Sunteți pe pagina 1din 60


Nursing Board Exam/Nursing Licensure Exam Coverage (Nursing Practice I)

TEST DESCRIPTION: Theories, concepts, principles and processes basic to the
practice of nursing with emphasis on health promotion and health maintenance. It
includes basic nursing skills in the care of clients across age groups in any setting.
Moreover, it encompasses the varied roles, functions and responsibilities of the
professional nurse in varied health care settings.
I. Personal and Professional Growth and Development

A. Historical Perspective in Nursing


The Four Great Periods of Nursing

*This untaught nursing was instinctive.
*Dated from pre-historic times.
*Practice among primitive tribes and lasted through Christian era.
*Performed out of feeling of compassion to others.
*Out of wish to do good- HELPING

*Extends from the founding of religious orders in the 6th century through the
crusades which began in the 11th century to 1836.
*The Deacons School of Nursing at Kaisserwerth, Germany established by
pastor Fliedner and his wife.
*Period of on the job training- desired of person to be trained

*Began in 1860.
*Florence Nightingale School of Nursing opened at St. Thomas in London.
First program of formal education for nurses started.

*Began at the end of World War II (1945)
*Scientific and Technological developments of many social changes occurs.

*Cause of illness was believed to be the invasion of the victims body by an evil spirit.
*Uses black magic or voodoo to harm or driven out by using supernatural power.
*Believed in medicine man (shaman or witch doctor) that had the power to heal by
using white magic.
They made use of hypnosis, charms, dances, incantations, purgatives, massage,fire,
water, herbs or other vegetations and even animals.
*Performing a trephine
Drilling a hole in the skull with a rock or stone without benefit of anesthesia.
Goal of this therapy is to drive the evil spirit from the victims body.
*Nurses role was instinctive directive toward comforting, practicing midwifery and
being wet nurse to a child.
*Act performed without training and direction.

*Practice of medicine is far advanced.
*Code of Hammurabi.
-Legal and Civil measures is establish
-Regulate the practice of physicians
-Greater safety of patient provided
*No mention of Nurses or nursing this time

*Art of embalming enhance their knowledge of human anatomy
*Developed the ability to make keen clinical observations and left a record of 250
recognized diseases.
*Control of health was in the hands of Gods. The first acknowledged physicians was
*Made great progress in the field of hygiene and sanitation.
*Reference to nurses in Moses 5th book is a midwife and wet nurse.

*The Hebrews book of genesis emphazised the teachings of Judaism regarding
hospitality to the stranger and acts of charity.
*Implementation of laws like
-controlling the spread of communicable disease
-preparation of food
-purification of man (bathing and his food.
*The ritual of circumcision of the male child on the 8th day
*The established of the High Priest Aaron as the physician of people.

*Culture was imbued with the belief in spirits and demons.
*Gave the world the knowledge of material medica (pharmacology); method of treating
wounds, infection and muscular afflictions.
*Chan Chun Ching Chinese Hippocrates.
*Emperor Shen Nung said to be the father of Chinese medicine and the inventor of
acupuncture technique.
*No mention of nursing in Chinese writings so it is assumed that care of the sick will fall
to the female members of the household.

*First recorded reference to the nurses taking care of patients on the writings of
*Functions and Qualifications of nurse includes:
- Knowledge in drug preparation and administration.
- Cleverness.
- Devotedness to the patient.
- Purity of both mind and body.
*King Asoke, a Buddhist, published an edict to established hospitals throughout India
where nurses were employed.

*Made contribution in the area aesthetic arts and clinical medicine, but nursing was the
task of the untrained slave.
*Aesculapius, The Father of Medicine in Greek mythology to whom we associate the
Caduceus, (known insignia of medical profession today)
*Hippocrates, the Father of Medicine insisted that magic and philosophical theories
had no place in medicine.
*The work of women was restricted to the household. Where mistress of the mansion
gave nursing care to the sick slaves.

*Acquired their knowledge of medicine from the Greeks.
*Emperor Vespasian opened schools to teach medicine.
*Developed military medicine First aid, field ambulance service and hospitals for
wounded soldiers.
*Translated Greek medical terminologies into Latin terms which has been used in
medicine ever since.

*Religious orders of Christian Church played a major role in this kind of nursing.

The Crusades (11th Century)

*Series of holy wars were conducted by Christian in an attempt to recapture the Holy
land from the Turks.
*Military religious orders founded during the crusades established hospitals and staffed
them with men who served as nurses. Among these were:
- The knights of St. John of Jerusalem served both as warriors in battle and
nurses in the hospital and was called Knights Hospitallers.
- The Teutonic Knights built hospitals cared for sick and denfended the faith.
- The Knights of St. Lazarus established primarily for the nursing of lepers,
forerunners of our now known communicable diseases hospital (also called lazarettos).

The Rise of Religious Nursing Orders

* The Regular Orders established monasteries to house travelers, paupers and
patient under one roof. Later as society became better organized hospitals tended to
become separate institutions apart from monsteries.
*The Secular Orders developed for the primary purpose of nursing; were similar to
the regular orders by their temporary vows, uniformity in dress and religious
*The Nursing Orders definitely organized. The sisters advanced the stage of
probationer to wearing the white robe to receiving the hood; They were all under the
superintendent of nurses or director of nursing; later adopted a uniform dress that
eventually became entirely standardized.

Nursing Saints
* St. Hildegarde a Benedictine abbess in Germany, actually prescribed cures in her 2
books on medicine and natural history.
* St. Francis and Clara took vows of poverty, obedience, service and chastity and
took care of the sick and the afflicted; founders of the Franciscan Order and the Order
of the Poor Clares respectively.
* St. Elizabeth of Hungary the patroness of nurses; built a hospital for the sick and
the needy.
* St. Catherine of Siena the 1st lady with a lamp; became a tertiary of St.
Dominic and engaged in works of mercy among the sick and of the Church.

The Reformation
* St. Vincent de Paul set up the first program of social service in France and
organized the Community of the Sisters of Charity. His 1st superior and co-founder
was Louise de Gras (nee de Marillac).

The Intellectual Revolution (17th Century)

Characterized by the development of natural science, medicine, arts and as well as
interest in human beings and their welfare. Among the leaders for reform were:
* St. John of God founder of the Brother Hospitallers and declared the patron of all
hospitals and sick folk by Pope Leo XIII in 1930.
* George Fox founder of the sect known as the Soicety of Friends (Quakers) who
advocated equality of men and women, thus making it easier for women to become
active in Nursing.
* John Howard introduced prison reforms (fresh air and plenty of water).
* Philippe Pinel introduced his modern open-door treatment of the mentally ill.
* Elizabeth Fry greatly improved prison conditions by developing work fo the
prisoners and the segregations of sexes, later established the Insitute of Nursing
sisters, the first organization of women to be trained as private duty nurse.
* Mother Mary Catherine MccAuley founder of the Order of the Sisters of Mercy,
2nd largest of the Roman Catholic Orders.
* Theodor Fliedner and his wife Friederike Mumster established the Institute of
Kaisserwerth on the Rhine for the practical training of Deaconesses (1836), which is
considered as the 1st Organized training school for nurses. It was here where Florence
Nightingale received some of her training and the inspiration for the establishment of
her school of nursing. Some of its features includes:
1. A rotating 3 year experience in cooking and housekeeping, laundry and linen and
nursing care in the womens and mens wards; and
2. A preliminary and probationary 3 months period of trial and error for both school
and student.

The Dark Period of Nursing (17th 19th Century)

* Many hospitals were closed; the wealth took care of their sick at home; the indigent
sick were taken care of by uneducated, illiterate women who had no background for
* Charles Dickens in his book entitled Martin Chuzzleswit published the selfish and cruel
conduct of 2 private duty nurses namely Sairey Gamp and Betsy Prig.


* June 15, 1860 marked the day when 15 probationers entered St. Thomas Hospital
in London to establish the Nightingale system of Nursing, founded by Florence
Nightingale (May 12, 1820). Among the highlights in her life are the following:
- At age of 31, obtained parental consent to enter the Deaconess School at
- Had 3 months training at Kaisserwerth; later superintendent of the Establishment
for Gentlewomen During Illness (1853) during which time she initiated the policy of
admitting and visiting the patients of all faiths.
- In 1854 a Volunteered for Crimean war service together with 38 women at Scutari
in the Crimea upon the request of Sir Sidney Herbert, Minister of War in England. At first
their work is not accepted because it consisted of cleaning the area, thus reducing the
infections, clothing for the men, writing letters to their families; their work served as
inspiration for the Red Cross later on.
- In 1860 started the Nightingale System of Nursing at the St. Thomas Hospital in
London believed that schools should be self-supporting; that schools of nursing should
have decent living quarters for their student; that they should have paid nurse
instructors; that the school should correlate theory to practice and these students should
be taught the why not just how in nursing.
- 2 books written Note on Nursing and Notes on Hospital, contain many timely
portions applicable in the 1970s as they were in 1859.

United States
* At the time that Florence Nightingale was opening her school in London; the U.S was
on the brink of the civil war. However though the country was in a condition of chaos,
nursing had many supporters and the needs to train nurses were recognized.
- Linda Richards is the first graduate nurse in the U.S completed her training at the
New England Hospital for Women and Children in Boston, Massachusetts, patterned
after the DeaconessesSchool of Kaisserwerth.
- In 1873 3 schools of nursing opened, patterned after the Nightingale plan the
Bellevue Training School for Nurse in the New York City , the Connecticut training.
School in New Haven and the Massachusetts General Hospital in Boston.
- In 1881 founding of American Red Cross by Clara Barton.
- In 1889 John Hopkins hospital opened a school of Nursing with Isabel Hampton
Robb as its 1st principal and the person most influential in directing the development of
nursing in the U.S.
- In 1893 the groundwork for the estimate of the 2 new nursing organization was
1. The Associated Alumnae, later known as the American Nurses Association was
begun at the Chicago Worlds fair and
2. The American Society of Superintendent of Training Schools for Nurses, later
known as the National League for Nursing Education, also began.
- During the Spanish American War (1898 1899) nurse were concerned with the
care of the wounded as well as care of those inflected with malaria and yellow fever.
Nurse Clara Louise Maas gave her life for the advancement of medical science in the
search for control yellow fever.

The 20th Century

*In 1900 1912
- advancement in hospital nursing, private duty nursing, public health nursing,
school nursing, government service and pre-maternal nursing;
- there was a growing awareness for the preventive measures that could be uses to
maintaing the heath of the nation;
- There was beginning specialization in medicine.

* 1913 1937
- a standard curriculum for schools of nursing was prepared by the National League
for Nursing Education.
- the practice of nursing was gradually infiltrated with educational objectives.

* Worl War I (1917 1918)

- Private duty nurses were now nursing in the hospitals rather than in homes.
- Opening of more nursing schools as a result of the construction of more hospitals.
- Increase demand for public health nurse for preventice aspects of care.
- Awareness of the need for military ranking among nurses for which a bill was later
introduced and passed.
Julia Stimson was the first woman to hold rank of major.

* World War II (1942 1945)

- the start of Aero-medical nursing (flight nursing)
- Creation of the U.S Cadet Nurses Corps with Mrs. Lucille Ptery Leone as director
and later the 1st woman to serve as assistant surgeon of the U.S public Health Service.
- granting of permanent commissioned rank for both army and navy nurses.
- the concept of family centered care as methods to help patient help themselves.
- concept of psychosomatic medicine and early ambulation.
- consept of creative nursing, which has necessitated the need for laundering
definitive studies of all aspects of nursing thus helping to raise the standards to a
professional level.

* Creation of United Nations in San Francisco California in 1945.
2 folds purpose are:
- International peace and international security with provisions for equal justice,
Machinery for peaceful disputes and provisions.
- Provisions for assuring human rights, social justice and economic progress.

