Conceptual
Foundations of Nursing
Peggy Korman, CNM
How would you define
Nursing?
Nursing
• Caring
• Commitment
• Dedicated to meeting the health needs of people
3
Florence Nightingale
• Environmental theory
• A person’s surroundings
such as clean air, water, and
lighting can play a part in
their healing process and
their quality of care
Virginia Henderson “first lady of nursing”
• “Definition of Nursing”
• Nurses should help a client
regain as much
independence as quickly as
possible with a holistic
approach
• Treat each client as an
individual, include them in
the plan of care and assist
them with a quick and
healthy recovery
Jean Watson
• Philosophy and Science of
Caring
• Supports humanistic and
holistic care; focus on
“caring” promoting health
and preventing illness.
• Focus on the importance
of the “caring “
relationship and
communication in an
individual’s health
Patricia Benner
• Nurses move through stages of
expertise and skill as they
practice nursing; defines a set of
competencies from novice to
expert nurse
• Made nursing aware of effects
of clinical skills on client care
and client outcomes.
• Made community more aware
of nursing as a responsible and
caring practice
Dorothea Orem
• Self-Care Deficit theory of
nursing
• Nurses assist clients to
their highest level of selfcare
• Made nurses more aware
of individualized client
care, their participation in
the plan of care and return
to their highest possible
level of self-care
Madeline Leninger
• “Margaret Mead of
Nursing”: pioneer nurseanthropologist
• Encourages nurses to gain
an awareness of the
uniqueness of each culture
to meet the individual
needs of each client
• Culturally specific care is
provided in a caring
manner
Betty Neuman
• Systems Model
• Wholistic approach to
client care, addresses
homeostasis of the client
and the environment
• Focus on primary
prevention
• Wholistic approach to
assessment and clientcentered care
• Encourages continued
research
Hildagard Peplau
• Client-nurse relationships
use interpersonal skills and
knowledge gained through
previous research from
other disciplines
• You must understand your
own behavior before you
can help someone else
understand his behavior
• Used in mental-health field
to develop therapeutic
communication
What did you see???
• Yes we provide care and comfort to the sick
• We function independently and collaboratively
• Must haves: assertiveness, knowledge, ability to make
sound judgments, ability to communicate in the written
and oral form, spirit of collegiality with other team
members.
Becoming A Caring Nurse at
DSN
Nursing, Person, Environment,
Wellness, RBC Values
The Nurse:
Patient Advocate, Care-Giver, Educator, Change
Agent,
Leader, User of RBC Values/Practice
Benners stages of Development:
Novice-Advanced Beginner-CompetentProficient-Expert
Nurses deal with the whole
person
Marjory Gordon’s Functional
Patterns
• Helps us organize information about patients
• Consistent with human needs
• Health perception, Activity & Exercise, Nutrition,
Elimination, Sleep & Rest, Cognition & Perception,
Coping & Stress, Sexuality
• Welcome to NRS 320!!!!
All this and more….
Health, Wellness, Illness
• Health is “a state of complete physical, mental and
social well-being, not merely the absence of disease
or infirmity” (WHO, 1948)
• Holism
• Disease: a state of disharmony of mind, body,
emotions, and spirit.
Illness Prevention
• Primary prevention:
• Secondary prevention:
• Tertiary prevention:
Complimentary
and Alternative
Therapies
Definitions
• Complementary therapy:
• Used with conventional treatment
• Alternative therapy:
• Used in place of conventional treatment
Complementary/Alternative
Medicine (CAM)
• Factors contributing to popularity:
National Center for CAM
• Established in 1998 at National Institutes of Health
(NIH)
• Rigorous research on CAM
• Training CAM researchers
• Disseminating information to public and
professionals
• Integrative medicine
Benefits of CAM
• Emphasizes maintenance of wellness and prevention
of illness
• Utilizes a holistic approach
• May be less expensive
• May be more accessible
Risks of CAM
• Lack of standardization
• Lack of regulation and research
• Inadequate training and certification of some healers
• Financial and health risks of unproven methods
Traditional Chinese Medicine
Ensures a balance of energy
Chi is invisible flow of energy in the body.
Chi flows along pathways or meridians.
