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UNIT VI: NURSING PARADIGM - NURSING

A. Nursing 1. Latin word NUTRIX - to nourish. 2. The act of utilizing the environment of the patient to assists him in his/her recovery - Florence Nightingale. 3. The unique function of the nurse is to assists the individual, sick or well, in the performance of those activities contributing to health or its recovery (or to peaceful death) that he will perform unaided if he had the necessary strength, will or knowledge, and to this in such a way as to help him gain independence as rapidly as possible - Henderson 4. It is also viewed as an art, a science and a social science. a. Art deals with skill that requires dexterity and proficiency b. Science it is a systematic and well defined body of knowledge which utilizes scientific measures and procedures, and applies nursing processes, or uses nursing care plans in caring, diagnosing and treating human responses to actual or potential health problems. c. Social Science because its primordial interest is man, whether well or sick, within the context of his life and environment

B. NURSING AS a PROFESSION 1. Profession a. Has been defined as an occupation that requires extensive education or a calling that requires special knowledge, skills and preparation. b. A profession is an organization of an occupational group based on the application of special knowledge which establishes its own rules and standards for the protection of the public and the professionals. c. A profession implies that the quality of work done by its members is of greater importance in its own eyes and the society than the economic rewards they earn. d. A profession serves all of society and not the specific interest of a group. e. The aim of a profession is altruistic rather than materialistic.

2. Criteria of a Profession: a. Specialized education b. Service Orientation c. On-going research d. A code of ethics e. Autonomy f. A professional organization

g. Body of Knowledge

3. A Professional Nurse a. Is a person who has completed a basic nursing education program and is licensed in his/her country or state to practice professional nursing? Philippine Nursing Act of 1991 (RA 7164) has been repealed by the Philippine Nursing Act of 2002 (R.A. 9173) known as the Nursing Law.

4. Professional Qualities of a Nurse: a. Interest and willingness to work and learn with individuals/groups in a variety of setting. b. A warm personality and concern for people. c. Resourcefulness and creativity as well as well-balanced emotional condition d. Capacity and ability to work cooperatively with others e. Initiative to improve self and service f. Competence in performing work through the use of nursing process

g. Skill in decision-making, communicating and relating with others and being research oriented h. Active participation in issues confronting nurses and nursing.

5. Personal Qualities of a Nurse: a. Good Personality

Consists of the distinctive individual qualities that differentiate one person from the other. It refers to the impression one makes on others which will include more than that which meets the eyes. It consists of deeper traits which come from the heart and which infiltrate the real person if one wishes to exert a magnetic influence on others. It is a result of integrating ones abilities, desires, impulses, habits and physical character into a harmonious whole.

b. Components of Good Personality: Personal Appearance Character Attitude Charm

6. Personal Appearance: a. Self-respect is the basis upon which personal appearance is established. b. Components: Posture it refers to the habitual or assumed position of your body in standing, positioning, sitting or moving about. It presents some clues to your personality. Grooming Hair is the crowning glory of your face. It should be neat, clean and well arranged. It also includes personal hygiene and cleanliness. Dress and Uniform (with cap) just as self respect is evident in good posture and personal hygiene, so as it reflected in the care you exercise with regards to dressing. Items comprising the uniform should be spotlessly clean, well fitting and in good repair. Shoes and hosiery worn with the uniform should provide for maximum comfort.

Uniform designated for use in a given hospital area is worn only in the line of duty and not to be worn outside specified department. Modification of any authorized uniform to suit individual preference is not permitted by the dictates of both good taste and integrity.

7. Character: a. It refers to the moral values and beliefs that are used as guide to personal behavior and actions. b. It is what a person is inside. c. It is the development in proportion to emotional and intellectual growth and involves the degree to which you understand, direct and channel your feelings. d. The practice of Nursing utilizes ones love for fellowman. Charity is the greatest virtue and serves as the foundation for a sense of values and the development of human character. e. 4 Virtues emanating from the practice of Charity: Justice quality of being righteous, correct, fair and impartial Prudence permits to live with good sense and perspective. Guides ones choice of action here and now. Fortitude assist in the control of feelings, thought and emotions in the face of difficulty. Temperance encourages constructive use of the pleasure of the senses

8. Attitude a. A manner of acting, thinking or feeling that is indicated by ones response toward another person, situation or experience. b. Personality is shaped by ones attitudes. c. It develops from awareness of oneself in relation to individuals and situation.

9. Charm

a. To influences the senses or the mind by some quality or attraction; delight b. Innate in one who has a depth of feeling and an outgoing manner c. May be cultivated by a desire to serve and a deep love for fellow human beings. d. To acquire charm, cultivate the following: Voice modulated with clear enunciation Manner courteous, attentive, patient, receptive Heart - attempt never to show indifference or a callused manner. Emphatic, understanding and tolerant. Remembers to say thank you as this works miracles in social harmony. Intelligence keep an active mind, recognize beauty, accept new ideas from others, read and exchange opinions with others. Poise equanimity, calmness, and composure (face reality, avoid emotional flare-ups), evenness of temper, self control (think before acting, avoid verbal and physical aggressiveness

C. HISTORY OF NURSING 1. Factors that affect and influenced Nursing History: a. Womens Roles and Status b. Traditional roles of mother, wife, daughter, sister c. Subservient and dependent role d. Nursing roots is in the home e. Traditional nursing role entails humanistic caring, nurturing, comforting and supporting.

2. Religion a. Christian value of love thy neighbor as thyself b. Parable of Good Samaritan c. Converted Christians used their wealth to provide house of healing (forerunner of hospitals)

d. Crusades and deaconess group provided nursing care to the sick and injured comrades. e. Early religious values, such as self-denial, spiritual calling and devotion to duty and hard work have dominated nursing throughout its history.

