NURSING AS AN ART, SCIENCE AND 3 types of clients

PROFESSION 1. Individual
2. Families
3. Communities
> Nightingale = Using the environment to
assist him in his recovery 4 areas of nursing practice
1. Promoting health & wellness
> Henderson = Assist the individual in the 2. Preventing illness
performance of those activities 3. Restoring health
contributing to health or its recovery 4. Care of the dying (not enhance)

WELLNESS - a state of well-being.

CNA (Canadian Nurses Association) Engaging in attitudes and behaviour that
= Dynamic, caring, helping relationship to enhance the quality of life.
achieve and obtain optimal health.
Goal of Illness - to maintain optimal health
DEFINITIONS of CNA by preventing disease.

1. - Nursing is caring Illness Nursing activities include:

2. - Nursing is an art 1. Immunization
3. - Nursing is a science 2. Prenatal and infant care
4. - Nursing is client-centered 3. prevent STD
5. - Nursing is holistic
6. - Nursing is adaptive General Nursing activities include:
7. - Nursing is concerned with health 1. Providing direct care
promotion, health maintenance, 2. Performing diagnostic
and health restoration. 3. Consulting
4. Teaching Client
ANA (American Nurses Association) 5. Rehabilitating
= Direct, goal-oriented, and adaptable to 6. Care of the Dying
the needs of the individual.
1. Care of the Dying
DEFINTIONS of ANA Involves comforting and caring for
people of all ages who are dying.
1. 1980, "nursing is the diagnosis and 2. Rehabilitating
treatment of human responses to optimal functional level following
actual or potential health physical or mental illness, injury or
problems" chemical addiction.
3. Teaching Clients
> Consumer - an individual, group of about recovery activities, such as
people or a community that uses a service exercises that will accelerate
or community. (Use health care product or recovery after a stroke.
service). 4. Consulting
with other healthcare professionals
Recipients of Nursing - sometimes about client problems.
patients and sometimes clients. 5. Provide Direct Care
Administer medications, baths,
> Patient - who is waiting or undergoing specific procedures and
medical treatment and care. treatments.
- "to suffer" or "to bear" 6. Perform diagnostic
measure blood pressure and
> Client - Engages in the advice or examine feces.
services of another who is qualified to
provide this service. Also Receivers of Settings for Nursing
Health Care/Collaborators of health care. 1. Client Homes
2. Hospitals > MANAGING - requires knowledge
3. Community Agencies about organizational structure and
4. Ambulatory clinic dynamics, authority and accountability,
5. Long-term care leadership, delegation and supervision
6. Nursing practice centers. and evaluation.

Standards of Clinical Nursing Practice > Nurse Case Manager - work with the
ANA Assessment - the nurse collects multidisciplinary health care team to
patient health data. measure the effectiveness of the case
ANA Diagnosis - Analyzes the management plan and to monitor
assessment data in determining outcomes.
diagnosis.
ANA Outcome Identification - The nurse e. Research consumer
identifies expected outcomes
individualized to the patient. use research to improve client care.
ANA Planning - the nurse develops a
plan of care that prescribes interventions Expanded career roles: Nurse
to attain expected outcome. practitioner, clinical nurse specialist, nurse
ANA Implementation - the nurse anaesthetist, nurse midwife, nurse
implements the interventions identified in researcher, nurse administrator, nurse
the plan of care. educator, nurse entrepreneur, forensic
ANA Evaluation - the nurse evaluates the nurse
patients progress towards attainment of
outcome. 1. Profession - defined as an
occupation that requires extensive
a. Caregiver education or calling that requires
special knowledge, skill, and
encompasses the physical, psychosocial, preparation
developmental, cultural and spiritual level. 2. Professionalism - professional
May provide care directly or delegate it to character, spirit, or methods. Set of
other caregivers. attributes, a way life that implies
responsibility and commitment.
b. Communicator 3. Professionalization - the process
of becoming professional, that is,
integral to all nursing roles. Nurses of acquiring characteristics
communicate with the client, support considered to be professional.
persons, other health professionals, and
people in the community. Factors influencing Contemporary
nursing practice:
c. Teacher
1. Economics
the nurse helps clients learn about their
health and the health care procedures 2. Consumer Demands
they need to perform to restore or
maintain their health. 3. Family Structure

