Health in its broadest sense is a dynamic state in which the
individual adapts to changes in internal and external
environments to maintain a state of well being.
The internal environment includes many factors that
influence health, including genetic and psychological
variables, intellectual and spiritual dimensions and disease
The external environment includes factors outside the person
that may influence health, including factors outside the
person that may influence health, including the physical
environment, social relationships, and economic variables
because both environments continuously change, the person
must to maintain a state of well being.
Health and illness therefore must be defined in terms of
individual. Health is also closely related to an individual‟s
work place and home life and stressors can be the result of
CONCEPT OF HEALTH
Health is considered by many as the opposite of illness
For some, it means well developed or adequately
nourished body, capable of various activities and able to
withstand physical stress.
All communities have their concepts of health integrated
as a part of their culture.
Widely differing culture groups share the concept of
health as a state of balance and harmony.
The WHO has defined as a “state of complete
physical, mental, social, spiritual well being and not
merely the absence of disease or infirmity”.
The concept of wholeness or completeness is
emphasized and health is seen as more than a physical
An individual‟s health is never static and is always in a
dynamic equilibrium with his environment.
Physical well being is measurable although it is varying
ranges and validity.
As regards mental well being, measurable standards
vary from culture and hence the criteria for mental well
being may differ from one country to another or from
place to place within the same country.
Social well being may be regarded as a state of
predisposing condition of health.
DIMENSIONS OF HEALTH
MULTIPLE FACTS OF HEALTH-WHO
Health a tridimensional state: “ Health is a state of
complete physical, mental and social well being and
not merely the absence of disease or infirmity”.
Health a fundamental right: “ The enjoyment of the
highest attainable standards of health is one of the
fundamental rights of every human being, without
distinction of race, religion, and political belief and
economic and social condition”.
Health for peace and security: “The health for all is
fundamental to the attainment of peace and security
and is dependent upon the fullest cooperation of
4. Health a government responsibility: Government has
a responsibility for the health of their people, which can
be fulfilled only by the provision of adequate health and
5. Health and health information: The extension to all
people of the benefits of medical, psychological and
related knowledge is essential to the fullest attainment of
6. Health and people cooperation : Informed opinion and
active cooperation on the part of the public, are of the
utmost importance in the improvement of health of the
7. Health and health care: Unequal development in
different countries in the promotion of health and control
of disease, especially communicable disease is a
8. Health and child development: Healthy development
of a child is of basic importance the ability to live
harmonically in changing total environment is essential
to such development.
9. Health gain for all: The achievement of any state in the
promotion and protection of health is of value to all.
MODEL OF HEALTH AND ILLNESS.
CONCEPT OF DISEASE
Disease can be considered as something more than mere
deviation from health, each disease being a distinct
entity, with distinguishing qualities in its pathologic
process, its typical clinical appearance and often its
characteristic epidemiologic pattern of distribution in
terms of time, place and person
The concept of disease also may vary from one society
to another society.
There will be no difficulty in distinguishing an illness
which severe enough to necessitate bed rest and
FACTORS AFFECTING HEALTH
CONCEPTS OF HEALTH, ILLNESS AND SICK
It is useful for the nurse to be aware of the behavioral
components of health, illness and sick role behavior
Every person develops a system of health beliefs and
attitudes and these tend to fall within the framework
provided by society or cultural heritage.
Health behavior activities a person engages in, when
feeling well, to take measures to prevent disease and
illness or to detect them before symptoms appear.
Illness behavior activities a person engages, when
feeling ill, that will lead to the defining of the state of
health and that will gain help.
Sick role behavior, activities a person engages in
believing himself ill.
Illness is not merely the presence of disease process.
It involves the ways persons monitor their bodies, definite
and interpret their symptoms, take remedial actions and use
their health care system.
The important internal values influencing the way clients
behave when they are ill. A client‟s illness behavior can also
be affected by the nature of the illness.
Acute illness involves symptoms of relatively short duration
that are usually severe and may affect functioning in any
Chronic illnesses persists, usually longer than 6 months, and
can affect functioning in any dimension.
External variables influencing a client‟s illness behavior
include the visibility of symptoms, social groups, cultural
background, economic variables, accessibility of the health
care system and social support.
