EGERTON UNIVERSITY

COLLEGE OF OPEN AND DISTANCE LEARNING

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NURS 100: Introduction to Fundamentals of Nursing

Topic 1 Handout

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Topic 1: Introduction To Concepts And Principles Of Nursing.

1.1 Definitions of nursing

i. Florence Nightngale’s definition.

Florence Nightingale defined nursing as "the act of utilizing the environment of the patient to assist
him in his recovery" Nightingale considered a clean, well-ventilated, and quiet environment essential
for recovery.

Often considered the first nurse theorist, Nightingale raised the status of nursing through education.
Nurses were no longer untrained housekeepers but people educated in the care of the sick.

ii. Virginia Henderson’s definition

She defined nursing as; "The unique function of the nurse is to assist the individual, sick or well, in
the performance of those activities contributing to health or its recovery (or to peaceful death) that
he would perform unaided if he had the necessary strength, will, or knowledge, and to do this in such

a way as to help him gain independence as rapidly as possible" Like Nightingale, Henderson
described nursing in relation to the client and the client's environment.

Unlike Nightingale, Henderson saw the nurse as concerned with both healthy and ill individuals,
acknowledged that nurses interact with clients even when recovery may not be feasible, and
mentioned the teaching and advocacy roles of the nurse.

Themes that are common to many of these definitions are; nursing is caring, nursing is an art, nursing
is a science, nursing is client centered, nursing is holistic, nursing is adaptive, that nursing is
concerned with health promotion, health maintenance, and health restoration, another team that
comes out clearly is that nursing is a helping profession.

1.2 The scope of nursing

You are now going to look at the scope of nursing, before that it is important that you identify the
recipients of nursing care who are referred to as consumers, patients, or clients. A consumer is an
individual, a group of people, or a community that uses a service or commodity. People who use
health care products or services are consumers of health care.

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A patient is a person who is waiting for or undergoing medical treatment and care. The word patient
comes from a Latin word meaning "to suffer" or "to bear." With the emphasis on health promotion
and prevention of illness, many recipients of nursing care are not ill. You as a nurse, will also interact
with family members and significant others to provide support, information, and comfort in addition
to caring for the patient hence referring to them as clients.

Hence as a nurse you will be required to provide care for three types of clients: individuals, families
and communities and it involves four areas: promoting health and wellness, preventing illness,
restoring health, and caring for the dying.

1.2.1 Promoting Health and Wellness

Wellness is a process that engages in activities and behaviors that enhance quality of life and
maximize personal potential, nurses promote wellness in clients who are both healthy and ill. This
may involve individual and community activities to enhance healthy lifestyles, such as improving
nutrition and physical fitness, preventing drug and alcohol misuse, restricting smoking, and
preventing accidents and injury in the home and workplace.

1.2.2 Preventing Illness

The goal of illness prevention programs is to maintain optimal health by preventing disease. Nursing
activities that prevent illness include immunizations, prenatal and infant care, and prevention of
sexually transmitted diseases.

1.2.3 Restoring Health

Restoring health focuses on the ill client, and it extends from early detection of disease through
helping the client during the recovery period.

Nursing activities towards restoring health include;

i. Providing direct care to the ill person, such as administering medications, baths, and
specific procedures and treatments.

ii. Performing diagnostic and assessment procedures, such as measuring blood pressure and
examining feces for occult blood.

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 iii. Consulting with other health care professionals about client problems.

iv. Teaching clients about recovery activities, such as exercises that will accelerate recovery
after a stroke.

v. Rehabilitating clients to their optimal functional level following physical or mental

illness, injury, or chemical addiction

1.2.4 Caring for the Dying

This area of nursing practice involves comforting and caring for people of all ages who are dying. It
includes helping clients live as comfortable as possible until death and helping support persons cope
with death. Nurses carrying out these activities work in homes, hospitals, and extended care facilities.
Some agencies, called hospices, are specifically designed for this purpose

1.3 Roles and functions of a nurse

Nurses assume a number of roles when-they provide care to clients. Nurses often carry out these roles
concurrently, not exclusively of one another. For example, the nurse may act as a counselor while
providing physical care and teaching aspects of that care. The roles required at a specific time depend
on the needs of the client and aspects of the particular environment.