d. Manager 4. Science and Technology

manages the nursing care of individuals, 5. Info and Telecommunication

families, and communities. Delegates
nursing activities to other nurses, and 6. Legislation
supervises and evaluates their
performances. 7. Demography
NURSING PROCESS : Facilitates professional growth
- A systematics, organised, rational : Avoidance of legal action
method of planning and providing :Meeting standards of accredited hospitals
individualised, humanistic nursing care.
PARTS OF NURSING PROCESS
PURPOSES OF NURSING 1. ASSESSMENT
- To identify health status 2. DIAGNOSING
- To establish 3. PLANNING
- To deliver specific nursing care. 4. INTERVENTION
5. EVALUATION
CHARACTERISTICS:
ASSESSMENT
1. Goal Oriented and Client-Centered Nursing activities:
2. Cyclical, Dynamic rather than 0 Data Collection
static 0 Data Organization
3. Plan of care organised according 0 Data Validation
to client problems rather than 0 Data Recording
nursing goals. (no conclusion is being made at this
4. Basis of prioritizing nursing = phase)
problems not goals
5. Follow a logical sequence PURPOSE
6. Universally applicable - To create a data base of the client’s
7. Interpersonal and collaborative response to health and illness
- W/ patients and relatives - To determine the nursing care needs of
- W/ colleagues and other the patient
healthcare
8. Adaptation of Problem-Solving 4 TYPES OF ASSESSMENT
techniques and principles 1. Initial Assessment
9. Problem-oriented, flexible, open to 2. Focus Assessment
new info 3. Emergency Assessment
10. Allows creativity of nurse and 4. Time-Lapsed Assessment
patient.
1. Initial Assessment
BENEFITS: At specified time after admission
Done at Ward
Concepts = Patient and nurse benefits = To create a data base for problem
patient has greater benefit CLIENT- identification and for reference and future
CENTERED. comparison.
: Improves quality of care
: Ensures continuity and appropriate level
of care
: Facilitates client participation through
planning with patient 2. Focus Assessment
: Enables nurse to maximise resources Integrated throughout the nursing
: Feedback allows nurse to evaluate care process
: Serves as a framework for accountability To identify problems overlooked
thru documentation earlier and To determine the status of a
health problem.
: Promotes positive working atmosphere =
collaboration 3. Emergency Assessment
: Helps nurse to define roles to those During acute physiologic and
outside profession psychologic crisis. Emergency, Anywhere,
: Job satisfaction On Site
 To identify life-threating condition Types of Interview Questions
FRAMEWORK: ABC - Airway, Breathing, 1. Open-Ended Questions = Not
Circulation answerable by yes or no. More for
explanation
4. Time-Lapsed Assessment
Several months after initial 2. Close-Ended Questions = Answerable
assessment by yes or no, leading questions and
To compare current status of phrasing question suggests about the
patient with the base line data. answer the interviewer is expecting.

- Initial Output of Assessment = 3. Neutral Questions = Phrasing allows

Recorded Data the patient to answer w/ least pressure.
Not addressed to the patient personally.
General topic.
Types of Data
1. Subjective or Covert Planning the interview:
Felt by Patient, Symptoms and stated by Concepts:
patient.
Before the interview = determine what you
2. Objective or Overt know and what you don’t know. An
Measured by nurse, observable by 5 interview is a planned convo w/ a purpose.
senses. Interviews are a two-way process.