STAGES OF ILLNESS BEHAVIOR
I. Symptom experience
1. During the initial stage , a person is aware that
something is wrong. A person usually recognizes a
physical sensation or a limitation but does not suspect
a specific diagnosis.
2. The person‟s perception of symptoms includes
awareness of a physical change such as pain, a rash or
II. Assumption of the sick role
1. The assumption of the sick role results in emotional
changes, such as withdrawal or depression and
2. Emotional changes may be simple or complex
depending on the severity of the illness, the degree of
disability and anticipated length of the illness.
III. Medical care contact
1. If symptoms persist despite home remedies, become
severe or require emergency care, the person is
motivated to seek professional health services.
2. In this stage the client seeks expect acknowledgement
of the illness, as well as treatment in addition, the
client seeks an explanation of the symptoms, the cause
of the symptoms, the course of the illness for future
3. Client‟s illness can be validated at any point on the
health illness continuum. A health professional may
determine that they do not have an illness or that
illnesses are present and may belief threatening.
IV. Dependent client role
1. After accepting the illness and seeking treatment, the client
enters the fourth stage of illness behavior.
2. The client depends on health care professionals for relief of
symptoms. The client accepts the care, sympathy and
protection from the demands and stresses of life.
3. It is socially permissible for clients in the dependent role to
be relieved of normal obligations and tasks.
V. Recovery stage
1. The final stage of illness behavior-recovery and
rehabilitation- can arrive suddenly, such as when a fever
2. The final stage is not prompt, long term care may be
required before the client is able to resume an optimal level
3. In the case of chronic illness, the final stage may involve an
adjustment to a prolonged reduction in health and
IMPACT OF ILLNESS OF FAMILY
I. Behavioral and emotional changes
1. People react differently to illness. Individual behavioral and
emotional reactions depend on the nature of the illness, the
client‟s attitude towards it, the reaction of others to it, and the
variables of illness behavior.
2. Severe illness, particularly one that is life threatening, can
lead to more extensive emotional and behavioral change such
as anxiety, shock, denial, anger and withdrawal.
II. Impact of family roles
1. When an illness occurs, the roles of client and family may
change. Such a change may be subtle and short term or
drastic and long term.
2. An individual and family generally adjust more easily to
short term changes in most cases .
3. Long term changes, require an adjustment process similar to
the grief process. The family and client often require
specific counseling and guidance to assist them in coping
with role changes.
III. Impact on body changes
1. Some illnesses result in changes in physical
appearance, and client‟s and families react differently
to these changes.
2. Withdrawal is an adaptive coping mechanism that can
assist the client in making the adjustments.
IV. Impact of self concepts
1. It is individual‟s mental image of themselves, including
how they view their strengths and weaknesses in all
aspects of their personalities.
2. Self concept depend on parts of body image and roles
but also include other aspects of the psychological and
3. Self concept changes because of illness may no longer
meet the expectations of the family, leading to tension
V. Impact of family dynamics
1. Family dynamics is the process by which the family
functions, make decisions, give support to individual
members and copes with everyday changes and
2. If a parent in a family becomes ill, family activities and
decision making often come to a habit as the other
family members wait for the illness to pass, or they
delay action because they are reluctant to assume the ill
person‟s roles or responsibilities.
HEALTH ILLNESS CONTINUUM
According to Neuman, health on a continuum is the degree
of client wellness that exist at any point in time ranging from
an optimal wellness condition, with available energy at its
maximum, to death, which represents total energy depletion.
According to health illness continuum model, health is a
dynamic state that continuously alters as a person adapts to
changes in the internal and external environments to maintain
a state of physical, emotional, intellectual, social,
developmental and spiritual well being.
The continuum is thought of a complex, dynamic process
that includes physical, psychological and social components.
There are adoptive and maladaptive behavioral responses to
internal and external stimuli.
Health and illness tend to merge but may represent
patterns of adoptive change along the continuum the
direction of change may be reversible, depending on the
quality of the individual‟s adoptive efforts.
