Chapter 1 introduction.

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 1. UNIT ONE Introduction to Nursing Profession Definition of nursing The word
“nursing” is originated from the Latin word “Nutrix” meaning “to nourish”. Nurse is a
person who nourishes, foster & protects others. or ; a person prepared to take care of
sick, injured & aged person 1
 2. WHAT IS NURSING? An acceptable version of the word nurse N – Noble U –
unselfish R – Responsible S – Sincere E – Efficient There were different definitions given
for nursing at different times by different individuals. Some of these are: 2
 3. • Nursing is an art and a science that deals with prevention of disease, care and
treatment of the sick and rehabilitation of patients. • Science- knowledge based for care
given • Art – means skilled application of knowledge to help others 3
 4. [Link] defination of nursing • Nursing is the act of utilizing the
environment of clients to assist him/her in his/her recovery. • It is to put the patient in a
best condition for nature to act up on him. • American nursing association (ANA) • It is
the diagnosis and treatment of human response to actual and potential health
problems. 4
 5. Cont…d • Nursing is an art, and if it is to be made an art, it requires as exclusive
devotion, as hard a preparation, as any painter’s or sculptor’s work, for what is having
to do with the living body - the temple of God’s spirit? It is one of the fine Arts; I had
almost said the finest of the fine Arts". Florence Nightingale 5
 6. Virginia Henderson definition of nursing “ Nursing is assisting the individuals sick
or well in the performance of those activities (contributing to health or its recovery or to
a peaceful death) that he will 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.” 6
 7. Nursing is profession (more than job or occupation) Criteria to be a profession •
has well defined body of knowledge • presence of strong service orientation • presence
of recognized authority by professional group • governed by code of ethics • has
professional organization that sets standards • conduct ongoing research & has
autonomy 7
 8. Definitions of important term • Care-involves activities from carrying out
complicated technical procedures to something seeming simple. • Health-is a state of
optimal functions. • Lay-point of view- doing ones activity& doesn’t outwardly show any
symptom of any disease. • Mahler- the ability to lead socially acceptable & economically
productive life. 8
 9. Cont..d • WHO – is a state of complete mental, physical& social well-being not
merely absence of disease or infirmity. • Physical health- anatomical integrity&
physiological functioning of the body. • To be physically healthy • All body parts must
be present • All body parts in natural place& position • None of them has any pathology
• All doing their physiological function properly • They work each other harmoniously •
Mental health- the ability to learn& think clearly. 9
 10. Cont…d • Social health- ability to make& maintain acceptable interaction with
others. • Illness- the subjective state of a person who feels aware of not being well. •
Disease- denotes the condition of the human body in which something has gone wrong
& has upset the normal functions of the body or mind. • Disability- any restriction or
lack of ability to perform an activity in a manner or range considered normal for human
beings. 10
 11. Cont…d Handicap- a long term disadvantage which adversely affects individual’s
capacity to achieve the personal economic independence. i.e. normal for ones peer.
Aims of Nursing 1. Promoting wellness Wellness- is the achievement of one maximum
attainable potential. 2. Preventing illnesses- the main objectives are To reduce the risk
 for illness To promote good health habit To maintain optimal functioning 3. Restoring
health 11
 12. Cont…d Providing direct care of the person. 4. Facilitating coping The goals of
health cannot always be met. The nurses also facilitate patient& family coping with
altered function, life crisis& death. Roles of Nursing To meet aims of nursing nurses use
knowledge, skill& critical thinking. To provide knowledgeable care the nurse uses
cognitive, technical, interpersonal& ethical competencies essential to nursing practice.
12
 13. Nurses – Care giver – Communicator – Teacher – Counselor – Leader – Researcher
– Advocator – Manager 13
 14. Guide lines for nursing practice • ANA congress for nursing practice stated that “A
profession must control its practice to guarantee the quality of its service to the public.”
• Nursing controls & guarantees its practice through • Standards of Nursing practice;
defines the actives of nurses that are specific and unique to nurses. • Nursing practice
acts; are laws established to regulate the practice of nursing. • Licensure • Nursing
process 14
 15. NURSING PROCESS • The nursing process is a systematic, patient centered, goal
oriented methods of caring that provides frame work for nursing practice. • Nursing is
independent scientifically based and creative required knowledgeable component and
independent profession. • Characteristics of Nursing Process • 1. Systematic- each
nursing activity is a part of an ordered sequence of activities. Each activity depends on
the accuracy of the activity that precedes it & influences the action that follows it. 15
