concepts of man

1. NCM 103
FUNDAMENTAL
S OF NURSING
PRACTICE
INTRODUCTOR
Y CONCEPTS

2. I. CONCEPT OF
MAN, Health, and
Illness

3. CONCEPT OF MAN
 A bio-psycho-socio-spiritual human
being.
• As a biological being, man is
like other men.
• As a psychological being, man
is like no other man.
• As a social being, man is like
some other man.
• As a spiritual being, man is like
all other men.

4. Four Major Attributes of a Human
Being:
1. The capacity to think or
conceptualize on the abstract
level.
2. Family formation
3. The tendency to seek and
maintain territory
4. The ability to use verbal symbols
as language, a means of
developing and maintaining
culture

5. Human Needs
 Necessary, useful, or desirable to
maintain well-being & life; motivation
for behavior.
 May be met consciously or
unconsciously
BASIC HUMAN NEEDS
 Each individual has a unique
characteristic, but certain needs are
common to all people.
 Human needs are physiologic and
psychologic conditions that an
individual must meet to achieve a state
of well-being.

6. Characteristics of Basic Human
Needs:
 Needs are universal.
 Needs may be met in different
ways.
 Needs may be deferred.
 Needs may be interrelated.
 An unmet human need results in
disruption of normal body
activities and frequently leads to
eventual illness.

7. CONCEPTS OF HEALTH, WELLNESS,
AND WELL-BEING
 Health was defined in terms of the presence or
absence of disease.
 Health as a state of being well and using every
power the individual possesses to the fullest
extent. Florence Nightingale (1860/1969
 Health has also been defined in terms of role
and performance. Talcott Parsons (1951)
 "Health is not a condition; it is an adjustment. It
is not a state but a process. The process
adapts the individual not only to our physical
but also our social environments" U.S.
President's Commission on Health Needs of the
Nation (1953)
 "Health as a state of complete physical, mental,
and social well-being, and not merely the
absence of disease or infirmity." (WHO) (1948)
 "Health and illness are human experiences. The
presence of illness does not preclude health,
nor does optimal health preclude illness" ANA
(2010)

8. PERSONAL DEFINITIONS
OF HEALTH
 Being free from symptoms
of disease and pain as
much as possible
 Being able to be active and
to do what they want or
must
 Being in good spirits most
of the time.

9. Wellness and Well-Being
 Wellness is a state of well-being.
Basic aspects of wellness include self-
responsibility; an ultimate goal; a
dynamic, growing process; daily
decision-making in the areas of
nutrition, stress management, physical
fitness, preventive health care, and
emotional health; and, most
importantly, the whole being of the
individual.
 Seven Components Of Wellness
1. Environmental 5. Emotional
2. Social 6. Physical
3. Occupational 7. Spiritual
4. Intellectual

10. Well-being
a subjective perception of
vitality and feeling well . . can
be described objectively,
experienced, and measured .
. . and can be plotted on a
continuum” (Hood, 2010, p.
185). It is a component of health.

11. MODELS OF HEALTH AND WELLNESS
 Clinical model
 The role performance model
 The adaptive model
 The eudaimonistic model
 The agent-host-environment
model
 Health-illness continua
Clinical Model
 The narrowest interpretation of
health occurs in this model.
 People are viewed as physiological
systems
 It is considered the state of not
being "sick.

12. Role Performance Model
 Health is defined in terms of an individual's
ability to fulfill societal roles.
 According to this model, people who can fulfill
their roles are healthy even if they have clinical
illnesses.
 It is assumed in this model that sickness is the
inability to perform one's work role.
Adaptive Model
 In the adaptive model, health is a creative
process; disease is a failure in adaptation or
maladaptation.
 According to this model, extreme good health
is a flexible adaptation to the environment and
interaction with the environment to maximum
advantage.

13. Eudaimonistic Model
 The eudaimonistic model incorporates a comprehensive
view of health.
 Health is seen as a condition of actualization or
realization of a person's potential.
 In this model the highest aspiration of people is fulfillment
and complete development, which is actualization.
 Illness, in this model, is a condition that prevents self-
actualization.
Agent-Host-Environment Mode
 The agent-host-environment model of health and illness,
also called the ecologic model.
 The model is used primarily in predicting illness rather
than in promoting wellness.
 The model has three dynamic interactive elements:
1. Agent2. Host 3. Environment

15. Health-Illness Continua
 Health-illness continua (grids or graduated
scales) can be used to measure a person's
perceived level of wellness.
 Health and illness or disease can be viewed
as the opposite ends of a health continuum.