The individual at the illness end of the continuum is
characterized by feeling of uncertainty, helplessness,
loss of control, loss of identity and incapacity for
As the patient is in the sick role, there is incapacity to
meet other social roles, the person has sought diagnosis
Less for along the illness end of the continuum, as
illness behavior are brought in to play, the person may
be tired, rundown and irritable with complaints of loss
of sleep, appetite, dependence, self absorption, minor
illnesses such as colds and infections.
Between illness and wellness there is the ambiguous
area where no symptoms are present and the person is
neither especially well nor especially ill.
At the health end of the continuum, as health behaviors
are utilized, the persons are not only unaware of disease
and with out pain, fatigue or somatic complications but
infections, industrious, vigorous and physically
agile, with a strong sense of identity and
autonomy, caring out usual social roles and needing no
The goal in preventive health care is to maintain
equilibrium between health and illness, with balance in
favor of maximum wellness for the individual.
HEALTH ILLNESS CONTINUUM
BODY DEFENSES :IMMUNITY &IMMUNIZATION
Immunity - Lasting resistance to infections
1. Active immunity – can be acquired in three ways
Following clinical infection eg. Chickenpox
Following subclinical infection eg. Polio
Following immunization with antigen
• Humroal immunity
comes from B cells which proliferate and manufacture
specific antibodies after antigen presentation by
• Cellular immunity
it is mediated by T cells which differentiate into
subpopulations able to help B lymphocytes. The T cells do
not secrete antibody but are responsible for recognition of
antigen.(activation of macrophages)
Combination of the above
In addition to the B &T lymphoid cells which are
responsible for recognizing self and non self, very often,
they operative with one another and with certain
accessory cells such as macrophages and human K cells
and their joint functions constitute the complex events of
It is superior to passive immunity
a) The duration of the protection
b) Severe reactions are rare
c) Protective efficacy of active immunization is high
d) Less expensive than passive immunization
2. Passive immunity
When antibodies produced in one body is transferred to
another to induce protection against diseases known as
By administer of an antibody- containing preparation
(immunoglobulins and antiserum)
By transfer of maternal antibodies through placenta
By transfer of lymphocytes- to induce passive cellular
Herd immunity : Level of resistance of a community
against particular diseases.
1. live – BCG,OPV,MMR
2. killed – cholera and rabies
3. toxoids- TT
• 1.human Ig-HBV,varicella
• 2. non human- Dt
Protecting the greatest number of people against some
HEALTH CARE SERVICES
it is the process of enabling people to increase control over and
to improve health.
(i). Health education
(ii) Environmental modification
(iii) Nutritional interventions
(iv) Life style and behavioral changes
Most cost effective intervention. The extension to all people of
the benefits of medical, psychological and related knowledge is
essential to the fullest attainment of health. The target groups
are general public, patients, priority groups, health
providers, community leaders and decision makers.
Environmental modifications : A comprehensive approach
of health promotion requires environmental modifications
such as safe water installation of sanitary latrines, control of
insects and rodents, improvement of housing etc.
Nutritional interventions : Comprise of food distribution,
nutritional improvement of vulnerable groups, child feeding
programmes, food fortification, nutrition education etc.
Life style and behavioral changes: It involves
organizational, political, social and economic interventions
designed to facilitate environmental and behavioral
adaptations that will improve and protect health.
To avoid disease altogether is the ideal but it is possible
only in a limited number of cases. The following are
currently available specific protection
Use of specific nutrients
Protection against occupational hazards
Protection against accidents
Avoidance of allergens‟
Control of consumer product quality and safety of
foods, drugs, cosmetics etc.
Health protection is defined as the provision of conditions
for normal mental and physical functioning of the human
being individually and in the group. It includes the
promotion of health, prevention of sickness and curative
and restorative medicines in all its aspects.
Diagnosis and treatment
Early detection and treatment are the main interventions
of disease control. The earlier the disease is diagnosed and
treated the better it is from the point of view of prognosis
and preventing the occurrence of further cases and long
Rehabilitation : It has been defined as the combined
and coordinated use of medical, social, educational and
vocational measures for training and retraining the
individual to the highest possible level of functional
ability. It includes all measures aimed at reducing the
impact on disabling and handicapping conditions and
enabling them to achieve social integration (active
participation in the main stream of community life)
a) Medical rehabilitation-restoration of function
b) Vocational rehabilitation- restoration of the capacity
to earn a livelihood
c) Social rehabilitation-restoration of family and social
d) Psychological rehabilitation- restoration of personal
dignity and confidence
The care for sick/ill healthy to continued throughout the
life after the period of rehabilitation also in all aspects of
physical, mental, social, spiritual to attain the maximum
HEALTH CARE TEAM
Definition : it is defined as a group of persons who
share a common health goal and common
objectives, determined by community need toward the
achievement of which each number of the team
contributes in accordance with her/his competence and
skills and respecting the functions of others.
