belief view – states that
• Bicultural – a person who crosses two cultures,
health and illness are controlled by supernatural
lifestyles, sets, and values.
forces.
• Diversity – refers to the fact or state of being
• Scientific or biomedical health belief – life and
different.
life processes are controlled by physical and
• Acculturation – occurs when people adapt or
biochemical processes that can be manipulated
borrow traits from another culture.
by humans.
• Assimilation – process by which an individual
• Holistic belief model – holds that the forces of
develops a new cultural identity.
nature must be maintained in balance or
harmony.
 • Folk medicine – defined as those beliefs and medical therapies such as drugs, surgery, radiation, and
practices relating to illness prevention and so on.
healing that derived from cultural traditions
2. Era 2 – refers to “mind-body” medicine and focuses on
rather than modern medicine’s scientific base.
helping individuals to use their minds to heal their own
COMMUNICATION STYLE bodies and includes relaxation techniques, imagery

• Through communication, the culture is therapies, biofeedbacks, hypmosis, and counseling.

transmitted from one generation to the next, and 3. Era 3 – refers to “nonlocal or transpersonal” medicine;
knowledge about culture is transmitted within it claims that mind can move through time and space and
the group and those outside the group. includes noncontact therapeutic touch, intercessory
• Verbal communication prayer, transpersonal imagery, and all forms of distant
• Nonverbal communication healing.

❖ The Bodymind or Minded Body

1. Bodymind – refer to a state of integration that includes

CHAPTER 13 COMPLEMENTARY & ALTERNATIVE body, mind, and spirit.

HEALING MODALITIES 2. Minded body – used to emphasized that the qualities

COMPLEMENTARY THERAPIES we associate with the mind (including knowledge,

emotion, and consciousness) are distributed thorughout
Defined as therapeutic practices which are not currently
the body.
considered an integral part of conventional allopathic
medical practice. 3. Information transduction – conversion or
transformation of information or energy from one form
CONCEPTS OF HOLISM & HOLISTIC NURSING
to another.
• Holistic health – involves the total person, the
whole of the person’s being, and the overall 4. Mind modulation – refers to the process by which the

quality of lifestyle. brain converts neural messages into neurohormonal

• Holistic health care – includes health education, messenger molecules and communicates them to all

health promotion, health maintenance, illness body systems that evoke states of health or illness.

prevention, and restorative rehabilitative care. 5. Psychoneuroimmunology – focuses on the

• Holistic nursing – with goal of enhancing healing relationships among stress, immune system and health
from birth to death. outcomes.

CONCEPTS OF HEALING HEALING MODALITIES

❖ Dossey’s Era of Medicine ❖ Touch therapies – stimulate the production of

1. Era 1 – refers to “physical” medicine and focuses on healing promoting chemicals by the immune or

the effects of things on the body and includes western limbic system.
Examples: 6. Sandalwood oil

1. Massage ❖ Transpersonal Therapies

2. Reflexology Therapies that effect healing between persons.

3. Acupressure Examples:

4. Reiki 1. Noncontact therapeutic touch – process by which

practitioners believe that they can transmit energy to a
❖ Mind-body therapies – individuals focus on re-
person who is ill or injured to potentiate the healing
aligning or creating balance in mental processes
process.
to bring about healing.
2. Intercessory prayer – prayer offered in favor of
Examples:
another.
1. Progressive relaxation
❖ Alternative medical therapies
2. Biofeedback
1. Acupuncture
3. Yoga
2. Chiropractic
4. Imagery
3. Herbal Medicine
5. Meditation
4. Homeopathy
6. Prayer
5. Naturopathy
7. Music Therapy

8. Humor and laughter

9. Hypnosis
CHAPTER 14 CRITICAL THINKING & THE NURSING
❖ Aromatherapy or clinical aromatherapy – the PROCESS
controlled use of essential oils for specific
CRITICAL THINKING
measurable outcomes.
It is the intellectually disciplined process of actively and
Selected essential oils used in aromatherapy:
skillfully conceptualizing, applying, analyzing,
1. Cinnamon oil synthesizing and/or evaluating information gathered
from, or generated by, observation, experience,
2. Eucalyptus oil
reflection, reasoning, or communication as a guide to
3. Geranium oil belief and action.

