PERIODS OF NURSING HISTORY Intuitive Period Apprentice Period Educative Period Contemporary Contemporary Period • • • •
INTUITIVE PERIOD Prehistoric à Early Christian Era, More on intuition NOMADS – travel from one place to another Survival of the fittest “Best for the most” – motto Sickness is due to “voodoo” Performed out of feeling of compassion for others Performed out of desire to help Performed out of wish to do good Nursing is given by the WOMEN INTUITIVE PERIOD SHAMAN – uses white magic to counteract the black magic --They are the doctors during those time. TREPHINING – drilling the skull Used to treat Psychotic patients Psychotic patients are believed to be possessed by evil spirits. Growth of religion – most important thing that happened Growth of civilization Law of self preservation – inspire man in search of knowledge RISE IN CIVILIZATION From the mode of Nomadic life à agrarian society à gradual development of urban community life Existence of means of communication communication Start of scientific knowledge à more complex life à increase in health problems à demand for more nurses • • • • • • • • •
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Nursing as a duty of SLAVES of SLAVES and WIVES. NURSING DID NOT CHANGE but there was progress in the practice of Medicine. Care of the sick was still closely allied with superstitions, religion and magic RISE IN CIVILIZATION Near East – birth place of 3 religious ideologist: Judaism Christianity Mohammedism or Islam - Near East culture was adopted by the Greeks and Romans combine wit the wonders of the Far East by returning crusaders crusaders and explorers improved and was carried to Europe during the Renaissance Period that resulted to greater knowledge then to the New World by the Early settlers.
RISE IN CIVILIZATION New World – a tiny area known as birth of monotheism that lies between Tigris and Euphrates River in the Nile River arose the cultures of Babylonia, Egypt and Hebrew. MONOTHEISM – believer of one God
BABYLONIANS CODE OF HAMMURABI H AMMURABI st 1 recording on the medical practice Established the medical fees Discouraged experimentation Specific doctor for each disease Right of patient to choose treatment between the use of charms, medicine, or surgical procedure EGYPTIANS • • • • •
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ART OF EMBALMING Mummification Removing the internal organs of the dead body Instillation of herbs and salt to the dead Used to enhance their knowledge of the human anatomy. Since work was done and performed on the dead, they learned nothing of Philosophy “THE 250 DISEASES” Documentation Documentation about 250 diseases and treatments
HEBREW Teachings of MOSES of MOSES Created Leviticus Father of sanitation Practice the values of “Hospitality to strangers” and the “Act of Charity” – contained in the book of Genesis LEVITICUS – 3 rd book of the Old Testament Laws controlling the spread of communicable communicable diseases Laws governing cleanliness Laws on preparation of food Purification of man and his food The ritual of CIRCUMCISION – on the 8 th day after birth MOSAIC LAW Meant to keep Hebrews pure so that they may enter the sanctuary without affronting God Meant as a survival for health and hygienic reason only • • • •
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CHINA Use of pharmacologic pharmacologic drugs “MATERIA MEDICA” Book that indicates the pharmacologic drug used for treatment no knowledge on anatomy. Use of wax to preserve the body of the dead Method of paper making FACTORS THAT HAMPERED THE ADVANCEMENT OF MEDICINE: Baby boys given girl’s name Prohibits dissecting of human body thus thwarting scientific study INDIA SUSHURUTO 1st recording on the nursing practice • •
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Hampered by Taboos due to social structures and practices of animal worship Medicine men built hospitals Intuitive form of asepsis There was proficient practice of Medicine and Surgery NURSES QUALIFICATIONS: Lay Brothers, Priest Nurses, combination of Pharmacist, Masseurs, PT, cooks There was also decline in Medical practice due to fall of Buddhism – state religion of India
GREECE AESCULAPUS Father of medicine in Greek mythology HIPPOCRATES Father of modern medicine 1st to reject the idea that diseases are caused by evil spirits 1st to apply assessment Practice medical ethics • • • • • • •
CADUCEUS Insignia of medicine Composed of staff of travellers intertwined with 2 serpent (the symbol of Aesculapus and his healing power). At the apex of the staff are two wings of Hermes (Mercury) for speed. NURSES à function of untrained slaves • •
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ROMANS Proper turnover for the sick people “If you’re strong, you’re healthy” – motto Transition from Pagan to Christianity FABIOLA Was converted to Christian and later she converted her home to a hospital and used her wealth for the sick. 1st hospital in the Christian world • • •
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11th century à 1836 On-the-job training period Refers to a beginner (on-the-job training). It means care performed by people who are directed by more experienced nurses Starts from the founding of Religious Orders in the 6 th century through the Crusades in the 11 th century (1836 – when the deaconesses School of Nursing was established in Kaiserswerth, Germany by Pastor THEODORE FLEIDNER)
APPRENTICE PERIOD There was a struggle for religious, political, and economic powerCrusades took place in order to gain religious, political, and economic power or for •
adventure during the Crusade in this period, it happened as an attempt to recapture the Holy Land from the Turk who obtained and gain control of the region as a result of power struggle. Christians were divided due to several religious war and Christians were denied visit to The Holy Sepulcher.