Sources of Data PATIENT SHOULD BE comfortable and

1. Primary Source available and must have 3-4 feet.
Patient himself except when:
Unconscious, Baby, Insane Stages of the Interview
1. Opening Stage =
2. Secondary Source Concept = most important part of the
Patient’s record, healthcare members, interview
related journal, significant others, family, Rationale = Sets the tone all throughout
person who brought the patient to the interview
hospital.
2. Body of Interview =
3. Environment of the Patient Occurs when patient responds to
Ex. Diabetes patient exhibits acetone questioning.
breath = Assess for diabetic ketoacidosis.
3. Closing Stage
Methods of Data Collection Using the summarising technique.
= Observing, Interviewing, Examining.
Validation of Data
2 Aspects of Observation Process: Act of double checking the data
1 Noticing the stimuli
2 Do an interpretation of the stimuli Purpose of Data Validation = Correctness,
Completeness, and Accuracy of data.
Interviewing
2 types of interview GUIDELINES in validation
1. Directive = Structured and close-ended 1. Compare subjective and objective
questions for specific data 2. Be Familiar with the word usage
When you need elicit specific data 3. Reassess/ double-check data which are
and little time available extremely abnormal
2. Non-directive = Open-ended and lets 4. Data contains CUES and not
patient to volunteer info INFERENCES
5. Free of Biases
6.. Avoid jumping to conclusions.
Data Recording: Fluid Volume Deficit, related to
Completes the assessment phase. frequent loss of bowel movement as
DATA = Initial Output evidenced by decreased skin turgor.
RECORDED DATA = Final Output
Advantages ofUsing a Standardised
DIAGNOSIS Diagnostic Terminology
- Provide professional accountability
Activities: and autonomy by defining and
- Sorting, clustering, analysing, and describing the independent areas of
interpreting data. practice
- Provides effective vehicle of
Concept: communication
Nursing Diagnosis = Final Output - Provides an organising principle for
meaningful research
Different Types of Nursing
- Facilitates continuity and
Diagnosis
individualised care.
1. Actual Nursing Diagnosis
- Present time statement
- Clinical judgement that the nurse has
PLANNING
validated because of the presence of
major defining characteristics. Concept: Determining ahead of time
and forecasting a course of action.
- For plans to be effective, involve the
2. High-Risk Nursing Diagnosis patient and the family.
- Diagnosis that a patient is more
Nursing Care Plan - Final output
vulnerable or susceptible compared
with others in the same situation. Types of Planning
1. Initial Planning
3. Possible Nursing Done by Nurse, at specified time upon
- Evidence of health problem but the or after admission of the patient.
causes are not fully understood
- Option to indicate that some data are 2. On-going Planning
present to confirm a diagnosis but are Done by all nurses who worked w/ the
insufficient as of this time. patient, patient himself, the family,
Nurse
4. Wellness Nursing Diagnosis
- Positive Statement and indicated a 3. Discharge Planning
healthy response Purpose - ensure the continuity of care

Domains of Diagnosis: Only includes

health problems that a nurse is Characteristics of Planning Process
capable and licensed to treat. S - Specific
M - Measurable
Parts of a Nursing Diagnosis: A - Attainable
1. Problem Statement R - Realistic
2. Presumed Etiology T - Time-bounded
3. Defining Characteristics
IMPLEMENTATION
Example of Nursing Diagnosis = Activities - Reassess the patient (To
determine if the procedure is still 2. Intermittend Evaluation = A
needed). specified time
- Determine the need for Purpose = Shows the extent of the
nursing assistance, and implement the progress
nursing strategies. Importance = To correct deficiencies
- Communicate the procedure and modify the NCP.
performed by documenting the
procedure. 3. Terminal Evaluation = Immediately
- Understand the orders (verify before discharge
Physician’s Order) Importance = States the status of a
-Encourage patient to health problem at the time of
participate actively. discharge. MET, PARTIALLY MET,
UNMET.
Guidelines for Implementation
1. Should be based on scientific
knowledge, research, and professional
standards of practice.
2. Should be adapted to the individual
patient
3. Should always be safe
4. Holistic
5. Should be accompanied by support,
comfort and teaching.

EVALUATION
Purpose - Determine client’s progress,
the effectiveness of the care plan,
determine to what extent the nursing
goals have been met.

Importance - Continued, Modified,

Discontinued.

Activities =
1. Identify the outcome criteria to be
used as measurement
2. Gather info relevant to the outcome
criteria
3. Compare info with the criteria
4. Assess the reasons for the outcome
5. Revise the nursing care plan as
needed

Types of Evaluation
1. On-Going = Done during after the
intervention.
Importance = allows the nurse to
decide and make on-the-spot
modifications in an intervention.
THERAPEUTIC COMMUNICATION seeking consensual validation
10. Giving information
Principles or Characteristic: 11. Acknowledging
1. Patient - primary focus 12. Presenting reality
2. Professional attitude - sets the tone 13. Clarifying time and
of therapeutic relationship sequence
3. Self-disclosure cautiously only for 14. Reflecting
therapeutic purposes 15. Focusing
4. Avoid social relationship w patient 16. Summarizing
5. Maintain patient confidentiality ●

Goal:
1. Establish therapeutic nurse-patient
relationship
2. Identify patient’s needs
3. Assess the patient’s perception of
problem
4. Facilitate the patient’s expression
5. Implement intervention designed to
address the patient’s needs
6. Assess patient’s intellect
competence to determine the level of
understanding
7. IMplement intervention
8. Maintain a non judgemental attitude.
9. Avoid giving advice
10. Guide the patient to interpret
experience

ACTIVE LISTENING
S - Sit facing the client
O - Open posture
L - Lean forward toward client
E - Establish eye contact
R - Relax

TECHNIQUES:

●
1. Using silence
2. Provide general leads
3. Being specific and tentative =
Rating pain and are you in
pain?
4. Using open ended questions
5. Using touch
6. Restating or paraphrasing
7. Seeking clarification
8. Offering self
9. Perception checking or