CARING around you every day.

Talk to them and tell

them how you feel.
 A. Qualities of a nurse
6.Be adaptable
 B. Core Values
 As a nurse, every day is different. You never
 1. Love of God know what is going to happen, and if you
 2. Caring as the core of nursing ever think you do, something will come
along to surprise you.
Qualities of A Nurse
 As a result, nurses have to be incredibly
1. A caring nature flexible. You must be prepared for all
eventualities, and be able to act quickly
The best nurses are those that truly, and deeply,
when needed.
care for the patients they work with. Being able to
comfort and support people who are ill, vulnerable, 7.Have physical and mental endurance
or scared, is the key to being a successful nurse.
 Being a nurse means long days that will
2. Be empathetic sometimes have little or no breaks. To get
 For most patients, being in the hospital is a through a day, a nurse must have
outstanding physical and mental endurance.
traumatic and emotional experience. One of
Exercise will help train your body and make
the most important nursing qualities is the
it easier to get through the day, as will
ability to empathize. Never think of, or
brain training apps and games.
treat, your patients as a burden.
8. Be a quick thinker (and have great
 To understand how patients are feeling,
judgement)
have to put ourselves in their shoes and
give them the emotional support they need.  Nurses must be able to think quick on their
feet and get decisions right – it could mean
3. Write everything down (in detail)
life or death for your patients. You can’t
 Great nurses are detail-orientated and write always wait for information, and must be
down everything. This is important because able to use your knowledge, expertise, and
even a seemingly throwaway comment from experience to make swift judgement calls.
a patient might hold the key to helping
 There is no substitute for experience, but
them. Make notes, and most importantly,
knowledge is the key to being able to make
listen – really listen – to your patients.
good decisions. Read and learn constantly,
4.Be organized especially if there are areas for
improvement
 Being organized is an absolute must as a
nurse! Remembering when to give patients 9.Be hard-working
medication is the foundation of the job, so
 Not only do you have to constantly keep
keep track of everything and be on time –
learning as a nurse, but you also have to be
no excuses!
naturally hard-working.
 5. Be emotionally stable
 Be passionate about what you do, and
 This one may sound obvious or even strive to be the best. Go the extra mile with
straight forward, but we are all infallible your patients, and prove to yourself that
human beings, prone to emotions such as you are an inspiring person. By doing this
stress – which can sometimes affect our for yourself, you’ll find it easier to be
work. As a nurse, however, you have a motivated and those around you will be
responsibility to patients to offer stability impressed.
while you’re at work.
10.Be a good communicator
 One of the best ways to encourage
 As a nurse, you are a member of an
emotional stability is to talk about the way
amazing, supportive community that will be
you feel. Bottling things up, instead of
there whenever you need it.
communicating with the people around you,
will only make things worse. As a nurse,  A problem shared is a problem halved, and
you have a wealth of understanding people when working in the nursing profession you

1
 are never alone, so open up to the people  Health instruction acts
around you and enjoy the incredible life-
long relationships you will build over the  Health maintenance acts
course of your career.  Helping behaviors
B. Core Values  Love
Caring as the Core of Nursing
 Nurturance
 Nursing requires extensive medical
 Presence
knowledge but it also requires something
even greater : Caring.  Protective behaviors
 Caring consists of several different
components , all of which are important for  Stress alleviation
creating better working relationships ,
 Support
better rapport with patients and can even
improve the chances of career  Surveillance
advancement.
 Tenderness
Caring
 Touching
 An essential aspect of nursing.
 trust
 Madeleine Leninger (1984 ) states that care
is the essence of nursing is dominant , Caring
distinctive and unifying feature of
Jean Watson (1985)
nursing.
 Believes that the practice of caring,
 According to her : there can be no cure
describes caring as grounded in a set of ,
without caring, but there may be
positive human values ( kindness, concern,
caring without curing.
and love of self and others).
 She emphasizes that human caring ,
 Caring is described as the moral ideal of
although a universal phenomenon , varies
nursing: it involves the will to care , the
among cultures in its expressions ,
intent to care, and caring actions.
processes, and patterns.
 Caring actions include communication ,
 She identified many caring constructs .
positive regard, support, or physical
She believes that health care personnel
interventions by the nurse.
should work toward an understanding
of care and values , health beliefs and  The outcomes of caring are varied.
lifestyles of different cultures which
 Caring can :
will form the basis for providing
culture – specific care. 1. Promote self actualization( realization
According to Leininger Caring Behaviors include: /fulfillment)

 Comfort 2. Promote individual growth

3. Preserve human dignity( worthy of honor

 Compassion
and respect) and worth
 Concern
4. Augment self- healing
 Coping behavior
5. Relieves distress
 Empathy  The goodness of caring is often found in the
 Enabling process itself – that of engagement and
connection.
 Facilitating interest
Caring as the Core of Nursing
 Involvement
The 6 C’s of Caring
 Health consultative acts
Sister Simone Roach’s 6 C’s of caring –

2
1. Commitment  Working consistently on another’s behalf,
and “representing the concerns of the
2. Conscience
patient.”
3. Competence
 Moral practices don’t just arise from a
4. Compassion strong internal sense of what’s right;
5. Confidence  They also come from a continued focus on
empathy and putting yourself in the
6. Comportment
patient’s shoes.
 are highly applicable to the nursing
profession.
3. Competence
 It’s fairly straightforward to grasp the
meaning of the 6 C’s, but it takes time and  Having the knowledge , judgement , skills,
effort to ensure they are consistently energy, experience, and motivation to
applied in the workplace. respond adequately to others within the
demands of professional responsibilities.
Commitment
 Consistently arriving to work on time and
 Convergence between one’s desires
presenting self in a professional manner .
and obligations and deliberate choice
to act in accordance with them.  Hold self to a high standard of excellence
when fulfilling daily tasks, regardless of the
 Nursing staff members must continually
behavior of others or the circumstances.
dedicate themselves to putting their best
foot forward.  It is also important to ask for help or
clarification when there is uncertainty .
 The act of committing oneself to work
means going above and beyond  to continually improve skills in order to
normally expected behaviors and develop competence
pledging to uphold strong values.
4. Compassion
 Commitment to career also involves
 Awareness of one’s relationship to others ,
continually improving one’s knowledge and
skills. sharing their joys, sorrows, pain, and
accomplishments .
 One way to do this is by seeking out higher
 Participation in the experience of another.
education. Pursuing an online nursing
degree is an excellent way to gain a higher  Empathize with their patients and provide
level of understanding about the profession. kind and considerate treatment at all times.
The devotion toward furthering education
will improve capabilities and enhance the  The more that nurses nurture their sense
level of care delivered to patients. of compassion, the more compassion grows
(and the greater positive effect it has on
2. Conscience
patient care and work relationships).
 Morals, ethics and an informed sense of
 Provide kind and considerate treatment at
right and wrong . Awareness of ones
all times. In return, nurses may receive an
responsibility.
inspirational sense of human connection
 Delivering the best possible care to patients and confirmation of the meaning of their
involves a resilient sense of moral work.
responsibility born of a strong conscience. 5. Confidence
 Conscience helps guide actions even when  The quality that fosters trusting
focus on stress or personal matters can relationships . Comfort with self , client ,
challenge the consistent application of best and family.
practices. Adherence to own conscience will
always help to put on the right course.  It takes confidence in personal skills and
knowledge to act with commitment, follow
conscience, consistently act in a competent

3
 manner, and express compassion, even in 5. Ethico-moral responsibility
the most difficult of situations.
6. Personal and professional development
 Confidence in experiences, education, and
7. Quality improvement
skills will ensure that nurses continually put
their best foot forward. 8. Research
 A confident nurse can help patients and 9. Record Management
family members deal with difficult news,
10. Communication
and a strong sense of self will invoke
positive change in patient care. 11. Collaboration and teamwork
6. Comportment  The BSN is a four-year program consisting
of general education and professional
 Appropriate bearing demeanor, dress,
courses. Professional courses begin in the
language, that are in harmony with caring
first year and threads through the
presence .
development of competencies up to the
 Presenting oneself as someone who fourth year level. The BSN program
respects others and demands respect. provides an intensive nursing practicum that
will refine clinical skills from the first year
 The way you carry yourself , in a very regal level to ensure basic clinical competencies
and proud manner ..is an example of required of a beginning nurse practitioner.
comportment..

