Introduction To Nursing

Faculty of Nursing
First Semester

1
 Chapter 1

The Nature of Nursing

I. Contemporary Nursing Practice

II. Scope of Nursing Practice
III. Roles and Functions of the Nurse
IV. Legal Aspects of Nursing
 Objectives

 Describe how the definition of nursing evolved since

Florence Nightingale.
 Identify recipient of nursing care.
• Identify the four major areas of nursing practice.
• Describe the role of nurses.
• Understand the legal aspects of nursing.
• Describe the purpose and essential elements of
informed consent.
• Identify basic human needs.
• Describe the three levels of prevention.
 I. Contemporary Nursing Practice

 Definitions of Nursing
 Common Themes to Nursing Definitions:
• Nursing is Caring.
• Art / Science.
• Client Centered >> Family Centered, Holistic,
and Adaptive.
• Nursing is concerned with health promotion.
and health maintenance.
• Nursing is a helping profession.
 I. Contemporary Nursing Practice

 Definitions of Nursing

 Florence Nightingale 1860/1969:

 “The act of utilizing the environment of the

patient to assist him in his recovery”.
 Florence Nightingale:
• Considered the founder of
modern nursing.
 I. Contemporary Nursing Practice

 Definitions of Nursing

 Virginia Henderson 1966 (researcher, theorist ):“The

unique function of the nurse is to assist the individual,

sick or well, in the performance of those activities
contributing to health or its 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 possible”.
 I. Contemporary Nursing Practice

 Definitions of Nursing

 American Nursing Association (ANA) 2003: “Nursing

is the protection, promotion, and optimization of health
and abilities, preventions of illness and injury, alleviation
of suffering through the diagnosis and treatment of
human response, and advocacy in the care of
individuals, families, communities, and populations”
(ANA, 2010,p.10).
 Recipients of Nursing Care

• Consumer: is an individual, a group of people, or a

community that use health care services.
• Patient
– Person waiting for, undergoing medical treatment
and care.
• Client
– Person who engages in advice, services of another
who is qualified to provide service.
– Increasingly used over patient.
– Presents the receivers of health care as
collaborators in the care.
  Scope of Nursing Practice

 Nurses provide care for three types of clients: Individuals,

Families, and Communities.
 Promoting Health and Wellness
– Individual and community activities to enhance health
lifestyles.
 Preventing illness
– Immunizations
– Prenatal and infant care
– Prevention of sexually transmitted infections (STIs).
 Scope of Nursing Practice

 Restoring Health
– Direct care to ill person
– Diagnostic and assessment procedures
– Consulting other health care professionals
– Teaching clients recovery activities
– Rehabilitating clients to optimal functional level
 Care of the Dying
– Comforting people of all ages
– In homes, hospitals, extended care facilities, hospices
 Settings for Nursing

• Acute care hospitals

• Clients' homes
• Community agencies
• Ambulatory clinics
• Long-term care facilities
• Health maintenance organizations (HMOs)
• Nursing practice centers
 Standards of Nursing Practice

• Establishing and implementing standards of practice are

major functions of a professional organization.
 American Nurses Association (ANA):
– Developed Standards Nursing of Practice
– ANA Standards of Professional Performance
describe behaviors expected in the professional
nursing role.

• Various specialty nursing organizations developed

specific standards of nursing practice for their area.
 Roles and Functions of the Nurse

• Caregiver

– Assist the client physically and psychologically while

preserving the client’s dignity (self-respect).
• Communicator
– Identify client problems and communicate them to
other members of the health care team.
• Teacher
– Help clients learn about health and health care
procedures to restore or maintain health.
 Roles and Functions of the Nurse

• Client Advocate
– Represent, protect the client's needs & wishes.
• Counselor
– Help client to recognize and cope with stressful
psychological or social problems, develop improved
relationships, and promote personal growth.
• Change Agent
– Assist clients to make modifications in behavior.
• Leader: Influence others to work together to accomplish
specific goal(s).
 Roles and Functions of the Nurse