The auxiliary is the essential member of the health team.
The team must have a leader. The leaders should be able
to evaluate the team adequately and should know the
motivation of each member in order to stimulate and
enhance their potentialities.
Aims : this aims to produce the right mix of health
personnel for providing full health coverage for entire
physician, asst.physician, nurse, dietician, pharmacist, p
hysiotherapist, radiologist, health assistants, lab
technician, social worker and chaplin etc.
technicians, health assistants, social workers, trained
dais, health educators, statistical analyzer etc.
It is important for each team member to have a specific
and recognized function in the team and to have freedom
to exercise his/her particular skills.
TYPES OF HEALTH CARE AGENCIES
The health care system is intended to deliver the health
care services. It constitutes the management sector and
involves organizational matters. It operates the context of
the socioeconomic and political frame work of the
In India there are 5 major health care sectors/agencies
which differ from each other by the health technology
applied by the source of the funds for operation
PUBLIC HEALTH SECTOR
a) primary health center
b) sub center
B) Hospitals/health centers
a) community health centers
c) District hospitals
d) Specialist hospitals
e) Teaching hospitals
C) Health insurance scheme
a) Employee state insurance
b) Central Govt. health scheme
D) Other agencies
a) Defense services
2. PRIVATE SECTORS
a) Private hospitals, polyclinics, nursing homes and
b) General practitioners and clinics.
3.INDIGENOUS SYSTEM OF MEDICINE
a) Ayurveda and siddha
b) Unani and tibbi
d) Unregistered practitioners.
4.VOLUNTARY HEALTH AGENCIES
Indian red cross society, Hind Kusht nivaran sangh etc
5.NATIONAL HEALTH PROGRAMMES
HOSPITALS : TYPES, ORGANISATIONS AND ITS
located, constructed, organized, staffed to supply
scientifically, efficiently and unhindered, all or any
recognized part of the complex requirements for the
prevention, diagnosis and the treatment of physical, mental
and medical aspects of social ills with functioning facilities
for training new workers in many special
profession, technical and economical fields, essential to the
discharge of its proper function and with adequate contacts
with physicians, other hospitals, medical schools and all
accredited health agencies engaged with better health
Hospital is an integral part of a social and medical
organization, the function which is to provide for the
population complete health care, both curative and
preventive and whose out patient services reach out to
the family and its home environment, the hospital is also
a center for the training of health worker and for
TYPES OF HOSPITALS
Length of stay of patient
chronic care hospitals
Acute care hospitals
(ii) Clinical basis
(iii) ownership/control basis
(iv) Classification based on objectives
(v) Based on size
(vi)Classification according to ministry
Union Govt / Govt of India
(vii)According to system
Hospitals of other systems of medicine
(i) Patient care – care of the sick and injured and
restoration of the health of a diseased person which
(ii) Diagnosis and treatment of disease
(iii) Out patient services
(iv) Medical education and training – provides
professional and technical education for many classes
of health personnel.
(v) Medical and nursing research – since because of
accumulation of different types of patients, the
hospital provides the basis for scientific investigation.
(vi) Prevention of disease and promotion of health – it
provides services to surrounding population that may
be preventive care and promoting their health.
HEALTH PROMOTION AND PREVENTION OF
Health promotion:- It is the process of enabling people
to increase control over and to improve health. This is
intended to strengthen the host through a variety of
(i) Health education
(ii) Environmental modifications
(iii) Nutritional interventions
(iv) Lifestyle and behavioral changes.
Primary prevention: Primary prevention can be
defined as “action taken prior to the onset of disease
which removes the possibility that a disease will ever
occur”. It is applied at the prepathogenic period; it
includes health promotion and specific protection.
a. Health promotion: The first level of prevention is by
promoting and maintaining the health of the host by
nutrition, health education, good heredity and other health
b. specific protection: It may be directed towards the
particles, materials, water, food, and other particles on the
assumption that the agent has escaped into these vehicles
2. Secondary prevention : It can be defined as “ action”
which halts the progress of a disease at its incipient stage
and prevents complications. The specific interventions are
early diagnosis and adequate treatment.
3. Tertiary prevention: It can be defined as “all measures
available to reduce or limit impairment and
disabilities, minimize suffering caused by existing
departures and disabilities, minimize suffering caused by
existing departures from good health and to promote the
patient‟s adjustments to irremediable conditions. It
includes disability limitation and rehabilitation.
PRIMARY HEALTH CARE
Primary health care is essential health care made
universally accessible to individuals and families in the
community, by means acceptable to them, through their
full participation and at a cost that the community and
country can afford. It forms an integral part both of the
country‟s health system of which it is the nucleus and the
overall social and economic development of the
PRIMARY HEALTH CARE SERVICES
child health care
PRINCIPLES OF PRIMARY HEALTH CARE
Coverage and accessibility
Appropriate health technology
Logistics of supply
The physical facilities
Control and evaluation
Role of nurse in primary health care
UNIT II - NURSING AS A PROFESSION
Nursing in today‟s world is completely different from
the nursing practiced in the past.
It is expected to change drastically in the present and in
Nursing has changed dramatically in response to the
societal needs and influences.
All through the years nurses and nursing struggled to
prove it as science, acquire autonomy and
professionalization and at last in many parts of the world
it is considered as a science, as a profession with gaining
autonomy in specified areas.
THE LIBERAL MEANING OF THE WORD
N- NOBILITY, KNOWLEDGE
U – UNDERSTANDING,
R – Responsibility
S- SIMPLICITY, SYMPATHY
E –Efficiency, equanimity
ESSENTIAL QUALITIES OF A NURSE
Discipline and obedience
Tact, sympathy, sense of humor and patience
Observation and adaptability
Gentleness and quietness
Sense of responsibility
DEFINITIONS OF NURSING
INTERNATIONAL COUNCIL OF NURSING (ICN) 1973
Nursing is to assist the individual(sick or well) in the
performance of those activities contributing to health, its
recovery (or to a 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.
• AMERICAN NURSES ASSOCIATION
Nursing is the protection, promotion and optimization of
health abilities; prevention of illness and injury; alleviation of
suffering through the diagnosis and treatment of human
responses; and advocacy in health care for individuals,
families, communities and populations.
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.
The act of utilizing the environment of the patient to
assist him in his recovery.
CANADIAN NURSES ASSOCIATION 1987
Nursing practice as a dynamic, caring and helping
relationship in which the nurse assists the client to
achieve and obtain optimal health.
BASIC NURSING PRINCIPLES
It is the protection to hazards to patients and members of
mechanical, chemical, thermal, bacteriological and
It is the result of the work, that is whether the purpose of
the procedure is fully achieved or out.
Every nursing procedure is aimed for the comfort of the
patient. It should give the satisfaction to the
patient, relatives and nurse on completion of the work.
USE OF RESOURCES
The use of time energy and material should be economic. A
procedure should not be cancelled due to the want of one or two
items required if they are not extremely essential. In such
situations adjustment can be done by improving materials with
the available resources.
• GOOD WORKMANSHIP
It is the skill in doing the procedure. There is great difference in
doing things by a fresh hand and an experienced hand. Nursing
is learning by doing not merely by reading.
The likes and dislikes are different persons. So when we are
planning nursing care to a person, his needs are to be anticipated
and problems are to be identified and feelings are to be
CONCEPTS OF NURSING
o Concepts are basically vehicles of thought that involves
o Concepts are words that describe objects, properties, or
events and are basic components of theory.
o Nursing refers to the process of caring for the health of
human beings and assisting individuals in meeting their needs
while also teaching them the basics of caring for themselves.
o The responsibilities of the nursing profession are to promote
good health, to prevent illness when possible, to promote
healing in those who are ill and to ease the suffering of dying
o The concept of nursing extends beyond the health care
facility to the community and society as a whole, and views
individual health and the environment as closely related.
