Introduction in applied medical sciences Introduction to nursing science

Prepared by: Eid Aldossary

FUNDAMENTALS OF NURSING

NURSING : the diagnosis of human responses to actual and potential problems. -- American Nurses Association NURSING is the act of utilizing the environment of the patient to assist him in his recovery. -- Florence Nightingale NURSING is to assist the individual sick or well. -- Virginia Henderson

Common Themes:

• Nursing is Caring.• Nursing is an Art. • Nursing is Science.• Nursing is Client-Centered. • Nursing is Holistic. • Nursing is Adaptive.• Nursing is concerned with health Promotion, Health Maintenance

and Health Restoration.• Nursing is a Helping Profession.

Nursing as a Profession

• Profession - calling that requires special knowledge, skill and preparation. Primary Characteristics :

• 1. Education • 2. Theory • 3. Service • 4. Autonomy • 5. Code of Ethics

“Education” Nursing :

“Education” Nursing a. Began in June 1860 when the Florence Nightingale School of Nursing opened at St. Thomas Hospital in London; this school had the first program

of formal education for the nurse b. The Philosophy of the Nightingale’s System was based on the following: - training of nurses should be considered as important as any other form

of education and be supported by public funds. - training schools for nurses should have close affiliation with hospitals but retain financial and administrative independence from them. - professional nurses should be responsible for the education of nursing students rather than persons not involved in nursing - nursing students should be provided with residence during their training which offer them pleasant, comfortable surroundings close to the hospital.

c. US and Canada copied the Nightingale Schools of England very closely but the US training schools failed to remain separate from the hospitals resulting in a form of educational abuse of nursing students by the hospitals

d. Written physician’s orders originated with Nightingale who insisted that nurses accompany the physicians on patient visits e. Believed that health teaching was a critical responsibility of the nurse if national health was to improve f. The last two decades of the 19 th century is also called the “awakening of nursing”g. In the early decades of the 20 th century, hospitals started to segregate patients according to their disease process thus the concept of clinical

nurse specialist arose h. Between 1913 and 1937, a standardized curriculum for Schools of Nursing was prepared by the National League for Nursing Education

Contemporary Nursing :

Contemporary Nursing a. Began at the end of World War II; associated with scientific and technological developments and social changes since 1945 b. Changing patterns in Nursing education by adding more clinical content c. Professionalization of Nursing d. Globalization: borderless nursing.

The Earliest Hospitals: A. Hospital Real de Manila (1577) - it was established mainly to care for the Spanish King’s soldiers but also

admitted Spanish civilians. - founded by Gov. Francisco de Sande. B. San Lazaro Hospital (1578) - built exclusively for patients with leprosy. - founded by Briother Juan

Clemente. C. Hospital de Indio (1586) - service was in general supported by alms and contributions from charitable

persons.D. Hospital de Aguas Santas (1590) - founded by Brother J. Bautista of the Franciscan Order. E. San Juan De Dios Hospital (1596) - founded byBrotherhood of Misericordia and administered by the

Hospitalliers of San Juan de Dios.

Socialization for Professional Nursing Practice

Socialization - process by which a person learns the ways of a group or society in order to become a functioning participant Benner’s (1984) five levels of proficiency as the nurse acquires SKA and values of nursing 5 STAGES:

Stage 1: Novice - may be student or nurse entering a clinical setting where that person has no experience

Stage 2: Advanced beginner - demonstrates marginally accepted performance.Stage 3: Competent - nurse has been on the job in the same situation for 2 to 3 years; demonstrates organizational ability but lacks the speed and flexibility of the proficient nurse. Stage 4: Proficient - perceives a situation as a whole rather than just its individual aspects; nurse focuses on long-term goals and is oriented toward managing the nursing care of the client rather than performing specific tasks Stage 5: Expert - no longer relies on rule, guidelines or maxims to connect an understanding of the situation to an appropriate action; have highly developed perceptual acuity or recognitional ability, and their performance is fluid, flexible and highly proficient.