16. DUNN'S HIGH-LEVEL WELLNESS
GRID

17. ILLNESS-WELLNESS CONTINUUM
 Ranges from optimal health to premature death
 The model illustrates arrows pointing in opposite
directions and joined at a neutral point. Movement
to the right of the neutral point indicates increasing
levels of health and wellness for an individual.
 In contrast, movement to the left of the neutral
point indicates progressively decreasing levels of
health.

18. 1. VARIABLES
INFLUENCING HEALTH
STATUS, BELIEFS, AND
PRACTICES
VARIABLE

19. Health status - state of health of an
individual at a given time.
Health beliefs - concepts about
health that an individual believes are
true.
Health behaviors - The actions
people take to understand their
health state, maintain an optimal
state of health, prevent illness and
injury, and reach their maximum
physical and mental potential time.

20. Internal Variables
 Biologic dimension - Genetic
makeup, sex, age, and
developmental level all
significantly influence a person’s
health.
 Psychological dimension -
Psychological (emotional) factors
influencing health include mind–
body interactions and self-
concept.
 Cognitive dimension - Cognitive
or intellectual factors influencing
health include lifestyle choices
and spiritual and religious beliefs
Examples of Healthy Lifestyle
Choices

21. External variables
 Environment - People are becoming increasingly
aware of their environment and how it affects their
health and level of wellness.
 Standards of living - An individual’s standard of
living (reflecting occupation, income, and
education) is related to health, morbidity, and
mortality. Hygiene, food habits, and the ability to
seek health care advice and follow health
regimens vary among high-income and low-
income groups.
 Family and cultural beliefs - The family passes on
patterns of daily living and lifestyles to offspring.
For example, a man who was abused as a child
may physically abuse his children.
 Social support networks - Having a support
network (family, friends, or a confidant) and job
satisfaction helps people avoid illness.

22. HEALTH BELIEF MODELS
 Health Locus of Control Model
 is a concept from social learning theory that nurses can use to
determine whether clients are likely to take action regarding health,
that is, whether clients believe that their health status is under their
own or others' control.
 Rosenstock and Becker's Health Belief Models
• Individual perceptions
o Perceived Susceptibility
o Perceived Seriousness
o Perceived Threat
• Modifying factors
Factors that modify a person’s perceptions include the following:
o Demographic Variables
o Sociopsychological Variables
o Structural Variables
o Cues of Action
• Likelihood of action
Depends on:
o Perceived Benefits to the Action
o Perceived Barriers to the Action

23. HEALTH CARE ADHERENCE
Adherence is the extent to which an individual's behavior (for
example, taking medications, following, or making lifestyle
changes) coincides with medical or health advice.
Factors Influencing Adherence
1. Motivation 4. Lifestyle change
2. Perceived severity5. Beliefs
3. Cost of Therapy
HEALTH CARE ADHERENCE
 When a nurse identifies nonadherence, it is important to take
the following steps:
• Establish why the client is not following the regimen.
• Demonstrate caring.
• Encourage healthy behaviors through positive
reinforcement.
• Use aids to reinforce teaching.
• Establish a therapeutic relationship of freedom, mutual
understanding, and mutual responsibility with the client
and support persons

24. ILLNESS AND DISEASE
Illness is a highly personal state in which the person's physical, emotional,
intellectual, social, developmental, or spiritual functioning is thought to be
diminished.
Disease can be described as an alteration in body functions resulting in a
reduction of capacities or a shortening of the normal life span.
Etiology - the causation of a disease or condition.
Acute illness is typically characterized by symptoms of relatively short
duration.
Chronic illness is one that lasts for an extended period, usually 6 months or
longer, and often for the person’s life.
Remission - when the symptoms disappear.
Exacerbation - when the symptoms reappear.
 Nurses are involved in caring for chronically ill individuals of all ages in all
types of settings.
 Care needs to be focused on promoting the highest level possible of
independence, sense of control, and wellness.
 Clients often need to modify their activities of daily living, social relationships,
and perception of self and body image.
 In addition, many must learn how to live with increasing physical limitations
and discomfort.

25. Illness Behaviors
 A coping mechanism, involves ways individuals
describe, monitor, and interpret their symptoms, take
remedial actions, and use the health care system.
Talcott Parsons' Sick Role Theory (1951)
 Rights:
1. Clients are not held responsible for their
condition. Even if the illness was partially caused
by an individual's behavior.
2. Clients are excused from certain social roles and
tasks.
3. Clients have the right to be taken care of.
 Obligations:
4. Clients are obliged to try to get well as quickly as
possible.
5. Clients or their families are obliged to seek
competent help.

