Fundamentals of Nursing Practice Notes

St. Dominic College of Asia - Fundamentals of Nursing Practice

Course Overview

  • Course Type: Professional Subject
  • Pre-requisites: Theoretical Foundations of Nursing, Anatomy and Physiology, and Biochemistry.
  • Course Credit: Theory - 3 units (54 hours)

Course Requirements

  • Clinical Laboratory
  • House Rules

Grade Computation

  • Lecture Class Standing (60%):
    • Recitation
    • Assignments
    • Classwork
    • Quizzes
    • Long Tests
    • Oral Presentation of Paper
    • Projects
    • OBE Related Output
  • Periodic Examination (40%)

History of Nursing in the World

Period of Intuitive Nursing/Medieval Period (Prehistoric Times to Early Christian Era)
  • "Untaught" and instinctive care.
  • Caregiving primarily done by women.
  • No formal training; care based on experience and observation.
  • Illness attributed to evil spirits invading the victim's body.
  • Trephining practiced (drilling holes in the skull).
Contributions During This Time
  • Babylonia: Code of Hammurabi.
  • Egypt:
    • Imhotep - Founder of Egyptian medicine.
    • Art of embalming introduced.
  • Israel: Moses - "Father of Sanitation".
  • India: Intuitive form of asepsis, advancements in medicine and surgery.
  • China: Materia Medica (pharmacology).
  • Ancient Greece: Introduced the Caduceus symbol.
  • Rome: Focused on maintaining vigorous health.
Period of Apprentice Nursing/Middle Ages (11th Century to 1836)
  • Care provided by crusaders, prisoners, and religious orders without formal education.
  • Dark period of nursing.
  • Pastor Theodore Fliedner and his wife Frederika: Established the Kaiserswerth Institute in Germany for the training of deaconesses (the 1st formal training school for nurses).
  • Florence Nightingale received 3 months of training at Kaiserswerth.
Military Religious Orders and Their Works
  • Teutonic Knights (German): Cared for the injured and established hospitals in military camps.
  • Knights of St. John of Jerusalem (Italian): Established to give care.
  • Knights of St. Lazarus: Cared for those who suffered from leprosy, syphilis, and chronic skin diseases.
  • Alexian Brothers: Operated the Alexian Brothers School of Nursing, the largest school under religious auspices exclusively in the US; closed in 1969.
  • St. Vincent de Paul: Founded "La Charite" and "Community of Sisters of Charity," dedicated to caring for the sick, poor, orphaned, and widowed. Founded the "Sisters of Charity School of Nursing" in Paris, France where Florence Nightingale had her 2nd formal education in Nursing.
Important Personalities
  • St. Clare: Took vows of poverty, obedience to service, and chastity; known as "The Poor Claire".
  • St. Catherine of Siena: "Little Saint"; cared for the sick from a young age; known as "1st Lady with a Lamp".
  • St. Elizabeth of Hungary: Saw her calling in caring for the sick; fed thousands of hungry people; The Patroness of Nursing.
Period of Educated Nursing/Nightingale Era (19th-20th Century)
  • June 15, 1860: Florence Nightingale School of Nursing established at St. Thomas Hospital in London.
  • Florence Nightingale was asked by Sir Sidney Herbert of the British War Department to recruit female nurses to provide care for the sick and injured in the Crimean War.
  • Formal nursing education and nursing service began.

Nursing Pioneers

  • Harriet Tubman (c. 1820 – 1913): African-American abolitionist, humanitarian, and Union spy during the U.S. Civil War; "The Moses of Her People".
  • Sojourner Truth (1797-1883): American abolitionist and women's rights activist.
  • Lillian D. Wald (1867–1940): Nurse, social worker, public health official, teacher, author, editor, publisher, women's rights activist, and the founder of American Community Nursing. Provided nursing care to the indigent and supported education for the mentally challenged; First community health nurse
  • Mary Breckinridge (1881-1965): American nurse-midwife and founder of the Frontier Nursing Service; introduced a model of rural healthcare in the United States in 1925.

