NCM 100- Lecture (3 units)

Fundamentals of Nursing
Jacqueline M. Calaycay, RN, MSN
Course Description: The course provides the students with the overview of nursing as a profession,
science, & as an art. It shall include a discussion on the different roles of a nurse emphasizing on
health promotion, illness prevention & utilizing the nursing process as a basis for nursing practice.
Three Main Topics
I.
II.
III.

Nursing as a Profession
Nursing as a Science
Nursing as an Art

Nursing as a Profession
Definition of Nursing:
It is a caring profession. A unique profession, it is practiced with an earnest concern for the art of care
& the science of health.
The profession involves a humanistic blend of scientific knowledge, & holistic nursing practice.
Definition of Nursing
The art & science by which people are assisted in learning to care for themselves whenever possible
& cared for by others when they are unable to meet their own needs.
Florence Nightingale (1860).
The act of utilizing the environment of the patients to assist him in his recovery.

Definition of
Nursing

Virginia Henderson (1960).

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 peaceful death) that he would perform
unaided if he had the necessary strength, will, or knowledge, & to do this in such a way as to help
him gain independence as rapidly as possible.

Virginia Henderson (1960).

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 peaceful death) that he would perform
unaided if he had the necessary strength, will, or knowledge, & to do this in such a way as to help
him gain independence as rapidly as possible.
Orem
A helping or assisting service to persons who are wholly or partly dependent- infants, children, &
adults- when they, their parents & guardians, or other adults responsible for their care are no longer
able to give or supervise their care.
American Nurses Association (ANA;1980)

The diagnosis and treatment of human responses to actual & potential health problems.
Canadian Nurses Association (CAN;1984)
The identification & treatment of human responses to actual & potential health problems & includes
the practice of & supervision of functions & services that directly or indirectly in collaboration with
client or providers of health care other than nurses, have as their objectives the promotion of health,
prevention of illness, alleviation of suffering, restoration of health & optimum development of health
potential & includes all aspects of the nursing process.

Nursing

Is a profession that serves the need of society, in the area of health. The practice of nursing
addresses a wide range of health problems, both actual & potential, requiring of its practitioners a
special body of knowledge including skills to meet client needs & a value system that recognizes the
client as autonomous human being with rights.

The Philippine Nursing Act

Professional Nursing as the performance for a fee, salary or other reward or compensation of
professional nursing services to individuals, families, communities in various stages of development
toward the promotion of illness, restoration of health, & alleviation of suffering through:

Professional Nursing as the performance for a fee, salary or other reward or compensation of
professional nursing services to individuals, families, communities in various stages of development
toward the promotion of illness, restoration of health, & alleviation of suffering through:
communities & the like settings: Undertaking consultation services & engaging in such other
activities that require the use of knowledge & decision-making skill of a registered nurse.
1.
Utilization of the nursing process.
2.
Establishment of connection with community resources & coordination of the heath team.
3.
Motivation of individuals, families, & communities & coordination of services with other members
of the health team.
4.
Participation in teaching, guidance & supervision of students in nursing education programs as
well as administering of nursing services in varied settings such as homes, hospitals,
5.
Undertaking nursing & health manpower development training & research & soliciting finances,
therefore, in cooperation with the appropriate government & private agencies.
Concepts of Profession
.
Is a calling, an occupation that requires special knowledge, skill & preparation.
.
A profession is generally distinguished from other kinds of occupation by: a) its requirement of
prolonged, especialized training to acquire a body of knowledge pertinent to the role to be
performed; b) an orientation of the individual toward service, either to a community or team
organization.

History of Nursing
FOUR GREAT PERIODS IN NURSING:
1.INTUITIVE:UNTAUGHT,INSTINCTIVE. It dated from prehistoric times; was practiced among
primitive tribes and lasted through the Christian era. It was performed out of feeling of
compassion for others, out of desires to help and out of a wish to do good.
2.APPRENTICE: on-the-job training, without formal education. It extends from the founding of
religious nursing orders in the 6th century, through the Crusades which means bean in the 11th
century, to 1836.
3.EDUCATED: June 1860 when Nightingale School of Nursing opened in London. Forma education
for nurses.
4. CONTEMPORARY: Began at the end of World War II.
INTUITIVE:
Reference to nursing was mother role because pre-historic man was a nomad who had to search
for food and shelter.

Philosophy then was self-preservation

Cause of illness was invasion of victims body by an evil spirit

Trephine is drilling a hole in the skull with a rock or stone to remove the evil spirit without the
benefit of anesthesia

Shaman or witch doctor had the power to heal by using white magic, but he also had the
ability to inflict greater harm through black magic.

Nurses role: instinctive directed towards comforting, practicing midwifery and being wet
nurse to a child without training or direction.
Near East:
A. Babylonia

King Hammurabi codified Babylonian Laws

Code of Hammurabi medical regulations established. Discouraged
experimentation, designed doctors for each diseases, and patients were given
the choice between the use of charms and medicine or surgery and cure of his
disease.

Ancient Civilization:
The evolution dated back to 400 BC to primitive societies in which mother nurse worked with the priest.
In 200 BC , the use of wet nurses is recorded in Babylonia.
During this time, beliefs about the cause of disease were embedded in superstitions & magic, caused by
angry spirit(demons)
Treatment : exorcism, drugs obtained from plants, fruits, animals.

B. Egypt:
Herodotus Time: 485 425 B.C., neurosurgery was advanced.
Imhotep Chief physician and advisor to Pharaoh, contributions in architecture, care of the sick and
formulated wise proverbs.
Greeks believed in life after death
Developed the ability to make clinical observation
Healthiest of all countries because of Hygiene principles
Exhibited careful planning to meet certain community needs and avert public health problems.
Art of Embalming for human anatomy but since done on dead, they learn nothing in physiology.
C. Hebrew:

Leviticus: Laws controlling the spread of communicable diseases

Judaic Covenant with God directing the ritual of circumcision of the male child on the 8 th day.
Mosaic Code Physical purity is equivalent to moral purity
Reference to nurses are midwives and wet nurses
Music Therapy: David played the harp for King Saul when depressed
Aaron The High Priest as physician of the people
Moses father of sanitation

Far East
A. China:
Belief in spirits and demons
Practice of ancestor worship prohibiting dissection of human body
Materia Medica (Pharmacology) 52 volumes of Chinese Medicine
Huae To exponent of acupuncture
Emperor Shen Nung father of Chinese Medicine
Diagnosis was made on the basis of the Pulse Theory
Yang and Yin Theory established some scientific basis for disease
Yang (Male principle) positive, active, fiery and full of life
Yin (Female Principle) negative, cold, weak, dark, an lifeless
B. India:

Built hospitals, practiced asepsis

Proficient in medicine and surgery
First reference to nurses taking care of the sick
Writings of Sushurutu found a list of functions and qualifications of the nurses
Medical practice declined with the fall of Buddhism
Diet was according to patients condition
India
Early hospitals were staffed by male nurses who were required to meet 4 qualifications:
Knowledge of drugs
Cleverness
Devotedness to patient
Purity of mind & body.

C. Greece:

Nursing was the task of untrained slave.

Caduceus insignia of the medical profession, associated with Aesculapius father of Medicine
in Greek Myth
Hippocrates Father of Medicine
Practices that brought about cure were rest, wholesome food, physiotherapy fresh air, sunshine

1.
2.

Greek medicine
Two kinds of refuges for the sick:
Secular- directed by physicians. Which corresponds roughly to our spas or health resorts of today.
Religious institutions-governed by priests. Prietesses attended to patients who were housed in the
temple.
.
They were known for their practice of gods & goddesses.

Apollo- of health; Aesculapius god of healing

Hygeia- goddes of health.

