null.pptxytgfhgjuhygfyuhgfhgfjuytfytfyjhgfjhyfryujtfjytg

HISTORY &
DEVELOPMENT OF NURSING
By : Ibne Amin
Institute of Nursing Sciences,
Khyber Medical University , Peshawar
SAMI
WTSP GRP:
0322-0998586
FOR Slides, ppprs, mcqs etc...

OBJECTIVES
• By the end of presentation learners will be able to:
• Summarize the Ancient Cultures in the field of Nursing.
• Describe site of health care in Ancient Cultures.
• Discuss Islam and Nursing.
• Explain Historical perspective and founder of Nursing.
• Discuss mughal period in Nursing. Define nursing by
WHO and different scholars
• Briefly describe types of Nursing educational programs
• History of Nursing Education in Pakistan

INTRODUCTION
• Treating the sick is nothing new. People have cared
for the sick throughout history, beginning in ancient
times
• However, considering the long history of nursing, it
was not until fairly recently that nurses received a
formal nursing education.
• Over hundreds of years, nursing has undergone an
evolution, eventually transforming itself into the
respected profession we all know of today.

NURSING IN ANCIENT TIMES
• In some early cultures, the provision of nursing
care was assigned to females, because women
provided nurturing to their infants and it was
assumed that they could provide the same type
of care to the sick and injured.

• In other ancient societies, however, men were
designated to care for the sick, because they
were considered priests, spiritual guides or
“medicine men.”

• There was no formal education available in primitive
societies, so the earliest nurses learned the tricks of
the trade via oral traditions that were passed down
from one generation to the next.
• They also learned how to nurse patients back to
health through trial and error and by observing
others who cared for the sick.

The earliest nurses used plants and herbs to heal and
believed that evil spirits and magic could affect one’s
health.
Illness was often viewed as a sign that something was
done to offend the priests or gods.

• The Egyptian healthcare system was the first to maintain
medical records starting at around 3000 B.C.
• Egyptian society was also the first to classify medications
and develop plans to maintain people’s health.
• They were the first to use the concepts of Sutures in
repairing wounds.
• Egyptian physicians are believed to have specialized in
certain diseases (such as internal diseases, fractured
bones, and wounds).

Greece
From1500 B.C. to 100 B.C., Greek philosophers sought to
understand man and his relationship with Gods ,nature and
other men.
They believed that god and goddesses of Greek mythology,
controlled health and illness. Temples were built to honor
the Asclepius , the god of medicine, and were designated
to care for the sick.
The Greeks believed in Apollo, the Greek god of healing
and prayed to him for magic cures for their illness.

Hippocrates was the first who attributed disease to
natural cause rather than supernatural causes and
curses of gods and 400 B.C. ,the famous Greek
physician Hippocrates believed that disease had
natural, not magical, causes.

INDIA
Dating from 2000 to 1200 B.C., the earliest cultures of
India were Hindu. The sacred books of Hindu, Vedas,
were used to guide healthcare practices.
The Vedas included herbs, spices, displays of magic,
and charms. The Indian documented information
concerning prenatal care and childhood illness.

CHINA
The teaching of Confucius (551-479 B.C.) had a powerful impact
on the customs and practices of people of ancient China. One
tradition that exemplified their belief about health and illness
was the yin and yang philosophy.
The Chinese believed that an imbalance between these two
forces would result in in illness, where as balance between the
yin and yang represent good health. The ancient Chinese used a
variety of treatments believed to promote health and harmony,
including acupuncture to affect the balance of yin and yang.
Hydrotherapy, massage, and exercise were used as preventive
health measures.

ROME
In ancient Rome, during the early Christian era,
deaconesses were selected by the church to provide care
for the sick.
Deaconesses had some education and were selected by the
church’s bishops to visit and care for the sick in their
homes.
The deaconess Phoebe is considered to be the first
“visiting nurse” who provided expert home nursing care.

The Roman Empire (27BC. - 476 A.D.) a military
dictatorship, adopted medical practices from the countries
they conquered and the physicians they enslaved. The first
military hospital in Europe was established in Rome. Both
male and female attendants assisted in the care of sick.
Galen was a famous Greek physician who worked in Rome
and made important contribution to the practice of
medicine by expanding his knowledge in anatomy,
physiology, pathology and medical therapeutics.

The Middle Ages
The Middle ages (476BC. To 1450 A.D.) followed the demise of
Roman Empire. Women used herbs and new methods of
healings whereas man continued to use purging and leeching.
This period also saw the Roman Catholic Church become a
central Figure in the organization and management of health
care.
Most of the changes in health care were based on the Christian
concepts of charity and sanctity of human life.
Wives of emperors and other women considered noble were
become nurses.

RENAISSANCE PERIOD
The Renaissance and Reformation period (1500 to 1700) also
known as the rebirth of Europe, followed the middle ages
period. During the renaissance period, a growing interest in
science and technology led to advances in medicine and
public health.
At the time, the rich paid for their sick to be cared for at home,
while the poor were cared for in hospitals. By the time many
poor people arrived at hospitals, they were already very ill, so
they often died in the hospitals.
Being hospitalized had negative connotations for most people,
as hospitals were considered places where people went to die.
It was also referred as the Dark Ages of Nursing.

• Following the Protestant Reformation, monasteries and
convents were closed, and the lands were seized. “Common”
women who were too old or ill to find other jobs started
caring for the sick.
• Although there were a few hospitals in Protestant Europe,
there were no regular system of nursing. Female practitioners
cared for neighbors and family, but their work was unpaid
and unrecognized.
• In Catholic areas, however, the tradition of nursing nuns
continued uninterrupted.

FOUNDATIONS OF MODERN NURSING
• Modern nursing began in the 19th century in
Germany and Britain.
• The practice had spread worldwide by about
1900. British social reformers advocated for the
formation of groups of religious women to staff
existing hospitals in the first half of the 19th
century.
• Two influential women in the field of nursing
during this time period were Elizabeth Fry and
Florence Nightingale.

THE 19TH AND 20TH CENTURIES
• In the late 19th century, nursing
professionalized rapidly in the United States.
• Women who had served as nurses during the
Civil War realized the importance of a formal
nursing education and played a crucial role in
establishing the first nurse training schools.
• Hospitals began setting up nursing schools
that attracted women from both working-
class and middle-class backgrounds.