Facts About Florence Nightingale

  • "Mother Of Modern Nursing" and "Lady With The Lamp".
  • Born May 12, 1800, in Florence, Italy; raised in England.
  • Self-appointed goal: to change the profile of nursing.
  • Led nurses that took care of the wounded during the Crimean War
  • Beliefs:
    • Holistic framework inclusive of illness and health.
    • Need for theoretical basis.
    • Liberal Education as foundation for nursing practice.
    • Need for the body of nursing knowledge distinct from medical knowledge.
  • Concepts:
    • Having systematic method of assessing patient.
    • Maintaining confidentiality.
    • Individualized care based on patient needs and preferences.
    • Nurses should be formally educated and function as client advocates.
  • Environmental factors affecting health: Pure or fresh air, pure water, sufficient food supplies, efficient drainage, cleanliness, light (especially direct sunlight).
Period of Contemporary Nursing (20th Century to Present)
  • Covers the period after World War II.
  • Licensure of nurses started.
  • Specialization of hospitals and diagnosis.
  • Training of nurses in diploma programs.
  • Development of baccalaureate and advanced degree programs.
  • Health is perceived as a fundamental human right.
  • Marked by scientific and technological development and social changes.
  • Nursing involvement in community health.
  • Technological advances: disposable supplies and equipment.
  • Expanded roles of nurses developed.
  • WHO established by the United Nations.
  • Aerospace Nursing developed.
  • Use of atomic energies for medical diagnosis and treatment.
  • Computers utilized for data collection, teaching, diagnosis, inventory, payrolls, record keeping, billing.
  • Use of sophisticated equipment for diagnosis and therapy.

History of Nursing in the Philippines

Early Beliefs, Practices, and Care of the Sick
  • Diseases and their treatment were associated with mysticism and superstitions.
  • Cause of disease attributed to another person (an enemy of a witch) or evil spirits.
  • Difficult childbirth attributed to "nonos".
  • Belief in special Gods of Healing.
  • Priest-Physician ("word doctors"), Herbolarios/Herb doctors.
  • Persons suffering from diseases believed bewitched by “mangkukulam”.
The Earliest Hospitals Established
  • Hospital Real de Manila (1577): Established mainly to care for the Spanish King’s soldiers, but also admitted Spanish civilians; Founded by Gov. Francisco de Sande
  • San Lazaro Hospital (1578): Built exclusively for patients with leprosy; Founded by Brother Juan Clemente. The American run the hospital in 1898 as a contagious disease hospital, after 320 years of Spanish governance. It was only in 1918 that Filipinos started operating the hospital. From 1930-31, insane patients were transferred to National Mental Hospital ( National Center for Mental Health). In 1949, patients with leprosy were located to Tala Leprosarium, now Jose N. Rodriquez Memorial Hospital.

Hospitals and Nursing Schools

  • Iloilo Mission Hospital School of Nursing (Iloilo City, 1906): Ran by the Baptist Foreign Mission Society of America; Miss Flora Ernst, an American nurse, took charge of the school. 1909 – distinction of graduating the 1st trained nurses in the Philippines with no standard requirements for admission of applicants except their “willingness to work”. April 1946 – a board exam was held outside of Manila. It was held in the Iloilo Mission Hospital thru the request of Ms. Loreto Tupas, principal of the school.
  • St. Paul’s Hospital School of Nursing (Manila, 1907): Established by the Archbishop of Manila, The Most Reverend Jeremiah Harty, under the supervision of the Sisters of St. Paul de Chartres; Located in Intramuros and provided general hospital services. St Paul Hospital School of Nursing Intramuros Manila P.I 1900's St. Paul’s Hospital at the corner of Gral. Luna and Anda Streets, Intramuros, which had been begun by Sisters of St. Paul de Chartres and later on the Maryknoll Sisters had assumed direction.
  • Philippine General Hospital School of Nursing (1907): In 1907, with the support of the Governor General Forbes and the Director of Health and among others, she opened classes in nursing under the auspices of the Bureau of Education. Anastacia Giron-Tupas, was the first Filipino to occupy the position of chief nurse and superintendent in the Philippines, succeeded her.
  • St. Luke’s Hospital School of Nursing (Quezon City, 1907): Episcopalian Institution; Began as a small dispensary in 1903; In 1907, the school opened with three Filipino girls admitted; Mrs. Vitiliana Beltran was the first Filipino superintendent of nurses. St. Luke's Hospital in Manila in 1923
  • Mary Johnston Hospital and School of Nursing (Manila, 1907): Started as a small dispensary on Calle Cervantes (now Avenida); Called Bethany Dispensary and was founded by the Methodist Mission; Miss Librada Javelera was the first Filipino director of the school.
  • Southern Island Hospital School of Nursing (Cebu, 1918): Established under the Bureau of Health with Anastacia Giron-Tupas as the organizer