4. Lavender oil NURSES USE CRITICAL THINKING IN A VARIETY OF WAYS:

5. Peppermint oil
• Nurses use knowledge from other subjects and • Confidence in reason
fields. • Interest in exploring both thoughts and feelings
• Nurses deal with change in stressful • Curiosity
environments.
APPLYING CRITICAL THINKING TO NURSING PRACTICE
• Nurses make important decisions.
• Problem-solving – the nurse obtains information
CREATIVITY that clarifies the nature and suggests possible
• The major component in critical thinking. solutions.
• It is thinking that results in the development of • Trial and error – a number of approaches are
new ideas and products. tried until a solution is found.
• In problem solving and decision-making, it is the • Intuition – it is the understanding or learning of
ability to develop and implement new ideas and things without conscious use of reasoning.
solutions. • Decision-making – a critical thinking process for
choosing the best actions to meet a desired goal.
SKILLS IN CRITICAL THINKING
• Nursing process – a systematic, rational method
• Critical analysis – is the application of a set of
of planning and providing individualized care.
questions to a particular situation or idea to
• COMPARISON BETWEEN THE NURSING PROCESS
determine essential information and discard
AND DECISION-MAKING PROCESS
superfluous, information and ideas.
• Socratic questioning – looking beneath the
surface, recognizing and examining assumptions,
search for inconsistencies, examine multiple
points of view, and differentiate what one knows
from what merely believes.
• Inductive reasoning – here, generalizations are
DEVELOPING CRITICAL THINKING ATTITUDES AND SKILLS
formed from a set of facts and observations.
• Deductive reasoning – is reasoning from general • Self-assessment

to specific. • Tolerating dissonance and ambiguity

• Seeking situations where good thinking is
ATTITUDES THAT FOSTER CRITICAL THINKING
practiced
• Independence of thought
• Creating environments that support critical
• Fair-mindedness
thinking
• Insight into egocentricity or sociocentricity
• Intellectual humility and suspension of judgment
• Intellectual courage
• Integrity
• Perseverance
 Chap 15: Documenting and Reporting c. Plan of care
– generated by the person who lists the problems.
Terms Related
d. Progress notes
Report – made by all professionals involved in a client’s
– an oral, written, or computer based care; they all use same type of sheets.
communication intended to convey information to
others S – Subjective data
O – Objective data
Record – written or computer based A - Assessment
P – Plan
Recording, charting or documenting I – Intervention
– the process of making an entry on a client record E – Evaluation

Purposes of client records Sample SOAPIE Charting

S : “Nahihirapan akong huminga, napagod agad ako
 Communication
nung pagkatayo ko” as verbalized by the client.
 Planning client care
 Auditing health agencies
O : with cyanotic nail beds
 Research
- respiratory rate = 45 breaths/min
 Education
- with clavicular retractions upon respiration
 Reimbursement
 Legal documentation A : Ineffective breathing pattern related to fatigue
 Health care analysis
P : After a series of nursing interventions, the patient
Documentation Systems will be able to decrease his breathing difficulties and
restore a normal breathing pattern.
1. Source-oriented record
- the traditional client record I – Administered oxygen inhalation at 2-3
- in this type of record, information about a liters/minute via nasal cannula to increase oxygen
particular problem is distributed throughout the levels.
record.
- Positioned on high back rest to promote better
Example: lung expansion.
Narrative charting (It consists of the written notes
that include routine care, normal findings, and client - Advised to minimize body movements to prevent
problems.) lung exhaustion.

2. Problem-oriented medical record - Respiratory rate referred to attending physician.

– here, the data are arranged according to the
problems the client has rather than the source of - Observed for other signs of respiratory difficulties.
information.
E – After a series of nursing interventions, the
4 BASIC COMPONENTS patient’s difficulty of breathing subsided and was
able to restore his breathing pattern as evidenced by
a. Database a respiratory rate of 28 breaths per minute, absence
– it consists of all information known about the of cyanosis, and absence of breathing complaints
client first enters the healthcare agency.

b. Problem list
– derived from the database
- usually kept at the front of the chart and serves as
an index to the number of entries in the progress
notes.
Focus Charting Flow Sheets
 Intended to make the client and the client  Enables nurses to record nursing data quickly
concerns and strengths the focus of care. and concisely and provides an easy-to read
record of the client’s condition over time.
 The FOCUS may be a condition, a nursing
diagnosis, a behavior, a sign or symptom, a change  Examples:
in the client’s condition, or a client strength. 1. Graphic record
2. Fluid balance record
 It is organized into DAR. 3. Medication administration record
(Data, Action, and Response) 4. Skin assessment record