The 19th and 20th Centuries
• The first permanent school of nursing
founded in the United States was the nurse
training school at the Women’s Hospital of
Philadelphia, which was established in 1872.
• During the second half of the 20th century,
the number of graduate programs in nursing
grew rapidly.

THE 19TH AND 20TH CENTURIES
• Graduate nursing programs focusing on
clinical specialties laid the basis for the
expansion of advanced practice nursing.
• By the end of the 1960s, there were 1,343
nursing schools with 1,64,545 nursing
students enrolled, according to the National
Student Nurses Association (NSNA)

NURSING IN ISLAM
• Nursing in Islam is a healthcare services related to
caring patient, individual, family, and community
as manifestation of love for Allah and the Prophet
Muhammad(PBUH).
• Nursing as a profession is not new to Islam. In
fact, it is attributive to sympathy and
responsibility towards the concerned in need.
• This undertaking had started during the
development of Islam as a religion, a culture, and
civilization.

NURSING IN ISLAM
1. “ heal the breasts of believers ” ‫ر‬
َ
‫و‬
‫د‬ ‫ﺻ‬
َ
‫ف‬
َ‫ﺷ‬
َ َ ‫ﯾ‬ ‫و‬
‫ن‬
َ‫ﯾ‬
‫ﻧ‬
َ ‫ﻣ‬
َ ‫ﻣؤ‬
َ ‫م‬
َ
‫و‬
َ
َ ‫ﻗ‬ Tawba -14
2. “ and a healing for the diseases in your
hearts ” ‫ر‬
َ
‫و‬
‫د‬ ‫ﺻ‬
‫ﱡ‬ ‫اﻟ‬
‫ﻲ‬
‫ﻓ‬
َ ‫ﺎ‬
‫ﻣ‬
َ ‫ﻟ‬
َ ‫ء‬
َ‫ﺎ‬
َ
‫ﻔ‬
‫ﺷ‬
َ ‫و‬
َYonos –
57
3. “ we send down stag by stage in the Qur'an
and that which is a healing and a
َ
m
َ
e
َ
rcy
t
َ
o those
َ
w
َ
ho belie
َ
ve”
َ
Israa – 82 َ
‫نآ‬ ‫ﺮ‬َ
‫ﻟﻘ‬ ‫ﻦا‬َ‫ﻣ‬َ‫َﻨﺰل‬ ‫ﻦوﻨ‬َ ‫ﻨﻴ‬َ ‫ﻣ‬َ ‫ﻣﺆ‬َ ‫ﻟﻠ‬َ ‫ﻣﺔ‬َ ‫ﺣ‬َ ‫ر‬
َ
‫و‬
َ
‫ء‬
َ ‫ﺷﻔﺎ‬َ
‫ﻮ‬َ ‫ﻫ‬ ‫ﻣﺎ‬َ “
4. “and when I am ill, it is He who cures me ”
‫ن‬
َ‫ﯾ‬
‫ﻔ‬
َ ‫ﺷ‬
َ َ ‫ﯾ‬ ‫و‬
َ‫ﮭ‬
ََ ‫ﻓ‬ ‫ت‬
َ‫ﺿ‬
َ ‫ر‬
َ‫ﻣ‬
َ ‫ا‬
َ
‫ذ‬
‫إ‬
َ
‫و‬
َ Shoaara –
80

NURSING IN ISLAM
• And there are many statements of our
prophet. Muhammad (PBUH) related to this
subject example:
– Our God create treatment for every disease
some people know it and some of them
don’t.
– Seek for treatment and medical help.

THE FIRST MUSLIM NURSE
• The first professional nurse in the history of Islam
is a woman named, Rufaidah bento Saad Al
Aslamiah, from the Bani Aslam tribe in Madina Al
Monawarah
• She lived at the time of Prophet Muhammad
(saw) and was among the first people in Medina
to accept Islam
• Rufaidah received her training and knowledge in
medicine from her father, a physician whom she
assisted regularly

After the Muslim state was established in Medina, she
would treat the ill in her tent set up outside the mosque
During times of war, she would lead a group of volunteers
to the battlefield and would treat casualties and injured
soldiers.
Rufaidah is described as a woman possessing the qualities
of an ideal nurse: compassionate, empathetic, good leader
and a great teacher, passing on her clinical knowledge to
others she trained.
.

Furthermore, Rufaidah’s activities as someone greatly
involved in the community, in helping those at the more
disadvantaged portions of society symbolize the ethos of
care identified above.
Anas ibn Mâlik said: “Muhammad (PBUH) used to go out to
the battles taking Umm Sulaym and some other women of
the Ansaar with Him; when He fights in the battle, they [i.e.
the women] would give water to the soldiers and treat the
injured.”

Florence Nightingale
• She was born in 1820 and died in 1910
• Born in Italy to wealthy English parents
• Frustrated by lack of options for women of her social
background
• Challenged parents and society and traveled to
Germany and throughout Europe to train as a nurse
• Her big opportunity came when the Crimean war
broke out in 1854

FLORENCE NIGHTINGALE
• Secretary of War asked her to go take charge of the
hospital at Scutari in Turkey.
• Nightingale showed up with 38 trained nurses and
faced a death rate of 40%
• Nightingale found that conditions in the military
hospitals were terrible. The absence of sewers and
laundry facilities, the lack of supplies, the poor food,
and the disorganized medical services contributed to
a death rate of more than 50% among the wounded.

Florence Nightingale
• She established cleanliness and sanitation rules
• Patients received special diets and plenty of food
• Improved water supply
• Patients received proper nursing care
• Nightingale established a reputation which allowed
her to improve nursing standards at home
• Nightingale’s strong statements about the role of
nurses and their need for lifelong education are still
quoted widely today

FLORENCE NIGHTINGALE
• Established nursing school at St. Thomas’ Hospital,
London.
• By 1887, had her nurses working in six countries and
U.S.
• She was a nurse, philosopher, statistician, historian,
politician and more
• Today she is considered the founder of modern
nursing

NURSING DEFINITIONS BY SCHOLARS
Nursing definitions by Florence Nightingale
She defined nursing 100 years ago as “ the act of
utilizing the environment of the patient to assist him in
his recovery”
(Nightingale 1860)

NURSING DEFINITIONS BY
SCHOLARS
Virginia Henderson’s Definition
“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
peace full death) that he would perform independently
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.”