World Health Organization (WHO)

- Special agency of U.N, established in Geneva, Switzerland in 1948
- providing health information in fighting diseases and improving the nutrition, living
standards and environmental conditions of all people.
- Scientific and Technical Research used in disease prevention and health care.
- Social Force affecting Nursing Legislation, prepared health care, technology
efficiency and nursing involvement with minority groups.


Early Care of the Sick

* Early life of Filipinos had been more or less mixed with superstitious belief.
- believed in the powers of witch.
- belief in the powers of herbolarios (albularyo)
* Hospitals existed as early as 15th Century, which were established by the religious
and also by Spanish administration.
* Franciscan Order is more than any other religious group. Among their early hospitals
The Earliest Hospitals Established were the following:
HOSPITAL REAL de MANILA (1577) established primarily for kings soldiers and
Spanish civilians. Founded by Gov. Francisco de Sande.
SAN LAZARO HOSPITAL (1578) exclusively for the service of leprous patients.
Named after San Lazaro, patron saint of lepers. Founded by Brother Juan Clemente.
HOSPITAL de INDIOS (1586) established by the Franciscan Order: offered general
services, supported purely by alms and contributions from charitable persons.
HOSPITAL de AGUAS SANTAS (1590) convalescent hospital in Pansol, Laguna;
this was near medicinal spring, which cured several patients. Founded by Brother J.
Bautista of the Franciscan Order.
SAN JUAN de DIOS HOSPITAL (1596) founded by brotherhood of misericordia;
administered by the hospitallers of San Juan de Dios.
HOSPITAL de DULAC (1602 1603) located in Paco and existed only for 1 year.
HOSPITAL de NUEVA CACERES (1655) general hospital located in Bicol.
HOSPITAL de CONVALENSCECIA (1656) estimated by the Brotherhood of San
Juan de Dios on the little island on the Pasig River, where the Hospicio de San Jose
now stands; patients of San Juan de Dios Hospital who were in the convalescent stage
were sent there for their complete recovery.
HOSPITAL de ZAMBOANGA (1842) this is a governement military hospital run and
finance by Spanish governement.
HOSPITAL de CAVITE (1842) a general hospital estimated and managed by
Brotherhood of San Juan de Dios.
HOSPITAL de SAN GABRIEL (1866) exclusively for Chinese patients .

*Fray Juan Clemente was one of the 1st members of the Mission of the Order of St.
Francis in the Philippines in 1578.
- Collected native herbs for medicine later set a little pharmacy which he filled with
various medical remedies.
- Performed both the function of a physician and those of a nurse.
*Persons who really did nursing care of the sick were religious group (called
hospitallers) but they were assisted by Filipino attendants.
*In the early development of nursing, the work of the nurse and those of the physician
were not clearly defined.

Nursing Service during the Philippine Revolution

* The women during the Philippine revolutions took active part in nursing the wounded
soldier. They dress wounds, alleviate pains, prepared food and gave comfort even
without previous trainings.
* These were the prominent women who volunteered and gave nursing service.
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.
Mrs. Rosa Sevilla de Alvaro volunteered her service for the wounded soldier at age
of 18; he work hand in hand with Dona Hilaria de Aguinaldo and they led other Filipino
women to form the Filipino Red Cross in 1899.
converted their house into quarters for the Filipino soldier, during the Philippine
American war that broke out in 1899.
Dona Hilaria de Aguinaldo wife of Emilio Aguinaldo; Organized the Filipino Red
Cross under the inspiration of Apolinario Mabini.
Dona Maria de Aguinaldo second wife of Emilio Aguinaldo. Provided nursing care
for the Filipino soldier during the revolution. President of the Filipino Red Cross
branch in Batangas.
Melchora Aquino (Tandang Sora) Nurse the wounded Filipino soldiers and gave
them shelter and food.
Captain Salome A revolutionary leader in Nueva Ecija; provided nursing care to the
wounded when not in combat.
Agueda Kahabagan Revolutionary leader in Laguna, also provided nursing
services to her troop.
Trinidad Tecson Ina ng Biac na Bato, stayed in the hospital at Biac na Bato to
care for the wounded soldier.

* The Filipino Red Cross had its own constitution approved by the revolutionary
government. This was founded on February 17, 1899 with Dona Hilaria Aguinaldo as
president and Dona Sabina Herrera as secretary.

The Rise of Hospital and Nursing Schools

*The need for hospitals, dispensaries and laboratories led to the establishement of the
Board of Health in July 1901;
*A small dispensary in Manila opened for civil officers and employees, called Civil
*The need for doctors and nurses to help eradicate the epidemics of cholera and
smallpox led to the employment of U.S physicians and graduate nurses.
*In 1906 the idea of training Filipino girls to become nurses intiated the growth of
nursing schools.
1. Iloilo Mission Hospital School of Nursing (Iloilo City, 1906)
- It was ran by the Baptist Foreign Mission Society of America.
- Miss Rose Nicolet, a graduate of New England Hospital for woman and
children in Boston, Massachusetts, was the first superintendent.
- Miss Flora Ernst, an American nurse, took charge of the school in 1942.

2. St. Pauls Hospital School of Nursing (Manila, 1907)

- 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.
- It was located in Intramuros and it provided general hospital services.
-First trained nursing student graduated after 3 years.
-No standard requirements for admission except willingness to work.
3. Philippine General Hospital School of Nursing (1907)
- In 1907, with the support of the Governor General Forbes and the Director of
Health and among others, she opened classes in nursing under the auspices of
the Bureau of Education.
- Anastacia Giron-Tupas, was the first Filipino to occupy the position of chief
nurse and superintendent in the Philippines, succeeded her.

4. St. Lukes Hospital School of Nursing (Quezon City, 1907)

- The Hospital is an Episcopalian Institution. It began as a small dispensary in
1903. In 1907, the school opened with three Filipino girls admitted.
- Mrs. Vitiliana Beltran was the first Filipino superintendent of nurses.

5. Mary Johnston Hospital and School of Nursing (Manila, 1907)

- It started as a small dispensary on Calle Cervantes (now Avenida)
- It was called Bethany Dispensary and was founded by the Methodist Mission.
- Miss Librada Javelera was the first Filipino director of the school.

6. Philippine Christian Mission Institute School of Nursing.

- The United Christian Missionary of Indianapolis, operated Three schools of
1. Sallie Long Read Memorial Hospital School of Nursing (Laoag, Ilocos
2. Mary Chiles Hospital School of Nursing (Manila, 1911)
3. Frank Dunn Memorial Hospital

7. San Juan de Dios Hospital School of Nursing (Intramuros, Manila, 1913)

- Was destroyed during the war with a new hospital built along Dewey Boulevard.

8. Emmanuel Hospital School of Nursing (Capiz, 1913)

9. Southern Island Hospital School of Nursing (Cebu, 1918)

- The hospital was established under the Bureau of Health with Anastacia
Giron-Tupas as the organizer.

10. Zamboanga general Hospital School of Nursing (1921)

11. Chinese General Hospital School of Nursing (1921)

12. Baguio General Hospital School of Nursing (1923)

13. Manila Sanitarium and Hospital School of Nursing (1930)

14. Quezon Memorial Hospital School of Nursing (1957)

15. North General Hospital School of Nursing (1946)

16. Siliman University School of Nursing (Dumaguete, 1947)

17. Occidental Negros Provincial Hospital School of Nursing (1946)

18. Cebu (Velez) General Hospital School of Nursing (1951)

19. Brokenshire School of Nursing (Nueva Ecija, 1960)

20. De Ocampo Memorial School of Nursing (1954)

21. Marian School of Nursing (1960)

22. St. Rita Hospital and School of Midwifery (1956) and Nursing (1960)

Advantages of University Hospitals over Hospital Schools of Nursing:

1. students are treated as students and not as employees.
2. adequate financial support.
3. The head of the school is responsible only for the education of students in
nursing and;
4. The environment for the university school of nursing school education.

The First Colleges of Nursing in the Philippines

a. University of Santo Tomas .College of Nursing (1946)
- The first basic collegiate school for Nursing in the Philippines.
b. Manila Central University College of Nursing (1948)
c. University of the Philippines College of Nursing (1948). Ms.Julita Sotejo was its
first Dean
d. Southwestern College College School of Nursing (Cebu, 1947)
e. Philippine Union College of Nursing (1947)
f. Central Philippine College of Nursing (1947)
g. Siliman University College of Nursing (1947)
h. Philippine Womens University College of Nursing (1951)
i. FEU Institute of Nursing (1955)
j. UE College of Nursing (1958)
k. Saint Paul College of Nursing (Manila, 1958)

Nursing Leaders in the Philippines

*Anastacia Giron-Tupaz First Filipino nurse to hold the position of Chief Nurse
Superintendent; Founder of PNA (Philippine Nurses Association)
*Cesaria Tan First Filipino to receive a masters degree abroad.
*Socorro Sirilan Pioneered in Hospital Social Service in San Lazaro Hospital where
she was the Chief Nurse.
*Rosa Militar Pioneered in School Health Education.
*Sor Ricarda Mendoza Pioneer in Nursing Education.
*Socorro Diaz First Editor of the PNA magazine called The Message
*Conchita Ruiz First full-time editor of the PNA magazine called The Filipino Nurse.
*Loreta Tupaz Dean of the Philippine Nursing, regarded as the Florence Nightingale
of Iloilo.

Some Highlights in the History of Nursing in the Philippines

*1906 at the Union Mission Hospital (now Iloilo Mission Hospital) in Iloilo City, 4
women started training in nursing; 3 female graduated in 1909 as Qualified Surgical
and Medical Nurses.
*1907 19 students admitted to a preliminary course in nursing as the Philippine
Normal College.
*1909 A nursing school was established under the Bureau of Education by Authority
of Act No. 1931.
*1910 Act No. 1975 recognized the school under the Bureau of Health. The school
continued as one of the activities of the newly opened Philippine General Hospital and
became known as the Philippine General Hospital School of Nursing.
*1915 Act No. 2468 authorized the granting of the titles of graduate in nursing and
graduate in midwifery to nursing midwifery students of the PGHSN.
- Public Health Nursing in the Bureau of Health began in accordance with Act No.
*1919 Act No. 2808 (Nurses Law) was passed, enacted regulating the practice of the
nursing profession in the Philippines Islands.It also provided the holding of exam for the
practice of nursing on the 2nd Monday of June and December of each year. This act was
later amended in 1922, 1933 and 1950.
*1920 1st Board Examination for Nurse was conducted by the Board of Examiners, 93
candidates took the exam, 68 passed with the highest rating of 93.5% - Anna Dahlgren.
- theoretical exam was held at the UP Amphitheater of the College of Medicine
and Surgery. Practical Exam at the PGH Library.
*1922 Filipino Nurses Association was established (now PNA) as the National
Organization of Filipino Nurses.
First President Rosario Delgado
Founder Anastacia Giron-Tupas
*1924 A standard curriculum for school of Nursing was published by the PNA.
*1948 UP College of Nursing was established.
- First attempt to offer a 4 year basic nursing course leading to a B.S Nursing
- The 1st attempt to elevate nursing as profession by enriching and broadening
the preparation of nurses and by educating them in a University Setting.
- The idea was conceived by Julita V. Sotejo, a Nurse and Lawyer, who later
became the 1st Dean of the School.
- A program was opened for graduate of the 3 year hospital nursing course to
obtain a B.S Nursing Degree at the U.P College of Nursing. This program ended in
*1951 Republic Act 649 provided for the standardization of nurses salaries both in
institution and in public health.
*1953 Republic Act No. 877 (Nursing Practice Law) was approved. Minor revisions
were incorporated in 1957, 1966 1970 and 1972.
*1955 The UPCN offered a Master of Arts in (Nursing) Degree program to prepare
BSN holders of demonstrated competence and scholarship for senior positions in
nursing and to encourage nursing research.
- A one-year course leading to a certificate of Public Health Nursing was opened
at the UPCN. This program ended in 1969.
*1965 The Academy of Nursing of the Philippines (ANPHI) approved its constitution.
- Among its objectives are initiate, promote, sponsor, encourage, and/or conduct
nursing studies and research, and to serve as a medium of exchange through
conference, seminar, institute and workshops.
*1966 R.A 4704, amending R.A 877 was approved.
*1968 A movement toward accreditation of Nursing Schools in the Philippines was
*1970 WHO started an ongoing project in nursing education on family planning to
prepare faculty members to introduce family planning in basic nursing curricula.
- R.A 6136 amending R.A 877 and 4704 was approved.
*1972 A national seminar on Public Health Nursing Education was held with WHO
technical assistance.
*1975 A national seminar on Public Health Nursing Education was held with WHO
technical assistance.
*1975 A National Health Plan was formulated.
- It redefined the functions and responsibilities of nurses and other health workers
with implication for Nursing Education and Community Health Nursing.
- The Psychiatric-Nursing Specialists, Inc. (PNSI), the 1st independent Nurse
Practitioners groups, was established.
*1976 A National Workshop on the Proposed Nurse-Midwife Curriculum of Schools of
Nursing in the Ministry of Health was sponsored by the Ministry. The Workshop drafted
an experimental 4-year Nurse-Midwifery curriculum.
*1977 ILO convention 149 and recommendations 157, concerning the employment of
Nursing Personnel and the conditions of their life and work, were adopted in Geneva.
*1978 The Declaration of the Economic and School Welfare of Filipino Nurses was
passed by the PNA.
*1979 The 1st National Nurse Congress was held, its theme Nursing Issues in the
- The 1st National Tripartite Conference on employment and conditions of life and
work of Nursing and other Health Personnel was held.
- Labor, management and government were involved.
*2002 Philippine Nursing Act of 2002 (R.A 9173)