1.3.1 Caregiver role

This nursing role includes activities that assist the client physically and psychologically while
preserving the client's dignity.

The required nursing actions include;

i. Complete nursing care for a dependent client

ii. Partial care for the partially dependent client

iii. Supportive-educative care to assist clients in attaining their highest possible level of
health and wellness.

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Care giving encompasses the physical, psychosocial, developmental, cultural, and spiritual levels.
The nursing process provides nurses with a framework for providing care

1.3.2 Communicator role

Nurses communicate with the client, support persons, other health professionals, and people in the
community. In the role of communicator, nurses identify client problems and then communicate these
to other members of the health team. The nurse should have good communication skills to be able to
communicate clearly and accurately in order for a client's health care needs to be met.

1.3.3 The Teacher role

The nurse helps clients to learn about their health and the health care procedures which restore or
maintain their health. The nurse 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.

1.3.4 Client Advocate

As the client’s advocate; the nurse acts to protect the client and represents the client's needs and
wishes to other health professionals, such as relaying the client's wishes for information to relevant
health team members, assist clients in exercising their rights and help them speak up for themselves.

1.3.5 Counselor

As a counselor; the nurse helps the client to recognize and cope with stressful psychologic or social
problems, to develop improved interpersonal relationships, and to promote personal growth; i.e
providing emotional, intellectual, and psychologic support. The nurse counsels primarily healthy
individuals with normal adjustment difficulties and focuses on helping the person develop new
attitudes, feelings, and behaviors by encouraging the client to look at alternative behaviors, recognize
the choices, and develop a sense of control.

1.3.6 Change Agent

The nurse assists clients to make modifications in their behaviours, acts to make changes in a system
e.g in clinical care, nurses are also continually dealing with change in the health care system e.g
change in the age of the client population, technology and changes in medications.

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1.3.7 Leader

As a leader, the nurse influences others to work together to accomplish a specific goal at different
levels; individual client, family, groups of clients, colleagues, or the community.

1.3.8 Manager

The nurse manages the nursing care of individuals, families, and communities. The nurse manager
also delegates, supervises and evaluates performance. Managing requires knowledge about
organizational structure and dynamics, authority and accountability, leadership, change theory,
advocacy, delegation, and supervision and evaluation

1.4 Nurses professional organizations

1.4.1 Nursing as a profession

Nursing is gaining recognition as a profession. A Profession is an occupation that requires extensive

education or a calling that requires special knowledge, skill and preparation.

Nursing as a profession is distinguished from other kinds of professions by

i. Its requirement of prolonged, specialized training to acquire a body of knowledge pertinent

to the role to be performed

ii. An orientation of the individual toward service, either to a community or to an organization

iii. Ongoing research

iv. A code of ethics

v. Autonomy

vi. A professional organization.

1.4.2 Professionalism and professionalization.

Professionalism refers to professional character, spirit, or methods. It is a set of attributes, a way of

life that implies responsibility and commitment.

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Nursing professionalism owes much to the influence of Florence Nightingale. Professionalization is
the process of becoming professional, that is, of acquiring characteristics considered to be
professional.

1.4.3 Nurses Professional Organizations

Operation under the umbrella of a professional organization differentiates a profession from an

occupation. Governance is the establishment and maintenance of social, political, and economic
arrangements by which practitioners control their practice, their self-discipline, their working
conditions, and their professional affairs. Nurses, therefore, need to work within their professional
organizations.

As a profession, nursing is involved in identifying its own unique body of knowledge essential to
nursing practice (nursing science) To identify this knowledge base, nurses must develop and
recognize concepts and theories that are specific to nursing. Because theories in some other
disciplines were developed and used much before most nursing theories, it is helpful to briefly
explore how theory has been used by those disciplines before considering theory in nursing.

1.5 Theories of nursing

1.5.1 Definitions

i. Theory has been defined as a supposition or system of ideas that is proposed to explain a
given phenomenon. It is very well-articulated idea about something important. Theories are
also used to describe, predict, and control phenomena.

ii. A conceptual framework is a group of related ideas, statements, or concepts that make up a
theory. Freud's structure of the mind (id, ego, superego) could be considered a conceptual
framework or model. The term conceptual model is often used interchangeably with
conceptual framework

iii. Concepts are often called the building blocks of theories.

iv. A conceptual model is often used interchangeably with conceptual framework, and
sometimes with grand theories, those that articulate a broad range of the significant
relationships among the concepts of a discipline

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 v. A paradigm refers to a pattern of shared understandings and assumptions about reality and
the world. Paradigms include notions of reality that are largely unconscious or taken for
granted, paradigm is used in a variety of ways by different authors hence its everyday usage
varies.