SAMPLE Focus (DAR) Charting Guidelines for Recording

 Date and time
 Timing
 Legibility
 Permanence
 Accepted terminology
 Correct spelling
 Signature
 Accuracy
 Sequence
 Completeness
 Legal prudence

Reporting
KARDEX
 Used to communicate specific information to a
 A widely-used, concise method of organizing, person or group of people.
recording data about a client, making information
quickly accessible to all healthcare professionals.
 Whether oral or written, it must be pertinent
information, but no extraneous detail
 The system consists of a series of cards kept in a
portable index file or on computer-generated Reports used in Hospital Settings
forms.
 Change of shift reports
 Telephone reports
SAMPLE Kardex
 Telephone orders
 Care plan conference
 Nursing Round
 Chap 16 – Vital Signs Factors Affecting Body’s heat production

Vital/Cardinal Signs 1. Basal metabolic rate

– the rate of energy utilization in the body required
- Includes body temperature, pulse, respirations, to maintain essential activities such as breathing.
and blood pressure.
2. Muscle activity
- Recently, many agencies such as the Veterans
Administration, designated PAIN as the 5th vital 3. Thyroxine output
sign.
4. Epinephrine, Norepinephrine, and sympathetic
- When and how often to assess a client’s specific stimulation
vital signs are chiefly nursing judgments; physicians
may specifically order a vital sign 5. Fever

Body Temperature Heat is lost from the body through the following
- It reflects the balance between the heat produced
and the heat lost from the body, measured in units Radiation
called DEGREES. – transfer of heat from the surface of one object to
the surface of another without contact between 2
2 KINDS OF BODY TEMPERATURE objects.

1. Core temperature Conduction

– temperature from the deep tissues of the body, – transfer of heat from one molecule to a molecule of
such as the abdominal and pelvic cavity. lower temperature.
- It remains relatively constant.
Convection
2. Surface temperature – dispersion of heat by air currents
– temperature of the subcutaneous tissue, skin, and
fat. It rise and fall, in response to the environment. Vaporization
– continuous evaporation of moisture from the
Normal Body Temperature respiratory tract and the mucosa of the mouth and
the skin
* The normal body temperature of a person varies
depending: Regulation of body temperature
 Gender
When the skin becomes chilled over the entire body, 3
 recent activity
physiologic processes take place to increase body
 food
temperature.
 fluid consumption
 time of day
1. Shivering increases heat production.
 in women, the stage of the menstrual cycle. 2. Sweating is inhibited to decrease heat loss.
3. Vasoconstriction decreases heat loss.
Normal body temperature, according to the
American Medical Association, can range from HYPOTHALAMUS
– part of the brain that regulates the body
97.8° F to 99° F temperature
36.5° C to 37.2° C
Factors affecting body temperature
 Age
 Diurnal variations (circadian rhythms)
 Exercise
 Hormones
 Stress
 Environment
Alliteration in Body Temperature  Provide adequate nutrition and fluids.
 Measure intake and output
Pyrexia/Hyperthermia  Reduce physical activity to limit heat
–body temperature above the usual range production
- in lay man’s terms – FEVER.  Administer antipyretics as ordered.
 Provide oral hygiene to keep the mucous
Hyperpyrexia – a very high fever; 41° celsius. membranes moist.
 Provide tepid sponge bath to increase heat
Febrile – the client who has a fever. loss though conduction.
 Provide dry clothing and linens
Afebrile – client without Fever
Hypothermia
4 common types of fevers A core body temperature below the limit of normal.

