Reviewer FUNDA-DIDA:

1. 6C’s of nursing
2. Levels of prevention
3. Nursing Process
4. Nursing Care Models
5. Roles of nurses
6. Communication models
7. Criteria of nursing as a profession

1. 6C’s of nursing
The 6Cs are Care, Compassion, Competence, Communication, Courage and
Commitment – all values essential to high quality care.

[1] Compassion
❖Awareness of one’s relationship to others, sharing their joys, sorrows, pain,
and accomplishments.
Participation in the experience of another.

[2] Competence
❖Having the “knowledge, judgment, skills, energy, experience and motivation
required to respond adequately to the demands of one’s professional
responsibilities”

[3] Confidence
❖Comfort with self, client, and others that allows one to build trusting
relationships.

[4] Conscience
❖Morals, ethics, and an informed sense of right and wrong.
❖ Awareness of personal responsibility.

[5] Commitment
❖The deliberate choice to act in accordance with one’s desires as well as
obligations, resulting
in investment of self in a task or cause.

[6] Comportment
❖Appropriate bearing, demeanor, dress, and language that are in harmony with
a caring presence.
❖Presenting oneself as someone who respects others and demands respect.

2. Levels of prevention
[1] Primary prevention—those preventive measures that prevent the onset of
illness or injury before the disease process begins.
- Examples include immunization and taking regular exercise.

[2] Secondary prevention—those preventive measures that lead to early

diagnosis and prompt treatment of a disease, illness or injury to prevent more
severe problems developing.
Here health educators such as Health Extension Practitioners can help
individuals acquire the skills of detecting diseases in their early stages.
- Examples include screening for high blood pressure and breast
self-examination.
[3] Tertiary prevention—those preventive measures aimed at rehabilitation
following significant illness.
At this level health services workers can work to retrain, re-educate and
rehabilitate people who have already developed an impairment or disability.
Health Education can be applied at all three levels of disease prevention
and can be of great help in maximizing the gains from preventive behavior.
3. Nursing Process
- is a systematic, rational method of planning and providing individualized
nursing care.
Purposes:
▪ identify a client’s health status and actual or potential health care
problems or needs
▪ to establish plans to meet the identified needs
▪ and to deliver specific nursing interventions to meet those needs.

CHARACTERISTICS OF THE NURSING PROCESS

▪ cyclical and dynamic nature
▪ client centeredness
▪ focus on problem solving and decision making
▪ interpersonal and collaborative style
▪ universal applicability
▪ and use of critical thinking and clinical reasoning

PHASES OF THE NURSING PROCESS

1. ASSESSING
- is the systematic and continuous collection, organization, validation, and
documentation of data (information).

AREAS TO BE ASSESSED:
✓ client’s perceived needs
✓ health problems
✓ related experience
✓ health practices
✓ values, and lifestyles
In other words:
o physical (physical examination)
o functional (history- taking)
o psychosocial
o emotional
o Cognitive
o sexual
o Cultural
o age-related
o environmental
o spiritual/transpersonal, and economic assessments

TYPES OF DATA (INFORMATION)

Subjective data
▪ also referred to as symptoms or covert data, are apparent only to the person
affected and can be described or verified only by that person.
▪ EXAMPLES: Itching, pain, and feelings of worry. It include the client’s
sensations, feelings, values, beliefs, attitudes, and perception of personal health
status and life situation
Objective data
▪ also referred to as signs or overt data, are detectable by an observer or can be
measured or tested against an accepted standard.
▪ They can be seen, heard, felt, or smelled, and they frequently, or rarely and
include such data as blood pressure, level of pain, and age.

SOURCES OF DATA
PRIMARY
❖ The client is the source

SECONDARY
❖ Family members or other support persons, other health professionals, records
and reports,
laboratory and diagnostic analyses, and relevant literature.

DATA COLLECTION METHODS

OBSERVING
❖ to gather data by using the senses.