1.5.2 Concepts central to nursing

The following four concepts are considered to be central to be central to nursing.

i. Person or client; This are the recipients of nursing care and includes individuals, families,
groups, and communities.

ii. Environment; This describes the internal and external surroundings that affect the client i.e
people in the physical environment, such as families, friends, and significant others.

iii. Health; the degree of wellness or well-being that the client experiences.

iv. Nursing; This includes the attributes, characteristics, and actions of the nurse providing care
on behalf of, or in conjunction with, the client.

1.5.3 Purpose of Nursing theory

Nursing theory has direct links to education, research and clinical practice; nursing theory guides
knowledge development and directs education, research and practice.

1.5.4 Selected nursing theories

i. Nightingale's Environmental Theory

Florence Nightingale, is considered the first nurse theorist, she defined nursing as "the act of utilizing
the environment of the patient to assist him in his recovery" she linked health with five environmental
factors; Fresh air, Pure water, efficient drainage, cleanliness and direct sunlight.

Deficiencies in these five factors produced lack of health or illness.

The environmental factors were important considering the sanitation conditions of hospitals in the
1800s where women who worked in the hospitals were uneducated. Nightingale also stressed the
importance of keeping the client warm, maintaining a noise-free environment, and attending to the
client's diet in terms of assessing intake, timeliness of the food, and its effect on the person.

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 ii. Palau’s Interpersonal Relations Model

Hildegard Peplau was a psychiatric nurse who introduced her interpersonal concepts in 1952. Her
theory is about a therapeutic relationship between a nurse and a client that is personal (Inter-personal
concepts)

Nurses enter into a personal relationship with an individual when a need is present. The nurse-client
relationship evolves in four phases.

• Orientation: In this phase the client seeks help; the nurse assists the client to understand the
problem and the extent of the need for help.

• Identification: In this phase, the client assumes a posture of dependence, interdependence or

independence in relation to the nurse. The nurse's focus is to assure the person that the nurse
understands the interpersonal meaning of the client's situation.

• Exploitation: In this phase, the client derives full value from what the nurse offers through
the relationship. The client uses available services based on self-interest and needs. Power
shifts from the nurse to the client.

• Resolution: This is the final phase where old goals are put aside and new ones adopted. Once
older needs are resolved, newer and more mature ones emerge.

To help clients fulfill their needs as a nurse, you need to assume many roles; teacher, resource person,
surrogate, leader and counselor.

iii. Henderson’s Definition of Nursing

She defined nursing as; "The unique function of the nurse is to assist the individual, sick or well, in
the performance of those activities contributing to health or its recovery (or to peaceful death) that
he would perform unaided if he had the necessary strength, will, or knowledge, and to do this in such
a way as to help him gain independence as rapidly as possible"

Implications of her theory

• In 1966, her definition was a major stepping stone in the emergence of nursing as a discipline
separate from medicine.

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 • Like Nightngale, Hernderson describes nursing in relation to the client and the client’s
environment.

• Unlike Nightngale, Henderson sees the nurse as concerned with both healthy and ill
individuals, acknowledges that nurses interact with clients even when recovery may not be
feasible.

• She mentions the teaching and advocacy roles of the nurse.

Henderson conceptualizes the nurse’s role as assisting the sick or healthy individuals to gain
independence in meeting 14 fundamental needs:

i. Breathing normally

ii. Eating and drinking adequately

iii. Eliminating wastes

iv. Moving and maintaining a desirable position.

v. Sleeping and resting.

vi. Selecting suitable clothes.

vii. Maintaining body temperature within normal range.

viii. Keeping the body clean and well groomed to protect the intergument.

ix. Avoiding dangers in the environment and avoiding injuring others.

x. Communicating with others in expressing emotions, needs, fears or opinions.

xi. Worshiping according to one’s faith.

xii. Working in such a way that one feels a sense of accomplishment.

xiii. Playing or participating in various forms of recreation.

xiv. Learning, discovering, or satisfying the curiosity that leads to normal development
and health and using available health facilities.