• Manager
– Manage care of individuals, families & communities
– Delegate nursing activities
• Case Manager
– Work with or act as primary nurse to oversee care
of specific caseload.
• Research Consumer
– Uses research to improve client care
 Functions of the Law in Nursing

• Framework for establishing which nursing actions

in the care of clients are legal.
• Differentiates nurse's responsibilities from those
of other health professionals.
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• Helps establish boundaries of independent
nursing action.
• Assists in maintaining standard of nursing
practice by making nurses accountable under the
law.
 Informed Consent
• Purpose
– Provides client with complete information prior to
obtaining agreement by client to accept a course of
treatment or procedure.
– The informed consent is the record of the informed
consent, not the informed consent itself.
• Express Consent
– Oral or written agreement
• Implied Consent (‫)موافقة ضمنية‬
– Individual's nonverbal behavior indicates agreement.
– Medical emergency when a person cannot express
content because of physical condition.
 Informed Consent

• Exceptions
– Except in specific circumstances, the following
individuals cannot provide informed consent:

• A minor, person 18 years or younger

• The unconscious or person injured in such a

way that they are unable to consent

• A mentally ill person judged by professionals

to be incompetent
 Informed Consent

• Nurse's Role

– Client gave consent voluntarily.

– Signature is true.

– Client appears competent to give consent.

– Client has right to refuse even after signing

consent form.

– Documentation important aspect.

 Documentation

• Medical chart is a legal document.

• Nurses need to provide accurate and complete

documentation of the nursing care provided.

• Failure to document can constitute negligence.

• Insufficient or inaccurate assessments can hinder

proper diagnosis and treatment causing harm to
client.
 Nursing Ethics

 Nursing Code of Ethics

 Formal statement of ideals and values shared by
members of a group.
• Reflects common moral judgment over time.
• Serves as a standard for professional actions.
• Usually higher standard than legal standard.
• Help the public understand ethical considerations of
professional nursing.
• Remind nurses of their special responsibilities in caring
for the sick.
Health Beliefs and Practices

I. Health, Wellness, and Illness

II. Basic Human Needs
III. Three Levels of Prevention
 Health

• Traditionally: Health is the “Presence or absence

of disease”.
• WHO 1848: “A state of complete physical,
mental, social well-being, and not merely the
absence of disease”.
• Talcott 1951: “Ability to maintain normal roles”.
• ANA 2010: “ Health and illness are human
experiences. The presence of illness does not
preclude health, nor does optimal health preclude
illness”.
• Health is a highly individual perception.
 Wellness and Well-Being

• Wellness- a state of well-being.

• Basic Aspects of Wellness Include:
– Self responsibility
– An ultimate goal
– A dynamic & growing process
– Daily decision-making in areas relevant to
health (e.g., nutrition, stress management,
physical fitness, preventive health care, and
emotional health).
– Whole being of the individual.
The Seven Components of Wellness
 Wellness

• Basic Components

– Environmental

• Ability to promote health measure that

improves the

Standard of living

Quality of life

Influences such as food, water, and air

 Wellness

• Basic Components

– Social- ability to

• Interact successfully with people

• Develop and maintain relationship with

others.

• Develop respect and tolerance for others

with different opinions and beliefs.
 Wellness

• Basic Components

– Emotional

• Ability to manage stress

• Ability to express emotion appropriately

• Ability to recognize, accept & express

feelings

• Accept one’s limitations

 Wellness
• Basic Components
– Physical

• Carry out daily tasks

• Achieve fitness

• Maintain nutrition and proper body fat

• Avoid abusing substances (e.g., drugs,
tobacco)

• Practice positive lifestyle habits

 Wellness

• Basic Components

– Spiritual

• Belief in some force that gives life meaning

and purpose (e.g., God, nature, science,
religion)

• Person's own morals, values, and ethics

 Wellness
• Basic Components
– Intellectual
• Ability to learn
• Ability to use information effectively
• Striving for continued growth
• Learning to deal with new challenges

– Occupational
• Ability to achieve balance between work and
leisure time
 Well-being

• A Subjective perception of vitality‫ الحيوية‬and

feeling well.