MILITARY RELIGIOUS ORDERS AND THEIR WORKS KNIGHTS OF ST. JOHN OF JERUSALEM (ITALIAN) Also called as “Knights of the Hospitalers”. Established to give care • •
TEUTONIC KNIGHTS (GERMAN) Took subsequent wars in the Holy Land Cared for the injured and established hospitals in the military camps • •
KNIGHTS OF ST.LAZARUS Care for those who suffered Leprosy, syphilis, and chronic skin diseases ALEXIAN BROTHERS A monasteric order founded in 1348. They established the Alexian Brothers School of Nursing, the largest School under religious auspices exclusively in US and it closed down in 1969 • • •
ST. VINCENT DE PAUL He organized the charity group called the “La Charite” and the “Community of Sisters of Charity” composed of women dedicated in caring for the sick, the poor, orphaned, and the widowed. He founded the “Sisters of Charity School of Nursing” in Paris, France where Florence Nightingale had her 2 nd formal education in Nursing. LOUISE de GRAS Was the 1st Superior and co-founder of the Community of Sisters of Charity NURSING SAINTS ST. CLAIRE OF ASSISI Took vows of poverty, obedience to service and chastity Founded the 2 nd order of St. Francis of Assisi “the poor Claire” ST. ELIZABETH OF HUNGARY The patroness of Nursing A princess Sees her calling to give care for the sick Fed thousands of hungry people St. CATHERINE OF SIENA “Little Saint” – took care of the sick as early as 7y/o “1st Lady with a Lamp” •
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RISE OF RELIGIOUS NURSING ORDER Orders of St. Francis of Assisi 1st order – founded by St. Francis 2nd order “the poor Claire” – founded by St. Claire 3rd “the tertiary order” Beguines Oblates Benedictines • • • •
Ursulites Augustinians
DARK PERIOD OF NURSING th th From 17 century – 19 century Also called the Period of Reformation until the American Civil War Hospitals were closed Nursing were the works of the least desirable people (criminals, prostitutes, drunkards, slaves, and opportunists) Nurses were uneducated, filthy, harsh, ill-fed, overworked Mass exodus for nurses The American Civil War was led by Martin Luther, the war was a religious upheaval that resulted to the destruction in the unity of Christians. The conflict swept everything connected to Roman Catholicism in schools, orphanages, and hospitals DARK PERIOD OF NURSING THEODORE FLIEDNER (a pastor) reconstituted the Deaconesses and later be established the School of Nursing at Kaiserswerth, Germany where Florence Nightingale had her 1 st formal training for 3 months as nurse FLORENCE NIGHTINGALE Practiced her profession during the Crimean War “Lady with a Lamp” From a well-known family Went to Germany to study EDUCATIVE PERIOD Florence Nightingale Era Began in June 15, 1860 when Florence Nightingale School of Nursing opened at St. Thomas Hospital in London England, where 1 st program for formal education of Nurses began and contributed growth of Nursing in the US FACTORS THAT INFLUENCED DEVELOPMENT OF NURSING EDUCATION: Social forces Trends resulting from war Emancipation of women Increased educational opportunities FLORENCE NIGHTINGALE Mother of Modern Nursing Lady with the Lamp Born on May 12, 1820 in Florence, Italy Her SELF-APPOINTED GOAL – to change the profile of Nursing She compiled notes of her visits to hospitals, her observations of sanitation practices and entered Deaconesses School of Nursing at Kaiserswerth, Germany for 3 months. •
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EDUCATIVE PERIOD FLORENCE NIGHTINGALE
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Became the Superintendent of the Establishment for Gentle Women during the Illness (refers to the ill governess or instructors of Nursing She disapproved restriction on admission of patient and considered this unchristian and contrary to health care. Upgraded the practice of Nursing and made Nursing a honorable profession led other nurses in taking care of the wounded and sick soldiers during the Crimean War. She was designated as Superintendent of the Female Establishment of English General Hospital in Turkey during the Crimean War She reduced the casualties of war by 42%-2% thru her effort by improving the practice of sanitation techniques and procedure in the military barracks
EDUCATIVE PERIOD THE CONCEPTS OF FLORENCE NIGHTINGALE ON NURSING SCHOOL: •
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School of Nursing should be self-supporting not subject to the whimps of the Hospital. Have decent living quarters for students and pay Nurse instructors Correlate theories to practice Support Nursing research and promote continuing education for nurses Introduce teaching knowledge that disease could be eliminated by cleanliness and sanitation and Florence Nightingale likewise did not believed in the Germ Theory of Bacteriology. Opposed central registry of nurses Wrote Notes on Nursing, “What it is and what it is not.” Wrote notes on hospitals