3. War d. Crimean War (1854-1856) Nightingale and her nurses provided care to the sick and injured. e. American Civil War (1861-1865) - Notable nurses during this period were: f. Harriet Tubman Moses of her People Sojourner Truth Claire Burton Dorothy Dix - The Unions Superintendent of Female nurses

World War I - American, British and French volunteered their services

g. World War II Cadet Nurse Corps. was established to address the acute shortage of caregiver Practical nurses aides and technician provided much of the actual nursing care.

h. Vietnam War 90% of military women were newly graduate nurses - this made the youngest group medical personnel ever to serve in the war time.

4. Societal Attitudes towards the Nursing Profession a. 1800s Womans place was in the house and no respectable woman should have a career. Nurses during this period were poorly educated, Negative attitude toward nurses up to the contemporary time due to a literary portrayal of Sairy Gamp, a nurse who cared for the sick by neglecting and physically abusing them.

b. c.

Later 19th Century Image of Angel of Mercy or Guardian Angel because of the work of Florence Nightingale Doctors handmaid Heroin portrayal evolved from nurses act of bravery in WW1 Other images in the late 1900s include the nurse as sex objects, surrogate mothers, tyrannical mothers 1990s up to present efforts have been done to improve the image of nurses

D. NURSING LEADERS

1. 19th Century a. Florence Nightingale (1820-1910) Lady with the Lamp First scientist-theorist for her work Notes on Nursing: What It Is and What It Is Not

b. Clara Burton (1812-1912) Established the American Red Cross

c. Linda Richards (1841-1930) Americas first trained nurse Introduced nurses notes and doctors orders Initiated the practice of nurses wearing uniform Pioneered work in psychiatric and industrial nursing

d. Mary Mahoney (1845-!926) First African American professional Nurse

e. Lilian Wald (1867-1940) Founder of Public Health Nursing

2. 20th Century a. Lavinia L. Dock (1858-1956) Active in the protest movement for womens right that resulted in allowing women to vote

b. Mary Breckinridge (1881-1965) Established the Frontier Nursing Service To provide family centered primary health care to rural population.

E. HISTORICAL EVOLUTION OF PROFESSIONAL NURSING

1. ANCIENT HISTORY a. Belief that diseases are caused by supernatural causes, temples became the center of medical care b. Early maternal child nursing was the responsibility of midwives and wet nurses were hired to breast feed babies. c. Priests were responsible for Healing practice. d. Hippocrates Father of Medicine rejected the belief that diseases is caused by supernatural dreams.

2. EARLY CHRISTIAN ERA a. Religious influence raised the social position of nursing by placing more value on human life b. Deacon and Deaconess were designated to perform services to the sick c. 380AD - Fabiola, established the first hospital in the Rome.

3. MIDDLE AGES a. The crusades resulted in the establishment of military nursing orders and recruitment of men into nursing. b. Church dictated the scope of nursing and viewed spiritual needs as the priority of care.

4. RENAISSANCE ERA a. Sound educational preparation of nursing contributed to the perfection for the advancement.

5. REFORMATION ERA a. The role of women changed dramatically during this period. b. Women were named as subordinates thus decreasing the number of qualified women practicing nursing.

6. NURSING IN THE 18th CENTURY a. Revolution and epidemics resulted in the expansion of nursing roles in the US. b. Nursing was prevalent in the hospital but working conditions were poor, resulting in loss of social status for the members of the profession (inferior undesirable occupation).

7. NURSING IN THE 19TH CENTURY a. Societys attitude about nursing is negative and seriously damage the professions image(Low Moral Standard). b. Continued emphasis was placed on the need for proper preparation of nurses. c. Hospital based school of nursing under medical supervision emerged. d. 1869- American Medical Association developed the training of nurses. e. Public Health Nursing Service was established.

8. NURSING IN THE 20TH CENTURY a. Military influenced nursing education b. 1898 Volunteer Nursing Corp was established later became the Nurse Army Corp(1901) c. Professional organization emerge ANA, ICN, NLN, AACN(American

Association of College of Nursing) d. Journals were developed American Journal of Nursing (AJN) was first published in 1900. It was the first nursing journal to be owned, operated and published by nurses

F. HISTORY OF NURSING IN THE PHILIPPINES

1. Early Beliefs and Practices a. Diseases and their causes and treatment were shrouded with mysticism and superstitions. b. Beliefs about causation of disease: Another person (an enemy or a witch) Evil spirits

c. People believed that evil spirits could be driven away by persons with powers to with powers to expel demons d. People believed in special gods of healing, with the priest-physician) called word Doctors) as intermediary. If they used leaves or roots, they were called herb doctors (herbolarios) e. Early Care of the Sick: Herb men were called Herbicheros meaning one who practiced Witchcraft. Persons suffering from diseases without any identified cause were believed to be bewitched by the mangkukulam or mangagaway. Difficult childbirth and some diseases (called pamano) were attributed to nonos, midwife assisted in childbirth. During labor the mabuting hilot (good midwife) was called in, if birth became difficult witches were supposed to be the cause. To disperse their influence, gunpowder was exploded from a bamboo cane to the head of the sufferer.

2. Heath Care during the Spanish Regime

a. The religious orders exerted their efforts to care for the sick by building hospitals in the different parts of the Philippines. b. The earliest hospitals established were the following: Hospital Real de Manila (1577) - established mainly to care for the Spanish Kings soldiers, but also admitted Spanish civilians: founded by Gov. Francisco De Sande. San Lazaro Hospital (1578) - founded by Brother Juan Clemente and was administered for many years by the Hospitalliers of San Juan de Dios; built exclusively for patients with leprosy. Hospital de Indio (1586) - established by the Franciscan Order service was in general supported by alms and contributions from charitable persons. Hospital de Aguas Santas (1590) - established in Laguna; near medicinal spring, founded by Brother J. Bautista of the Franciscan Order. San Juan de Dios Hospital (1596) Founded by the Brotherhood of Misericordia and administered by the Hospitalliers of San Juan de Dios; support was derived from alms and rents; rendered general health service to the public.