INTERVIEWING
❖ is a planned communication or a conversation with a purpose, for example, to
get or give information, identify problems of mutual concern, evaluate change,
teach, provide support, or provide counseling or therapy.
EXAMINING
❖ The physical examination or physical assessment is a systematic data
collection method that uses observation (i.e., the senses of sight, hearing, smell,
and touch) to detect health problems..

The following are included:

▪ Inspection
▪ Palpation
▪ Percussion
▪ Auscultation

VALIDATING DATA
Validating data helps the nurse complete these tasks:
• Ensure that assessment information is complete.
• Ensure that objective and related subjective data agree.
• Obtain additional information that may have been overlooked.
• Differentiate between cues and inferences

Cues are subjective or objective data that can be directly observed by the nurse;
that is, what the client says or what the nurse can see, hear, feel, smell, or
measure.

Inferences are the nurse’s interpretation or conclusions made based on the cues
(e.g., a nurse observes the cues that an incision is red, hot, and swollen; the
nurse makes the inference that the incision is infected).

2. DIAGNOSING
- diagnosing refers to the reasoning process.
- Analyze data, identify health problems, risk and strengths.
- Formulate diagnostic statements.

Components of NANDA Nursing Diagnosis

A nursing diagnosis has three components:
(1) the problem and its definition
(2) the etiology (related factors and risk factors)
(3) the defining characteristics (signs and symptoms)

FORMULATING DIAGNOSTIC STATEMENT

The basic two-part statement includes the following:
1. Problem (P): statement of the client’s response (NANDA label)
2. Etiology (E): factors contributing to or probable causes of the responses

The basic three-part nursing diagnosis statement is called the PES format and
includes the following:
1. Problem (P): statement of the client’s response (NANDA label)
2. Etiology (E): factors contributing to or probable causes of the response.
3. Signs and symptoms (S): defining characteristics manifested by the client.

3. PLANNING
- is a deliberative, systematic phase of the nursing process that
involves decision making and problem solving.
- the nurse refers to the client’s assessment data and diagnostic
statements for direction in formulating client goals and designing the
nursing interventions required to prevent, reduce, or eliminate the
client’s health problems.

IN THE PROCESS OF DEVELOPING CLIENT CARE PLANS, THE NURSE

ENGAGES IN THE
FOLLOWING ACTIVITIES:

✓ SETTING PRIORITIES
✓ ESTABLISHING CLIENT GOALS/DESIRED OUTCOMES
✓ SELECTING NURSING INTERVENTIONS AND ACTIVITIES
✓ WRITING INDIVIDUALIZED NURSING INTERVENTIONS ON CARE PLANS

SETTING PRIORITIES
Priority Setting
➢ is the process of establishing a preferential sequence for addressing nursing
diagnoses
and interventions.
➢ The nurse and client begin planning by deciding which nursing diagnosis
requires attention first, which second, and so on.
➢ Nurses frequently use Maslow’s hierarchy of needs when setting priorities
➢ They use also ABC’s to make priorities (Airway, Breathing, Circulation)
Factors to be considered when prioritizing:

1. Client’s health values and beliefs

2. Client’s priorities
3. Resources available to the nurse and client
4. Urgency of the health problem
5. Medical treatment plan

PURPOSE OF GOALS/DESIRED OUTCOMES

o Provide direction for planning nursing interventions.
o Serve as criteria for evaluating client progress
o Enable the client and nurse to determine when the problem has been
resolved
o Help motivate the client and nurse by providing a sense of achievement

Goals/ desired outcomes

▪ describe, in terms of observable client responses, what the nurse hopes to
achieve by implementing the nursing interventions
▪ Some references also use the terms expected outcome, predicted outcome,
outcome criterion, and objective
Goals as broad statements about the client’s status.
Desired outcomes as the more specific, observable criteria used to evaluate
whether the goals have been met.
Example:
Goal (broad): Improve nutritional status
Desired outcome (specific): Gain 5 lb by April 25

Goals and outcomes: Improved nutritional status as

evidenced by weight gain of 5 lbs by April 25.

A short-term goal might be:

“Client will raise right arm to shoulder height by Friday.”

