PERIODS OF NURSING HISTORY Intuitive Period Apprentice Period Educative Period 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
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PERIODS OF NURSING HISTORY
Intuitive Period
Apprentice Period
Educative Period
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
Start of scientific knowledge à more complex life à increase in health problems à demand for more nurses
Nursing as a duty 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 ideologies:
Judaism
Christianity
Mohammedism or Islam
- Near East culture was adopted by the Greeks and Romans combine with the wonders of the Far East by returning 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
1st 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
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 about 250 diseases and treatments
HEBREW
Teachings 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 – 3rd book of the Old Testament
Laws controlling the spread of communicable diseases
Laws governing cleanliness
Laws on preparation of food
Purification of man and his food
The ritual of CIRCUMCISION – on the 8th 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
CHINA
Use of 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
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
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
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
APPRENTICE PERIOD
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 6th century through the Crusades in the 11th 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 power
Crusades 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 for men 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 2nd 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 2nd 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”
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 – Lambert Le Begue
Oblates (12th Century)
Benedictines
Ursulites
Augustinians
DARK PERIOD OF NURSING
From 17th century – 19th 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 1st 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 1st 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
EDUCATIVE PERIOD
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.
EDUCATIVE PERIOD
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:
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.
Includes scientific and technological development, social changes occurring after the war.
Nursing is offered in College and Universities
CONTEMPORARY PERIOD
DEVELOPMENT AND TRENDS:
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
HISTORICAL PERSPECTIVE
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
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
HISTORICAL PERSPECTIVE
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 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 arose 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 19th 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
HISORICAL PERSPECTIVE
SOCIETAL ATTITUDES
Doctor’s handmaiden – image arising in the early 19th 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
NURSING LEADERS
Florence Nightingale
Clara Barton
Lillian Wald
Lavinia L. Dock
Margaret Higgins Sanger
Mary Breckinridge
NURSING LEADERS
FLORENCE NIGHTINGALE
Contributions are well documented
Lady with the Lamp
She was the 1st 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 1st 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.
NURSING LEADERS
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
Wald and Mary Brewster were the 1st one to offer trained nursing services to the poor in the New York slums
NURSING LEADERS
LAVINIA L. DOCK
Feminist, prolific writer, political activist
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
NURSING LEADERS
MARGARET HIGGINS SANGER
Public health nurse in New York
Had a lasting impact on women’s health care
Imprisoned for opening the 1st birth control information clinic in America
Considered to be the founder of “Planned Parenthood”
NURSING LEADERS
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
HISTORY OF NURSING(PHILIPPINE SETTING)
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 (PAMAO) 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
HISTORY OF NURSING(PHILIPPINE SETTING)
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
HISTORY OF NURSING(PHILIPPINE SETTING)
EARLY HOSPITALS:
Hospital de Indios – 1586
Franciscan Orders
Hospital for the poor Filipino people
Hospital de Aguas Santas – 1590
Fray Juan Bautista
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
HISTORY OF NURSING(PHILIPPINE SETTING)
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
HISTORY OF NURSING(PHILIPPINE SETTING)
PERSONAGES:
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
HISTORY OF NURSING(PHILIPPINE SETTING)
PERSONAGES:
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
HISTORY OF NURSING(PHILIPPINE SETTING)
EARLY NURSING SCHOOLS
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
April 1944 – 1st Nursing Board Exam at Iloilo Mission Hospital
HISTORY OF NURSING(PHILIPPINE SETTING)
EARLY NURSING SCHOOLS
PGH School of Nursing – 1907
St. Paul School of Nursing – 1907
St. Luke’s School of Nursing – 1907
UST – 1946
MCU – 1947
Fatima – 1947
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
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
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.
Provision of caring relationship that facilitates health and healing.
NURSING: DEFINITIONS
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.
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
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.
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
REGISTERED NURSING PROGRAMS
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
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
Provide specialized knowledge and skills that enable nurses to assume advanced roles in practice, education, administration, and research.
MAN / MSN
GRADUATE NURSING EDUCATION
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
ROLES OF A NURSE
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.
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.
ROLES OF A NURSE
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.
ROLES OF A NURSE
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
ROLES OF A NURSE
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
ROLES OF A NURSE
Role Model
Has good physical appearance
Practices proper hygiene
Practices healthy lifestyle
ROLES OF A NURSE
Administrator
Assumes middle management position
Connects the patient to other services of the hospital
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
SCOPE OF NURSING PRACTICE
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
SCOPE OF NURSING PRACTICE
CARE OF THE DYING
Involves comforting and caring for people of all ages who are dying
Includes 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.
• HEALTH: A MULTIFACTORIAL PHENOMENON
• HEALTH
• “State of complete physical, mental and social well-being, not merely the absence of disease or infirmity” (WHO)
• Major contributor to the over arching goal of poverty reduction
• CLAUDE BERNARD
• Ability to maintain internal milieu.
• Illness is the result of failure to maintain internal environment.
• WALTER CANON
• Health is the ability to maintain homeostasis or dynamic equilibrium.
• Homeostasis is regulated by the negative feedback mechanisms.
• FLORENCE NIGHTINGALE
• Health is being well and using one’s full potential/power to the fullest extent.
• Maintained through prevention of diseases through ENVIRONMENTAL FACTORS.
• VIRGINIA HENDERSON
• Health is viewed in terms of the ability to perform 14 components of nursing care unaided.
• MARTHA ROGERS
• POSITIVE health symbolizes WELLNESS.
• It is a value term defined by the culture or individual.
• ROY
• Health is a STATE and a PROCESS of being and becoming an integrated and WHOLE PERSON.
• OREM
• Health is a state that is characterized by soundness or wholeness of developed human structures and of bodily and mental functioning.
• KING
• Health is a dynamic state in the life cycle; illness is the interference in the life cycle.
• NEUMAN
• Parts and subparts of an individual are in harmony with the whole system.
• JOHNSON
• Health is an elusive, dynamic state influenced by biologic, psychologic, and social factors. Health is reflected by the organization, interaction, interdependence and integration of sub-systems of the behavioral systems.
• WELLNESS AND WELL-BEING
• Wellness is well-being. It involves engaging in attitudes and behaviors and enhance the quality of life and maximize personal potential.
• Well-being is a subjective perception of balance, harmony, and vitality.
• Wellness is a choice.
• Wellness is a way of life.
• Wellness is the integration of body, mind, and spirit.
• Wellness is the loving acceptance of one’s self.
• MODELS OF HEALTH AND ILLNESS
• THE HEALTH-ILLNESS CONTINUUM (DUNN)
• Describes the interaction of the environment will well-being and illness.
• HIGH LEVEL OF WELLNESS (HLW) is an integrated of functioning that is oriented towards maximizing one’s potentialities within the limitations of the environment.
• Concepts connotes ability to perform ADL or to function independently.
• THE HEALTH-ILLNESS CONTINUUM (DUNN)
• THE HEALTH-ILLNESS CONTINUUM (DUNN)
• PRECURSORS OF ILLNESS
1. HEREDITY: family history of DM, HPN, CA
2. BEHAVIORAL FACTORS: cigarette smoking, alcohol abuse, high cholesterol diet
3. ENVIRONMENTAL FACTORS: overcrowding, poor sanitation, poor supply of potable water
• HEALTH BELIEF MODEL (BECKER, 1975)
• Describes the relationship between a person’s belief and behavior.
• Individual perceptions and modifying factors may influence health beliefs and preventive health behaviors.
• HEALTH BELIEF MODEL (BECKER, 1975)
1. INDIVIDUAL PERCEPTIONS:
1. PERCEIVED SUSCEPTIBILITY TO AN ILLNESS: family hx of DM increases risk to develop the disease
2. PERCEIVED SERIOUSNESS OF ILLNESS: DM lifelong disease
3. PERCEIVED THREAT OF ILLNESS: DM causes damage to brain, heart, eyes, kidneys, blood vessels
• HEALTH BELIEF MODEL (BECKER, 1975)
2. MODIFYING FACTORS
1.DEMOGRAPHIC VARIABLES: age, sex, race
2. SOCIOPSYCHOLOGIC VARIABLES: social pressure or influence from peer
3. STRUCTURAL VARIABLES: knowledge about the disease and prior contact with it
4. CUES TO ACTION: internal (fatigue, uncomfortable symptoms) external (mass media advice from others)
• HEALTH BELIEF MODEL (BECKER, 1975)
3. LIKELIHOOD OF TAKING RECCOMMENDED PREVENTIVE HEALTH ACTION
1. Perceived benefits of preventive action
2. Perceived Barriers to preventive action
Preventive health behavior may include lifestyle changes, increased adherence to medical therapies, search medical advice or treatment.