 The BSN program aims to produce a fully

Love of People functioning nurse who is able to perform
 Respect for the dignity of each person the competencies under each of the Key
regardless of creed, color, gender, and Areas of Responsibility. Safe and Quality
political affiliations. Nursing Care Core competency

a. Respect for the dignity of each person  1: demonstrates knowledge base on the
regardless of creed, color, gender and political health/illness status of individual / groups
affiliation. Core competency

Love of Country  2: provides sound decision making in the

care of individuals / groups considering their
a. Patriotism (Civic duty, social responsibility and beliefs and values Core competency
good governance) .
 3: promotes safety and comfort and
b. Preservation and enrichment of the environment privacy of patients Core competency
and culture heritage
 4: sets priorities in nursing care based on
c. A strong liberal arts and sciences education with
patients’ needs
a transdisciplinary approach, enhances this core
values. The BSN program therefore, aims to  Core competency 5: ensures continuity of
prepare a nurse, who, upon completion of the care
program, demonstrates beginning professional
competencies and shall continue to assume  Core competency 6: administers
responsibility for professional development and medications and other health therapeutics
utilizes research findings in the practice of the  Core competency 7:utilizes the nursing
profession. process as framework for nursing
 The following are the Key Areas of
Responsibility for which a nurse should
demonstrate competence in:

1. Safe and quality nursing care  Management of Resources and Environment

2. Management of resources and environment  Core competency 1: organizes work load to

facilitate patient care
3. Health education

4. Legal responsibility
4
 Core competency 2: utilizes resources to  Core competency 1: identifies own learning
support patient care needs

 Core competency 3: ensures functioning of  Core competency 2: pursues continuing

resources education

 Core competency 4: checks proper  Core competency 3: gets involved in

functioning of equipment professional organizations and civic
activities
 Core competency 5: maintains a safe
environment  Core competency 4: projects a professional
image of the nurse

 Core competency 5: possesses positive

 Health Education
attitude towards change and criticism
 Core competency 1: assesses the learning
 Core competency 6: performs function
needs of the patient
according to professional standards
 Core competency 2: develops health
education plan based on assessed and
anticipated needs  Quality Improvement

 Core competency 3: develops learning  Core competency 1: gathers data for

materials for health education quality improvement

 Core competency 4: implements the health  Core competency 2: participates in nursing

education plan audits and rounds

 Core competency 5: evaluates the outcome  Core competency 3: identifies and reports
of health education varainces

 Core competency 4: recommends solutions

to identified problems
 Legal Responsibility

 Core competency 1: adheres to practices in

accordance with the nursing law and other  Research
relevant legislation including contracts,
 Core competency 1: gathers data using
informed consent
different methodologies
 Core competency 2: adheres to
 Core competency 2: recommends actions
organizational policies and procedures, local
and national for implementation

 Core competency 3: documents care  Core competency 3: disseminates results of

rendered to patients research findings

 Core competency 4: applies research

findings in nursing practice
 Ethico-moral Responsibility
Records Management Core competency
 Core competency 1: respects the rights of
1: maintains accurate and updated documentation
individual/ groups
of patient care
 Core competency 2: accepts responsibility
Core competency
and accountability for own decision and
actions 2: records outcome of patient care Core
competency
 Core competency 3: adheres to the national
and international code of ethics for nurses 3: observes legal imperatives in record keeping

 Personal and Professional Development  Communication

5
  Core competency 1: establishes rapport  Nurses identify client problems and
with patients, significant others and communicate these verbally or in writing to
members of the health team other members of the health team.

 Core competency 2: identifies verbal and  Nurse must be able to communicate clearly
non-verbal cues and accurately in order for a client’s health
care needs to be met.
 Core competency 3: utilizes formal and
informal channels 3. Teacher

 Core competency 4: responds to needs of  As a teacher, nurse helps clients learn

individuals, family, group, and Community about their health and the health care
procedures they need to perform to
 Core competency 5: uses appropriate restore or maintain their health.
information technology to facilitate
communication  Nurse assesses the client’s learning needs
and readiness to learn, sets specific learning
goals in conjunction with teaching the
 Collaboration and teamwork client, enacts teaching strategies, and
measures learning.
 Core competency 1: establishes
collaborative relationship with colleagues  Teaches unlicensed assistive personnel
with colleagues and other members of the (UAP) to whom they delegate care , and
health team they share expertise with other nurse’s and
health professional.
 Core competency 2: collaborative plan of
care with other members of the health team  Explains to clients concepts and about
health
5. Maintaining Caring Practice
 Demonstrate procedures such as self- care
6. Caring for Self
 Determine that the client understands ,
ROLES AND FUNCTIONS OF THE NURSE reinforce learning or client behavior
FUNCTIONS: 4. Client Advocate
1. A Caregiver  Acts to protect the client.
 As a caregiver , nurse helps the client
 Nurse may represent the client’s needs and
regain health through the healing process. wishes to other health professionals, such
as relaying the client’s wishes for
 Activities includes ; physical and information to the physician.
psychological care while preserving
client’s dignity.  Also assist clients in exercising their rights
and help them speak up for themselves.
 The required nursing actions may involve :
 Helps maintain safe environment
- Full care for the completely dependent
client  Take steps to prevent injury

- Partial care for partially dependent client  Protect confirming client from possible
effects of diagnosis or treatment measures
- Supportive – educative care
client does not have an allergy to
To assist clients in attaining their highest possible medication
level of health and wellness.
 Providing immunizations
2. Communicator
 Collaborates with health professionals
-Communication with client and health
5. Counselor
professional
 Counselling – the process of helping a
 Communication is integral to all nursing
client to recognize and cope with stressful
roles.
psychologic or social problems, to develop

6
 improved interpersonsal relationships , and EXPANDED CAREER GOALS
to promote personal growth.
1. Nurse Practitioner
 It involves providing emotional,
 A nurse who has advanced education , and
intellectual, and psychologic support.
is a graduate of a nurse practitioner
 Nurse counsels primarily healthy individuals program.
with normal adjustment difficulties and
 Are certified by the American Nurses
focuses on helping the person develop new
Credentialing Center in areas such as:
attitudes , feelings, and behavior by
encouraging the client to look at alternative a. Adult nurse practitioner nurse practitioner
behaviors , recognize the choices , and
develop a sense of control. b. Family nurse practitioner

6. Change Agent c. School nurse practitioner

 Assist clients to make modifications in d. Pediatric nurse practitioner

e. Gerontology
their behavior.
 They are employed in health care agencies
 Acts to make changes in a system,
or community- based settings
such as clinical care.
 Provides ambulatory care
7. Nurse as Leader