In the same context, a long-term goal/outcome might be:

“Client will regain full use of right arm in 6 weeks.”

COMPONENTS OF GOAL/DESIRED OUTCOME STATEMENTS

Goal/desired outcome statements should have the following four components:

1. Subject - The subject, a noun, is the client

2. Verb - Specifies an action the client is to perform
3. Conditions or modifiers - Modifiers may be added to the verb to explain the
circumstances under which the behavior is to be performed. They explain what,
where, when, or how
4. Criterion of desired performance - The criterion indicates the standard by
which a performance is evaluated or the level at which the client will perform the
specified behavior

TYPES OF NURSING INTERVENTIONS

1. Independent interventions are those activities that nurses are licensed to

initiate on the basis of their knowledge and skills.
Examples: ongoing assessment, emotional support and comfort, teaching,
counseling,
environmental management, and making referrals to other health care
professionals

2. Dependent interventions are activities carried out under the orders or

supervision of a licensed physician or other health care provider authorized to
write orders to nurses.

3. Collaborative interventions are actions the nurse carries out in collaboration

with other health team members, such as physical therapists, social workers,
dietitians, and primary care providers

4. IMPLEMENTING
- The action phase in which the nurse performs the nursing interventions.
- Consists of doing and documenting the activities that are the specific
nursing actions needed to carry out the interventions.
- The nurse performs or delegates the nursing activities for the interventions
that were developed in the planning step and then concludes the
implementing step by recording nursing activities and the resulting client
responses.

5. EVALUATING
- is a planned, ongoing, purposeful activity in which clients and health care
professionals determine:
(a) the client’s progress toward achievement of goals/ outcomes and
(b) the effectiveness of the nursing care plan

ALWAYS REMEMBER:
SMART
S-Specific
M-Measurable
A-Achievable
R-Realistic
T-Timely

4. Nursing Care Models

- are different approaches to providing care for patients.
 - These models are frameworks that are used to help nurses assess, plan
and implement care.

Four types of nursing care models are:

1. Functional nursing
- is a task-oriented approach to delivering care.
- The functional nursing method focuses on the jobs to be completed
(e.g., bed making, temperature measurement)
- Tasks are delegated to individual members of the team. The team
members are focused on their specific task(s) instead of the total
patient.
- Advantages to this approach are that tasks can be done in a shorter
amount of time
2. Team nursing
- an approach where the team is led by a team leader (usually a
registered nurse) who is knowledgeable about the patients and in
charge of evaluating the patient’s care plans.
- Advantages to this model are that each patient receives
individualized care, and that every member of the team can
contribute to decision making.
- Disadvantages include that the nurse is still responsible for duties
being performed without performing them personally.
3. Primary nursing
- also known as relationship-based practice, and this model focuses
on keeping the nurse at bedside, actively involved in patient care.
- In this model, one primary nurse is responsible for managing the
client’s care while in the hospital, from admission to discharge.
- Primary nursing is a system in which one nurse is responsible for
overseeing the total care of a number of hospitalized clients 24
hours a day, 7 days a week, even if he or she does not deliver all of
the care personally.
4. Total patient care
- Total patient care or patient-focused care is a model where the
registered nurse takes on total responsibility for planning and
delivering care to the patient for the assigned time period.
Others:

● Managed Care
- Managed care describes a healthcare system whose goals are to provide
cost -effective, quality care that focuses on decreased costs and improved
outcomes for groups of clients.
- In managed care, healthcare providers and agencies collaborate to render
the most appropriate, fiscally responsible care possible. Managed care
denotes an emphasis on cost controls, customer satisfaction, health
promotion, and preventive services.
- Managed care can be used with primary, team , functional , and alternative
nursing care delivery systems.

● Case Management
- Case management describes a range of models for integrating healthcare
services for individuals or groups.
- Generally, case management involves multidisciplinary teams that assume
collaborative responsibility for planning, assessing needs, and
coordinating, implementing, and evaluating care for groups of clients from
pre admission to discharge or transfer and recuperation.