3. Nursing during the Philippine Revolution a. Josephine Bracken - wife of Jose Rizal. Installed a field hospital in an estate house In Tejeros: provided nursing care to the wounded night and day b. Rosa Sevilla de Alvero - Converted their house into quarters for the Filipino soldiers, during the Philippine-American War that broke out in 1899. c. Dona Hilaria de Aguinaldo - Wife of Emilio Aguinaldo organized the Filipino Red Cross under the inspiration of Apolinario Mabini. d. Dona Maria Agoncilla de Aguinaldo. Second-wife of Emilio Aguinaldo provided nursing care to Filipino soldiers during the revolution. President of the Filipino Red Cross branch in Batangas. e. Melchora Aquino (Tanding Sora) - Nursed the wounded Filipino soldiers and gave them shelter and food. f. Capitan Salome - revolutionary leader in Nueva Ecija provided nursing care to the wounded when not in combat.

g. Agueda Kahabagan revolutionary leader in Laguna which also provided

services to her troops. h. Trinidad Tecson - Ina ng Biac na Bato stayed in the hospital at Biac na Bato to care for the wounded soldiers.

G. Filipino Red Cross 1. Malolos, Bulacan was the location of the national headquarters 2. Established branches in the provinces 3. Functions of Filipino Red Cross: 4. Collection of the war funds and materials through concerts, charity, bazaars and voluntary contributions 5. Provisions of nursing care to wounded Filipino soldiers.

H. Hospitals and Schools of Nursing

1. Iloilo Mission Hospital School of Nursing (Iloilo City, 1906) a. Ran by the Baptist Foreign Mission Society of America b. Miss Rose Nicolet, graduate of New England Hospital for Women and Children in Boston, Massachusetts was the first superintendent for nurses. It moved to its present location in Jaro Road, Iloilo City 1929. c. Miss Flora Ernst, An American nurse, took charge of the school in 1942. d. March 1944 - 22 nurses graduated. e. April 1944 - graduate nurses took the first Nurses Board Examination at the Iloilo Mission Hospital

2. St Pauls Hospital School of Nursing (Manila, 1907) a. The Hospital was established by the Archbishop of Manila, the Most Reverend Jeremiah Harty under the supervision of the Sisters of St. Paul de Chartres. b. Located in the Intramuros and it provided general hospital services. c. 1908- Operated its training school for nurses with Rev. Mother Melanie as superintendent and Miss E. Chambers as Principal.

3. Philippine General Hospital School of Nursing (1907) a. 1901 - The Philippine General Hospital as a small dispensary mainly for Civil Officers and Employees in the City Manila. It later grew into Civil Hospital. b. 1906 - Mrs. Mary Coleman Masters, an educator advocated idea of training Filipino girls for the profession of Nursing. c. Opened a dormitory for girls enrolled at the Philippine Normal Hall and the University of the Philippines. d. 1907 - Opened classes in the nursing under the auspices of the Bureau of education. e. Julia Nichols and Charlotte Clayton taught the students nursing subjects. American physicians also served as lecturers. f. 1910, Act No. 1976, modified the organization of the school placing it under the supervision of the Director of Health. The Civil Hospital was abolished; the Philippine General Hospital was established.

g. The School became known as the Philippine General Hospital School of Nursing. h. Anastacia Giron-Tupas, first Filipino nurse to occupy the position of chief nurse and superintendent in the Philippines.

4. St. Lukes Hospital School of Nursing (Quezon City, 1907) a. 1903 - An Episcopalian Institution began as a small dispensary. b. 1907- The school opened with three Filipino girls admitted. These girls had their first year in combined classes with the Philippine General Hospital School of Nursing and St. Pauls Hospital school of Nursing. c. Miss Helen Hicks was the first principal. d. Vitaliana Beltran was the first Filipino superintendent of nurses. e. Jose Fores was the first Filipino medical director of the hospital. f. IIn the period of the organization between1907 and 1910 the first year nursing students of the Philippine General Hospital , St Lukes Hospital and St. Pauls Hospital had a common first year course, this was known as the Central School Idea in nursing education.

g. The first the three graduates were Candida Goco, Quintana Beley and

Veneranda Sulit. h. 1911 - Graduated its 1st batch of nurses i. j. 1941(December) - World War II broke out and schools were closed. 1943 - Schools were resumed after the Japanese doctors and nurses took over.

k. 1907 - St. Lukes Hospital then called University Hospital opened training school for nurses. l. 1945 - Japanese team left the country, Filipino staff continued the work

m. 1946 - Graduation of the post-war class n. 1954 - Incorporation of the St. Lukes Hospital School of Nursing. It began to have a separate Board of trustees and operated its own budget. It was during this year when Mrs. Ester A. Santos o. (Principal of the School at that time proposed that the school look into the possibility of offering a BSN Program for its nurses. p. 1956 - BSN proposal was shelved by the Board of Trustees because of requirements for a collegiate program. q. 1963 - Purchase of Capitol City College by the Episcopal Church thru Prime Bishop Ret. Rev. Lyman C. Ogilby. It was renamed Trinity College of Quezon City r. 1965 - The 1st class was admitted to take courses under the BSN program of TCQC SLCN.