 To direct and achieve the specific goals. 2. Clinical Nurse Specialist

 Has advanced degree or expertise and is

 Influences others to work together to
considered to be an expert in a specialized
accomplish a specific goal.
area of practice.
8. Nurse as Manager
 Provides direct client care, educate others,
 Manages nursing care of individuals, consults, conducts research, and manages
families and communities. care
 Delegates activities to ancillary workers and  The American credentialing center provides
other nurses and supervises and evaluates national certification of clinical specialist.
their performance.
3. Nurse Anesthetist
9. Case Manager
 Has completed advanced education in an
 Plans, implement and evaluate client care.
accredited program in anesthesiologist.
 Works with the multidisciplinary health care
 Carries out preoperative visits and
team to measure the effectiveness of the
assessments, and administers general
case management plan and to monitor
anesthetics for surgery under the
outcomes.
supervision of a physician prepared in
 Review provided the care being provided to anesthesiologist.
client
 Assesses the postoperative status of clients.
 Making arrangements for discharge
4. Nurse Midwife
 Is part of the quality improvement
 An RN , who has completed a program in
department
midwifery and is certified by the American
10. Research Consumer college of Nurse Midwives.

in clinical area , nurses need to :  Gives prenatal care and manages deliveries
in normal pregnancies.
a. Have awareness of the research process
 Practices in association with a health care
b. Be sensitive to issues related to protecting
agency and can obtain medical services if
the rights of human subjects
complications occur.
c. Participate in the identification of significant
 May conduct routine Ppanicolaou smeras,
research able problems
family planning, and routine breast
d. Discriminate consumer of research findings examinations.
7
 5. Nurse administrator  Is credited with performing miracles; the
mortality rate in Barrack Hospital in Turkey,
 Manages client care , including delivery of
was reduced from 42% to 2%.
nursing services.
American Civil War
 Have a middle management position : head
nurse/ supervisor, senior management  Harriet Tubman and Sojourner Truth –
position such as director of nursing services. provided care and safety to slaves fleeing to
the North on the Underground Railroad.
 Functions of nurse administrators:
 Mother Biekerdyke and Clara- searched the
a. Budgeting
battlefields and gave care to the injured and
b. Staffing dying soldiers

c. Planning programs  Walt Whitman and Louisa May Alcott noted

authors, volunteered as nurses to give care
 Qualifications : baccalaureate degree in
to injured soldiers in military hospitals.
nursing and masters/doctoral degree
 Dorothea Dix- woman leader provided care
6. Nurse Educator
during the Civil War . Became the Union’s
 Are employed in nursing programs, at Superintendent of female Nurses
educational institutions, and in hospital staff responsible for recruiting nurses, and
They also built hospital , the organization supervising nursing care in the army
and management of which set a standard hospitals.
for the administration of hospitals through World War I
out Europe.
 American, British, and French women
 Knights of Saint Lazarus dedicated
volunteer their nursing services.
themselves to care of people with leprosy ,
syphilis, and chronic skin conditions.  They endured harsh environments and
treated injuries not seen before.
 1836 – Theodore Flieddner – opened a
small hospital and training school in  “ The Spirit Of Nursing “ a monument
Kaiserswerth, Germany. stands in Arlington National Cemetery in
honor of the nurses who served in the U. S.
 Florence Nightingale receive her “training”
Armed services in World War I.
in nursing at the Kaiserwerth School.
 Progress in the field of Surgery occurred in
 Early religious values, such as self-denial,
world war 1. The use of anesthetic agents,
spiritual calling, and devotion to duty and Infection Control, blood typing and
hard work , have dominated nursing prosthetics.
throughout its history.
World War II
WAR
 Casualties created an acute shortage of care
Crimean War (1854-1856)
givers.
 Inadequacy of care given to soldiers led to a
 Cadet Nurse Corps _ was established in
public outcry in Great Britain
response to marked shortage of nurses.
 The role of Florence Nightingale played in
 Auxiliary health care became prominent.
addressing the problem is well known.
 “Practical” nurses, aides, and technicians
 Sir Sidney Herbert of the British War
provided much of the actual nursing care
Department asked nightingale to recruit a
under the instruction and supervision of
contingent of female nurse to provide care
better prepared nurses.
to the sick and injured in the Crimea.
 Medical specialties – arose at the time to
Florence Nightingale
meet the needs of hospitalized clients.
 and her nurses transformed the military
hospitals by setting up sanitation practices,
such as handwashing and washing clothing Vietnam War
regularly.
8
  Approximately 90% of the 11,000 American  These standards are used to evaluate the
military women stationed in Vietnam were quality of care nurses provide and,
nurses. therefore, become legal guidelines for
nursing practice.
 Most of them volunteered to go to Vietnam
after they graduated from nursing school. ACCOUNTABILITY

 These made them the youngest group of a  A person can be held to account for what
medical personnel ever to serve in war time. happens, especially if something goes
wrong.
 Near the Vietnam Veterans Memorial ( “the
Wall “) stands the Vietnam Women’s  If you perform a task, such as admitting a
Memorial. patient, you take responsibility for that task
and its outcomes.
 The monument was established to “ honor
the women who served and also for the  Similarly, a person supervising a student or
families who lost their loved ones during the team member, she take some responsibility
war… to let them know about the women for his or her performance of the task.
who provided comfort, care and a human
 Nurses and midwives are accountable both
touch for those who were suffering and
legally and professionally for their practice,
dying.
that is, professionally; for their decisions
SCOPE OF NURSING PRACTICE ON RA 9173 they make and the consequences of those
decisions.
General Legal Concepts
DELEGATING TASKS TO OTHERS
a. Law
 As a nurse , you need to know how you are
 Defined as “ the sum total of rules and
accountable when you delegate tasks to
regulations by which a society is governed.
others, such as nursing auxillaries ( person
“
providing supplementary care or additional
 A system of rules that are created and help ) or care assistants.
enforced through social or governmental  When delegating, you should take on board
institutions to regulate behavior.
the mix of skills in your team.
 Created by people and exists to regulate all
 ‘ Make sure that the person who does the
persons.
work is able to do it and that appropriate
b. Functions of the Law in Nursing levels of supervision or support are in place’

 The law serves a number of functions in ACCOUNTABLE TO WHOM

nursing. You are accountable to :
1. It provides a framework for establishing which 1. The patients , through a duty of care,
nursing actions in the care of clients are legal. underpinned by a common-law duty to
2. It differentiates the nurse’s responsibilities from promote safety , and legal responsibility
those of other health professionals. trough civil law;

3. It helps establish the boundaries of independent 2. The Employers , as defined by your contract of
nursing action. employment

4. It assists in maintaining a standard of nursing and job description.

practice by making nurses accountable under the 3. The profession, as stated in the relevant codes
law of conduct.
STANDARDS OF CARE 4. The public.
 Are the skills and learning commonly
possessed by members of a profession .
A. PROFESSIONAL/LEGAL AND MORAL
 Purpose : ACCOUNTABILITY/ RESPONSIBILITY
- To protect the consumer . 1. Informed Consent

9
  Is an agreement by a client to accept a 3. The client or individual must be given
course of treatment or a procedure after enough information to be the ultimate
being provided complete information, decision maker.
including the benefits and risks of
Who can give/sign the consent
treatment, alternatives to the treatment,
and prognosis if not treated by a health A competent adult
care provider.
 over 18 years of age
 Client signs a form provided by the agency.
 Conscious and oriented
 The form is a record of the informed
 A legal guardian or representative can
consent, not the informed consent it self.
provide consent or refuse for the
Two types of consent: incompetent adult.
1. Express consent - A client who is confused , disoriented, or sedated
is not considered functionally competent.
 May be an oral or written agreement .
Delegation
 Usually for more invasive a procedure
and/or the greater the potential risk for the  As “ transferring to a competent individual
client, the greater the need for written the authority to perform a selected nursing
permission. task in selected situation.”
2. Implied consent Sexual harassment
 Exists when the individual’s non-verbal  Is a violation of the individual’s rights and a
behavior indicates agreement . form of discrimination.
 Example :  1987 – the law prohibiting sexual
discrimination was clarified to apply to all
- Clients who positions their body for injection or
educational and employing institutions
taking of vital signs infer implied consent.
receiving federal funding.
- in a medical emergency when an individual
Abortions
cannot provide express consent because of physical
condition.  Abortion laws

Invasive procedure –  Provide specific guidelines for nurses about

 is one that is carried out by entering the what is legally permissible.
body through the Skin or through body Death and related Issues
cavity or anatomical opening.
 Advance health care directives :
General guidelines :
Include a variety of legal and lay documents that
1. The purposes of the treatment allow persons to specify aspects of care they wish
2. What the client can expect to feel or to receive should they become unable to make or
experience communicate their preferences .

3. The intended benefits of the treatment a. Euthanasia

4. Possible risks or negative outcomes of the b. Do not resuscitate (DNR) orders

treatment c. Certification of death
5. Advantages and disadvantages of possible d. Autopsy
alternatives to the treatment .
e. Inquest
THREE MAJOR ELEMENTS OF INFORMED CONSENT
f. Organ donation
1. The consent must be given voluntarily.
ADVANCE HEALTH CARE DIRECTIVES
2. The consent must be given by a client or
individual with the capacity and competence 1. Euthanasia
to understand.

10
 The act of painlessly putting to death performed, when death is sudden or occurs
persons suffering from incurable or within 48 hours of admission to a hospital.
distressing disease.
 Organs and tissues of the body are
 Sometimes referred to as “ mercy Killing “ examined first to establish the exact cause
of death, and to assist in the accumulation
 Legally wrong in both Canada or United of statistical data.
States – can lead to criminal charges of
homicide or to a civil lawsuit for withholding 5. Inquest
treatment or providing an unacceptable
 Is a legal inquiry into the cause or manner
standard of care.
of a death.
2. Do-Not-Resuscitate Orders
 When the death is the result of an accident,
 Physicians may order “no code “ or do- not- for example, an inquest is held into the
resuscitate “ (DNR) for clients who are in a circumstances of the accident to determine
stage of terminal , irreversible ( cannot be any blame.
undone/ cannot be altered) illness or
6. Organ Donation
expected death.
 Under the Uniform anatomical Gift Act and
 A DNR order is generally written when the
the National Organ Transplant Act in the
client or proxy has expressed the wish for
United States or the Human Tissue Act in
no resuscitation in the event of a respiratory
Canada
or cardiac arrest.
 People 18 years or older and of sound mind
 Some physicians are reluctant to write such
may make a gift of all or any part of their
an order if there is any conflict between the
own bodies for the following purposes:
client and the family members.
- For medical or dental science
 A DNR order is written to indicate that the
goal of treatment is a comfortable, dignified - Therapy or
death and that further life- sustaining
- Transplantation
measures are not indicated.
- The donation can be made by a provision in
3. Certification of Death
a will or by signing a card- like form.
 Formal determination of death , or
- Card is carried at all times by the person
pronouncement , must be performed by a
who signed it.
physician , a coroner, or a nurse.
- Nurses can witness for people, consenting
 The granting of the authority to nurses to
to donate organs.
pronounce death is regulated by the state
or province . 7. Privacy of Client’s Health Information

 May be limited to nurses in long- term Confidentiality

care , home health, and hospice agencies or
 Confidentiality in health care refers to the
to advanced practice nurses.
obligation of professionals who have access
 By law, a death certificate must be made to patient records or communication to hold
out when a person dies. that information in confidence.

 Usually signed by the attending physician  This professional obligation to keep health
and filed with a local health or other information confidential is supported in
government office. professional ethics, as can be seen in
principle I of the American Health
 The family is given a copy to use for legal Information Management Association Code
matters such as insurance claims. of Ethics, “ Advocate, uphold, and defend
4. Autopsy or Postmortem examination the individuals right to privacy and the
doctrine of confidentiality in the use and
 Is an examination of the body after death. disclosure of information.”

 The law describes under what Privacy

circumstances an autopsy must be

11
  Viewed as the right of the individual client 6. The patient has the right to expect that all
or patient to be let alone and to make communications and records pertaining to his/
decisions about how personal information is care be treated as confidential by the hospital,
shared. except in cases such as suspected abuse and public
health hazards when reporting is permitted by law.
8. Unprofessional Conduct
7. The patient has the right to review the records
 According to the Medical Practice Act , pertaining to his/ her medical care and to have the
 Unprofessional conduct includes “any information explained or interpreted as necessary,
departure from or failure to conform to the except when restricted by law.
minimal standards of acceptable and 8. The patient has the right to expect that, within
prevailing medical practice and shall also its capacity and policies, a hospital will make
include, but not limited to the prescribing or reasonable response to the request of a patient for
use of drugs, treatment or diagnostic appropriate and medically indicated care and
procedures which are detrimental to the services.
patient as determined by the minimal
standards of acceptable medical care.” 9. The patient has the right to asked and be
informed of the existence business relationships
PROFESSIONAL NURSING PRACTICE among the hospital, educational institutions, other
Patient’s Bill of Rights health care providers or payers that may influence
the patient’s treatment and care
 Is A document that provides patients with
10. The patient has the right to consent to or
information on how they can reasonably
decline to participate in proposed research studies
expect to be treated during the course of
or human experimentation affecting care and
their hospital stay.
treatment.
 Is not legally binding.
11. The patient has the right to expect reasonable
 Simply provide goals and expectations for continuity of care when appropriate and to be
patient treatment. informed by physicians and other caregivers.

1. The patient has the right to considerate and 12. The patient has the right to be informed of
respectful care. hospital policies and practices that relate to patient
care, treatment, and responsibilities.
2. The patient has the right to and is encouraged to
obtain from physicians and other direct caregivers FIELDS OF NURSING
relevant, current, and understandable information
1. Community health nursing
concerning diagnosis, treatment, and prognosis.
 Is the synthesis of nursing and public health
3. The patient has the right to make decisions
practice applied to promote and protect the
about plan of care prior to and during the course of
health of population.
treatment and to refuse a recommended treatment
or plan of care to the extent permitted by law and  It combines all the basic elements of
hospital policy and to be informed of the medical professional, clinical nursing with public
consequences of this action. health and community practice.
4. The patient has the right to have an advance  Is the nursing care which is given in the
directive (such as a living will, health care proxy, or community where people live, work and
durable power of attorney for health care) gather formally and informally.
concerning treatment or designating a surrogate
decision maker with expectation that the hospital a. home
will honor the intent of that directive to the extent b. farms
permitted by law and hospital policy.
c. School
5. The patient has the right to every consideration
of privacy. d. clinics

- Case discussion, consultation, examination, e. health center

and treatment should be conducted so as to
2. Institutional nursing
protect each patient’s privacy.
 Is the nursing which is given in hospitals of
different levels.
12
3. Independent nursing practice  Moreover, they also teach students the
basics of health care.
 A registered nurse who provides
professional nursing services, as a
proprietor of a business, through direct
d. Medical Assistance
patient care, education, research,
administration or consultation.”  Medical assistance is another specialization
4. Nursing education of nursing where nurses are responsible for
managing patients, schedule, and setting up
  consists of the theoretical and practical referrals.
training provided to nurses with the purpose
 Doctors prefer hiring nurses for their
to prepare them for their duties as nursing
care professionals. assistance in their personal clinics and
nursing homes.
 This education is provided to nursing
 It is there that nurses can offer assistance
students by experienced nurses and other
medical professionals who have qualified or to the clinic on a part-time basis, after
experienced for educational tasks. working all day in a hospital.