Yin and yang:
Opposing pathways that form the whole
Quigong
Ayurveda
• Five elements:
• Ether, wind, fire, water, and
earth
• Three tendencies, called
doshas:
• Vata, pitta, and kapha
• The goal is to balance the
doshas
Homeopathy
Healing system that uses like to cure like
Remedies are minute dilutions of substances
Reiki
Therapeutic Touch
YOGA
Reflexology
Massage
Meditation
Herbal Remedies
• Nutritive value of foods
• Dietary supplements
• Herbal medicine
Manipulative and Body-Based
Therapies
• Chiropractic medicine
• Hydrotherapy
• Exercise
• Massage therapy
• Hatha Yoga
• Reflexology
Acupressure/Acupuncture
More Mind-Body Therapies
• Hypnosis
• Biofeedback
• Visualization
• Guided imagery
• Meditation
• Prayer
Healthcare in the community
and Home
• The design, delivery and evaluation of healthcare
services in the community.
• Community= workplace, school district, geographic
area, managed-care enrollees, the HOME.
• Discharge planning “a coach”: helps pt move from one
level of care to another within or outside the current
healthcare facility. Referrals. Assessment. Pt education.
Advocacy. Holistic care. Know the community resources.
Cultural Awareness,
Sensitivity and Competence
A Culturally Competent
Professional
….performs in a manner that meets the expectations of
a particular cultural group, and acknowledges that
group’s values, beliefs and practices.
“Indeed nursing itself, is a largely cultural
phenomenon”
Specific to Nursing…
“Culturally competent care occurs when the
nurse adjusts attitudes and behaviors to work
effectively in cross-cultural situations.”
(Cross, Bazron, Dennis, & Issacs, 1989)
Who says we need cultural
sensitivity
• WHO
• US HHS
• The Bureau of Nursing
• CDC
• JCAHO
• Healthy People 2020
• Be honest, you do too!
Iceberg
“Awareness” a better word
• Be very cautious with generalizations
• Learn to ask questions and listen to the answer
• Be prepared to get a different answer to what you
believe to be the same question
• Be flexible
• Laugh: culture can become very political, be more
lighthearted
Watch Translation
• Medical words
• What the pt hears
• Could be completely different
Stategies to Achieve Cultural
Competence
Strategies….
How do you ask about
Cultural Wishes or Needs???
• Don’t be shy
• Let the patient and family know that you CARE!
• Approach in a non-judgmental manner
• Express an interest in their culture and traditions
• Keep a resource book or current articles available on your
unit
• Document any preferences so the next shift will be able to
provide continuity
Use Translation Services
• Availabililty of translator (NOT family or friends) is
now required by Federal payers
• Lay workers are NOT adequate for medical
translation
• 1-800-At & T Translation Line!!!!! 1-800-874-9426
• Many local advocacy groups offer assistance
• Internet translation available
Plan for “Cultural
Transformation”
• Review JCAHO Standards regarding patient care
• Seek resources for written materials with diverse
ethnic representation
• Consider a “Cultural Nursing Rounds” format for
education of staff
• Develop contacts in your community with various
ethnic groups
• Be a cultural Change Agent
100 Questions and Answers
About Arab Americans
• www.allied-media.com/ArabAmerican/100%20questions%20about%20arab%20ameri
cans.htm
DSN Video
• Jane’s School Video
Communication and Nursing
Practice
• A lifelong process for
nurses
• An essential attribute of
professional practice
• Builds relationships with
clients, families, and
multidisciplinary team
members
Nonverbal Communication
Communication and
Interpersonal Relationships
• The means to establish helping and healing
relationships.
• The ability to relate to others is important for
interpersonal communication.
• Developing communication skills requires both an
understanding of the communication process and of
one’s own communication experience
Levels of Communication
matching exercise
1. Intrapersonal
A. One-to-one interaction
between two people
2. Interpersonal
B. Occurs within an individual
3. Transpersonal
C. Interaction with an audience
4. Small Group
D. Interaction within a person’s
spiritual domain
5. Public
E. Interactions with a small group
of people
Professional Nursing
Relationships
• Nurse-client helping relationships
• Nurse-family relationships
• Nurse-health team relationships
• Nurse-community relationships
Elements of Professional
Communication
Appearance, Demeanor, and
Behavior
Courtesy
Use of Names
Trustworthiness
Autonomy and responsibility
Assertiveness
Therapeutic Communication
• Seeking Clarification:
• Sharing Observation:
• Silence:
• Summarization:
Therapeutic Communication
• Open Question:
• Paraphrasing:
• Reflection:
Therapeutic Communication
• Acknowledgement:
• Closed Question:
• Focused Question:.
• Giving information:
Blockers
• False Reassurance:
• Giving Advice or Opinions:
• Showing Approval or Disapproval:
• Sidestepping the Topic:
• Stereotyped Responses:
Blockers
• Asking “Why” Question:
• Changing the topic:
• Defensive Responses:
• Failure to listen: