Fundamentals of Nursing Practice

NCM 100 FUNDAMENTALS OF
NURSING PRACTICE
P R E PA R E D B Y: L E N D E L L K E L LY B . Y TA C , R N
LEARNING OBJECTIVES
1 Define health and wellness.
2 Describe factors causing significant changes in the health care
delivery system and their impact on health care and the nursing
profession.
3 Describe the practitioner, leadership, and research roles of
nurses.
4 Describe nursing care delivery models.
5 Discuss expanded nursing roles.
WHAT IS NURSING?
• “to put the patient in the best condition for nature to act upon
him,”(Florence Nightingale,1858).
• nursing leaders have described nursing as both an art and a
science.
• nursing as the diagnosis and treatment of human responses to
health and illness (ANA Social Policy Statement, 2003).
FOCUS OF NURSING CARE AND RESEARCH
• Self-care processes
• Physiologic and pathophysiologic processes such as
• rest, sleep, respiration, circulation, reproduction, activity,
nutrition, elimination, skin, sexuality, and communication
• Comfort, pain, and discomfort
• Emotions related to health and illness
• Meanings ascribed to health and illnesses
• Decision making and ability to make choices
FOCUS OF NURSING CARE AND RESEARCH
• Perceptual orientations such as self-image and control over

one’s body and environments
• Transitions across the lifespan, such as birth, growth,
development, and death
• Affiliative relationships, including freedom from oppression
and abuse
• Environmental systems
RESPONSIBILITIES OF A NURSE
• Nurses have a responsibility to carry out their role as described
in the Social Policy Statement to comply with the nurse
practice act of the state in which they practice, and to comply
with the Code of Ethics for Nurses as spelled out by the ANA
(2001) and the International Council of Nurses (ICN, 2006).
THE PATIENT/CLIENT
• Patient-which is derived from a Latin verb meaning “to
suffer,” has traditionally been used to describe a person who is
a recipient of care. Connotes dependence.
• Client-which is derived from a Latin verb meaning “to lean,”
connoting alliance and interdependence.
THE PATIENT NEEDS
• Maslow’s Hierarchy of Needs
• Maslow ranked human needs as follows: physiologic needs; safety and
security; sense of belonging and affection; esteem and self-respect; and
self-actualization, which includes self fulfillment, desire to know and
understand, and aesthetic needs.
• Lower-level needs always remain, but a person’s ability to pursue higher-
level needs indicates movement toward psychological health and well-
being.
• Such a hierarchy of needs is a useful framework that can be applied to the
various nursing models for assessment of a patient’s strengths, limitations,
and need for nursing interventions.
MASLOW’S HIERARCHY OF NEEDS
HEALTH, WELLNESS AND HEALTH PROMOTION
• Health- “state of complete physical, mental, and social well-

being and not merely the absence of disease and infirmity”
(WHO, 2006 pg. 1).
• Wellness-Wellness- is Considered a conscious, sefl-directed
and evolving process of achieving full potential.
-is multidimensional and holistic, encompassing
lifestyle, mental and spiritual well-being, and the environment.
HEALTH VS. WELLNESS
• Health- is a state of being
• Wellness- is a state of living a healthy lifestyle.
COMPONENTS OF WELLNESS
1. The capacity to perform to the best of one’s ability.
2. The ability to adjust and adapt to varying situations.
3. A reported feeling of well-being
4. A feeling that “everything is together” and harmonious.
COMPONENTS OF HEALTH
• Social Health-refers to the ability or interact with people and
the environment with and having satisfying interpersonal
relationships.
• Mental Health- the ability to learn; one’s intellectual
capabilities.
• Emotional Health- ability to control emotions so that one
feels comfortable expressing them appropriate and does
express them appropriately.
COMPONENTS OF HEALTH
• Spiritual Health- refers to the belief in some unifying force.
For some people that will be nature, scientific laws, godlike
force.
• Physical Health- It refers to the ability to perform daily task
without undue fatigue; biological integrity of the individual.
MODELS OF HEALTH
LEAVELLAND CLARK’S AGENT-HOST-
ENVIRONMENTAL MODEL
• State that there are three interactive factors that affect health
and illness
• Agent
• Host
• Environment
MODELS OF HEALTH
LEAVELLAND CLARK’S AGENT-HOST-

ENVIRONMENTAL MODEL
• Agent-any factor or stressor that can cause or lead to illness
• Host- person who may or may not be risk of acquiring the
disease
• Environment- any factor external to the host that may or may
not predispose to the development of the disease.
COMMON CAUSE OF DISEASE
• Biologic agents (Microorganisms)
• Inherited genetic defects (hemophilia, Cancer, Hypertension)
• Developmental defects (imperforated anus)
• Physical agents (hot and cold substance)
• Chemical agents ( emissions from smoke)
• Tissue response to injury (inflammation)
COMMON CAUSE OF DISEASE
• Faulty chemical/metabolic process (inadequate iodine
intake- goiter)
• Emotional/physical reaction to stress (anxiety)
THE HEALTH-ILLNESS CONTINUUM
• Continuum- is a grid or graduated scale. The health grid
shows where a health axis and an environmental axis intersect.
The resulting quadrants represent degrees of health and
wellness.
• Health and illness- conceptualized along separate but
coexisting continuum.
MAGNIFICATION OF DOTS ON THE CONTINUUM
Physical
Health
Spiritual TOTAL Mental