NURSING DEFINITIONS BY
SCHOLARS
ANA’s Definition
• In 1980, the ANA (American Nurses Association)
published this definition of nursing “Nursing is the
diagnosis and treatment of human responses to
actual or potential health problems.”
(ANA, 1980, p. 9)

Nursing Definition WHO
Nursing definition WHO
Nursing encompasses 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.

MUGHAL PERIOD AND NURSING
Maham Anga, a great lady served as a wet
Nurse of King Akbar in Mughal Empire
She nursed during Wars in India and Afghanistan

TYPES OF NURSING EDUCATION
PROGRAMMES
• NURSING DIPLOMA
• ASSOCIATE OF SCIENCE IN NURSING
• BACHELOR OF SCIENCE IN NURSING (BSN
• RN-TO-BSN (POST RN BSN)
• MASTER OF SCIENCE IN NURSING (MSN)
• DOCTORATE NURSING DEGREE PROGRAMS
• MPH
• MSPH

HISTORY OF NURSING EDUCATION
IN PAKISTAN
• Initially, the health-care services in Pakistan were ill-
developed and the rate of employment in health-care
jobs in Pakistan was very low. Since 1951 Pakistani
governments have concentrated on the development
and improvement of health care services and one of
the major steps is increasing the rate of funding to
PNC Clinics. The Nursing council (PNC) has also played
a key role to provide world-class health care and
nursing services to the patients.
• Pakistan had a nurse-to-population ratio of 1:32000 in
1960, improving to 1:5199 by 1997

IN PAKISTAN
• According to figures cited by the Journal of
Pioneering Medical Sciences in 2013, the existing
nurse-patient ratio in Pakistan is approximately 1:50
whereas the ratio prescribed by the Pakistan Nursing
Council (PNC) is 1:10 in general areas and 2:1 in
specialized areas.
• Currently, Pakistan has 162 registered nursing
colleges.

PAKISTAN NURSING COUNCIL
(PNC)
The PNC is an autonomous, regulatory body
constituted under the Pakistan Nursing Council Act
(1952, 1973) and empowered to register (license)
Nurses, Midwives, Lady Health Visitors (LHVs) and
Nursing Auxiliaries to practice in Pakistan. PNC was
established in 1948.
The PNC has involvement in improving and
standardizing public education and clinical nursing
standards. They also oversee the ethical standards and
general welfare of nurses.

(PNC)
Roles/functions of the PNC?
1. PNC sets the curriculum for the education of
Nurses, Midwives, LHVs and Nursing Auxiliaries.
2. PNC inspects educational institutions for approval
based on established standards
3. PNC provides registration (license) to practice.
4. PNC maintains standards of education and practice.

(PNC)
5.PNC works closely with the four provincial Nursing
Examination Boards (NEBs).
6.PNC plays and advisory role for the overall benefit of
Nurses, Midwives, LHVs and Nursing Auxiliaries in the
country.
7.PNC maintains an advisory role for the Federal and
Provincial Government regarding nursing education
and nursing services.

(PNC)
8.PNC communicates policy decisions regarding nursing
education and the welfare of nurses, taken in Council
meetings, to Governments, Nursing Institutions, NEBs and
Armed Forces Nursing Services for implementation.
9.PNC prescribes penalties for fraudulent registration by
intention of removes persons from the Register for
professional misconduct.

IN PAKISTAN
• 1948: First Nursing School was established in Ganga
Ram small private Hospital Lahore.
• In 1952: first group of 07 girls passed the nursing
course from this school.
• In 1948: Second School of Nursing was opened in
JPMC Karachi.
• This development followed by Bahawalpur,
Hyderabad and Multan, Lady Reading Hospital
Peshawar, Civil Hospital Karachi, Mayo Hospital
Lahore.
• In 1951: LHV Training extended to 02years, one year
midwifery and second in nursing emphasized on
community nursing.

IN PAKISTAN
Every year 1800-2000 Registered Nurses,
1200-1300 Midwives Nurses and 300-400 Lady
Health Visitors are produced in the country.

THE FUTURE OF NURSING
• International Nurses Day is observed on May 12 across the
globe to acknowledge the role that nurses play in the
healthcare system
• Pakistan is running short of nursing staff and currently
nursing education is in transition period and diploma
education has been replaced by university degree by 2018.

THE FUTURE OF NURSING
A few universities offer master degree & PhD in
nursing sciences. Recently KMU has started PhD
Nursing ( First ever public sector university of Pakistan).
However, there is a lot to be done more as currently
degree program is lacking quality with exception to
some institution, along with surfacing of some ghost
institutions offering degree to remote students even
without attendance, reason behind is the culture of
political nepotism and corruption.

REFERENCES
1.Craven, R. F., & Hirnle, C. J. (2000). Fundamentals of
Nursing: Human Health and Function. (3rd ed.). New York:
Lippincott.
2.Delaune, S. C., & Ladner, P
. K. (2002). Fundamentals of
Nursing:Standards and Practice. (2nd ed.) Canada: Delmar.
3.Erb, G. K., B. (2000). Fundamentals of Nursing: Concepts,
Process and Practice (5th ed.) Addison: Wesley.
4.Potter, P
. A & Perry, A. G. (2003). Basic Nursing: Essentials for
Practice (5th ed.) St. Louis: Mosby.

Communication
By : Ibne Amin
BSN , MSN
INS , Khyber Medical University
ibneamin.ins@kmu.edu.pk

Objectives
At the end of this unit students will be able to
1. Define communication, elements of the
communication process, ways of communication.
2. Identify the characteristics of the effective verbal
communication
3. Describe the factors that's facilitate and interfere with
the effective communication
4. Define ways to respond therapeutically
5. Identify non therapeutically respond
6. Discuss the legal aspects of documentation

Communication
Communication is regarded as a two- way process of
exchanging ideas, feelings, emotion and information so
as to
– To increase knowledge
– To change existing patterns of behavior & attitudes
– To acquire new skills.
It has two main purposes:
• To influence others
• To gain information

Components of Communication
It has the following main components
• Sender (source, communicator)
• Receiver (Audience)
• Message (content)
• Channels (medium or pathway)
• Feedback (effect)

Sender:
• A sender is a person who encodes & sends the
message to the expected receiver through an
appropriate channel.
• A sender is the source of the message that is
generated to be delivered to the receiver after
appropriate stimulus from the referent.