• Can be described objectively, experienced, and

measured.

• Can be plotted on a continuum.

 Illness - Wellness Continuum

 Arrows pointing in opposite directions and

joined at a neutral point.
 Illness and Disease

• Illness
– A highly personal state in which
• Person's physical, emotional, intellectual, social,
developmental, or spiritual functioning is thought to
be diminished.
– Not synonymous‫ مرادف‬with disease
– May or may not be related to disease
– An individual could have a disease and not feel ill.
– Illness is highly subjective; only a person can say he
or she is ill.
 Illness and Disease

• Disease
– Alteration in body functions resulting in
• Reduction of capacities or shortening of
normal life span.
• The causation of a disease is called its
Etiology.

• Etiology of a disease includes the

identification of all causal factors that act
together to bring the particular disease.
 Illness and Disease

• Acute illness
– Characterized by symptoms of relatively short
duration.

– Symptoms appear abruptly & subside quickly

– May or may not require intervention by health
care professionals

– Some acute illness are serious (Appendicitis)

– Most people return to normal level of wellness.

 Illness and Disease

• Chronic illness
– Usually slow onset and lasts for 6 months or longer
– Often has periods of remission (symptoms disappear)
and exacerbation (symptoms reappear)
– Care focuses on promoting independence, sense of
control, and wellness.
– Client must learn how to live with physical limitations
and discomfort.
– E.g; arthritis, heart & lung disease, Diabetes
 Effects of Illness

• Impact on the Client

– Behavioral and emotional changes
– Self-concept and body image changes
– Loss of autonomy & Lifestyle changes
• Impact on the Family
– Role changes & Task reassignments
– Stress due to anxiety about outcomes
– Financial problems
– Loneliness as result of separation or loss
 Needs Theories

• Maslow's Five Levels of Human Needs

– Ascending order
• Physiological needs
• Safety and security needs
• Love and belonging needs
• Self-esteem needs
• Self-actualization needs
Maslow’s Hierarchy of Needs
 Maslow’s Hierarchy of Needs

• Physiologic Needs: such as air, food, water, shelter, rest,

sleep, activity, and temperature maintenance are crucial to
survival.
• Safety & Security Needs: needs to feel safe both in the
physical environment and in relationships.
• Love& Belonging Needs: giving and receiving affection,
attaining a place in a group, and feeling of belonging.
• Self-Esteem Needs: feelings of independence,
competence, & self-respect, and recognition, respect, and
appreciation from others.
• Self-Actualization: the innate need to develop one’s
maximum potential and realize one’s abilities and qualities.
 Disease Prevention

 Disease Prevention or Health Protection

– Behavior motivated by desire to actively avoid

illness, detect it early, or maintain functioning

with constraints of illness.

 Three Levels of Prevention

– Primary: focuses on:

• Health Promotion
• illness prevention
– Secondary: focuses on:
• Early identification (Diagnosis), Treatment
– Tertiary: focuses on:
• Health Restoration
• Rehabilitation
• Palliative Care
 Primary Prevention

 Focus on health promotion & protection against

specific health problems.

• Address adequate and proper nutrition, weight

control and exercise, and stress reduction

• Emphasize the important role clients play in

maintaining their own health and encourage them
to maintain the highest level of wellness they can
achieve.
 Secondary Prevention

 Focuses on early identification and prompt

intervention for health problems.
– Early detection
– Routine screening
• Hospitals
– Emergency care
– Intensive care
– Around-the-clock care
 Tertiary Prevention

 Focuses on restoration and rehabilitation.

 Goal to return individual to optimal level of functioning.
• Restoration to previous level of health or highest level
possible, given current health status.
• Rehabilitation to function adequately in the physical,
mental, social, economic, and vocational areas of their
lives.
• Palliative Care
 Providing comfort and treatment
 End-of-life care conducted in many settings
including the home.