 16. Cont..d • 2. Dynamic- no one step in nursing process is a one time phenomenon.
• There is Overlapping and interaction among steps in some nursing situations, all five
stages occur almost simultaneously. • Interpersonal- nursing process insures that
nurses are patient centered rather than task centered. Always at the heart of nurse is
human being. • The nursing process encourages nurses to work together to help patient
use their strengths to meet all their human needs. 16
 17. Cont..d 4. Goal oriented- nursing process offers a means for nurses & patients to
work together to identify specific goals to determine which goals are the most important
to the patient and to match them with appropriate nursing action. 5. Universally
applicable- the nursing process offers direction for all the activities carried out by the
nurse when caring for well or ill, any age at any practice setting. 17
 18. Benefits of nursing process • When used well, the nursing process achieves for
the patient • scientifically based holistic individualized care • provides opportunity to
work collaboratively with other nurses • provides continuity of the patient’s care •
nurses who use nursing process achieves a clear and efficient plan of action by which
they process can achieve the best results for the patients. 18
 19. Documenting the nursing process • The ability to communicate clearly in writing
is a critical nursing skill. • Accurate, concise, timely & relevant documentation provides
all the members of the care giving team with a picture of the patient. • Legally
speaking, a nursing action not documented is not performed. 19
 20. Cont..d 20
 21. Steps of nursing process • Assessment • Nursing diagnosis • Planning •
Implementation • Evaluation 1. Assessment; is the systematic & continuous collection,
validation, & communication of patient data. Data (information)-reflects how health
function is enhanced by health promotion or compromised by illness. 21
 22. Cont..d • Database: - includes all pertinent patient information collected by the
nurse. This enables a comprehensive and effective plan of care to be designed and
implemented. • Data collection is a vital step in nursing process because the remaining
step depends on the assessment data. • Nursing assessments focuses on the patient’s
 response to health problems Data collection • Data collection takes place during every
nurse patient interaction. 22
 23. Cont..d • Types of data- there are two types of data. • Subjective (covert data) or
symptoms; Data that are not verified by other person. E.g. nausea, headache,
abdominal pain . • Objective data (overt data or sign)- observable& measurable data. •
Can be verified by other person. E.g. vital sign 23
 24. Cont..d • Purpose of nursing assessment • To establish base line data • To
determine the patients normal function • To determine presence or absence of
dysfunction • To determine patients strength • Steps of nursing assessment • Data
collection • Validation • Organizing (clustering data) • Documentation of data 24
 25. Cont..d • Characteristics of data – Complete; all the patient data needed to
understand the patients’ health problem should be identified. – Factual or accurate –
Relevant Sources of data – Primary Source:-is the most reliable information obtained
from the patient. – Secondary Sources:-information obtained from: Support people&
patient records 25
 26. Cont..d • Data collection methods • Observation:-is the conscious and deliberate
use of the senses to gather data • Interview:-is the planned communication to obtain
nursing history • Physical assessment:-is the examination of the patient for objective
data. The nurse’s physical assessment focuses primarily on the patient’s functional
abilities rather than pathologic conditions and their causes. 26
 27. Cont... • Methods of assessment are: •Nursing health history •Physical
assessment •Diagnostic evaluation 27
 28. Types of Nursing Assessment • Depending on the clinical condition, patient
status, time valuable and purpose, it is classified into:- • Initial(admission) assessment:-
is performed w/n the patient is admitted to hospital. • Purpose:-To establish a complete
database for problem identification and care planning. • To identify functional health
patterns those are problematic • To evaluate the patient health status 28
 29. Cont..d 2. Focused Assessment:-the nurse gathers data about a specific
problem that has already been identified. • Purpose:-to identify new or over looked
problems • The nurse determines if the problem still exists • Weather the status of the
problems has changed 3. Emergency assessment:-When physiologic or psychological
crisis presents or takes place in life threatening situations where the preservation of life
is the top priority. E.g. ABCs 29
 30. Cont..d 4. Time Lapsed assessment:-is scheduled to compare a patient’s current
status to base line data obtained. • Purpose:-to evaluate any changes in patient’s
functional health • Performed when substantial periods of time have elapsed between
assessments. • Problems Related to Data collection • Inappropriate organization of the
data base • Omission of relevant data • Commission of irrelevant data • Error of data •
Failure to establish rapport and partnership • Failure to update database 30
 31. Cont..d • Data Validation:-is the act of confirming or verifying. • Purpose:-to
keep the data from error, bias, or misinterpretation 2. Nursing Diagnosis:-is the clinical
judgment about individual, family, or community responses to actual or potential health
problems that the nurse is licensed and competent to treat. OR • Is a statement that
describes the human response (health state or actual/potential altered interaction
pattern) of an individual or group that the nurse can legally identify and for which the
nurse can order definitive interventions to maintain the health state or to reduce,
eliminate, or prevent alterations. 31
 32. Cont..d • Nursing diagnosis focuses on un healthy responses to health and
illness, but • Medical Diagnosis:-identify diseases; describe a problem which directs the
primary treatment. • Medical diagnosis remain the same as long as the disease is
present but • Nursing diagnosis may change from day to day as the patient’s response
 changes. • Steps of nursing diagnosis • Analyzing and interpreting data • Identifying
client problem • Formulating Nursing Diagnosis • Documenting Diagnosis 32
 33. Types of Nursing Diagnosis • Actual:-describes a clinical judgment that the nurse
has validated b/c of the presence of major defining characteristics; problem is present
at the moment (experienced). • Potential (risk):- describes a clinical judgment that an
individual or group is more vulnerable. Nurse determines that the patient is more
vulnerable to develop. • possible/probable: - problem may be present. The nurse
suspects that a health problem exists but need to gather more data to confirm the
diagnosis. 33
 34. Cont..d 4. Wellness: - clinical judgments about an individual, family, or
community in transition from it a specific level of wellness to higher level of wellness. 5.