First Colleges of Nursing in the Philippines

  • University of Santo Tomas College of Nursing (1877)
  • Manila Central University College of Nursing (1947)
  • University of the Philippines College of Nursing (1948): 1st BSN Program
  • Far Eastern University Institute of Nursing (1955)
  • University of the East College of Nursing (1958)

Nursing Leaders in the Philippines

  • Anastacia Giron-Tupas: First Filipino nurse to hold the position of Chief Nurse Superintendent; Founder of PNA (Philippine Nursing Association).
  • Cesaria Tan: First Filipino to receive a master’s degree abroad.
  • Socorro Sirilan: Pioneered in Hospital Social Service in San Lazaro Hospital where she was the Chief Nurse.
  • Rosa Militar: Pioneered in School Health Education.
  • Sor Ricarda Mendoza: Pioneer in Nursing Education.
  • Socorro Diaz: First editor of the PNA magazine called “The Message”.
  • Conchita Ruiz: First full-time editor of the PNA magazine called “The Filipino Nurse”.
  • Loreta Tupaz: Dean of the Philippine Nursing; regarded as the Florence Nightingale of Iloilo.

Years to Remember

  • 1909: 3 females graduated as "qualified medical-surgical nurses".
  • 1920: 1st board examination for nurses was conducted by the Board of Examiners. Theoretical Exam was held at the UP Amphitheater of the College of Medicine and Surgery. Practical Exam at the PGH Library.
    • 93 candidates took the exam, 68 passed with the highest rating of 93.5% - Anna Dahlgren.
  • 1919: The 1st Nurses Law (Act#2808) was enacted regulating the practice of the nursing profession in the Philippines Islands. It also provided the holding of exam for the practice of nursing on the 2nd Monday of June and December of each year.
  • 1953: Republic Act 877, known as the “Nursing Practice Law” was approved.
  • 1921: Filipino Nurses Association was established (now PNA) as the national organization of Filipino nurses: 1st President – Rosario Delgado.

Nursing As A Profession

  • NURSE: "Noutrix"
Definition of Nursing
  • Florence Nightingale: “The act of utilizing the environment of the patient to assist him in his recovery” ENVIRONMENTAL THEORY
  • Virginia Henderson: “Assisting the individual, sick or well, in the performance of those activities contributing to health or its recovery (or to peaceful death)” 14 BASIC NEEDS
  • Martha Rogers: “A humanistic science dedicated to compassionate concern with maintaining and promoting health and preventing illness and rehabilitating the sick and disabled”SCIENCE OF UNITARY HUMAN BEINGS
  • Sister Callista Roy: “A theoretical system of knowledge that prescribes a process of analysis and action related to care of the ill person” ADAPTATION MODEL
  • Dorothea Orem: “Helping or assisting service to persons who are wholly or partly dependent – infants, children and adults – when they, their parents and guardians, or other adults responsible for their care are no longer able to give or supervise their care. SELF-CARE AND SELF-CARE DEFICIT THEORY
  • Betty Neuman: “A unique profession in that it is concerned with all of the variables affecting an individual’s response to stressors, which are intra-, inter-, and extra-personal in nature. HEALTH CARE SYSTEM MODEL
  • Dorothy Johnson: “An external regulatory force that acts to preserve the organization and integration of the client’s behavior at an optimal level under those conditions in which the behavior constitute a threat to physical or social health or in which illness is found” BEHAVIORAL SYSTEM MODEL
  • ANA (1973): “Direct, goal-oriented, and adaptable to the needs of the individual, the family, and community during health and illness”.
  • ANA (1980): “The diagnosis and treatment of human responses to actual or potential health problems”.
  • ANA (2003): “The protection, promotion, and optimization of health and abilities, preventions of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations”.
Nursing as a Discipline
  • A unique perspective or way of viewing something.
  • A body of knowledge, practice, and system of rules.
  • Defines the boundaries in which nurses practice.
  • "Nursing is an evolving discipline".
  • Nursing falls under professional disciplines.
  • Nursing is a science: a body of knowledge based on scientific research and analysis.
  • Nursing is an art: the creative use of knowledge in service to others.
Characteristics of Nursing
  • Nursing is caring.
  • Nursing involves close personal contact with the recipient of care.
  • Nursing is concerned with services that take humans into account as physiological, psychological, and sociological organisms.
  • Nursing is committed to promoting individual, family, community, and national health goals in its best manner possible.
  • Nursing is committed to personalized services for all persons without regard to color, creed, social or economic status.
  • Nursing is committed to involvement in ethical, legal, and political issues in the delivery of health care.
Recipients of Nursing
  • Consumer: An individual, a group of people, or a community that uses a service or commodity.
  • Patient: A person who is waiting for or undergoing medical treatment and care.
  • Client: A person who engages the advice or services of another who is qualified to provide this service.
Scope of Nursing: Four (4) Areas of Nursing Practice
  • Promoting Health and Wellness: A process that engages in activities and behaviors that enhance quality of life and maximize personal potential.
  • Preventing Illness: Goal is to maintain optimal health by preventing disease.
  • Restoring Health: Focuses on the ill client, extends from early detection of disease through helping the client during the recovery period.
  • Care for the Dying: Involves comforting and caring for people of all ages who are dying.