D. Rome( early Christian church & hospital)

Illness was a sign of weakness

Sick was left to care of slaves
Evidence of specialization
Translation of Greek medical terms to Latin
Celsius his concept of cardinal signs of inflammation: redness, swelling, heat, pain
Christianity value life and equality
a.
Phoebe first visiting nurse
b.
Fabiola her home was the first hospital in the Christian World

APPRENTICE:

Europe:

Medicine in Europe was under two influences lay medicine and ecclesiastical medicine
During the middle ages, thousands of years after the death of Christ, three organizations were
developed military orders, regular vows (with vows) and the secular orders (without vows)
Nursing care performed by people who are directed by more experienced nurses

A. Crusades: (began before 1100-1300

Military religious orders founded during the Crusades. Established hospitals and staffed
them with men who served as nurses.
B. Military Orders (Knight Hospitaliers)
Knights of St. John established organization of rank and the principles of complete and
unquestioned devotion of duty
Teutonic Knights German equivalent of St. John
Knight of St. Lazarus for lepers
Alexian Brothers one of the largest school of nursing under religious auspices operated
exclusively for men in the US.
C. Secular Orders the work of these nurses was complicated by religious taboos and the social restrictions of
their cultures and education
Augustinian Sisters
Third Order of St. Francis
Order of St. Vincent de Paul
Ladies of Charity
Benedictines
Order nuns prayed with and took care of patient; younger ones washed soiled linens

D. Regular Orders: These religious orders gave rise to nursing saints:

1. St. Catherine of Siena Original Lady with a Lamp
2. St. Hildegarde prescribed cures and was supposed to have performed miracles
3. St. Elizabeth of Hungary Patroness of Nurses

Care of the sick were performed mainly by volunteers who devoted themselves to nursing.
Renaissance : 14-15-17th century the period of great revival of learning.

Forerunners of the great development during this period were:

Leonardo da Vinci- anatomical studies, described muscle & arteries.

Andreas Vesalius- described human anatomy.

William Harvey- discovered how blood circulates.

Ambroise Pare- surgeon, developed principles of surgery.

During this period, nursing reached a high level of organization & efficiency with religious &
military orders.
Because of renewed interest in science, universities were established, but no formal nursing
schools were founded.
Women continued to fullfill the traditional role of nurturer & caregiver in the home.
Reformation (1600) religious movement that aimed in reforming the Roman catholic church &
resulted in establishing the Protestant Churches.
Religious upheaval of the 16th century which destroyed the unity of Christian faith in Europe

Transition from medieval to modern civilization which left the world with the following:
a. Economic changes
b. political changes
c. cultural changes

Reformation: 17th to 19th century, nursing sank to its lowest levels. This is the DARK Period of Nursing.
Crimean War: FLORENCE NIGHTINGALE took care of wounded soldiers, believed that a clean environment
played an important role in early recovery.
Nursing during the Civil War:

Early American Nursing

Miss Dorothy Dix, though not a nurse, as appointed Superintendent of Female Nurses, and got
together the first Nurse Corps of US Army
Clara Barton was president of the American Association of the Red Cross in the District of
Colombia

Period of Educated Nursing

This period began on June15, 1860 when the Florence Nightingale School of Nursing opened at St.
Thomas Hospital in London (St. Thomas School of Nursing).
The development of nursing during this period was strongly influenced by:
Trends resulting from wars
From arousal of social consciousness
From the emancipation of women
From the increased educational opportunities offered to women.
FLORENCE NIGHTINGALE:
Recognized as the Mother of Modern Nursing; known as the Lady with the Lamp.
Born on May 12, 1820 in Florence Italy
Raised in England in an atmosphere of culture & affluence.
Learned languages, literature, mathematics, & social graces.
Her education was rounded out by a continental tour.
Not contented with social custom imposed upon her as a Victorian Lady, she develop her self-appointed
goal: To change the profile of Nursing.

Compiled notes of her visits to hospitals, her observation of the sanitary facilities & social
problems of the places she visited.
Noted the need for preventive medicine & good nursing.
Advocated for care of those afflicted with diseases caused by lack of hygienic practices.
At the age of 31, she overcame the familys resistance.
She entered the Deaconess School at Kaiserwerth , Germany- where she received
training for three months.
In 1853- studied in Paris with the sister of Charity after which she returned to England, &
worked as a superintendent of a charity hospital for ill governesses.
Disapproved of the restrictions on admission of patients & considered this as unchristian
& incompatible with health care.
Upgraded the practice of nursing & made nursing an honorable profession for
gentlewomen.
Led the nurses that took care the wounded during the Crimean War.(1854-1856)
She implemented her principles in the areas of nursing practice & environmental
modification resulted in reduced morbidity & mortality during the war.
As a result of her experiences , she forged the future of nursing education, she believed
that nurses should be formally educated & should function as client advocates.
1860 establishment of the Nightingale Training School of Nurses.
Put down her ideas in two published books: Notes in Nursing and Notes on Hospitals.

The Nightingale Pledge

I solemnly pledge myself before God,
and in the presence of this assembly,
to pass my life in purity & to practice my profession faithfully.
I will abstain from whatever is deleterious and mischievous, and will not take or knowingly
administer any harmful drugs.

I will do all in my power to maintain and elevate the standard of my profession, and will hold in confidence
all personal matters committed to my keeping and all family affairs, coming to my knowledge in the
practice of my profession,
With loyalty, Will I endeavor to work closely with the health team, and devote myself to the welfare of
those committed to my care.
So help me GOD.

Nightingale Pledge was written in 1893 by: Canadian born Lystia Grette- principal of the Farrand
Training School for Nurses in Detroit.
It reflects Nightingales philosophy & styles.

EDUCATED: Established of the Nightingale System of Nursing for improve nursing practice. First decade of
the 20th century: age of specialization. Standard curriculum for nursing was prepared by the National
League for Nursing Education between 1913 & 1937.
Early Schools:
1. Bellevue Training School of Nurses in NY.
2. Connecticut Training School of New
Haven, Conn
3. John Hopkins in Baltimore, Maryland
Leaders:
1. Linda Richards instituted the system of keeping records and orders. The first graduate nurse in the US
2. Isabel Hampton Robb standardized nursing education programs and prepared teachers
instruction in schools of nursing
3. Mary Adelaide Nutting had a unique collection of works on the history of nursing
4. Lilian Wald first President of the National Organization for Public Health Nursing
5. Isabel Maitland Stewart first nurse to receive an MA degree
6. Mary Elizabeth Mahoney first professional black nurse in the US
7. Florence Nightingale stated that environment played an important role in mans health

Period of contemporary Nursing

This period covers the period after World War II to the present.
Scientific & technological developments as well as social changes mark this period.
- The United Nations was created in 1945. Under this was the World Health Organization, created to fight
diseases by providing health information and improving the living standards of all people
- WHO was formed to assist in fighting disease by providing health information and improving the
nutrition, living standards and environmental conditions for all people.
Use of atomic & nuclear energy for medical diagnosis & treatment.
Utilization of computers for collecting data, teaching etc.
The advent of space medicine also brought about the development of aerospace nursing.
Health is perceived as a fundamental human right .
Nursing involvement in community is greatly intensified.
Development of the expanded role of nurses.

History of Nursing in the Philippines

Early Beliefs & Practices
1. ANCIENT TIME
Care of the sick was based on mythical superstitions and mythical background.
Disease and death were said to be god-given in a way of punishment.
People found relief from pain or illness from herbs, roots and tubers without knowing the
principles
People were graced with amulates to subdue the spirits that caused illness
Persons with powers to expel demons can drive away evil spirits (Herbolarios)

Early care of the sick

The early Filipinos subscribed to superstitious beliefs & practices in relation to health &
sickness.
Herbmen were called herbicheros meaning the one who practiced witchcraft.
Persons suffering from diseases without any identified cause were believed to be bewitched by
the mangkukulam or mangagaway

Difficult childbirth & some diseases (called pamao) were attributed to nonos.
Midwife assisted in childbirth. During labor, the mabuting hilot (good midwife) was called in.
If the birth became difficult witches were supposed to be the cause.

Spanish Regime

1.
2.
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The religious orders exerted effort to care for the sick by building hospitals.
Earliest Hospitals Established:
Hospital Real de Manila (1577)- to care for the Spanish Kings soldiers & Spanish civilians.
San Lazaro Hospital (1578)- was built exclusively for patients with leprosy.
Hospital de Indio (15 86)-established by the Franciscan Order; service was supported by alms &
contributions from charitable institutions.
Hospitals de Aguas Santas (1590) estabished in Laguna, near a medicinal spring.
San Juan de Dios Hospital (1596). Founded by the brotherood of Misericordia ; support was derived
from alms & rents; rendered general services to the public.
Nursing began during the Revolution against the Spanish Sovereignty in 1896.
Filipino women volunteered to take care of the sick & the wounded Filipino soldiers.
Humanitarian work
Concept of Nursing-as the taking care of the sick & the injured .