1. Intermittent fever 3 physiologic mechanisms of hypothermia:

– body temperature alternates at regular intervals
between periods of fever and periods of normal or 1. Excessive heat loss
subnormal temperatures. 2. Inadequate heat production to counteract heat
loss
2. Remittent fever 3. Impaired hypothalamic thermoregulation
– wide range of temperature fluctuations (more than
2° C) occurs over a 24-hour period of time. Clinical Signs of Hypothermia
 Decrease body temperature, pulse and
3. Relapsing fever respirations
– short, febrile periods of a few days are
 Severe shivering (initially)
interspersed with periods of 1 or 2 days of normal
 Feelings of colds and chills
temperature.
 Pale, cool, waxy skin
 Hypotension
4. Constant fever
 Decreased urinary output
– body temperature fluctuates minimally but
remains above normal  Lack of muscle coordination
 Disorientation
Clinical Signs of fever  Drowsiness resulting to coma
 Increased heart rate
 Increased respiratory rate and depth Types of Hypothermia
 Shivering
Accidental hypothermia
 Pallid, cold skin
– occur as a result of exposure to a cold environment,
 Cyanotic nail beds
immersion in cold water, and lack of adequate
 Gooseflesh appearance of the skin
clothing, shelter, and heat.
 Cessation of sweating
Induced hypothermia
Nursing interventions for clients with fever –the deliberate lowering of the body temperature
 Monitor vital signs to decrease the need for oxygen by the body tissues
 Assess skin and temperature
 Monitor white blood cell count, hematocrit Nursing Interventions
and other pertinent laboratory reports  Provide a warm environment
 Remove excess blankets when the client  Provide dry clothing
feels warm, but provide extra warmth when  Apply warm blankets
the client feels chilled.
 Keep limbs close to the body
 Cover the client’s scalp with a cap or turban
 Supply warm, oral, intravenous fluids
 Apply warm pads
4 Common sites for assessing body temperature Factors affecting pulse
 Age
1. Rectal temperature  Gender
– considered to be very accurate.  Exercise
 Fever
2. Axillary temperature  Medications
– preferred site for measuring temperature in  Hypovolemia
newborns because it is accessible and offers no  Stress
possibility of rectal perforation.  Position changes
 Pathology
3. Tympanic membrane
– the nearby tissue in the ear canal; is another site Pulse Sites
for ore body temperature.

4. Forehead
– another site of for measuring body temperature.

Types of Thermometers
 Electronic thermometers
 Chemical disposable thermometer
 Temperature sensitive tape
 Infrared thermometers
 Digital Thermometers

Pulse
- It is a wave of blood created by contraction of the
left ventricle of the heart

- Described in BEATS PER MINUTE. Apical-Radial Pulse Assessment

- Must be assessed for clients with certain
Related Terms: cardiovascular disorders.

1. Peripheral pulse NOTE: Any discrepancy between the 2 pulse rates is

– is a pulse located away from the heart. called PULSE DEFICIT.

2. Apical pulse Bradycardia – abnormally slow pulse rate.

– central pulse; located at the apex of the heart. Tachycardia – pulse rate above the normal range

Age Normal PR Average PR Respiration

(bpm) (bpm) - The act of breathing.
Newborn 100 - 170 140
Infants
80-170 120 2 Types of Respiration:
(1yr or less)
Toddlers
80-130 110 1. External Respiration
(1-3 yrs old)
Pre-schooler – interchange of oxygen and carbon dioxide between
75-120 100
(3-6 yrs old) alveoli of the lungs.
School child
70-100 90
( 7-12 yrs old)
2. Internal Respiration
Adolescent
60-90 75 – interchange of the same gases between the
(12-17 yrs old)
Adults circulating blood and the cells of the body tissues.
60-110 80
(up 18yrs old)
 Age Normal RR Average RR During normal respiration, an adult takes in 500ml
(bpm) (bpm) of air and this volume is called TIDAL VOLUME.
Newborn 30-50 40
Infants
(1yr or less)
20-40 30  Body position
Toddlers  Respiratory rhythm – refers to the regularity of
20-30 25
(1-3 yrs old) the expirations and inspirations.
Pre-schooler  Respiratory Quality/Character – aspects of
16-22 19
(3-6 yrs old) breathing that are different form normal,
School child
14-20 17 effortless breathing.
( 7-12 yrs old)
Adolescent  Sound of breathing
12-20 16  The RESPIRATORY RATE is described in
(12-17 yrs old)
Adults
12-20 18
BREATHS PER MINUTE.
(up 18yrs old)
 Eupnea- Breathing that is normal in rate and
Inhalation depth.
– the intake of air into the lungs.
 Bradypnea – abnormally slow respirations.
Exhalation/Expiration
– refers to breathing out of the movement of gases  Tachypnea/Polypnea – abnormally fast
from the lungs to the atmosphere. respirations.