Message:
• The message is the content of communication &
may contain verbal, nonverbal or symbolic language.
• Perception & personal factors of the sender &
receiver may sometimes distort this element & the
intended outcome of communication may not be
achieved. For ex, the same message may be
communicated or perceived differently by two
individuals.

Channel:
• A channel is a medium through which a message is
sent or received between two or more people.
• Several channels can be used to send or receive the
message, i.e seeing, hearing, touching, smelling, &
tasting.
• While selecting channels of communication, several
factors must be considered: availability of channels ,
purpose, suitability, types of receivers, types of
message, preference of sender & receivers,
communication skills of the sender, cost, etc.

Classification of channels of communication:
• Visual channel: Facial expression, body language,
posture, gestures, pictures & written words, electronic
mails, mass media, etc.
• Auditory channel: Spoken words, sounds, telephone or
mobile communications, delivering audio content (radio,
voicemail), etc.
• Tactile channel: Touch sensations, therapeutic touch, etc.
• Combined channel: Audiovisual media, consoling a person
with touch & spoken words.

Receiver:
• A receiver is an individual or a group of individuals
intended to receive, decode & interpret the message
sent by the sender/source of message.
• A receiver also known as decoder.
• He is expected to have the ability & skills to receive,
decode & interpret the message

Feedback:
• It is a return message sent by the receiver to the sender.
• It is most essential element of the communication
process as it shows that the receiver has understood
the primary message sent by the sender & the
communication process is now consider complete.
• A successful communication must be a two-way process
where the sender sends the message & receives
feedback from the receiver.
• These feed back could be verbal & nonverbal.

Types of Communication
1. One way communication
2. Two way communication
3. Verbal communication
4. Non-verbal communication
5. Formal and informal communication
6. Visual communication
7. Telecommunication and internet

One Way Communication
• The flow of communication is “one-way” from the
communicator to the audience.
• Example - Lectures in classroom

Two Way Communication
• Two-way method of communication in which both
communicator and audience take part.
• Learning is active
• More likely to influence behavior.

Verbal Communication
• In Verbal communication, Spoken words are used. It
includes face-to-face conversations, speech.
• The words used vary among individuals according to
culture, socioeconomic background, age, and
education.

Characteristics of effective verbal
communication
Use of commonly understood words
• Simplicity
• Clarity Say exactly what it means
• Timing and relevance
This involves being sensitive to the clients' needs and concerns
• Adaptability Spoken message needs to be altered in accordance with
behavioral cues from the receiver
• Credibility
the quality of being trusted & believed

Nonverbal communication
• Communication can occur even without words.
• It includes whole range of bodily movements, postures,
gestures and facial expression.
• Silence is non verbal communication, it can speak louder
than words.

Visual communication
• The visual form of communication comprise ;
• Charts
• Graphs
• Pictograms
• Tables
• Maps
• posters

Telecommunication and internet
• Telecommunication is the process of communication
over distance using electromagnetic instruments
designed for the purpose.
• For example radio, TV, internet , telephones, satellite
etc

Levels of communication
• Intrapersonal communication
• Interpersonal communication
• Transpersonal communication
• Small group communication
• Public communication

Intrapersonal communication
• It occurs within an individual. This level of
communication is also called self talk, inner thought
and inner dialogue.

Interpersonal communication
• It is one to one interaction between the nurse and
another person that often occurs face to face.
• Meaningful interpersonal communication results in
exchange of ideas, problem solving, expression of
feelings, decision making and personal growth.

Transpersonal communication
• It occurs within a person’s spiritual domain. Many
persons use prayer, meditation religious rituals to
communicate with their higher power.

Small group communication
• It occurs when a small number of persons meet
together. It is usually goal directed and requires an
understanding of group dynamics.

Public communication
• It is the interaction with the audience. Nurses have
opportunities to speak with groups of consumers
about health related topics, present scholarly work
to colleagues at conferences or lead classroom
discussions

Therapeutic Communication
“In therapeutic communication the nurse directs the
communications towards the patient to identify his
current health problem, plan, implement & evaluation
the action taken.”

Therapeutic Communication
Techniques
• Offering self
• Giving broad opening
• Silence
• Exploring
• Focusing
• Providing general leads
• Giving information
• Restating

Technique purpose example
Using silence
Accepting pauses or silences that
may extend for several seconds or
minutes without
any verbal response.
Sitting quietly (or walking
with the client) and
waiting attentively until
the client is able to put
thoughts and feelings
into words.
Providing
general leads
Using statements or questions that
(a) encourage the client to verbalize,
(b) choose a topic of conversation,
and (c) facilitate continued
verbalization.
“Where would you like to
begin?”
“And then what?”
Broad
Opening
Initiates conversation;
Encourage the patient to select
Topics for discussion.
Tell me something
About your family?
What would you like to
discuss?
eg; “What are you
thinking about?”

Offeringself Making oneself
Available on an
Unconditional basis,
increasingclient‟s
Feelingof self-worth
I‟ll stay with you until
I‟ll be hear till 12.00
Clock.
“I’ll stay with you until your family
members arrives.”
Restating Repeating the main thought
expressed by the patient.
Eg; “You say that your mother left
you when you were five years old.”
Giving
information
Providing, in a simple and direct
manner, specific
factual information the client may or
may not
request. When information is not
known, the nurse
states this and indicates who has it
or when the
nurse will obtain it.
Your surgery is scheduled for 11
AM tomorrow.”
“You will feel a pulling sensation
when the tube is removed
from your abdomen.”
“I do not know the answer to that,
but I will find out from
Mrs. King, the nurse in charge.”

Exploring
delving further
into a subject or an idea
“Tell me more about that.
”
“Would you describe it
more
fully?”
“What kind of work?”
Focusing Concentrating on a single point. “This point seems worth
looking at more closely.”