o Nursing is defined as care that is tailored to the needs of
individuals and that is provided in an efficient and effective
CONCEPTS OF NURSING
health care systems
Nursing : caring in the human health
SCOPE OF NURSING
Nurses provide care for 3 types of clients. They are
The scope of nursing practice involves 4 areas. They are
1. Promoting health and wellness:
Wellness is a process of enhancing the quality of life and
improve personal potential. Nurses promote wellness in
clients who are both well and ill. This may include
activities like enhancing healthy lifestyles, improving
nutrition and physical fitness, preventing drug or alcohol
2. Preventing illness
The goal of illness prevention is to maintain optimal health by
preventing disease. This may include nursing activities like
immunizations, prenatal and infant care, prevention of sexually
3. Restoring health
It focuses on the client, and it extends from early detection of
disease through helping the client during the recovery period.
This includes providing direct care to the ill person, performing
diagnostic and assessment procedures, consulting with other
health care professionals about client problems, teaching clients
and rehabilitating clients.
4. Caring for the dying
This area of nursing involves comforting and caring for people
of all ages who are dying. The ultimate concept is to undergo a
painless and peaceful death in case of terminally ill clients and
also be treated with human dignity
NURSING AS A PROFESSION
Profession has been defined as that requires extensive
education or a calling that requires special knowledge, skill
Profession is an occupation with moral principles that are
devoted to the human and social welfare.
Professional nursing is a service devoted to the promotion of
human and social welfare.
Professionalization is the process of becoming professional
that is of acquiring characteristics considered to be
Professional nurse is a health worker, a graduate from a
recognized school who is identified by law as a registered
nurse whether graduated from a B.Sc or a diploma program.
Criteria for profession: specialized education is an
important aspect of professional status.
Body of knowledge: As a profession, nursing is
establishing a well defined body of knowledge and
expertise. A number of nursing conceptual frameworks
contribute to the knowledge base of nursing and give
direction to nursing practice, education and ongoing
Service orientation: nursing as a tradition of service to
others. This service, however, must be guided by certain
rules, policies or codes of ethics.
Ongoing research: since the 1960‟s nursing research
has focused on practice related issues.
Code of ethics: ethical code change as the needs and
values of society change
Autonomy: A profession is autonomous, if it regulates
itself and sets standards for its members.
CHARACTERISTICS OF A PROFESSIONAL NURSE
Good physical and mental health
Truthful and efficient in technical competence
Cleanliness, tidy, neat and well groomed
Confidence in others and itself
Open minded, cooperative, responsible able to develop good interpersonal
Self-belief towards human care and cure
Convey cooperative attitudes towards co-worker.
Responsible towards family and society
Be gentle and polite in your talk
Greet your seniors, co-workers, your patient
Keep your dress neat and tidy
Help the seniors to carry a heavy load if you find them on the way
Be punctual always
Keep eye contact and sit face-to-face when listening to some one.
Knock at the door and wait for the answer before you enter into other’s room
Excuse yourself before you interfere with others engaged in talking or doing some work.
You should not give and receive any gifts or present especially from the patients and their relatives.
Criteria of a profession
According to Wickenden
Renders a specialized service based upon advanced
specialized knowledge and skill and dealing with its problems
primarily on an intellectual plane rather than on a physical or
a manual labor plane.
Involves a confidential relationship.
Is charged with a substantial degree of public obligation
Enjoys a common heritage of knowledge, skill, and status.
Performs its services to a substantial degree in the general
Is bound by a distinctive ethical code in its relationships with
clients, colleagues and the public.
According to Flexner
Uses a specialized body of knowledge on the level of higher
learning in its practice.(intellectual)
Constantly enlarges its body of knowledge and improves its
service through scientific methods.(scientific)
Educate its practitioners in institutes if higher
education(requires higher education)
Offers services which are vital to human and social
Makes its own policies and controls its own activities(selfgoverning)
Attracts those who put service above personal gain and accept
their occupation as their life work.(altruism or service
Strives to provide freedom of action, opportunity for
continuous professional growth and economic security.
Nursing as a profession
The study of the fundamental nature of
knowledge, reality and existence esp when considered as
an academic discipline.