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Prominent Women involved in Nursing Work

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Josephine Bracken, wife of Jose Rizal, installed a field in an state house in Tejeros: provided nursing
care to the wounded,night & day.
Rosa Sevilla de Alvero. Converted their house into quarters for the filipino soldiers, during the
Philippine-American War that broke out in 1899.

Filipino Red Cross

1.
2.

Malolos, Bulacan was the location of the National head quarters.

Established branches in the provinces.
Functions:
Collection of war funds & materials through concerts, charity bazzars, & voluntary contributions.
Provision of nursing care to wounded fil. soldiers

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1.
2.

Requirements for membership:

At least 14 y/o, age requirement for officer was 25y/o.
Of sound reputation.

INTUITIVE:
Reference to nursing was mother role because pre-historic man was a nomad who had to search for
food and shelter.

Philosophy then was self-preservation

Cause of illness was invasion of victims body by an evil spirit

Trephine is drilling a hole in the skull with a rock or stone to remove the evil spirit without the
benefit of anesthesia

Shaman or witch doctor had the power to heal by using white magic, but he also had the ability
to inflict greater harm through black magic.

Nurses role: instinctive directed towards comforting, practicing midwifery and being wet nurse
to a child without training or direction.

Dona Hilaria de Aguinaldo. Wife of Emilio Aguinaldo; organized Filipino Red Cross under the
inspiration of Apolinario Mabini.

Dona Maria Agoncillo de Aguinaldo. Second wife of Emilio Aguinaldo; provided nursing care to
Filipino soldiers during the revolution. President of the Phil. Red Cross in Batangas.

Melchora Aquino (Tandang Sora). Nursed the wounded soldiers, gave them shelter & food.

August, 1898- there was a great need for doctors & nurses to help prevent the recurring epidemic
of communicable diseases.

1906- strong agitation for establishment of nursing schools began.

Capitan Salome. A revolutionary leader in Nueva Ecija, provided nursing care t the wounded, when
not in combat.

Agueda Kahabagan. Revolutionary leader in Laguna, also provided nursing services to her troops.

Trinidad Tecson.Ina ng Biac Bato, stays in the hospital at Biac na Bato to care for the wounded
solders.
Hospitals & Schools of Nursing
1.
Iloilo Mission hospital School of Nursing (Iloilo City, Aug. 19060)- ran by the Baptist Foreign
mission Society of America.
.
Established when the American system of education was just introduced in the country.
.
Miss rose Nicolet- waa the first superintendent- who was a graduate of

New England Hospital for Women & Children in Boston, Massachusetts.

Miss Flora Ernst -American nurse, took charge in 1942.

1909-graduated the ist class of trained nurses.

1944- 22 nurses graduated & took the first board exam held in Iloilo Mission Hospital.
2.
St. Pauls Hospital School of Nursing (Manila,1907)
.
Established by the Archbishop of Manila, located in Intramuros & provided general hospital services.
.
It had a free dispensary & dental clinic.
.
Training School for nurses opened in 1908, with Rev. Mother Melanie as superintendent & Miss E chambers as Principal.
3.
The Philippine General Hospital School of Nursing (1907)
.
Began in 1901 as a small dispensary- mainly for civil officers & employees in Manila & later grew into Civil Hospital.
.
1906, Mrs Mary Coleman Masters, an educator advocated for idea of training Filipino girls for the profession of Nursing.
.
1907, with the support of Governor General Forbes & the Director of Health among others, opened classes in nursing
under the auspices of the Bureau of Education
.
Admission was based on entrance examination.
.
The applicant must have completed elementary education to seventh grade.
.
Julia Nichols & Charlotte Clayton taught nursing subjects & American physicians served as lecturers.
.
19010,Act No. 1976 modified the organization of the school, placing it under the supervision of the Director of Health.
.
The civil hospital was abolished, & became the Philippine General Hospital.
.
The school became known as the Philippine General Hospital school of Nursing.
.
Elsie McCloskey Gaches became the chief nurse, & introduced several improvements, that made nursing attractive &
more practical.
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Anastacia Geron Tupas- the first Filipino nurse to occupy the position of chief nurse & superintendent in the country.

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

It began as a small dispensary in 1903.
1907, the school was opened with three Filipino girls admitted. These girls had their first year in
combined classes with PGHSN & SPHSN
Helen Hicks was the first principal.
Vitallana Beltran was the first Filipino superintendent.
Dr. Jose Fores was the first Filipino medical director
1907-1910- the period of reorganization, the first year nursing students of PGHSN, SLHSN, SPHSN had a
common first year course-known as the Central School idea in nursing education.
They were later own fused in one class, lived in a dormitory, & received the same instruction in
anatomy & physiology, massage, practical nursing, materia medica, bacteriology & English.
The three schools agreed on how students were selected.
Educational preparation, at least completion of seventh grade.
Sound physical & mental health.
Good moral character.
Good family & social standing.
Recommendations from three different persons well known in the community.
Mary Johnston Hospital & School of Nursing (Manila, 1907)Funded by Methodist mission
The nurses training course began with three fil. young girls from elementary grade, which was
organized by Sr. Rebecca Parrish together with the registered nurses Rose Dudely & Gertrude
Dreisback.
It was burned down in 1945 & was reconstructed in 1947.
Mis Librada Javalera was the first fil. Director of the school.

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Philippine Christian Institute Schools of Nursing

The United Christian Missionary Society of Indianapolis, Indiana, a Protestant organization of the
Disciples of Christ, operated three schools of nursing:
Salle Long Road Memorial Hospital School of Nursing (Laog, Ilocos Norte, 1903)
Mary Chiles Hospital School of Nursing (1911)
Frank Dunn Memorial Hospital (Vigan, Ilocos Sur,1912
San Juan de Dios hospital School of Nursing ( Manila, 1913)
The school was opened through the initiative of Dr. Benito Valdez.
The school is run by the Daughters of Charity since then
Sister Taciana Trinanes was the first directress of the school.
Emmanuel Hospital School of Nursing (Capiz,1913)
The school offered a three year training course for an annual fee of P100.00.
Miss Ciara Pedrosa was the first filipino principal.
Southern Islands School of Nursing (cebu,1918)
Anastacia Giron-Tupas organized the school.
Visitacion Perez was the first principal.
Other schools of Nursing established:
Zamboanga General Hospital school of Nursing (1921)
Chinese General Hospital school of Nursing (1921)
Baguio General Hospital school of Nursing (1923)
Manila Sanitarium & Hospital school of Nursing (1930)
St. Pauls school of Nursing in Iloilo city(1945)

The first Colleges f Nursing in the Philippines

1.
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University of Santo Thomas college of Nursing (1945)

The college began as the UST School of Nursing Education on feb. 11,1941
Manila central University college of Nursing (1947)
University of the Philippines College of Nursing (1948) Julita Sotejo was the first dean

Nursing Leaders in the Philippines

1.
Anastacia Giron-Tupas- the first fil. Nurse to hold the position of Chief Nurse Suprintendent;
founder of PNA.
2.
Cesaria Tan. First fil. to receive a Mastrs degree in Nursing Abroad.
3.
Socorro Sirilan. Pioneered in Hospital Social Service in San Lazaro Hospital where she was the
Chief Nurse.
4.
Rosa Militar. A pioneer in school health Education.
5.
Sor Ricarda Mendoza. A pioneer in nursing education
6.
Socorro diaz. First editor of the PNA magazine called the Message.
7.
Conchita Ruiz. First full- time editor of the newly named PNA magazine the filipino Nurse
8.
Loreto Tupaz. Dean of the Philippine Nursing; Florence Nightingale of Iliolo

Far East
A. China:
Belief in spirits and demons
Practice of ancestor worship prohibiting dissection of human body
Materia Medica (Pharmacology) 52 volumes of Chinese Medicine
Huae To exponent of acupuncture
Emperor Shen Nung father of Chinese Medicine
Diagnosis was made on the basis of the Pulse Theory
Yang and Yin Theory established some scientific basis for disease
Yang (Male principle) positive, active, fiery and full of life
Yin (Female Principle) negative, cold, weak, dark, an lifeless
NURSING LEADERS:
1.
Annie Sand- Chief Nurse of the San Lazaro Hospital in Manila
2.
Loreta Tupaz- Dean of Philippine Nursing, Florence Nightingale of Iloilo
3.
Jovita Sotejo- Graduate of PGH 1929, elevated nursing education to its professional level
4.
Maria Tinawin- Chairman, Board of Examiner for Nurses
5.
Anastacia Giron- Tupas- Superintendent and Chief Nurse of PGH, founder of PNA
6.
Leah Samaco- Paquiz- Present PNA President
7.
Dean Carmelita Divinagracia- President ADPCN
8.
First BON that gave the first nurse exam- Dr Juan Cabarrus, Belen del Rosario, Anastacia GironTupas
.
The first Nursing Law Act No. 2808 .An act Regulating the Practice of Nursing Profession in the
Philippines Islands.
.
June 1919 nurses were registered without taking the examination.
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June 1920. the first Nursing Board Examination.
Definition:
Profession is an occupation or calling requiring advanced training and experience in some specific or
specialized body or knowledge which provides service to society in that special field.