s. 1970 - The 1st BSN class who graduated under a 5 Yr. Curriculum. t. 1975 - School granted special permission to offer a 2 year program. Graduated later on took a 3 year Diploma Program. Took licensure examination and became Registered Nurses. u. 1975 - Accredited by the Philippine Accrediting Association For Schools, Colleges, and Universities. (PAASCU) v. 1980 - Graduated the last batch of the 5 year curriculum and started the 1st batch of the 4 year curriculum w. 1984 - New Curriculum with RLE implemented x. 1988 - 1st graduates of the New BSN curriculum with RLE

I. First Colleges of Nursing in the Philippines

1. University of Santo Tomas College of Nursing (1946) a. February 11, 1941 - The College began as the UST School of Nursing Education. b. The School was unique since it operated as a separate entity from the Santo Tomas University Hospital. c. The ideals of Christian charity permeated this course. d. In 947, the Bureau of Private Schools permitted UST to grant the title of graduate Nurse to the 21 students who were at the advanced standing. e. Sor Taciana Trinanes was its first directress

2. Manila Central University College of Nursing (1947) a. In 1947, offered the BSN course. b. Miss Consuelo Gimeno was its first principal.

3. University of the Philippines College of Nursing (1948) a. The idea of opening the college began in conference between Miss Julita Soteja and the UP President Gonzales. b. 1948, the University Council approved the curriculum, and the Board of Regents recognized the profession as having equal standing as medicine, law, engineering, etc. c. Miss Julita Sotejo was its first dean.

J. Nursing Leaders in the Philippines 1. Anastacia Giron- Tupas - First Filipino nurse to hold the position of Chief Nurse Superintendent; founder of the Philippine Nurses Association. 2. Cesaria Tan - First Filipino to receive a Masters degree in nursing abroad. 3. Socorro Sirilan - Pioneered in Hospital Social Service in San Lazaro Hospital where she was the Chief Nurse. 4. Rosa Militar - pioneer in school health education. 5. Sor Ricarda Mendoza - pioneer in nursing education.

6. Socorro Diaz - First editor of the PNA magazine called The Message. 7. Conchita Ruiz - First full -time editor of the newly named PNA magazine The Filipino Nurse. 8. Loreto Tupaz - Dean of the Philippine Nursing; Florence Nightingale of Iloilo

L. Nursing Organizations: 1. Philippine Nurses Association - This is the national organization of Filipino nurses. 2. National League of Nurses - The association of nurses employed in Department of Health. 3. Catholic Nurses Guild of the Philippines 4. Others: ORNAP, MCNAP, IRNOP, etc.

M. Professionalism

1. Definitions: a. Profession is an occupation that requires extensive education or a calling that requires special knowledge, skills & preparation. b. Professionalism refers to professional character, spirit, or methods and implies respectability and commitment c. Professionalization is the process of becoming professional, of acquiring characteristics considered to be professional.

2. Difference of a profession to other occupations : a. It requires a prolonged specialized training to acquire a body of knowledge pertinent to the role to be performed. Specialized Education is an important aspect of professional status: Bachelors degree, Masters degree, doctoral degree Body of Knowledge Nursing has a well developed body of knowledge and expertise.

Nursings conceptual frameworks contribute to the knowledge base of nursing. Give direction to nursing practice, education and ongoing research. b. An orientation of an individual towards service either to community or an organization. A service orientation differentiates nursing from an occupation pursued primarily for profit. Altruism [selfless concern for others] is the hallmark of a profession.

c. Ongoing research. d. A Code of Ethics Nurses are expected to do what is considered right regardless of the personal cost Nursing can develop its own code of ethics and set up means to monitor the professional behavior of its members.

e. Autonomy A profession is autonomous if it regulates itself and sets standards for its member. It should have legal authority to delineate scope of its practice, describe functions and roles and determine goals and responsibilities. There is independence at work, responsibility and accountability to ones actions.

N. Roles and Responsibilities of a Professional Nurse:

1. Caregiver a. The roles include those activities that assist the client physically and psychologically while preserving the clients dignity. b. The required nursing actions may involve full care for the completely dependent client, partial care for the partially dependent client, and supportive-educative care to assists clients in attaining their highest possible level of health and wellness.

c. The nurse addresses the holistic health care needs of the clients, including measures to restore emotional, spiritual and social well-being.

2. Communicator a. The nurse identifies client problems and then communicates this verbally or in writing to other members of the health team. b. The quality of communication is critical factor in meeting the needs of individuals, families, and communities.

3. Teacher/ Educator a. The nurse explains to clients concepts and facts about health, demonstrates procedures such as self-care activities, determines that the client fully understands, reinforces learning or client behavior, and evaluates the clients progress in learning. b. Nurses also teach unlicensed assistive personnel to whom they delegate care, and they share their expertise with other nurses and health professionals.

4. Client Advocate a. In this role the nurse may represent the clients needs and wishes to other health professionals, assists the clients in exercising their rights and help them speak for themselves. b. The nurse protects the clients human and legal rights, keeping in mind the clients religion and culture.

5. Counselor a. The nurse helps the clients to recognize and cope with stressful psychological or social problem, to develop improved interpersonal relationships, and to promote personal growth.

6. Change Agent a. The nurse acts as a change agent when assisting clients to make modifications in their behavior.

b. Technological change, change in the age of the clients population, and changes in medications are just a few of the changes nurses deal daily.

7. Leader a. Nurses influences others to work together to accomplish a specific goal. b. The leader role can be employed at different levels: individual client, family, and groups of clients, colleagues, or the community.

8. Manager a. The nurse manages the nursing care of individuals, families, and communities. b. Also delegates nursing activities to ancillary workers and other nurses, and supervises and evaluates their performance.

9. Case Manager a. They work with the multidisciplinary health care team to measure the effectiveness of the case management plan and to monitor outcomes.

10.

