Comprehensive Nursing

COMPREHENSIVE
NURSING AND
PATHOPHYSIOLOGY
UNIT – I
INTRODUCTION
Mrs. D. Melba Sahaya Sweety RN,RM
PhD Nursing , MSc Nursing (Pediatric Nursing), BSc Nursing
Associate Professor
Department of Pediatric Nursing
Enam Nursing College, Savar,
Bengladesh.

CONCEPT OF
COMPREHENSIVE
NURSING

INTRODUCTION
 “Comprehensive” Means all inclusive, Comprehensive
nursing is an Approach that encompasses the total care of
patients which includes Physical, Mental, Social and Spiritual
needs .
 In a comprehensive nursing care system the nurses are
assigned to provide complete care of a assigned patient.
 Comprehensive nursing entails an optimum skill mix of
general nursing, psychiatric, pediatric, community health
nursing and midwifery.

DEFINITION OF
COMPREHENSIVE NURSING
 Comprehensive nursing is defined as an integrated
nursing approach that apply the scientific process of
the full range of nursing in the areas of general,
obstetric and mental health, that promotes and
maintains the health status of patients.
 Comprehensive nursing is a systematic process of
problem diagnosis, problem analysis, development of
plan of care and continuous assessment of evolving
plan of care.

IMPORTANCE OF
COMPREHENSIVE NURSING
 Comprehensive nursing enable the nurses to develop competence in
identifying patient’s physical illnesses and their related psychological and
sociological factors.
 It empower the nurses to provide total curative, preventive nursing care.
 It guide the nurses to carrying out practical care, display the professional
ability, knowledge, skills and attitude in patient care.
 It strengthen the nurses to work independently and safely in the ward/
community.
 It helps the patient to receive preventive, promotive and curative care.
 It facilitate the nurses to care individuals of all ages, families and
communities.

DEFINITION OF
NURSE AND
NURSING

NURSE
• The term ‘nurse’ evolved from the root latin word nutrix
which means “ nourishing” A nurse is a licensed health
care professional person who cares for the sick or infirm
clients.
• A nurse is a medical professional who provides general
patient care and triage. Nurses usually work with a team
of other medical professionals, such as physicians and
other healthcare specialists.
• Nurses can work in a wide variety of environments,
including: Hospitals, Clinics, Schools, Rehabilitation
centers, Senior care homes, Industries Etc.,
MEANING

MEANING FOR THE WORD NURSE
N = Noble ,Nurture
U = Understanding, Usefulness
R = Responsible, Resourceful, Righteousness
S = Simple, Sympathy, Sincere
E = Efficient, Educated

NURSE
DEFINITION
• The nurse is a person who has completed a program of basic,
generalized nursing education and is authorized by the
appropriate regulatory authority to practice nursing in his/her
country. The nurse is prepared and authorized
(1) to engage in the general scope of nursing practice, including
the promotion of health, prevention of illness, and care of
physically ill, mentally ill, and disabled people of all ages and in
all health care and other community settings;
(2) to carry out health care teaching;
(3) to participate fully as a member of the health care team;
(4) to supervise and train nursing and health care auxiliaries; and
(5) to be involved in research.
(ICN, 1987)

DEFINITION OF NURSING
• Nursing encompasses autonomous and
collaborative care of individuals of all ages,
families, groups and communities, sick or
well and in all settings. Nursing includes the
promotion of health, prevention of illness,
and the care of ill, disabled and dying
people, Advocacy, promotion of a safe
environment, research, participation in
shaping health policy and in patient and
health systems management, and education
are also key nursing roles. (ICN, 2002)

• Nursing is the protection, promotion, and
optimization of health and abilities,
prevention of illness and injury, alleviation of
suffering through the diagnosis and
treatment of human response, and advocacy
in the care of individuals, families,
communities, and populations (ANA, 2010).
• Nursing is an act of utilizing the
environment of the patient to assist him in
his recovery
(Florence Nightingale 1859 )

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

• Nursing consists of autonomous and
collaborative care of individuals of all
ages, families, groups and
communities, sick or well and in all
settings. It includes the promotion of
health, the prevention of illness, and
the care of ill, disabled and dying
people. (-World
Health Organization “WHO”)

GOALS OF NURSING
1. To Promote health and wellness
Health promotion is motivated by the desire to increase a person’s well- being
and maximize personal potential. Such as improving nutrition and physical
fitness, restricting smoking and alcoholism, maintaining proper environmental
sanitation etc.,
2. To Prevent illness
The illness can be prevented by creating awareness among the people regarding
maternal and child care, hazardous of smoking and alcoholism, stress reduction
techniques, healthy eating habits, prevention of infection Etc…
Screening of diseases, also prevent illness.

GOALS OF NURSING
3. To Restore health
Health can be restored by Performing health assessment to detect illness as early ,
Providing direct care to the ill person, such as administering medication etc,
Performing diagnostic and assessments that detect an illness e.g., Blood sugar , Bp
Referring the client with abnormal findings to the other health care providers as
appropriate.
Collaboration with other health care providers in providing care.
Rehabilitating clients to their optimal functional level following physical or
mental illness, injury.

GOALS OF NURSING
4. To facilitate coping with disability and death.
Nurse can Maximizing person’s strength and potentials by patient teaching and
Referral to community support systems to facilitate the coping .
Providing end-of- care through Hospice program to assist the patient and families in
preparing for death and living as comfortably as possible.
5. To Provide Quality Patient Care
A nurse's primary objective – regardless of work environment is to make sure all of
her patients receive quality treatment in a timely manner

GOALS OF NURSING
6. To Educate the Patients and Families
Nurses play an important role in patient education, and their goal is to make sure
all patients fully understand any information provided to them. Nurses listen
carefully to their patients' concerns and answer any questions they, or their family
members, may have. Additionally, In the Community the nurses are highly active
in presenting seminars or workshops to various topics related to health.
7. To Promote a Safe Environment
Patient Safety is important ,so it's essential that the environment is sterile and free
of germs as possible. Nurse should follow the safety guidelines at all times to
minimize the risk of patients injury. Additionally, nurses look out for emotionally
unstable patients and visitors.

8. To develop Nurse patient relationship
Nurse patient relationship is one of the foundation of quality of patient care , It
helps the nurse to understand the patient concerns. A good nurse patient relationship
reduces the length of hospital stay and improve the quality and satisfaction of the
care.
9. To Alleviate Sufferings
Nurses are having the ethical responsibility to alleviate suffering and pain of the
patient .Nurses should ensure that each patient experiencing pain has an
individualized pain management plan . The main goal of the nurse to promote the
best possible quality of life for patients and their families, regardless of the stage of
the disease.
GOALS OF NURSING

10. To Protect the rights of a patient
The nurse must safeguard the patient’s right to privacy and confidentiality of all
patient information. Nurse should protect and promote the autonomy of patients.
11 .To foster the professional development of nurse
As technology and medical knowledge are constantly evolving, It's important for
nurses to stay up-to-date in order to provide best possible patient care. As a result, all
nurses strive to hone their skills throughout their careers and continue their
educations. Nurses often attend continuing education courses hosted by colleges and
universities, as well as professional workshops and seminars.
OTHER GOALS OF
NURSING

• Nursing has been called the oldest of the arts and
the youngest of the professions.
• Today nursing emerged as a learned profession,
that is both a science and an art.
• It is a body of knowledge.
• Knowledge is an awareness or perception of
reality, which is acquired through learning or
investigation.
INTRODUCTION

A profession is an occupation based on specialized
intellectual study and training, the purpose of which is
to supply skilled services with ethical components and
others.
According to Webster:
Occupation: It occupies or engages, one’s time, business and
employment.
Profession: It is a vocation requiring advanced training and
usually involving mental rather than manual work, as teaching,
engineering, especially medicine, law etc.
DEFINITION

Profession Occupation
Education through colleges or
universities
On the job training
Prolonged education Length varies
Mental creativity Largely manual work
Values, beliefs & ethics integral
part of preparation
Values, beliefs & ethics not a part
of preparation
Decision based on science or
theoretical construct.
Guided decision making
Strong commitment Commitment may varies
Unlikely to change profession Often change jobs
DIFFERENCE BETWEEN PROFESSION AND OCCUPATION

CRITERIA OF A PROFESSION
 A profession utilizes in its practice a well defined
and well organized body of knowledge , which is on
the intellectual level of higher training
 A profession constantly enlarges the body of
knowledge its uses and improves its techniques of
education and services by the use of scientific
method.
 A profession entrusts the education of its
practitioners to institutions of higher education.

CRITERIA OF A PROFESSION
 A profession applies its body of knowledge in
practical service, which is vital to human beings and
social welfare.
 A profession functions autonomously in the
formation of professional policy and control of
professional activity there by.
 The profession has a code of ethics for practice.

High Intellectual Level Of Functioning:
Modern nurses use assessment skill and knowledge, have the
ability to reason and make routine judgment depending on
patient’s condition. Professional nurses functions at a high
intellectual level. Florence nightingale raised the bar for
education and graduates of her school were considered to be
highly educated.
High Level Of Individual Responsibility And
Accountability:
Nurses must be accountable and demonstrate a high level of
individual responsibility for the care and services they
provide. The concept of accountability has legal, ethical and
professional implications that include accepting responsibility
for action taken to provide client care as well as accepting
responsibility for the consequences of action that are not
performed.
NURSING IS AS PROFESSION

Specialized Body Of Knowledge:
Nursing has developed into an identifiable separate
discipline, a specialized body of knowledge called as
nursing science. It was compiled through the research
effort of nurses with advanced educational degrees.
Although this body of specialized knowledge is relatively
small, it forms a theoretical basis for the practice of nursing
today. As more nurses obtain advanced degrees, conduct
research and develop philosophies, and theories about
nursing, this body of knowledge will increase in scope.

Evidence Based Practice:
Almost all the currently used nursing theories address this
issue in some way. Evidenced based practice is the practice of
nursing in which interventions are based on data obtained
from research that demonstrate that, the findings are
appropriate and successful. It involves a systematic process of
uncovering, evaluating and using information from research
as the basis for making decisions about providing client care.
Public Service And Altruistic Activities:
Individual is the focal point of all nursing models and nursing
practice. Nursing has been viewed universally as being an
altruistic profession composed of selfless individuals who
place the lives and well being of their clients above their
personal safety. Dedicated nurses provide care for victims of
deadly diseases with little regard for their own welfare.

• Well Organised And Strong Representation:
Professional organizations represent the members of the
profession and control the quality of professional practice.
In Bangladesh BNA is the organizations that represent
nursing in today’s health care system. Many do belong to
specialty organizations that represent a specific area of
practice.
• Code Of Ethics:
A code of ethics document may outline the mission and
values of the business or organization, how professionals
are supposed to approach problems, the ethical principles
based on the organization's core values and the standards
to which the professional is held. Some of the ethical
principles are autonomy, justice, non-maleficence ...
.

Competencies And Professional License:
Nurses must pass a national licensure examination to
demonstrate that they are qualified to practice nursing. Only
after passing the examination the nurses are allowed to practice.
The granting of a nursing license is a legal activity conducted
by the individual state under the regulations contained in the
state’s nursing practice act.
Autonomy And Independence Of Practice:
In reality nursing is both an independent and interdependent
discipline. Nurses in all health care setting must work with
physicians, hospital administrators, pharmacists and other
groups in the provision of care. In some cases nurses in
advanced practice role eg. Nurse practitioners can do establish
their independent practices. To be considered a true profession,
nursing will need to be recognised by other disciplines as
having practitioners who practice nursing independently.
NURSING IS A PROFESSION

Professional Identity And Development:
Until nurses are fully committed to the profession
of nursing, identify with it as a profession and are
dedicated to its future development, nursing will
probably not achieve professional status.

• Nursing is a basic science,, whereas nursing
science is the study of the principles and
application of nursing.
• According to the National Research
Council (NRC), nursing science also produces
information to:
• Assess healthcare systems and environments.
• Improve patient, family and community outcomes.
• Shape healthcare policy.
INTRODUCTION

• Nursing science consists of theoretical and practical
knowledge. It began as a philosophical discipline and now also
contributes information about specific phenomena within the
clinical practice of nursing.
Nursing science includes knowledge such as:
• Philosophical Positions: Nursing philosophies were developed
in the early 20th century to describe the intellectual
understanding of the discipline. They include statements about
ethics and values.
• Grand Theories: Grand theories are the conceptual models of
nursing. They emerged in the 1970s to define the discipline of
nursing.
STRUCTURE OF NURSING SCIENCE

• Middle-Range Theories: Beginning in the mid-1980s,
theorists developed middle-range theories to help
nurses apply research to practice. They derive from
grand theories and explain “the doing of nursing.”
• Situation-Specific Theories: The late 1990s introduced
situation-specific theories. They “link theory to both
practice and research” by explaining particular
occurrences in nursing.
• Graduate-level nursing science courses tend to
emphasize middle-range theories because they connect
theory and practice.
STRUCTURE OF NURSING SCIENCE

Carper’s (1978) description of the values and beliefs for
professional practice expanded our understanding of empirical
and aesthetic ways of knowing. Empirical knowing allows
scientific evidence to guide practice, while the aesthetic way of
knowing embraces the art of nursing.
• Science, as a way of knowing, serves as a basis to advance
nursing practice necessary to continue the service of human
health needs (Grace & Zumstein-Shaha, 2019). This
perspective is encompassed in the four nursing metaparadigm
concepts of health, person, environment, and nurse.
THE ARTS AND SCINCE OF NURSING

• Collectively, nursing science informs the evidence base necessary for
the practice arm of the profession and is vital to improve healthcare
and patient outcomes (Titler, 2011).
• Evidence-based practice includes evidence from scientific studies, as
well as patient preferences and nurse expertise. It is nurse expertise
that may often be unobserved and only known through a deeper
understanding of the art of nursing.
• Evolving over time, the art of nursing has been defined as the nurse’s
ability to be compassionate, caring, and communicative (Palos,
2014). These behaviours enable nurses to interpersonally connect
with patients, a skill which is critical to quality patient-centered care
and deeply valued by patients and families.

Nurses use the science of knowing and art of nursing in
their daily practice across a breadth of situations. Nurses
use the science of knowing and art of nursing in their
daily practice across a breadth of situations. For
example, nurses learn the best approach to provide
comfort for patients and families, especially for those
who struggle to cope with a diagnosis and experience
frustration and anger. Nurses advocate for patients and
families using compassionate and empathetic
communication to help them understand and navigate
the healthcare environment and health outcomes.

• Nursing is indeed an art and science. Science helps to
explain the work of a nurse, while art addresses the
human connections, empathetic communication, and
dedicated care and compassion that make nursing a
critical element of healthcare.
• Although the science and the art of nursing practice
are synergistic, in recent years, the worldview of the
art of nursing continues to evolve. Emerging
scientific evidence indicates that the art of nursing
promotes positive physical and psychological effects
on healing (Trzeciak & Mazzarelli, 2019).

1. Recording medical history and symptoms
• Nurses record and maintain accurate documentation of their
patients' health to ensure they receive the proper treatment.
• Nurses are collecting history regarding previous diagnoses and
surgeries, current medications, allergies and relevant family
medical information. They may also ask the patient questions
about any symptoms they are currently experiencing and record
their vitals.
• If the patient receives a new diagnosis, medication or treatment
plan during their visit, a nurse may be responsible for updating
their medical record with this information.
FUNCTIONS OF A NURSE

2. Administering medications and treatments
• Most nurses can administer medications and treatments to
their patients with a physician's order. They can also help
develop a treatment plan for their patients.
• Specialized nurses, such as nurse practitioners, may be able
to prescribe medications without a doctor's approval.
• Some treatments nurses may help with include cleaning
and dressing wounds, changing bandages and inserting
catheters.
• Nurses may also assist doctors with more advanced
procedures or administer emergency care to patients in
critical condition.

3. Collaborating with teams for patient care
• Nurses play a vital role in collecting information from patients
and sharing it with the rest of their medical team. Because this is
such a key responsibility for those in the nursing profession,
nurses must have excellent verbal and written communication
skills to effectively collaborate with physicians and other
healthcare providers.
4. Performing diagnostic tests
• Nurses may perform a wide variety of diagnostic tests, including
checking vitals and collecting tissue, blood, stool or urine
samples for analysis. Nurses may also be responsible for
analyzing the results and sharing what they find with the rest of
their medical team.

5. Conducting physical examinations
• Nurses often conduct a physical examination of patients at the
beginning of their visit to assess their overall health. The physical
examination provides nurses and the rest of the medical team
with a current update on the patient's health and an opportunity to
talk to patients about their health goals and concerns.
6. Monitoring patients' health
• This may involve carefully checking patient records to ensure the
correct medications and dosages are listed, maintaining
intravenous (IV) lines to ensure they are changed regularly and
monitoring the patient's vital signs. Nurses must also pay close
attention to nonverbal cues from their patients to help them
identify underlying causes for their health-related issues.

7. Providing support and advice to patients
• It is important to make sure patients feel cared for,
listened to and understood, especially when nurses
need to deliver challenging medical news.. Nurses
who are empathetic toward patients and their family
members can provide comfort and guidance during
these situations. They may also equip their patients
with effective coping strategies or provide them with
inpatient and outpatient resources.
.

8. Operating medical equipment
• Nurses use a wide variety of diagnostic tools to care for
their patients, including stethoscopes, glucometers, pulse
oximeters, thermometers and blood pressure machines.
Depending on where they work and what licenses they
hold, nurses may also be trained to operate more
specialized machinery, such as intravenous infusion pumps,
ventilation equipment and wound drainage systems.
Having a strong background in technology and
mathematics can help nurses properly operate medical
equipment and analyze the results.
•

9. Educating patients about how to manage an illness
• Part of a nurse's role is to educate their patients about various
medical conditions and provide clear instructions on how they
can manage their symptoms.. Nurses may also be responsible for
explaining additional post-treatment home care needs to a
patient's family or caregiver. This can include recommendations
for the patient's diet and nutrition, exercise routine and physical
therapy.
• Some nurses may also proactively educate people about common
diseases by speaking at seminars, helping with blood drives or
offering their services at health screening and immunization
clinics.

10. Advocating for the health and well-being of patients
• In order to properly care for their patients and ensure their safety,
nurses may often act as advocates for their health and overall well-
being. This can involve translating the medical information or
diagnosis a doctor provides to ensure the patient understands the
important details, encouraging patients to ask questions or connecting
patients with resources at another facility that's better suited for their
needs.
11. Providing basic bedside care
• Nurses may be responsible for a wide range of basic bedside care tasks,
depending on their particular working environment. These tasks can
include helping patients bathe, use the bathroom and perform other
hygiene-related activities. Bedside nurses also offer their patients
emotional support, administer medications and track their vitals.

12. Training and educating staff
• In addition to the clinical work they do to take care of patients,
qualified nurses with an appropriate amount of experience may help
train and supervise newer members of their medical team, including
practical nurses and nurses' aides. Some nurses may even provide
continuing education programs for nurses looking to advance in their
careers.
13. Maintaining inventory
• Experienced nurses may take on extra job roles, such as maintaining
inventory and ordering supplies. This is often a shared responsibility,
but tenured nurses may supervise entire departments. Making sure
supplies are properly organized, accounted for and restocked on time
can help ensure the medical team has all of the resources they need to
provide quality care for their patients.

COMPETENCIECS OF
A
PROFESSIONAL NURSE
Mrs. D. Melba Sahaya Sweety RN,RM
PhD Nursing , MSc Nursing (Pediatric
Nursing), BSc Nursing
Associate Professor
Department of Pediatric Nursing
Enam Nursing College, Savar,
Bengladesh.

INTRODUCTION
 Competence is a system of knowledge, skills, personal qualities, practical experience that
determine a person’s readiness for successful activity in a certain area.
 A core competency of nursing is he ability to understand needs, the ability to provide care,
the ability to collaborate and the ability to support decision-making.
 Nursing competencies are very important because a patient’s life can depend on them. A
nurse must independently monitor, treat (keep a nursing history) certain groups of patients
(for example, in hospices) and call the doctor for consultation only.
 Nurses having the best knowledge can do their job more efficiently, which will not only
influence the well-being of patients, improve the provision of medical care, and also satisfy
nurses with their work.

COMPETENT : A person performs assigned duties &
responsibilities in job description correctly.
COMPETENCE :A combination of skills, knowledge,
attitudes, values & abilities that underpin effective
performance as a nurse.
COMPETENCY : Ability to demonstrate knowledge, skills
& attitude to perform a specific job.
DEFINITION

Knowledgeable
Willingness to Learn
Empathy
Compassionate
Communication Skill
Emotional Stability
Flexibility
Attentive
Interpersonal Skills
Problem Solving Skills
Critical Thinking Skill
Leadership
Time Management
Physical Endurance
Quick Response
Collaboration and cooperation
COMPETENCIES OF A PROFESSIONAL NURSE

• Nurses must possess extensive knowledge to care effectively for
their patients. For example, they must have an in-depth
understanding of subjects such as human anatomy, microbiology
and pathophysiology. In addition, they must have the skills to
apply healthcare theories in real-life situations. In order to become
a registered nurse, they will have earned a degree through a
program that imparted this knowledge and let them practice
implementing it. Therefore, successful nurses are well-rounded
and educated in their practice.
COMPETENCIES OF A
PROFESSIONAL NURSE
Knowledgeable

• With technological improvements and breakthrough studies in the
healthcare industry (and healthcare workers) must prove to be successfully
adaptive to provide the highest quality patient care possible. Nurses spend
more bedside time with patients than any other role in healthcare and their
willingness to learn and put new knowledge into practice is one of the
leading traits of a good nurse.
• Improvements in education approaches (e.g., multidisciplinary training,
personalized learning, etc.) can help foster successful learning environments,
but a good nurse must possess a natural willingness to learn for them to be
truly beneficial. This important skill applies to nurses of all ages, throughout
every stage of their career, from recent graduates to the highly experienced.
COMPETENCIES OF A
PROFESSIONAL NURSE
Willingness to Learn

COMPETENCIES OF A
PROFESSIONAL NURSE
Empathy
• This is the most basic quality a nurse needs to possess. You cant take care of
the patient until you realize their suffering and pain. Having empathy toward
the patient makes them trust the nurse. Providing good quality is
not possible if you are not having compassion or concern toward the patient.
Compassionate
• One of the most important qualities of a good nurse is compassion. In their
career, nurses will see patients suffer. Beyond simply offering a solution, they
must be able to express compassion for patients and their families. This allows
them to form meaningful relationships with their patients.

COMPETENCIES OF A
PROFESSIONAL NURSE
A nursing job demands good communicational skills. A patient will not be
able to communicate properly during the state of injury or if they are suffering from
illness. It is up to the nurse to understand what the patient is trying to say and
anticipate the concerns. In the workplace, nurses must be able to communicate
clearly with their coworkers and with patients and their families. The ability to
receive information effectively and efficiently is essential for nurses.
Communication Skill
Emotional Stability
Nursing is not an easy job, nurse may have to go through some traumatic situation.
A nurse needs to be strong enough to go through times that can break them, but a
good nurse needs to have emotional stability. They need to accept that suffering and
death will not get them emotional on a personal scale.

COMPETENCIES OF A
PROFESSIONAL NURSE
Being a nurse is not a job of fixed hours, a nurse may be needed at any time. A good
nurse understands that they can be needed anytime, so they have to be more flexible
in regard to the working hours. Remaining calm under pressure also helps nurses
stay flexible in their work since shifts are typically long. Nurses may have to work
nights, weekends and holidays. They may be called in on their days off to cover
shifts. On the job, flexibility is a must for nurses. They cannot predict what the day
will bring and what illnesses or injuries they will have to treat.
The duty of nurses demands attention to details, they need to know the timing to
give medicine to the patient or to performs any other activity as per the time
scheduled.
Flexibility
Attentive

COMPETENCIES OF A
PROFESSIONAL NURSE
Becoming a good nurse is only possible if you have excellent interpersonal skills,
and you are ready to tackle all kind of situation which rises during caring of patient.
Nurses are the link between doctors and patients. A great nurse has excellent
interpersonal skills and works well in a variety of situations with different people.
They work well with other nurses, doctors, and other members of the staff. Nurses
are the glue that holds the hospital together.
Problem solving skills are essential to nursing, as nurses generally have the most
one-on-one time with patients and are often responsible for much of the decision-
making related to their care. Even seemingly small decisions can have major impacts
and cause adverse patient outcomes if incorrectly made.
Interpersonal Skills
Problem Solving Skills

Strong critical thinking skills are necessary to put together pieces of information
that may seem unrelated (such as medications for different conditions) and draw
rational conclusions. Nurses may have to think quickly under pressure to
troubleshoot patient needs. Those who work in triage are especially good at critical
thinking. They must interpret diagnostic data to determine the next course of
action in life-or-death situations.
Critical Thinking Skill
COMPETENCIES OF A
PROFESSIONAL NURSE
Leadership
A quality of a good nurse that will become more and more valuable in the growing
nursing field is the ability to successfully lead.

COMPETENCIES OF A
PROFESSIONAL NURSE
Balancing multiple patients, stressful care settings, and competing priorities is no small
feat during a 12-hour shift. Having the ability to implement effective time management
is a key personality trait for nursing, as is being able to concentrate on the most critical
issues first, which isn’t necessarily the patient/family that’s demanding the most. Setting
time aside for selfcare is also a crucial component to time management.
Time Management
Physical Endurance
Frequent physical tasks, standing for long periods of time, lifting heavy objects (or people),
and performing a number of taxing maneuvers on a daily basis are staples of nursing life.
It’s definitely not a desk job. Always on the go, a great nurse maintains her energy
throughout her shift, whether she’s in a surgery or checking in on a patient. Staying strong,
eating right, and having a healthy lifestyle outside of nursing is important too!

COMPETENCIES OF A
PROFESSIONAL NURSE
Quick Response
Nurses need to be ready to respond quickly to emergencies and other situations that
arise. Quite often, health care work is simply the response to sudden incidences, and
nurses must always be prepared for the unexpected. Staying on their feet, keeping
their head cool in a crisis, and a calm attitude are great qualities in a nurse.
Collaboration and cooperation
• Nurses works cooperatively with health team members is an effort to give good
nursing care even when there is conflict or misunderstanding.
• Coordinate effectively with other health professionals in the health sector in
relation to hospital discharge planning or referral and facilitating patients’ access
to other services.

Acronym- Qualities
Q – Qualified, Quietness
U – Understanding
A – Alertness
L – Loyalty , Listener
I - Intelligent , Independent
T – Technical competence
I – Integrity , Impartial
E – Empathy
S – Sympathy, Self confidence
QUALITIES OF A NURSE

Shortage of Nurses
Changing Education
Lack of Professional Assertiveness
Lack of effective Nurse leader and manager
Lack of Nursing Autonomy
Poor working Condition
In adequate Inservice Education
CURRENT ISSUES IN NURSING

• Inadequate staffing pattern is
one of the major issue
causing shortage of nurses.
Nurses are moving for higher
paying health care settings in
Abroad.
SHORTAGE OF NURSES

CHANGING EDUCATION
Nursing education must make curriculum
changes in order to prepare the nurses
who meet today’s and tomorrow’s health
care needs
• Before: knowledge on comfort
measures, hygiene and diet was important
• Present : need specialization and
advanced knowledge . Hence

• Assertive in claiming there right
•Control over own profession
• Health care delivery has become more
business oriented and knowing its effect
on nursing practice is also important.
Nurses perform many non-nursing
functions But nurses should direct
themselves towards developing the
LACK OF PROFESSIONAL ASSERTIVENESS

LACK OF EFFECTIVE NURSE LEADER AND MANAGER
• Inadequate number of nurses and
midwives as leaders in national and state
levels.
• Nurse leaders and managers can help
in improving the nursing practice,
nursing research, nursing education,
administration and making policies.
• Nurses responsibility increased, she

LACK OF NURSING AUTONOMY
• Nurses have many roles and
responsibilities
There are number of care activities that
nurse can undertake according to their
educational background. But doctors do
not delegate responsibility to them So
nurses should be allowed to work
independently.

• Nurses' working conditions are risk factors for
healthcare-associated infections as well as
occupational injuries and infections
• Poor infrastructures
• NURSE BURN OUT -Over worked -Stress -No
breaks
• Improper Incentives & Pay scales
• Emigration of nurses were for financial needs.
• The payment scale is still low compared to
other professions
POOR WORKING CONDITION

• Less human resources
• Less Job in government
• Brain drain
• Poor living conditions
• Lack of appreciative system
• Non uniformity in pay structure
• Limited career development
• Less opportunity
POOR WORKING CONDITION

• Nursing is a dynamic profession that is subject
to rapid changes in health care provision, hence
the need for in-service training programmes for
nurses.
•Newly employed registered nurses require in-
service training in order to update them
regarding the latest developments in nursing
practice.
•Technological Advancement in Health care
demand In-service Education for nurses.
IN ADEQUATE INSERVICE EDUCATION

• Ethics is derived from the Greek word ethos, meaning
custom or character
• Ethics refers to the practices or beliefs of a certain group
(i.e. Nursing ethics, Physicians' ethics). It also refers to the
expected standards as described in the group's code of
professional conduct. Ethics is concerned what ought to be,
what is right, or wrong, good or bad. It is the base on moral
reasoning and reflects set of values.
• Nursing ethics is the applied discipline that addresses the
moral features of nursing practice.

 Ethics is a field in philosophy that aims to individuate the
rights and wrongs by trying to understand the nature of
morality. (Senturk, 2013; Karaoz, 2000)
 Ethics is the study of good and bad, of moral duty and
moral obligations. Ethics is concerned with doing good
and avoiding harm. (Bandman & Bandman, 2002)
 ‘Ethics asks and tries to identify what is good and right,
bad and wrong’. (Tschudin 2003)
 ‘Ethics is a generic term for various ways of
understanding and examining the moral life’. Beauchamp

• Autonomy can be defined as „ self-rule with no control, undue
influence or interference from other”.
• Refers to make one’s own decision.
• Nurses recognize the individual’s uniqueness.
• It is about respecting other people’s wishes and supporting them
in their decisions.
1. Autonomy

• Beneficence is doing or promoting good.
The principle of beneficence has three components:
 Promote good
 Prevent harm
 Remove evil or harm
2. Beneficence

3. Non – Mal eficience
Non - maleficence is the converse of beneficence. It means to
avoid doing harm.
4. Justice
Justice is fair, equitable and appropriate treatment. It is the basis
for the obligation to treat all clients in an equal and fair way

•Veracity means telling the truth, which is essential to the integrity
of the client-provider relationship
• Health care providers obliged to be honest with clients
• The right to self-determination becomes meaningless if the client
does not receive accurate,Unbiased, and understandable
information
5. Veracity

 Fidelity means being faithful to one's commitments and promises.
 Nurses’ commitments to clients include providing safe care and maintaining competence
in nursing practice.
 Nurse must use good judgment when making promises to client.
Fidelity is about
• Being Faithful , keeping promises
• always doing what is right
• being trust worthy , Confidential
• Showing respect and dignity
• respecting autonomy
6. Fidelity

• Confidential or in confidence is “a secret or private matter not to
be divulged to others”
• It refers to the rights of clients for protection of privacy without
diminishing access to quality care.
• It is important for trusting relationship.
• Nurses will not share information about the client unless it is
agreement from the client or required by the law.
7. Confidentiality

ETHICAL
RIGHTS OF
PATIENT
RIGHTS OF
PERSONAL
DIGNITY
RIGHTS TO
INFORMED
CONSENT
RIGHT TO
REFUSE
TREATMENT
RIGHTS TO
INDIVIDUALIZED
CARE
RIGHTS TO
CONFIDENTIALITY

Nurses and
patients or
other
people
requiring
care or
services
Nurses
and the
profession
Nurses
and
global
health
Nurses
and
practice

Nurses and patients or other
people requiring care or services
1.1 Nurses’ primary professional responsibility is to people requiring
nursing care and services now or in the future, whether individuals,
families, communities or populations.
1.2 Nurses promote an environment in which the human rights, values,
customs, religious and spiritual beliefs of the individual, families and
communities are acknowledged and respected by everyone.
1.3 Nurses ensure that the individual and family receive understandable,
accurate, sufficient and timely information in a manner appropriate to the
patient’s culture, linguistic, cognitive and physical needs, and
psychological state on which to base consent for care and related
treatment.

1.4 Nurses hold in confidence personal information and respect
the privacy, confidentiality and interests of patients in the
lawful collection, use, access, transmission, storage and
disclosure of personal information.
1.5 Nurses respect the privacy and confidentiality of colleagues
and people requiring care and uphold the integrity of the nursing
profession in person and in all media, including social media.
1.6 Nurses share with society the responsibility for initiating
and supporting action to meet the health and social needs of all
people.

1.7 Nurses advocate for equity and social justice in resource
allocation, access to health care and other social and
economic services.
1.8 Nurses facilitate a culture of safety in health care
environments, recognizing and addressing threats to people
and safe care in health practices, services and settings.
1.9 Nurses ensure that the use of technology and scientific
advances are compatible with the safety, dignity and rights
of people.

2.1 Nurses carry personal responsibility and accountability for
ethical nursing practice, and for maintaining competence by
engaging in continuous professional development and lifelong
learning.
2.2 Nurses maintain fitness to practice so as not to compromise
their ability to provide quality, safe care.
2.3 Nurses practise within the limits of their individual
competence and regulated or authorised scope of practice and use
professional judgement when accepting and delegating
responsibility
Nurses and practice

2.4 Nurses maintain standards of personal conduct at all times.
They reflect well on the profession and enhance its image and
public confidence. In their professional role, nurses recognise and
maintain personal relationship boundaries.
2.5 Nurses share their knowledge and expertise and provide
feedback, mentoring and supporting the professional development
of student nurses, novice nurses, colleagues and other health care
providers.
2.6 Nurses are patient advocates, and they maintain a practice
culture that promotes ethical behaviour and open dialogue.
Nurses and practice

2.7 Nurses maintain a person’s right to give and withdraw
consent to access their personal, health and genetic
information. They protect the use, privacy and
confidentiality of genetic information and human genome
technologies.
2.8 Nurses take appropriate actions to safeguard
individuals, families, communities and populations when
their health is endangered by a co-worker, any other person,
policy, practice or misuse of technology.
Nurses and practice

2.9 Nurses are active participants in the promotion of
patient safety. They promote ethical conduct when errors or
near misses occur, speak up when patient safety is
threatened, advocate for transparency, and work with
others to reduce the potential of errors.
2.10 Nurses are accountable for data integrity to support
and facilitate ethical standards of care.
Nurses and practice

3.1 Nurses assume the major leadership role in determining and
implementing evidence-informed, acceptable standards of clinical
nursing practice, management, research and education.
3.2 Nurses and nursing scholars are active in expanding research-
based, current professional knowledge that supports evidence-
informed practice.
3.3 Nurses are active in developing and sustaining a core of
professional values
3.4 Nurses, through their professional organisations encompasses
clinical care, education, research, management and leadership.
Nurses and the
profession

3.5 Nurses contribute to positive and ethical organisational
environments and challenge unethical practices and
settings.
3.6 Nurses engage in the creation, dissemination and
application of research that improves outcomes for
individuals, families and communities.
3.7 Nurses prepare for and respond to emergencies,
disasters, conflicts, epidemics, pandemics, social crises and
conditions of scarce resources.
Nurses and the
profession

4.1 Nurses value health care as a human right,
affirming the right to universal access to health care
for all.
4.2 Nurses uphold the dignity, freedom and worth of
all human beings and oppose all forms of exploitation,
such as human trafficking and child labour.
4.3 Nurses lead or contribute to sound health policy
development.
Nurses and global health

4.4 Nurses recognise the significance of the social
determinants of health. They contribute to, and advocate
for, policies and programmes that address them.
4.6 Nurses collaborate and practise to preserve, sustain and
protect the natural environment and are aware of the health
consequences of environmental degradation, e.g. climate
change. They advocate for initiatives that reduce
environmentally harmful practices to promote health and
well-being.

4.7 Nurses collaborate with other health and social care
professions and the public to uphold principles of justice by
promoting responsibility in human rights, equity and
fairness and by promoting the public good and a healthy
planet.
4.8 Nurses collaborate across countries to develop and
maintain global health and to ensure policies and principles
for this.

ETHICAL ISSUES IN
NURSING
1.Unsafe patient to nurse ratio
2. Inappropriate medication order
3. Unresponsive
4. Inappropriate task
5.Life threatening patient decisions

DEFINITION
• Law is a body of rules of conduct
inherent in human nature and
essential to human society and
guide human functions.

PURPOSES
1. Safeguarding the public:
The public safety is guaranteed
The individual is secure to the event of sickness or disability with
no fear of anxiety of being cared for by a competent person.
It protects the patients /clients against deliberate injury by a nurse.
2. Safe guarding the nurse:
It protects the nurses also against the legal action if she renders
right care.

LEGAL LIABILITY
IN NURSING
1. UNINTENTIONAL TORTS:
These types of torts are accidents that cause injury to another person or
property.
NEGLIGENCE: Nursing negligence usually means failure by the nurse
to take the appropriate action to protect the patient from harm.
E.g.: Burns, falls, medication errors, failure to observe, use of defective
equipment’s, loss of patient property, patient mix up.
MALPRACTICE: Medical malpractice is an act by a health care
provider which deviates from accepted standards of practice in the medical
community and which cause injury to the patient.

LEGAL LIABILITY
IN NURSING
ELEMENTS OF MALPRACTICE
BREACH OF DUTY- failed to provide care in acceptable manner.
INJURY (DAMAGES)- nurses act caused harm.
Failing to assess and observe patient as directed.
Failing to report a change in a patient’s condition such as vital signs, circulatory
status and level of consciousness.
Failure to select appropriate site by the nurse to administer intramuscular
injection that causes permanent damage to patient’s extremity.
Falling to obtain an informed consent.

LEGAL LIABILITY
IN NURSING
2. INTENTIONAL TORTS:
These types of torts are deliberate actions in which the intent is cause
injury to a person or property.
ASSAULT: Assault is the threat of unlawful touching of another, the
wilful attempt to harm someone. Assault can be verbally threatening
a patient.
BATTERY: Battery is the unlawful touching of another without
consent or justification. In legal medicine battery occurs if a medical
or surgical procedure is performed without patient consent.

LEGAL LIABILITY
IN NURSING
3. QUASI INTENTIONAL TORTS:
It is usually involving situations of communication and often violates a person’s
reputation, personal privacy or civil rights.
Defamation : It is the issuance of a false statement about another person which
causes that person to suffer harm. (the action of damaging the good reputation of
someone)
Fraud: Fraud is a crime or offence of deliberately mislead another in order to
damage another to obtain property or services and a civil law violation.
Invasion of privacy: Clients have claims for invasion of privacy , e.g. their private
affairs, with which the public has no concern, have been publicized.

LEGAL ISSUES IN
NURSING PRACTICE
NURSING PRACTICE ISSUES:
Patients property
Caring patients with AIDs
Living wills and health care
surrogates
 Deaths and dying
Autopsy and organ donation
PATIENT CARE ISSUES
Nursing shortage
Low salaries
Standard care
MANAGEMENT ISSUES
 Turnover
 Funding
Workload
Issues regarding malpractice in
nursing management
Issues of delegation and supervision
Issues related to staffing
Collaboration issues

LEGAL ISSUES IN
NURSING PRACTICE
EMPLOYMENT ISSUES
 Issues related to nursing shortage
Issues in nurse migration
The right to work and right to practice
Exploitation and discrimination
Misconduct and imposition of punishment
Sexual harassment at the workplace
Renewal of nursing registration
Specialization in clinical area
Nursing care standards

LEGAL
RESPONSIBILITIES OF
NURSE
1. AT ADMINISTRATIVE AND
SUPERVISORY LEVEL
Appointing and assigning the
nurses
Quality control
Material management
Proper documentation system
Staff management
2. AT OPERATIONAL
LEVEL
 Carrying out physician’s
orders
Maintaining safe
environment
 Use of safe equipment's
Maintenance of proper
records

Comprehensive Nursing

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