26. Edward A. Suchman's 5 stages of illness:
Stage-1 Symptom experience
Stage-2 Assumption of the sick role
Stage-3 Medical care contact
Stage-4 Dependent client care
Stage-5 Recovery or rehabilitation
Effects of Illness
 Impact on the client
o body image or physical appearance
o self-esteem and self-concept
o dependence on others
o unemployment, financial problems
o inability to participate in social functions
 Impact on the family
o Role changes
o Increased stress
o Financial problems
o Loneliness as a result of separation and pending loss
o Change in social customs

27. 2. HEALTH CARE
DELIVERY
SYSTEM

28. The healthcare system
 Comprised of healthcare settings and services,
policies, payment plans, providers, patients,
families, and caregivers.
TYPES OF HEALTH CARE SERVICES
 Healthcare services are often described in
terms of how they are correlated with levels of
disease prevention:
(a)primary prevention - which consists of
health promotion and illness prevention
(b)secondary prevention - which consists of
diagnosis and treatment
(c) tertiary prevention - which consists of
rehabilitation, health restoration, and
palliative care.

29. METHODS OF HEALTHCARE DELIVERY
 Managed care systems - a way of providing care that
is designed to control the cost while still maintaining
the quality of that care.
 Case management - a method used to coordinate a
patient’s healthcare to achieve patient wellness and
optimum function through advocacy, communication,
and education.
 Primary healthcare - defined as essential healthcare-
based on practical, scientifically sound, and socially
acceptable methods and technology, made universally
accessible to individuals and families in the community
through their full participation and at a cost the
community can afford.

30. HEALTHCARE SETTINGS AND SERVICES
 Healthcare is provided within many different types of
facilities to meet the needs of people.
A. HOSPITALS
Classification:
• Public/non-profit
• Private/profit
Size and Services
• Hospital size ranges from as few as 20 beds to
large medical centers with hundreds of beds.
Various services are provided, depending on
the size and location of the hospital.
Inpatient and Outpatient Services
• Inpatient - a person who enters a hospital and
stays overnight for an indeterminate time
(ranging from days to months).
• Outpatients—those who are not hospitalized
overnight but who require diagnosis or
treatment.

31. B. PRIMARY CARE CENTERS
• Physicians and advanced practice nurses provide
primary healthcare services in offices and clinics.
Services include the diagnosis and treatment of minor
illnesses; performing minor surgical procedures; and
providing obstetrical care, well-childcare, counseling,
and referrals.
C. AMBULATORY CARE CENTERS AND CLINICS
• Ambulatory care centers and clinics (agencies that
deliver medical care on an outpatient basis) may be
located in hospitals and may be a free-standing service
provided by a group of healthcare providers who work
together or may be managed by an APRN.
D. HOME HEALTHCARE
• Home healthcare is one of the most rapidly growing
areas of the healthcare system.

32. E. LONG-TERM CARE
• Long-term care provides medical and nonmedical care
for people with chronic illnesses or disabilities.
F. SPECIALIZED CARE CENTERS AND SETTINGS
• Specialized care centers and settings provide services
for a specific population or group. They are usually
located in easily accessible locations within a
community.
1. Daycare Centers
2. Mental Health Centers
3. Rural Health Centers
4. Schools
5. Industry
6. Homeless Shelters
7. Rehabilitation Centers

33. G. HEALTHCARE SERVICES FOR
CAREGIVERS AND END-OF-LIFE CARE
 Healthcare services are provided for the
caregivers of those who are chronically ill and for
patients and caregivers as a part of end-of-life
care. These services include:
o respite care
o Hospice
o palliative care
H. HEALTHCARE AGENCIES
 Many different types of agencies provide
healthcare services.
o voluntary agencies
o religious agencies
o government agencies
 Veterans Administration And Military
Agencies
 Public Health Service
 Public Health Agencies

34. PROVIDERS OF HEALTHCARE
• The providers of health care, also referred to as the health care team or health
professionals, are nurses and health personnel from different disciplines who
coordinate their skills to assist clients and their support people.
o Nurse
o Alternative (Complementary) Care Provider
o Case Manager
o Dentist
o Dietitian or Nutritionist
o Emergency Medical Personnel
o Occupational Therapist
o Paramedical Technologist
o Pharmacist
o Physical Therapist
o Physician
o Physician Assistant
o Podiatrist
o Respiratory Therapist
o Social Worker
o Spiritual Support Personnel
o Unlicensed Assistive Personnel