A set of views and theories of a particular philosopher
concerning such study or an aspect of it.
PHILOSOPHY OF NURSING
Philosophy of nursing states our thoughts on what we
believe to be true about the nature of the profession of
nursing and provide a basis for nursing activities. It
endorses ethical values we hold as basic and bases our
beliefs in theory.
learning, accountability for their practice and
participation in interdisciplinary activities.
The statement of philosophy is defined as an explanation
of the systems of beliefs that determine how a mission
or a purpose is to be achieved.
NURSING SERVICE PHILOSOPHY
The nursing service philosophy is a statement of beliefs
that flows from and is congruent with the institution‟s
philosophy. The belief system of the nursing philosophy
should reflect the nursing division member‟s ideas and
ideals for nursing and should be endorsed by others.
COMPONENTS OF NURSING SERVICE
1.Nursing /nursing practice
Nursing is a health care service mandated by society, the
practice of nursing stems from the beliefs and ideals of the
nursing service department.
In the first area, nursing theory, the task of the nurse manager
is to decide whether and how to incorporate theory. Three
different methods may be considered.
One method is to use an eclectic approach, selecting ideas
and constructs from various nursing theories and
incorporating these in to philosophy.
ii. A second method is to use one theory throughout the
iii. A third approach is to adopt a theory, then attach the entire
document describing the theory to the philosophy and refer
to the theory at appropriate places in the philosophy.
second set of values related to nursing/nursing
practice center around practice, education and research.
The patient is the main reason for the institutions‟
existence, examine patient‟s rights.
Beliefs concerning patients rights will be influenced in
part by institutional policies and practices.
Nurses are essential in the day-to-day operations of the
They are the providers of nursing acts which result in
To keep the organization smoothly, it is necessary to
address values related to and beliefs about nurses.
PHILOSOPHY OF NURSING EDUCATION
Philosophy of nursing education is the written statement of
the believes, values, attitudes and ideas which the faculty as a
group agreed upon in relation to the nursing educational
programme such as health, disease, nursing, nurse, nursing
profession, education, learner, society, patient, nursing
education and preparation of nurses.
Philosophy of nursing education is a perfect combination of
nursing and philosophy of education, more precisely,
philosophy of nursing and philosophy of education is the
application of the fundamental belief of nursing and
education in the field of nursing.
The objectives formulated with a philosophical basis of
education focus on the student life and the all round
FACTORS INFLUENCING PHILOSOPHY OF
The philosophical values and beliefs of the institution
The environment where the education takes place
The student and activities
Health needs of the society
The culture and background of the people
Developments in nursing, medicine and allied fields.
Philosophy of nursing service administration
The goals and objectives of the health care delivery system
The disease pattern, the health awareness and health facilities
The available resources in terms of man, money and
Objectives are the ends toward which activity is aimedthey are the end results toward which activity is aimed.
Objectives are goals, aims, or purposes that
organizations wish over varying periods of timeMcFarland
CHARACTERISTICS OF OBJECTIVES
Specific: clear about what, where, when, and how the
situation will be changed.
Measurable: able to quantify the targets and benefits.
Achievable: able to attain the objectives.
Realistic : able to obtain the level of change reflected in
Time bound: stating the time period in which they will
each be accomplished.
Each organization or group of individuals have some
Objectives may be broad or they may be specifically
Objectives may be clearly defined.
Objectives have hierarchy.
Organizational objectives have social sanction, that is,
they are created within the social norms.
An organization may have multiple objectives
Organizational objectives can be changed.
OBJECTIVES OF NURSING
Examples of objectives in nursing
The department of nursing will;
Provide quality nursing services to our patients by
preventing illness, promoting and restoring their health.
Provide individualized holistic patient care utilizing the
Establish effective communication, cooperation and
coordination with all health professionals and
administrative services involved in the planning and
delivery of patient care.
Foster a positive work atmosphere based on team spirit
and trust among nursing staff and members of the health
team to ensure job satisfaction.
Maintain standards of professional practice among
nurses by implementing a continuous in-service training
Assess and evaluate our quality of nursing care on an on
going basis through quality improvement and nursing
Initiate and carry out research, surveys, studies
etc., aimed at improving quality of patient care
Participate in the teaching learning experience of
students by providing guidance and assistance in the use
of hospital resources.