Characteristics & Attributes of a Professional Person

Profession

A calling in which members profess to have acquired special knowledge, by training or experience or
both, so that they may guide, serve or advice others in that special field
1.
Is concerned with quality. He/she possesses competence to practice the profession in terms of
scientific knowledge, technological skills & desirable attitudes & values.
2.
Is self-directed, responsible & accountable for his/her actions.
3.
Is able to make independent & sound judgment including high moral judgment.
4.
Is dedicated to improvement of life.
5.
Is committed to the spirit of inquiry. Demonstrates zest for continued studies including research
which will steadily increase & improve knowledge, skills & attitude needed by the profession.
Nursing as a Profession
6.
Education. A profession requires an extended education of its members, as well as basic liberal
foundation.
7.
Theory. A profession has theoretical body of knowledge leading to defined skills, abilities & norms.
8.
Service. A profession provides basic service.
4.
Autonomy. Members of a profession have autonomy in decision making & in Practice.
5.
Code of Ethics. The profession as whole has a code of ethics for practice.
6.
Caring. The most unique characteristic of nursing as a profession is that, it is a CARING profession.

Flexners Criteria for a Profession compared with Nursing.

Patterns of Developing Profession

Nursing Profession

Profession are basically intellectual

Nurses are educated institution of higher learning &

function in a responsible & accountable manner. Critical
thinking is being emphasized to a great extent at all
levels of nursing function.

Profession are based on a specific body of

knowledge that can be learned.

Professions are practical as well as theoretical.

Professional work can be taught through

professional education
Professions have strong internal
organization.
Practitioners are guided by altruism.

Nursing has identified and continues to develop its own

specific body of knowledge from which nursing practice
emerges. Application of theory derived from research
provides the rationale for action.
Nursing professionals accept great responsibility for
providing for peoples healthcare needs. The profession
evolved in response to needs identified by society and is
guided by an ethical code.
Nurses are educated primarily in different types of
degree programs baccalaureate degree and advanced
nursing degree programs (Masters degree and
Doctorate
degree).
The Philippines
Nurses Association (PNA) and other
bodies provide internal organization
Many nurses enter the profession out of a desire to help
others.

Benners Stages of Nursing

Expertise

Stage I Novice
No experience
Performance is limited, inflexible, governed by context-free rules & regulations, rather than
experience.
Stage II Advanced Beginner
Demonstrates marginally acceptable performance.
Recognizes the meaningful aspects of real situation.
Has experienced enough real situation to make judgements about them.
Stage III-Competent
Has 2-3 years experience
Demonstrates organizational & planning abilities.
Differentiates important factors from less important aspects of care.
Stage IV-Proficient
Has 3-5 years experience
Perceives situation as whole rather than as parts.
Uses maxims as guides for what to consider in a situation.
Has holistic understanding of the client, which improves decision making.
Focuses on long term goals.
Stage V- Expert
Performance is flexible & highly proficient
No longer requires rules, guidelines or maxims to connect an understanding of the situation to
appropriate action.
Demonstrates highly skilled intuitive & analytic activity in new situations.
Is inclined to take certain action because it felt right.

Professional Nurse

Is one who has acquired the art and science of nursing through her basic education, who
interprets her role in nursing in terms of the social ends for it exists - the health and welfare
of society and who continues to add to her knowledge, skills, and attitudes through continuing
education and scientific inquiry (research) or the use of the results of such inquiry.
Professional Nurse is a person who has completed a basic nursing education program and is
licensed in his / her country or state to practice professional nursing.
Qualifications and Abilities of a Professional Nurse
Professional preparation:
1.
Have a license to practice nursing in the country
2.
A Bachelor of Science degree in Nursing
3.
Be physically and mentally fit
Personal Qualities and Professional Nurse
Professional proficiencies:
1. Interest and willingness to work and learn with individuals/groups in a variety of setting.
2. A warm personality and concern for people.
3. Resourcefulness and creativity as well as well-balanced emotional condition
4. Capacity and ability to work cooperatively with others.
5. Initiative to improve self and service.
6. Competence in performing work through the use of nursing process.
7. Skill in decision-making, communicating, and relating with others and being research oriented.
8. Active participation in issues confronting nurses and nursing.

Basic Educational Program in Nursing

Before 1983, Basic three-year hospital-based program leading to the title Graduate in Nursing
Until 1983, Only basic educational program in nursing ~ the four-year collegiate degree leading to
the Bachelor of Science in Nursing (BSN).

Council of Deans

Philippine Colleges of Nursing

Department of Education

Nursing Practitioners
1998-1999: Effective Enforcement of the common two- year Associate in Health Science Education
(AHSE).

The BSN intends to produce a professional nurse who demonstrates the ff. behaviours:
1.
Caring behaviours ( compassionate, committed, competent, & confident).
2.
Ability to practice legal, ethico-moral, social responsibilities & accountabilities.
3.
Critical & creative thinking
4.
Skills in practicing KSA for the promotion of health, prevention of illness, restoration of health,
alleviation of sufferings & assisting client to face death with dignity & in peace.
Professional Nursing
Is an art and a science, dominated by an ideal of service in which certain principles are applies in the
skillful care of the well and the ill, and through relationship with the client/patient, significant
others, and other members of the health team.
.The performance for salary or remuneration, of professional nursing service, particularly that of

diagnosing and treating human responses and potential health problems.

Types of Educational Program

1.

LPN/LVN Program

Lasts 9 or 12 months ( classroom & clinical practice.

A graduate takes the NCLEX-PN to obtain license.

Practice is under the supervision of an RN.

Provide basic technical care to client.

2.

Registered Nursing Program

Diploma Program patterned after Florence Nightingale.

3.
Associate Degree Program

First & only program for nursing that were systematically developed from planned research &
controlled experimentation.
4.
Baccalaureate Program

First school of nursing in a university setting.

2 years of liberal arts & basic 3 year diploma prog.

5.
Graduate Nursing Program
.
Masters Program-(1.5-2years) provides specialized knowledge & skills that enable nurses to assume
advanced roles in practice, education administration & research.
.
Doctoral Program (PhD, DNS) emphasis is on theory development; research.
Nursing Practice
.
Nurses practice in an ever- increasing variety of ways & setting.
.
The focus of all nursing practice is the client, who may be an individual, family. Group or community.
.
RA No. 9173- Philippine Nursing Act- an act providing for a more responsive nursing profession, repealing
for the purpose RA No.7164, otherwise known as the the Philippine Nursing Act of 1991.
The Recepients of nursing
1.
Consumer- people who use health care products or services are consumer of health.
2.
Patient- a person who is waiting for or undergoing medical treatment & care; traditionally we call them
patients when they seek assistance because of illness or for surgery.
3.
Client- a person who engages the advice or services of another who is qualified to provide care or to
provide this services.
.
Refers as the receivers of health care less as passive recepients & more as collaborators in the care,
that is a person who are responsible for their health.

Different Fields of Nursing

1.

2.
.
.

3.
.
4.
.
5.
.

6.
.
7.
.

Institutional Nursing- nursing in hospitals & related health facilities.

The nurse provides direct nursing care, using the nursing process & critical thinking skills.

The nurse participates in all phases of patient care of the acutely ill, the convalescing & the
ambulatory patient.
Community Health Nursing/Public Health Nursing.
Public Health Nursing- focus requires understanding the needs of a population, or a collection of
individuals who have in common one or more personal or environmental characteristics.
Community Health Nursing- is a nursing approach that merges knowledge from the public health
sciences with professional nursing theories to safeguard & improve the health of population in the
community.
School Health Nursing.
they are responsible for the schools activities in the areas of health service, health education
& environmental health & safety.
Occupational health Nursing/Industrial Nursing.
Provides & delivers health care services to workers. The practice focus on promotion, protection &
supervision of workers health within the context of safety & healthy work environment.
Private Duty Nursing.
Nurses in private practice, who undertakes to give a comprehensive nursing care to a client on oneto-one ratio. She/he is an independent contractor.