Roles of the Professional Nurse1. Care provider/Parent Surrogate - primarily concerned with the clients needs. Recognize the patient’s most immediate needs. 2. Communicator/Helper - communicates with the client, support persons and colleagues. ***Establish trust. 3. Teacher - provides health teaching to effect behavior change which focuses on acquiring new knowledge or technical skills. *** Assess client’s learning needs/ Assess client’s readiness to learn.4. Counselor - process of helping a client to recognize and cope with stressful psychological or social problems, to develop improved interpersonal relationships and to promote personal growth. *** Render active listening/ Do not give advice. 5. Client advocate - advocates for client rights. 6. Change agent - initiates changes and assists the client makes modifications in the lifestyle to promote health. - helps the client to speak up for themselves. *** Patient must develop self awareness.

Roles of the Professional Nurse

7. Leader - mutual process of interpersonal influence through which the nurse helps a client make decisions in establishing and achieving goals to improve client’s well-being.

8. Manager - plans, gives direction, develops staff, monitors operations, gives reward fairly and represents both staff members and administration as needed.

9. Researcher - participates in scientific investigation and uses research findings in practice.

10. Collaborator - initiates nursing actions within the health team .

EXPANDED CAREER ROLES FOR NURSES:

EXPANDED CAREER ROLES FOR NURSES: 1. Nurse Practitioner .2. Clinical Nurse Specialist. 3. Nurse Anesthetist. 4. Nurse Midwife. 5. Nurse Researcher. 6. Nurse Administrator 7. Nurse Educator .

Focus of Nursing

1. Health and Wellness Promotion - helping people develop resources to maintain or enhance their well-being.

2. Illness Prevention - maintain optimal health by preventing disease. 3. Health Restoration - helping people to improve health following health

problems or illness. 4. Care of the Dying - comforting and caring for people of all ages while they

are dying.

The 4 Major Concepts: 1. Person - recipient of the nursing care. 2. Health - the degree of wellness and well being that a person

experiences. 3. Environment - pertains to the internal and external surroundings

that affects a person. 4. Nursing - pertains to attributes, characteristics and actions of the

nurse providing care in behalf of the client or in conjunction with the client.

NURSING THEORIES :

• NURSING THEORIES• GENERAL THEORIES • 1. Nightingale’s Environmental Theory > focuses on the

patient and his environment. > her work in Crimea (1854-1856) earned her the title “The Lady with the Lamp”. > also known as the First Nurse Scientist Theorist for her work, Notes on Nursing: What it is and What it is Not (1860). > she focused on changing and manipulating the environment in order to put the patient in the best possible conditions for nature to act.

Con’t Nursing theories

• 2. Virginia Henderson’s Nature of Nursing Model > conceptualizes the nurse’s role as assisting sick or healthy individuals to gain independence in meeting 14 FUNDAMENTAL NEEDS. > she postulated that the unique function of a nurse is assist the individual, sick or well, in the performance of those activities contributing to health or its recovery (or peaceful death) that he would perform unaided if he had the necessary strength, will or knowledge. > she further believed that nursing involves assisting the client in gaining independence as rapid as possible, of assisting him achieves peaceful death if recovery is no longer possible.

Basic Components of Nursing Care According to Virginia Henderson :

Basic Components of Nursing Care According to Virginia Henderson 1. Breath normally 2. Eat and drink adequately 3. Eliminate body wastes 4. Move and maintain desirable posture 5. Sleep and rest 6. Select suitable clothes 7. Maintain body temperature within normal range by adjusting

clothing or modifying the environment 8. Keep the body clean and well-groomed and protect the integument 9. Avoid dangers in the environment and avoid injuring others

10. Communicate with others in expressing emotions, needs, fears or opinions

11. Worship according to one’s faith 12. Work in such a way that there is a sense of accomplishment13. Play or participate in various forms of recreation 14. Learn, discover or satisfy the curiosity that leads to the

normal development and health and use the available health facility.

1-9 Physiologic Component 10 & 14 Psychological 11 Spiritual 12 & 13 Sociological.

Con’t nursing theories

3. Martha Roger’s Science of Unitary Human Beings > Considers man as a unitary human being co-existing with in the universe, views nursing primarily as a science and is committed to nursing research. >

Five assumptions about human beings: 1. Is an irreducible, four-dimensional energy field identified by

pattern. 2. Manifests characteristics different from the sum of the parts. 3. Interacts continuously and creatively with the environment. 4. Behaves as a totality. 5. As a sentient being, participates creatively in change.