35. FACTORS AFFECTING HEALTH CARE DELIVERY
• Increasing Number of Older Adults
• Advances in Technology
• Economics
The major reasons for cost increases are as follows:
o Existing equipment and facilities are continually becoming
obsolete as research uncovers new and better methods in health
care.
o Health care providers and clients want the newest and the best
and replacing equipment costs more each year.
o Inflation increases all costs.
o The total population is growing, especially the segment of older
adults who tend to have greater healthcare needs than younger
people.
o As more people recognize that health is everyone’s right, a large
number of people are seeking assistance in health matters.
o The relative number of people who provide health care services
has increased.
o The numbers of uninsured individuals are changing.
o The cost of prescription drugs is increasing. Medicare recipients
are eligible for prescription drug coverage to help cover some
basic and catastrophic medication costs.

36. FACTORS AFFECTING HEALTH CARE DELIVERY
• Women’s Health
• Uneven Distribution of Services
• Access to Health Insurance
• The Homeless and the Poor
Factors Contributing to Health Problems of the Homeless and
the Poor
o Poor physical environment resulting in increased
susceptibility to infections
o Inadequate rest and privacy
o Improper nutrition
o Poor access to facilities for personal hygiene
o Exposure to the elements
o Lack of social support
o Few personal resources
o Questionable personal safety (physical assault is a constant
threat for the homeless)
o Inconsistent health care
o Difficulty with adherence to treatment plans
• Health Insurance Portability and Accountability Act (US)
• Demographic Changes

37. 1.NURSING AS A
PROFESSION, SCIENCE
AND ART
II. Concept of
Nursing

38. Definitions of
Nursing:
“The act of utilizing the
environment of the
patient to assist him in
his recovery”
(Nightingale,
1860/1969)
“The unique function of the nurse is to assist
the individual, sick or well, in the performance
of those activities contributing to health or its
recovery (or to peaceful death) that he would
perform unaided if he had the necessary
strength, will, or knowledge, and to do this in
such a way as to help him gain
independence as rapidly as possible”
(Henderson, 1996)
“Nursing is the diagnosis and
treatment of human responses to
actual or potential health problems”
(ANA, 1980)
“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.”
(The current definition of nursing remains unchanged
from the 2003 edition of Nursing’s Social Policy
Statement.)

40. Nursing as a Profession
 The patient is the center of your practice. Your patient
includes individuals, families, and/or communities. Patients
have a wide variety of healthcare needs, knowledge,
experiences, vulnerabilities, and expectations, but this is what
makes nursing both challenging and rewarding.
Nursing is recognized increasingly as a profession
based on the following defining criteria:
• Well-defined body of specific and unique knowledge
• Strong service orientation
• Recognized authority by a professional group
• Code of ethics
• Professional organization that sets standards
• Ongoing research
• Autonomy

41. Science and Art of Nursing Practice
 Because nursing is both an art and a
science, nursing practice requires a blend
of current knowledge and practice
standards with an insightful and
compassionate approach to your patient’s
healthcare needs.
Five Levels Of Proficiency According to
Brenner:
 Novice
 Advance Beginner
 Competent
 Proficient
 Expert

42. Is Nursing a
Profession,
Discipline, or
Occupation?
DISCIPLINE
A case can be made that nursing is both a profession
and a discipline:
 It is a scientifically based and self-governed profession
that focuses on the ethical care of others.
 It is a discipline, driven by aspects of theory and
practice. It demands mastery of both theoretical
knowledge and clinical skills.
OCCUPATION
Rather than continuing to develop arguments to “prove”
that nursing is a profession, the following actions might do
more to improve the status of nursing:
 Standardizing the educational requirements for entry
into practice
 Enacting uniform continuing education requirements
 Encouraging the participation of more nurses in
professional organizations
 Educating the public about the true nature of nursing
practice

43. ROLES AND FUNCTIONS OF THE NURSE
1. Caregiver
2. Communicator
3. Teacher
4. Client Advocate
5. Counselor
6. Change Agent
7. Leader
8. Manager
9. Case Manager
10.Research Consumer
11.Expanded Career Roles

44. Expanded Career Roles for Nurses
1. Nurse Practitioner
2. Clinical Nurse Specialist
3. Nurse Anesthetist
4. Nurse Midwife
5. Nurse Researcher
6. Nurse Administrator
7. Nurse Educator
8. Nurse Entrepreneur
9. Forensic Nurse

45. THANK YOU
FOR
LISTENING!