Personal Qualities of a Nurse

  • Philosophy of Nursing: A statement that outlines a nurse's values, ethics, and beliefs, as well as their motivation for being part of the profession. It covers a nurse's perspective regarding their education, practice, and patient care ethics.
  • Good Personality: Consists of the distinctive individual qualities that differentiates one person from another; The impression one makes on others which will include more than what meets the eye. Consists of deeper traits which come from the heart and which infiltrate the real person if one wishes to exert a magnetic influence on others.
Components of Good Personality
  • Personal Appearance:
    • Posture – habitual or assumed positions of your body in standing, sitting or moving about.
    • Grooming
    • Dress and uniform
  • Character: Moral values and beliefs used as guides to personal behavior. Charity is the greatest virtue and serves as the foundation for a sense of values and the development of human character
Attributes of Character
  • Moderation: limiting, controlling, restricting.
  • Motivation: enthusiasm, interest, or commitment.
  • Resourcefulness: initiative, problem-solving skills.
  • Reliability: trustworthiness, accuracy, correctness.
  • Loyalty: devotion, attachment, trust & affection towards others.
  • Tolerance: ability to endure hardship, acceptance of different views.
  • Judgment: discernment of “good sense”.
  • Honesty: truthfulness, honor, integrity.
Eight (8) Be-Attitudes of a Nurse
  • Permissiveness: loosening or tightening authority
  • Friendliness: warmth of manner, pleasant interaction.
  • Firmness: showing certainty and determination.
  • Competence: ability to do something well.
  • Limit Setting: knowing the value of influence
  • Acceptance: facing known and meeting the unknown.
  • Sincerity: honesty and genuineness.
  • Helpfulness: giving attention, reassurance & protective security
  • Charm: To influence the senses or the mind by some quality or attraction; delight
Characteristics of a Profession
  • An occupation that requires extensive education or specialized training
  • A special calling that requires special knowledge, skills, attitudes, and preparation.
  • Serves all of society and not the specific interest of a group.
  • Aims of a profession are altruistic rather than materialistic
  • Implies that the quality of work done by its members is of greater importance in its own eyes and the society than the economic rewards they earn.
  • An organization of an occupational group based on the application of special knowledge which establishes its own rules and standards for the protection of the public and the professionals.
CRABSS P - Criteria of a Profession
  • C - Code of Ethics:
    • A formal statement of a group’s ideal and values
    • A set of ethical principles that (a) is shared by members of the group, (b) reflects their moral judgments over time, and (c) serves as a standard for their professional actions.
    • Nursing profession requires integrity of its members: do what is considered right regardless of the personal cost
  • R - Research: A methodological investigation into nursing-related subjects to discover new facts, to establish or revise a theory, or to develop a plan of action based on the facts discovered
  • A - Autonomy:
    • A profession is autonomous if it regulates itself and sets standards for its members
    • Granted legal authority to define the scope of its practice, describe its particular functions and roles, and determine its goals and responsibilities.
    • Means independence at work, responsibility, and accountability for one’s actions.
  • B - Body of Knowledge: Inclusion of a number of nursing conceptual frameworks gives direction to nursing practice, education, and ongoing research
  • S - Specialized Education: Programs in colleges and universities. Undergraduate nursing curriculum should include liberal arts education in addition to the biologic and social sciences and the nursing discipline
  • S - Service Orientation: Nursing has a tradition of service to others. This service, however, must be guided by certain rules, policies, or codes of ethics. Altruism – selfless concern for others
  • PO - Professional Organization: Governance – the establishment and maintenance of social, political, and economic arrangements by which practitioners control their practice, self-discipline, working conditions, and their professional affairs.
Professional Nursing
  • An art and a science, dominated by an ideal of service in which certain principles are applied 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.

