PRINCIPLES AND PRACTICE OF NURSING.docx

PRINCIPLES AND PRACTICE OF NURSING ( FUNDAMENTALS OF NURSING)
LIST OF ABBREVIATIONS AND ACRONYMS
ANA American Nurses Association
APSEA Association of Professional Societies of East Africa
BP Blood Pressure
BSN Bachelor of Science Nursing
CDC Centre for Disease Control
CGFNS Certificate of Graduates of Foreign Nursing Schools
CRHC Commonwealth Regional Health Community
DNR Do Not Resuscitate
EBP Evidence – based Practice
ECSA East, Central and Southern Africa
ECSACON East Central Southern Africa College of Nursing
HIV/ AIDS Human Immune Deficiency Virus/ Acquired Immunodeficiency Syndrome
ICN International Council of nurses
ICU Intensive Care Unit
ICNP International Classification of Nursing Practice
ID Intradermal
IO Intraosseous
IM Intramuscular
IV Intravenous
KMA Kenya Medical Association
KNH Kenyatta National hospital

KOGS Kenya Association of Obstetricians/Gynecologists
KPNA Kenya Progressive Nurses Association
KECHN Kenya Enrolled Community Health Nursing
KRCHN Kenya Registered Community Health Nursing
LOC Level of consciousness
MTC Medical Training College
NCK Nursing Council of Kenya
NCLEX Nursing Council Licensure Exam
NCN National Commission on Nursing
NLN National League for Nurses
NNAK National Nurses Association of Kenya
NNAS National Nurse Associations
NMAS National Midwifery Associations
NNCS National Nursing Councils
PPE Personal Protective Equipment
porn when necessary or as needed
Sc Subcutaneous
TB Tuberculosis
USA United States of America

UNIT INTRODUCTION
In this unit you are going to study the trends and dynamics in the development of professional
nursing. You will then learn about the professionalization of nursing. You will also study
about the contextual and philosophical elements of nursing and later the nursing process and
the application of critical thinking and reflective practice in nursing. You shall then study
some theories, models and nursing care delivery modalities, nursing ethics and finally you
will learn some fundamental concepts and skills in nursing.
Nursing has come a long way from being a vocation as we shall see in the trends of nursing
development to a profession. Traditionally, only a few fields were considered as professions
for instance medicine and law. Currently the profession has strong, caring, committed and
educated nurses who have given it vitality.
This unit is divided into seven sections as follows:
1. The trends and dynamics in the development of professional nursing.
2. The professionalization of Nursing.
3. The basic concepts, contextual and philosophical elements of nursing.
4. The nursing process and critical thinking in nursing.
5. Nursing theory; the basis for professional nursing.
6. Nursing ethics.
7. Fundamental concepts and skills in nursing.
Definition and Developmental Trends in Nursing
Definition of Nursing
Having undergone your basic training, you must be having an idea of what nursing is. To
refresh your knowledge about nursing you will start by answering the following question.
The word nursing is defined from a Greek word “nutricia” which means to nurture or nourish.
Virginia Henderson in 1966 defined Nursing as an art of assisting an individual sick or
well, in the performance of those activities contributing to health or its recovery (or to
peaceful death) that he/she would perform unaided if he/she had the necessary strength, will
and knowledge.
Nursing may also be described as use of clinical judgment in the provision of care to enable
people to improve, maintain or recover health, to cope with health problems, and to achieve
the best possible quality of life, whatever their disease or disability, until death (Royal college
of Nursing, 2003).

Having reminded yourself of the definitions of a nurse and nursing you can now proceed to
look at the historical background of the nursing practice.
Evolution of nursing
To understand the current status of nursing it is necessary to have a base of the historical
knowledge about the profession. By learning from historical role models, nurses can enhance
their abilities to create positive change in the present and the future. They can also appreciate
the advancements of the profession. The historical background of nursing may be divided into
four main phases. These are:
a. Ancient civilization (From early civilization to the 16th century)
Most early civilizations believed that illness had supernatural causes. The theory of animism
attempted to explain the cause of mysterious changes in bodily functions. Good spirits
brought health whereas evil spirits brought sickness and death. Nursing care was usually
provided by mothers and other female relatives who cared for her family during sickness by
providing physical care and herbal remedies.
Traditionally, the women were considered to have nurturing attributes and this was extended
to caring for the sick. This nurturing and caring role of the nurse has continued to the present.
It used to be done at home except for the destitute, orphaned and the chronically incapacitated
patients who used to be admitted in hospitals.
b. Religious influences
Religion has played a significant role in development of nursing. Early religious values such
as self denial, spiritual calling and devotion to duty and hard work have dominated nursing
throughout its history. Care of the sick in battle fields, military hospitals and prisons was by
the religious bodies.
c. War
War has brought about the need for nursing. It began during the Crimean war (1854 to 1856).
There was a public outcry when the British people learnt about the poor care the sick and the
wounded soldiers were receiving. The secretary of war contacted Florence Nightingale who
played a great role in recruiting female nurses to provide care to the sick and the injured
during the war. During the American civil war (1861 to 1865) several nurses (the sisters of the
holy cross among others) contributed remarkably to the war torn country. Dorothea Dix was
appointed superintendent of women nurses for all military hospitals.

d. Contemporary nursing Practice
The emergence of nursing is attributed to Florence Nightingale who is the most influential
nurse in the history of modern nursing. Florence Nightingale lived between 1820 and 1910. At
an early age Florence Nightingale received a classic education which coupled with her
characteristics of sensitivity, compassion and restlessness provided her with a foundation for
the role she would play as a nurse.
Occasionally Florence would visit the poor hence she became aware of the diseases and
horrible conditions in public hospitals. During the early 1850s she underwent training in
nursing for 3 months in Kaiser Worth – Germany. A year later she used her skills in providing
nursing care to soldiers during the Crimean war. This she did with assistance of untrained
women at Scultari hospital where they provided care to the wounded soldiers.
Following the Crimean war Florence Published her first nursing notes in December 1859 and
then established the first training school for nurses in 1860.In her write up she had described
nursing as an art which included giving attention to the symptoms of a disease and factors in
the environment. The Criteria for training as a nurse was that one had to be a sober, honest
and truthful woman. Nurses were trained on basic nursing procedures and documentation of
care. Cases of indiscipline led to dismissal from training.
In 1887 the British Nurses Association of trained nurses was formed as the first organization
of trained nurses. In 1916 college of nursing was born and nurse leaders felt the need for the
state to recognize Nursing. The recognition was to involve drawing up of a syllabus for nurse
training and prescribing a qualifying examination. It also aimed at safeguarding public
interests by preventing unqualified people from practicing as nurses. This prompted the
enactment of the nursing registration Act in 1919.
Educational Programs
Educational patterns in nursing
Educational preparation for nursing practice involves several different types of programs that
lead to licensure or the legal authority to practice as a nursing professional. There are various
programs in nursing and they include:
i. Practical Nursing program took one year and the trainees were trained on technical
skills. In the USA they do licensure examination upon completion of the course.
ii. Diploma in nursing takes three years. Clinical experience is extensive and the
graduates undertake the licensure examination.
iii. Associate degree nursing program: this began in 1952 in Columbia. It is meant to
prepare nurses to function as quality practitioners under the supervision of`
professional nurses.
iv. Baccalaureate program prepares nurses in all areas of nursing practice to including
research, education, leadership and management.

v. Masters level education in nursing/post graduate programs began in the last quarter of
the 19th
Century. They prepare nurses for advanced, independent practice with
emphasis on research. In the developed countries many nurses have undertaken
doctoral programs in nursing.
1.4.2 History of development in nursing education in Kenya
The following is a chronology of the history on how nursing developed in Kenya.
In 1918 there existed the colonial nursing association in Great Britain which was responsible
for the recruitment of nursing sisters who intended to come to work in colonies in Africa.
Until 1920 the training of nurses was not systematic. It was carried out according to the needs
of the mission hospitals.
In 1950 the training of grade I Assistant enrolled nurses was started in mission hospitals.
In 1951 KNH was approved by the NCK to train registered nurses.
In 1954 nine dressers were allowed to train as enrolled nurses by virtue of their work
experience.
In 1965 Kenyatta National Hospital started training of Kenya Registered Midwives.
In 1966 Kenya Enrolled Community Health Nursing training started in Kisumu.
In 1979 training of Kenya registered Psychiatric nurses started.
In 1987 Kenya Registered Community Health Nursing training started in Mombasa MTC.
In 1990 Bachelor of Nursing training started in University of East Africa Baraton.
In 1992 Bachelor of Science in Nursing training started in the University of Nairobi and later
the masters’ degree program was started in 2004.
Currently nurses have undergone training up to PhD level.
Evolution of Scientific Thought In Nursing
Development of nursing science
The first nursing school – St. Thomas was opened in London in 1860 by Florence
Nightingale. From 1872 to 1879 several training schools were established in the US and the
length of training ranged between 6 months and two years.
During the 1980s and 1990s there occurred shortages of nursing staff and as a result there was
increased enrolment in diploma programs who were prepared to work at the bedside
performing routine nursing care under the supervision of professional nurses. Since 1973
however their market declined as there was a felt need in the US that nursing education levels
had to march those of other professions. This gave way for increased enrolment in
baccalaureate programs which produce professional nurses with a scientific base in training.
1.5.2 Baccalaureate program
In this topic you are going to learn about the evolution of the degree program in nursing. To
qualify nursing as a recognized profession nurses believed that there was a need for them to
train at a degree level. At this level nurses were prepared to provide leadership and

administration, teaching and public health nursing roles. The first baccalaureate nursing
program was established in 1909 at the University of Minnesota. The theoretical scientific
orientation was different from the hands- on skill and service orientation which was the
hallmark of diploma education.
Influences on the growth of baccalaureate education
The growth of the baccalaureate program has been influenced by many factors over the years
as we shall see in this topic.
Since 1948 national studies on nursing and nursing education stated the need for nursing
education and practice to be based on knowledge from the sciences and humanities. Chief
among them was a study by Esther Brown entitled nursing for the future.
In 1965 the American Nurses Association recommended that the minimum preparation for
beginning professional nursing practice should be at degree level.
In 1970 the national Commission for the study of nursing and nursing education identified the
need to intensify nursing research.
In 1980s the National Commission on Nursing reported that advancement was impaired by
differences in educational preparation and recommended the need for establishment of a clear
pathway for educational mobility and additional BSN programs.
In 1992 the National League for Nurses affirmed the degree as the minimum level of
professional nurse preparation by approving their scope and preparation. Today Baccalaureate
programs provide education for both basic students and the registered nurses desiring to
advance. Additional hours of clinical experience have made the degree nurses to develop
competence on top of their theoretical scientific base. Upon completion of the program they
are recognized as professional nurses.