Perceived barriers to preventive action may be due difficulty to lifestyle changes, social pressures, physical symptoms such as fatigue, joints pains, economic factors, accessibility of healthcare facilities.
• HEALTH BELIEF MODEL (BECKER, 1975)
• SMITH’S MODEL OF HEALTH
1. CLINICAL MODEL: views people as physiologic system with related functions and identifies health as absence of signs and symptoms of disease or injury.
2. ROLE PERFORMANCE MODEL: defines health in terms of individual’s ability to fulfill societal roles such as performing work.
• SMITH’S MODEL OF HEALTH
3. ADAPTIVE MODEL: adaptation is the focus; views health as a creative processes and diseases as a failure in adaptation or mal-adaptation. Aim of treatment is to restore the ability of the person to adapt; COPE
4. EUDAEMONISTIC MODEL: HEALTH is a condition of actualization or realization of a person’s potential; avers the highest aspiration of people is fulfilment and complement development - actualization
• LEAVELL AND CLARK’S
Avers that there are three interactive fact be affected ors that affect health and illness.
1. AGENT: any factor or stressor that can lead to illness
2. HOST: persons who may or may not be susceptible to disease
3. ENVIRONMENT: any factor external to the host that may or may not predispose the person to a certain disease.
• LEAVELL AND CLARK’S
• DETERMINANTS OF HEALTH
• Affected by a combination of many factors
• Determined his circumstances and environment
• It is inappropriate therefore to blame or credit the persons state of health to himself alone because he is unlikely able to directly control many of these factors
• Knowledge of these factors is important in order to effectively promote health and prevent illnesses
• FACTORS AFFECTING HEALTH AND ILLNESS
• PHYSICAL DIMENSION
• Genetic make-up, age, developmental level, race and sex are all part of an individual’s physical dimension and strongly influence health status and health practices.
Examples:
a. The toddler just learning to walk is prone to fail and injure himself.
b. The young woman who has a family history of breast cancer and diabetes and therefore is at a higher risk to develop these conditions.
• EMOTIONAL DIMENSION
• How the mind and body interact to affect body function and to respond to body conditions also influences health. Long term stress affects the body systems and anxiety affects health habits; conversely, calm acceptance and relaxation can actually change body responses to illness.
Examples:
a. Prior to a test, a student always has diarrhea.
b. Extremely nervous about a surgery, a man experiences severe pain following his operation.
c. Using relaxation techniques, a young woman reduces her pain during the delivery of her baby.
• INTELLECTUAL DIMENSION
• The intellectual dimension encompasses cognitive abilities, educational background and past experiences. These influence a client’s responses to teaching about health and reactions to health care during illness. They also play a major role in health behaviors.
Examples:
a. An elderly woman who has only a third-grade education who needs teaching about a complicated diagnostic test.
b. A young college student with diabetes who follows a diabetic diet but continues to drink beer and eat pizza with friends several times a week.
• ENVIRONMENTAL DIMENSION
• The environment has many influences on health and illness. Housing, sanitation, climate and pollution of air, food and water are aspects of environmental dimension.
Example:
a. Increased incidence of asthma and respiratory problems in large cities with smog.
• SOCIO-CULTURAL DIMENSION
• Health practices and beliefs are strongly influenced by a person’s economic level, lifestyle, family and culture.
• Low-income groups are less likely to seek health care to prevent or treat illness; high-income groups are more prone to stress-related habits and illness.
• SOCIO-CULTURAL DIMENSION
• The family and the culture to which the person belongs determine patterns of livings and values, about health and illness that are often unalterable.
Examples:
a. The adolescent who sees nothing wrong with smoking or drinking because his parents smoke and drink.
b. The person of Asian descent who uses herbal remedies and acupuncture to treat an illness.