Professional Qualities of a Nurse

  • PRESSURE
    • Poise
    • Respect for Human Dignity
    • Emotionally Stable
    • Self-Sacrifice for the Common Good
    • Spiritual Understanding
    • Responsible
    • Ethical
  • CHICKS
    • Critical Thinker
    • High Standards of Workmanship
    • Indiscriminate
    • Composed
    • Knowledgeable
    • Skillful

Roles and Functions of A Professional Nurse

  • Autonomy and Accountability
    • Autonomy is the essential element of professional nursing. Person is reasonably independent and self-governing in decision making & practice
    • Accountability - Nurse is responsible professionally & legally for type & quality of care provided
  • Clinical Decision Maker: Utilizes critical thinking skills and the nursing process
    • Nursing Process: Assessment, Diagnosis, Planning, Implementation, Evaluation
  • Care Provider:
    • The traditional and most essential role Functions as nurturer, comforter, provider “Mothering actions” of the nurse
    • Show concern for client welfare and acceptance of the client as a person
    • Activities involves knowledge and sensitivity to what matters and what is important to clients
  • Teacher: Provides information and helps the client to learn or acquire new knowledge and technical skills; Encourages compliance with prescribed therapy; Interprets information to the client
  • Counselor: Helps client to recognize and cope with stressful psycho logic or social problems; to develop an improve interpersonal relationships and to promote personal growth. Encourages the client to look at alternative behaviors recognize the choices and develop a sense of control.
  • Change Agent: Initiate changes or assist clients to make modifications in themselves or in the system of care.
  • Client Advocate: Involves concern for and actions in behalf of the client to bring about a change. Provides explanation in client’s language and support client’s decisions.
  • Manager: Makes decisions, coordinates activities of others, allocate resource Plans, give direction, develop staff, monitors operations, give the rewards fairly and represents both staff and administrations as needed.
  • Researcher: Participates in identifying significant researchable problems; Participates in scientific investigation and must be a consumer of research findings

Expanded Role of the Nurse

  • Clinical Specialists: Is a nurse who has completed a MASTER’S DEGREE in specialty and has CONSIDERABLE CLINICAL EXPERTISE in that specialty. She provides expert care to INDIVIDUALS, PARTICIPATES in EDUCATING health care professionals and ancillary, acts as a CLINICAL CONSULTANT and participates IN RESEARCH.
  • Nurse Practitioner: Is a nurse who has completed either as certificate program or a master’s degree in a specialty and is also certified by the appropriate specialty organization. She is SKILLED at making NURSING ASSESSMENTS, performing P. E., COUNSELING, TEACHINg and TREATING MINOR and SELF- LIMITING ILLNESS.
  • Nurse-Midwife: A nurse who has completed a program in MIDWIFERY; provides PRENATAL and POSTNATAL CARE and DELIVERS BABIES to woman with UNCOMPLICATED PREGNANCIES.
  • Nurse Anesthetist: A nurse who completed the course of study in an ANESTHESIA SCHOOL and carries OUT PRE- OPERATIVE STATUS OF CLIENTS.
  • Nurse Educator: A nurse usually with ADVANCED DEGREE, who teaches in CLINICAL OR EDUCATIONAL SETTINGS, TEACHES THEORETICAL KNOWLEDGE, CLINICAL SKILLS and conduct RESEARCH.
  • Nurse Entrepreneur: A nurse who has an ADVANCED DEGREE, and MANAGES HEALTH-RELATED BUSINESS.
  • Nurse Administrator: A nurse who functions at VARIOUS LEVELS of MANAGEMENT IN HEALTH SETTINGS; RESPONSIBLE FOR THE MANAGEMENT and ADMINISTRATION OF RESOURCES and PERSONNEL involved in GIVING PATIENT CARE.