Research Consumer

a. The use of research improves the client care. The nurses need to: have some awareness of the process and language of research be sensitive to issues related to protecting the rights of human subjects participate in the identification of significant researchable problems be a discriminating consumer of research findings

O. Scope of Nursing Practice based on RA 9173: 1. Sec. 28. Scope of Nursing Practice As independent practitioners, nurses is primarily responsible for the promotion of health and prevention of illness. As members of the health team, nurses shall collaborate with other health care

givers for the curative, prevention, and rehabilitative aspects of care, restoration of health, alleviation of suffering, and when recovery is not possible, towards a peaceful death. 2. A nurse while in practice of nursing in all settings is duty-bound/ required to: a. Observe the Code of Ethics for Nurses b. Uphold standards for safe nursing practice c. Maintain competence by continual learning through CPE to be provided by the APO (PNA) or any recognized professional nursing organization. Resolution No. 2004-179 s. 2004

S. ETHICO-MORAL- LEGAL RESPONSIBILITIES IN NURSING

1. Ethical Principles of Professional Patient Relationship:

a. Autonomy The right to make ones own decision the right to choose personal goals nurses respect a clients right best interest treating clients with consideration and respect In the health care setting, informed consent is a direct application of the principle. The client who declines treatment or discharges against medical advice (AMA) exercises autonomous right. Always explain the purpose of the interview or assessment, how the information will be obtained, and how the information will be used.

b. Non-maleficence Duty to do no harm Harm includes risk of harm which is not always clear Ex. nursing intervention that is meant to be helpful may have a harmful side

effect.

c. Beneficence doing good Nurses are obligated to implement actions that benefit clients and families

d. Justice Fairness Nurses often face decisions that call for sense of fairness They must weigh the facts carefully to divide their fairly among the clients they care for during a workday

e. Fidelity Keeping promises and agreements.

f. Veracity Telling the truth Honesty in disclosure is essential at the all levels of professional practice.

g. Respect for others Includes the clients right for selfdetermination Sensitivity to cultural, religious and lifestyle diversity transcend respectful nursing practice.

2. Legal Roles of Nurses:

a. Provider of Service The nurse is expected to provide safe and competent care so that harm

(physical, psychological or material) to the recipient of the service is prevented

b. Liability Is the quality or state of being legally responsible for ones obligations and actions and to make financial restitution for wrongful acts

c. Standards of Care It is by which the nurse acts or fails to act are legally defined by nurse practice acts and by rule of reasonable and prudent professional with similar preparation and experience would do in similar circumstances

d. Employee or Contractor for Service A nurse who is employed by a hospital work as an agent of the hospital and the nurses contract with the clients is an implied one.

e. Contractual Relationship Independent Nurse Practitioner contractual relationship with the client is independent. Nurse employed by the Hospital functions with employer-employee relationship. The nurse represents and acts for the hospital and therefore must function within policies of the agency. (Also, respondent superior let the superior answer). The nurse may also be held liable as an individual in case of inappropriate behavior. Hitting client in any part of the body. Assisting in criminal abortion Taking drug from the clients supply for personal use. Citizen. The rights and responsibilities of the nurse in the role of citizen are the same as those individuals under the legal system.

3. Areas of Potential Liability in Nursing:

a.

Crime An act committed in the violation of public (criminal) law and punishable by a fine and or imprisonment. May be intentional or unintentional.

b.

Classification of Crimes: Felony crime of serious nature is committed with deceit, when the act is performed with deliberate intent and there is fault when the wrongful acts results from imprudence, negligence, or lack of skill or foresight

Manslaughter second degree of murder

Misdemeanor offense with less serious nature and is usually punishable by a fine or short term jail sentence

c.

Tort Is a civil wrongdoing committed against a person or a persons property

d.

Kinds of Tort:

Intentional Tort: Fraud (deception or trickery), the false presentation of some facts with the intention that it shall be acted upon by another person. Invasion of Privacy it is the right of an individual to withhold himself or his life from publics scrutiny; the right to be alone

Defamation - a communication that is false or made with careless disregard for the truth, and results in injury to the reputation of the person Libel is defamation by means of print, writings or pictures Slander is defamation by spoken words, stating unprivileged or false words by which a reputation is damage. Assault an attempt or threat to touch another person unjustifiably. Battery the willful touching of a person (including persons clothes or something the person is carrying) that may or may not cause him harm. False Imprisonment is the unlawful restraint or detention of another person against his or/her wishes.

Unintentional Tort: Negligence Failure to behave in a reasonably and prudent manner, whether as a lay person or a professional and whether engage in the simplest or most complex type of activity. Harm/injury results from this failure. Malpractice Negligent act of a person engage in professions or occupations in which highly technical or professional skills are employed. Elements of proof in Nursing Negligence and Malpractice: Duty of the nurse to the client. A breach of the duty on the part of the nurse. An injury to the client. A casual relationship between the breach of duty and the clients subsequent injury. Potential Malpractice Situations in Nursing: Medication error

Sponge count error Burning a client Clients fall Failure to observe and take proper actions Mistaken identity Loss/damage of clients property Failure in reporting crimes, torts and unsafe practice.