EDUCATIVE PERIOD OTHER SCHOOLS OF NURSING Bellevue Training School for Nurses – New York City Alexian Brothers Hospital School of Nursing in US exclusively for men. It opened in 1348 and it closed down in 1969. • •
LINDA RICHARDS – the first graduate nurse in US. Graduated in September 1, 1873. 2 NURSING ASSOCIATION / ORGANIZATIONS THAT UPGRADED NURSING PRACTICE IN US: American Nurses Association National League for Nursing Education • •
CONTEMPORARY PERIOD • •
World War II – present This refers to the period after World War I and the changes and development in the trends and practice of Nursing occurring since 1945 after World War II.
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Includes scientific and technological development, social changes occurring after the war. Nursing is offered in College and Universities
CONTEMPORARY PERIOD DEVELOPMENT AND TRENDS: •
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W.H.O established by U.N to fight diseases by providing health information, proper nutrition, living standard, environmental conditions. The use of Atomic energy for diagnosis and treatment. Space Medicine and Aerospace Nursing Medical equipment and machines for diagnosis and treatment Health related laws Primary Health Care – Nurses involvement in CHN Utilization of computers Technology advances such as development of disposable equipment and supplies that relieved the tedious task of Nurses. Development of the expanded role of Nurses
CONTEMPORARY PERIOD FACTORS AFFECTING NURSING TODAY: Economics Consumer’s Demand Family Structure Information and Telecommunications Legislation • • • • •
HISTORICAL PERSPECTIVE Women’s Roles Religion War Societal Attitudes • • • •
HISTORICAL PERSPECTIVE WOMEN’S ROLES The role as a wife, mother, daughter, sister has always been included in the care of their family. They cared for their infants, members of the family and members of the community (It could be said that Nursing have its roots in the home). Has the will to serve for others (subservient). The care provided were related to physical maintenance and comfort. They care given were humanistic, nurturing comforting and supporting. • •
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RELIGION Played a significant role in the development of Nursing The Christian values of LOVE THY NEIGHBOR AS THY SELF, PARABLE OF THE GOOD SAMARITAN had a significant impact on Nursing • •
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CHRISTIANITY – the greatest impact in the influence of religion in the development The religious values of self-denial, Spiritual Calling, Devotion to Duty, and Hard Work dominated Nursing throughout the history and led to the development. Knights’ contributions, Fabiola’s contributions, the saints and other personalities Deaconesses – Theodore Fliedner
HISTORICAL PERSPECTIVE WAR Crimean War (Arm conflict between England and allies Turkey, Sardinia vs. Russia); 1854-1856. Florence Nightingale emerged and became well-known (Crimean War) She was asked by Sir Sidney Herbert of the British war department to recruit contingent of female nurses to provide care to the sick and injured in Crimea. She transformed military camps into hospitals by setting up sanitation process: hand washing and washing clothes regularly. WAR American Civil War (1861-1865) Harriet Tubman and Sojourner Truth – provided care and safety to slaves fleeing to the North on the Underground Railroad Mother Biekerdyke and Clara Barton – searched the battlefield and gave care to injured and dying soldiers Walt Whitman And Loiusa May Alcott – volunteered as nurses to give care to injured soldiers in military hospitals World War II Created acute shortage of care Cadet Nurse Corps – established in response to markes shortage of nurses Auxiliary health care workers became prominent Practical Nurses, aides, and technicians provided much of the actual nursing care under the instruction and supervision of better prepared nurse Medical specialties aros to meet the needs of hospitalized clients HISORICAL PERSPECTIVE SOCIETAL ATTITUDES Nursing was without organization, no education, and social status Women’s role was – in the home and no respectable woman should have a career Victorian Middle Class Women – were just wives to their husbands and children Nurses were poorly educated, some were incarcerated criminals – This was reflected in the book written by Charles Dickens through the character of Sairy Gamp – who cared for the patients by stealing from them, physically abused them. This literary works has greatly affected social attitudes about nursing, the negative impression and image of nurses up to the contemporary period. Guardian Angel or Angel of Mercy – image arose in the latter part of 19 th century because of work of Florence Nightingale in the Crimean War. She brought respectability to the nursing profession, nurses were viewed as noble, compassionate, moral, religious, dedicated, and self-sacrificing • • •