Syndrome: - comprises a cluster of actual or risk nursing diagnosis that is predicted to
present b/c of a certain situation or event. 34
 35. Parts of Nursing Diagnosis • Problem Statement:-describes a physiological or
psychological response to a health problem. When writing use: altered, disturbed,
decreased, excessive, dysfunctional…etc • Etiology Statement:-describes contributing
factors that influence development of the response. Identifies the physiologic,
psychological, sociologic, spiritual, and environmental factors believed to be related to
the problem as either a cause or a contributing factor. • Etiology identifies the factor
that maintain the un healthy patient state and prevent the desired change, thus directs
the nursing intervention. Unless the etiology is correctly identified, nursing actions may
be inefficient and ineffective. 35
 36. Cont..d • 3. Defining Characteristics:-the subjective and objective data that signal
the existence of the actual health problem. • Writing Nursing Diagnosis • The actual
nursing diagnosis has data that support and the presence of the problem. It has three
parts: • Problem (NANDA) + related to etiology + as evidenced by defining
characteristics. • E.g. Ineffective airway clearance related to weak cough and incision
pain, as evidenced by poor or no cough effort. 36
 37. Cont..d • 2. The high-risk nursing diagnosis- indicates the clients at risk for this
response, although it is not yet present. • It has only two parts:-Problem (NANDA) and
related to etiology. • It has no defining characteristics. • E.g. .high- risk for impaired
skin integrity related to advanced age, immobility, confinement to bed • 3.
Possible/probable-has possible problem and factor. • E.g. .possible sexual patterns
related to partner’s diagnosis of herpes 37
 38. Cont..d • 4. Diagnostic statements for wellness nursing diagnoses are one- part,
containing the diagnostic label. • e.g -Readiness for enhanced family process. • -
Readiness for enhanced nutrition • 5. Syndrome nursing diagnoses usually are one- part
diagnostic statements with the contributing factors contained in the diagnostic lable. 38
 39. Cont..d NANDA has five syndrome diagnoses: - Rape trauma syndrome. - Disuse
syndrome. - Post -trauma syndrome. - Relocation stress syndrome. - Impaired
environmental Interpretation syndrome. 39
 40. Guidelines for Writing Nursing Diagnosis • Phrase the nursing diagnosis a
patient’s problem or alteration in health state rather than as a patient need • Use
“related to” rather than “caused by” or “due to” • Write the diagnosis in legally
advisable terms • Use non-judgmental language • Do not reverse the cause with the
problem • Single nursing diagnosis should contain only one specific problem • Avoid
medical diagnosis 40
 41. Cont..d 8. The problem and etiology should be expressed in terms of that can be
change 9. Check the diagnosis to make sure the problem statements patient goals and
that the etiology will direct the selection of nursing measures 10. Defining
characteristics should follow the etiology and be lining by the phrase “as evidenced by”
or “as manifested by” 41
 42. 42 Focusedon physical illness Holisticcare approach Focusedon actual
healthproblem Actual and potential
 43. 43 Impaired Skin Integrity related to prolonged pressure on bony prominence
as manifested by (AMB) Stage II pressure ulcer over coccyx, 3 cm in diameter. Risk for
Impaired Skin Integrity related to inability to turn self from side to side in bed. Possible
Self-Esteem Disturbance related to recent retirement and relocation. Potential for
Enhanced Nutrition.