Different Fields of Nursing

5. Different fields of nursing

a. Hospital Nursing

 hospital nursing, a female clad in a white

uniform with a tray full of medicines

 Hospital nursing involves a wide variety of

medical jobs.

 From hands-on patient care to assisting

doctors, from management of hospital
processes to training newbie nurses,
hospital nursing is full of career
opportunities for the ones interested in
health activities.

b. Community Nursing

 Community nursing is a better option in

terms of specialization as in this field,
nurses can pick and choose the type of
patients they prefer to work with.

 They choose to work in the home health

care industry, and hence, it is naturally
easier for them to enjoy flexibility in
scheduling.

 A community nurse is responsible for

following a treatment procedure proposed
by a doctor, and performing relevant
medical methods.

c. School Nursing

 A school nurse is responsible for taking care

of students' health in schools.

 They deliver medications as prescribed by

doctors, and offer first-aid to those who get
injured.

13
 opportunities will also increase. After all,
nursing is about taking care of all right from
their birth to the old age!

HEALTH STRATEGIES, INTERVENTIONS,

CARE AGENCIES AND SERVCES

A. Categories of health care strategies and

Intervention

 Prevention

 Curative

 Rehabilitative

 Facilitative

 Direct

Categories of Health Care

a. Health care System

 Is the totality of services offered by all

health disciplines.

 Services provided are commonly

 While above were some of the most sought categorized to type and level.
after fields in nursing, following is a list of a
 b. 3 types of health care services :
few more nursing domains that a health
care aspirant can browse through:Advance  Often described in a way correlated with
Practice Registered Nursing levels of disease prevention
 Clinical Nursing 1. primary prevention - health promotion and
illness prevention
 Developmental Disability Nursing
2. secondary prevention - diagnosis and
 Diabetes Nursing treatment
 Genetics Nursing 3. tertiary prevention - rehabilitation and
 HIV/AIDS Nursing health restoration

 Hematology Nursing
1. Health Promotion and Illness Prevention
 Perinatal Nursing
(primary prevention)
 Radiology Nursing
a. World Health Organization ( WHO )
 Surgical Nursing  Developed a project called healthy People.
 Transplant Nursing b. The U.S. Department of Health and Human
 Perioperative Nursing Services (2000) project that evolved from the
original work is called Healthy People 2010 and has
 Vocational Nursing 2 primary goals :

 Above was a fleeting glimpse of the 1. Increase quality and years of health life
different fields of nursing and health care.
2. Eliminate health disparities.
For aspirants ready to work in a
challenging, terse, yet rewarding  Health promotion programs areas such as :
environment, nursing is the most suited
a. Adequate and proper nutrition
career option for them. What's more, the
terrific salary range of a nurse contributes b. Weight control and exercise
to one of the highest salaries in the U.S.
However, with increasing experience, c. Stress reduction
14
  Health promotion activities emphasize the  Rehabilitative care emphasizes the
important role clients play in maintaining importance of assisting clients to function
their own health and encourage them to adequately in the physical, mental, social,
maintain the highest level of wellness they and vocational areas of their lives.
can achieve.
 Goal of rehabilitation :
 Health promotion services :
- To help people move to their previous level
- Regular dental exams from childhood of health or to the highest level
throughout life
- they are capable of given their current
- Bone density tests for women at health status.
menopause to evaluate for early
B. TYPES OF HEALTH CARE AGENCES AND
osteoporosis.
SERVICES
- Early detection for cancer : provide
1. Public Health
mammograms and education regarding
early detection of CA of the breast.  Government ( official ) agencies are
- Voluntary HIV testing and counselling established at the local, state or provincial ,
and federal levels.
 Health prevention Programs
 To provide public health services.
.- directed at the client or the community
 Their funds generally from taxes,
- involve such practices : administered by elected or appointed
officials .
1. providing immunizations
 Local health departments have
2. identifying risk factors for illnesses
responsibility for developing programs to
3. helping people take measures to prevent illness meet the health needs of the people,
from occurring providing necessary staff and facilities to
carry out this programs, continually
a. environmental programs to reduce the
evaluating the effectiveness of the
incidence of illness or disability.
programs and monitoring changing needs.
 Example :
2. Physician’s offices
- Steps to decrease pollution : requiring
 Clients go to the physician’s office for
inspection of automobiles exhaust system to
routine health screening, illness diagnosis,
ensure acceptable levels of fumes.
and treatment.
2. Diagnosis and Treatment (Second
 People often seek consultation when they
Prevention)
are experiencing symptoms of illness
 Hospitals and physician’s offices have been
 Do not usually require the services of RNs
the major agencies offering complex
services : 3.Ambulatory Care Centers
a. Freestanding diagnostic and treatment facilities : Have diagnostic and treatment facilities providing
- Magnetic resonance imaging (MRI) Scans medical, nursing, laboratory and radiological
services, and they may be attached to or
- MRI scan uses a strong magnetic field , associated with an acute care hospital.
radio waves, and a computer to create a
Also provides services such as :
detailed, cross- sectional image of internal
organs and structures within the body.  Minor surgical procedures client is sent
3. Rehabilitation and Health Restoration home after the procedure.
(Tertiary Prevention) 4. Occupational ( industrial ) Health clinics
 Rehabilitation : the process of restoring ill or  Setting for employee health care.
injured people to optimum and functional
levels of wellness.  Companies recognize the value of healthy
employees and encourage healthy lifestyles

15
 by providing exercise facilities and  Are independent community centers or
coordinating health- promotion activities. special units .
 Nurses are employed in the occupational  Assists client to restore their health and
setting. recuperate .
 Worker safety – main concern  Drug and alcohol rehabilitation centers help
client be free of drug and alcohol
 Nursing functions in industrial health care :
dependence and assist them to reenter the
- Work safety and education community and function to the best of their
ability.
- Annual employee health screening for
tuberculosis  Nurses in the centers coordinate client
activities and ensure that clients are
- Maintaining immunization complying with their treatments.
- Screening for hypertension and DM 9. Health care Agencies
5. Hospitals  Offers education to clients and families and
 Classification: also provide comprehensive care to acute,
chronic, and terminally ill clients.
A. ownership: governmental ( public ) or
nongovernmental ( private ). 10. Day – Care Centers

B. services they provide  Provide care for infants and children while
parents are at work.
a. general hospitals : medical, surgical, obstetric,
pediatric and psychiatric services  May also provide care and nutrition for
adults who cannot be left home alone but
b. specialty services : psychiatric or pediatric care
do not need to be in an institution
C. Acute or chronic Care facilities :
 Elder care centers provide care involving
a. acute care hospital provides assistance to clients socializing, exercise programs, and
who are acutely ill or whose illness and need for stimulation .
hospitalization are relatively short term (2 days)
 Some provide counseling and physical
b. long term care hospitals ; provide services for therapy
longer periods , years or the remainder of the
 Nurses employed in day care centers may
client’s life.
provide medications , treatments, and
6. Extended Care ( Long Term Care ) counseling, thereby facilitating continuity
between day care and home care.
 Formerly nursing homes, now these are
multilevel campuses that includes living 10. Rural care
quarters for seniors ad assisted facilities.
 To make available primary care access to
7. Retirement and Assisted – living Centers improve emergency care for rural residents.
 Consists of separate houses, condominiums  Nurses in rural settings must be generalists
or apartments for residents. who are able to manage a wide variety of
clients and health care problems.
 Residents live independently : they offer
meals , laundry services, nursing care,  Nurse practitioners are particularly suited to
transportation and social services. these roles.
 Sometimes have separate hospitals to care 11. Hospice services
for residents.
 Health care service for the dying provided in
 Works collaboratively with case managers . the home or another health care setting.