Health HEALTH Health
Social
Health Emotional
Health
STAGES OF ILLNESSS
1. Symptoms Experience- Person come to believe something is
wrong
-Physical-experience of symptoms
-Cognitive- the interpretation of the symptoms in terms that
have some meaning to the person.
-Emotional- fear and anxiety
STAGES OF ILLNESSS
2. Assumption of the sick role
- Acceptance of the illness
- Excuse from normal duties and role expectation
- Confirm from family and friends
3. Medical care contract
- Seek advice of the health professionals for validation of real
illness, explanation of symptoms, and reassurance or prediction
of of what the outcome will be.
STAGES OF ILLNESSS
4. Dependent client role
- Client becomes dependent on the health professionals for help
- Accept/rejects health professional’s suggestions.
5. Recovery of Rehabilitation
- Client is expected to relinquish the dependent role and resume
former roles and responsibilities
LEAVELL AND CLARK’S THREE LEVEL OF
PREVENTION
1. Primary prevention
- To encourage optimal health and to increase the person’s
resistance to illness
- Seeks to prevent a disease or a condition at a pre-pathologic
state
- Health Promotion –Avoid smoking, alcohol intake; Exercise
regularly, Eat- well balance diet, reduce fat intake and increase
fiber in diet
PREVENTION
2. Secondary prevention
- Health maintenance
- seek identify specific illness or conditions at an early stage
with prompt intervention to prevent or limit disability
- Early diagnosis/detection/ screening – annual PE, Pap’s
Smear for women, BSE
PREVENTION
3. Tertiary Prevention
- Occurs after a disease or disability has occurred and the
recovery process has begun
- Intent is to halt the disease or injury process and assist the
person in obtaining an optimal health status.
Rehabilitation
ADVANCED PRACTICE NURSE (APN)
• A title which encompasses the nurse practitioners (NPs),

clinical nurse specialists (CNSs), certified nurse midwives
(CNMs) and certified registered nurse anesthetists (CRNAs).
COLLABORATIVE PRACTICE MODEL
• involves nurses, physicians, and ancillary health personnel

functioning within a decentralized organizational structure and
collaboratively making clinical decisions.
COMMUNITY-ORIENTED NURSING PRACTICE
• nursing intervention that promotes wellness, reduces the

spread of illness, and improves the health status of groups of
citizens or the community at large with emphasis on primary,
secondary, and tertiary prevention.
CONTINUOUS QUALITY IMPROVEMENT (CQI)
• The ongoing examination of processes used to provide care,

with the aim of improving quality by assessing and improving
those processes that might improve patient care outcomes and
patient satisfaction.
INFLUENCE OF HEALTH CARE DELIVERY
• The health care delivery system is constantly adapting as the

population shifts its health care needs and expectations
change.
• The shifting demographics of the population, the increase in
chronic illnesses and disability, the greater emphasis on health
care costs, and technologic advances have resulted in changing
emphases in health care delivery and in nursing.
FACTORS AFFECTING HEALTH CARE DELIVERY
SYSTEM
• Population and demographics

- Aging population
- Cultural Diversity
• Changing in pattern of disease
• Advances in Technology and Genetics
• Demand for Quality Health Care
- Quality Improvement and Evidence-Based Practice
- Clinical Pathways and Care Mapping
-Case Management
ROLES OF THE NURSE
• Practitioner Role
• Leadership Role
• Research Role
CRITICAL THINKING EXERCISES
1 Your clinical assignment is in a long-term care facility.
Identify a patient care issue (eg, nutritional status) that could be
improved. Describe the mechanism that is available within a
clinical facility to address such quality improvement issues.
CRITICAL THINKING EXERCISES
2. You are planning the discharge of an elderly patient who has
several chronic medical conditions. A case manager has been
assigned to this patient. How would you explain the role of the
case manager to the patient and her husband?
3 You are assigned to care for a hospitalized patient who is
obese, with a history of diabetes, and a new diagnosis of stable
angina. There is a clinical nurse leader (CNL) assigned to
provide consistent, quality care for this patient from hospital
admission to discharge. Identify the evidence that supports the
effectiveness of CNLs in supervising care of patients and
promoting positive patient outcomes. What is the strength of the
evidence? How might this specific patient’s care be affected?
INTERDISCIPLINARY COLLABORATIVE
PRACTICE

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NCM 100 FUNDAMENTALS OF

• Perceptual orientations such as self-image and control over

• Health- “state of complete physical, mental, and social well-

LEAVELLAND CLARK’S AGENT-HOST-

Spiritual TOTAL Mental

• A title which encompasses the nurse practitioners (NPs),

• involves nurses, physicians, and ancillary health personnel

• nursing intervention that promotes wellness, reduces the

• The ongoing examination of processes used to provide care,

• The health care delivery system is constantly adapting as the

• Population and demographics

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