2 Types of Breathing
 Apnea – the absence of breathing.
Costal/Thoracic Breathing –involves the external
Factors affecting Respirations
intercostal muscles and other accessory muscles.
THOSE THAT INCREASE RESPIRATORY RATE:
Diaphragmatic/Abdominal Breathing
 Exercise
– involves the contraction and relaxation of the
 Stress
diaphragm, and is observed by the movement of the
 Increased environmental temperature
abdomen.
 Lowered oxygen concentration at increased
Assessing Respirations altitudes
Before assessing a client’s respirations, the nurse
must be aware of the following: THOSE THAT DECREASE RESPIRATORY RATE:
 Decreased environmental temperature
1. The client’s normal breathing pattern  Certain medications
2. The influence of the client’s health problems that  Increased intracranial pressure
might affect respirations.
3. Any medications or therapies that might affect Blood pressure/ Arterial Pressure
respirations - It is the measure of the pressure exerted by the
4. The relationship of the client’s respiration to blood as it flows through the arteries; measures
cardiovascular function. in millimeters of mercury (mmHg)

Assessment Parameters 2 blood pressure measures:

Depth - can be established by watching chest
movements. It is generally described in terms of: 1. Systolic pressure – pressure of the blood as a
result of the contraction of ventricles.
1. Deep Respirations
– large volume of air is inhaled and exhaled; very 2. Diastolic pressure – pressure when the
deep respirations are called HYPERVENTILATION. ventricles are at rest.

2. Shallow respirations
– involve the exchange of small air volume and
minimal use of lung tissues; very shallow
respirations are called HYPOVENTILATION.
 Assessing Blood Pressure
Age Systolic Diastolic Average
Newborn 65-95 30-60 80-60 Blood pressure is measured with a
Infants (1) BLOOD PRESSURE CUFF,
65-115 42-80 90-61
(1yr or less)
(2) SPHYGMOMANOMETER,
Toddlers
76-112 46-84 99-65 (3) STETHOSCOPE
(1-3 yrs old)
Pre-schooler
85-115 48-64 100-56
(3-6 yrs old) Blood pressure sites
School child The blood pressure is usually measured in the
( 7-12 yrs 93-125 48-68 100-56 client’s arm using a BRACHIAL ARTERY and a
old)
standard stethoscope.
Adolescent
(12-17 yrs 93-137 51-71 118-61
old) Assessing blood pressure on the client’s thigh is
Adults usually indicated in these situations:
100-140 60-90 120-80
(up 18yrs old)
 When blood pressure cannot be measured on both
arms
Determinants of Blood Pressure  When blood pressure in one thigh is to be
 Pumping action of the heart compared with the pressure on the other thigh.
 Peripheral vascular resistance
 Blood volume Blood pressure cannot be measured on a client’s
 Blood viscosity arm or thigh in the following situations:

Factors affecting blood pressure  When the shoulder, arm, or hand is injured or
 Age diseased.
 Exercise  A cast or bulky bandage is on any part of the limb
 Stress
 Race Methods of Measuring Blood Pressure
 Gender
 Medications Direct Invasive Monitoring
 Obesity  involves the insertion of a catheter into the
 Disease process brachial, radial, or femoral artery.
 Through the OSCILLOSCOPE, blood pressure is
Abnormal Blood Pressures read as represented by wavelike forms.
 With correct placement, this measurement is
A. Hypertension - a blood pressure persistently highly accurate
above normal.
Non-invasive Methods
2 TYPES OF HYPERTENSION:  includes the AUSCULTATORY & PALPATORY
1. Primary hypertension METHOD.
– elevated blood pressure of unknown cause.
1. Auscultatory methods
2. Secondary Hypertension - Most commonly used in hospitals, clinics, and
– elevated blood pressure of known cause. homes.
- When carried out correctly, the auscultatory
B. Hypotension – blood pressure below normal. method is relatively accurate

1. Orthostatic hypotension
– blood pressure that falls when the client sits or
stands.
Korotkoff’s Sound Chap 17 – Asepsis
BACTERIOCINS
- Microorganisms found in the intestines which are
lethal to related strains of bacteria.

- It also produces antibiotic like substances and toxic

metabolites that repress the growth of other
microorganisms.