T. FIELDS of OPPORTUNTIES in NURSING 1. Classification of fields of nursing in General 2. The fields of nursing may be classified according to the following: 3. Hospital or Institutional Nursing 4. Public health Nursing or Community health Nursing 5. Private Duty or Special Duty Nursing 6. Industrial or Occupational Health Nursing 7. Nursing Education 8. Military Nursing 9. School Nursing 10.Clinical Nursing 11.Independent Nursing Practice

1. HOSPITAL / INSTITUTIONAL NURSING a. Staff nurse, cares for the patient in the hospital or in the out-patient department and plans for the nursing care needs of the patient about to be discharged b. The nurse performs nursing measures that will meet the patients physical, emotional, social and spiritual health needs while in the institution and helps him and his family plan for his further health care needs when he returns home

2. Community Health Nursing a. Promotion of health and prevention of diseases rather than care for the sick b. Focus of nursing care is on family and community health and more on educational preventive aspects c. Individuals, families and communities are motivated to assume responsibilities for their own health d. With the implementation of the primary health care, public health nursing up to date through various continuous education program by the department of health

3. School Health Nursing a. Responsible for the schools activities in the areas of health service, health education and environmental safety b. Organize and implementing the school health programs c. Evaluating school health programs

4. Occupational Health Nursing or Industrial Nursing a. Specialty practice that provides and delivers health care services to workers b. Focuses on promotion, protection and supervision of working health within the context of safe and healthy environment c. They need to be fully informed of their legal responsibilities and their professional limitations d. Knowledgeable of companies policies and personnel, insurance benefits, sick leaves, health programs and other medical matters and records

5. Nursing Education a. Qualifications of the Faculty: Be a registered nurse in the Philippines Have at least one (1) year of clinical practice in a field of specialization Be a member of good standing in the accredited professional

organization of nurses Be a holder of a masters degree in nursing, education, or other allied medical and health sciences conferred by a college or university duly recognized by the Government of the Republic of the Philippines

6. Military Nursing a. Provides comprehensive and quality nursing care to all military personnel, their dependents and authorized relatives b. Functions of the AFP Nurse Corps: To meet the nursing needs of todays patients in AFP medical facilities To prepare each Nurse Corps Officer (regular and reserve) for future assignments at a higher level of responsibility in the different stations and general hospitals in time o peace and war To teach and train enlisted personnel who perform nursing functions under supervision. Special emphasis on enlisted members who function in settings where there are no nurses

7. Flight Nursing or Aero-space Nursing a. Responsible for patients, military or otherwise who have been evacuated from battle areas to the nearest installation for treatment

8. Clinic Nursing a. Acts as a receptionist, answers phone, does the billing, takes x-rays and ECGs, changes dressings, gives injections and assists in physical examinations b. Have excellent teaching and communication skills, exhibit organizational and leadership ability, possess good assessment skills, have good insight in order to anticipate and interpret the needs of their patients

9. Independent Nursing Practice a. Self employed and proves professional nursing services to clients/patients and their families b. Set up their clinics near a hospital and most of them are community-based

c. Perform both independent and collaborative roles d. Make referrals and collaborate with physicians and other disciplines as needed by the clients or family e. Accountable to their own decisions

10.

Private Duty Nursing

a. A private duty nurse is a registered nurse who undertakes to give comprehensive nursing care to a client on a one to one ratio b. An independent contractor c. Expected to be expert clinicians as well as expert generalists in nursing d. Use the title Private Nurse Duty Nurse, Private Nurse Practitioner, Special Duty Nurse or Private Duty Nurse Specialist

11.

Other Emerging Nursing Opportunities:

a. Traveling Nurses b. Medical Sales Pharmaceutical Representatives c. Nurse Entrepreneur d. Advance Practice Nursing e. Clinical Nurse Specialist (CNS) f. Certified Nurse Mid-wife (CNM)

g. Certified Registered Nurse Anesthetist (CRNA) h. Nurse Practitioner (NP)

U. COMMUNICATION SKILLS

1. Communication a. Process of exchanging information and the process of generating and transmitting meanings between two or more individuals. b. It is the foundation of society and the most primary aspect of a nurse-patient

interaction. c. It is the medium to share family experiences, gain knowledge, establish and maintain governmental agencies and enhance entertainment.

2. Levels of Communication a. Intrapersonal Communication (or self talk) Communication that happens within the individual Used to enhance positive interaction with the patient and family.

b. Interpersonal Communication Occurs between two or more people with a goal to exchange messages The nurses ability to communicate at this level influences the nurses interpersonal sharing, problem solving, goal attainment, team building and effectiveness in crucial nursing roles

c. Group Communication Small Group Communication - occurs when nurses interact with two or more individuals to attain their goals. Organizational Communications - occurs when individuals and groups within an organization communicate to achieve established goals. Group Dynamics - can be described most simply as how individual group members relate to one another during the process of working toward group goals. The success and failures of groups depends largely on the behavior of its members.

3. PROCESS OF COMMUNICATION Scenario: Picture yourself walking into a patients room to administer a pain medication by injection. What do you see yourself communicating through each of the three channels of communication?

Channel

Mode of Transmission

Outcome

Nursing Behavior

Visual

Sight

Receiving a visual stimulus Patient sees nurse walking into the room holding desired medication Interpreting a visual Patient make note of the nurses stimulation by making note sense of competence, of non-verbal enhancement confidence, and sympathetic expression. Assigning meaning to a visual event Receiving the auditory stimuli Patient concludes that the nurse is willing and able to help him and feels comfortable. Patient hears the nurse say I understand your hip is hurting. This injection should help you to start feeling better within 15 minutes. Patient sense that the nurse said he should start feeling better soon and really wants this to happen because he cares about him.

Observation

Perception

Auditory

Hearing

Listening

Gaining awareness of underlying messages and feelings accompanying auditory events.

Kinestheti Procedural touch c Caring touch

Performing nursing Patient feels that nurse touching procedures and techniques him while administering injection in the left buttocks. Conveying emotional support Patient feels that the nurse cares about him as a person when he touches his shoulder upon first entering the room while asking about his pain.