1. Nursing Leaders
Florence Nightingale (1820-1910)
-recognized as nursings first scientist-theorist for her work, Notes on Nursing:
What It is, and What It is Not
-considered the founder of modern nursing.
-developed the Nightingale Training School of Nurses, which operated in 1860.
The scchool served as a model for other training schools. Its graduates traveled
to other countries to manage hospitals and institute nurse-training programs.
-Nightingales vision of nursing, which include public health and healt promotion
roles for nurses, was only partially addressed in the early days of nursing. The
focus tended to be on developing the profession within hospitals.
Clara Barton (1812-1921)
-organized the American Red Cross, which linked with the International Red
Cross when the U.S Congress ratified the Geneva Convention in 1882.
Lilian Wald (1867-1941)
-considered the founder of Public Health Nursing.
Lavinia L. Dock (1858-1956)
-active in the protest movement for womens right that resulted in the U.S
Constitution amendment in 1920, allowing women to vote.
Margaret Sanger (1879-1966)
-a nurse activist; considered the founder of planned Parenthood, was imprisoned
for opening the first birth control information clinic in Baltimore in 1916.
Lydia Hall
-developed the Care, Core, and Cure Theory
-Goal: To Care, and Cure Cores disease.
-Care for the patients BODY. Cure the DISEASE. Treat the PERSON ( or
patient) as the Core.

B. Nursing as a Profession

Profession is a calling that requires special knowledge, skill and preparation.

An occupation that requires advanced knowledge and skills and that it grows out
societys needs for special services.

Criteria of Profession:
1. To provide a needed service to the society.
2. To advance knowledge in its field.
3. To protect its memebers and make it possible to practice effectively.

Characteristics of a Profession:
1. A basic profession requires an extended education of its members, as well as a basic
liberal foundation.
2. A profession has a theoretical body of knowledge leaing to defined skills, abilities and
3. A profession provides a specific service.
4. Members of a profession have autonomy in decision-making and practice.
5. The profesion has a code of ethics for practice.
- is a desciplined involved in the delivery of health care to the society.
- is a helping profession.
- is service-oriented to maintain health and well-being of people.
- is an art and science.

NURSE originated from a Latin word NUTRIX, to nourish.

Characteristics of Nursing:
1. Nursing is caring.
2. Nursing involves close personal contact with the recipient of care.
3. Nursing is concerned with services that take humans into account as physiological,
psychological, and sociological organism.
4. Nursing is committed to promoting individual, family, community, and national health
goals in its best manner possible.
5. Nursing is committed to personalized services for all persons without regard to color,
creed, social or economic status.
6. Nursing is committed to involvement in ethical, legal, and political issues in the
delivery of health care.

Personal Qualities of a Nurse:

1. Must have a Bachelor of Science degree in Nursing.
2. Must be physically and mentally fit.
3. Must have a license to prac tice nursing in the country.

- A professional nurse therefore, is a person who has completed a basic nursing

education program and is licensed in his country to practice professional nursing.

Roles of a Professional

1. Caregiver/Care provider
- the traditional and most essential role.
- functions as nurturer, comforter, provider.
- mothering actions of the nurse.
- provides direct care and promotes comfort of client.
- activities involves knowledge and sensitivity to what matters and what is important to
- show concern for client welfare and acceptance of the client as a person.

2. Teacher
- provides information and helps the client to learn or acquire new knowledge and
technical skills.
- encourages compliance with prescribed therapy.
Promotes healthy lifestyle.
- interprets information to the client.

3. Counselor
- helps client to recognize and cope with stressful psychologic or social problems; to
develop an improve interpersonal relationships and to promote personal growth.
- Encourages the client to look at alternative behaviors recognize the choices and
develop a sense of control.

4. Change agent
- initiate changes or assist clients to make modifications in themselves or in the system
of care.

5. Client advocate
- involves concern for and actions in behalf of the client to bring about a change.
- promotes what is best for the client, ensuring that the clients needs are met and
protecting the clients right.
- provides explanation in clients ;anguage and support clients decisions.

6. Manager
- makes decisions, coordinates activities of others, allocate resource evaluate care and
- plans, give direction, develop staff, monitor operations, give the reward fairly and
represent both staff and administrations as needed.

7. Researcher
- participates in identifying significant researchable problems.
- participates in scientific investigation and must be a consumer of research findings.
-must be aware of the research process, language of research, a sensitive to issues
related to protecting the rights of human subjects.

Expanded role as of the Nurse

1. Clinical Specialists
- is a nurse who has completed a masters degree in specialty and has considerable
clinical expertise in that specialty. She provides expert care to individuals, participates in
education health care professionals and ancillary, acts as a clinical consultant and
participates in research.

2. Nurse Practitioner
-is a nurse who has completed either as a certificate program or a masters degree in a
specialty and is also cerified by the appropriate specialty organization. She is skilled at
making nursing assessments, performing P.E., counselling, teaching and treating minor
and self-limiting illness.
3. Nurse-Midwife
- a nurse who has completed a program in midwifery; provides prenatal and postnatal
care and delivers babies to woman with uncomplicated pregnancies.

4. Nurse Anesthetist
- a nurse who completed the course of study in an anesthesia school and carries out
pre-operative status of clients.

5. Nurse Educator
- a nurse usually with advanced degree, who beaches in clinical or educational settings,
teaches theoretical knowledge, clinical skills and conduct research.

6. Nurse Entrepreneur -
- a nurse who has an advanced degree, and manages health-related business.

7. Nurse Administrator
- a nurse who functions at various levels of management in health settings; responsible
for the management and administration of resources and personnel involved in giving
patient care.

Fields and Opportunities in Nursing

1. Hospital/Institutional Nursing a nurse working in an institution with patients.

Example: rehabilitation, lying-in, etc.

2. Public Health Nursing/Community Health Nursing usually deals with families

and communities. ( no confinement, OPD only ).
Example: brgy, Health Center.

3. Private Duty/Special Duty Nurse privatey hired.

4. Industrial/Occupational Nursing a nurse working in factories, office, companies.

5. Nursing Education nurses working in school, review center and hospital as a C.I.

6. Military Nurse nurses working in a military base.

7. Clinic Nurse nurses working in a private and public clinic.

8. Independent Nursing Practice private practice, BP monitoring, home service.

- Independent Nurse Practtioner.
Nursing Theory and Theorists

4 Essential concepts common among nursing theories:

- Individual
- Health
- Environment
- Nursing


- Defined Nursing: The act of utilizing the environment of the patient to assist him
in his recovery.
- Focuses on changing and manipulating the environment in order to put the patient in
the best possible conditions for nature to act.
- Identified 5 environmental factors: fresh air, pure water, efficient drainage,
cleanliness/sanitation and light/direct sunlight.
- Considered a clean, well-ventilated, quiet environment essential for recovery.
- Deficiencies in these 5 factors produce illness or luch of health but with a nurturing
environment, the body could repair itself.


- Defined Nursing: The act of assisting others in the provision and management of
self-care to maintain/improve human functioning at home level of effectiveness.
- Focuses on activities that adult individuals perform on their own behalf to maintain life,
health and well-being.
-Has a strong health promotion and maintainance focus.

C. Theoretical Foundation of Nursing Applied in Health Care Situations

I. Philosophy
Specifies the definition of the metaparadigm concepts (person, environment, health,
and nursing) in each of
the conceptual models of nursing.
Sets forth meaning through analysis, reasoning, and logical argument. It provides a
broad understanding and

Florence Nightingale - Modern Nursing; Environmental Theory

*Disease is a reparative process, and that the manipulation of the environment -
ventilation, warmth, light, diet, cleanliness, and noise - would contribute to the process
and health of the patient.
*Did not agree with the germ theory of disease although she accepted the ill effects of
contamination from organic materials from the patients and the environment hence
found sanitation as important.
*Also renowned for pioneering statistical analysis of healthcare.

Ernestine Wiedenbach - Helping Art of Clinical Nursing

* nursing is nurturing or caring for someone in a motherly fashion.
*Proposed that nurses identify patients need-for-help by:
o Observing behaviors regarding comfort.
o Exploring meanings of the behavior.
o Knowing the cause of discomfort.
o Knowing if they can solve on their own or need help.

Virginia Henderson - Definition of Nursing; 14 Basic Needs

*The unique function of the nurse is to assist the individual, sick or well, in the
performance of those activities contributing to health or to recovery (or to a peaceful
death) that he would perform unaided if he had the necessary strength, will, or
knowledge and to do this in such a way as to help him gain independence as rapidly as
*14 Basic Needs:
1. Breathe 8. Clean body and intact integument
2. Eat and drink 9. Safe environment
3. Eliminate 10. Communicate
4. Motion and position 11. Worship
5. Rest and sleep 12.Work
6. Clothing 13.Play
7. Temperature 14.Learn

Faye Glenn Abdellah - 21 Nursing Problems

*Problem solving was seen as the way of presenting nursing(patient) problems as the
patient moved towards health.
*Contributed to nursing theory development through the systematic analysis of research
reports to formulate the 21 nursing problems that served as an early guide for
comprehensive nursing care.