Legal Aspects of Nursing

  • Knowledge of laws is needed to:
    • Ensure that the nurse's decisions and actions are consistent with current legal principles.
    • Protect the nurse from liability.
Functions of the Law in Nursing
  • Framework for establishing which nursing actions in the care of clients are legal.
  • Differentiates nurse's responsibilities from those of other health professionals.
  • Helps establish boundaries of independent nursing action.
  • Assists in maintaining standard of nursing practice by making nurses accountable under the law.
Nurses as Witnesses
  • Any nurse who is asked to testify should seek advice of an attorney.
  • Expert Witness: Special training, experience, or skill in relevant area and allowed by court to offer opinion on a related issue.

Regulation of Nursing Practice

  • Defining scope of nursing practice, licensing requirements, and standards of care for the purpose of protecting the public.
  • RA 9173 “THE PHILIPPINE NURSING ACT OF 2002”
    • Define and describe scope of nursing practice.
    • Control practice through licensing.
    • Easily accessed at specific state board of nursing's website.

Credentialing

  • Process of determining and maintaining competence in nursing practice.
  • Licensure: Legal permit that government agency grants to individuals to engage in profession and use title.
Informed Consent
  • Purpose:
    • Provides client with complete information PRIOR TO obtaining agreement by client to accept a course of treatment or procedure.
    • The informed consent is the record of the informed consent, not the informed consent itself.
  • Express Consent: Oral or written agreement.
  • Implied Consent: Individual's NONVERBAL BEHAVIOR indicates agreement; Medical emergency when a person CANNOT EXPRESS CONTENT BECAUSE OF PHYSICAL CONDITION.
  • Essential Elements of Informed Consent:
    • Consent must be voluntary.
    • Consent must be given by client or individual with capacity to understand.
    • Must be given enough information to be the ultimate decision maker.
    • Client must not feel coerced.
    • The consent must be read to the client or an interpreter appropriately used to be certain client understands; Important to consider the problem of illiteracy and other language barriers.
  • Exceptions:
    • Except in specific circumstances, the following individuals cannot provide informed consent:
      • A minor, person 18 years or younger.
      • The unconscious or person injured in such as way that they are unable to consent.
      • A mentally ill person judged by professionals to be incompetent.
    • Parent, legal guardian, or representative provides or refuses consent for these individuals.
  • Nurse’s Role:
    • Client gave consent voluntarily.
    • Signature is authentic.
    • Client appears competent to give consent.
    • Client has right to refuse even after signing consent form.
    • Documentation is an important aspect.
    • Obtaining informed consent is the responsibility of the individual performing the procedure. The nurse may be asked to witness the client's signature on the consent form.

Violence, Abuse, and Neglect

  • Nurses are mandated reporters.
  • Required by law to report suspected abuse, neglect, or exploitation.
  • Detect cases at an early stage, protect children, and facilitate provision of services.
  • Includes domestic violence, child abuse, abuse of older adults, and sexual abuse.

The Impaired Nurse

  • Inability to perform essential job functions due to:
    • Chemical dependency on drugs
    • Alcoholism
    • Mental illness
  • Peers have responsibility to report suspicions to protect patients and to obtain treatment quickly for affected peers.
Sexual Harassment
  • Unwelcome sexual advances, requests for sexual favors, and other verbal or physical conduct of a sexual nature.
  • Violation of individual's rights.
  • Can be from male or female.
  • Does not have to be from opposite sex.
  • Follow institution for reporting.
Abortion
  • Roe v. Wade allows a woman the right to control her own body; A woman can abort a fetus in early stages of pregnancy.
  • Nurses have the right to refuse to participate in an abortion.