4. Components of Communication:

a. Verbal Communication It is considered to be the most common type of communication. Characteristics: written or oral, tone, language, volume, frequency, choice of words, rate and accent. Influenced by: persons age, gender, culture, stereotypes and biases, education and impairments like hearing or sight loss, geographic and

ethnic origin. An exchange of communication using words, including both the spoken and written words. Verbal communication depends on language which is a prescribe way of using words so that people can share information effectively. It reveals aspects of persons intellectual development, educational level, and geographical and ethnic origin. In nursing this includes, verbal interactions with patient and family, giving oral reports to other nurses, writing care plans, and recording patients progress in the patients charts.

b. Non-Verbal Communication The transmission of information without the use of words, and often termed as body language. The transmission of information without the use of words. often termed as body language It often helps nurses to understand subtle and hidden meanings in what is being said verbally.

Kinds:

Touch a personal behavior and means different things to different people. Despite its individuality, it is one of the most effective non verbal ways to express feelings of discomfort, love, affection, security, anger, frustration, aggression, excitement, and many others.

Eye Contact this usually begins communication. It also suggests respect and willingness to listen and keep communication open. On the other way, a blank stare may indicate daydreaming or inattentiveness.

Facial Expression the face is the most expressive part of the

body. It may convey anger, joy, suspicion, sadness, fear, contempt

Posture the way a person holds the body carries a message.

Gait - ex. A bouncy and purposeful walk carries a message of wellbeing; if in pain, walk slightly bent or move slowly

Gesture - movements of various parts of the body carries numerous messages: thumbs up victory, tapping of a footanxiety or anger

General Physical Appearance observing for changes in appearance is an important nursing responsibility for detecting illness or evaluating the effectiveness of care and therapy. Ex. Sunken eye; dry skin that wrinkles easily; radiance of good health

Mode of dress and grooming

Sounds - crying (sadness or joy), moaning, gasping (indicates fear, pain or surprise), sighing (reluctant to do something or of relief)

Silence may also be a positive or negative expression of a feeling.

5. Metacommunication a. Used to describe all of the factors that influence how the message is perceived. It is the communication about communication so that the deeper message within a message can be uncovered and understood. (Wood, 1999). b. It includes the verbal communication and all of its factors, which include culture, native language, gender, vocal pitch, as well as the non-verbal communication and all of its factors which includes body language, culture, gender, appearance, etc.

c. The focus is on the whole rather than on the parts of the communication.

6. Seven Principles for Effective Communication:

a. Information giving is not communication. Communication requires the sharing of information-which means the person receiving it understands the content of the message or the feelings communicated in the message, or both.

b. The sender is responsible for clarity. Making messages clear to others, it is understood, and feedback from the receiver is encouraged to help clarify any confusion.

c. Use simple and exact language. Use precise but simple language, in both spoken and written message to be easily understood.

d. Feedback should be encouraged. This is the best way to help people understand each other and work together better.

e. The sender must have credibility. If the receiver does not perceive the sender as credible, it is not likely that the message will be given importance.

f. Acknowledgement of others is essential. Everyone ones to feel that he/she has worth.

g. Direct channels of communication are best. The greater the number of individuals involve in filtering a message, the

less likely the message is to be received correctly.

7. Developing Therapeutic Communication Skills:

a.

Conversation skills Exchange of verbal communication and is a social interaction Tone of voice should indicate interest rather than boredom, patience rather than anger, acceptance rather than hostility. Be knowledgeable of the topic of conversation and have accurate information. Be clear and concise and make statements as simple as possible. Be flexible. Avoid words that might have different interpretations. (Ex. Love, hate, freedom and liberty might have different meaning to different people). Semantics the study of the meaning of the words. Be truthful. A patient who is given false information will soon distrust the nurse. Keep an open mind. The pt. can make valuable contributions to their own healthcare. Take advantage of available opportunities.

b.

Listening skills Skill that involves both hearing and interpreting what the other says. It requires attention and concentration to sort out, evaluate, and evaluate clues to better understand the true meaning of what is being said. When possible, sit when communicating with pt. (body language) Sit when communicating with patient when possible. (Cross arms/legs may convey a message of being closed to the patients comments. Be alert, relax, and take sufficient time so that the patient feels at ease during the conversation. Keep the conversation as natural as possible and avoid sounding overly

eager. If culturally appropriate, maintain an eye contact with the patient without staring, face-to-face pose. Indicate that you are paying attention to what the patient is saying by using appropriate facial expression and body gesture. Think before responding to the patient. Do not pretend to listen. Listen for themes in the patients comments. (Repeated or avoided themes).

c. Silence Periods of silence during communication can carry a variety of meaning: The patient may be comfortable and content in the nurse-patient relationship. Continuous taking is unnecessary. The patient might be trying to demonstrate stoicism and the ability to cope without help. The patient might be exploring his/her inner thoughts or feelings, and conversation would disrupt this. The patient might be fearful and use silence as an escape from a threat. The patient might be angry and use silence to display this emotion.

d. Touch the use of touch is one comforting approach whereby the nurse reaches out to clients to communicate concern and support. Nurses use task-oriented touch when performing a task or procedure. Nurses uses a caring touch in a form of non-verbal communication that can successfully influence a clients comfort and security, enhance selfesteem, and improve reality orientation. Protective touch is a form of touch used to protect the nurse and /or client. Because touch conveys many massages, it must be used with discretion. Touch oriented tasks can have some exceptions because of clients cultural background.

Touch should be as gentle or as firm as needed and delivered in a comforting, nonthreatening manner. Touch should be withheld for highly suspicious or angry patient may respond negatively or even violently to the nurses touch.

e. Humor laughter releases excess physical and psychological energy and reduce stress, anxiety, worry, and frustration.

f.

Assertiveness skills The key to assertiveness is open, honest and direct communication. I statements I feel and I think play an important role in assertive statements. Four basic components of assertive response or approach: Having empathy Describing ones feelings or the situation Clarifying ones expectations Anticipating consequences

V. THERAPEUTIC COMMUNICATION

1. ATTENTIVE LISTENING a. Is listening actively, using all the senses as opposed to listening passively with just the ear. It involves paying attention to the total message, both verbal messages and non-verbal messages and noting whether these communications are congruent.