Con’t nursing theories

4. Dorothea Orem’s Self-Care Deficit Theory > emphasizes the client’s self-care needs, nursing care becomes necessary when client is unable to fulfill biological, psychological, developmental or social needs. > she defined self-care as “ the practice of activities that individuals initiate to perform on their own behalf in maintaining life, health well-being. > conceptualized 3 Nursing Systems:

1. Wholly compensatory :nurse acts for the patient; patient has no active role.

2. Partially compensatory :both nurse and patient perform care measures.

3. Supportive-Educative :patient is able to perform. patient only needs health teaching.

MAN and His Basic Human Needs

CONCEPT OF MAN A. ATOMISTIC APPROACH The atomistic study of man views man as an organism composed of

different organ systems where each system is composed of organs and each organ is composed of tissues and cells.

B. HOLISTIC APPROACH This view traces man’s relationship with other human beings in the suprasystem of society. This approach views man as a whole organism with interrelated and interdependent parts functioning to produce behavior. Man as a whole therefore is different from and more than the sum of his component parts. The dimensions of man include the physical, social, spiritual, cognitive and psychological aspects.

- Man as a social being is capable of relating with others. His first agent of socialization is the family where he is nurtured, where he learns his first language and where he first learns to socialize. - Man as a spiritual being is capable of such virtues as faith, hope and charity. Faith is the unquestioning belief in someone or something. It is the foundation where hope rests. Charity means the love of man for his fellowmen. Man as a spiritual being believes in a power beyond himself and of transcending one’s limitations.

Con’t MAN and His Basic Human Needs

-Man as a thinking being is capable of perception, cognition, and communication. He is also capable of logical thinking and reasoning. - Man as a psychological being is capable of rationality. His rational side makes him merciful, kind and compassionate. - Man as a physical being has such characteristics as genetic endowment, sex, other physical attributes, physical structure and functions.

Con’t MAN and His Basic Human Needs

Abraham Maslow’s Hierarchy of Basic Human Needs NEED - is something that is essential to the survival of humans. A basic need is something whose:

1. Absence may lead to illness 2. Presence may signal health or prevent illness 3. If unmet needs are met or fulfilled, health may be restored. FIRST LEVEL: Physiological Needs a. Oxygen b. Elimination c. Fluids d. Shelter e. Nutrition f. Rest g. Temperature h. Sex SECOND LEVEL: Safety and Security Needs 4. Physical Safety: - involves reducing or eliminating threats to the body such as illness, accident and

environmental exposure. 5. Psychological Safety : - understanding and the appropriateness of what to expect from others,

from new experiences and from encounters with the environment. THIRD LEVEL: Love and Belonging Needs - need to establish social relationships and to experience

emotional nurturance and care to and from others. FOURTH LEVEL: Esteem and Self-Esteem Needs - linked with the desire for strength, achievement,

adequacy, competence, confidence, and independence. FIFTH LEVEL: Need for Self-Actualization - highest level of all needs.

Con’t MAN and His Basic Human Needs

Characteristics of a self-actualized individual: 1. Solves own problems. 2. Assists others in problem-solving. 3. Accepts suggestions of others. 4. Has broad interest in work and social topics. 5. Possesses good communication skills as a listener and communicator.6. Manages stress and assists others in managing stress. 7. Enjoys privacy. 8. Seeks new experiences and knowledge. 9. Shows confidence in abilities and decisions. 10. Anticipates problems and successes. 11. Likes self.

Characteristics of Basic Human Needs: 12. Needs are universal 13. Needs may be met in different ways. 14. Needs may be stimulated by external and internal factors. 15. Priorities may be altered. 16. Needs may be deferred. 17. Needs are interrelated.

HEALTH and ILLNESS

CONCEPT OF HEALTH, WELLNESS, WELL-BEING AND ILLNESS HEALTH > is the fundamental right of every human being. It is the state of integration of the body and mind. –(HEALTH) is a state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity. (WHO) - is the ability to maintain the internal milieu (environment). Illness is the result of failure to maintain the internal environment. (Claude Bernard)

is being well and using one’s power to the fullest extent. Health is maintained

through the prevention of diseases via environmental health factors. (Florence Nightingale) > is the ability to maintain homeostasis or dynamic equilibrium. (Walter Cannon) > is a dynamic state in the life cycle. Illness is an interference in the life cycle. (Imogene King) > is a state of a process of being becoming an integrated and a whole as a person. (Sister Calista Roy)

HEALTH and ILLNESS

WELLNESS AND WELL-BEING > Wellness is a state of well-being. > Well-Being is a subjective perception of balance, harmony and vitality. > Wellness has different dimensions :

1. Physical - the ability to carry-out daily tasks (grooming, mobility, etc.) and to achieve fitness of the different organ systems of the body.