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Doctor’s handmaiden – image arising in the early 19 th century ; this image evolved when women had yet to obtain the right to vote; the family structures were highly paternalistic, and when the medical profession portrayed increasing use of scientific knowledge that was viewed as male domain. Heroine – evolved from nurses acts of bravery during World War II and their contributions in fighting poliomyelitis – in the work of Australian nurse, Elizabeth Kenney.
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Florence Nightingale Clara Barton Lillian Wald Lavinia L. Dock Margaret Higgins Sanger Mary Breckinridge
FLORENCE NIGHTINGALE Contributions are well documented Lady with the Lamp st She was the 1 nurse to exert political pressure on government Notes on Nursing: What It is and What It Is Not – her greatest achievement ; made her be recognized as nursing’s 1 st scientist-theorist Born on a wealthy and intellectual family She was given an honorarium of 4500 and used it to develop Nightingale Training School for Nurses, which was opened in 1860. CLARA BARTON A school teacher who volunteered as nurse during the American Civil War Her responsibility was to organize the nursing services Established the American Red Cross LILIAN WALD Founder of Public Health Nursing st Wald and Mary Brewster were the 1 one to offer trained nursing services to the poor in the New York slums LAVINIA L. DOCK Feminist, prolific writer, political activist, suffragette Friend of Wald She participated in protest movements for women’s rights which granted women to vote. Campaigned for legislation to allow nurses rather than physicians to control their professions Founded the American Society of Superintendents of Training Schools for Nurses on the United States and Canada – precursor to the current National League for Nursing
MARGARET HIGGINS SANGER Public health nurse in New York Had a lasting impact on women’s health care st Imprisoned for opening the 1 birth control information clinic in America Considered to be the founder of “Planned Parenthood” MARY BRECKINRIDGE Notable pioneer nurse Established “Frontier Nursing Service (FNS)” She worked with the American Committee for Devastated France, distributed food, clothing, and supplies to rural villages and taking care of the sick children. • • •
HISTORY OF NURSING (PHILIPPINE SETTING) EARLY BELIEFS AND PRACTICES Beliefs About Causation of Diseases: Caused or inflicted by other person (enemy or witch) Evil spirits Beliefs That Evil Spirits Could Be Driven Off By Person With Powers To Expel Bad Spirits: Believed in Gods of healing Word doctors – priest physicians Herbolarios – herb doctors • • •
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EARLY CARE OF THE SICK HERBICHEROS – herbmen who practice witchcraft MANGKUKULAM / MANGANGAWAY – a person suffers from disease without any identified cause and were believed bewitched by such Difficult child birth and some diseases (PMAO) attributed to (NONO) midwives Difficult birth, witches were supposed to be the cause, gunpowder exploded from a bamboo pole close to the head of the mother to drive evil spirits • •
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EARLY HOSPITALS: Hospital Real de Manila – 1577 1st hospital established Gov. Francisco de Sande To give service to king’s Spaniard soldiers San Lazaro Hospital – 1578 Fray Juan Clemente Named after the Knights of St. Lazarus Hospital for the lepers Hospital de Indios – 1586 Franciscan Orders Hospital for the poor Filipino people Hospital de Aguas Santas – 1590 Fray Juan Bautista • • • • • • • • • • • • •
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Named after its location (near spring) because people believed that spring has a healing power. San Juan de Dios Hospital – 1596 For poor people Located at Roxas Boulevard