● Differentiated Practice
- Differentiated nursing practice seeks to provide quality care at an
affordable cost.
- Differentiated practice is a system in which the best possible use of nursing
personnel is based on their educational preparation and resultant skill sets.
- Thus, differentiated practice models consist of specific job descriptions for
nurses according to their education or training.
- The model is customized within each healthcare institution by the nurses
employed there. This enables nurses to progress and assume roles and
responsibilities appropriate to their level of experience, capability, and
education.

● Case Method
- The case method, also referred to as total care, is one of the earliest
nursing models developed.
 - In this client -centered method, one nurse is assigned to and is responsible
for the comprehensive care of a group of clients during a shift.
- For each client, the nurse assesses needs, makes nursing plans,
formulates nursing diagnoses, implements care, and evaluates the
effectiveness of care . In this method, a client has consistent contact with
one nurse during a shift but may have different nurses on other shifts.

5. Roles of nurses

● Nurse
- The role of the nurse varies with the needs of the client, the nurse's
credentials, and the type of employment setting.
- An RN assesses a client's health status, identifies health problems,
and develops and coordinates care.
- A licensed vocational nurse (LVN), in some states known as a
licensed practical nurse (LPN), provides direct client care under
the direction of an RN , physician , or other licensed practitioner.
- As nursing roles have expanded, new dimensions for nursing
practice have been established. Nurses can pursue a variety of
practice specialties (e.g., critical care, mental health, oncology).
- Advanced practice registered nurses (APRNs) provide direct
client care as NPs, nurse midwives, certified registered nurse
anesthetists, and clinical nurse specialists. These nurses have
education and certifications that, depending on state regulations may
allow them to provide primary care, prescribe medications, and
receive third-party (insurance) reimbursement directly for their
services.

● Alternative (Complementary) Care Provider

- Alternative or complementary healthcare refers to those practices not
commonly considered part of Western medicine.
- Chiropractors, herbalists, acupuncturists, massage therapists,
reflexologists, holistic health healers, and other healthcare providers
are playing increasing roles in the contemporary healthcare system.
- These providers may practice alongside Western healthcare providers, or
clients may use their services in conjunction with, or in lieu of, Western
therapies.
● Assistive Personnel
- Assistive personnel (AP) are healthcare staff who assume delegated
aspects of basic client care. These tasks include bathing, assisting with
feeding, and collecting specimens.
- AP titles include nurse's aides, hospital attendants, nurse technicians,
client care technicians, and orderlies.

● Case Manager
- The case manager's role is to ensure that clients receive fiscally sound,
appropriate care in the best setting.
- This role is often filled by the member of the healthcare team who is most
involved in the client's care.
- Depending on the nature of the client's concerns, the case manager may
be a nurse, a social worker, an occupational therapist, a physical
therapist, or any other member of the healthcare team.

● Dentist
- Dentists diagnose and treat mouth, jaw, and dental problems. Dentists
(and their dental hygienists) are also actively involved in preventive
measures to maintain healthy oral structures (e.g., teeth and gums).

● Dietitian or Nutritionist
- A dietitian has special knowledge about the diets required to maintain
health and to treat disease.
- Dietitians in hospitals generally are concerned with therapeutic diets,
supervise the preparation of meals to ensure that clients receive the proper
diet, and may design special diets to meet the nutritional needs of
individual clients.
- A nutritionist is an individual who has special knowledge about nutrition
and food.
- The nutritionist in a community setting recommends healthy diets and
provides broad advisory services about the purchase and preparation of
foods.

● Emergency Medical Personnel

- These personnel are trained to assess, treat, and transport clients
experiencing a medical emergency, accident, or trauma.

● Occupational Therapist
- An occupational therapist (OT) assists clients with impaired function to gain
the skills to perform activities of daily living (ADLs).
- The OT teaches skills that are therapeutic and at the same time provide
some fulfillment.