 44. 44
 45. Nursing planning • Planning involves a series of steps in which the nurse and the
client prioritize problems , set goals and expected out comes to resolve or minimize the
identified problems of the client. 45
 46. Outcome Identification and Planning • The planning phase involves several
tasks: –The list of nursing diagnoses is prioritized. –Priorities are classified as high
(psychological or Physiological). –Intermediate (non- emergency, non- life threatening)
or – low (needs that may not be directly related to a specific illness but may affect their
future well- being). 46
 47. Cont…d – Client-centered long- and short-term goals and out-comes are
identified and written. – Specific interventions are developed. – The entire plan of care is
recorded in the client’s record. • Once the list of nursing diagnoses has been developed
from the data, decisions must be made about priority. • Critical thinking enables the
nurse to make decisions about which diagnoses are the most important and need
attention first. • There are a number of frameworks used to prioritize nursing diagnoses;
however, those diagnoses involving life-threatening situations are given the highest
priority. • For example, the following nursing diagnoses would be stated in this order of
priority: 47
 48. Cont…d • Ineffective Airway Clearance related to excessive, thick secretions and
pain secondary to surgery and inability to cough effectively • Risk for Injury (falls)
related to unsteady gait • Imbalanced Nutrition: Less Than Body Requirements related
to nausea and vomiting • Client-centered goals are established in collaboration with the
client whenever possible. 48
 49. Goal • A goal is an aim, intent, or end. • Goals are broad statements that describe
the intended or desired change in the client’s behavior. • If the client or significant
others are unable to participate in goal development, the nurse assumes that
responsibility until the client is able to participate. • Client-centered goals assure that
nursing care • is individualized and focused on the client. 49
 50. Expected outcomes • Expected outcomes are specific objectives related to the
goals and are used to evaluate the nursing interventions. • They must be measurable,
have a time limit, and be realistic. • Once goals and expected outcomes have been
established, nursing interventions are planned that enable the client to reach the goals.
• Examples of goals setting • Nursing diagnosis :Knowledge deficit regarding
postoperative care at home. • Goals: Client will state four postoperative risks before
discharge • Expected outcome : Client will identify need to drink 2-3 liters of fluid every
day Client will name three signs of infection Client will demonstrate aseptic wound care
50
 51. Nursing intervention • A nursing intervention is the activity that the nurse will
execute for and with the client to enable accomplishment of the goals. • Nursing
interventions refer directly to the related factors in the actual nursing diagnoses and the
risk factors in risk nursing diagnoses. • If the nursing interventions can remove or
reduce the related factors and the risk factors, the problem can be resolved or
prevented. • Nursing interventions also refer to the diagnostic label for possible
diagnoses and focus on data needed to confirm or eliminate the diagnosis. 51
 52. Cont…d • For each nursing diagnosis there may be a number of nursing
interventions. • Nursing interventions are individualized and are stated in specific
terms. 52
 53. Implementation • Implementation involves the execution of the nursing plan of
care derived during the planning phase. • It consists of performing nursing activities
that have been planned to meet the goals set with the client. • Nurses may delegate
some of the nursing interventions to other persons assigned to care for the client. 53
 54. Evaluation • Evaluation, the fifth step in the nursing process, involves
determining whether the client goals have been met, partially met, or not met. • If the
goal has been met, the nurse must then decide whether nursing activities will cease or
continue in order for status to be maintained. • If the goal has been partially met or not
been met, the • nurse must reassess the situation. • Data are collected to determine
why the goal has not been achieved and what modifications to the plan of care are
necessary. • There are a number of possible reasons that goals are not met or are only
partially met, including: 54
 55. Cont…d – The initial assessment data were incomplete. – The goals and expected
outcomes were not realistic. – The time frame was too optimistic. – The goals and/or the
nursing interventions planned were not appropriate for the client. – Evaluation is an
ongoing process. – Nurses continually evaluate data in order to make informed
decisions during other phases of the nursing process. 55
 56. Revision • Case study 1 exercise • Ato Hialu has been admitted to the hospital
with car accident. He is sin bed and could not be able to take care of himself. He has not
passed stool for the last 3 days. He has severe pain and is not sleeping well. He has an
open wound on the fractured leg and is not taking food. He lives with his wife, three
young children and works as taxi driver which he describes as very stressful. (Musculo-
skeletal problems) • Which of the assessment discussed is most appropriate at the time
of his admission? • Do nursing care plan to mr hailu which includes all of the five
phasess. 5