Factors influencing communication
process
• Person Socio cultural background
• Language
• Age
• Education
• Ability of communication
• Time and setting
• Emotions and self esteem

Nontherapeutic response
• Not listening properly
• Rejection (refusing from discussion)
• False hopes
• Too much probing into personal matters
• Changing the subject
• Sharing personal or work related problems
• Reveal confidential information

Legal Aspects of Documentation

Legal Aspects of Recordkeeping
• Legally, the documentation of the care given to a
patient must be completed.
• If no documentation is recorded, no care was given
at all.
• Hospital accreditation agencies will carefully
evaluate the medical records of patients.

• If documentation is not done the hospital and the
practitioner could be accused of patient neglect.
• Proper documentation of care is valuable only in
reference to standards and criteria of care.

• For each standard, criteria must be outlined so that
adequacy of patient care be measured.
• Documentation will reflect the standards of the
department.

Practical Aspects of
Recordkeeping
• Recordkeeping is one of the most important parts of
our duties.
• Documentation must be done for each medication,
treatment, and procedure.
• Accounts of patient’s condition and activities must
be charted correctly and be very clear.
• Briefness is important, although a complete account
of each patient encounter

General Rules for Recordkeeping
• Legible. Print or hand write entries in chart.
• Begin with date and time, then enter order and sign
the chart:
• Errors? Don’t erase, or use correction tape. If a
mistake, drawn a line through it, write date and
write the word error above it, with your initials
• Chart patient complaints and general behavior

General Rules of Recordkeeping
• Leave no blank or empty lines. Draw a line through
the center of the empty space in order to prevent
someone else from signing in your area.
• Use Standard abbreviations
• Spell Correctly
• Document conversations with patient and
healthcare providers that you feel are important

References
• Andrea Ackermann, Mount St. Mary College,
Critical-thinking-the-nursing-process 2001.
• http://www.umanitoba.ca/nursing/
courses/128,(2005)
• Sara-jo Wiscombe, Nursing Process ,Wallace
Community College ,May 22,2001.
• Tucker C, MODULE A INTRODUCTION TO NURSING
Process, August 21, 2002 .

Roles of the Nurse in Health
Care
By : Ibne Amin
BSN,MSN
Khyber Medical University

Objectives
1. Professional
2. Characteristics of a Profession
3. Role of the Professional nurse
4. Description of Career roles
5. Description of role as Communicator
6. Description of role as a Teacher
7. Description of role as Counselor

Professional
A person who belongs to one of the profession.
A professional is a member of a profession or any
person who earns their living from a specified
professional activity. The term also describes the
standards of education and training that prepare
members of the profession with the particular
knowledge and skills necessary to perform their
specific role within that profession

Professionalism
Professionalism refers to professional character, spirit,
or methods. It is a set of attributes, a way of life that
implies responsibility and commitment.
Professionalization is the process of becoming
professional, that is, of acquiring characteristics
considered to be professional.

Criteria of a Profession
• To provide a needed services to the society.
• To advance Knowledge in its field.
• To protect its members and make it possible to
practice effectively.

Vocation / Profession
• A vocation is generally a job that requires a
particular set of skills acquired through experience
or through training but not necessarily dependent
on a college degree. These would include plumbing,
electrician, mechanic, etc.
• A profession could be one of the above but
generally references a doctor, lawyer, nurse or other
skilled worker who was required to obtain college/
university training.

Vocation /Profession
• Though both vocation, as well as profession,
indicates the career or the occupation through
which an individual makes a livelihood, vocation is a
broader term than profession.
• Profession refers to the career that one opts for,
getting extensive training and acquiring special skills
to become eligible for a job in it.
• Profession requires training and qualification
whereas vocation is the innate ability in an
individual towards a particular occupation.

Vocation /Profession
Vocations almost always carry the connotation of some
kind of manual labor (plumber, carpenter, electrician,
mechanic, etc). By contrast, "profession" implies
some kind of white collar job (historically the
contrast was much stronger, but today any kind of
"knowledge worker", including being a clerk, is
considered a "professional").

Occupation
Occupation
An activity or task with which one occupies oneself;
usually specifically the productive activity, service,
trade, or craft for which one is regularly paid; a job.
The act, process or state of possessing a place.

Characteristics of a profession
• Great responsibility
• Accountibility
• Allows Autonomy in decision making
• Involve a skill based on specialized,theoritical
knowledge
• Involve a skill that require training & education
• Integrity is maintained by adherence to a code of
conduct
• Is organized
• Ethical constraints

Characteristics of a profession
• Self regulation
• Honesty and integrity
• Competency
• Image
• It renders an essential socail service

Nursing as a Profession
Nursing is recognized increasingly as a profession
based on the following 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

Characteristics of a Professional Nurse
• Caring
• Honest
• Faithful
• Patient
• Good listener
• Accountable
• Competent
• Confident
• Commitment
• Reflective
• Non judgmental
• Safe care provider

Career Role
A role is a set of expected behaviors associated with a
person’s status or position. Role includes behaviors,
rights, and responsibilities.
Nurses function in a variety of roles every day. Often
roles overlap, which may lead to a conflict in
expectations or responsibilities.

Roles of a Professional nurse
• Caregiver
• Counselor
• Teacher
• Client advocate
• Change agent
• Communicator
• Team member
• Resource person
• Leader
• Decision maker

Role as a Care giver
The caregiver is the role most commonly associated
with nursing by the general public. In the role of
caregiver, the nurse provides direct care when
clients are unable to meet their own needs. This
includes physical needs, which can range from total
care to helping a patient with illness
prevention(completely dependent, partialy
dependent,supportive-educative care).

Role as a Care giver
• Holistic care emphasizes that the whole person is
greater than the sum of their parts.
• This means that nurses also address psychosocial,
developmental, cultural, and spiritual needs.
• The role of caregiver includes all of the tasks and
skills that we associate with nursing care, but also
includes the other elements that make up the whole
person.

Role as a Counselor
Counseling is the process of helping a client to
recognize and cope with stressful psychologic or
social problem.When acting as a counselor, the
nurse assists clients with problem identification and
resolution. The counselor facilitates client action and
does not tell clients what to do but assists clients to
make their own decisions. Counseling is done to
help clients increase their coping skills.