● Paramedical Technologist
- Laboratory technologists, radiologic technologists, and nuclear medicine
technologists are just three kinds of paramedical technologists in the
expanding field of medical technology.
- Paramedical means having some connection with medicine.
- Laboratory technologists examine specimens such as urine, feces, blood,
and discharges from wounds to provide exact information that facilitates
the medical diagnosis and the prescription of a therapeutic regimen.
- The radiologic technologist assists with a wide variety of x -ray film
procedures, from simple chest radiography to more complex fluoroscopy.
- The nuclear medicine technologist uses radioactive substances to provide
diagnostic information and can administer radioactive materials as part of a
therapeutic regimen.

● Pharmacist
- A pharmacist prepares and dispenses pharmaceuticals in hospital and
community settings.
- The role of the pharmacist in monitoring and evaluating the actions and
effects of medications on clients is becoming increasingly prominent.
- A clinical pharmacist is a specialist who guides primary care providers in
prescribing medications.
- Pharmacists also work directly with clients and with other healthcare team
members to ensure safe integration of medications into the client's
comprehensive health plan.

● Physical Therapist
- The physical therapist (PT) assists clients with musculoskeletal problems .
Physical therapists treat movement dysfunctions by means of heat, water,
exercise, massage, and electric current.
- The functions of a PT include assessing client mobility and strength,
providing therapeutic measures (e.g., exercises and heat applications to
improve mobility and strength ), and teaching new skills ( (e.g , how to walk
with an artificial leg).

● Physician
- The physician is responsible for medical diagnosis and for determining the
therapy required by an individual who has a disease or injury. The
physician's role has traditionally been the treatment of disease and trauma
(injury); however, many physicians include health promotion and disease
prevention in their practice.

● Physician Assistant
- Physician assistants (PAS) perform certain tasks under the direction of a
physician and are increasingly positioned to provide primary care. They
treat various diseases, conditions, and injuries.

● Podiatrist
 - Doctors of podiatric medicine (DPM) diagnose and treat foot and ankle
conditions. They are licensed to perform surgery and prescribe
medications.

● Respiratory Therapist
- A respiratory therapist is skilled in therapeutic measures used in the care
of clients with respiratory problems.
- These therapists are knowledgeable about oxygen therapy devices,
respirators, mechanical ventilators, and accessory devices used in
inhalation therapy.
- Respiratory therapists administer many of the pulmonary function tests.

● Social Worker
- A social worker counsels clients and their support individuals regarding
problems such as finances, marital difficulties, and adoption of children.
- They are particularly familiar with both public and private resources
available to clients according to their socioeconomic qualifications.
- It is not unusual for health problems to produce problems in day- to-day
living and vice versa.

● Spiritual Support Personnel

- Chaplains, pastors, rabbis, priests, and other religious or spiritual advisers
serve as part of the healthcare team by attending to the spiritual needs of
clients.
- In most facilities, local clergy volunteer their services on a regular or on-call
basis. Hospitals affiliated with specific religions, as well as many large
medical centers, have full- time chaplains on staff.

6. Communication models
- is the interchange of information between two or more people; in other
words, the exchange of ideas or thoughts.
- uses methods such as talking and listening or writing and reading.
COMPONENTS:
➢ Sender
- a person or group who wishes to communicate a message to another, can
be considered the source-encoder.
- Encoding involves the selection of specific signs or symbols (codes) to
transmit the message, such as which language and words to use, how
to arrange the words, and what tone of voice and gestures to use.
➢ Message
- what is actually said or written, the body language that accompanies the
words, and how the message is transmitted.
- It is important for the method to be appropriate for the message, and it
should help make the intent of the message clearer.
➢ Receiver
- is the listener, who must listen, observe, and attend. This person is
the decoder, who must perceive what the sender intended (interpretation).
- perception uses all the senses to receive verbal and nonverbal
- messages.
- to decode means to relate the message perceived to the receiver’s
storehouse of knowledge and experience and to sort out the meaning
of the message.
➢ Response or feedback
- is the message that the receiver returns to the sender.
- It is also called feedback.
- Feedback can be either verbal, nonverbal, or both. Nonverbal
examples are a nod of the head or a yawn. Either way, feedback allows
the sender to correct or reword a message.

7. Criteria of nursing as a profession