Fundamentals of Nursing

FUNDAMENTALS OF NURSING
NCM 56
Submitted to:
Rey T. Palacios, RN, MSN
Submitted by:
Geno Adrian T. Pampanga
Nursing as an Art
Nursing is broadly considered as a art and a science, wherein caring structures the
framework of nursing. Nursing and caring are grounded in a relational understanding, solidarity,
and association between the expert medical caretaker and the patient. Undertaking focused
methodologies challenge nurture in keeping care in nursing.
Caring
Caring is at the heart of nursing’s identity; indeed, the root of the word nursing means
“nurturance” or “care”. Nurse scholars have reviewed the literature, conducted research, and
analyzed nurses’ experiences, resulting in the development of theories and models of caring.
CARING PRACTICE MODELS
1. Culture Care Diversity and Universality (Leininger)

Her theory of culture care diversity and universality is based on the assumption that
nurses must understand different cultures in order to function effectively. Transcultural nursing
focuses on both the differences and similarities among individuals in diverse cultures. Although
cultures have different ways of caring for others, certain universal behaviors are seen among all
cultures of the world.
2. Theory of Bureaucratic Caring (Ray)

This theory suggests that caring in nursing is contextual and is influenced by the
organizational structure. The meaning of caring varied in the emergency department, intensive
care unit, oncology unit, and other areas of the hospital. According to Ray’s theory, “Spiritual-
ethical caring for nursing does not question whether or not to care in complex systems, but
intimates how sincere deliberations and ultimately the facilitation of choices for the good of
others can or should be accomplished.”
3. Caring, the Human Mode of Being (Roach)

All individuals are caring and developed their caring abilities by being true to self, being
real, and being who they truly are. Thus, caring is not unique to nursing. Roach defines these
attributes as the six C’s of caring: compassion, competence, confidence, conscience,
commitment, and comportment. The six C’s are used as a broad framework, suggesting
categories of behavior that describe professional caring. Each category reflects specific values
and includes virtuous actions by which a nurse can demonstrate caring.
4. Nursing as Caring (Boykin and Schoenhofer)

Boykin and Schoenhofer suggest that the purpose of the discipline and profession of
nursing is to know people and nurture them as individuals living and growing in caring. Respect
for people as caring individuals and respect for what matters to them are assumptions underlying
the theory of nursing as caring. By living nursing as caring, the nurse establishes a mutual
relationship of trust and respect with the client. Through fully appreciating the lifeworld of
others, the nurse energizes self and others to grow as caring individuals.
5. Theory of Human Care (Watson)

Watson’s theory of human care views caring as the essence and the moral ideal of
nursing. Human care is the basis for nursing’s role in society; indeed, nursing’s contribution to
society lies in its moral commitment to human care. Nursing as human care goes beyond the
realm of ethics. The nurse and client are coparticipants in the client’s movement toward health
and wholeness. This human connection is labeled transpersonal human caring, through which the
nurse enters into the experience of the client, and the client can enter into the nurse’s experience.
By identifying with each other, the nurse and client gain self-knowledge and, in doing so, keep
alive his or her common humanity and avoid reducing the other to an object.
6. Theory of Caring (Swanson) Swanson

Defines caring as “a nurturing way of relating to a valued ‘other,’ toward whom one feels
a personal sense of commitment and responsibility.” The theory focuses on caring processes as
nursing interventions. Swanson’s theory was developed through interactions with parents at the
time of pregnancy, miscarriage, and birth. These processes provide guidance to nurses who work
with pregnant and postpartum clients.
6 C’s of Caring
1. Compassion
Awareness of one’s relationship to others, sharing their joys, sorrows, pain, and
accomplishments. Participation in the experience of another.
2. Competence
Having the “knowledge, judgment, skills, energy, experience and motivation required to
respond adequately to the demands of one’s professional responsibilities”.
3. Confidence
Comfort with self, client, and others that allows one to build trusting relationships.
4. Conscience
Morals, ethics, and an informed sense of right and wrong. Awareness of personal
responsibility.
5. Commitment
The deliberate choice to act in accordance with one’s desires as well as obligations,
resulting in investment of self in a task or cause.
6. Comportment
Appropriate bearing, demeanor, dress, and language that are in harmony with a caring
presence. Presenting oneself as someone who respects others and demands respect.
Caring for Self and Others

Self-care, when defined as responding to one’s own needs to grow, is the opposite of the
self-complacency that often accompanies egocentricity. Caring for self means taking the time to
nurture oneself. This involves initiating and maintaining behaviors that promote healthy living
and well-being. Although different activities may be helpful to different people, some examples
of these activities include:
• A healthy lifestyle (e.g., nutrition, activity and exercise, recreation)
• Mind–body therapies (e.g., guided imagery, meditation, yoga).
Activity and Exercise