Lydia Hall - Care, Core, and Cure

*The theory consists of 3 major tenets:
o The nurse functions differently in the 3 interlocking aspects of the patient:
-Cure (Disease) shared with doctors
-Core (Person) addressed by therapeutic use of self; shared with
psychiatry/psychology, religious ministry, etc.
-Care (Body) exclusive to nurses; involves intimate bodily care like feeding, bathing
and toileting
o As the patient needs less medical care, he needs more professional nursing care
o Wholly professional nursing care will hasten recovery

Jean Watson - Philosophy and Science of Caring; Carative Factors

*Caring is a universal social phenomenon that is only effective when practiced
interpersonally. Nurses should be sensitized to humanistic aspects of caring
*10 Carative Factors
1. Form humanistic-altruistic values 6. Scientific problem-solving method for decisions
2. Instill faith-hope 7. Promote interpersonal teaching-learning
3. Cultivate sensitivity 8. Provide supportive, protective, or corrective
4. Develop helping-trust relationship 9. Assist gratifying human needs
5. Promote and accept expression
of positive and negative 10. Allowance for existential-phenomeno-
logical forces

Patricia Benner - Novice to Expert

*Validated the Dreyfus Model of Skill Acquisition in nursing practice with the systematic
description of the 5 stages (Novice, Advanced beginner, Competent, Proficient, and
STAGE I, Novice
*Has no experience (e.g., Nursing Student)
*Performance is limited inflexible, and governed by context-free rules and regulations
rather than experience.
*Novices have no life experience in the application of rules.
*Just tell me what I need to do and I do it.
STAGE II, Advanced Beginner
*Demonstrate marginally acceptable performance.
* Recognizes the meaningful aspect of a real situation.
*Has experienced enough real situations to make judgement about them.
*Principles to guide actions begin to be formulated and are focused on experience.
STAGE III, Competent
*Has 2 to 3 years of experience.
*Demonstrates organizational and planning abilities.
*Differentiates important factors from less inportant aspects of care.
*Coordinates multiple complex care demands.
*Develops when the nurse begins to see his or her actions in terms of long-range goals
or plans which he or she is consciously aware of.
STAGE IV, Proficient
*Has 3 to 5 years of experience.
*Perceives situations as a whole rather than in terms of parts as in Stage II.
*Uses maxims as guides for what to consider in a situation.
*Has holistic understanding of the client, which improves decision making.
*Focuses on long-terms goals.
STAGE V, Expert
*Performance is fluid, flexible, and highly proficient; no longer requires rules guidelines,
or maxims to connect an understanding of the situation to appropriate action.
*Demonstrates highly-skilled intuitive and analytical ability in new situations.
*Is inclined to take a certain action because it felt right.

II. Conceptual Models

*Frameworks or paradigms that give a broad frame of reference for systematic
approaches to the concerned phenomena.
*Concepts that specify their interrelationship to form an organized perspective for
viewing the phenomena
Grand Theories
*Derived from models but as theories, they propose testable truths or outcomes based
on use of the model in Practice.

Dorothea Orem - Self- Care Deficit Theory

*Composed of 3 Theories:
o Theory of Self Care
o Theory of Self-Care Deficit
o Theory of Nursing Systems - 3 Types:
Wholly Compensatory - do for the patient.
Partly Compensatory - help the patient do for himself.
Supportive Educative - help the patient learn to do for himself; nurse has important
role in designing nursing care.

Myra Estrin Levine - Conservation Model

*Major Concepts:
o Wholism (Holism)
o Adaptation - process whereby patients retain integrity; establish body economy to
safeguard stability:
Organismic Response - (1)Fight or flight, (2)inflammatory response,
(3)response to stress, (4)perceptual awareness
Trophicogenesis - alternative to nursing diagnosis
o Conservation - 4 principles of conservation - Nursing intervention is based on the
conservation of the patients:
Structural Integrity
Personal Integrity
Social Integrity
*Composed of 3 Theories- (1) conservation (2) redundancy (3) therapeutic intention.

Martha Rogers - Unitary Human Beings

*Principles of Homeodynamics
Helicy - spiral development in continuous, non-repeating, and innovative patterning.
Resonancy - patterning changes with development from lower to higher
Integrality - continuous mutual process of person and environment.
*Theoretical Assertions
Energy - Man as a whole is more than the sum of his parts.
Openness - Man and environment continuously exchange matter and energy.
Helicy - Life evolves irreversibly and unidirectionally along space and time.
Pattern and organization identify man and reflect his innovative wholeness.
Sentient, thinking being - man has capacity for abstraction and imagery, language
and thought, sensation and emotion.

Dorothy Johnson - Behavioral Systems Model

*Considered attachment or affiliative subsystem as cornerstone of social organizations
*Nursing problems arise because there are disturbances in the structure or function of
the subsystems:

Sister Callista Roy - Adaptation Model

*Proposed that humans are biophychosocial beings who exist within an environment
*Environment and self provides 3 types of stimuli: (1) focal (2) residual (3) contextual
*Human stimuli create needs in adaptation modes, such as physiological self-concept,
role function, and interdependence
*Through adaptive mechanisms, regulator and cognator, a person shows adaptive or
ineffective response that need nursing intervention.

Imogene King - Interacting Systems Framework; Goal Attainment Theory

*Nursing is a process of human interaction between nurses and patients who
communicate to set goals, explore means of attaining goals, and agree on what
means to use
*Perceptions, judgement and actions of nurse and patient lead to reaction, interaction
and transaction
*Interacting systems:
Personal System - perception, self, body image, growth and development
Interpersonal System - role, interaction, communication, transaction, and stress
Social System - organization, power-authority status, decision making.

Roper, Logan, and Tierney - Model for Nursing Based on a Model of Living
Conceptual Components
o 12 Activities of Living (AL) - complex process of living in the view of an amalgam of
1. Maintain safe environment 7. Temperature
2. Communicate 8. Mobility
3. Breathe 9. Work and play
4. Eat and drink 10. Express sexuality
5. Eliminate 11. Sleep
6. Personal cleansing and dressing 12. Dying

Life span - concept of continuous change from birth to death

Dependence-independence continuum
5 factors influencing AL: Biological, Psychological, Socio-cultural, Environmental,
*The individuality of living is the way in which the individual attends to ALs in regard to
place on life span and dependence-independence continuum and as influenced by the 5

III. Theories
*Group of related concepts that proposes actions that guide practice. May be broad but
limited only to particular aspects
Middle-range Theories
*The least abstract level because they include specific details in nursing practice like
population, condition and location.

Hildegard Peplau - Psychodynamic Nursing; Mother of Psychiatric Nursing

*Stressed the importance of the nurses ability to understand ones own behavior to help
others identify felt difficulties.
*4 Phases of Nurse-Patient Relationship
*6 Nursing Roles
1. Stranger 4. Leader
2.Resource Person 5. Surrogate
3. Teacher 6. Counselor
*4 Psychobiological Experiences that compel destructive or constructive responses
Ida Jean Orlando - Nursing Process; Dynamic Nurse-Patient Relationship
*Focused on patients verbal and nonverbal expressions of need and the nurses
reactions to the behavior
*3 Elements of a Nursing Situation
Patient behaviors
Nurse reactions
Nurse actions
*Used the nursing process to meet patients needs through deliberate action; advanced
nursing beyond automatic response to disciplined and professional response.

Joyce Travelbee - Human-to-Human Relationship Model

*Nursing was accomplished through human-to-human relationship:
1. Original encounter
2. Emerging identities
3. Developing empathy
4. Developing sympathy
5. Rapport

Katherine Kolcaba - Theory of Comfort

*Defined healthcare needs as those needs for comfort including physical, psycho-
spiritual, social, andenvironmental needs
*Intervening factors influence clients perception of comfort: age, attitude, emotional
support, experience, finance, prognosis
*Types of comfort:
1. Relief when specific need is fulfilled
2. Sense of ease, calm, and contentment
3. Transcendence or rising above the problems of pain

Erikson, Tomlin and Swain - Modeling and Role-Modeling

*Synthesis of multiple theories related to basic needs, developmental tasks, object
attachment, and adaptive coping potential
*Views nursing as self-care based on the persons perception of the world and
adaptation to stressors
*Promotes growth and development while recognizing individual differences according
to worldview and inherent endowment.

Ramona Mercer - Maternal Role Attainment

*Focused on parenting and maternal role attainment in diverse populations.
*Developed a complex theory to explain the factors impacting the maternal role over
Kathryn Barnard - Parent-Child Interaction; Child Health Assessment Interaction
*Individual characteristics of each member influence the parent-infant system and that
adaptive behavior modifies those characteristics to meet the needs of the system
*The theory is based on scales developed to measure feeding, teaching, and

Madeleine Leininger - Transcultural Care Theory; Ethnonursing

*Some of the major concepts are care, caring, culture, cultural values, and cultural
*Caring is seen as the central theme in nursing care, knowledge and practice.
*Caring includes assistive, supportive, facilitative acts towards people with actual or
anticipated needs
*3 types of Nursing Actions
Cultural Care Preservation or Maintenance - retention of relevant care values unique
to culture
Cultural Care Accommodation or Negotiation - adapting culture with professional care
Cultural Care Repatterning or Restructuring - changing life-ways while still respecting
culture for a healthier outcome.

Rosemarie Rizzo Parse - Human Becoming

*A unique, humanistic approach instead of a physiological basis for nursing
*Nursing is a human science that is not dependent on medicine or any discipline for its
*Major concepts include:
Imaging Connecting-separating
Valuing Powering
Languaging Originating
Revealing-concealing Transforming

Merle Mishel - Uncertainty in Illness

*Researched into experiences with uncertainty as it relates to chronic and life-
threatening illness.
*Later reconceptualized to accommodate the responses to uncertainty over time in
people with chronic conditions who may not resolve the uncertainty.

Margaret Newman - Model of Health

*Major concepts are movement, time, space and consciousness. Movement is a
reflection of consciousness.
Time is a function of movement. Time is a measure of consciousness.
*The goal of nursing is not to promote wellness or to prevent illness, but to help people
use the power within them as they evolve toward a higher level of consciousness.
Evelyn Adam - Conceptual Model for Nursing
*Used a model from Dorothy Johnson and definition of nursing from Virginia Henderson
*Identified assumptions, beliefs, and values, and major units
*Included goal of the profession, beneficiary of the professional service, role of the
professional, source of the beneficiarys difficulty, the intervention of the professional,
and the consequence.

Nola Pender - Health Promotion Model

*The goal of nursing care is the optimal health of the individual
*Developed the idea that promoting optimal health supersedes disease prevention
*Identifies cognitive-perceptual factors of a person, like importance of health-promotion
behavior and its perceived barriers, and these factors are modified by demographics,
biology, interpersonal influences, and situational and behavioral factors.

D. Continuing Professional Education

E. Professional Organizations in Nursing

F. The Nurse in Health Care

1. Eleven Key Areas of Responsibility



1. Demonstrate knowledge based on the health/Illness status of indiidual groups.
2. Provides sound decision making in the care of individuals/groups.
3. Promote wholeness and well-being including safety and comfort of patients.
4. Sets priorities in nursing care based on patients need.
5. Ensures continuity of care..
6. Administersmedications and other health therapeutics.
7. Utilizes the nursing process as framework for nursing.
8. Formulates a plan of care in collaboration with patients and other members of the
health team.
9. Implements planned nursing care to achieve identified outcomes.
10. Evaluates progress toward expected outcomes.
11. Responds to the urgency of the patients condition.


1. Organizes work load to facilitate patient care.
2. Utilizes resources to support Patient care.
3. Ensures availability of human resorces.
4. Checks proper functioning of equipment/facilities.
5. Maintains a safe and therapeutic environment.
6. Practices stewardship in the management of resources.

1. Assess the learning needs of the patient and family.
2. Develops health education plan based on assessed and anticipated needs.
3. Develops learning materials for health education.
4. Implements the healtheducation plan.
5. Evaluates the outcome of health education.

1. Adheres to practice in accordance with the nursing law and other relevant legislation
including contracts, informed consent.
2. Adheres to organizational policies and procedures, local and national.
3. Documents care rendered to patients.

E. Ethico-Moral Responsibility
1. Respects the rights of individuals/groups.
2.Accepts responsibility and accountability for own decisions and actions.
3. Adheres to the national and international code pf ethics for nurses.

F. Personal and Professional Development

1. Identifies own learning needs.
2. Pursues continuing education.
3. Gets involved in professional organizations and civic activities.
4. Projects a professional image of the nurse.
5. Possesses positive attitude towards change and criticism.
6. Performs function according to professional standards.

G. Quality Improvement
1. Utilizes data for quality improvement
2. Participtaes in nursing audits and rounds.
3. Identifies and reports variances.
4. Recommends solutions to identified causes of the problems.
5. Recommends improvement of systems and processes.