 Intended to meet the needs of people who  It is not saving life but improving or
are unable to to remain at home but do not maintaining the quality of life until death.
require hospital or nursing home care
 Hospice nurse does ongoing assessment
8. Rehabilitation Centers needs of the client and family and helps to
16
 find the appropriate resources and   provides direction on the type of nursing
additional services for them as needed. care the individual/family/community may
need.[1] 
12. Crisis Centers
 The main focus of a nursing care plan is to
 Provide emergency services to clients
facilitate standardized, evidence-based and
experiencing life crisis.
holistic care.[2]
 Operates out of the hospital, or in then
  Nursing care plan includes the following
community and provide 24- hour telephone
components: assessment, diagnosis,
service.
expected outcomes, interventions, rationale
 Also provide direct counseling to people at and evaluation.[2
the center or in their homes.
2. Kardex
 Primary purpose :
 a trademark for a card filing system
- To help people cope with an immediate
 that allows quick reference to the particular 
crisis and then provide guidance and
needs of each patient for certain aspects
support for long term therapy. of nursing care.

 Nurses working in crisis centers:   Included on the card may be a schedule of 

medications, level of activity allowed, ability 
- need well-developed communication and
to perform basic self-
counseling skills. care, diet, any special problems, a schedule 
- Must immediately identify the person’s of treatments and procedures, and a care pl
problem, offer assistance to help, to cope an. 
and later direct the person to resources for  The Kardex is updated
long-term support.
as necessary and is usually kept at the nurs
13. Mutual Support and Self – Help Groups es' station.

 Self-help groups, also known as mutual  Widely used, concise method of organizing
help, mutual aid, or support groups, are & recording data about a client, making
groups of people who provide mutual information quickly accessible to all health
support for each other. professionals. Consists of a series of cards
kept in a portable index file or on computer
 In a self-help group, the members share a generated forms
common problem, often a common disease
or addiction. 3. Flow sheet

 Their mutual goal is to help each other to  A

deal with, if possible to heal or to recover patient care record that documents interven
from, this problem. tions through the use of check marks and br
ief notations.
 Example :
  a graphic summary of several changing fact
a. Alcoholics Anonymous – formed in 1935 ors, especially the patient's vital signs or wei
- Served as the model for many these groups ght and the
treatments and medications given.
RECORDS IN NURSING PRACTICE
  In labor the flow sheet displays the progres
A. Importance and use of Records s of labor, including centimeters of cervical
Law courts adopt the attitude that if something is dilation, cervical effacement, position of the 
not recorded, it did not happen and, therefore, baby's head, baby's heart rate, frequency of 
nurses have a professional and legal duty to keep contractions, mother’s
records. temperature and blood pressure, and medic
ations given or procedures performed.
B. Types of Records
4. Graphic record
1. Nursing Care Plan

17
  This record typically indicates body  serve to communicate findings, opinions
temperature, pulse, respiration and blood and plans between physicians
pressure.
 and other members of the medical care
5. Intake and Output Record team, and
 A record of the patient’s  allow retrospective review of case details for
a variety of interested parties.
 total fluid intake : Oral ,
9. Nursing Discharge/Referral Summaries
 Nasogastric tube,
Discharge Planning
 Iv fluids and blood products.
 Is the process of anticipating and planning
 Intake is measured in milliliters and a for needs of patient following discharge
record of patient’s output: amount of
vomitus , urine output.  Nursing Discharge & Referral Summaries

6. Medication Administration Record (MAR )  These are completed when the client is
being discharged or transferred to another
  is the report that serves as a legal record
institution or to a home setting where a visit
of the drugs administered to a patient at a by a community health nurse is required.
facility by a health care professional. Regardless of format, it includes some or all
 The MAR is a part of a patient's permanent of the following:
record on their medical chart.  Description of client’s physical, mental &
 The health care professional signs off on emotional state
the record at the time that the drug or  Resolved health problems
device is administered.
 Unresolved continuing health problems
 MARs are commonly referred to as drug
charts.  Treatments that can be continued (e.g.
wound care, oxygen therapy)
7. Progress Notes
 Current medications
 are the part of a medical
record where healthcare professionals  Restrictions that relate to activity, diet &
record details to document a patient's bathing
clinical status or achievements during the
course of a hospitalization or over the  Functional/self-care abilities
course of outpatient care.[  Comfort level
 One example is the SOAP note, where the note is  Support networks
organized into Subjective, Objective, Assessment,
and Plan sections.  Client education provided in relation to
disease process
Another example is the DART system, organized
into Description, Assessment, Response,  Discharge destination
and Treatment.[2]
 Referral Services (e.g. social worker, home
 Documentation of care and treatment is an health nurse)
extremely important part of the treatment process.
Progress notes are written by  for Good Documentation and
both physicians and nurses to document patient Reporting
care on a regular interval during a patient's
 Fact – information about clients and their
hospitalization.
care must be factual. A record should
Progress notes contain Guidelines in descriptive, objective
information about what a nurse sees, hears,
 serve as a record of events during a
feels and smells
patient's care,
 Accuracy – information must be accurate so
 allow clinicians to compare past status to
that health team members have confidence
current status, in it
18
  Completeness – the information within a  This does not however, exclude the client’s
record or a report should be complete, rights to the same record.
containing concise and thorough
 According to Guido (2001) , the client has
information about a client’s care. Concise
data are easy to understand the right to access all information contained
within his or her own record and to have a
 Currentness – ongoing decisions about care copy of the original record.
must be based on currently reported
 Hospital may charge a copy fee and may
information. At the time of occurrence
include the following:a. Vital signs also require certain procedures such as
presence of a hospital representative to
 b. Administration of medications and answer questions.
treatments
 For purposes of education and research,
 c. Preparation of diagnostic tests or surgery most agencies allow student and graduate
professionals access to client records.
 d. Change in status
 Records are used in client conferences,
 e. Admission, transfer, discharge or death of
clinics, client studies, and written papers.
a client
 The student / graduate is bound by a strict
 f. Treatment for a sudden change in status
ethical code to hold all information in
 5. Organization – the nurse communicate in confidence
a logical format or order 3. Purposes of client records
 6. Confidentiality – a confidential a. Communication
communication is information given by one
person to another with trust and confidence  Serves a s the vehicle by which different
that such information will not be disclosed health professionals who interact with a
client communicate with each other.
C. DOCUMENTATION SYSTEMS
b. Planning patient care
1. Key Terms
 professionals uses data from client’s
a. Report – oral, or written, or computer- record to plan care for that patient.
based communication intended to convey
information to others. for instance ; nurses  Example :
always report on clients at the end of the
 Physicians orders specific antibiotic after
hospital work shift.
establishing client’s temperature is steadily
b. Recording, charting, or documenting – rising and that laboratory tests reveal
the process of making an on a client record. presence of a certain microorganisms.
c. Chart or client record – formal, legal  Nurses use baseline and on going data to
document that provides evidence of client evaluate the effectiveness of the nursing
care. care plan.
d. Documentation – is a set of documents c. Auditing Health Agencies
provided on paper, or nline, or on digital or
on analog media. Documents or records  Audit – review of client records for quality
that are used to prove something or make it assurance purposes.
official.  To determine if agency is meeting its stated
2. Legal confidentiality of computer records. standards.