PERSONAGES: Dona Hilaria de Aguinaldo 1st wife of Emilio Aguinaldo Established Philippine Red Cross – February 17, 1899 Dona Maria Agoncillo de Aguinaldo 2nd wife of Emilio Aguinaldo 1st president of Philippine Red Cross (Batangas Chapter) Josephine Bracken Helped Rizal in treating sick people Melchora Aquino Took care of the wounded Katipuneros Anastacia Giron Tupaz Founder of Filipino Nurses Association – established on October 15, 1922 1st Filipino chief nurse of PGH 1st Filipino Superintendent of Nurses in the Philippines Francisco Delgado 1st president of Filipino Nurses Association Cesaria Tan 1st Filipino to receive Masteral Degree in Nursing abroad Socorro Sirilan Pioneer in Social Service at San Lazaro Hospital Also the chief nurse Rosa Militar Pioneer in nursing education Socorro Diaz 1st editor of PNA magazine called, “The Message” Conchita Ruiz Full time editor of the PNA newly named magazine, “The Filipino Nurse • •
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Iloilo Mission Hospital and School of Nursing Established in 1906 under the supervision of Rose Nicolet (American) Nursing course – 3yrs. Produced 1st batch of Nursing graduates in 1909 – 22 nurses 1st TRAINED NURSES: Nicasia Cada Felipa Dela Pena Dorotea Caldito st April 1944 – 1 Nursing Board Exam at Iloilo Mission Hospital PGH School of Nursing – 1907 St. Paul School of Nursing – 1907 St. Luke’s School of Nursing – 1907 UST – 1946
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NURSING: DEFINITIONS NURSING (as an art) Is the art of caring sick and well individual. It refers to the dynamic skills and methods in assisting sick and well individual in their recovery and in the promotion and maintenance of health NURSING (as a science) Is the scientific knowledge and skills in assisting individual to achieve optimal health. It is the diagnosis and treatment of human responses to actual or potential problem •
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NURSING: DEFINITIONS FLORENCE NIGHTINGALE Nursing is the act of utilizing the environment of the patient to assist him in his recovery. •
VIRGINIA HENDERSON Nursing is the act of assisting the individual, sick or well, in the performance of those activities contributing to health or its recovery (or to a peaceful death) that he would perform unaided if he had the necessary strength, will, or knowledge, and to do this in such a way as to help him gain independence as rapidly as possible. •
NURSING: DEFINITIONS CANADIAN NURSES ASSOCIATION (CNA) Nursing is a dynamic, caring, helping relationship in which the nurse assist the client to achieve and obtain optimal health. – 1987 THEMES THAT ARE COMMON TO THESE DEFINITION: Nursing is caring Nursing is an art Nursing is a science Nursing is client-centered Nursing is holistic Nursing is adaptive Nursing is concerned with health promotion, health maintenance, and health restoration Nursing is a helping profession •
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NURSING: DEFINITIONS
AMERICAN NURSES ASSOCIATION (ANA) 1973 Nursing is direct, goal oriented, and adaptable to the needs of the individual, the family, and community during health and illness. 1980 Nursing is the diagnosis and treatment of human responses to actual or potential health problems. 1995 ANA acknowledges FOUR ESSENTIAL FEATURES OF CONTEMPORARY NURSING PRACTICE: Attention to the full range of human experiences and responses to health and illness without restriction to a problem-focused orientation. Integration of objective data with knowledge gained from understanding of the client or group’s subjective experience. Application of scientific knowledge to the processes of diagnosis and treatment. Provision of caring relationship that facilitates health and healing. • •
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NURSE: DEFINITION
NURSE ✔ Comes from a Latin word “to nourish” or “to cherish ✔ One who cares for the sick, the injured, and the physically, mentally, and emotionally disabled. One who advise and instruct individuals, families, groups and communities in the prevention, treatment of illness and diseases and in the promotion of health. ✔ An essential member of a health team who cares for individuals, families and communities in disease and illness prevention and in the promotion of health and healthy environment. PATIENT: DEFINITION PATIENT ✔ Comes from a Latin word, “to Suffer” or “to Bear” ✔ An individual who is in the state of physical, mental, and emotional imbalance. An individual who seeks for nursing assistance, medical assistance, or for surgery due to illness or a disease. Is an individual who is waiting or undergoing medical or surgical care. One who is physically or mentally disabled. NURSING PROGRAMS Licensed Vocational Nursing Program / Licensed Practical Nursing Program (LVN,LPN) REGISTERED NURSING PROGRAMS: Community College / Associate Degree Diploma Program Baccalaureate Degree Program •