H. Reasearch
1. Utilizes varied methods of inquiry in solving problems.
2. Recommends actions for implementation.
3. Disseminates results of research findings.
4. Applies research findings in nursing practice.

I. Record Management
1. Maintains accurate and updated documentation of patient care.
2. Records outcome of patient care.
3. Observes legal imperatives in record keeping.
4. Maintains an effective recording and reporing system.
J. Communication
1. Utilizes effective communication in relating with clients, members with the team and
the public in general.
2. Utilizes effective communicationin therapeutic use of self to meet the needs of clients.
3. Utilizes formal and informal channels.
4. Responds to needs of individuals, families, groups and communities.
5. Uses appropriate information technology to facilitate communication.

K. Collaboration and Teamwork

1. Establishes collaborative relationship with colleagues and other members of the
health team for the health plan.
2. Functions effectively as a team player.

2. Fields of Nursing
3. Roles and Functions

II. Safe and Quality Care

A. The Nursing Process
- It is a systematic, client-centered method for structuring the delivery of nursing care.

B. Basic Nursing Skills

1. Vital Signs
2. Physical Examination and Health Assessment
3. Administration of Medications
4. Asepsis and Infection Control
5. First Aid Measures
6. Wound Care
7. Perioperative Care
8. Post-operative Care
9. Post-mortem Care
C. Measures to meet physiological needs
1. Oxygenation
2. Nutrition
3. Activity, Rest and Sleep
4. Fluid and Electrolyte Balance
5. Urinary Elimination
6. Bowel Elimination
7. Safety, Comfort and Hygiene
8. Mobility and Immobility

III. Health Education

A. Teaching and Learning Principles in the Care of Client
B. Health Education in All Levels of Care
C. Discharge Planning

IV. Ethico-Moral Responsibility

A. Bioethical Principles
1. Beneficence
2. Non-maleficence
3. Justice
4. Autonomy
5. Stewardship
6. Truth Telling
7. Confidentiality
8. Privacy
9. Informed Consent
B. Patients Bill of Rights
C. Code of Ethics in Nursing

V. Legal Responsibility
A. Legal Aspects in the Practice of Nursing
B. The Philippine Nursing Law of 2002 (R.A 9173)
C. Related Laws Affecting the Practice of Nursing

VI. Management of Environment and Resources

A. Theories and Principles of Management
B. Nursing Administration and Management
C. Theories, Principles and Styles of Leadership
D. Concepts and Principles of Organization
E. Patient Care Classification
F. Nursing Care Systems
G. Delegation and Accountability

VII. Records Management

A. Anecdotal Report
B. Incident Report
C. Memorandum
D. Hospital Manual
E. Documentation
F. Endorsement and End of Shift Report
G. Referral

VIII. Quality Improvement

A. Standards of Nursing Practice
B. Nursing Audit
C. Accreditation/Certification in Nursing Practice
D. Quality Assurance

IX. Research
A. Problem Identification
B. Ethics and Science of Research
C. The Scientific Approach
D. Research Process
E. Research Designs and Methodology
1. Qualitative
2. Quantitative
F. Utilization and Dissemination of Research Findings

X. Communication
A. Dynamics of Communication
B. Nurse-Client Relationship
C. Professional-Professional Relationship
D. Therapeutic Use of Self
E. Use of Information Technology

XI. Collaboration and Teamwork

A. Networking
B. Inter-agency Partnership
C. Teamwork Strategies
D. Nursing and Partnership with Other Profession and Agencies

Nursing Board Exam/Nursing Licensure Exam Coverage (Nursing Practice II)

TEST DESCRIPTION: Theories, concepts, principle and processes in the care of
individuals, families, groups and communities to promote health and prevent illness, and
alleviate pain and discomfort, utilizing the nursing process as framework. This includes
care of high risk and at-risk mothers, children and families during the various stages of
life cycle.
Part I: CHN

I. Safe and Quality Care, Health Education and Communication, Collaboration and
Team work
1901 Act # 157 (Board of Health of the Philippines) ;
Act # 309 (Provincial and Municipal Boards of Health) were created.
1095 Board of Health was abolished; functions were transferred to the Bureau of
1912 Act # 2156 or Fajardo Act created the Sanitary Divisions, the forerunners of
present MHOs; male nurses performs the functions of doctors.
1919 Act # 2808 (Nurses Law was created)
- Carmen del Rosario, 1st Filipino Nurse supervisor under Bureau of Health.
October 22, 1922 Filipino Nurses Organization (Philippines Nurses Organization)
was organized.
1923 Zamboanga General Hospital School of Nursing and Baguio General Hospital
were established; other government schools of nursing were organized several years
1928 1st Nursing convention was held
1940 Manila Health Department was created.
1941 Dr. Mariano Icasiano became the first ciy health officer; Office of Nursing was
created through the effort of Vicenta Ponce (Chief Nurse) and Rosario Ordiz (assistant
chief nurse)
December 8, 1941 Victims of World War II were treated by the nurses of Manila.
July 1942 Nursing Office was created; Dr. Eusebio Aguilar helped in the release of 31
Filipino Nurses in Bilibid Prison as Prisoners of War by the Japanese.
February 1946 Number of Nurses decreased from 556 308.
1948 First training center of the Bureau of Health was organized by the Pasay City
Health Department. Trinidad Gomez, Marcela Gabatin, Constancia Tuazon, Ms.
Bugarin, Ms. Ramos, and Zenaida Nisce composed the training staff.
1950 Rural Health Demonstration and Training Center was created.
1953 The first 81 Rural Health Units were organized.
1957 RA 1891 Ammended some sections of RA 1082 and created the eight
categories of Rural Health Unit causing an increase in the demand for the community
health personnel.
1958 1965 Division of Nursing was abolished (RA 977) and Reorganization
Act (EO 288)
1961 Annie Sand organized the National Nurses of DOH.
1967 Zenaida Nisce became the nursing program supervisor and consultant on the
six special diseases (TB, Leprosy, V.D., Cancer, Filariasis, and Mental Health Illness).
1975 Scope of responsibility of nurses and midwives became wider due to
restructuring of the health care delivery system.
1976 1986 The need for Rural Health Practice Program was implemented.
1990 1992 Local Government Code of 1991 (RA 7160)
1993 1998 Office of Nursing did not materialize in spite of persistent
recommendation of the officers, board members, and advisers of the National League of
Nurses Inc.
January 1999 Nelia Hizon was positioned as the nursing adviser at the Office of
Public Health Services through Department Order # 29.
May 24, 1999 EO # 102, which redirects the functions and operations of DOH, was
signed by former President Joseph Estrada.

Laws Affecting Public Health andPractice of Community Health Nursing

R.A 7160 or the Local Government Code. This involves the devolution of powers,
functions and responsibilities to the local government both rural and urban. The Code
aims to transform local government unit into self-reliant communities and active partners
in the attainment of national goals thru a more responsive and accountable local
government structure instituted thru a system of decentralization. Hence, each
province, city and municipality has a LOCAL HEALTH BOARD ( LHB ) which is
mandated to propose annual budgetary allocations for the operation and maintenance
of their own health facilities.

Composition of Local Health Board ( LHB )

Provincial Level
1. Governor Chair
2. Provincial Health Officer vice chair
3. Chair, Committee on Health of Sangguniang Panlalawigan.
4. DOH Representative.
5. NGO Respresentative.
City and Municipal Level
1. Mayor Chair
2. MHO vise chair
3. Chair, Committee on Health of Sangguniang Bayan.
4. DOH Representative
5. NGO Representative
Effective LHS Depends on:
1. The LGUs financial capability.
2. A dynamic and responsive political leadership
3. Community Empowerment

R.A 2382 Philippine Medical Act. This act defines the practice of medicine in the
R.A 1082 Rural Health Act. It created the 1st 81 Rural Health Units.
- amended by R.A 1891; more physicians, dentists, nurses, midwives and
sanitary inspectors will live in the rural areas where they are assigned in order to raise
the health conditions of barrio people, hence help decrease the high incidence of
preventable diseases.
R.A 6425 Dangerous Drugs Act. It stipulates that the sale, administration, delivery,
distribution and transportation of prohibited drugs is punishable by law.
R.A 9165 The New Dangerous Draug Act of 2002.
P.D No. 651 requires that all Health Workers shall identify and encourage the
registration of all births within 30 days following delivery.
P.D No. 996 requires the compulsary immunization of all children below 8 years of
age against the 6 childhood immunizable diseases.
P.D No. 825 provides pernalty for improper disposal of garbage.
R.A 8749 Clean Air Act of 2000
P.D No. 856 Code of Sanitation. It provides for the control of all factors in mans
environment that affect health including the quality of water, food, milk, insects, animal
carriers, transmitters of disease, sanitary and recreation facilities, nilse, pollution and
control of nuisance.
R.A 6758 Standardizes the salary of government employees including the nursing
R.A 6675 Generics Act of 1988 which promotes, requires and ensures the production
of an adequate supply, distribution, use and acceptance of drugs and medicines
identified by their generic name.
R.A 6713 Code of Conduct and Ethical Standards of Public Officials and Employees.
It is thepolicy of the state to promote high standards of ethics in public office. Public
officials and employeesshall at all times be accountable to the people and shall
discharges their duties with utmost responsibility, integrity, competence and loyalty, act
with patriotism and justice, lead modest lives uphold public interest over personal
R.A 7305 Magna Carta for Public Health Workers. This act aims: To promote and
improve the social and economic well-being of health workers, their living and working
conditions and terms of employment; to develop their skills and capabilities in order that
they will be more responsive and better equipped to deliver health projects and
programs; and to encouragethose with proper qualifications and excellent abilities to
join and remain in government service.
R.A 8423 Created the philippine Institute of Traditional and Alternative Health Care.
P.D No. 965 requires applicants for marriage license to receive instructions on family
planning and responsible parenthood.
P.D No. 79 defines, objectives, duties, and functions of POPCOM.
R.A 4073 advocates home treatment for lepsrosy.
Letter of Instruction No. 949 legal basis of PHC dated october 19, 1979.
-- promotes development of health programs on the
community level.
R.A 3573 requires reporing of all cases of communicable diseases and administration
of prophylaxis.
Misnistry Circular No. 2 of 1986 includes AIDS as notifiable disease.
R.A 7875 National Health Insurance Act
R.A 7432 Senior Citizens Act
R.A 7719 National Blood Services Act
R.A 8172 Salt Iodization Act ( ASIN LAW)
R.A 7277 Magna Carta for PWDS, provides their rehabilitation, self-development and
self-reliance and integration into the mainstream of society.

*A.O No. 2005 0014 National Policies on Infant and Young Child Feeding:
1. All newborns be breastfeed within 1 hour after birth.
2. Infants be exclusively breastfeed for 6 months.
3. Infants be given timely, adequate and safe complementary foods
4. Breastfeeding be continued up to 2 years and beyond.

E.O 51 Philippine Code of Marketing of Breastmilk Substitutes.

R.A 7600 Rooming In and Breastfeeding Act of 1992.
R.A 8976 Food Fortification Law
R.A 8980 Promulgates a comprehensive policy and a national system for ECCD.

A.O. No. 2006 0015 Defines the Implementing guidelines on Hepatitis B

Immunization for infants.
R.A 7846 Mandates Compulsary Hepatitis B Immunization among infants and children
less than 8 years old.
R.A 2029 Mandates Liver Cancer and Hepatitis B Awareness Month Act ( February ).
A.O No. 2006 0012 Specifies the Revised Implementing Rules and Regulations of
E.O 51 or Milk Code, Relevant International Agreements, Penalizing Violations thereof
and for other purposes.

I. Definition of Terms
Community derived from a latin word communicas which means a group of people.
- a group of people with common characteristics or interests living together within a
territory or geographical boundary.
- place where people under usual conditions are found.

HEALTH is the OLOF (Optimum level of Functioning).