2. PHYSICAL ATTENDING a. The manner of being present to another or being with another: Face the other person squarely Maintain good eye contact

Lean toward the person Maintain an open posture Remain relatively relaxed

3. THERAPEUTIC COMMUNICATION TECHNIQUES THAT FACILITATE COMMUNICATION AND FOCUS ON CLIENTS CONCERN

a. USING SILENCE Accepting pauses or silences that may extend for several seconds or minutes without interjecting any verbal response.

b. PROMOTING GENERAL LEADS Using statements or questions that: encourage the client to verbalize choose a topic of conversation facilitate continued verbalizations

c. BEING SPECIFIC AND TENTATIVE Making statements that are specific rather than general, and tentative rather than absolute.

d. USING OPEN-ENDED QUESTIONS Asking broad questions that lead or invite the client to explore thoughts or feelings.

e. USING TOUCH Providing appropriate forms of touch to reinforce caring feelings.

f. RESTATING / PARAPHRASING

Actively listening for the clients basic message and then repeating those thoughts and/or feelings in similar words.

g. SEEKING CLARIFICATION A method of making the clients overall meaning of the message more understandable.

h. PERCEPTION CHECKING OR SEEKING CONSENSUAL VALIDATION A method similar to clarifying that verifies the meaning of specific words rather than the overall meaning of a message.

i. OFFERING SELF Suggesting ones presence, interest, or wish to understand the client without making any demands or attaching conditions that would make the client comply to the suggestion to receive the nurses attention.

j. GIVING INFORMATION Providing, in a simple and direct manner, specific factual information the client may or may not request.

k. ACKNOWLEDGING Giving recognition, in a non-judgmental way, or a change in behavior, an effort the client has made, or a contribution to a communication.

l. CLARIFYING TIME OR SEQUENCE Helping the client to clarify an event, situation, or happening in relationship to time.

m. PRESENTING REALITY Helping the client to differentiate the real from the unreal.

n. FOCUSING Helping the client expand on and develop a topic of importance. The focus may be an idea or feeling.

o. REFLECTING Directing ideas, feelings, questions or content back to the client to enable him to explore his own ideas and feelings about a situation.

p. SUMMARIZING AND PLANNING Stating the main points of a discussion to clarify the relevant points discussed. This technique is useful at the end of an interview or to review a health-teaching session. It often acts as an introduction to future care planning.

W. COMMUNICATION STRATEGIES PROVIDING COMFORT

1. PITY An expression of regret or sorrow for a client who is suffering, distressed, or unhappy. Confirms the sufferers state.

2. SYMPATHY An expression of the nurses own sorrow for the clients condition or situation. Shows acceptance of the clients state, thereby providing comfort.

3. COMPASSION Expresses a strong emotional response to the clients distress; leads to sharing of the suffering. Shows acceptance of the clients problem. Strengthens and comforts; nurse experiences the clients pain.

4. CONSOLATION

Involves soothing and encouraging to ease discomfort and pain, may offer support and hope

5. COMMISERATION Used commonly in support groups or when the nurse has experienced the clients problem in some form. Nurse and client have mutual response to a common experience.

6. REFLEXIVE REASSURANCE Spontaneous reaction by the nurse to try to calm the client who feels anxiety and distress over some circumstance.

X. NON-THERAPEUTIC COMMUNICATION

1. STEREOTYPING Offering generalized and oversimplified beliefs about groups of people that are based on experiences too limited to be valid.

2. AGREEING AND DISAGREEING Agreeing and disagreeing imply that the client is either right or wrong and that the nurse is in the position to judge this.

3. BEING DEFENSIVE Attempting to protect a person or health care services from negative comments. These responses prevent the client from expressing true concerns.

4. CHALLENGING Giving a response that makes clients prove their statement or point of view. These responses indicate that the nurse is failing to consider the clients feelings, making the client feel it is necessary to defend a position.

5. PROBING Asking for information chiefly out of curiosity rather than with the intent to assist the client.

6. TESTING Asking questions that make the client admit to something.

7. REJECTING Refusing to discuss certain topics with the client.

8. CHANGING TOPICS AND SUBJECTS Directing the communication into areas of self-interest rather than considering the clients concerns often arises as a self-protecting response to anxiety-causing topics.

9. UNWARRANTED REASSURANCE Using clichs or comforting statements of advice as a means to reassure the client.

10.

PASSING JUDGMENT Giving opinions and approving or disapproving responses, moralizing or implying ones own values.

11.

GIVING COMMON ADVICE Telling the client what to do. These responses deny the clients right to be an equal partner.

Y. NURSING AS AN ART

1. ART

a. The application of knowledge and skill to bring about desired results b. Individualized action

2. NURSING ART a. Carried out by the nurse in one-to-one relationship with the patient, and constitutes the nurses conscious responses to specifics in the patients immediate situation

3. ART OF CLINICAL NURSING a. Understanding of the patient and his/her condition, situation, and need b. Enhancement of the patients capability c. Improvement of his condition or situation within the framework of the medical plan for his care d. Prevention of the recurrence of his problem or development of a new one which may cause anxiety, disability, or distress

4. NURSING ARTS THREE INITIAL OPERATIONS:

a. STIMULUS the helping process is triggered by a stimulus which is the patients presenting behavior

b. PRECONCEPTION is an expectation of what the patient may be like and is based on knowledge gained from a great variety of sources including: Patients chart, Reports from other nurses, Doctors or family members, What the nurse has read or heard of patients in similar condition, Her/his own experiences with patients in similar condition, Her/his recollection of previous contacts with the patient.

c. INTERPRETATION comparison of perception with expectation.

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