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GRADUATE NURSING EDUCATION: Master’s Degree Doctoral Degree External Degree LVN / LPN Licensed Vocational Nursing Program / Licensed Practical Nursing Program (LVN,LPN) Last for 9 – 12 months Provide both classroom and clinical experiences Provided by the community colleges, vocational schools, hospitals, or other independent health agencies. Under supervision of RN Prepares students how to give basic direct technical care Graduate takes NCLEX – PN to obtain license as a practical or vocational course. • • • • •
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REGISTERED NURSING PROGRAMS Community College / Associate Degree Arose in early 1950s 2-year program Technical nurse or bedside nurse ADN (AA or AS) Diploma Program 3-year program Hospital-based Provide rich clinical experience for nurses Associated with colleges and universities • • • • • • • • • •
REGISTERED NURSING PROGRAMS Baccalaureate Degree Program Early Baccalaureate Program à 5-year program (3-year diploma program in addition to 2 years of liberal arts) Today’s Baccalaureate Degree Program à 4-5-year program Offer courses in the liberal arts, sciences, humanities, and nursing Graduates must fulfill both the degree requirements of the college or university and the nursing program before being awarded a baccalaureate degree. BSN Also admit RN who have diplomas or associate degrees. Much background More theories • •
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GRADUATE NURSING EDUCATION Master’s Degree 1.5 – 2-year program Encourage the development of graduate study in nursing Major emphasis was to be research and specialization for teaching and administration • • • •
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Provide specialized knowledge and skills that enable nurses to assume advanced roles in practice, education, administration, and research. MAN / MSN Doctoral Program PhD, DNS, ND Further prepares the nurse for advanced clinical practice, administration, education, and research. Content and approach vary among doctoral programs. All emphasized research No specific time EXTERNAL DEGREE External Degree Offers credit for expertise gained outside formal classroom setting Seminars post- grad courses No specific time Short courses
ROLES OF A NURSE Caregiver Communicator Teacher Client Advocate Counselor Change Agent Leader Manager Case Manager Research Consumer Role Model Administrator Expanded Career Roles ROLES OF A NURSE Caregiver Primary goal TYPES OF CARE: Full Care à for completely dependent patient Partial Care à for partially dependent patient Supportive-Educative care à to assist clients in attaining their highest possible level of health and wellness; for learnings Communicator Integral to all nursing roles Nurses communicate with the client, support persons, other health professionals, and people in the community Nurses identify client problems and then communicate these verbally or in writing to other members of the health team ROLES OF A NURSE Teacher Nurses help clients learn about their health and the health care procedure they need to perform to restore or maintain their health. • • • • • • • • • • • • •
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Nurses assesses the client’s learning needs and readiness to learn, sets specific learning goals in conjunction with the client, enacts teaching strategies, and measures learning. Nurses also teaches unlicensed assistive personnel to whom they delegate care, and they share their expertise with other nurses and health professionals. Client Advocate Acts to protect the client Nurse may represent the client’s needs and wishes to other health professionals, such as relaying the client’s wishes for information to the physician. Nurses assist clients in exercising their rights and help them speak up for themselves ROLES OF A NURSE Counselor Helping a client recognize and cope with stressful psychologic or social problems, to develop improved interpersonal relationships, and to promote personal growth. Involves providing emotional, intellectual and psychologic support. Nurses counsel primarily healthy individuals with normal adjustment difficulties and focuses on helping the person develop new attitudes, feelings, behaviors by encouraging the client to look at alternative behaviors, recognizing the choices, and develop sense of control. Change Agent Assisting others to make modifications in their own behavior. Nurses also often act to make changes in a system if it is not helping client