(WHO)- state of complete physical, mental and social well being, not merely the
absence of disease or infirmity.
-It primarily affects the physical well-being of people in a society.
-Health is a fundamental human right.
-A personal and social responsibility.
-A multifactorial approach.
- A predictive grid that displays the Likelihood of a person to participate in
preventive health care.



HEALTH ILLNESS CONTINUUM, as shown here, represents the process of

achieving HIGH LEVEL OF WELLNESS or the consequences of unhealthy
lifestyle. In this figure, there are three parameters on how to achieve high level of
These are: (A) Awareness, (E) Education, and (G) Growth. Otherwise, an
individual who continuously live an unhealthy lifestyle, will be on the other side of
the grid, and would develop the following: (S) Signs and Symptoms (S)
Syndrome, and (D) Disorder or disability which may lead disease or premature


- Primarily used to predict an illness

AGENT Any environmental factor or stressor, chemical, mechanical, physical,

psychosocial, that by its presence or absence can lead to illness or disease.
HOST Persons who may or may not be at risk of acquiring the disease.
ENVIRONMENT All factors external to the host that may or may not predispose
the person to the development of the disease.


- Helps determine whether an individual is likely to participate in disease
prevention and promotion activities.
- Usefool tools in developing programs for helping people change to healthier
lifestyles and develop a more positive attitudetoward preventivehealthier

INDIVIDUAL PERCEPTIONS: Includes perceived susceptivility,seriousness and
MODIFYING FACTORS: Includes demographic variables, sociophysiologic
variables, structural variable, and cues to action.
LIKELIHOOD TO ACTION: Depends on the perceived benefit versus the
perceived barriers.



Illness Highly subjective feeling of being sick or ill.

PUBLIC HEALTH ( Dr. C.E. Winslow ) the science and art of preventing disease,
prolonging life, promoting health and efficiency through organized community effort for
the sanitation of the environment, control of communicable diseases, the education of
individuals in personal hygiene, the organization of medical and nursing services for the
early diagnosis and preventive treatment of diseases and the development of social
machinery to ensure everyone a standard of living adequate for the maintenance of
health, so organizing these benefits as to enable every citizen to realize his birthright of
birth and longevity.( Dr C.E Winslow ).

COMMUNITY HEALTH part of paramedical and medical intervention/approach which

is concerned on the health of the whole population.

1. health promotion
2. disease prvention
3. management of factors affecting health.

NURSING both profession and a vocation. Assisting sick individuals to become

healthy and healthy individuals achieve optimum wellness.


-Synthesis of public and nursing practice.

(WHO Expert Committee of Nursing)

- special field of nursing that combines the skills of nursing, public health and some
phases of social assistance and functions as part of the total public health program for
the promotion of health, the improvement of the conditions in the social and physical
environment, rehabilitation of illness and disability.

- a specialized field of nursing practice.

1. Utilitarianism: greatest good for the greatest number.
2. Nursing Process.
3. Priority of health-promotive and disease-preventive startegies over curative
4. Tools for measuring and analyzing Community Health problems.
5. Application of principles of management and organization in the delivery of health
services to the community.
(Maglaya) The Utilization of the nursing process in the different levels of clientele
individuals, families, population groups and communities, concerned with the promotion
of health, prevention of disease and disability and rehabilitation.

(Jacobson) is a learned practice disciplined with the ultimate goal of contributing as

individual and incollaboration with others to the promotion of clients optimum level of
functioning through teaching and delivery of care.

(Dr. Ruth B. Freeman)

- a service rendered by a professional nurse to IFCs population groups in health
centers, clinics schools, workplace for the promotion of health, prevention of illness,
care of the sick at home and rehabilitation.
- Technical nursing, interpersonal, analytical and organizational skills are applied to
problems of health as they affect the community.

Factors affecting Optimum Level of Functioning (OLOF)

1. Political
2. Behavioral
3. Hereditary
4. Health Care Delivery System
5. Environmental Influences
6. Socio economic Influences

1. The primary focus of community health nursing practice is on health promotion.
2. Community Health Nurses are generalist in terms of their practice through life but
the whole community.
3. Community Health Nurses are generalist in terms of their practice through life
continuity in its full range of health problems and needs.
4. The nature of CHN practice requires that current knowledge derived from the
biological, social science, ecology, clinical nursing and community health organizations
be utilized.
5. Contact with the client and or family may continue over a long period of time which
includes all ages and all types of health care.
6. The dynamic process of assessing, planning, implementing and intervening provide
measurements of progress, evaluation and a continuum of the cycle until the
termination of nursing is implicit in the practice of Community Health Nursing.

II. Community Health Nursing

- The utilization of the nursing process in the different levels of clientele- individuals,
families, population groups and communities, concerned with the promotion of health,
prevention of disease and disability and rehabilitation.
Goal: To raise the level of citizenry by helping and families to cope with the
discontinuities in and threats to health in such a way as to maximize their potential for
high-level wellness. Nisce, et al
To elevate the level health of the multitude.


*Health Promotion activities related to enhancement of health.
*Health Protection activities designed to protect the people.
*Health Balance activities designed to maintain well being.
*Disease Prevention activities relate to avoid complication = primary, secondary,
*Social Justice activities related to practice practice equity among clients.

*The philosophy of CHN is based on the worth and dignity of man.


CLINICIANS - who is a health care providers, taking care of the sick people at home or
in the RHU.
HEALTHEDUCATOR who aims towards health promotion and Illness prevention
through dissemination of correctr information; educating people.
ADVOCATOR acts on behalf of the client.
FACILITATOR who establishes multi sectoral linkages by referral system.
SUPERVISOR who monitors and supervises the performance of midwives.
COLLABORATOR working with other health team member.

-In the event that the Municipal Health Officer ( MHO ) is unable to perform his
duties/functions or is not available, the Public Health Nurse will take charge of the
MHOs responsibilites.
-Other Responsibilities of a Nurse, spelled by the implementing rules and regulations of
RA 7164 ( Philippine Nursing Act of 1991 ) includes:
*supervision and care of women during pregnancy, labor, and puerperium.
*Performance of Internal Examination and Delivery of Babies.
*Suturing lacerations in the absence of a Physicians.
*Provisions of First aid measures and Emergency Care.
*Recommending Herbal and Symptomatic Meds... Etc.

In the Care of the Families:

-Provision of Primary Health Care Services.
-Developmental/Utilization of Family Nursing Care Plan in the provision of Care.

In the Care of the Communities:

-Community organizing mobilization, Community development, and People
-Program planning, Implementation, and Evaluation.
-Influencing executive and legislative individuals or bodies concerning health and

Responsibilities of COMMUNITY HEALTH NURSE

-Be a part in developing an overall health plan, it is implementation and evaluation for
-Provide quality nursing services to the three levels of clientele.
-Maintain coordination/linkages with other health team members, NGO/government
agencies in the provision of public health services.
-Conduct researches relevant to CHN services to improve provision of health care.
-Provide opprotunities for professional growth and continuing education for staff


(Cuevas, 2007)
-In the light of the changing national and global helath situation and the
acknowledgement that nursing is a significant contributor to health, the public health
nurse is strategically positioned to make a difference in the health outcomes of
individuals, families, and communities cared for.

1. Science and Art of Preventing diseases, prolonging life, promoting health and
efficiency through organized community effort for the:
a. sanitation of the environment.
b. control of communicable diseases.
c. the education of individuals in personal hygiene.
d. organization of medical and nursing services for early diagnosis and preventive
treatment of disease, and the development of social machinery to ensure everyone a
standard of living adequate for the maintenance of health, so organizing these benefits
as to enable every citizen to realize his birthright of health and longevity.

Determinants of Health
*Factors that can affect health
a. Income and social status - socioeconomic
b. Education - socioeconomic
c. Physical Environment - Environment
d. Employment and working conditions - socieconomic
e. Social support networks - socioeconomic
f. Culture, Customs and Traditions - Behavior
g. Genetics - Heredity
h. Personal Behavior and coping skills - Behavior
i. Health Services Health Care Delivery System
j. Gender Heredity
-ECOSYSTEM influence on OLOF ( Blum 1974 ).

CORE Busyness of Public Health:

1. Disease control
2. Injury Prevention
3. Health Protection
4. Health public policy including those in relation to environmental hazards such as in
the work place, housing, food, water, etc.,
5. Promotion of health and equitable health gain.

In response to above trends, the global community, represented by the United Nations
General Assembly, decided to adopt a common vision of poberty reduction and
sustainable development in september 2000.
This vision is exemplified by the Millenium Development Goals (MDGs) which are
based on the fundamental values of:
RESPECT FOR NATURE MDG 1: Eradicate extreme poverty and hunger
SHARED RESPONSIBILITY MDG 2: Achieve universal primary education
MDG 3: Promote gender equality and women
MDG 4: Decreased child mortality
MDG 5: Increased maternal health
MDG 6: Combat HIV/AIDS, Malaria and other
MDG 7: Ensure environmental sustainability
MDG 8: Develop a global partnership for


( ART ) and Science ( SCIENCE ) and Art
*Synthesis of nursing practice and *Synthesis of public health and
public health practice applied to nursing practice.
promoting and preserving the health *Specific/subspecialty nursing
of the populations. practice.
*Directs care to individuals, families, *Defined as the practice of
or groups; this care, in turn promoting and protecting health of
contributes to the health of the total populations using knowledge from
population. nursing social and public health
*knowldge = nursing and PHN sciences.
*More General Specialty area that *CORE FUNCTIONS:
encompasses subspecialties that a. Assessment
include Public Health Nursing and b. Policy development
other developing fields of practice c. Assurance
such as home health, hospice care, *Essential Functions:
and independent nursing practice. -Heart monitoring and analysis.
surveillance/disease prevention
and control and all.

A. Principles and Standards of CHN


1. The need of the community is the basis of community health nursing.
2. The community health nurse must understand fully the objectives and policies of the
agency she represents.
3. The family is the unit of service.
4. CHN must be available to all regardless of race, creed and socioeconomic status.
5. The CHN works as a member of the health team
6. There must be provision for periodic evaluation of community health nursing service.
7. Opportunities for continuing staff education programs for nurses must be provided by
the community health nurisng agency and the CHN as well.
8. The CHN makes use of available community health resources.
9. The CHN taps the already existing active organized groups in the community.
10. There must be provision for educative supervision in community health nuraing.
11.There should be accurate recording and reporting in community health nursing.
12. Health teaching is the primary responsibility of the community health nurse.

I. Theory
Applies theoretical concepts as basisfor decisions in practice.
II. Data Collection
Gathering comprehensive, accurate data systematically.
III. Diagnosis
Analyzes collected data to determine the needs / health problems of Individual,
Family, Community.
IV. Planning
At each level of prevention, develops plans that specify nursing actions unique to
needs of clients.
V. Intervention
Guided by the plan, intervenes to promote, maintain or restore health, prevent illness
and institute rehabilitation.
VI. Evaluation
Evaluates responses of clients to interventions to note progress toward goal
achievement, revise data base, diagnose and plan.
VII. Quality Assurance and Professional Development
Participates in peer review and other means of evaluation to assure quality of
nursing practice.
Assumes professional development.
Contributes to development of others.
VIII. Interdisciplinary Collaboration
Collaborates with other members of the health team, professionals and community
representatives in assessing, planning, implementing and evaluating programs for
community health.
IX. Research
Indulges in research to contribute to theory and practice in community health

B. Levels of Care

- activites that prevent a problem before it occurs. Example: Immunization.
- activities that provide early detection/diagnosis and treatment and Intervention.
Example: Breast self-examination, HIV screening, Operation timbang.
- activities that correct a disease state and prevent it from further deteriorating.
Example: Teaching Insulin Administration in the home

C. Types of Clientele

- People who visits the health center.
- People who receives health services.
e.g., Prenatal Supervision
Well Child Follow ups.
Morbidity Service
Teaching Client on Insulin Administration
Basic approaches in looking at the individual:
1. atomistic
2. holistic
Perspective in understanding the individual:
a. unified whole
b. holon
c. diporphism
a. Essentialism
b. Social constructionism
a. Psychosexual
b. Psychosocial
c. Behaviorism
d. Social learning
a. Family and kinship
b. Social groups

- Considered as the basic unit of care.
a. Nuclear
b. Extended with lolos and lalas, titios and titas
c. Cohabiting live-in, Not married but with kids.
d. Dyad married but without kids.