RESIDENT FLORA
- The collective vegetation in one area/part of the
2.Palpatory Methods body, yet produce infection in another.
– sometimes used when the Korotkoff’s sounds
cannot be heard and electronic equipment to Example: Escherichia coli
amplify sounds is not available, or to prevent
misdirection from the presence of auscultatory INFECTION
gaps. - Invasion of body tissue by microorganisms and
their proliferation there.
AUSCULTATORY GAPS –temporal disappearance of
sounds normally heard over the brachial artery, COMMUNICABLE DISEASE
when the cuff pressure is high followed by the - The resulting condition if the infectious agent can
reappearance of sounds at lower level. be transmitted to an individual by direct or indirect
contact, through a vector or a vehicle, or as an
Common Errors in Assessing Blood Pressure infection.
 Bladder cuff too narrow or too wide.
 Arm unsupported PATHOGENICITY
 Insufficient rest before assessment - The ability to produce disease.
 Repeating assessment too quickly - A true pathogen causes disease or infection in a
 Cuff wrapped too loosely or to evenly healthy individual.
 Deflating cuff too quickly or too slowly. - An opportunistic pathogen causes disease only in
 Failure to use the same arm consistently susceptible individual.
 Arm above level of the heart
 Assessing immediately after a meal or ASEPSIS
while a client smokes or in pain. - It is the freedom from disease-causing
 Failure to identify auscultatory gap microorganisms.

2 basic types:

1. Medical asepsis
– refers to all practices intended to confine a specific
organism to a specific area, limiting the number,
growth, and transmission of a specific
microorganism.

2. Surgical asepsis/Sterile technique

– refers to those practices that keep an area or object
free from microorganisms
- involves practices that destroys microorganisms
and spores.

Sepsis – the state of infection.

 TYPES OF MICROORGANISMS CAUSING BACTEREMIA & SEPTICEMIA
INFECTIONS Bacteremia – a condition wherein a culture of the
person’s blood reveals microorganisms.
Bacteria
– the most common infectious agent Septicemia – results when bacteremia becomes a
- can cause human diseases and can be transported systemic infection.
through air, water, food, soil, body tissues and
inanimate objects. Chain of infection

Viruses 1. Etiologic agent

– consist primarily of nucleic acid - the disease- causing microorganism.
- must enter living cells in order to reproduce.
2. Reservoir
Fungi – yeasts and molds. - the sources of the microorganisms.
(Ex. Organisms, plants, animals, environment)
Parasites – live on living organisms.
3. Portal of exit of reservoir
COLONIZATION – it is here where the microorganism leaves before
- The process by which strains of microorganisms an infection can establish itself in a host.
become resident flora.
4. Method of transmission
TYPES OF INFECTIONS – a means of transmission to reach another person
or host through a receptive portal of entry.
Local infection – limited to a specific part of the
body where the microorganisms remain. 5. Portal of entry
– here, microorganisms enter the body.
Systemic infection – infection where the
microorganisms spread into different parts of the 6. Susceptible Host - any person at risk for
body. infection.

Acute infection – generally appear suddenly or last METHODS OF TRANSMISSION

a short time.
1. Direct transmission
Chronic infection – may occur slowly, over a long – involves and immediate and direct transfer of
period, and may last months or years. microorganisms from person to person through
touching, biting, kissing or sexual intercourse.
NOSOCOMIAL INFECTIONS
 Classified as infections associated with the Ex: Droplet spread
delivery of health care services in a health care
facility 2. Indirect transmission
 It can develop either during the client’s stay in – may either be vehicle-borne or vector-borne.
the hospital or after discharge.
a. Vehicle-borne – microorganism is transmitted
LATROGENIC INFECTIONS through a vehicle, which is any substance that serves
– direct result of diagnostic or therapeutic as an intermediate means of transport and introduce
procedures. an infectious agent into a susceptible host through a
suitable portal of entry.
Endogenous – infection originates from the clients
(Ex. Fomites: handkerchiefs, toys, clothing, etc.)
Exogenous – infection originates from the hospital
environment/hospital personnel. b. Vector-borne - microorganism is transmitted
through a vector, which is usually a flying or
crawling insect that serves as an intermediate
means of transporting the infection.
3. Airborne transmission – may involve droplets
or dust. Here, the material may be transmitted by air 3 major types of exudates
currents to a suitable portal of entry, usually, the 1. Serous
respiratory tract of another person. 2. Purulent
3. Hemorrhagic (Sanguineous)
Droplet nuclei - the residue of evaporated droplets 4. Serosanguineous
emitted by an infected host.
3. Reparative phase
BODY DEFENSES AGAINST INFECTION – involves the repair of the injured tissues by
1. Nonspecific defenses regeneration/replacement with fibrous tissue/scar
– protect the person against all microorganisms, formation.
regardless of prior exposure.
Regeneration – the replacement of destroyed tissue
2. Specific defenses cells that are identical or similar in function.
– directed against identifiable bacteria, viruses,
fungi, or other infectious agents. When regeneration is not possible, repair occurs by
fibrous tissue formation.
EXAMPLES OF NONSPECIFIC DEFENSES
 Moist mucous membranes and cillias in the nasal EXAMPLES OF SPECIFIC BODY DEFENSES
passages
 Saliva in the mouth
 Tears in the eyes
 High acidity of the stomach
 Secretions in the vagina