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 iv. Roger’s Science of Unitary Human Beings

Martha Rodgers first presented her theory of unitary human beings in 1970

It contains complex conceptualizations related to multiple scientific disciplines (e.g., Einstein's

theory of relativity, Burr and Northrop's electrodynamic theory of life, von Bertalanffy's general
systems theory, and many other disciplines, such as anthropology, psychology, sociology,
astronomy, religion, philosophy, history, biology, and literature).

Rodgers views the person as an irreducible whole, the whole being being greater than the sum of its
parts. She states that humans are dynamic energy fields in continuous exchange with environmental
fields both of which are infinite. According to Rodgers unitary man is an irreducible, four-
dimensional energy field identified by pattern.

As a nurse, when you are applying Rodger’s theory, you should;

i. Focus on the person’s wholeness.

ii. Seek to promote symphonic interaction between the two energy fields (human and
environment) to strengthen the coherence and integrity of the person.

iii. Coordinate the human field with rhythmicities of the environmental field

iv. Direct and redirect patterns of interaction between the two energy field to promote maximum
health potential

Nurses' use of noncontact therapeutic touch is based on the concept of human energy fields. The
qualities of the field vary from person to person and are affected by pain and illness.

v. Orem’s General Theory of Nursing.

This theory was published in 1971, it includes three related concepts: self-care, self-care deficit and
nursing systems.

Self-care theory is based on four concepts, self-care, self-care agency, self-care requisites and
therapeutic self-care demand.

Self-care refers to those activities an individual performs independently throughout life to promote
and maintain personal wellbeing.

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Self-care agency is the individual’s ability to perform self-care activities. It has two agents.

i. A self-care agent (an individual who performs self-care independently)

ii. A dependent care agent (a person other than the individual who provides the care).

Most adults care for themselves, whereas infants and people weakened by illness or disability require
assistance with self-care activities.

Self-care requisites/self-care needs are measures or actions taken to provide self-care.

There are three categories of self-care requisites:

i. Universal requisites are common to all people. They include maintaining intake and
elimination of air, water, and food; balancing rest, solitude, and social interaction; preventing
hazards to life and well-being; and promoting normal human functioning.

ii. Developmental requisites result from maturation or are associated with conditions or events,
such as adjusting to a change in body image or to the loss of a spouse.

iii. Health deviation requisites result from illness, injury, or disease or its treatment. They
include actions such as seeking health care assistance, carrying out prescribed therapies, and
learning to live with the effects of illness or treatment.

Self-care deficit results when self-care agency is not adequate to meet the known self-care demand.
Orem’s theory explains not only when nursing is needed but also how people can be assisted through
five methods of helping i.e acting, guiding, teaching, supporting and providing an environment that
promotes the individual’s abilities to meet current and future demands.

Orem identifies three types of nursing systems:

i. Wholly compensatory systems are required for individuals who are unable to control
and monitor their environment and process information.

ii. Partly compensatory systems are designed for individuals who are unable to perform
some, but not all, self-care activities.

iii. Supportive-educative (developmental systems are designed for persons who need to
learn to perform self-care measures and need assistance to do so.

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vi. King's Goal Attainment Theory

Imogene King's theory of goal attainment (1981) was derived from her conceptual framework which
shows the relationship of operational systems (individuals), interpersonal systems (groups such as
nurse-patient), and social systems (such as educational system, health care system). She selected 15
concepts from the nursing literature (self, role, perception, communication, interaction, transaction,
growth and development, stress, time, personal space, organization, status, power, authority, and
decision making) as essential knowledge for use by nurses.

Ten of the concepts in the framework were selected; self, role, perception, communication,
interaction, transaction, growth and development, stress, time and personal space as essential
knowledge for use by nurses in concrete nursing situations.

The process describes the nature and standard for nurse-patient interactions that lead to goal
attainment that nurses purposefully interact and mutually set, explore and agree to the means of
achieving goals. When this information is recorded in the patient’s record, nurses have data that
represent evidence-based nursing practice.

Implications of king’s theory;

• Offers insight into nurses’ interactions with individuals and groups within the environment.

• Highlights the importance of a client’s participation in decisions tht influence care and
focuses on both the process of nurse-patient interaction and the outcomes of care.