return to health. ROLES OF A NURSE Leader Influences others to work together to accomplish a specific goal. Can be employed at different levels: individual client, family, groups of clients, colleagues, or the community Case Manager Work with the multidisciplinary health care team to measure the effectiveness of the case management plan and to monitor outcomes. Works with primary or staff nurses to oversee the care of a specific caseload. Primary nurse or provides some level of direct care to the client and family Helps ensure that care is oriented to the client, while controlling costs. ROLES OF A NURSE Research Consumer Often use research to improve client care Have some awareness of the process and language of research Be sensitive to issues related to protecting the rights of human subjects Participate in the identification of significant researchable problems Be a discriminating consumer of research findings Role Model Has good physical appearance Practices proper hygiene Practices healthy lifestyle ROLES OF A NURSE •
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Administrator Assumes middle management position Connects the patient to other services of the hospital Expanded Career Roles Nurse practitioner, clinical nurse specialist, nurse midwife, nurse educator, nurse researcher, and nurse anesthetist All of which allow greater independence and autonomy.
SCOPE OF NURSING PRACTICE FOUR AREAS: ✔ Promoting Health and Wellness ✔ Preventing Illness ✔ Restoring Health ✔ Care of the Dying SCOPE OF NURSING PRACTICE PROMOTING HEALTH AND WELLNESS ✔ Wellness – state of well-being. Engaging in attitudes and behavior that enhance the quality of life and maximize personal potential ✔ For both healthy and ill. ✔ Involve individual and community activities to enhance healthy lifestyle, such as improving nutrition and physical fitness, preventing drug and alcohol misuse, restricting smoking, and preventing accidents and injury in the home and workplace. SCOPE OF NURSING PRACTICE ✔ PREVENTING ILLNESS ✔ The goal is to maintain optimal health by preventing diseases ✔ Nursing activities includes immunizations, prenatal and infant care, and prevention of sexually transmitted disease. SCOPE OF NURSING PRACTICE ✔ RESTORING HEALTH ✔ Focuses on the ill client ✔ Extends from early detection of disease to helping the client during the recovery period NURSING ACTIVITIES: Providing direct care to the ill person: administering medications, baths, and specific procedures and treatments Providing diagnostic and assessment procedures: measuring BP and examining feces for occult blood Consulting with other health care professionals about client’s problems Teaching clients about recovery activities: exercise that will accelerate recovery after a stroke Rehabilitating clients to their optimal functional level following physical or mental illness, injury, or chemical addiction •
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SCOPE OF NURSING PRACTICE CARE OF THE DYING Involves comforting and caring for people of all ages who are dyingIncludes helping clients live as comfortable as possible until death and helping support persons cope with death. Work in homes, hospitals, and extended care facilities Hospices are specifically designed for this purpose. • •
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BIOETHICAL ISSUES IN NURSING “DO NOT RESUSCITATE” ORDER (DNR) Physician may order “no code” or “do not resuscitate” for client who are in stage of terminal, irreversible illness, or expected death. DNR order that no effort be made to resuscitate the client in the event of respiratory or cardiac arrest. ABORTION Termination of pregnancy before the fetus reaches the stage of viability. EUTHANASIA “mercy killing” The act of painlessly putting to death persons suffering from incurable or distressing disease. HUMAN CLONING Human reproduction / replication SEX TRANSPLANT Sex change • •
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PROFESSIONAL CRIMES CRIME – act committed in violation of Public Law and punishable by a fine and/or imprisonment FELONY – serious in nature (ex. Murder) MISDEMEANOR – less serious in nature (ex. Negligence) nd MANSLAUGHTER – 2 degree crime; unintentional TORT – civil wrong against a person TYPES: Intentional Unintentional NEGLIGENCE The doing of that thing, which a reasonably prudent person would not have done, or the failure to do that thing which a reasonably prudent person would have done, in like or similar circumstance. Act of omission or commission • •