Inflammation
– a local and nonspecific defensive response of the
tissues to an injurious or infectious agent. It has 5
signs, namely:

1. Pain (Dolor)
2. Swelling (Tumor)
3. Redness (Rubor) 2 TYPES OF IMMUNITY
4. Heat (Calor)
5. Impaired function of the body part, if the injury is Active immunity
severe. – host produces antibodies in response to a natural
or artificial antigen.
3 STAGES OF INFLAMMATORY RESPONSE
Passive/Acquired immunity
1. Vascular/Cellular responses – the host receives natural or artificial antibodies
– constriction of the blood vessels at the site of the produced by another source.
injury, lasting a few moments; then, dilation of the
blood vessels, causing more blood to flow in the 2 COMPONENTS OF THE IMMUNE SYSTEM
injured area, called HYPEREMIA. I. Antibody-mediated defenses
- the “Humoral/Circulating Immunity”
- Here, there is altered permeability of the - defenses reside ultimately in the B-lympocytes and
interstitial spaces due to accumulation of fluid, are mediated by antibodies produced by B-cells.
causing pain and swelling.
II. Cell-mediated defenses
2. Exudate production - The “Cellular Immunity”
– inflammatory exudate is produced, consisting of - Occur through the T-cell system
fluid that escape from blood vessels, dead
phagocytic cells, dead tissue cells and products that
they release.
 FACTORS INCREASING SUSCEPTIBILITY TO STERILIZATION
INFECTION - The process that destroys all microorganisms
 Age including spores and viruses.
 Heredity
 The nature, number, and duration of METHODS USED IN STERILIZATION
physical and emotional stressors 1. Moist heat 2. Gas 3. Boiling water
 Individual’s resistance to infection 4. Radiation
 Certain medications like antineoplastic drugs
 Disease TRANSMISSION-BASED PRECAUTIONS

SUPPORTING DEFENSES OF A 1. Airborne precautions

SUSCEPTIBLE HOST – used for clients known to have or were suspected
 Hygiene of having serious illnesses transmitted by airborne
 Nutrition droplet nuclei smaller than 5 microns.
 Fluid (Ex. Rubeola, Varicella, TB)
 Rest and sleep
2. Droplet precautions
 Immunizations
– used for clients known or suspected to have
serious illnesses transmitted by particle droplets
CLEANING
larger than 5 microns. (URTI, LRTI)
Antiseptics
3. Contact precautions
– agents that inhibit the growth of some
- used for clients known or suspected to have serious
microorganisms.
illnesses transmitted by direct client contact or
contact with the client’s environment (Wound
Disinfectants
infection, Hepa A)
– a chemical preparation such as phenol or iodine
compounds, used on inanimate objects.
PERSONAL PROTECTIVE EQUIPMENT
STEPS WHEN CLEANING OBJECTS IN HOSPITALS
Gloves – worn for 3 reasons:
1. Rinse the article with cold water to organic
1. First, they protect the hands when the nurse is
material.
likely to handle any substances.
2. Wash the article in hot water and soap.
2. Second, it reduces the likelihood of nurses
transmitting their own endogenous microorganisms
3. Use an abrasive, such as stiff-bristled brush, to
receiving individual care.
clean equipment with grooves and corners.
3. Third, it reduces the chance that the nurse hands
4. Rinse the article well with warm to hot water.
will transmit microorganisms from one client or
fomite to another client.
5. Dry the article; it is now considered clean.
Gowns – worn during procedures when the nurse’s
6. Clean the brush and sink.
uniform is likely to become soiled. After it is worn,
the nurses discard it or places it in a laundry hamper.
ISOLATION PRECAUTIONS
Masks – worn to reduce the risk for transmission of
Isolation – refers to measures designed to prevent
organisms by the droplet contact and airborne
the spread of infectious microorganisms to health
routes and by splatter of body substances.
personnel, clients, and visitors.
UNIVERSAL PRECAUTION – Hand washing.
Eyewear – may be indicated in situations where
body substances may splatter to face.
CDC isolation precautions:
1. Standard precautions
Examples: Goggles, glasses, or face shields
2. Transmission-based precautions
 Chap 18 – Skin Integrity and Wound Care Pressure Ulcers
- Also called decubitus ulcers, pressure sores, or bed
Skin Integrity sores.
- Any lesion caused by unrelieved pressure that
Skin – the largest external organ of the body. results in damage to underlying tissue.