Types of nursing knowledge specific to the discipline of nursing
a. Clinical knowledge - Results from engaging in caring activities with an aim of solving
patients’ problems. It is manifested in the acts of practicing nurses, is individualized and
personal. Clinician acts are based on their experience with patients. Clinical knowledge has
been traditionally communicated through journals and other publications which report
individual case descriptions that provide answers to problems in practice.
b. Conceptual knowledge - Is abstracted and generalized beyond personal experiences.
Propositions are supported by empirical or defended by inferences and logical reasoning.
Conceptual knowledge is the product of reflection on nursing phenomena. It emanates from
curiosity and evolves from innovation and imagination in inquiry as well as gathering of facts
and reliable generalizations. Conceptual knowledge requires logical reasoning and belief that
knowledge is constructed within a context and in a never- ending process. Its development is
influenced by both empirical and aesthetic knowing. Credibility rests on the extent to which
models and theories can be identified to communicate nurses’ conceptual knowledge and the
credibility of the propositions used.
c. Empirical knowledge- This type of knowledge results from research. It is published and
used to justify actions and procedures in practice. It forms the basis for new studies and
contributes to accumulation of knowledge. Empiric theory relies on observable reality and can
be confirmed by others. The credibility of empirical knowledge rests on:
 The degree to which the researcher has followed procedures accepted.
 Logical derivation of conclusions from the evidence without bias.
 Systematic review and critique of publications.
Credibility criteria must be consistent with nurses’ various ways of knowing and types of
knowledge. The researcher should recognize previous research findings and base their
research on them.

Current Trends in Nursing. NURSING IS DYNAMIC
Nursing practice changes continually in response to the needs and resources of the society as a
whole. It also changes in response to factors such as definitions of nursing, the aims of
nursing, the educational preparation for nursing, and expanded practice roles. The trends
discussed in the following text are currently affecting nursing education and practice. These
trends and many others provide the background for nursing in this century. As nurses continue
to define their own practice, the special and distinctive role of nursing in caring for others will
become increasingly recognized in society.
Nursing Shortage
Nurses form the majority of workforce in the health sector in Kenya and many other parts of
the world for example the United States. However, there have been various forces that have
led to decrease number of nurses in the health sector. The nursing workforce is aging, as are
the faculty needed to educate nursing students. Although more nurses are being trained, their
numbers are not high enough to compensate for the reduction. This is due to emigration of
nurses to other countries in search of better remuneration and working conditions, inability to
employ adequate numbers of nurses by both the private and public sector. Nurses have opted
for employment in other sectors e.g. the insurance sector where they may not be involved in
provision of nursing care. The scourge of HIV/AIDS has also led to reduction in nursing
workforce. This reduction in the workforce continues to occur at the same time as the
population is aging and developing chronic illnesses and disabilities that require skilled
nursing care.
1.6.2 Evidence-Based Practice
Although nurses have conducted and published research since the 1950s, only recently has the
importance of using scientific evidence to develop guidelines for nursing care been
recognized. EBP blends both the science and the art of nursing so that the best patient
outcomes are achieved.
The information that is collected is analyzed and used to answer questions (the science of
nursing), taking into consideration patient preferences and values, as well as the clinical
experiences of the nurse (the art of nursing). By identifying and analyzing the best available
scientific evidence, nurses are steadily developing further guidelines for clinical practice that
are useful nationally and internationally.
1.6.3 Community-Based Nursing
Health awareness and the desire to be involved in one’s own healthcare have strongly
influenced the delivery of healthcare services in our society. Healthcare is increasingly
provided in community-based settings such as clinics, outpatient settings, and homes. The

impetus for this change has largely been the implementation of a system of managed care to
control and monitor healthcare services to minimize costs. Home health care is becoming one
of the largest practice areas for nurses. Tertiary preventive nursing care, which focuses on
rehabilitation and restoring maximum health function, is a major goal for home care nurses,
although primary and secondary prevention are also included in care.
1.6.4 Decreased Length of Hospital Stay
Even though patients who require in-hospital care are more acutely ill or injured than in the
past, their length of stay in the hospital has remarkably decreased. This trend affects nursing
in several ways. Nurses employed in hospital settings must have the knowledge and skills to
provide often-complex care to very ill patients. In the home, nurses may find themselves
providing much the same type of care, as well as teaching patients and their families how to
provide self-care.
1.6.5 Aging Population
The older adult population is expanding more rapidly than any other age group, with the
greatest increase in those older than 70 years of age. This has been due to increased life
expectancy and improvement in the quality of life. This population trend means that patients
in all healthcare settings increasingly are older and require teaching and nursing interventions
designed to meet needs different from those of younger patients. Older healthcare consumers
are also demanding more disease-prevention interventions, new building designs to meet their
housing needs, and a focus on communities of care. Nursing will continually need to research
health issues related to the oldest old, ethnically diverse populations, quality of life, and
innovative systems of care.
1.6.6 Increase in Chronic Health Conditions
Chronic health conditions, such as heart disease, cancer, respiratory disease, and acquired
immunodeficiency syndrome (AIDS), are major health problems in our society. As the
population ages, the risk of developing chronic illnesses tend to increase. Meeting the
healthcare needs of many aged people with chronic illnesses is becoming more difficult for
society, particularly for those who live in poverty, are homeless, are mentally ill, or are of
different cultures. Demand for Nurses is therefore increasing.
1.6.7 Culturally Competent Care and Complementary Therapies
The importance of culturally competent care and the use of alternative or complementary
therapies to treat illnesses are recognized as crucial to providing holistic, individualized care.
Nurses must become more culturally aware as our society becomes increasingly global.
1.6.8 Independent Nursing Practice

Advanced practice nurses, such as critical care nurses, emergency care nurses, nephrology
nurse practitioners and midwives, are increasingly establishing independent practices in which
they diagnose and treat illnesses, promote health, provide antenatal care, and deliver babies.
Depending on state certification requirements, they may also practice in collaboration with a
physician.
Professional Associations
Professional Associations may be defined as organizations of practitioners who perform
social functions which they cannot perform in their separate capacity as individuals.
Beneficiaries of professional organizations
The public: By enforcing codes and good standards of practice the organizations ensure the
public of quality service.
Nursing profession: The interests of the nurses are pressed collectively through the
association and channeled politically for the benefit of the nurses and the recipients of health
services.
Individual nurses: Associations provide continuing education and mechanism for a
professional workplace. Please note that as a practicing nurse it is important to join a
professional organization.
Having looked at the beneficiaries of professional associations you may now go on and study
some examples.
The National Nurses Association of Kenya
The National Nurses Association of Kenya (NNAK) is a professional association for nurses,
which is registered by the Registrar of Societies as a welfare association. It has branches in the
eight counties in Kenya.
Membership of NNAK
Membership of NNAK is open to all nurses who are either registered or enrolled by the
Nursing Council of Kenya. Student nurses can join as associate members.
There are two types of membership: Life membership and Ordinary membership.
The Association has branches in all provinces. Members in each branch elect a branch
chairman, secretary and treasurer. Members elect national office bearers every three years.
The Association has an Executive Committee which comprises national office bearers and
branch chairmen. Various nursing disciplines are represented as sections. The headquarters of
NNAK is in Nairobi.

NNAK is a member of the East Central Southern Africa College of Nursing (ECSACON), the
Association of Professional Societies of East Africa (APSEA) and the International Council of
Nurses (ICN). Additionally, NNAK collaborates with other professional bodies such as the
Royal College of Nurses, Royal College of Midwives, the Canadian Nurses Association,
American Nurses Association, Kenya Medical Association, (KMA) the Association of Kenya
Obstetricians/Gynecologists (KOGS) and other health organizations.
Functions of NNAK
We are now going to look at the major functions of NNAK. These include:
i. Promoting nursing and maintaining the honors, interest and practice of all aspects of
the profession as a whole
ii. Stimulating and encouraging nursing research
iii. Promoting co-operation between NNAK and other National and international
professional bodies as well as the Government
iv. Supporting a high standard of nursing ethics, conduct and practice which is organized
and functions unrestricted by consideration of nationality, race, creed, politics, sex or
social status
v. Assisting whenever possible members who by reason of adversity or ill health are in
need of help.
These functions are executed through sections and committees.
Benefits of membership to NNAK
In- text question 1.4
How doyou benefit frombeing a member of NNAK?
The following are just some brief highlights of how you will benefit from NNAK:
a. Updates in knowledge, attitude and skills in nursing and midwifery.
b. Interactions and the opportunity to share experiences with other nurses.
c. The formation of links with other organizations.
d. Advocacy on welfare issues such as better education as well as better remuneration
and improved conditions of service.
1.7.4 The Kenya Progressive Nurses Association (KPNA)
Membership
General membership is open to all nurses in the country provided such nurse is Enrolled/
Registered and licensed by the Nursing Council of Kenya. Students may become members
once indexed by the NCK.

Functions of KPNA
The functions of KPNA include: to promote nursing profession and maintain the honor,
interest and practice by participating in nursing research, advocate for nurses’ better
remunerations and better Working Conditions regardless of the employer, and to ensure that
salaries are standard. Promote cooperation between the Association and both government and
non-governmental organizations, communities, other relevant bodies and international
organizations. Establish and maintain funds for the benefit of the association and promote
high standard of nursing ethics, conduct and practice.
Benefits of membership to KPNA
Social support during sickness, accident, disability, distress, unemployment, victimization
and any other assistance to a member’s immediate nuclear family as agreed by the central
council.
The East Africa College of Nursing
The East, Central and Southern African College of Nursing (ECSACON) is a regional
professional body that serves as a technical advisory group to the Commonwealth Regional
Health Community (CRHC) for East, Central and Southern Africa (ECSA) countries on
nursing and midwifery.
It is a corporate body of nurses and midwives of member states comprising Botswana,
Lesotho, Kenya, Malawi, Mauritius, Mozambique, Namibia, Seychelles, South Africa,
Swaziland, Tanzania, Uganda, Zambia, Zimbabwe and any other states that will accede to
membership of CRHC for the ECSA region. ECSACON aims at strengthening nursing and
midwifery in the ECSA region through relevant activities.
Objectives
ECSACON’s objectives in pursuance of its goal and realization of its mission include:
Develop leadership and management skills in nurses and midwives. Strengthen skills of
nursing and midwifery educators and practitioners. Promote health information, education and
communication. Provide forums for sharing of experiences and lessons learned within the
region and beyond. Facilitate collaboration between and among member states on health
matters, and in nursing and midwifery activities. Encourage research that will promote
evidence-based practice and decision making.

Who can become a member of ECSACON?
The membership of the college consists of: individual nurses/midwifes and professional
organizations such as: National Nurse/Midwifery Association (NNAS/NMAS) and National
Nursing Councils (NNCS). An individual can become a member once registered by the
Nurses Regulatory Body as a nurse/midwife in any of the member states.
Benefits of membership to ECSACON
The first benefit is knowledge, which is power. This knowledge is obtained through the many
activities ECSACON conducts, such as quadrennial conferences where nurses from member
countries meet and share research findings on topics of national interests in health. They
exchange information on various topical issues on nursing, midwifery and health, mapping the
way forward for excellence in nursing/midwifery, education and practice and interacting with
nurses from the region is a benefit on its own. Apart from this, ECSACON has conducted
many projects.
Finally, members have rights or privileges which include the right to:
Vote and speak at the ECSACON meetings; Nominate candidates for ECSACON elections
and Standing Committees; Participate in ECSACON conferences, workshops, seminars and
other professional activities as appropriately promoted by ECSACON; Nominate candidates
for ECSACON fellowships and awards; Receive professional guidance and assistance from
ECSACON among others.
As we mentioned earlier in this section, NNAK is a member of the International Council for
Nurses. Let us now discuss the ICN.
1.7.6 The International Council of Nurses (ICN)
The ICN is a federation of National Nurses Associations representing nurses in more than
128 countries. It is the World’s first and widest reaching international organization for health
professionals, founded in 1899. ICN was one of the first health organizations to develop strict
policies of non – discrimination on the basis of race, creed, color, politics, sex or social status.
It is operated by nurses for nurses. The secretariat is based in Geneva Switzerland. Overseeing
the ICN is the Council of National Representatives which serves as the governing
organization.
The ICN has three key program areas listed as crucial to nursing:

i. Professional nursing practice with a focus on an international classification of nursing
practice (ICNP, the Nature of Nursing practice, and specific health issues, such as
acquired immunodeficiency syndrome, tuberculosis, malaria, women’s health, family
health, and safe water.
ii. Regulation of the standards of nursing, including aspects related to credentialing,
standards of competencies, and a code of ethics.
iii. Socioeconomic welfare for nurses, which includes areas such as occupational health
and safety, human resource planning and policies, remuneration, and career
development.
ICN Philosophy entails commitment to caring, advocating on behalf of patients and helping
people help themselves
Congratulations for coming this far in the learning process. We can summarize the section as
follows.

1.8 Summary
Historical perspectives of nursing practice revealed that women
have traditionally cared for the sick. Religious orders made an
impact in nursing by instilling values of compassion, commitment
to duty and hard work. War created an increased need for nursing
services. Volunteer civil war nurses played a major role in reforms
of military hospitals and advancement of professional nursing. In
1860 Florence Nightingale founded the first nursing school at St.
Thomas hospital, London. It became the model for nursing
education in United States. Originally the focus of nursing
education was to teach the knowledge and skills to equip them to
work in hospital setting. Today the scope of educational
preparation has expanded to prepare nurses to work in more
diverse settings and assume more roles. History of nursing has an
impact on current state of the nursing profession. The
development of nursing education and practice has been
influenced by many factors leading to emergence of many
programs. Master’s and doctoral degrees are needed to meet
healthcare needs of the society. Professional nursing associations
are a channel through which nursing can improve both nursing
profession and healthcare delivery. There are many nursing
associations locally, regionally and globally. These offer a variety
of benefits to the public, the profession and to individual
members. The ICN is the World’s first and widest reaching
international organization for health professionals, founded in
1899.
1.9 Review questions
1. Describe the four phases in the evolution of nursing.
2. Explain two types of nursing knowledge specific to the
nursing discipline.
3. State three benefits of belonging to a professional
association.
4. State three key program areas of the ICN which are crucial
to nursing.
5. State three current trends in nursing.

SECTION TWO: THE NURSING PROFESSIONALISM
2.0 Section outline
2.1 Introduction
2.2 Objectives
2.3 Definition of terms
2.4 Characteristics of a profession.
2.5 Nursing as a profession.
2.6 Barriers to professionalism in nursing.
2.7 Nursing licensure and certification.
2.8 Scope of practice in nursing.
2.9 Nursing Council of Kenya.
2.10 Summary
2.1 Introduction
Welcome to section two of unit six which discusses the professional nurse. We shall study the
characteristics of the nursing profession and the professional regulatory body. Nursing has
evolved a long way from being an art of nurturing to a science of providing well organized
and planned care to patients using evidence based practice. Having trained and worked as a
professional nurse you should have an idea of what a profession is.
Let us begin by defining some key terminologies in Nursing.
2.3 Definition of terms
Before we proceed attempt the following question.
In text question 2.1
What do you understand by the term profession?
2.2 Section Objectives
By the end of this section you should be able to:-
1. Define some key terminologies
2. Identify the characteristics of a profession.
3. Evaluate nursing’s current status as a profession.
4. Discuss the barriers to professional practice.
5. Analyze the various components of a nursing practice Act.
6. Discuss the Nursing Council of Kenya.
7. State the benefits of defining the scope of practice for nurses.

Probably you came up with a definition similar to this;
A profession is an occupational group with a set of attitudes, behaviors, or both. A profession
requires advanced specialized training and the professionals must meet specified criteria.
A Professional Nurse This is a person who has successfully undergone a prescribed nurse
training program has passed a licensing examination and has been registered by the regulatory
body, in our context the Nursing Council of Kenya.
2.4 Characteristics of a profession
Professions have characteristics as given below.
 A profession has a specialized body of knowledge that is continually enlarged
through research.
 Practitioners acquire their knowledge in institutions of higher learning.
 The services provided are vital to humanity and social welfare.
 There’s high level of individual responsibility and accountability.
 A profession exercises autonomy in the formulation and control of policies by
the practitioners.
 Practitioners are motivated by service (altruism) exalting their work above
personal gains.
 The professionals are guided by a code of conduct in their decisions.
 There’s a professional organization and a regulatory body that encourages and
supports high standard of practice.
2.5 Nursing as a profession
Having looked at the characteristics of a profession do you
think nursing meets criteria for a profession?
To be able to answer this question let us examine how well contemporary nursing fulfils the
eight characteristics of a profession.
There is a special body of knowledge in nursing that is enlarged through research.
Nursing is no longer based on intuition and task orientation but increasingly relies on research
as a basis for practice. The profession has also adopted evidence based practice through
application of research in carrying out of nursing activities. Nursing has developed a unique
body of knowledge through training in specialized areas like critical care, peri-operative
nursing as well as specialties at masters and PhD level.
Knowledge is acquired in institutions of higher learning

In the developed world most of the nursing schools offer associate degrees and basic
programs for professional nurses. In Kenya the institutions of higher learning for nurses have
expanded, however these are not able to cater for the number requiring to up-grade to degree
level. This has necessitated therefore the need to up-grade nurses from diploma to degree
level through Distance learning. There are growing numbers of master’s and doctoral
programs in nursing though it has not reached the level of other professions.
Services provided are vital to humanity and social welfare
Nursing promotes the maintenance and restoration of health of individuals, groups and
communities. Assisting others to attain the highest level of wellness is the goal of nursing.
Service to the society involves ethical responsibility and nurses have various ethical principles
which govern their practice as we shall see later in this unit.
Individual responsibility and accountability
A professional must be accountable to the profession and the public. The consumer has the
right to receive the best quality care grounded in a firm knowledge base and by those who can
utilize the knowledge appropriately by use of sound judgment. Utilization of the nursing
process in planning and provision of nursing care to patients has instilled a level of
responsibility and accountability among nurses. The professional nurses engage the cognitive,
psychomotor and affective domains in provision of care.
Altruism
Altruism (derived from the Greek word alter- other) is the conduct aimed at the good of
others. Most nurses are dedicated to the ideal of service to others. However due to economic
hardships and social problems this has been hard to practice. The services offered by nurses
may not be compensated for adequately hence it takes a great deal of sacrifice. It’s only
through good remuneration that the profession will become attractive.
Code of Ethics
A code of ethics provides professional standards and a framework for decision making.
Various codes for nurses have been developed by the ICN and other professional associations.
Intrinsic to these codes is the belief that the client has basic rights and that a nurse’s primary
responsibility is to the client. The Nursing Council of Kenya code of Ethics guides the nurses
practicing in Kenya. Nurses also use the ICN code of conduct.
Professional organization and the regulatory bodies
The nursing profession is regulated by professional bodies established by statutes in any given
country, (for example, the nurses Act Cap 257 of the laws of Kenya which established the

Nursing Council of Kenya). The function of the professional bodies is to define, promote,
oversee, support and regulate the affairs of its members. These bodies are responsible for the
licensure of professionals, and may additionally set registration examinations for the
graduates of the various programs. However, they all require that the individual hold at least a
first professional degree or a diploma before licensure. There may be several such bodies for
one profession in a single country all of them mandated to regulate the profession e.g. in
America most of the cities have regulatory bodies.
Professional associations: Most nurses belong to professional associations organized by the
nurses themselves. The professional associations such as, the ECSACON are intended to
enhance the status of their members and have carefully controlled entrance requirements. The
professional organizations (NNAK and KPNA) promote high standards of nursing practice
and advocate for good terms of employment for the nurses. Some associations have divided
themselves into chapters which cater for nurses with similar specialties as we shall see later in
this section. Most of the nurses’ professional organizations negotiate for good working
conditions and terms for the nurses.
Autonomy
Professional autonomy is often described as a claim of professionals that has to serve
primarily their own interests. The concept of autonomy can be seen to embrace not only
judgment, but also self-interest and a continuous process of critical evaluation of ethics and
procedures from within the profession itself.
Would you describe the nursing profession as autonomous? Why?
The nursing profession can be described as being autonomous due to the following
characteristics:
i. Nursing has both dependent and inter-dependent roles
Most nurses however are employed in hospitals where authority resides in one’s
position rather than expertise. Nurses have therefore been required to perform certain
actions when only authorized by a physician or health administrators.
ii. High status and rewards
The most successful professions achieve high status, public prestige and rewards for
their members. In the developed world the services of a nurse are highly valued hence
nurses are well paid.
iii. Control of remuneration and advertising

Where levels of remuneration are determined by government, nurses professional
bodies are active in negotiating remuneration packages for their members. Though this
is sometimes done in good intention some employers tend to question the aspect of
altruism in nursing when they negotiate for better pay.
iv. Work autonomy
Professionals tend to retain control over their work, even when they are employed
outside the profession in commercial or public organizations. Nurses who are highly
educated and involved in research are able to publish and own their work which is an
aspect of autonomy.
v. Self-regulation
Nursing Professional bodies are established by statutes though like any other
professional bodies they experience political interference. The professionals therefore
agitate for self regulation.
vi. Individual clients
Many nurses are engaged in private practice. They therefore have their own clients
who pay for the services offered.
2.6 Barriers to professionalism in nursing
Before we delve into the barriers of professionalism in nursing, reflect on the question below.
Take Note 2.1
Although nursing is a profession, we must appreciate that it is undergoing
challenges in its evolution just like any other profession.
The following are some of the barriers to professionalism in Nursing.
Variability in education:
Most of the professional nurses in Kenya and other parts of the world hold less than a
baccalaureate degree unlike in other professions e.g. medicine. Professional status and power
increase with education. It is difficult therefore for nursing to take its place as a peer among
the professions. Secondly differentiation between technical and professional nursing is a
challenging issue that has not been resolved.
Gender issues:
Nursing is a female dominated profession. Nurses have faced challenges as people look at it
as “women’s duties” hence there’s intimidation.
Historical influence:
Historically nurses were connected to religious orders hence most people tend to view nursing
as a vocation rather than a profession. This has contributed to retardation of the profession.

When nurses bargain for their rights to fair treatment their altruism is questioned. Most
employers take advantage of altruism and end up exploiting nurses.
Internal and External conflicts:
Due to difference levels of education nursing has developed internal conflicts to the extent
that nurses have turned to compete negatively rather than complementing one another. On the
other hand external conflicts between nurses and other medical personnel have arisen due to
the expanded scope of practice for nurses as a result of higher levels of training.
2.7 Nursing practice Acts
Each state has rules and regulations to govern the practice of nursing within that state. These
rules are in the nursing practice Acts or in various policy documents that accompany the Act
for the purpose of administration.
2.7.1 Components of the Acts
Purpose of the act
Each Act begins with a purpose. Most nursing Acts include two purposes i.e. a description of
the qualification and responsibilities of those covered by the regulation as well delineating
those excluded from the practice of nursing. Secondly it protects the legal title of the nurse
which is reserved for those meeting the requirements to practice nursing.
Definition of nursing and scope of practice
Many Nurse Practice Acts define the practice of professional nursing. To prevent the acts
from becoming outdated, in the face of new skills, no lists of techniques and procedures are
included in the Acts. The definitions of basic and advanced nursing practice including the
scope are done separately.
It is imperative for every nurse to familiarize self with their scope of practice so as to avoid
illegal practice. Nurses are accountable for knowing the definition and scope of practice
within their jurisdiction and practicing accordingly.
Licensure requirements
A section of each nursing act describes the requirements and procedures for initial entry into
nursing practice, or licensure. Most states require statements from the school of nursing
attesting to the eligibility of the candidate for licensure. Temporary permits are available for
nurses moving from one jurisdiction/country to another. Nurses may apply to practice in a
state different from their state of licensure through writing. They may require verification of
their license from their state of jurisdiction before they are licensed to practice in the new
state.

Renewal of licensure
Most nursing practice Acts include the requirements for the renewal of one’s practice license.
These regulations include: the length of time a license is valid and the requirements for
renewal.
Mandatory continuing education
All nurses are expected to remain competent to practice through various means of continuous
education. The number of hours necessary varies from state to state.
2.7.2 Nursing licensure
In 1860 Florence Nightingale created a list of all graduates from St. Thomas school of nursing
which was known as the registry of graduate nurses. It provided institutions with a system of
identifying graduates of particular nursing programs. Nursing institutions and programs
maintain a record of all graduates. Likewise, Professional bodies and state agencies maintain a
register/ roll of the nurses practicing under their jurisdiction.
Purpose of licensure
The primary purpose is to protect the public by providing a distinction between those
sufficiently trained to provide care from the untrained or lesser trained individuals.
Early licensure activities
Before the late 1800s, many nursing hospital based programs prepared nurses based on the
hospitals’ needs. It became apparent to nurses that consistent minimal standards to practice
across setting were necessary. These standards would provide public safety as well as improve
mobility of nurses among institutions. In 1901 the ICN passed a resolution that each nation
and state examine and license its nurses.
Mandatory licensure
Most states require that all nurses must be licensed to practice. This is referred to as
mandatory licensure. Different state regulatory bodies have different licensure requirements,
for instance in the USA one has to pass the NCLEX (Nursing Council Licensing
examination). Nurses trained from other countries are usually required to do CGFNS
(certificate of graduates of foreign nursing schools).
Take Note 2.2
It is important for you as a practicing nurse to have a valid practice
license. In case you have not applied for a nursing practice license or
renewed your license obtain details of requirements for renewal of
your practice license from the NCK website or from their head office.

2.8 Nursing Council of Kenya (NCK)
As you saw earlier in this section, one of the characteristics of a profession is that it has
professional regulatory bodies in our context the Nursing Council of Kenya. This topic will
give you an overview if the nursing Council of Kenya to be able to understand the
composition and how it functions. Read through.
2.8.1 Introduction
The Nursing Council of Kenya is established under an act of parliament Cap 257 laws of
Kenya. Its mandate is to make provision for training, registration, enrolment and licensing of
nurses, to regulate their conduct and to ensure their maximum participation in the health of the
community and for connected purposes.
2.8.2 Membership of the nursing council
According to the NURSES (AMENDMENT) ACT NO.27 of 2011 the council shall consist
of-
(a) The director of medical services or his representative.
(b) The Director of education or his representative.
(c) The chief nursing officer or his representative.
(d) The Attorney general or his representative.
(e) The following persons appointed by the Minister:
(i) One registered midwife , to be elected by registered midwives;
(ii) One registered community health nurse, to be elected by registered
community health nurses;
(iii) One registered psychiatric nurse, to be elected by registered psychiatric
nurses;
(iv) One registered general nurse, to be elected by registered general nurses;
(v) One nurse nominated by National Nurses Association of Kenya;
(vi) One nurse nominated by Kenya Progressive Nurses Association;
(vii) One registered nurse educator actively involved in the training of
nurses nominated by recognized Universities in Kenya;
(viii) Two registered nurses nominated by registered religious organizations
providing health services in Kenya;
(ix) One person with a professional background in human resource
management;
(f) The chief Executive officer of the Kenya Medical training college or his
representative.
2.8.3 Functions of the Nursing Council

Having discussed the membership of the Nursing Council of Kenya, now we can proceed to
its functions. Start by trying to attempt this question.
In Text Question 2.4
What are the functions of the Nursing Council of Kenya?
The council is vested with such powers to:-
1. Establish and improve standards of all branches of the Nursing profession in all
their aspects and to safeguard the interests of all nurses.
2. Establish and improve the standards of professional nursing and health care within
the community.
3. Make provision of the training and instruction for persons seeking registration or
enrolment under this Act
4. Prescribe and regulate syllabi of instructions and courses of training for persons
seeking registration or enrolment under the Nurses Act
5. Recommend to the minister institutions to be approved for training of persons
seeking registration or enrolment.
6. Prescribe badges, insignia or uniforms to be won by persons registered, enrolled or
licensed under the Nurses Act.
7. Prescribe and conduct examination for persons seeking registration or enrolment
under the Nurses Act.
8. Have regard to the conduct of persons registered, enrolled or licensed under the Act
and to take such disciplinary measures as may be necessary to maintain a proper
standard of conduct among such persons.
9. Have regards to the standards of nursing care, qualified staff, facilities, conditions
and environment of health institutions and to take such disciplinary or appropriate
measures as may be necessary to maintain proper standards of nursing care in health
institutions.
10. Direct and supervise the compilation and maintenance of registers, rolls and records
required to be kept under section 12, 14 and 16 of the Act.
11. Advice the Minister of Health on matters concerning all aspects of Nursing.
For the proper functioning of the Council, Standing Committees have been appointed with
specific tasks. All the committees report to the full council, except where the council has by
resolution authorized a committee to manage, regulate or conclude any matter, no decision of
a Committee shall be binding until it has been ratified by the full Council.
2.8.4 Committees of the nursing council

The full council
This is composed of the fourteen members discussed earlier. The council holds its meeting
every three months and the first meeting was held in February 1950. The Full council is the
supreme decision making organ of the Nursing Council of Kenya. The main functions of the
full council are too; deliberate on reports from the standing committees, policies from the
Government and other various organizations. The Council ratifies the decisions made by the
standing committees.
The Standing Committees meet every three months to discuss issues under their mandate.
Take Note 2.3
The standing committees have various roles as stipulated below.
The Education, research and examination Standing Committee
Designing nursing programs, syllabi and national curricula according to the health needs of
the community. Scrutiny of institutional curricula and ensures that they meet the required
standards to train. Preparing training materials for example, training manuals and log books
for recording clinical practice during training.
Discussing and recommending examination results to the full board for approval. Prescribing
the training requirements and this involves setting the criteria for admission to various
programs. Approving various nursing programs, other functions include: development of
research guidelines carrying out performance evaluation for council examination, formulation
of data protection policy and coordination of the nursing workforce project.
Discipline, Standards and Ethics Committee
The standards committee was formed in March 2001. It was later upon the amendment of the
Act in 2011, merged with the investigation committee to become the discipline, standards and
ethics committee. It is charged with the responsibility of establishing facts or issues against
nurses or institutions run by nurses brought before the council. It investigates all cases of
professional misconduct, negligence, malpractice and impropriety. The committee ensures
professional discipline among practicing nurses by implementing the relevant parts of the
nurses Act. As a practicing nurse you may be familiar with the offences under the 257 Act.
Other functions include: Initiation and maintenance of standards of nursing education and
practice, Coordination of council visits to health institutions for the purposes of monitoring
the quality of nursing education or quality of care offered to patients and clients and

recommending institutions to be approved as nurse training institutions. Decisions made by
this committee are recommended made to the Full Council.
Registration and licensing Standing Committee
The committee is mandated to set criteria and oversee the implementation of regulations
governing the registration, enrolment and licensure of nurses in Kenya. The functions include:
Approving the registration, enrolment and licensing of nurses for nursing practice. This is
applicable to those trained in Kenya and those trained outside Kenya. Licensing nurses for
private practice upon meeting the requirements, approving retention of nurses in the registers,
rolls and records.
Human resource and Finance Standing Committee
This committee is the main agency involved with the generation and utilization of the
council’s revenue subject to the Government regulations. The main purpose of the committee
is to ensure that the council finances are administered effectively for the benefit of the Council
and the profession. Recruitment and development of council staff.
The nursing council secretariat
The Nursing Council Secretariat conducts the day to day activities of the Council. The
Secretariat is composed of council officers and council staff. The council officers are currently
employees of the Ministry of Health deployed to work at the council. The council staffs are
employees of the Council. The Council officers coordinate various Standing Committees and
Subcommittees as discussed earlier. They implement the decisions of the committees.
2.9 The Scope of practice in nursing
Up to now we have focused on defining Nursing, the nursing profession and how nursing
measures to a profession. We have also gone through the historical milestones of nursing. Let
us now look at the scope of their practice.
2.9.1 Definition of the scope of practice
The scope of practice for nurses is prepared based on the existing laws and it aims at
establishing boundaries of practice for all nurses.
The scope may be narrowed for nurses within a particular setting but it may not be broadened
without legal and ethical ramifications.

Activity 2.1
As a nurse practitioner you need to understand your scope of
practice to be able to function within your level. Buy yourself a copy
of the scope of practice form the NCK offices.
2.9.2 Benefits of defining a scope of practice for nurses
As you read earlier in this section, one of the functions of nurses’ practice Acts is to define the
scope of practice for nurses, in this topic you will study the benefits of doing so. You will
examine the reasons why it is imperative to define the scope of practice in nursing.
Defining the scope of practice; Guides training institutions on how to prepare nursing
students.
Enables employers to prepare job descriptions for their nurses. Allows the public to know who
qualifies to provide various nursing services. Assists practicing nurses to re-examine practice
roles in time of rapid changes in healthcare. Determines boundaries between nurses and other
health professionals to avoid conflicts. Allows Governments and other employers to employ
the most cost-effective mix of providers.
In accordance to the authority vested by the nurses Act Cap 257 of the laws of Kenya the
Nursing Council of Kenya has prescribed a scope of practice for nurses. Based on the level of
preparation the duties and responsibilities of nurses registered/enrolled/licensed to practice in
Kenya have been grouped into; nurse managers, educators, researchers and clinical nurse
practitioners.
Congratulations for coming this far in the learning process. We can now summarize the
section as follows.
2.10 Summary
There are several characteristics that all true professions have in
common. These include; a body of knowledge, specialized education,
altruism, service to society, accountability, autonomy, professional
bodies and ethical standards. Nursing is still facing challenges in its
evolution to a full professional status. The practice of nursing is
governed by Acts of parliament which regulate practice in different
states. The Acts stipulate the licensure requirements as well as the
scope of practice for the nurses under its jurisdiction. The scope of

practice for nurses prescribes the duties nurses are allowed to do
based on their level of qualification. It has benefits to the nurses, the
employers and the public. The NCK is a body corporate established
under Cap 157 of the laws of Kenya. It is mandate is to regulate
training and practice of nurses as well as their conduct. To execute its
mandate the council is divided into six committees with various
functions. The activities of the council are executed by the council
secretariat.
1. State three characteristics of a profession
2. Explain at least two barriers of professionalism in nursing.
3. State three functions of the NCK.
4. Explain three components of the Nursing practice Acts.
5. Name three benefits of defining the scope of practice for
nurses.
SECTION THREE: THE MAJOR CONCEPTUAL AND PHILOSOPHICAL
ELEMENTS IN NURSING
3.0 Section Outline
3.1 Introduction.
3.2 Section objectives
3.3 Major concepts in nursing.
3.4 Components and processes of systems.
3.5 Health, illness and wellness.
3.6 The contextual basis of nursing practice.
3.7 Philosophical basis of nursing practice.
3.8 The role of the nurse.
3.9 Nursing care delivery models.
3.10Summary
3.11Review question.
3.1 Introduction

Welcome to section 3 of Fundamentals in nursing. In this section we are going to discuss the
concepts, context and philosophy of nursing focusing on: description of selected concepts,
philosophic basis of nursing practice, major contextual elements affecting nursing practice
and finally we shall look at knowledge basis of nursing, the role of the nurse and nursing care
modalities.
By the end of the section, you should be able to:
1. Summarize concepts basic to professional nursing.
2. Describe the components and processes of systems.
3. Differentiate health, illness and wellness.
4. Explain the contextual basis of nursing practice
5. Discuss the philosophy of nursing and its significance to
practice.
6. Discuss the role of the nurse.
7. Discuss the various nursing care modalities (giving
advantages and disadvantages of each).
Let start by defining major concepts in nursing practice
3.3 Major concepts in nursing
Nursing is an art and science focused directly on mankind in an intricate technologic world.
There are certain basic concepts that are essential to an understanding of nursing practice.
These are the building blocks to nursing and include; person, health and environment
Professional nurses have values and beliefs that influence their lives. These values and beliefs
interact directly with the conditions in the environment (context of nursing). Context can be
defined as the circumstances or settings in which events occur while philosophy of nursing
refers to the nurses’ beliefs about people, the world, health and nursing. Nursing traditionally
was based on intuition and experience which led to stereotypical practice. Practice based on
knowledge and theories however allows one to reason and derive a rationale for their practice.
You shall also learn the role of the nurse and various nursing care delivery models.
Metaparadigms
Metaparadigms can be defined as global concepts that identify the phenomena of central
interest to a discipline. The concept of metapardigm was introduced in 1970 when nursing
defending its status as a science. Concepts and propositions are essential in specifying the
subject matter of a discipline. Fawcett in 1987 defined the central units of nursing
(metaparadigms) as: person, health, environment and nursing.
Concepts and propositions

A concept is a word or phrase that summarizes ideas, observations, and experiences.
Concepts are tools that provide mental images that can facilitate communication about and
understanding of phenomena; they are not real entities. A proposition is a statement about a
concept or a statement of the relation between two or more concepts. A nonrelational
proposition is a description or definition of a concept. A relational proposition asserts the
relation, or linkage, between two or more concepts.
Philosophies
Philosophies are directed at discovery of knowledge and truth, as well as the identification of
what is valuable and important to members of a discipline; philosophic problems focus on the
nature of existence, knowledge, morality, reason, and human purpose. In other words, the
function of each philosophy is to inform the members of disciplines and the public about the
beliefs and values of a particular discipline.
3.4 Systems
The General systems theory is a framework that was originally developed by von Bertalanffy
in 1936. Systems theory is concerned with changes due to interactions among all the factors
(variables) in a situation. Before you study the systems theory attempt this question
What is a system?
A system may be defined as a set of interrelated parts that form a whole in which the parts
have a function and the system as a totality has a function. A person is a system of cells,
organs and physiologic systems. A person is a subsystem of the family (supra- system),
which is a subsystem of the community.
3.4.1 Component of the system
The system is comprised of three parts. These are;
i. Input: Raw material (information, energy) that enters the system through put: process
of converting the raw material into a form that can be utilized.
ii. Output: End product
iii. Evaluation: Measuring success or failure of the output (effectiveness) of the system.
iv. Feedback: Information given back to determine whether the purpose is achieved.
Below is an illustration of how the components of systems interrelate.
Out Put
Through Put
Input

Figure 1: Components of the systems and their Interrelationships
3.4.2 Major concepts of a general systems model
A system consists of several parts called subsystems which function collaboratively for its
success. For instance in a hospital set-up the departments form the sub-systems. Systems can
be broadly categorized into two, that is:
Open system
An open system promotes the exchange of material with other systems and the environment.
The larger environment outside is the supra-system. For example, the human being is an
open system
Closed system
A closed system does not interact with other systems or environment. Matter, energy or
information does not flow out. For example, a stone or an inanimate object.
Please note that, the whole is different, greater than sum of the sub-systems. For example,
departments in a hospital join efforts with families and to make up a whole. Systems are
dynamic in nature to an extent that, change in one part of the system creates change in other
parts.
3.4.3 Application of the systems model to nursing
Why is it necessary for nurses to understand systems?
Nurses work within systems every day, the hospital for instance is an open systems with
various departments which interact with one another as the sub- systems. To work effectively
in this complex system they need to have an understanding of how systems operate.
Understanding the body systems helps the nurses assess the relationships among all the factors
that affect patients which makes nursing interventions possible. This understanding will
enable the nurse view the patient holistically including the sub- systems (body systems) and
the supra system (family and community) and to appreciate the influence of change in the

systems. For instance a patient with diabetes develops high blood pressure which makes him
unable to run his business properly. The two body systems are affected and the dependants
will suffer loss of income.
Person
Each individual is an open system with numerous sub-systems. There are physiological,
psychological, social, cultural and spiritual sub-systems. Each person is unique and the
uniqueness is determined both genetically and environmentally and forms the basis for
holistic nursing care. A person belongs to a family (supra-system).
Human needs
In 1954 Abraham Maslow, a psychologist wrote a book titled “Motivation and Personality” in
which he presented his human needs theory. He explained that human behavior is motivated
by intrinsic human needs. He identified five categories of human needs arranged in order of
importance from those essential for human survival to those necessary to develop a person’s
fullest potential. The most basic level consists of those necessary for physiological survival.
These are common to all people regardless of culture and social status. The second level is
safety and security needs which are both physical and psychological security needs. The third
level is love and belonging while the next one constitutes self esteem needs. The highest level
is need for self- actualization whereby people achieve their highest potential.

Figure 2: A pyramid showing Maslow’s Hierarchy of Human needs.
It is assumed that basic needs should be met first before the rest and that individuals have
different ways of addressing their needs.
Nursing
The systems model is applicable in the practice of nursing in that: Nurses work within systems
in hospitals which are exemplified by various departments. Understanding that different
systems in a body interrelate and affect one another in sickness helps them to develop a
holistic approach to patient care.
3.5 Health, Illness and Wellness
Health
A classic definition of health is that health is a state of complete physical, mental, and social
well-being, not merely the absence of disease or infirmity (World Health Organization, 1974).

Exchange of information and energy within and between systems in continuous process. The
dynamic balance within systems, sub-systems and supra-systems helps maintain homeostasis
(internal stability).
3.5.1 Health- illness continuum
Wellness, a term often used interchangeably with health, is an active state of being healthy by
living a lifestyle that promotes good physical, mental, and emotional health.
Dunn’s high level- wellness grid
Dunn (1961) described a health grid in which a health axis and an environmental intersect.
The health axis extends from wellness to death while the environmental axis extends from
favorable to unfavorable environment. The intersection of the two forms four quadrants of
health and wellness. These are;
i. High level wellness in a healthy environment, for example, implementing a health
dietary plan when one has the capacity to maintain it.
ii. Emergent high level health in an unfavorable environment, for example, a lady with
knowledge of family planning methods but cannot use them due to her religious
beliefs.
iii. Protected poor health in a favorable environment, for example, a sick person who is
receiving adequate medical attention.
iv. Poor health in an unfavorable environment, for example, a sick person who is unable
to access medical care.
v. Dunn’s model encourages the nurse to care for the total person, with regard for all
factors affecting the person’s state of being while striving to reach maximum potential.
3.5.2 Illness and disease
An illness is the response of the person to a disease; it is an abnormal process in which the
person’s level of functioning is changed when compared with a previous level. This response
is unique for each person and is influenced by self-perceptions, others’ perceptions, the effects
of changes in body structure and function, the effects of those changes on roles and
relationships, and cultural and spiritual values and beliefs. It is important for nurses to
remember that a person may have an illness or injury but still achieve maximum functioning
and quality of life and consider themselves to be healthy.
Disease is a medical term, meaning that there is a pathologic change in the structure or
function of the body or mind.
3.5.3 Health behaviors
Behavior can be defined as the observable response of an individual to external stimuli. It is
the individual’s attempt to achieve satisfaction of needs. All behavior has meaning and nurses

should try to determine the meaning of client behavior. When a person becomes severely ill,
certain illness behaviors may occur in identifiable stages (Suchman, 1965). These behaviors
are the way people cope with alterations in function caused by the disease. They are unique to
the individual and are influenced by age, gender, family values, economic status, culture,
educational level, and mental status. These stages include:
Stage 1: Experiencing symptoms
How do people define themselves as “sick”? The first indication of an illness usually is
recognizing one or more symptoms that are incompatible with one’s personal definition
of health. Symptom indicating illness include: pain, a rash, fever, bleeding, or a cough. If the
symptoms last for a short time or are relieved by self-care, the person usually takes no further
action. If the symptoms continue, however, the person enters the next stage.
Stage 2: assuming the sick role
The person now defines himself or herself as being sick, seeks validation of this experience
from others, gives up normal activities, and assumes a “sick role.” At this stage, most people
focus on their symptoms and bodily functions. Depending on individual health beliefs and
practices, the person may seek divine intervention, do nothing, may buy some medications to
relieve symptoms, or may visit a healthcare facility for diagnosis and treatment.
Stage 3: medical care contact
Sick people sick for treatment on their own or when urged to do so by others. In doing so the
client is seeking for: validation of the disease, clarification of symptoms in understandable
terms and/or reassurance. The healthcare provider may confirm the presence of a life
threatening illness of declare that there is no disease. An illness becomes legitimate when a
healthcare provider makes a diagnosis and prescribes its treatment. When help from the
healthcare provider is sought, the person becomes a patient and enters the next stage.
Stage 4: assuming a dependent role
This stage is characterized by the patient’s decision to accept the diagnosis and follow the
prescribed treatment plan. The person becomes dependent on the professional for help. People
vary in the degree of ease with which they can give up their independence, most of them will
retain some degree of control over their own lives. If the disease is serious the patient may
enter the hospital for treatment. If the symptoms can be managed by the patient or family
alone or with the assistance of home care providers, the patient is cared for at home. To
facilitate adherence to the treatment plan, the patient needs effective relationships with
caregivers, knowledge about the illness, and an individualized plan of care. The patient’s
responses to care depend on; the seriousness of the illness, the patient’s degree of fear about
the disease, the loss of roles, the support of others, and previous experiences with care of a
similar illness.
Stage 5: achieving recovery and rehabilitation
At this stage the client is expected to relinquish the dependent role and resume former roles
and responsibilities. The people with short illness recover faster. Recovery and rehabilitation

might begin in the hospital and conclude at home, or may be totally concluded at a
rehabilitation center or at home. If the plan of care includes health education, the individual
may return to health at a higher level of functioning and health than before the illness.
3.5.4 Variables influencing health behaviors
There are various variables that influence health including:
Lifestyle
This consists of a person’s usual daily activities and routines that are that are acceptable
practices in the person’s life. Such habits influence health status. Lifestyles are developed
within one’s family and one’s cultural environment. Unhealthy behavior is a leading cause of
deaths in industrialized nations. Smoking, obesity sedentary lifestyle, substance abuse are risk
factors for various diseases. Life style modifications are necessary to improve health though
many people find compliance difficult.
Perceived locus of control
This refers to individual’s sense of being able to influence events and situations affecting their
lives. People with external locus of control feel that they have very little control over their
lives while those with internal locus of control have a strong sense of control over their lives.
Therefore individuals with internal locus of control are more willing to make lifestyle changes
that will affect their health positively.
Self efficacy
Self efficacy is an individual’s belief in their ability to perform a certain task (Albert Bandura
1997). The theory of efficacy is that the more one believes in the efficacy of a specific activity
the more motivated he or she is to perform it. Nurses should help clients to achieve a high
level of self – motivation so as to facilitate behavior change. Self efficacy is a form of self
confidence that leads to successful behavior performance. It encompasses two types of
expectations:
Outcome expectations: beliefs about whether behavior will produce desirable results.
Efficacy expectations: Beliefs the person has about his or her ability to perform the behavior.
Self concept
A person’s self-concept incorporates both an individual’s perception about self worth (self-
esteem) and the way he or she perceives his or her physical self (body image). Self-concept
has both physical and emotional aspects and is an important factor in the way the individual
reacts to stress and illness, follows self-care health practices, and relates to others. A person’s
self-concept results from a variety of past experiences, interpersonal interactions, physical and
cultural influences, and education. It includes perceptions of one’s own strengths and
weaknesses. Self concept is dynamic and may change according to health status. Illness can
alter a person’s self-concept as it affects roles, independence, and relationships with important

others. Self concept influences individual’s health in that a person who feels highly of
themselves will take care of their health and vice versa.
Healthcare attitude
Heath behaviors are based on beliefs. Attitudes about health and personal vulnerability greatly
influence behavior. Socialization influences the development of beliefs about healthcare. The
family and the culture to which a person belongs influence the person’s patterns of living and
values about health and illness. All of these factors are involved in personal care, patterns of
eating, lifestyle habits, and emotional stability. For instance an adolescent may develop
smoking habit because her parents smoke.
3.5.5 Health beliefs model
Rosenstock (1966) formulated a model of health beliefs which included three components: An
evaluation of one’s vulnerability to a condition and the seriousness of the condition. An
evaluation of how effective the health maintenance behavior might be. The presence of a
trigger event may precipitate the health maintenance behavior. Using this model one may
choose to participate in a stop- smoking program depending on his perception of smoking-
related heart diseases and his personal susceptibility to it.
In text Question 3.3
Identify specific behaviors that promote a person’s ability to stay
healthy. What are some of the behaviors that are considered as
unhealthy?
3.5.6 The environment
All persons are open systems which exchange matter, energy and information across their
boundaries with the environment. A person’s internal environment is in constant interaction
with a changing external environment. Individual nurses in the interest of world health, may
choose to engage in a variety of environmentally sound practices in their personal lives e.g.
good waste management. Nurses can join committees dealing with waste management in
hospitals.
3.6 The contextual basis of Nursing Practice
Begin this topic by asking yourself a question. What is the world or nursing like today? To
answer this question we are going to look at the world in general. Naisbitt and Aburdene in
1990 predicted the changes which they believed would occur in the social, political, cultural
and economic context. Some of the trends they predicted are:

3.6.1 Communication
Due to the introduction of the fiber optic cable ability to communicate and travel widely
which has led to more similar global lifestyles however there has developed a desire to assert
the uniqueness of one’s own culture. Nurses therefore need to respect the cultural nationalism
of their clients of the patients
3.6.2 Women as leaders
Women have been believed to be good leaders due to their ability to coach their sub-
ordinates. Caring in the nursing environment should be supported by the changing view of
leadership in the world.
3.6.3 The ethical individual
Living in a global world has made people develop commitment to eradicate warfare and
poverty. This shows that clients are empowered to accomplish their goals and nurses should
move from dealing with oppressed people to empowered people.
3.6.4 Major contextual elements affecting nursing practice.
To understand the moral dimensions of nursing (to be covered later in section 6) the nurse
needs to understand the contextual elements of nursing that either reinforce or challenge belief
and value system. Let us now look at some selected contextual elements.
1. Demographic elements
The demographic of the world population is changing significantly. Due to improvement in
healthcare life expectancy and growth in total population has increased among other changes.
These changes have necessitated the planning for health programs that will maximize the
health of all people.
Implications for nursing
What are the implications for nursing that emerge from these
demographic changes? Please note down in your journal and
compare your answers to the text below.
Population increases
Increased size of population mandates increased healthcare services. As people become more
informed about their healthcare nature of their nursing care needs also to change. All people
need a primary health care provider and this should be the professional nurse. The need for
providing quality training to our nurses therefore, cannot be over emphasized.
Aging population

The increasing age of the population poses special demands on nursing. The older people are
more at risk of suffering from chronic illnesses and require frequent admissions. These aged
people also have greater need for assistance to meet their activities of daily living. The goal of
nurses should be therefore to improve the quality of life for every older adult client they
interact with.
Changing household and family structures
Declining household sizes translate into increased nursing care needs. Most of the family
members work outside hence if one falls sick a professional nurse will be required to care for
them. Even when someone is around, care may need to be planned with a professional nurse.
2. Environmental elements
A number of environmental factors affect global health. These include; socio - economic
consideration like poverty, unemployment, overcrowding, poor waste disposal system,
inadequate diet among others. These socioeconomic conditions affect infrastructure and
nurse mat tend to move and work in urban areas leaving some population without
professionals to nurse them. Violence due to poverty, and accidents due to poor roads and
congestion in towns may result.
Pollution and global warming
Fumes from industries and automobiles have led to environmental pollution and depletion of
the ozone layer which is a critical resource. Deforestation has also contributed to carbon
pollution and global warming. Clearing of forests has led also to depletion of trees which are a
source of herbal medicines.
Availability of primary healthcare
This has been a problem due shortage of qualified staff to provide the services and also due to
the fact some cultural beliefs discourage some PHC activities like growth monitoring, family
planning etc.
Implications for nursing
People living in poor socioeconomic conditions engage in struggle for survival hence their
focus is on short- term benefits as opposed to investing in quality life. Nurses need to consider
the client’s motivation when intervening to promote health. Availability of healthcare is a
significant factor to consider when considering the utilization. Distance to the health facility,
cultural and religious beliefs affect utilization of health services.
3.7 The philosophical Basis of Nursing
The philosophy of nursing is critical to the practice of professional nursing. Philosophy
encompasses the belief system of the professional nurse as well as a quest for knowledge. A

person’s belief system and understanding determine how he thinks about a phenomenon or a
situation. Nurses need to understand the definition, purposes, significance and elements in
order to develop a personal philosophy. This section will thus, present a definition of
philosophy and discuss the significance of philosophy to human systems and nursing.
The term philosophy is derived from a Greek word for ‘lover’. Philosophy may therefore be
defined as love and pursuit of wisdom by intellectual means and moral self- discipline.
3.7.1 Significance of philosophy for nursing
The society improves when members grow in knowledge. This is because in pursuit of
objectives of philosophy members are afforded an opportunity to exercise both understanding
and value judgment. The nursing profession needs leaders who are philosophers of nursing.
Nursing must prepare nurse practitioners who have: vision for nursing, concern for the good
of humankind, belief systems reflecting sound ethics, developed and reflected on their own
philosophies of nursing.
3.7.2 Relation of philosophy to the nursing process
Nursing process is the systematic problem solving approach used to identify, prevent and treat
actual or potential health problems and promote wellness. It is also a systematic way to plan,
implement and evaluate care for individuals, families, groups and communities. Nursing
process promotes individualized care, that is, human beings are treated holistically.
Philosophy of nursing provides the framework on which nursing practice is based. It defines
the values, beliefs and ideals about nursing, human being, environment and health.
The nursing process enables the nurse systematically to assess or collect data about the patient
himself and his environment. Since the philosophy of nursing recognized that human beings
are active and consistently interacts with their environment, any deviation from this will alert
the nurse through nursing process to act upon it so that there is balance between man
environment interactions. Therefore, nursing process is the mechanism used to implement the
philosophy of caring while facilitating optimum level of wellness with the client.
3.7.3 Developing a personal philosophy of nursing
To develop a personal philosophy of nursing the professional nurse must focus on concern
about the nature of human and the life processes. The nurse should therefore attempt to
answer the following questions.
a) What is the society (constituents and the nature of their relationships)?
b) What is your central belief about the individuals and their potential?
c) What constitutes the environment?
d) How do human beings and the environment interact?
e) What is your view of health- Is it a continuum, unidirectional, a state, a process?
f) How do illness and wellness relate to health?

g) What is the central reason for the existence of nursing?
h) Who is the recipient of nursing care?
3.8 The Role of the Nurse
Before you go through this topic, here is an activity for you.
Activity 3.2
Write down the roles of a professional nurse from your
experience and compare with what is given in the text.
The professional nurse based in any given health care settings has three major roles: The
Practitioner role (which includes teaching and collaborating); the leadership role; and the
research role. These roles are interrelated and are designed to meet the immediate and future
health care needs of consumers who are the recipients of nursing care.
3.8.1 Practitioner role
The practitioner role of the nurse involves those actions that the nurse takes when assuming
responsibility for meeting the health care and nursing needs of clients (patients and significant
others). This role is the dominant role of nurses and can be achieved using the nursing
process. The nurse helps patients meet their needs through direct intervention, by teaching
patients and family members to perform care, and by coordinating and collaborating with
other health care team members to provide needed services.
3.8.2 Leadership role
The leadership role is inherent within all nursing positions and is not just based on titles. This
role involves those actions the nurse executes when assuming responsibility for the actions of
others that are directed toward determining and achieving patient care goals. Nursing
leadership is a process involving four components: decision making, relating, influencing, and
facilitating. Each of these components promotes change and the ultimate outcome of goal
achievement. Effective communication and use of interpersonal skills are vital in leadership as
they determine the accomplishment of the leadership process.
3.8.3 Research role
Participation in the research process is a responsibility of nurses both academic and clinical
practice. The primary task of nursing research is to generate evidence base for nursing
practice. Studies are needed to determine the effectiveness of nursing interventions and
nursing care. Through such research efforts, the science of nursing will grow and a
scientifically based rationale for making changes in nursing practice and patient care will be
generated. Nurses who have preparation in research methods can use their research knowledge

and skills to initiate and implement timely, relevant studies. All nurses must constantly be
alert for nursing problems and important issues related to patient care that can serve as a basis
for the identification of researchable questions.
Those nurses directly involved in patient care are often in the best position to identify
potential research problems and questions. Nurses also have a responsibility to become
actively involved in ongoing research studies. This participation may involve facilitating the
data collection process, or it may include actual collection of data.
Above all, nurses must use research findings in their nursing practice. Only with the use and
evaluation of research findings in nursing practice will the science of nursing be furthered.
Research findings can be substantiated only through use, validation, replication, and
dissemination.
Activity 3.2
Read on other roles the nurses play in the course of their practice.
3.9 Models of nursing care delivery
Nursing care can be carried out through a variety of organizational methods. The model of
nursing care used varies greatly from one facility to another and from one set of patient
circumstances to another.
With the current shortage of nursing staff, it is practically hard to
practice primary nursing. What improvement can be done in the
system to avoid task allocation?
3.9.1 Team nursing
Team nursing involves use of a team leader and team members to provide various aspects of
nursing care to a group of patients. In team nursing, various aspects of nursing care are given
by different members under the supervision of the nurse team leader.
a) Advantages
High quality care is provided in a cooperative manner. Each team member participates in
decision making and problem solving. Team members are able to contribute their expertise
and special skills in provision of care.

b) Disadvantages
The fragmentation of care is a major concern and the patient is attended to by different nurses
in a shift. Team leader may lack skills to effectively guide the team create a team spirit.
Continuity of care may be impaired if the daily team assignments vary.
3.9.2 Primary nursing
Primary nursing refers to comprehensive, individualized care provided by the same nurse
throughout the period of care. This type of nursing care allows the nurse to give direct patient
care rather than manage and supervise the functions of others. The primary nurse accepts total
24-hour responsibility for a patient’s nursing care. Nursing care is directed toward meeting all
of the individualized patient needs. The primary nurse is responsible and accountable for
involving the patient and family directly in all facets of care and has autonomy in making
decisions in this regard. The primary nurse communicates with other members of the health
care team and family regarding the patient’s health care which promotes continuity of care
and collaborative efforts directed toward quality patient care.
a) Advantages
There is one- to – one relationship established between the nurse and the patient.
The nurse exercises autonomy in planning and provision of quality to the patients.
There is accountability and provision of high quality un-fragmented nursing care.
b) Disadvantages
Implementation may be difficult as the primary nurse is required to have a high degree of
responsibility and autonomy.
It requires a big number of staff which may not be affordable to many institutions.
An inadequately prepared primary nurse may find it difficult plan and coordinate care with
other team members.
3.9.3 Case assignment
In this model nurses are responsible for planning, implementing total patient care required for
the assigned patients during the shift. This nursing care model is mostly used in critical care
units.
a) Advantages
Patient receives unfragmented care by only one nurse per shift.
Handing over of care from shift to shift is easy and collaboration is effective due to few
number of nurses are involved.
The nurse maintains a high degree of practice autonomy.
There are clear lines of responsibility and accountability.
b) Disadvantages
The number of nurses required to provide this type of care may be unavailable due to
shortage.
It requires a great deal of expertise which may be lacking in some nurses.

3.9.4 Functional nursing
In this modality of care staff members are assigned to complete certain tasks for a group of
patients rather than care for specific patients.
a) Advantages
Since task completion is the focus, less skilled staff can be used to perform some tasks which
make it cost effective.
A minimum number of registered nurses are required to supervise and perform strictly nursing
duties.
b) Disadvantages
Care may be fragmented with a possibility of overlooking some priority needs because the
focus is usually on the tasks.
Care providers feel unchallenged by performing repetitive tasks.
Many care givers may confuse the patient.
3.9.5 Partnership model
This is a modification of primary nursing. The primary nurse delegates non professional tasks
to a lesser qualified/experienced nurse while she concentrates on assessment, planning and
patient education.
a) Advantages
It is more cost effective than true primary nursing as it requires less number of registered
nurses.
The primary nurse can perform duties requiring expertise while the rest can be performed by
the assistant.
b) Disadvantages
The registered nurse may find difficulties in delegating to the partner.
Consistent partnerships are difficult to maintain based on the staff schedules.
Activity 3.3
When you go to work, talk to one of your nursing colleagues and find
out which systems he or she has used to deliver care. Note down the
strong and weak points and compare with what is in the text.
Congratulations for coming this far in the learning process. We can now summarize the
section as follows.

3.10 Summary
Nursing integrates three basic components – person, environment
and health to form its focus. Knowledge of and human needs can be
used to understand the major concepts in nursing. Maslow organized
human needs into five levels which range from physiological needs
(common to all) to self actualization needs (attained by few). Health
is dynamic and viewed a continuum. Health is affected by health
beliefs and behaviors. Concepts are abstract vehicles of thought and
are the building blocks of theories. A statement of beliefs can be
referred to as a philosophy. The nursing process is the mechanism
used to implement the philosophy of caring while facilitating
optimum level of wellness with the client. As nurses progress
professionally they develop various ideas about nursing from which
they develop their own philosophy of nursing. There are some
contextual elements which affect the nursing practice and these
include both environmental and demographic elements. Historically
there has been a number of nursing care delivery models which have
advantages and disadvantages. These include: primary nursing,
functional nursing, case management and team nursing. In
conclusion, we have seen that nurses play various roles in practice,
such as care provider, teacher, counselor, manager, researcher,
collaborator, change agent and patient’s advocate.
1. State the stages of illness behavior
2. What are the factors that influence an individual’s personal
health behavior?
3. Discuss two major contextual elements affecting nursing
practice and their implications.
4. Explain two models of care giving advantages and
disadvantages of each.
5. List the roles of today’s nurse, briefly explaining each one.

SECTION FOUR: THE NURSING PROCESS AND CRITICAL THINKING
4.0 Section Outline
4.1 Introduction
4.3 Characteristics of the nursing process
4.4 Steps of the nursing process
4.5 Documentation and reporting
4.6 S-B-A-R
4.7 Benefits and criticisms of the nursing process
4.8 Critical thinking process
4.9 Attitudes that foster critical thinking
4.10 Summary
4.11 Review questions.
4.1 Introduction
Welcome to section four of unit six of trimester one. In this section we are going to discuss
the nursing process focusing on the steps, application plus the strengths and weaknesses of
using this tool. Effective clinical decision making skill is essential for professional nursing
practice. We are also going to study critical thinking and relate it to the nursing process.
Nursing process, as a problem solving method, is a discipline specific version of critical
thinking. Traditionally, nurses have used a problem-solving approach in planning and
providing nursing care. Today the decision-making part of problem solving has become
increasingly complex and requires critical thinking.
4.2 Section Objectives
By the end of this section you should be able to:
1. Identify the characteristics of the nursing process.
2. Discuss the content within the steps of the nursing process.
3. Explain S-B-A-R as an important mode of handover for
nursing care activities.
4. Describe the benefits and criticisms of the nursing process.
5. Describe the critical thinking process
6. State the attitudes that foster critical thinking.
Let us start by defining the term Nursing process and other key terminologies applied in this
section.
Nursing process is a systematic rational method of planning and providing individualized
quality nursing care to an Individual, Family and Community. It provides a systematic guide
or method to assist nurses and students to develop a style of thinking that leads to appropriate
clinical judgment.

What do you understand by the terms systematic, rational and
individualized care?
I hope you got the definitions are described in the text that follows.
i. Systematic – the nursing process is planned in sequence; step by step.
ii. Rational – one applies reasoning and critical thinking.
iii. Individualized –It is based on specific needs and focuses on the unique response of a
client to the actual or potential alteration in health.
4.3 Characteristics of the nursing process
a) The nursing process is client centered – the planning and implementation of care is
based on the needs of a particular client rather than nursing goals.
b) It is humanistic - client’s assessment is done by human beings in a sensitive and
caring manner. It allows for application of critical thinking skills as we shall see later
in this section.
c) Decision making - Nurses are highly creative in determining how to use the data
obtained in decision making.
d) Universally applicable – the nursing process is accepted as a standard tool for
planning and provision of nursing care by nurses in all healthcare settings and for all
age groups.
e) It is cyclic and Dynamic - All phases are interrelated/ Interdependent. Data from one
phase provide input to the next.
Before you proceed reflect upon the following statement:
The nursing process is an interpersonal process that is always
patient centered rather than task centered.
Think through the meaning of this claim and the implications of
approaching patients as “problems to be solved.”
4.4 Steps of the nursing process.
The nursing process has five steps. As you go through them you will be able to learn how to
plan and organize for the provision of nursing care to clients in a systematic way. The steps/
phases are:

i. Assessment
ii. Nursing Diagnosis
iii. Planning
iv. Implementation/Intervention
v. Evaluation

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