General Private Duty Nurse

Private Duty Especialist

Nursing Education.
Role can be developed in many settings including schools of nursing & hospital staff development
departments.
Military Nursing (The Nurse Corps)
Provides comprehensive & quality nursing care to all military personnel, dependents & authorized
relative.

Flight Nursing or Aero- Space Nursing. Responsible for patients, military or otherwise, who have
been evacuated from battle areas to the nearest installation for treatment.

8.
.

Clinic Nursing.
Requires that a nurse possesses general skills. The nurse acts as a receptionist, answers phone, does
the billing, takes x-rays, ECG, changes dressing & assist in physical examination.
9.
Advanced Nursing Practice.
.
The field of nursing synonymous with specialization. For example clinical nurse specialist or a nurse
specialist, nurse clinician or clinical specialist.
Expanded Nursing Roles
1.
Nurse Practitioner (NP)- has advanced education (at least MA) & is a graduate of nurse practitioner
program.
.
Nurse practitioner function with more independence & autonomy than other nurses.
.
They are highly skilled in performing nursing assessment, PE, counseling, teaching, & treating minor
health problems.
2.
Clinical Nurse Specialist (CNS). Has MA & may have advanced experience in specialized area of
practice (e.g.,Gerontology, Pediatric, Critical Care, Oncology0.
.
Clinical nurse specialists work in various settings, depending on their specialty.
.
Roles of clinical nurse specialists include clinician, educator,, manager, consultant & researcher.
3.
Nurse Midwife. Is educated in Nursing & midwifery & is licensed.
4.
Nurse Anaesthetist. Provides general anaesthesia for clients undergoing surgery, under the
supervision of a physician prepared in anaesthesiology.
.
Nurse anaesthetist are the RNs with advanced education in anaesthesiology.
5.
Nurse Researcher. Is responsible for the continued development & refinement of nursing knowledge
& practice through investigation of nursing problems.
6.
Other Opportunities
.
Immigration (USA, Canada )
.
Short Term Employment.
Nurses who work in Germany, Vienna, Saudi Arabia, & other middle East countries are not required
to take the board exam.
.
Entrepreneurship.
Day Care
Special school

Geriatric Care

Roles & Functions of a Professional Nurse

1.
.
.
2.
.
.
3.
4.
.
.
.
5.
6.
.
7.
8.
9.

Care Provider. Referred as the mothering actions in nursing.

The nurse supports the client by attitudes & actions that show concern for client welfare & acceptance
of the client as a person.
The nurse s primarily concerned with the clients needs.
Communicator. Effective communication is an essential element of all helping profession.
Communication shapes relationships between nurses & clients.
The nurse communicates with clients, supports person & colleagues to facilitate all nursing actions.
Teacher. The nurse provides health teaching to effect behaviour change which focuses on acquiring
new knowledge or technical skills.
Counselor.
Counselling is the process of helping a client to recognize & cope with stressful psychologic or social
problems, to develop improve interpersonal relationships & to promote personal growth.
This role includes providing emotional, intellectual & psychologic support.
Counselling is done to help client increase their coping skills.
Client Advocate- the nurse promotes what is best for the client, ensures that clients needs are met,
protects the clients right.
Change agent. The nurse initiates changes & assists the client make modifications in the lifestyle to
promote health.
This involves the use of nursing process, & will help the client to propose, implement & maintain
change that promote the clients change.
Leader. The nurse through the process of interpersonal influence helps the client make decision in
establishing & achieving goals to improve his well being.
Manager. The nurse plans, gives direction, develop, staff, monitors operations, gives rewards fairly, &
represents both staff members & administration as needed.
Team member/collaborator. A vital role of a nurse. The nurse works in a combined effort with all those
involved in care delivery.

10.
11.
12.

Researcher. The nurse participates in scientific investigation & uses research findings in practice.
Case Manager. The nurse coordinates the activities of other members of the health team, such as
nutritionists & physical therapist, when managing a group of client.
Resource Person. The nurse function as a resource person by providing skilled intervention, &
information.

Ethico-Moral-Legal Responsibilities in Nursing

. Safe & compassionate nursing practice includes an understanding of the ethico-moral &
legal boundaries within which nurses must function.
. To be able to determine what is good or valuable for all people & to judge what is right &
wrong.
. The nurse must understand the law to protect themselves from liability & to protect
their clients right.
. Ethics a branch of philosophy that examines differences between right & wrong.
(study of morality).
. Refers to expected standards of behaviour of a particular group.(professional ethics).
. It came from the Greek word ethos which means moral duty.
. Morals- are specific ways of behaviour or of accomplishing ethical practices.
. Morality derived from the Greek word moralis which refers to social consensus about
moral conduct for human beings & society.
.

.
.

Ethical problems are created as a result of;

Changes in the society
Advances in technology
Conflicts within the nurses role itself
Nurses conflicting loyalties & obligation.
As technology, has expanded the role of the nurse, the ethical dilemmas associated with the client care
have increased & often become legal issues as well.
Nurses familiarity with ethico-moral-legal implications of nursing enhances their ability to be client
advocate.


1.
.
2.
.
.

3.
.
4.
5.
6.
.
.

1.

Nurses Ethical Decision are influenced by:

Role perception & responsibilities. Nurses are responsible for determining their own action & for
supporting clients who are making ethical decision.
What is a good decision?
Moral theories.
Teleology- looks to the consequences of an action in judging whether the action is right or wrong.
Deontology or duty oriented theory.
Ethical theory that considers the intrinsic significance of the act itself as criterion for determination
of right or wrong.
The morality of a decision is not determine by its consequences.
Moral Principles.
can be used as guidelines in analyzing dilemmas, they can also serve as justification for the resolution
of ethical problems.
Nursing Code of Ethics. A formal statement of a groups ideals & values.
Provide direction for nurses to act morally.
Cognitive Moral Development- ethics problems requires nurses to think & reason in making decisions,
judgment & choices.
Values, Beliefs, & Attitudes. Nurses should be aware of their values.
Moral Principles
When a nurse is confronted with situations where moral judgment is necessary, the nurse may be guided
by the following principles or rules:
The Golden Rule - Do unto others what you would like others do unto you. Since nurses like others to
treat them kindly and with respect, they should be willing to do same to others too.

That the action must be morally good

That the good effect must be willed and the bad effect merely allowed
That the good effect must not come from an evil action but from the initial action itself
directly
That the good effect must be greater than the bad effect.
Examples:
It is not morally good if a boy steals in order to alleviate his hunger because the action
itself is already bad.
If the patient who has a cancer of the uterus submits to hysterectomy she will not be able
to bear a child. If she does not have the operation, she will die. It is the gynecologists intention to
help the mother and not to harm her. The surgeons action is morally good since saving the
mothers life is of primary importance. Also the doctor himself did not will that the patient lose her
child-bearing function.
Examples:
It is not morally good if a boy steals in order to alleviate his hunger because the action
itself is already bad.
If the patient who has a cancer of the uterus submits to hysterectomy she will not be able
to bear a child. If she does not have the operation, she will die. It is the gynecologists intention to
help the mother and not to harm her. The surgeons action is morally good since saving the
mothers life is of primary importance. Also the doctor himself did not will that the patient lose her
child-bearing function.
One who acts through an agent is himself responsible
Example: A patient wants to have an abortion and asks a nurse if she can do it. The nurse refuses,
but recommends a doctor who is capable of performing. The nurse is liable to such crime, since he /
she is an accomplice of the said doctor.
5. No one is obliged to betray himself / herself. In testifying before the court, no one can
force any person to answer a question if such will incriminate him / her.
6. The end does not justify the means. Example: Giving sleeping tablet to a chronically ill
person so she / he can die in peace is morally wrong.

7. Defects of nature may be corrected.- Example: Patient with a Harelip or cleft palate may have their
defects corrected by plastic surgery.
8. If one is willing to cooperate in the act, no injustice is done to him / her. - Example: A patient
subjects himself / herself willingly to an experimental drug and she / he has been told of the possible effects
of the same, is of right age, and is sane, there is no violation of human rights.
9. A little more or less does not change the substance of an act.
Example: If a nurse gets medicine from the hospital stock without permission or without prescription, he /
she will be guilty of theft even if he / she got only one tablet of the same.

10. The greatest good for the greatest

number.
Example: During an epidemic, immunization
against communicable diseases is administered
to the people. If there may be some who may
have slight reactions to the vaccine, the greater
majority of the population shall be considered
rather than the isolated few.
11. No one is held to the impossible.
Example: To promise that a patient with heart
transplant will live may be impossible. Yet, such
procedures are done in the hope of saving or
prolonging a patients life. The doctor or the
nurse cannot be held to the impossible if they
have done their best to take care of the patient
and the latter dies.

12. The morality of cooperation. Formal

cooperation in an evil act is never allowed.
Immoral operations such as abortion shall not
be participated upon by a nurse even if the
doctor commands it.
13. Principle relating to the origin and
destruction of life. One of GODs
commandments is Thou shall not kill.

Ethical Principles
1. Autonomy
Self- governing
An individual has the right to make
decisions and take independent
actions without external control.

Based on the belief that a person has

unconditional value and has the
capacity to determine own destiny

Examples
Consent on all treatments
Knowing policies on advance
directives like DNR
Privileged Communication
Physical privacy

Persons who lack capacity to

be autonomous
Infants
Irrationally suicidal individuals
Drug-dependent individuals

2. Beneficence
Do good. The duty to do good to
others and maintain balance between
benefits and harms
One person takes action for the
good of another person.
Act in ways that benefit others

Examples
Providing ALL patients including terminally
ill patients with EQUAL CARING attention
Organ donations
Treating every patient with respect and
courtesy
Obligation to help others further their
legitimate and important interests
Contribute to the well being of another

3. Nonmaleficence
Do no harm
Do not commit acts that cause
deliberate harm Ex. Experimental
research
Avoid harm as a consequence of
doing good Ex. Immunization of
infants

Examples
Working within the scope of nursing
practice
Observing safety rules and
precautions
Perform procedures according to
protocols. Never do shortcuts!
Ask appropriate person if in doubt or
unsure
Continuing Professional Update

4. Veracity
*Obligation to tell the truth
*Not to lie or deceive others
essential to the integrity of the
client-provider relationship.

Examples
Admit mistakes promptly. Offer to do
whatever is necessary to correct
them
Refusal to participate in any fraud
Give an honest day work every day

5. Confidentiality
Non- disclosure of private or secret
information
with
which
one
is
entrusted.
Requires that information about client
be
kept
private
unless
client
consented.

6. Justice
Fair, equitable and appropriate treatment
To each equally
To each according to need
To each according to merit
To each according to social contribution
To each according to the persons rights
To each according to individual effort
To each as you would be done by
To each according to the greatest good
to the greatest number

7. Fidelity

Concept of faithfulness and the

practice of keeping promises
Upholding the professions code of ethics
Practice within the scope of nursing
Examples:
a. Contracts
b. loyalty within the nurse- patient
relationship

Patients Bill of Rights:

1.The patient has the right to considerate
and respectful care.
2.Except in emergencies when the patient
lacks decision-making capacity and the
need for treatment is urgent, the patient is
entitled to the opportunity to discuss and
request information related to the specific
procedures and / or treatments, the crisis
involved,
the
possible
length
of
recuperation, and the medically reasonable
alternatives and their accompanying risks

3. The patient has the right to make

decisions about the plan of care prior to
and during the course of treatment and to
refuse a recommended treatment or plan
of care to the extent permitted by law and
hospital policy and to be informed of the
medical consequences of this action.
4.The patient has the right to have an
advance directive (such as a living will,
health care) concerning treatment or
designating a surrogate decision maker
with the expectation that the hospital will
honor the intent of that directive to the
extent permitted by law and hospital
policy.

4. The patient has the right to every

consideration of his privacy.

5. The patient has the right to expect that
all
communications
and
records
pertaining to his / her care should be
treated as confidential by the hospital.
6. The patient has the right to review the
records pertaining to his / her medical
care and to have the information
explained or interpreted as necessary
except when restricted by law.

7. The patient has the right to expect

that, within its capacity and policies, a
hospital will make reasonable response
to the request of a patient for
appropriate and medically indicated
care and services.
8. The patient has the right to ask and
be informed existence of business
relationships
among
the
hospital,
educational institutions, other health
care providers, or players that may
influence the patients treatment and

9. The patient has the right to consent to

or decline to participate in proposed
research
studies
or
human
experimentation affecting his care and
treatment or requiring direct patient
involvement, and to have those studies
fully explained prior to consent.
10. The patient has the right to expect
reasonable continuity of care when
appropriate and to be informed by
physicians and caregivers of available and
realistic patient care options when hospital
care is no longer appropriate.

11. The patient

be informed of
and practices
patient care,
responsibilities.

has the right to

hospital policies
that relate to
treatment, and

Scope of Nursing Practice

The Phil. Nursing Act of 1991 (R.A.
7164) has been repealed by the Phil.
Nursing Act of 2002 (R.A. 9173)

Section 28. scope of Nursing

Practice
A person shall be deemed to be practicing nursing
within the meaning of this act, when he/she singly
or in collaboration with another, initiates &
performs nursing services to individuals, families,
communities in any health care setting.
It includes but not limited to, nursing care during
conception, labour, delivery, infancy, childhood,
toddler, pre-school, school age, adolescence,
adulthood and old age.

 As independent practitioners,
nurses are primarily responsible for
the promotion of health and
prevention of illness.
As members of the health team,
nurses shall collaborate with other
health care providers for the
curative, preventive and
rehabilitative aspects of care,
restoration of health, alleviation of
suffering, and when recovery is not
possible, towards a peaceful death.

 It shall be the duty of the nurse to:

Provide nursing care through the
utilization of the nursing process. Nursing
care includes, but is not limited to,
traditional and innovative approaches,
therapeutic of use of self, executing
health care techniques and procedures ,
essential primary health care, comfort
measures, health teachings, and
administration of written prescription for
treatment, therapies, oral, topical and
parenteral medications, internal
examination during labour in the absence
of antenatal bleeding and delivery, In
case of suturing of perineal
laceration, special training shall be
provided according to protocol

 Establish linkages with community

resources and coordination with the
health team;
Provide health education to
individuals, families and communities;
Teach, guide and supervise students
in nursing education programs
including the administration of
nursing services in varies settings
such as hospitals and clinics;
undertake consultation services;
engage in such activities that require
the utilization of knowledge and
decision-making skills of a registered

 Undertake nursing and health human

resource development training and
research, which shall include, but not
limited to, the development of
advanced nursing practice

Provided, that this section shall not

apply to nursing students who
perform nursing functions under
the direct supervision of a qualified
faculty:

 Provided further, that in practice of

nursing in all setting, the nurse is
duty-bound to observe the Code
of Ethics for nurses and uphold
the standards of safe nursing
practice. The nurse is required to
maintain competence by continual
learning through continuing
professional education to be
provided by the accredited
professional organization or any
recognized professional nursing
organization:

 Provided finally, that the program

and activity for the continuing
professional education shall be
submitted to and approved by the
board.

Legal Roles of Nurses

1. Provider of Service. The rights &
responsibilities of the nurse in the role
of a citizen are the same as those
individual under the legal system.
2. Liability. Is the quality or state of
being legally responsible for ones
obligations & actions & to make
financial restitution for wrongful acts.
3. Standards of Care. It is by which a
nurse acts or fails to act are legally

nurse practice acts & by rule &

reasonable prudent professional with
similar preparation & experience
would do in similar circumstances.
4. Employee or Contractor for Service. A
nurse who is employed by a hospital
work as an agent of the hospital &
the nurses contract with the clients is
an implied one.
5. Contractual Relationships.
Independent Nurse Practitioner
Nurse Employed by a Hospital

 The nurse represents & acts for hospital &

therefore must function within the policies
of the agency.

6. Citizen. The rights & responsibilities of

the nurse in the role of a citizen are
the same as those individual under
the legal system.

Documentation -as written

evidence of:
The interaction between & among
health professionals, clients, their
families & health care organization.
The administration of tests procedures,
treatments & client education.
The result or clients response to these
diagnostic tests & interventions.
Documentation provides a written
records that reflect client care
provided on the

basis of assessment data & the clients

response to interventions.
Reporting & recording are the major
communication techniques used by
health care provider.
The medical record serve as a legal
document for recording all clients
activities assessed & initiated by health
care provider.

Purposes of documentation
or Client Record
1. Communication- the record serve as
the vehicle by which health
professionals who interact with a
client communicate with each other.
2. Legal documentation. In the cases of
law suit the record serve as the
description of what exactly happen to
a client.
3. Research. The information contained
in a record can be valuable source of

4. Education. Students In health

disciplines often use client records as
educational tools, a record can
frequently provide a comprehensive
view of the client, illness &
treatments.
5. Quality assurance Monitoring. Use to
monitor the care the client is receiving
& the competence of the people
giving the care

6. Statistics- Statistical information from

client records can help an agency
anticipate & plan for future needs.
7. Accrediting & licensing. JCAHO, Phil.
Health
8. Reimbursement. Helps facility receives
reimbursement or received or
obtained payment from Phil. Health.

Incident Report
An agency record of any accident or
incident.
The report should be completed as
soon as possible always within 24
hours.
The IR is not part of the clients record,
but the facts of the incident should be
noted in the medical record.
When an accident occurs the nurse
should assist first the client.

 Information to include in an IR:

Identify client with the hospital number.
Date, time, & place of the incident.
Describe the facts of the incident. Avoid
any conclusion or blame.
Identify all the witnesses to the incident.
Identify any equipment or medication.
Document any circumstances surrounding
the incident.

II. Nursing as a Science

Definition of terms
Concept- the building blocks of
theory.
Abstract ideas or mental images of
phenomena or reality.(abstract or
concrete ideas)
Concepts helps us to name things &
occurrences in the world around us &
assist us in communicating with each
other about the world.

 Conceptual framework- is a group of

related concepts. It provides overall
view or orientation to focus our
thoughts.
Can be visualized as an umbrella under
which many theories can exist.
Is a structure that links global concepts
together & represents a unified whole
of a larger reality.
The concepts in a conceptual
framework are linked together to form
proposition.

 Proposition- is a statement that

expresses the relationship between
concepts & is capable of being tested,
believed or denied.
E.g., People & their Environment are
open System.
Theory- is a set of concepts &
propositions that provide an orderly
way to view phenomena.
a supposition or system of ideas that is
proposed to explain a given
phenomenon.

 Purpose of a Theory: is to guide

research to enhance the science by
supporting existing knowledge or
generating new knowledge.
Nursing Theory (purposes)
1. To provide direction & guidelines for
structuring, a) professional nursing
practice b) education c) research.
2. Differentiating the focus of nursing
from other professions.

 In Practice
Assist nurses to describe, explain &
predict everyday experiences.
Serve to guide assessment,
intervention, evaluation of nursing
care.
Provide a rationale for collecting
reliable & valid data about the health
status of clients, which are essential for
effective decision making &
implementation.
Help to establish criteria to measure

 Help build a common nursing

terminology to use in communicating
with other health professionals. Ideas
are developed & words defined.
Enhance autonomy of nursing through
defining its own independent function.
In Education
Provide a general focus for curriculum
design.
Guide curricular decision making.

 In Research
Offer a framework for generating
knowledge & new ideas.
Assist in discovering knowledge gaps in
the specific field of study.
Offer a systematic approach to identify
questions for study, select variables,
interpret findings, & validate nursing
intervention.

General Nursing Theories

1. Florence Nightingales
Environmental Theory (1859)
. The first theory of Nursing. Notes on
Nursing: What it is, what it is not.
. She focused on changing, &
manipulating the environment in
order to put patient in the best
possible conditions for nature to act.
. She believed that nurturing the
environment, the body could repair

 She linked health with 5 environmental

factors; 1) Pure fresh air 2) pure water
3) efficient drainage 4) cleanliness 5)
light especially direct sunlight.
Deficiency in these five factors produce
lack of illness or illness.
Her general concept about ventilation,
cleanliness, quiet, warmth, & diet
remain integral parts of nursing &
health care today.

2. Virginia Henderson: Definition of

Nursing (1955)
. She postulated that the unique
function of the nurse is to assist the
client sick or well, in the performance
of those activities contributing to
health or its recovery, that client will
perform unaided if they have the
necessary strength, will or knowledge,
. She further believed that nursing
involves assisting the client, in
gaining independence as rapidly as
possible,

or assisting him achieve peaceful death

if recovery is no longer possible.
3. Martha Rogers: Science of Unitary
Human Beings. ( 1970)
. Rogers views the person as an
irreducible whole, the whole being
greater than the parts. The distinctive
properties of the whole are
significantly different from its part
. Unitary man is an energy field in
constant interaction with the
environment

 She believed that human being is

characterized by the capacity for
abstraction & imagery language &
thought, sensation & emotion.
E.g., Therapeutic touch- process by
which energy is transmitted or
transferred from one person to another
with the intent of potentiating the
feeling of healing process of who is ill
or injured.

4. Dorothea Orem: Self care and Self

care Deficit Theory (1971)
. She defined self care as the practice
of activities that individuals initiate &
perform on their own behalf in
maintaining life, health & well being.
. According to this theory self care is a
learned behaviour & a deliberate
action in response to a need

 She identified 3 kinds of self care

requisites:
1. Universal requisites- common to all
people, include the maintenance of
air, water, food, elimination, activity &
rest, solitude & social interaction,&
the promotion of human functioning
both physiological & social interaction
needs.
2. Developmental requisites -are the
needs that arise as the individual
grows & develop.

the needs produced by disease or

illness states. It impairs the individual
to perform self care.
Theory of Self Care deficit.
This theory purports (claims) that nursing
care is needed when people are affected
by the limitation that do not allow them to
met their self care needs.
The relationship between the nurse &
client is established when a self care
deficit is present.
It also determines the need for nursing
care.

Nursing System Theory

Attempts to answer the question What
do nurses do?
Three types of Nursing Systems
1. Wholly compensatory system: when
the nurse is expected to accomplish
all the patients self care or to
compensate for the clients inability to
care for self or when the client needs
continuous guidance in self care.

2. Partially compensatory: are designed

for individuals who are unable to
perform some ( but not all) self care
activities.
. Both nurse & client engage in meeting
self care needs.
3. Supportive Educative
(developmental): the that requires
assistance in decision making
behaviour control & acquisition of
knowledge & skills.

System Theories
1. Sister Callista Roy: Adaptation
Model (1979,1984)
. Widely used by nurse educator,
researchers, & practitioners.
. She viewed each person as a unified
biopsychosocial adaptive system in
constant interaction with the
changing environment.

 She viewed that the nurse must first

assess how the client behaves in each
adaptive mode & then determine what
can be altered in that mode to produce
more efficient & effective responses.
Four adaptive Modes:
1. Physiologic mode- involves the bodys
basic physiologic needs & ways of
adapting in regard to fluid &
electrolytes, activity & rest, circulation
& oxygen etc. e.g., caring for a patient
with fever.

2. Self Concept Mode- includes two

components; the physical self,
( sensation & body image) & the
personal self ( whish involves of self
ideal, self consistency & moral ethical
self. E.g., patient who will undergo
surgery & caring for an obese client.
3. The role function mode- is determine
by the need for social integrity &
refers to the performance of duties
based on given positions within
society.

4. The interdependence mode- involves

ones relation with significant others &
support system that provide help,
affection & attention. E.g., a grieving
widow.
5. Imogene King: theory of goal
Attainment (1971)
. Derived from a conceptual framework
of 3 dynamic interacting systems:
1. Personal system- perception, self,
body image,, growth & development,
space & time.

2. Interpersonal system- interaction,

communication, transaction, roles &
stress.
3. Social system- organization, authority
power, status, & decision making.
. To identify problems & establish goals
the nurse & client perceive one
another, act & react, interact &
transact.

3. Betty Neuman: Health care

system Model. (1972)
. Based on the individuals relationship
to stress, the reaction to it &
reconstitution (state of adaptation to
stressors) .
. She viewed the client as an open
system consisting of a basic structure
or central core of energy resources
( physiologic, psychologic, sociocultural, developmental & spiritual)
surrounded by two cocentric

 The two lines of resistance represent

internal factors that help the client
depend against on stressors.
The inner or normal lines of defense
represents the persons state of
equilibrium, or the state of adaptation
developed & maintained overtime &
considered normal for that person.
The flexible lines of defense is dynamic
& can be rapidly altered over a short
period of time. It is a protective buffer
that prevents

stressors from penetrating the normal

lines of defence.
The concern of nursing is to prevent
stress invasion, to protect the clients
basic structure & to obtain or maintain
a maximum level of wellness.
Nursing actions are carried out on the
three preventive levels:
1. Primary prevention- identify risk
factors, attempt to eliminate the
stressors & focuses on protecting the
first line of defense strengthening the
first line of

defense.
2. Secondary prevention- relate to
intervention or active treatment
initiated after symptoms have
occurred.
. The focus is to strengthen the internal
lines of resistance, reduce the
reaction & increase resistance factors.
3. Tertiary prevention- refers to
interventions following that in the
secondary level.
. It focuses on readaptation & stability

protects reconstitution or return to

wellness following treatment.
The nurse emphasizes educating the
client in strengthening resistance to
stressors & ways to help prevent
recurrence of reaction or regression.
4. Dorothy Johnson: Behavioural
System Model (1960)
. She used her observation of
behaviour over many years to
formulate this theory.