Exercise is recognized as a lifetime endeavor that is essential for energetic, active, and
healthy living. The benefits of exercise have been linked to many physiological and
psychological responses, from a reduced feeling of stress to an increased sense of well-being.
Exercise strengthens the heart, lungs, and blood vessels to prevent heart disease, keeps the joints
flexible, and helps many people deal with sad or unhappy feelings. For individuals who are
overweight, exercise has the added benefit of burning calories, resulting in weight loss or
maintenance.
B. Communicating
Communication is a critical skill for nursing. It is the process by which humans meet
their survival needs, build relationships, and experience emotions. In nursing, communication is
a dynamic process used to gather assessment data, to teach and persuade, and to express caring
and comfort. It is an integral part of the helping relationship.
SENDER - The sender, a person or group who wishes to communicate a message to another, can
be considered the source-encoder. This term suggests that the person or group sending the
message must have an idea or reason for communicating (source) and must put the idea or
feeling into a form that can be transmitted.
MESSAGE - The second component of the communication process is the message itself—what
is actually said or written, the body language that accompanies the words, and how the message
is transmitted. The method used to convey the message can target any of the receiver’s senses. It
is important for the method to be appropriate for the message, and it should help make the intent
of the message clearer.
RECEIVER - The receiver, the third component of the communication process, is the listener,
who must listen, observe, and attend. This person is the decoder, who must perceive what the
sender intended (interpretation). Perception uses all the senses to receive verbal and nonverbal
messages.
RESPONSE - The fourth component of the communication process, the response, is the
message that the receiver returns to the sender. It is also called feedback. Feedback can be either
verbal, nonverbal, or both. Nonverbal examples are a nod of the head or a yawn.
Modes of Communication
Communication is generally carried out in two different modes: verbal and nonverbal.
VERBAL COMMUNICATION - Verbal communication is largely conscious because people

choose the words they use. The words used vary among individuals according to culture,
socioeconomic background, age, and education.
 Pace and Intonation - The manner of speech, as in the rate or rhythm and tone, will
modify the feeling and impact of a message.
 Simplicity - Simplicity includes the use of commonly understood words, brevity, and
completeness.
 Clarity and Brevity - A message that is direct and simple will be effective. Clarity is
saying precisely what is meant, and brevity is using the fewest words necessary.
 Timing and Relevance - Nurses need to be aware of both relevance and timing when
communicating with clients.
 Adaptability - The nurse needs to alter spoken messages in accordance with behavioral
cues from the client.
 Credibility - Credibility means worthiness of belief, trustworthiness, and reliability.
- Credibility may be the most important criterion of effective
communication.
 Humor - The use of humor can be a positive and powerful tool in the nurse–client
relationship, but it must be used with care. Humor can be used to help clients adjust to
difficult and painful situations.
NONVERBAL COMMUNICATION - Nonverbal communication, sometimes called body
language, includes gestures, body movements, use of touch, and physical appearance, including
adornment.
 Personal Appearance - Clothing and adornments can be sources of information about a
person. Although choice of apparel is highly personal, it may convey social and financial
status, culture, religion, group association, and self-concept.
 Posture and Gait - The ways people walk and carry themselves are often reliable
indicators of self-concept, current mood, and health.
 Facial Expression - No part of the body is as expressive as the face (Figure 26–5 •).
Feelings of surprise, fear, anger, disgust, happiness, and sadness can be conveyed by
facial expressions.
 Gestures - Hand and body gestures may emphasize and clarify the spoken word, or they
may occur without words to indicate a particular feeling or to give a sign.
ELECTRONIC COMMUNICATION - Electronic mail (e-mail) can be used in health care

facilities for many purposes: to schedule and confirm appointments, report normal lab results,
conduct client education, and for follow-up with discharged clients.
 E-mail - is the most common form of electronic communication. It is important for the
nurse to know the advantages and disadvantages of e-mail and also other guidelines to
ensure client confidentiality.
Therapeutic Communication
Therapeutic communication promotes understanding and can help establish a

constructive relationship between the nurse and the client. Unlike a social relationship, where
there may not be a specific purpose or direction, the therapeutic helping relationship is client and
goal directed.
Visibly Tuning In - At times, your nonverbal behavior may be as important, or more important,
than your words. There are key nonverbal skills that can be used to visibly tune in to clients,
which is an expression of empathy that tells “clients that you are with them, and it puts you in a
position to listen carefully to their concerns.”
The Helping Relationship - Nurse–client relationships are referred to by some as interpersonal
relationships, by others as therapeutic relationships, and by still others as helping relationships.
Helping is a growth-facilitating process that strives to achieve three basic goals:
1. Help clients manage their problems in living more effectively and develop unused or
underused opportunities more fully.
2. Help clients become better at helping themselves in their everyday lives.
3. Help clients develop an action-oriented prevention mentality in their lives.
Phases of the Helping Relationship
Pre-Interaction Phase - The pre-interaction phase is similar to the planning stage before an
interview. In most situations, the nurse has information about the client before the first face-to-
face meeting.
Introductory Phase - The introductory phase, also referred to as the orientation phase or the
pre-helping phase, is important because it sets the tone for the rest of the relationship.
Working Phase - During the working phase of a helping relationship, the nurse and the client
begin to view each other as unique individuals. They begin to appreciate this uniqueness and care
about each other.
Termination Phase - The termination phase of the relationship is often expected to be difficult
and filled with ambivalence.
Communication and the Nursing Process