• Believes that her theory used in theory based practice blends the art and science of nursing.

vii. Neuman’s systems model.

Betty Neuman was a community health nurse and clinical psychologist. She developed a model based
on an individual’s relationship to stress in relation to reactions to stress and reconstitution factors that
are dynamic in nature.

Reconstitution is the state of adaptation to stressors.

In her theory: -

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 • She views the client as an open system consisting of a basic structure i.e a central core of
energy sources (physiologic, psychologic, social-cultural, developmental and spiritual)
surrounded by two concentric boundaries or rings referred to as lines of resistance.

• The lines of resistance represent internal factors that help the client defend against a stressor
e.g increase in white blood cell count in response to an infection.

• Outside the lines of resistance are two lines of defense; the inner/normal line of defense shown
as a solid line represents the person’s state of equilibrium or the state of adaptation developed
and maintained over time and considered normal for that person.

• The flexible line of defense shown by a broken line is dynamic and can be rapidly altered
over a short period of time. It is a protective buffer that prevents stressors from penetrating
the normal line of defense. Some factors e.g lack of sleep can create changes in the flexible
line of defense.

She categorizes stressors as;

• Intra-personal stressors; Those that occur within an individual e.g when one has an
infection.

• Interpersonal stressors; Those that occur between individuals e.g unrealistic

expectations.

• Extra-personal stressors; Those that occur outside the individual e.g concerns about
financial security.

An individual’s reaction to stressors depends on the strength of the lines of defense. When the lines
of defense fail, the resulting reaction depends on the strength of the lines of resistance. As part of the
reaction, a person's system can adapt to a stressor referred to as reconstitution.

As a nurse; your nursing interventions will focus on maintaining the stability of the system through
three preventive levels;

i. Primary prevention focuses on protecting the normal line of defense and strengthening the
flexible line of defense.

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 ii. Secondary prevention focuses on strengthening internal lines of resistance, reducing the
reaction, and increasing resistance factors.

iii. Tertiary prevention focuses on re-adaptation and stability and protects reconstitution or
return to wellness following treatment.

Betty Neuman’s model of nursing is applicable to a variety of nursing practice settings which involve
individuals, families, groups and communities; it is utilized in many countries to direct nursing
administration and research.

viii. Roy’s adaptation model.

Sister Callista Roy defines adaptation as the process and outcome whereby thinking and feeling
person uses the conscious awareness and choice to create human development and intergration, this
was in the year 1997.

It focuses on the increasing complexity of person and environment self-organization, and on the
relationship between and among persons, universe, a supreme being or God, her philosophical
assumptions have been refined using major characteristics of "creation spirituality" a view that
"persons and the earth are one, and that they are in God and of God"., also focuses on the individual
as a biopsychosocial adaptive system that employs a feedback cycle of input (stimuli), throughput
(control processes), and output i.e behaviors or adaptive responses.

According to Roy; both the individual and the environment are sources of stimuli that require
modification to promote adaptation and an ongoing purposive response.

Adaptive responses contribute to health, which she defines as the process of being and becoming
integrated while ineffective or maladaptive responses do not contribute to health. Each person's
adaptation level is unique and constantly changing, hence the goal of Callista Roy's model is to
enhance life processes through adaptation in four adaptive modes. Individuals respond to needs
(stimuli) in one of the four modes:

The physiologic mode involves the body's basic physiologic needs and ways of adapting with regard
to fluid and electrolytes, activity and rest, circulation and oxygen, nutrition

and elimination, protection, the senses, and neurologic and endocrine function.

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The self-concept mode includes two components: the physical self, which involves sensation and
body image, and the personal self, which involves self-ideal, self-consistency and the moral-ethical
self.

The role function mode which is determined by the need for social integrity and refers to the
performance of duties based on given positions within society.

The interdependence mode which involves one's relations with significant others and support
systems that provide help, affection and attention.

ix. Leininger's Cultural Care Diversity and Universality Theory

Madeleine Leininger was a nurse anthropologist, her theory of transcultural nursing was written in
the 1970’s, late on published in her book Culture Care Diversity and Universality: A Theory of
Nursing.