Intact skin – refers to the presence of normal skin ETIOLOGY:

and skin layers uninterrupted by wounds.
1. Localized ischemia
Types of Wounds According How they were – deficiency of tissue blood supply.
acquired
2. Friction
A. Clean wounds – force acting parallel to skin surface
– uninfected wounds in which minimal
inflammation is encountered and respiratory, 3. Shearing force
genital, and urinary tracts are not entered. – combination of friction and pressure.

B. Clean-contaminated wounds Risk Factors for Pressure Ulcers

–surgical wounds in which the respiratory, genital,
and urinary tracts are entered; but no evidence of  Immobility – reduction in the amount of
infection movement and control that a person has.
 Inadequate nutrition
C. Contaminated wounds  Fecal and urinary incontinence
– open, fresh, accidental and surgical wounds  Decreased mental status
involving a major break in sterile technique or a  Diminished sensation
large amount of spillage from GI tract; with evidence  Excessive body heat
of inflammation.  Advanced age
 Chronic medical conditions
D. Dry/Infected wounds
– contains dead tissue and with evidence of clinical Stages of Pressure Ulcers
infection, such as purulent drainage.

Types of Wounds According to depth

Incision – caused by sharp instrument

Contusion – blow from a blunt instrument

Abrasion – surface scrape; either intentional

or not.

Puncture – penetration of the skin and often the

underlying tissues by a sharp instrument
Wound Healing
Laceration – tissues torn apart; often from A quality of living tissue; also referred to as
accidents REGENERATION.

Penetrating wound –penetration of the skin TYPES OF WOUND HEALING:

and the underlying tissues
1. Primary intention healing
– occurs when tissue surfaces has been
approximated (closed); characterized by minimal
formation of granulation tissue and scarring.
2. Secondary intention healing Yellow wounds are characterized primarily by
– cannot or should not be approximated; repair time liquid to semiliquid slough that is often accompanied
is longer, scarring is greater and with higher by purulent drainage or previous infection.
susceptibility to infection.
Black wounds are covered with thick necrotic
Exudate tissue, or eschar; it requires debridement, or
- It is a material such as fluids and cells, that has removal of the necrotic material.
escaped from blood vessels during the inflammatory
process and is deposited in tissue or on tissue Types of debridement
surfaces.
Sharp debridement – uses scalpel or scissors to
TYPES OF EXUDATE: separate or remove dead tissue

1. Serous exudate Mechanical debridement – accomplished through

– consists chiefly of serum derived from blood and scrubbing force or moist to moist dressings.
the serous membranes of the body
Autolytic debridement
2. Purulent exudate – dressings that contain wound moisture and clear
– thicker than serous exudate because of the absorbent acrylic dressings, trap the wound
presence of pus; pus formation is called drainage against the eschar
SUPPURATION.
Wound Dressings are applied for the following
3. Sanguineous exudate purposes
– consists of large amounts of RBC, indicating
damage to capillaries.  To protect the wound from mechanical injury.
 To protect the wound from microbial
4. Serosanguineous exudate contamination
– commonly seen in surgical inscisions.  To provide or maintain moist wound healing.
 To provide thermal insulation
Complications of Wounds  To absorb drainage or debridea wound or both
1. Hemorrhage  To prevent hemorrhage
2. Infection  To splint or immobilize a wound site and thereby
3. Dehiscence and possible evisceration facilitate healing and prevent injury

Dehiscence – partial or total rupturing of a sutured Types of Dressings

wound.
Transparent dressings
Evisceration – protrusion of an internal viscera – often applied to wounds including ulcerated or
through incision burned skin areas.

Factors Affecting wound healing Hydrocolloid dressings

 Nutrition – frequently used over pressure ulcers
 Lifestyle
 Medications Securing dressings
– nurse tapes the dressings over the wound,
The RYB COLOR CODE ensuring that the dressings cover the entire wound
This concept is based on the color of an open wound and does not become dislodged
– red, yellow, or black rather than the depth or size
of the wound.

* Wounds that are Red are usually in the late

regeneration phase of tissue repair; they need to be
protected to avoid disturbance of regenerating
tissue through gentle cleansing.