Death and Other Related Issues

  • Advance Health Care Directives: Allow persons to specify aspects of care they wish to receive if unable to make decisions.
    • Two kinds of health care directives:
      • Living will
      • Health care proxy (durable power of attorney for health care)
  • Autopsy (Postmortem Examination): Performed only in certain cases when death is sudden or occurs within 48 hours of admission to hospital.
Certification of Death
  • Formal determination (pronouncement).
  • Authority to pronounce regulated by state.
Do-Not-Resuscitate Orders
  • Generally written when client or proxy wishes for no resuscitation.
  • Values and choices given highest priority.
  • DNR explicitly discussed with client, family, and designated decision maker, and health care team.
  • DNR clearly documented, reviewed, and updated.
  • Other care should not be withdrawn.
Euthanasia
  • Painlessly putting to death people suffering from incurable or distressing disease.
Organ Donation
  • People 18 years or older may make a gift.
  • Almost always a greater need for transplantation than organs are available.
  • If no valid donor document, must discuss with survivors.
Data Privacy Act RA 10173
  • Inappropriate use leads to loss of jobs, discipline from board of nursing.
  • Standards of professionalism the same online as in any other circumstance.
  • Do not take photos, videos of clients on personal devices.
  • Maintain professional boundaries.
  • Do not transmit individually identifiable client information.
Good Samaritan Acts
  • Protect health care providers providing assistance at an emergency scene against claims of malpractice
  • Some states have statutes requiring people to stop and aid persons in danger
  • Guidelines for nurses who choose to render emergency care include:
    • Limit actions to those normally considered first aid, if possible
    • Do not perform actions which the nurse does not know how to perform.
    • Offer assistance but do not insist.
    • Have someone call or go for additional help.
    • Do not leave the scene until the injured person leaves or another qualified person take over.
    • Do not accept compensation.
Legal Responsibilities of Students
  • Responsible for own action and liable for their own acts of negligence.
  • Lower standards are not applied to nursing students.
  • Function within scope of education, job description and nurse practice act
  • Follow procedures and policies
  • Ask for additional help or supervision in situations they feel inadequately prepared
  • If working as an aide, only perform tasks in job description, not from nursing school

Health, Wellness & Illness

The Basic Human Needs
  • Each individual has unique characteristics, but certain needs are common to all people.
  • A need is something that is desirable, useful or necessary.
  • Human needs are physiologic and psychologic conditions that an individual must meet to achieve a state of health or well-being.
  • Characteristics of Basic Human Needs
    • Needs are universal.
    • Needs may be met in different ways
    • Needs may be stimulated by external and internal factor
    • Priorities may be deferred
    • Needs are interrelated
Health

  • The fundamental right of every human being.

  • It is the state of integration of the body and mind.

  • Health and illness are highly individualized perception.

  • Meanings and descriptions of health and illness vary among people in relation to geography and to culture.

  • Definitions:

    • WHO: Health - is the state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity.
    • Claude Bernard: Health – is the ability to maintain the internal milieu. Illness is the result of failure to maintain the internal environment.
    • Walter Cannon: Health – is the ability to maintain homeostasis or dynamic equilibrium. Homeostasis is regulated by the negative feedback mechanism.
    • Florence Nightingale: Health – is being well and using ones’ power to the fullest extent. Health is maintained through prevention of diseases via environmental health factors.
    • Virginia Henderson: Health – is viewed in terms of the individual’s ability to perform 14 components of nursing care unaided.
    • Sister Callista Roy: Health – is a state of a process of being becoming an integrated and whole as a person.
    • Dorothea Orem: Health – is a state the characterized by soundness or wholeness of developed human structures and of bodily and mental functioning.

  • Imogene King: Health- is a dynamic state in the life cycle; illness is an interference in the life cycle.

  • Betty Neuman: Wellness – is the condition in which all parts and subparts of an individual are in harmony with the whole system.

Illness vs. Disease
  • Illness: A personal state in which the person feels unhealthy. Illness is a state in which a person’s physical, emotional, intellectual, social, developmental, or spiritual functioning is diminished or impaired compared with previous experience. Illness is not synonymous with disease.
  • Disease: Transmittable, one can catch it, and is caused by something external.
  • Disorder: Not transmittable, one cannot catch it and is caused by something internal

Common Causes of Illness

  • Biologic Agent
  • Inherited Genetic Defects
  • Developmental Defects
  • Physical Agents
  • Chemical Agents
  • Tissue Response to Irritations/Injury
  • Faulty Chemical/Metabolic Process
  • Emotional/Physical Reaction to Stress
Stages of Illness
  • Symptoms Experience: Experience some symptoms, person believes something is wrong.
  • Assumption of Sick Role: Acceptance of illness, seeks advice
  • Medical Care Contact: Seeks advice to professionals for validation of real illness, explanation of symptoms, reassurance or predict of outcome
  • Dependent Patient Role: The person becomes