Nurses has a duty to maintain confidentiality of all d. Research

patient information.
 Contains information valuable for research
 The clients record is protected legally as a purposes.
private record of the client’s care.
d. Education
 The institution or agency is the rightful e. Reimbursements
owner of the client’s record. f. Legal documentation
g. Health care Analysis

19
 c. Basic components of POMR

4. Documentation System 1. Data Base

A. Source – Oriented Record 2. Problem List

- information of about a particular problem is 3. Plan of Care

distributed throughout the record.
4. Progress notes
- example :
5. Final Progress Note or Discharge Summary
- if patient is with Left hemiplegia , data about
Components of POMR
this problem might in the physician’s history sheet,
in the nurses notes, on the physician’s orders and  NOTE: 1, 2 and 3 above must be completed
in the physical therapists’ record. by the admitting physician.
1. Narrative charting 1. Data Base:
 Traditional part of the source- oriented  Consists of all information know about
record. the client when the client first enter
 Consists of written notes that include the health care agency.
routine care, normal findings and client  must include a complete physician’s
problems. history, physical exam, nursing
B. PROBLEM-ORIENTED MEDICAL RECORD (POMR) assessment, social family data, and
baseline diagnostic tests.
Official Method of Record keeping.
 Many hospitals include certain routine
 The POMR as initially defined by Lawrence laboratory studies (CBC, SMAC(Sequential
Weed, MD, Multiple Analysis ), EKG, chest x-ray,
urinalysis, etc.) for each patient admitted.
 is the official method of record keeping
used at Foster G. McGaw Hospital and its  SMAC test : Sequential Multiple Analysis,
affiliates. tests blood chemistry, complete blood
count, and lipid profile( screening tool for
 Data are arranged according to the
abnormalities in lipids, such as cholesterol
problems the client has rather than the
and triglycerides).
source of the information.
2. Complete Problem List
 Members of the health care team contribute
to the problem list, plan of care, and  Derived from the data base.
progress notes.
 Kept in the front of the chart and serves as
 Plans for each active or potential problem an index to the progress notes
are drawn up and progress notes are
 Problems are listed in the order in which
recorded for each problem.
they are identified
a. Advantages of POMR
 List is continually updated as new problems
1. It encourages collaboration ( working with are identified.
other health care professionals )
3. Plan of Care
2. The problem list in the front chart alerts
caregivers  Care plans are generated by the person
who lists the problems.
b. Disadvantages :
 Physicians write physician’s orders or
1. Caregivers differ in their ability to use the medical care plans; nurses write nursing
required charting format. orders or nursing care plans.
2. It takes constant vigilance to maintain an  The written plan in the record is listed
up-to- date problem list
under each problem in the progress notes .
3. Inefficient because assessments and
4. Progress Notes
interventions that apply to more than one
problem must be repeated.
20
  Is a chart entry made by all health Soap format has been modified . The acronyms
professionals involved in client care. SOAP / SOAPIE and SOAPIER format

 Examples : Refer to formats that add interventions, evaluation

and revision.
a. The SOAP / SOAPIE format
I – Intervention
b. Focus Charting
 Refer to the specific interventions that have
SOAP FORMAT IN WRITING PROGRESS NOTES actually been performed by the caregiver.
 SOAP documentation E- Evaluation
 is a problem-oriented technique whereby  Includes client responses to nursing
the nurse identifies and lists the patient’s interventions and medical treatments.
health concerns.
R- Revision
 is commonly used in primary health-care
settings.  Reflects care plan modifications suggested
by the evaluation
S – Subjective Data
 Example: SOAP Format or SOAPIE and
 Information taken from client says . SOAPIER
 It describes client’s perceptions of and  S – Subjective data
experience with the problem O – Objective data
 Nurse’s quotes the client’s words. A – Assessment
P – Plan
O – Objective data I – Intervention
E – Evaluation
 Information is measured or observed by the
R– Revision
use of the senses
S = subjective data
 Example : vital signs , laboratory and x-ray
results  Example: What is the patient experiencing
or feeling, how long has this been an issue,
A – Assessment
what is the frequency, intensity, duration,
 Is the interpretation or conclusions drawn what makes it worse or better, any past
about the subjective and Merely stating the history, family history, home monitoring
problem or diagnosis results (BP, weight, glucose monitoring),
etc.
P- Plan
O = objective data
 Plan of care designed to resolved the stated
problem  Example: Results of the physical exam,
relevant vital signs, what the nurse
observes, etc.
 PIE (Problems, Interventions, and A = assessment
Evaluation)
 Example: What is the nursing diagnosis or
 Groups information in to three (3) medical diagnosis (for existing problems),
categories identification of the problem, etc.
 This system consists of a client care P = plan
assessment flow sheet & progress notes
 Example: What interventions are done
 FLOW SHEET – uses specific assessment during the visit, what is the follow-up, what
criteria in a particular format, such as medications have been prescribed or
human needs or functional health patterns changed, what further testing or
investigations are required, when will the
 Eliminate the traditional care plan &
patient be seen again, etc.
incorporate an ongoing care plan into the
progress notes  S = In for refills and review of diabetes.
Home glucose monitoring – taking BG
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 readings 3 times/week in morning only COMMUNICATION
(fasting). Average BG 7-8. Has been trying
I. Definition :
to avoid sugary snacks but has just quit
smoking so is finding this difficult. Walking 5 Communication : is any means of exchanging
times/week for 30 minutes. information or feelings between two or more
people.
 O: Blood work – A1C 7.2 (was 7.3), LDL
1.9, Ratio 3. BP 118/70. HR 72 regular. 2. Purposes of effective communication
 A: Diabetes (A1C not at target)  Effective communication plays an
instrumental role throughout a patient’s
 P: Provided with information on A1C,
entire healthcare experience, and a large
diabetes and targets. Provided with support
portion of the responsibility falls on nurses.
and information related to nutrition and
Responsible for relaying information to a
strategies to reduce sugary snacks.
number of individuals, nurses must be able
 I : Reviewed blood glucose testing and will to communicate clearly, especially during
check postprandial sugars 2/week until next periods of intense stress.
visit. The Communication Process
 1. Encouraged to book eye exam  Communication is a two way process
 2. Due for foot exam next visit involving the sending and the receiving of
message .
 3. Increase metformin to 1000mg bid
 The intent of communication is to elicit a
 4. Repeat BW in 3/12 (annual inc response , the process is ongoing : the
nephropathy screening) – encouraged to receiver of the message then becomes the
check sender of a response , and the original
sender then becomes the receiver.
 glucometer with bloodwork
1. Sender
FOCUS DAR CHARTING
 A person or group who wishes to convey a
a. Intended to make the client & client concerns &
message to another , can be considered the
strengths the focus of care
source encoder. encoding – involves
b. Three (3) columns for recording are usually
selection of specific signs or symbols
used: date & time, focus & progress notes
( codes) to transmit the message such as:
CHARTING BY EXCEPTION language , how to arrange words, tone of
voice and gestures to use.
charting by exception
2. Message
charting
 What is said or written , the body language
 the keeping of a clinical record of the import
that accompanies the words, and how
ant facts about a patient and the progress o message is transmitted.
f his or her illness.
 Channel – the medium used to convey the
 The patient's chart contains
message .
history; laboratory reports; list of medicatio
ns; results of physical examinations, consult 3. Receiver
ations, and
 Is the listener
special diagnostic tests; treatments of the h
ealth care team; any problems; and the pati  Is the decoder – who perceive what the
ent's response to interventions and sender intended ( interpretation )
treatment.
 To decode means to relate the message
 charting by exception a method of charting  perceived to the receiver’s storehouse of
designed to minimize clerical activities; a no knowledge and experience and to sort out
tation is made only when there the meaning of the message.
is a deviation from the baseline or expected 
outcome, or when a procedure or expected  4. Response / feedback
activity is to be omitted.