 Described the individual as a

behavioural system composed of seven
sub-systems:
1. Attachment- Affiliative subsystem
security seeking behaviour, provides
survival & security.
. Its consequences are social inclusion,
intimacy, & the formation &
maintenance of a strong social bond.
2. Dependency subsystem- promotes
helping behaviour that calls for a
nurturing response.

 Its consequences are approval,

attention or recognition & physical
assistance.
3. The Ingestive subsystem- satisfies
appetite. It governed by social &
psychologic consideration as well as
biologic.
4. The Eliminative subsystem- ridding
the body waste in socially & culturally
acceptable ways.

5. The Sexual subsystem- dually for

procreation & gratification
6. The Achievement subsystem-attempts
to manipulate the environment.
. It controls or masters an aspect of the
self or environment to some standard
of excellence.
7. The Aggressive subsystem- protects &
preserves the self & society & within
the limits imposed by society.

 Each of the above subsystem has the

same functional requirements;
protection, nurturance, &
stimulation.
The subsystem responses are
developed through motivation,
experience & learning & are
influenced by biopsychosocial factors.

Interpersonal/Caring
Theories
1. Hildegard Peplau: Interpersonal
Model / Psychodynamic Nursing
Theory (1952 )
. Psychodynamic Nursing- is defined as
understanding ones own behaviour to
help others identify felt difficulties &
applying principles of human relations
to problem arising during the
experience.
. She defined nursing as an

an individual who is sick & in need of

health services & a nurse especially
educated to recognize & respond to the
need for help.
She identified four phases of nursepatient relationship namely:
1. Orientation: The nurse & client initially
do not know each other. The patient
seeks help, & the nurse assists the
patient to understand the problem &
the extent of need for help.

2. Identification: during this phase, the

patient assumes a posture of
dependence, interdependence in
relation to the nurse.
. The nurses focus to assure the
person that the nurse understands,
the interpersonal meaning of the
patient situation.
3. Exploitation: in this phase the patient
derives full value from what the nurse
offers through the relationship.
. The patient utilizes all available

to move toward a goal of maximum

health or functionality.
4. Resolution: refers to the termination
phase of the nurse-patient
relationship. It occurs when the
patients needs are met, & client can
move toward new goal.
. Peplau further assumed that that the
nurse-patient relationship fosters
growth for both the nurse & client.

2. Jean Watson: Philosophy &

Science of Caring (1979 ).
. She believes that the practice of
caring is central to nursing & it is the
unifying focus for practice.
. Her theory is composed of ten (10)
carative factors which are classified as
nursing actions or caring process.
1. Forming a humanistic-altruistic system
of values.

 This factor relates to satisfaction

through giving & extending of the
sense of self.
Although the values are learned early
in life, but they can greatly influenced
by education.
2. Instilling Faith & Hope.
. Feeling of faith & hope promote
wellness by helping client adopt
health seeking behaviours.

3. Cultivating sensitivity to ones self &

others.
. Nurses who are able to recognize &
express their feelings are better able
to allow others to express theirs.
4. Developing a helping trust (human
care) relationship.
. This kind of relationship involves
effective communication, empathy &
non possesive warmth.
. It promotes & accepts the expression
of positive, & negative feelings.

5. Expressing positive & negative

feelings.
. Sharing feelings of sorrow, love & pain
is risk taking experience. The nurse
must be prepared for negative feeling.
6. Using a creative problem-solving
approach or caring process.
7. Promoting transpersonal teaching
learning.
. This factor separate caring from
curing & shifts responsibility for
wellness to the client.

8. Providing a supportive, protective or

corrective mental, physical, sociocultural, & spiritual environment.
. The nurse must asses & facilitate the
clients abilities to cope with mental,
emotional & physical changes.
9. Assisting with gratification of human
needs.
. Recognizing & attending to the
physical, emotional, social, & spiritual
needs of the client.

10.Being sensitive to existential

phenomenologic- spiritual forces.
. Existential psychology is a science of
human existence that employs the
method of phenomenologic analysis.
. Person possesses three spheres of
being: mind , body, & soul.
. Allowing for expression of these forces
leads to better understanding of self &
others.

3. Madeleine Leininger:
Transcultural Care Theory (1978)
. The goal of transcultural nursing is to
develop a scientific & humanistic body
of knowledge in order to provideculture specific & culture-universal
nursing practices.
. She believes culture is the broadest &
the most holistic means to
conceptualize, understand & be
effective with people.
. there can be no cure without caring

 Faye Abdellah (1960): PatientCentered Approaches to Nursing

Model.
She defined nursing as service to
individuals & families; therefore to
society.
She conceptualized nursing as an art
& a science that molds the attitudes,
intellectual competencies & technical
skills of the individual nurse into the
desire & ability to help people, sick or
well, & cope with their health needs.

III.

Nursing as an Art

Caring Theories
Peplaus Interpersonal Nursing Theory
Watsons Philosophy & science of
Caring
Leinnengers Transcultural Nursing
Theory

Therapeutic Use of Self

A process in which nurses deliberately
plan their actions & approach the
relationship with a specific goal in
mind before interacting with the client.
The most effective tool for
demonstrating caring is not some
technologically sophisticated machines
with lights & alarms but rather oneself.

 Therapeutic use of self makes the art

of nursing as different from science of
nursing.
This is an oppurtunity of the nurse to
be with the person at a human to
human level.
Characteristics of therapeutic
Relationship
1. Warmth- exhibiting positive behaviour
toward a client. Respect, genuine
interest, caring are all expression of
warmth.

helping clients look realistically at their

potentials.
Hope is the energy source that allows
individuals to plan, act & achieve.
2. Rapport- is a bond or connection
between people that is based on
mutual trust.
3. Trust- must be present for help to be
given & received. ( consistency,
respect, honesty are essential in the
development of trust.)

5. Empathy understanding another

perception of the situation.
6. Acceptance- accepting client as a
person & working with clients even
those clients who exhibit undesirable
behaviours.
7. Active Listening- is required in every
nurse-client relationship.
8. Humor- can assist in establishing a
relationship because it helps break
the ice, decreases fear, & establish
trust, & can help strengthen

9. compassion- you care what happen to

another person.
. Kindness & genuine concern are
demonstrated through compassionate
acts.
10.Self Awareness- necessary to be
therapeutic.
. Being aware of ones feeling is the
first step in developing therapeutic
behaviour.
. Self-awareness allow the nurse to
remain objective, that is separate

11.Non-judgmental approach- acting

without biases, pre conceptions or
stereotypes.
12.Flexibility- a flexible nurse is one who
is ready for the unexpected.
13.Risk taking- the nurse must give
themselves permission to try
something new, to step outside the
ordinary & not to be bound by
tradition or fear.

Phases of Nurse- Client

Relationship
1. Orientation phase:
. Introductory phase, it sets the tone
for the rest of the relationship.
. Getting to know each other &
developing a degree of trust.
. Client may display some resistance
behaviour- inhibit involvement.
. Assessment of client is the most
important goal .

2. Working Phase:
. The nurse & client begin to view each
other as unique individuals.
. They begin to appreciate this
uniqueness & begin to care about
each other.
. Behaviours that indicate the client is
in the working phase; asking
questions about own problem,
seeking clarification from the nurse,
being attentive to instructions, asking
for more information about his role in

3. Termination Phase- is often difficult &

filled with ambivalence.
. It focuses in evaluation of goal
achievement & effectiveness of
treatment.
. Many methods can be used to
terminate relationships;
Summarizing or reviewing the process
can produce a sense of accomplishment.
Planning for termination is actually
initiated during the beginning of the
relationship.

Thank You