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THEORIES OF NEGLIGENCE: Respondeat Superior – let the superior answer ; let the principal answer for the acts of his agent Res Ipsa Loquitur – the thing speaks for itself; talks about the evidence; you cannot deny the negligence because of the presence of evidence. Force Majeure – irresistible or superior force. It is a fact or accident which human prudence can neither foresee nor prevent •
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PROFESSIONAL CRIMES MALPRACTICE Any professional misconduct, or any unreasonable lack of skill, or fidelity in the performance of the professional or fiduciary duties. For Nurses, Malpractice refers to the failure to follow a reasonable professional standard of care, thereby, resulting to injury of patient • •
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PROFESSIONAL CRIMES INVASION OF PRIVACY Violation on the right of an individual to withhold herself and her life from public scrutiny. Violation on the right to remain alone and the right to keep information. FRAUD False presentation of some facts with the intention that will be acted upon by another person. Willful misrepresentation PROFESSIONAL CRIMES DEFAMATION Derogatory remarks about a person Making false statements about a person that can result to the injury of his reputation KINDS OF DEFAMATION: Slander – oral defamation Libel – written defamation ASSAULT Attempt or threat or to touch another person unjustifiably PROFESSIONAL CRIMES BATTERY Assault that is carried out Willful touching of a person (without consent) that may or may not cause harm Performing procedures without consent INCOMPETENCE Lack of knowledge or skills FALSE IMPRISONMENT Prevention of movement without consent Unlawful restraint or detention of another person against his or her wishes CONSENT KINDS OF CONSENT: IMPLIED CONSENT ○ ○ INFORMED CONSENT • •
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Agreement by the client to accept a course of treatment or a procedure after complete information, including the risk of treatment and facts relating to it, has been provided by the physician ELEMENTS OF INFORMED CONSENT: Consent must be given voluntarily Consent must be given by an individual with the capacity, competence, and understanding. The client must be given enough information to be the ultimate decision maker. CONSENT ○
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NURSE’S RESPONSIBILITY Witnessing the exchange between the client and the physician. Establish that the client really did understand, that is, was really informed Witnessing the client’s signature PEOPLE WHO ARE NOT ALLOWED TO PROVIDE CONSENT: Minors – below 18 years old; except for married and already a parent Mentally ill Unconscious or injured in such a way that they are unable to give consent.
IMPLIED CONSENT In a life threatening situations and consent can not be obtained from the client or relatives, the law generally agrees that consent is assumed. •
Concept of man •
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Atomistic approach- views man as an organism composed of different organs systems where its system is composed of organs and each organ is composed of tissues and cells. Holistic approach-this view traces man’s relationship with other human beings in the supra system of society. ○ - views man as a whole organism with interrelated and inter dependent parts functioning to produce behavior The Dimention of man- Man as a physical being has such characteristics as genetic endowment, sex, other physical attributes, structure and fnx. Man as a social being- capable of relating with others Man as spiritual being- capable of such virtues as faith,hope and charity Man as a cognitive (thinking)-capable of perception,cognition and communication (logical thinking and reasoning) Man as a psychological being- capable of of rationality. His rational side makes him merciful, kind and compassionate.
Abraham Maslow’s heirarchy of basic needs NEED- IS SOMETHING THAT IS ESSENTIAL TO THE SURVIVALS OF hUMAN •
*A basic need is something whose: 1. absence may lead to illness 2. presence may signal health or prevent illness 3. if unmet needs are met, health maybe restored.
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Concept of health,wellness and well-being Health- is a state of complete physical,mental, social well-being, not merely the absence of disease or infirmity(WHO, 1947) Wellness and Well-being- a state of well being, a subjective perception of balance,harmony and vitality. Wellness different Dimention Physical-the ability to carry-out daily task (grooming,mobility, etc.)to achieve fitness of the diff. organ organ systems ofb the body. Social Emotional Intellectual Spiritual