She states that care is the essence of nursing and the dominant, distinctive, and unifying feature of
nursing. She emphasizes that human caring, although a universal phenomenon, varies among cultures
in its expressions, processes, and patterns; it is largely culturally derived.

When assisting people of diverse cultures, you should apply her intervention modes; i.e;

• Culture care preservation and maintenance

• Culture care accommodation, negotiation, or both

• Culture care restructuring and repatterning

She states that her theory is the only one that searches for comprehensive and holistic care data
relying on social structure, world view and multiple factors in a culture in order to get a holistic
knowledge view about care.

x. Watson's Human Caring Theory

Jean Watson believes that the practice of caring is central to nursing that it is the unifying focus of
practice. Her theory of human caring has received worldwide recognition and is a major force in
redefining nursing as a caring- healing health model. Nursing interventions related to human care
have now been translated into clinical processes by the year 2006.

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They include;

i. Formation of humanistic-altruistic system of values becomes: "practice of loving-kindness

and equanimity within context of caring consciousness."

ii. Instillation of faith-hope, becomes: "being authentically present, and enabling and sustaining
the deep belief system and subjective life world of self and one-being-cared-for."

iii. Cultivation of sensitivity to one's self and to others becomes: "cultivation of one's own
spiritual practices and transpersonal self, going beyond ego self."

iv. Development of a helping-trusting, human caring relationship becomes: "developing and

sustaining a helping trusting, authentic caring relationship."

v. Promotion and acceptance of the expression of positive and negative feelings, becomes:
"being present to and supportive of the expression of positive and negative feelings as
aConnection with deeper spirit of self and the one-being cared- for."

vi. Systematic use of a creative problem-solving caring process, becomes: "creative use of self
and all ways of knowing as part of the caring process; to engage in artistry of caring healing
practices."

vii. Promotion of transpersonal teaching-learning, becomes: "engaging in genuine teaching-

learning experience that attends to unity of being and meaning attempting to stay within
other's frame of reference."

viii. Provision for a supportive, protective, and/or corrective mental, physical, societal, and
spiritual environment, becomes: "creating healing environment at all levels (physical as well
as non-physical), subtle environment of energy and consciousness, whereby wholeness,
beauty, comfort, dignity, and peace are potentiated."

ix. Assistance with gratification of human needs, becomes: "assisting with basic needs, with an
intentional caring consciousness, administering 'human care essentials,' which potentiate
alignment of mind body spirit, wholeness, and unity of being in all aspects of care," tending
to both embodied spirit and evolving spiritual emergence.

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 x. Allowance for existential-phenomenological-spiiitual forces, becomes: "opening and
attending to spiritual-mysterious, and existential dimensions of one's own life-death; soul care
for self and the one-being-cared-for."

Congratulations! You have come to the end of this topic.

In summary you learnt that;

• Nursing has been defined by many nurse theorists including Virginia Henderson who defined
nursing as; "The unique function of the nurse is to assist the individual, sick or well, in the
performance of those activities contributing to health or its recovery (or to peaceful death)
that he would perform unaided if he had the necessary strength, will, or knowledge, and to do
this in sucha way as to help him gain independence as rapidly as possible" Like Nightingale,
Henderson described nursing in relation to the client and the client's environment.

• The scope of nursing includes care of individual clients, families, communities and the
environment.

• The nurse has unique roles and functions to include ‘teacher’ where she teaches clients on
health promotion, ‘advocate’ where the nurse protects the client’s rights e.t.c.

• Operation under the umbrella of a professional organization differentiates a profession from

an occupation.

• Nursing theories are valuable in research, education and practice, they identify and define
interrelated concepts important in nursing and clearly state the relationships between and
among these concepts, they seek to improve nursing body of knowledge by guiding research.
The common concepts in nursing theories are the person (patient), the environment, health
and nursing. That each of these concepts are uniquely defined and described by each nurse
theorist but the focus of nursing regardless of definition or theory is the person(patient).

Glossary

Concepts are often called the building blocks of theories.

A conceptual framework: is a group of related ideas, statements, or concepts that make up a theory.

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Conceptual model: articulates a broad range of significant relationships among the concepts of a
discipline

Paradigm: a pattern of shared understandings and assumptions about reality and the world.

Reconstitution: is the state of adaptation to stressors.

Theory: a supposition or system of ideas that is proposed to explain a given phenomenon.

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