Role as a Counselor
Clients are frequently counseled in stress management,
how to deal with chronic conditions, grief and
bereavement. Effective counseling is holistic, in that
it addresses the individual’s emotional,
psychological, spiritual, and cognitive dimensions.

Role as a Teacher
Teaching is an active process in which one individual
shares information with others to provide them with
the information to make behavioral changes.
Learning is the process of assimilating information
with a resultant change in behavior

Role as a Teacher
Teaching is an intrinsic part of nursing.The nurse views
each interaction as an opportunity for education;
both client and nurse can learn something from
every encounter with each other. Teaching by nurses
can be formal, informal, intentional, or incidental.

Role as a Client Advocate
A client advocate is a person who speaks up for or acts
on behalf of the client so as to protect him.In this
role the nurse may represent the client’s need &
wishes to other health professional.
Advocacy empowers clients to be partners in the therapeutic
process rather than passive recipients of care. The
relationship that encourages client empowerment is one of
mutual participation by client and nurse. Clients and families
are actively involved in establishing goals.

Role as a Client Advocate
• Frequently, clients and families do not
communicate their concerns to physicians but
will do so to the nurse with whom a bond has
been established.
• Nurses function as client advocates by listening
and communicating the expressed concerns to
other health care providers and including those
concerns into care planning.

Role as a Change Agent
Nurses who function in the role of change agent
recognize that change is a complex process.
The nurse change agent is proactive (takes
the initiative to make things happen) rather
than reactive (responding to things after they
have happened). Change should not be done
in a random manner. It should be planned
carefully and implemented in a deliberate
way to facilitate the client’s progress.

Role as a Team Member
A vital role of the nurse is that of team member.
The nurse does not function in isolation but
rather works with other members of the
health care team. Collaboration requires the
nurse to use effective interpersonal skills and
promotes continuity of care. They use their
professional and communication skills
applicable to promoting healthy relationships
with clients and colleagues.

Role as a Resource Person
The nurse functions as a resource person by
providing skilled intervention and information.
Identifying resources and making referrals as
needed also fall under the auspices of this
role. Nurses must consider the client
strengths and access to resources, including
physical, intellectual, economic, social, and
environmental.

Role as a Leader
• A leader influences others to work together to
accomplish a specific goal.
• The leader role can be employed at different
levels; individual client, family, groups of clients,
colleagues, or the community.
• Effective leadership is a learned process requiring
an understanding of the needs and goals that
motivate people, the knowledge to apply the
leadership skills, and the interpersonal skills to
influence others.

Role as a Reasercher
• Nurse researchers are scientists who study
various aspects of health, illness and health
care.
• By designing and implementing scientific
studies, they look for ways to improve health,
health care services and health care
outcomes.

Role as a Communicator
• As a communicator, the nurse understands that
effective communication techniques can help
improve the healthcare environment.
• Barriers to effective communication can inhibit the
healing process.
• The nurse has to communicate effectively with the
patient and family members as well as other
members of the healthcare team.
• In addition, the nurse is responsible for written
communication, or patient charting, which is a key
component to continuity of care.

Role as a decision maker
• As a decision maker, is to use critical thinking
skills to make decisions, set goals, and promote
outcomes for a patient.
• These critical thinking skills include assessing the
patient, identifying the problem, planning and
implementing interventions, and evaluating the
outcomes.
• A nurse uses clinical judgment - his or her ability
to discern what is best for the patient to
determine the best course of action for the
patient.

References
kozier & Erb’s Fundamental of Nursing ,8th
edition
( Audrey Berman ,Shirlee J. Synder).
Fundamentals of Nursing: Standards & Practice, 2nd
Edition
( Sue C. DeLaune Patricia K. Ladner.)
www.slideshare.com
www.google.com

CONCEPT OF SAFETY AND RISK
MANAGEMENT
By : Ibne Amin
BSN,MSN
Khyber Medical University, Peshawar

12/7/2019
12
5
OBJECTIVES
By the end of presentation the learners will be able to:
▪ Define safety and Risk.
▪ Identify factors affecting safety.
▪ Identify environmental hazards.
▪ Identify hazards in hospital environment (Physical &
Microbial) which alter patient safety.

12/7/2019
12
6
CONT......
▪ Discuss general preventive measures for patient
safety.
▪ Identify the preventive measures to ensure health
care workers and patient safety.
▪ Discuss specific safety concerns in hospital

12/7/2019
12
7
DEFINITION OF SAFETY, RISK & HAZARD
□ Safety may be defined as freedom from psychological and
physical injury. It is a basic human need which must be met.
(Potter & Perry, 2007)
□ Risk is the probability/chance of exposure to danger, harm or
loss.
□ Hazard is an agent which has the potential to cause harm.

12/7/2019
12
8
RISK
Risk can be Acute, intermediate, and chronic.
Acute: leads quickly to a health crises like fall, electric
current, radiation.
Intermediate: cause a problem not too fast or too slow.
Like elevated lipid, blood pressure, obesity.
Chronic: behavioral risk like tobacco use, unhealthy diet
use and physical inactivity

12/7/2019
12
9
DIFFERENT FORM OF HAZARD
• Physical:Noise, slippery floors, poor lighting,
fire.
• Chemical: toxic properties of gases, fumes, dust
and liquids.
• Radiation: X-rays, gamma rays, Microview,
ultraviolet rays. Ergonomics: poor design of
equipment, work station, work flow, method ,
manual handling.

12/7/2019
13
0
CONT……..
• Biological: Infection by bacteria, viruses, fungi, insect
bite, plant, bird, and contact with infected person.
RISK MANAGEMENT
• Risk management is complex process that involves
identification, analysis, and elimination of the risk
factors.

12/7/2019
13
1
FCATORS AFFECTING SAFETY
• Age and development (old or young child)
• Life styles
• Mobility status
• Sensory Perception
• Safety awareness
• Communication
• Cognitive impairment
• Environmental factor such as Health acre setting, home
and community.