Stages of Family Development
STAGE 1 The Beginning Family ( newly wed couples ).
TASK: Compliance with the PD 965 and acceptance of the new member of the family.

STAGE 2 The Early Child Bearing Family ( 0 30 months ).

TASK: Emphasize the importance of pregnancy and immunization and learn the
concept of parenting

STAGE 3 The Family with Preschool Children ( 3 6 years old ).

TASK: Learn the concept of Responsible Parenthood.

STAGE 4 The Family with School Age Children ( 6 -12 years old).
TASK: Reinforce the concept of Responsible Parenthood.

STAGE 5 The Family with Teenagers (13 25 years old ).

TASK: Parents to learn the concept of let go system and understand the generation
STAGE 6 Launching Center ( 1st Child will get married upto the last child ).
TASK: Compliance with the PD 965 and acceptance of the new member of the Family.

STAGE 7 Family with Middle Adult Parents ( 36 60 years old ).

TASK: Provide a Healthy Environment, adjust with a new lifestyle and adjust with the
financial aspect.

STAGE 8 The Aging Family ( 61 years old upto death ).

TASK: Learn the concept of Death Positively.

Initial Data Base
Family Structure and Characteristics
Socio-economic and cultural Factors
Environmental Factors
Health Assessment of Each Member
Value Placed on Prevention of Disease

Family Coping Index

Physical Independence ability of the family to move in and out of bed and performed
activities of daily living.
Therapeutic Independence abilty of the family to comply with the therapeutic regimen
( diet, medication and usage of appliances ).
Knowledge of Health Condition wisdom of the family to understand the disease
Application of General and Personal Hygiene ability of the family to perform hygiene
and maintain environment conducive for living.
Emotional Competence ability of the family to make decision maturely and
appropriately ( facing the reality of life ).
Family Living Pattern the relationship of the family towards each other with love,
respect and trust.
Utilization of Community Resources ability of the family to know the function and
existence of resources within the vicinity.
Health Care Attitude relationship of the family with the health care provider.
Physical Environment ability of the family to maintain environment conducive for living.

- Defined by geographic boundaries with certain identifiable characteristics, with
common values and interests.

-Aggregation of people who share common chaaracteristics, developmental stage or
common exposure to particular environmental factors thus resulting in common health
problems ( Clark, 1995: 5 ) e.g. children, elderly, women, workers, etc.
D. Health Care Delivery System

Classify as to what level the following belong

1. Teaching and Training Hospitals _______________
2. City Health Services _______________
3. Emergency and District Hospitals _______________
4. Private Practitioners _______________
5. Heart Institutes _______________
6. Puericulture Centers _______________
7. RHU Primary Level Facilities

Primary RHU, Brgy health centers

Secondary District Hospitals
Tertiary Provincial Hospitals, City Hospitals


Roles of DOH:
1. Leadership in Health
*Serve as the national policy and regulatory institution.
*Provide leadership in the formulation, monitoring and evaluation of the national health
policies, plans and programs.
*Serve as advocate in the adoption of health policies, plans and programs
2. Enabler and Capacity builder
*Innovate new strategies in health.
*Exercise oversight functions and monitoring and evaluation of national health plans,
program and policies.
*Ensure the highest achievable standards of quality health care, promotion and
3. Administrator of specific services
*Manage selected national health facilities and hospitals with modern and advanced
*Administer direct services for emergent health concerns that require new complicated
- Health for all Filipinos
- The Leader of health for all in the Philippines

- The DOH is the leader, staunch advocate and model in promoting Health for all in the

(by 2030)
- A global leader for attaining better health outcomes, competetive and responsive
health care system, and equitable health financing.

- To guarantee equitable, sustainable and quality health for all Filipinos, especially the
poor, and to lead the quest for excellence in health.

GOAL: Heal Sector Reform Agenda ( HSRA ).

Rationale for HSRA:

*Slowing down in the reduction of Infant Mortality and Maternal Mortality Rates.
*Persistence of large variations in health status across population groups and
geographic areas.
*High burden from infectious diseases.
*Rising burden from chronic and degenerative diseases.
*Unattended emerging health risks from environmenmental and work related factors.
*Burden of disease is heaviest on the poor.

Framework for the Implementation of HSRA: FOURmula One for Health

Goals of FOURmula ONE for Health:

1. Better health outcomes
2. More responsive health systems
3. Equitable health care financing

Elements of the Strategy:

1. Health financing to foster greater, better and sustained investments in health.
2. Health regulation to ensure quality and affordability of health goods and services.
3. Health service delivery to improve and ensure the accessibility and availability of
basic and essential health care in both public and private facilities and services.
4. Good governance to enhance health system performance at the national and local

Roadmap for All Stakeholders in Health: National Objectives for Health 2005 2010.
National Objective for Health: sets the target and the critical indicators, current
strategies based on field experience, and laying down new avenues for improved

Objectives of the Health Sector:

*Improve general health status of the population.
( reduce the infant mortality rate, reduce child mortality rate, reduce maternal mortality
rate, reduce total fertility rate, increase life expectancy and the quality of life years ).
*Reduce morbidity and mortality from certain diseases.
*Eliminate certain diseases as public health problems.
- Schistosomiasis
- Malaria
- Filariasis
- Leprosy
- Rabies
- Measles
- Tetanus
- Diphtheria and Pertussis
- Vitamin A Deficiency and Iodine deficiency disorders.
*Eradicate Poliomyelitis
*Promote healthy lifestyle and environmental health.
*Protect vulnerable groups with special health and nutrition needs.
*Strenthen national and local health systems to ensure better health service delivery.
*Pursue public health and hospital reforms.
*Reduce the cost and sure the quality of essential drugs.
*Institute health regulatory reforms.
*Strengthen health governance and management support systems.
*Institute safety nets for the vulnerable and margenalized groups.
*Expand the coverage of social health insurance.
*Mobilize more resources for health
*Improve efficiency in the allocation, production and utilization of resources for health.

Basic Principles to Achieve Improvement in Health

1. Universal access to basic health servicesmust be ensured.
2. The health and nutrrition of vulnerable groups must be prioritized
3. The epidemiological shift from infection to degenerative diseases must be managed.
4. The performance of the health sector must be enhanced.

Primary Strategies to Achieve Goals

1. Increasing investment for primary Health Care.
2. Development of national standards and objectives for health.
3. Assurance of health care.
4. Support to the local system development.
5. Support for frontline health workers.

E. PHC as a Strategy
PHC as a Strategy


*May 1977 30th World Health Assembly decided that the main health target of the
government and WHO is the attainment of a level of health that would permit them to
lead a socially and economically productive life by the year 2000.

*September 6 12, 1978 First InternationalConference on PHC in Alma Ata, Russia

( USSR ) the Alma Ata Declaration stated that PHC was the key to attain the health for
all goal.

*October 19, 1979 Letter of Instruction ( LOI 949 ), the legal basis of PHC was
signed by President Ferdinand E. Marcos, which adopted PHC as an approacch toward
the design, development and implementation of programs focusing on health
development at community level.
LOI 949 signed by President Marcon with an underlying theme: Health in the hands
of the People by 2020.

Rationale for Adopting PRIMARY HEALTH CARE:

*Magnitude of Health Problems.
*Inadequate and unequal distribution of health resources.
*Increasing cost of medical care.
*Isolation of health care activities from other development activities.


*Essential health care made universally accessible to individuals and families in the
community by means acceptable to them, through their full participation and at cost that
the community can afford at every stage of development.
*A practice approach to making health benefits within the reach of all people.
*An approach to health development, which is carried out through a set of activities and
whose ultimate aim is the continuous improvement and maintenance of health status of
the community.


*Health for all Filipinos by the year 2000 and health in the Hands of the people by the
year 2020.

An improved state of health and quality of life for all people attained through SELF-
Concept of PHC
- charactterized by partnership and empowerment of the people that shall permeate as
the core strategy in the effective provision of essential health service that are
community based, accessible, acceptable and sustainable at a cost, which the
community and the government can afford.


*Improvement in the level of health care of the community.
*Favorable population growth structure.
*Reduction in the prevalence of preventable, communicable and other disease.
*Reductionin morbidity and mortality rates especially among infants and children.
*Extension of essential health services with priority given to the underserved sectors.
*Improvement in Basic Sanitation.
*Development of the capability of the community aimed at self reliance.
*Maximizing the contribution of the other sectors for the social and economic
development of the community.

*To strengthen the health care system by increasing opportunities and supporting the
conditions wherein people will manage their own health care.


1. Barangay Health Workers trained community health workers or health auxiliary
volunteers or traditional birth attendants or healers.
2. Intermediate Level Health Workers include the Public Health Nurse, Rural Sanitary
Inspector and Midwives.


1. 4 As = Accessibility, Availability, Affordability and Acceptability,
Appropriateness of Health Services. The Health Services should ebe present
where the supposed recipients are. They should make use of the available
resources within the community wherein the focus would be more on health
promotion and prevention of illness.
2. Community Participation = Heart and Soul of Primary Health Care.
3. People are the center, object and subject of development =
- Thus, the success of any undertaking that aims at serving the people is
dependent on peoples participation at all levels of decision - making; planning,
implementing, monitoring and evaluating. Any undertaking must also be based
on the peoples needs and problems ( PCF, 1990 ).
- Part of the peoples participation is the partnership between the community and
the agencies found in the community; social mobilization and decentralization.
- In general, health work should start from where the people are and building on
what they have. Example: Scheduling of Barangay Health Workers in the Health


Elements/Componentd of Primary Health Care:

F. Family-based Nursing Services (Family Health Nursing Process)

G. Population Group-based Nursing Services
H. Community-based Nursing Services/ Community Health Nursing Process
I. Community Organizing
J. Public Health Programs

II. Research and Quality Improvement

A. Research in the Community
B. National Health Situation
C. Vital Statistics
D. Epidemiology
E. Demography

III. Management of Resources and Environment and Records Management

A. Field Health Services and Information System
B. Target-setting
C. Environmental Sanitation

IV. Ethico-Moral-Legal Responsibility

A. Socio-cultural Values, Beliefs and Practices of Individuals, Families, Groups and
B. Code of Ethics for Government Workers
C. WHO, DOH, LGU Policies on Health
D. Local Government Code
E. Issues

V. Personal and Professional Development

A. Self-assessment of CHN Competencies, Importance, Methods, Tools
B. Strategies and Methods of Updating Ones Self, Enhancing Competence in
Community Health Nursing and Related Areas.