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  The message the receiver returns to the  To observe nonverbal behavior requires a
sender. systematic assessment of the person’s :

 Also called the feedback 1. overall physical appearance

MODES OF COMMUNICATION 2. Posture

1. Verbal communication - uses the spoken or 3. Gait ( person’s manner of walking)

written word
4. Facial expressions
2. Non-verbal communication – uses other
5. gestures
forms, such as :
Therapeutic Communication
- gestures
 Promotes understanding and can help
- facial expressions
establish a constructive relationship
- touch between the nurse and the client.

Things to consider when choosing words to say or  It is client and goal oriented
write ;
 refers to the process in which the nurse
1. Pace and intonation consciously influences a client or helps the
client to a better understanding through
2. Simplicity
verbal or nonverbal communication.
3. Clarity and brevity(concise and exact use of
 involves the use of specific strategies that
words in writing or speech)
encourage the patient to express feelings
4. Timing and relevance and ideas and that convey acceptance and
respect.
5. Adaptability ( to fit to, adjust )
1. Attentive Listening
6. Credibility ( Reliable , quality of being
trusted)  Listening actively, using all senses
7. Humor ( mood or state of mind )  An active process that requires energy and
Non – verbal communication concentration.

 Sometimes called body language.  Involves paying attention to the message,

both verbal and nonverbal and noting if
 Often tells others what a person is feeling communication is congruent.
than what is usually said, because
nonverbal behavior is controlled less  Means absorbing both the content and the
consciously than verbal behavior. feeling the person is conveying.

 It either reinforces or contradicts what is  It conveys an attitude of caring and

said. interest, thereby encouraging the patient to
talk.
 Example :
2. Physical attending
 If the nurse says to a client, “ I’d be happy
 The manner of being present to another or
to sit here and talk to you for a while.” yet
glances nervously at a watch every few being with another.
seconds, the actions contradict the verbal 5 actions of physical attending (SOLER )
message.
1. Face the person squarely .
 The client is more likely to believe the
nonverbal behavior, which conveys 2. Adopt an open posture.

“ I am very busy and need to leave.” 3. Lean toward the person

 Observing and interpreting the client’s 4. Maintain good eye contact.

nonverbal behavior is an essential skill for 5. Try to be relatively relaxed.
nurses to develop.
Five Actions of Physical Attending

1. Face the other person squarely

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 - Position says “ I am available to you.”  Definition

- Moving to the sides lessens the degree of  Consists of five elements

Involvement “
– Encoder, or sender
2. Adapt an open Posture
– Message
- Non-defensive position
– Sensory channel
- Which neither arms nor legs are crossed
– Decoder
- It conveys that the person wishes to
– The feedback, or return
encourage the passage of the
communication, as the open door of a home • This indicates the degree of
or an office, understanding of the
message
3. Lean toward the person
 Levels of Communication
- Move naturally, moving toward the front of
class – Intrapersonal ( internal use of
language or thought )
- Conveys involvement by leaning forward
– Interpersonal ( exchange of
4. Maintain eye contact
communication between two or
- Natural no glaring more people )
- Denotes willingness to maintain – Public (groups of people engage in
communication dialogues, speaking events)
5. relaxed Manner Forms of Communication
- -allows pauses as needed  Verbal
- -balance tensions with relaxation – Vocabulary
- Use gestures that are natural – Denotative meaning
The Helping Relationship – Connotative meaning
 Nurse – client relationships are referred to – Pacing
as:
– Intonation
- interpersonal relationships.
– Clarity & Brevity
- Therapeutic relationships
– Timing & Relevance
2 basic goals :
 Non-verbal
1. Helps clients manage their problems in living
– *adds cues & meaning to verbal
more effectively and develop unused or underused
communication
opportunities.
– Personal appearance
2. Helps clients become better at helping
themselves in their everyday lives. – Posture & gait
Phases of the Helping Relationship – Facial expression
1. Preinteraction Phase – Eye contact
 Similar to the planning stage before an – Gestures
interview
– Territoriality & Space
COMMUNICATION MODULE B
 Therapeutic- Communication that is
Communication: Communication is the process of beneficial in developing a nurse-client
transmitting messages and interpreting meaning. helping relationship (Ex. Active listening-
This is an important skill that is acquired through SOLER, empathy, humor, touch)
study and application.

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 – SOLER- Sit facing the client, • Sometimes it’s necessary to acknowledge
Observe and open posture, Lean what patients say and affirm that they’ve
toward client, Establish and been heard. Acceptance isn’t necessarily the
maintain intermittent eye contact, same thing as agreement; it can be enough
Relax to simply make eye contact and say “Yes, I
understand.” Patients who feel their nurses
 Non-Therapeutic- Communication that is
are listening to them and taking them
not beneficial or helpful to people involved
seriously are more likely to be receptive to
Ex. Personal questions, personal opinions,
care.
changing the subject.
3. Giving Recognition
ZONES OF PERSONAL SPACE
• Recognition acknowledges a patient’s
 Intimate (0-18 in)
behavior and highlights it without giving an
 Personal (18-4ft) overt compliment. A compliment can
sometimes be taken as condescending,
 Social (4- 12 ft) especially when it concerns a routine task
 Public (12 ft or greater) like making the bed. However, saying
something like “I noticed you took all of
ZONES OF TOUCH your medications” draws attention to the
action and encourages it without requiring a
 Social ( permission not needed)
compliment.
 Consent (permission needed)
4. Offering Self
 Vulnerable (special care needed)
Hospital stays can be lonely, stressful times; when
 Intimate (great sensitivity needed) nurses offer their time, it shows they value patients
and that someone is willing to give them time and
THERAPEUTIC COMMUNICATION
attention. Offering to stay for lunch, watch a TV
TECHNIQUES
show, or simply sit with patients for a while can
Therapeutic Communication help boost their mood

• is a collection of techniques that prioritize

the physical, mental, and emotional well-
11 CORE COMPETENCIES
being of patients opens in new window.

• Nurses provide patients with support and

information while maintaining a level of
professional distance and objectivity.

• With therapeutic communication, nurses

often use open-ended statements and
questions, repeat information, or use silence
to prompt patients to work through
problems on their own.

Therapeutic Communication Techniques

1. Using Silence

• At times, it’s useful to not speak at all.

• Deliberate silence can give both nurses and

patients an opportunity to think through
and process what comes next in the
conversation.

• It may give patients the time and space

they need to broach a new topic.

• Nurses should always let patients break the

silence.

2. Accepting
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