ENVIRONMENTAL HAZARDS
Pollution Electricity Radiations
Natural Disaster Violence Accidents
12/7/2019
13
2

CONT....
Extreme
temperature
Poison
Machinery Microorganisms
12/7/2019
13
3

HAZARDS IN HOSPITAL
Electrical
Hazards
Radiations
Equipments out of
order
Mercury spill
Workplace
violence
Accidents (Falling)
12/7/2019
13
4

CONT....
Stress
Non sterile
techniques
Body Mechanics
12/7/2019
13
5
Needle stick injury (HIV, Hep B, Hep C etc )

Assessment for Environmental
Hazard or Risk
12/7/2019
13
6
A nurse must assess the environment for any threat to the
client safety.
• Client’s immediate environment.
• Individual risk factors
• Home hazard assessment
• Medication or undergoing for any procedure.

General Preventive Measures for
Patient Safety
12/7/2019
13
7
• Give orientation to the client about unit
• Ensure the provision of basic needs (oxygen, Nutrition,
Temperature)
• Place a call bell within reach of the patient and teach
how and when to use it.
• Have proper lighting in the room
• keep the bed locked and in low position

12/7/2019
13
8
CONT.....
• Use infection control measures (hand washing)
• Maintain close supervision of confused patient
• Place all equipment with in easy approach
• Use restrain if required
• Provide clean and calm environment
• Explain the procedures and plans

12/7/2019
13
9
CONT……
• Answer the call bell on time
• Use isolation precautions where applicable
• Provide non-slippery, well-fitting footwear.
• Keep floor surface clean and dry.
• Ensure six rights of the patient (right patient, medicine,
dose, rout, time and documentation)

Preventive Measures for Health Care
Professionals’ Safety
12/7/2019
14
0
• Awareness about standard safety policies and
procedures
• Know the emergency phone numbers like
fire, & Security emergency services
• Vaccination e.g. Hepatitis B vaccine
• Use of universal precautions (Hand washing
Protective measures such as using of gloves, gown,
cap, etc)
• Do not recap the needle
• Use of danger box

12/7/2019
14
1
CONT.....
• Use proper body mechanics
• Learn proper use of equipments
Needle stick injury is one of the most serious exposures
for health care personnel that may cause blood borne
diseases, such as Hepatitis or AIDS. Always plan safe
handling and disposal of needles before beginning the
procedure. (Craven & Hirnle, 2003)
In case of accident, error or injury complete an incident
report according to policy and inform the supervisor.

12/7/2019
14
2
Specific Safety Concerns In Hospitals
• The nurse should be aware of how to protect his/her
client from various kinds of hazards.
Fall:
• Familiarize the client with environment.
• Teach the client how to use the call bell.
• Keep the bed in low position with brakes locked.
• Provide non-slippery footwear
• Toilet should have safety bars for weak patients

RESTRAINS
• Obtain consent from the attendants
• It must be in the form of belt or soft clothes
• Restrain should be temporary.
• Apply in such way not to impede blood circulation (not too
tight or too loose).
• Always tie a limb restrain with knot that will not tighten when
pulled.
Mitt Restrain
12/7/2019
14
3
Limb Restrain

SIDERAILS
• Help to increase patient’s mobility when on bed
• Helps to prevent fall of unconscious patients.
• When siderails are used then bed should be
maintained at the lowest position.
12/7/2019
14
4

12/7/2019
14
5
FIRE
• Home fire mostly result from careless disposal of
cigarette, matches, faulty electric wiring.
• In hospital usually from short circuit.
• Organization should have fire alarm, extinguisher and
hydrants system in every area.
• Organization should have fire exit door
• Once the smoke is detected the nurse should follow the
mnemonics RACE for others.
• All nurses, clients and family members including children
should know the steps when they themselves catch fire
STOP, DROP and ROLL for self.

12/7/2019
14
6
CONT………
RACE
• Rescue: if the area is safe to enter, take out the client
• Alarm: Pull the fire alarm to report the exact location
• Confine: Confine the fire by closing all the doors
• Extinguish: Use the fire extinguisher

CONT…….
• Stop: Stop where you are
• Drop: Drop to the ground and
cover your eyes and mouth with
your hands.
• Roll: Roll over and over and back
and forth until the flames are out
12/7/2019
14
7

Electric Hazards
• Electricity wire should be grounded in good working
order.
• Don not place wire under the carpet or on floor.
• No loose wire or connection
• Grasp the plug not the cord while unplugging
• Keep the electric equipment/wire away from sink,
bathtub and shower.
• Keep all the electric appliance out of the reach of
children.
12/7/2019
14
8

Poison
• Lock all potentially toxic agent and medicine as well
• Avoid storing toxic agent in food container.
• Do not remove container label and label the container
• Do not keep poisonous plant at home
• Poison impair the function of respiratory, CNS, GI, CVS,
and Renal failure
• Urgently need specific antidotes
12/7/2019
14
9

Lighting
• Adequate light is essential to reduce the risek of fall and
to work easily
• House exterior, interior and specially staircases should
have good lighting
• Night light (dim light )
12/7/2019
15
0

BATHROOMS
To minimize the risk of injuries in
toilets, should take care of:
• Place safety bar
• Place raise commode
• Don’t use slippery material in
floor (tiles)
• Use non-slip, well-fitting footwear
• Keep the surface clean and dry
• Should have good lighting
12/7/2019
15
1

12/7/2019
15
2
SECURITY SYSTEM
The most common cause of death is falling asleep while
the ignition source was burning.
• Smoke detector should be installed
• Lead should not be used in house paint
• Especially gas valve should be closed before going to bed
• Secure house from intruders

12/7/2019
15
3
REFERENCES
• Christensen, B. L., & Kockrow, E. O. (2006). Foundations and Adult Health Nursing.
(5th
ed.). philadelphia: Mosby.
• Craven, R. F., & Hirnle, C. J. (2003). Fundamental of Nursing Human Health and
Function. (4th
ed.). New York: Lippincott.
• Potter, P.A & Perry, A.G (2007). Basic Nursing: Essentials for Practice. (6th
ed.) St.
Louis: Mosby.
• Roger Pressman, ÒSoftware Engineering:A PractitionerÕs ApproachÓ, McGraw-Hill,
5th edition, ISBN: 0-07-709677-0 (Chapter 6). Retrieved from
http://www.cs.ucl.ac.uk/staff/A.Finkelstein/advmsc/15.pdf
• Faculty & staff safety hand book , The Aga Khan University
• JCIA International patient safety goals