VI. Part II: MCN

VII. Safe and Quality Care, Health Education, and Communication, Collaboration and
A. Principles and Theories of Growth and Development (Pediatric Nursing)
Growth and development are continuous Although there are highs and lows in terms
processes from conception until death of the rate at which growth and
development proceed, a child grows new
cells and learns new skills at all times. An
example of how the rate of growth
changes is a comparison between that of
the first year and later in life. An infants
triples birthweights and increases height
by 50% during the first year of life. If this
tremendous growth rate were to continue,
the 5 ye-old child, when ready to begin
school, would weigh 1,600 Ib. And be 12
ft. 6 in. Tall.
Growth and development proceed in an Growth in height occurs in only one
orderly sequence. sequence from smaller to larger.
Development also proceeds in a
predictable order. For example, the
majority of children sit before they creep,
creep before they stand, stand before they
walk, and walk before they run. Some
children may skip a stage ( or pass
through it so quickly that the parents do
not observe the stage) or progress in a
different order, but most children follow a
predictable sequence of growth and
Different children pass through the All stages of development have a range of
predictable stages at different rates. time rather than a certain point at which
they are usually accomplished. Two
children may pass through the motor
sequence at different rates. For example,
one child begins walking at 9 months while
another at 14 months. Both are developing
normally. They are both following the
predictable sequence; they are merely
developing at different rates.
All body systems do not develop at the Certain body tissues mature more rapidly
same rate. than others. For example, neurologic
tissue experiences its peak growth during
the first year of life, whereas genital
tissues grows little until puberty.
Development is cephalocaudal. Cephalo is a Greek word meaning head;
Caudal means tail. Development
proceeds from head to tail. A newborn can
lift only his or her head off the bed when
he or she lies in a prone position. By age 2
months., the infant can lift his or her head
and chest off the bed; by 4 months., he or
she can lift his or her head, chest, and part
of the abdomen; by 5 months., the infant
has enough control to turn over ; by 9
months., he or she can control the legs
enough to crawl; and by 1 year., the child
can stand upright and perhaps walk. Motor
development has proceeded in a
cephalocaudal order from the head to
the lower extremities.
Development proceeds from proximal to This principle is closely related to
distal body part. cephalocaudal development. It can be
illustrated by tracing the progress of upper
extremity development. A newborn makes
;ittle use of the arms or hands. Any
movement, except to put a thumb in the
mouth, is a flailing motin. By age 3 or 4
months., the infant has enough arm control
to support the upper body weight on the
forearms, and the infant can coordinate
the hand to sccop up objects. By 10
months., the infant can coordinate the arm,
thumb, and index fingers, sufficiently well
to use a pincer-like grasp or be able to
pick up an object as fine as a piece of
breakfast cereal on a high-chair train.
Development proceeds from gross to This principle parallels the proceeding one.
refined skills. Because the child is able to control distal
body parts such as fingers, he or she is
able to perform fine motor skills ( a 3-year-
old colors best with a large crayon; a 12
yr-old can write with a fine pen).
There is an optimum time for initiation of A child cannot learn a task until his or her
experiences or learning. nervous system is mature enogh to allow
that particular learning. A child cannot
learn to sit, for example, no matter how
much thechilds parentshave him or her
practice, until the nervous system has
matured enough to allow back control. A
child who is not given the opportunity to
learn developmental tasks at the
appropriate or targert times for such
tasks may have ,ore difficulty than the
usual child learning the tasks later on. A
child who is confined to a body cast at 12
months., which is the time he or she would
normally learn to walk, may take a long
time to learn this skill once free of the cast
at, say, age 2 years old. The child has
passed the time of optimal learning fo that
particular skill.
Neonatal reflexes must be lost before An infant cannot grasp with skill until the
development can proceed. grasp reflex has faded nor stand steadily
until the walking reflex has faded.
Neonatal reflexes are replaced by
purposeful movements.
A great deal of skill and behavior is An infants practices taking a first step over
learned by practice. and over before he or she accomplishes
this securely. If a child falls behind the
normal growth and development rate
because of illness, he or she is capable of
catch-up growth to bring him or her on
equal footing again with his or her age

1. Definition of Theories
Theory a systematic statement of principles that provides a framework for explaining
some phenomenon. Developmental theories provide road maps for explaining human
Developmental Task a skill or a growth responsibility arising at a particular time in an
individuals life, the achievement of which will provide a foundation for the
accomplishment of future tasks. It is not so much chronological as the completion of
developmental tasks that defines whether a child has passed from one developmental
stage of childhood to another. For example, a child is not a toddler just because he or
she is 1 year plus 1 day old; he or she becomes a toddler when he or she has passed
through the development stage of infancy.

2. Basic Division of Childhood

Stage Age Period
Neonate From 28 days of life
Infant 1 month 1 year
Toddler 1 3 years
Preschooler 3 5 year
School-age child 6 12 years
Adolescent 13 20 years

3. Freuds Stages of Childhood (Psychosexual Development)

Stage Psychosexual Stage Nursing Implications
Infant ORAL STAGE: Child explores the Provide oral stimulation by
world by using his or her mouth, giving pacifiers; do not
especially the tongue. discourage thumb sucking.
Breastfeeding may provide
more stimulation than
formula feeding because it
requires the infant to
expend more energy.
Toddler ANAL STAGE: Child learns to control Help children achieve
urination and defecation. bowel and bladder control
without undue emphasis on
its importance. If at all
possible, continue bowel
and bladder training while
child is hospitalized.
Preschooler PHALLIC STAGE: Child learns sexual Accept childs sexual
identity through awareness of genital interest,such as fonding his
area. or her own genitals, as a
normal area of exploration.
Helps parents answer the
childs questions about birth
or sexual differences.
School-age child LATENT STAGE: Childs personality Help the child have positive
development appears to be non- experiences as his or her
active or dormant. self-esteem continues to
grow and as he or she
prepares for the conflicts of
Adolescent GENITAL STAGE: Adolescent Provide appropriate
develops sexual maturity and learns opportunities for the child to
to establish satisfactory relationships relate with opposite sex;
with the opposite sex. allow the child to verbalize
feelings about new

Eriksons Stages of Childhood (Psychosocial Development)

Stage Developmental Task Nursing Implications
Infant Developmental task is to Provide a primary
form a sense of trust versus caregiver.Provide
mistrust. Child learns to experiences that add to
love and be loved. security such as soft
sounds and touch. Provide
visual stimulation for active
child involvement.
Toddler Developmental task is to Provide opportunities for
form a sense of autonomy decision makingsuch as
versus shame. Child learns offering choicesof clothes to
to be independent and wear or toys to play with.
make decisions for himself Praise ability to make
or herself. decisions rather than judge
or correct the childs
Preschooler Developmental task is to Provide opportunities for
form a sense of initiative exploring new places or
versus guilt. Child learns activities. Allow play to
how to do things (basic include activities involving
problem solving) and that water, clay (for modeling),
doing things is desirable. or finger paints.
School-age child Developmental task is to Provide opportunities such
form a sense of industry as allowing child to
versus inferiority. Child assemble and complete a
learns how to do things short project so that the
well. child feels rewarded for the
Adolescent Developmental task is to Provide opportunites for the
form a sense of identity adolescent to discuss
versus role confusion. feelings about events
Adolescent learns who he important to him or her.
or she is and what kind of Offer support and praise for
person he or she will be by decision making.
adjusting to a new body
image, seeking
emancipation from parents,
choosing a vocation, and
determining a value

Piagets Stages of Cognitive Development

Stage of Development Age Span Nursing Implication

Sensorimotor neonatal 1 month Stimuli are assimilated into
reflexes beginning mental
images.Behavior is entirely
Primary circular reaction 1 4 months Hand mouth and ear
eye coordination develop.
Infant spends much time
looking at objects and
separating self from them.
Beginning intention of
behavior is present ( the
infant brings thumb to
mouth for a purpose: to
suck it ). An enjoyable
activity for the period: a
rattle or a tape of parents
Secondary circular reaction 4 8 months Infant learns to initiate,
recognize, and
experiences from
environment. Memory
traces are present; infants
anticipates familiar events
( a parent coming near him
will pick him up ). Good toy
for this period: mirror; good
game: peek a boo.
Coordination of secondary 8 12 months Infant can plan activities to
reaction attain specific goals; can
perceive that others can
cause activity and that
activities of own body are
separate from activity of
objects; can search for and
retrieve toy that disappears
from view; and can
recognize shapes and sizes
of familiar objects. Because
of increased sense of
separateness, infant
experiences separation
anxiety when primary
caregiver leaves. Good toy
for this period: nesting toys
( e.g., colored boxes ).
Tertiary circular reaction 12 18 months Child is able to experiment
Invention of new means 18 24 months
through mental combination
Pre operational thought 2 7 years
Concrete operational 7 12 years
Formal operational thought 12 years

B. Nursing Care in the Different stages of Growth and Development including

1. Nutrition
2. Safety
3. Language Development
4. Discipline
5. Play
6. Immunization
7. Anticipatory guidance
8. Values formation
C. Human Sexuality and Reproduction including Family Planning
D. Nursing Care of Women during Normal Labor, Delivery and Postpartum
E. Nursing Care of the Newborn
1. APGAR Scoring
2. Newborn Scoring
3. Maintenance of Body Processes (oxygenation, temperature)
F. Nursing Care of Women with Complications of Pregnancy, Labor, Delivery and
Postpartum Period (High-risk conditions)
G. Nursing Care of High-risk Newborn
1. Prematurity
2. Congenital defects
3. Infections
H. Nursing Care of Women with Disturbances in Reproduction and Gynecology

VIII. Research and Quality Improvement

A. Fertility Statistics
B. Infant Morbidity and Mortality
C. Maternal Mortality
D. Standards of Maternal and Child Nursing Practice

IX. Ethico-Moral-Legal Responsibility

A. Socio-Cultural Values, Belief, and Practices of Individuals, Families related to MCN.
B. WHO, DOH, LGU Policies on Health of Women and Children
C. Family Code
D. Child and Youth Welfare Code
E. Issues related to MCN

X. Personal and Professional Development

A. Self-assessment of MCN Competencies, Importance, Methods, Tools
B. Strategies and Methods of Updating Ones self, Enhancing Competence in MCN and
Related Areas.

Nursing Board Exam/Nursing Licensure Exam Coverage (Nursing Practice III, IV

and V)
TEST DESCRIPTION: Theories, concepts, principles and processes in the care of
clients with altred health patterns, utilizing the nursing process and integrating the key
areas of nursing competencies.
I. Safe & Quality Care, Health Education, Management of Environment & Resources,
and Quality Improvement.

1. Client in Pain

Pain- the fifth vital sign

- an unpleasant sensory and emotional experience associated with actual or


Basic Categories of Pain:

1. Acute Pain- sudden pain which is usually relieved in seconds or after a few
2. Chronic Pain (Non-Malignant)- constant, intermittent pain which usually
persists even after healing of the injured tissue
3. Cancer-Related Pain- May be acute or chronic; may or may not be
relieved by medications.

Pain Transmission:
1. Nociceptors are called pain receptors. These are the free nerve endings in the skin
that respond to intense, potentially damaging stimuli.
2. Peripheral Nervous System
3. Central Nervous System
4. Descending Control System

2. Peri-operative Care
3. Alterations in Human Functioning
a Disturbance in Oxygenation
b Disturbance in Metabolic and Endocrine Functioning
c Disturbance in Elimination

1. Alterations in Human Functioning
a. Disturbances in Fluids and Electrolytes
b. Inflammatory and Infectious Disturbances
c. Disturbances in Immunologic functioning
d. Disturbances in Cellular functioning
2. Client Biologic Crisis
3. Emergency and Disaster Nursing

1. Disturbances in Perception and Coordination
a. Neurologic Disorders
b. Sensory Disorders
c. Musculo-skeletal Disorders
d. Degenerative Disorders
2. Maladaptive Patterns of Behavior
a. Anxiety Response and Anxiety Related Disorders
b. Psycho-physiologic Responses, Somatoform, and Sleep Disorders
c. Abuse and Violence
d. Emotional Responses and Mood Disorders
e. Schizophrenia and Other Psychotic and Mood Disorders
f. Social Responses and Personality Disorders
g. Substance related Disorders
h. Eating Disorders
i. Sexual Disorders
j. Emotional Disorders of Infants, Children and Adolescents.

II. Personal and Professional Development

A. Nurse-Client Relationship
B. Continuing Education

III. Communication, Collaboration and Teamwork

A. Team approach
B. Referral
C. Network/linkage
D. Therapeutic communication

IV. Ethico-Moral-Legal Responsibility

A. confidentiality
B. Clients Rights
1. Informed Consent
2. Refusal to take medications, Treatment and Admission Procedures
C. Nursing Accountability
D. Documentation/charting
E. Culture Sensitivity