2. Emotional - the ability to manage stress and to express emotions appropriately. 3. Social - ability to interact successfully with people and within the environment of

which each person is a part, to develop and maintain intimacy with significant others and to develop respect and tolerance for those with different beliefs.

4. Intellectual - the ability to learn and use information effectively for personal, family, and career development.

5. Spiritual - the belief in some force (nature, science, religion, or a higher power) that serves to unite human beings and provide meaning and purpose of life.

6. Occupational - ability to achieve balance between work and leisure time.

Disease and Illness DiseaseDisease and Illness Disease – alteration in the body functioning which results in the reduction of capacities

and shortening of life span. Illness – a personal state in which the person feels unhealthy. In other words: Disease is an illness with

objective facts while Illness is a subjective perception of not being well. Stages of Illness: Stage 1. Symptoms Experience - experience some symptoms, persons believes something is wrong. 3

aspects – physical, cognitive and emotional. Stage 2. Assumption of the Sick Role - acceptance of illness, seeks advice. Stage 3. Medical Care Contact - seeks advice to professionals for validation of real illness, explanation of

symptoms, reassurance or predict of outcome.Stage 4. Dependent Patient Role - the person becomes a client dependent on the health professional for

help; accepts or rejects health professional’s suggestions; becomes more passive and accepting. Stage 5. Recovery/Rehabilitation - gives up the sick role and returns to former roles and functions.

Classification of DiseasesClassification of Diseases: 1. According to Etiologic Factors:A. Hereditary – due to defect in the genes of one or other parent which is transmitted to the offspring. B. Congenital – due to defect in the development, hereditary factors or prenatal infection C. Metabolic – due to disturbance or abnormality in the intricate processes of metabolism D. Deficiency – results from inadequate intake or absorption of essential dietary factor E. Traumatic – due to injuryF. Allergic – due to abnormal response of the body to chemical and protein substances or to physical stimuliG. Neoplastic – due to abnormal or uncontrolled growth of cell H. Idiopathic – cause is unknown; self-originated; of spontaneous originI. Degenerative – results from the degenerative changes that occur in the tissues and organsJ. Iatrogenic – result from the treatment of the disease2. According to Duration or Onset: K. Acute Illness – has short duration and is severe. Signs and symptoms appear abruptly, intense, and often subside after a

relatively short period. L. Chronic Illness – usually longer than 6 months, and can also affects functioning in any dimension. Is characterized by: >

Remission – periods during which the disease is controlled and symptoms are not obvious. > Exacerbations – disease becomes more active given at a future time, with recurrence of pronounced symptoms.

M. Sub-Acute – symptoms are pronounced but more prolonged than the acute disease.3. Disease may also be described as:A. Organic B. Functional C. OccupationalD. VenerealE. Familial F. Epidemic G. EndemicH. Pandemic I. Sporadic

Risk Factors of a Disease:

Risk Factors of a Disease: 1. Genetic or Physiologic - genetic predisposition. 2. Age - increase or decrease client’s susceptibility to

acquire disease. 3. Environment - surroundings that can affect the

person. 4. Lifestyle - habits that increases the chance of

acquiring a disease. 5. Sex - gender.

Levels of Prevention

Levels of Prevention: 1. Primary Prevention - applied on healthy individual.

focus: health promotion, disease prevention 2. Secondary Prevention - applied on patient’s with

signs and symptoms. focus: screening, diagnosing, case-finding, early detection, prompt treatment

3. Tertiary Prevention - applied on patients with chronic and debilitative disease. focus: rehabilitation

THE NURSING PROCESS

Nursing Process - provides the framework in which nurses use their knowledge and skills to express human caring and to help clients meet their health needs. - a systematic, rational method of planning and providing care using the process of ADPIE. Steps:

1. A SSESSMENT 2. D IANOSIS 3. P LANNING 4. I MPLEMENTATION (interventions)5. E VALUATION

References

• Kozier & Erb's Fundamentals of Nursing Package (8th Edition) Audrey J. Berman Ph.D. RN AOCN (Author), Shirlee Snyder EdD RN (Author), Barbara J. Kozier MN RN (Author), Glenora Erb BScN RN (Author)