Process of Hospitalization
By : Ibne Amin
Institute of Nursing Sciences,
Khyber Medical University , Peshawar

Objectives
At the end of this unit learners will be able to:
1. Define the term admission, transfer and discharge
2. Discuss the procedure for admission, transfer and
discharge
3. Identify nursing responsibility during admission,
transfer and discharge
4. Discuss nurse role in preparing patients and family
for discharge
5. Discuss the normal reaction of patient being
hospitalized

Hospital
The word “ Hospital’’ has been derived from the Latin hospes,
signifying a stranger or foreiner, hence a guest.Another noun
derived hospitium came to signify hospitality, that is the
relation between guest and shelterer and hospitality
Types
Government Hospital
Semi Government hospitals
Private hospitals
Special hospital
Hierarchy in Pakistan
BHU-RHC-THQ-DHQ-TCH

Admission
• Admission is a process of receiving a new patient to an
individual unit (ward) of the hospital. OR
• It is the entry and acceptance of a patient to stay in a
health facilty.
• Purpose of Admission
1.Observation
2.Diagnosis
3.Procedure/Surgery
4.Treatment

Types of admission
There are two major types of admission,
1.
2.
Elective / Planned
Emergency
Elective /Planned Admission
In this typ of admission the health care provider e.g.
medical officer plans a convenient date for admission.
Patient is informed well before the time so as to
make him prepare for Admission.Patient is taken
through the admission process from OPD

Types of admission
• In Elective admission there is known medical
condition or complaint that requires further
workup,treatment or surgery

Types of admission
Emergency Admission
In this type of admission, the patient is being brought to
the hospital in a critical /serious condition which
needs prompt admission and immediate treatment so
as to prevent complication.

Admission Procedure
1. The admitting department
2. Arrival on Nursing unit
3. Hospital orientation
4. Preventing Dehumanization

Admission Procedure
1. The admitting department
• Fill out admission form
• Take Admission consent
• Provide identification Band
• Allocate Hospital’s bed
• Take care of personal belonging

Admission Procedure
2. Arrival on Nursing Unit
• Height & weight
• Vital signs
• Send samples for lab investigation
• Reporting The admission
• Admission Documentation

Admission Procedure
3. Hospital Orientation
• Ward routine
(doctor, Nurses round)
• Physical facilities in room
(Internet,TV, Bathroom,teleph etc.)
• Hospital services & timing
(meals ,medication, Med/surg.supply ,linen)
• Hospital Policies
(smoking policy, LAMA, MLC)

Admission Procedure
4. Dehumanization
• Anxiousness or Apprehension
• Fear of Unknown
• Fear of body image changes
• Financial concerns
• Embarressment

Transfer to other Unit
Reason for Transfer
1. Temporary Assignment
2. Change in patient’condition
3. Quieter environment is required
4. Pt disturbing other patients
5. Patient needs special care or procedure etc.

Guidelines for Pt’s Transfer
1. Check doctor’s order.
2. Explain to pt and family.
3. Provide detail for safety
4. Hand over to other unit staff
5. Inform other department about pt’s transfer
6. Assemble all personal belonging & medicines

Patient’s Discharge
Discharge planning Begin at admission
Assess
1. patient’s personal Hx & health Data
2. Pt’s ability to perform ADL
3. Any physical, cognitive, or other functional
limitation
4. Care giver’s responses or ability
5. Financial resources
6. Community support
7. Need for home care assistant

Discharge Teaching
• Medication
• Activity (rest/ Exercise)
• Diet
• Appointment for next visit (Follow -up)
Day of Discharge
Discharge documentation

Hospital Discharge
Indication for discharge: After completion of
Required diagnosis,Observation,Procedure,treatment as
suggested by attending physicain or surgeon.
• Progress in the patient's condition
• No change in the patient's condition (Referral)
• After an Expiry
• Leaving Against Medical advice (LAMA)
• Stay against Medical advice (SAMA)

Reaction to Hospitalization
Illness Behaviour
• Pt not held responsible for their condition
• Excused from certain social role & tasks
• Obligate to try to get well ASAP
• Obliged to seek competent help

Reaction to Hospitalization conti…
Effect of illness
• Change in Behaviour
• Disruption of privacy & Autonomy
• Lifestyle,Roles and Finances
• Change in self concept, body image

Discharge of a Patient from the
Hospital
The Role of Nurse in discharge planning
• Includes all caregivers involved in the care of the
patient i.e. Pysiotherapist (multidisciplinary).
• Adequate assessment of the patient during all stages
of care to identify discharge needs.
• Assess health teaching needs of clients and family
and provide family members with the knowledge
and skill to care for the client in the home setting e.g.
wound care, range of motion exercise etc.

Hospital
• Ensure discharge is ordered by a medical officer
• Patient and relatives are informed about discharge
• They are educated on the need for continuing
treatment and follow up care
• Ensure patient’s hospital bills are worked out and
submitted to health insurance officer

Hospital
Discharge summaries usually include:
• Description of client’s condition at discharge
• Treatment (e.g. Wound care, Current medication)
• Diet
• Activity level
• Restrictions

References
Basic clinical Nursing Skill, 1st
edition
(Abraham Alano, B.Sc.,M.P.H,HawassaUniversity)
www.google.com
www.slideshare.com

null.pptxytgfhgjuhygfyuhgfhgfjuytfytfyjhgfjhyfryujtfjytg

null.pptxytgfhgjuhygfyuhgfhgfjuytfytfyjhgfjhyfryujtfjytg

Recommended

Recommended

More Related Content

Similar to null.pptxytgfhgjuhygfyuhgfhgfjuytfytfyjhgfjhyfryujtfjytg

Similar to null.pptxytgfhgjuhygfyuhgfhgfjuytfytfyjhgfjhyfryujtfjytg (20)

Recently uploaded

Recently uploaded (20)

null.pptxytgfhgjuhygfyuhgfhgfjuytfytfyjhgfjhyfryujtfjytg