• SPIRITUAL DIMENSION
• Spiritual and religious beliefs are important components of the way the person behaves in health and illness.
Examples:
a. Roman Catholics require baptism for both live births and stillborn babies.
b. Jehovah Witnesses’ are opposed to blood transfusions.
• ILLNESS AND DISEASE
ILLNESS
Personal state in which the person feels unhealthy.
State in which a person’s physical, emotional, intellectual, social development or spiritual functioning is diminished or impaired with previous experience.
• ILLNESS AND DISEASE
ILLNESS
Illness is not synonymous with disease ; although nurses must be familiar with different kinds of diseases and their treatments thay are concerned more with illness which may include disease but also the effects on functioning and well-being in all dimensions.
• DISEASE
Alteration in body functions resulting in reduction of capacities shortening of the normal life span.
COMMON CAUSES OF DISEASE
1. Biologic agents (microorganisms)
2. Inherited genetic defects (cleft palate)
3. Developmental defects (imperforate anus)
4. Physical agents (radiation, UV rays, hot & cold substances)
5. Chemical agents (lead)
6. Tissue response to irritation (fever, inflammation)
8. Emotional/physical reaction to stress (anxiety. Fear)
• STAGES OF ILLNESS
1. Symptom experience
Transition stage
WRONG
Experiences some symptom
3 ASPECTS:
PHYSICAL (muscle aches, headache)
COGNITIVE (perception of having “flu”)
EMOTIONAL (worry on consequence of illness)
• STAGES OF ILLNESS
2. Assumption of Sick Role
Acceptance of the illness
Seeks medical advice, support for decision to give up some activities
3. Medical Care Contact
Seeks advice to medical professionals for several reasons:
1. validation of real illness
2. explanation of symptoms
3. reassurance or prediction of outcome
• STAGES OF ILLNESS
4. Dependent Patient Role
The person becomes a client dependent on health professional for help
Accepts/rejects health professiona’s suggestions
Become more passive and accepting
May regress to an earlier behavioral stage.
• STAGES OF ILLNESS
5. Recovery and Rehabilitation
Gives up the sick role and returns to former roles and functions.
• ASPECTS OF SICK ROLE
One is not held responsible for his condition and person did not cause his illness
Excused from social roles and person is allowed to rest by seeking sick leave or LOA.
Obliged to get well as soon as possible and expected to cooperate and comply with recommended therapies.
Obliged to seek for competent help and expected to seek help from health professionals.
• RISK FACTORS
Any situation, habit, social or environmental condition, physiological, or psychological condition, developmental, intellectual condition or spiritual or other variable that increases the vulnerability of an individual or group to an illness or accident.
It s presence doesn’t necessarily mean that a disease will develop but risks factors increases the chances that the individual will experience a particular dysfunction.
• RISK FACTORS OF A DISEASE
1. GENETIC AND PHYSIOLOGICA FACTORS
2. AGE
3. ENVIRONMENT (CA)
4. LIFESTYLE
GOAL OF RISK FACTOR IDENTIFICATION: merely assist clients in visualizing those areas in their life that can be modified or even eliminated to promote wellness and prevent illness.
• CLASSIFICATION OF DISEASE: ETIOLOGIC FACTORS
1. Hereditary
2. Congenital
3. Metabolic
4. Deficiency
5. Traumatic
6. Allergic
7. Neoplastic
8. Idiopathic
9. Degenerative
10. Iatrogenic
• CLASSIFICATION OF DISEASE: DURATION OR ONSET
1. ACUTE ILLNESS: short duration; severe; symptoms are abrupt; intense and subside after relatively short periodaffects functioning in any dimension
2. CHRONIC ILLNESS: persists usually longer than 6 months and can also affect functioning in any dimension. Client may fluctuate between maximal functioning and serious relapses that may be life threatening. Characterized by REMISSION AND EXACERBATION
• CLASSIFICATION OF DISEASE: DURATION OR ONSET
REMISSION: period during which the disease is controlled and symptoms are not obvious
EXACERBATION: disease becomes more active again at a future time, with reccurence of pronounced symptoms.