Communication is an integral part of the nursing process. Nurses use communication
skills in each phase of the nursing process.
Assessing - To assess the client’s communication abilities, the nurse determines communication
impairments or barriers and communication style. Remember that culture may influence when
and how a client speaks. Obviously, language varies according to age and development. With
children, the nurse observes sounds, gestures, and vocabulary.
Diagnosing - Impaired Verbal Communication may be used as a nursing diagnosis when

individual experiences a “decreased, delayed, or absent ability to receive, process, transmit,
and/or use a system of symbols.” Communication problems may be receptive (e.g., difficulty
hearing) or expressive (e.g., difficulty speaking).
Planning - When a nursing diagnosis related to impaired verbal communication has been made,
the nurse and client determine outcomes and begin planning ways to promote effective
communi-cation.
Implementing - Nursing interventions to facilitate communication with clients who have

problems with speech or language include manipulating the environment, providing support,
employing measures to enhance communication, and educating the client and support person.
Evaluating - Evaluation is useful for both client and nurse communication.
C. Teaching
Teaching is a system of activities intended to produce learning. The teaching process is
intentionally designed to produce specific learning.
Promotion of health
• Increasing a person’s level of wellness
• Growth and development topics
• Fertility control
• Hygiene
• Nutrition
• Exercise
• Stress management
• Lifestyle modification
• Resources within the community

Prevention of Illness/Injury
• Health screening (e.g., blood glucose levels, blood pressure, blood cholesterol, Pap test,
mammograms, vision, hearing, routine physical examinations)
• Reducing health risk factors (e.g., lowering cholesterol level)
• Specific protective health measures (e.g., immunizations, use of condoms, use of sunscreen, use
of medication, umbilical cord care)
• First aid • Safety (e.g., using seat belts, helmets, walkers)
Restoration of Health
• Information about tests, diagnosis, treatment, medications
• Self-care skills or skills needed to care for family member
• Resources within health care setting and community
Rehabilitation
• Adaptations in lifestyle
• Problem-solving skills
• Adaptation to changing health status
• Strategies to deal with current problems (e.g., home IV skills, medications, diet, activity limits,
prostheses)
• Strategies to deal with future problems (e.g., fear of pain with terminal cancer, future surgeries,
or treatments)
• Information about treatments and likely outcomes • Referrals to other health care facilities or
services
• Facilitation of strong self-image
• Grief and bereavement counseling

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FUNDAMENTALS OF NURSING

CARING PRACTICE MODELS

1. Culture Care Diversity and Universality (Leininger)

2. Theory of Bureaucratic Caring (Ray)

3. Caring, the Human Mode of Being (Roach)

4. Nursing as Caring (Boykin and Schoenhofer)

5. Theory of Human Care (Watson)

6. Theory of Caring (Swanson) Swanson

Caring for Self and Others

• A healthy lifestyle (e.g., nutrition, activity and exercise, recreation)

• Mind–body therapies (e.g., guided imagery, meditation, yoga).

Activity and Exercise

VERBAL COMMUNICATION - Verbal communication is largely conscious because people

ELECTRONIC COMMUNICATION - Electronic mail (e-mail) can be used in health care

Therapeutic communication promotes understanding and can help establish a

Helping is a growth-facilitating process that strives to achieve three basic goals:

2. Help clients become better at helping themselves in their everyday lives.

3. Help clients develop an action-oriented prevention mentality in their lives.

Phases of the Helping Relationship

Communication and the Nursing Process

Diagnosing - Impaired Verbal Communication may be used as a nursing diagnosis when

Implementing - Nursing interventions to facilitate communication with clients who have

Evaluating - Evaluation is useful for both client and nurse communication.

• Increasing a person’s level of wellness

• Growth and development topics

• Resources within the community

• First aid • Safety (e.g., using seat belts, helmets, walkers)

• Information about tests, diagnosis, treatment, medications

• Self-care skills or skills needed to care for family member

• Resources within health care setting and community

• Adaptation to changing health status

• Facilitation of strong self-image

• Grief and bereavement counseling

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