Develop staff readiness and efficiency to respond
promptly in disaster and war situations.
CHARACTERISTICS OF NURSING
Qualities of nurses
Attention to detail
Problem solving skills
ROLE OF A NURSE/FUNCTIONS OF A NURSE
Care giver/care provider
The traditional and most essential role
Functions as nurture, comforter, provider
Mothering actions of the nurse
Provides direct care promotes comfort of client
Activities involves knowledge and sensitivity to what
matters and what is important to clients
Shows concern for client welfare and acceptance of the
client as a person
Provides information and helps the client to learn or
acquire new knowledge and technical skills encourages
compliance with prescribed therapy.
Promotes healthy lifestyle
Interprets information to the client.
Helps client to recognize and cope with stressful
psychological or social problems
To develop and improve interpersonal relationships and
to promote personal growth.
Focuses on helping a client to develop new
attitudes, feelings and behaviors rather than promoting
• Change agent
Initiate changes or assist clients to make modifications
in themselves or in the system of care.
• Client advocate
Promotes what is best for the client, ensuring that the
client‟s needs are met and protecting the client‟s rights.
Provides explanation in clients language and support
give direction, develop staff, monitors
operations, give the rewards fairly and represents both
staff and administrations as needed.
Participates in scientific investigation and must be a
consumer of research findings.
Must be aware of the research process, language of
research, a sensitive to issues related to protecting the
rights of human subjects.
EXPANDED ROLE OF THE NURSE
Clinical specialistsA nurse who has completed a master‟s degree in specialty
and has considerable clinical expertise in that specialty.
She provides care to individuals, participates in educating
health care professionals and ancillary, acts as a clinical
consultant and participates in research.
Nurse practitionerA nurse who has completed either as certificate program or
a master‟s degree in a specialty and is also certified by the
appropriate specialty organization.
She is skilled at making nursing assessments, performing
P.E, counselling, teaching and treating minor and self
3. Nurse midwife- a nurse who completed a program in
midwifery, provides prenatal and postnatal care and
delivers babies to woman with uncomplicated pregnancies.
4. Nurse anesthetist- a nurse who completed the course of
study in an anesthesia school and carries out pre operative
status of clients.
5. Nurse educator- a nurse usually with advanced degree,
who beaches in clinical or educational settings, teaches
theoretical knowledge, clinical skills and conduct research.
6. Nurse entrepreneur- a nurse who has an advanced
degree, and manages health related business.
Nurse administrator-a nurse who functions at various
levels of management in health settings; responsible for
the management and administration of resources and
personnel involved in giving patient care.
CATEGORIES OF NURSING PERSONNEL
SECTOR HEALTH NURSE
MPHW OR VILLAGE
ETHICAL ISSUES IN NURSING
• Ethics are the rules or principles that govern right contact.
• Ethics are designed to protect the rights of human being.
• Ethics are characteristics of a healthy profession.
o The nursing ethics provide professional standards for nursing
activities which protect the nurse and the patient.
o In 1973, the ICN adopted code of ethics.
o The fundamental responsibility of the nurse is four fold-to
promote health, to prevent illness, to restore health and to
o Nurses render health services to the individual, the family and
the community and coordinate their services with those of
CODE OF ETHICS
Nurses and people:
The nurses primary responsibility is to those people who require
nursing care. The nurse holds in confidence personal
information‟s and use judgment in sharing this information.
Nurses and practice:
The nurse maintains the highest standards of nursing care
possible within the reality of a specific situation. The nurse
when acting in a professional capacity should at all times
maintain standards of personal conduct which credit upon the
Nurses and society:
The nurse shares with other citizens the responsibility for
initiating and supporting action to meet the health and social
needs of the public.
Nurses and co workers:
The nurse maintains a cooperative relationship with coworkers in nursing and other fields. The nurse takes
appropriate action to safeguard the individual when his
care is endangered by a co-worker or any other person.
Nurses and profession :
The nurse acting through the professional organization
participates in establishing and maintaining equitable
social and economic working conditions in nursing.
Ethical principles are defined as basis for nurse‟s decisions on
consideration of consequences and of universal moral principles
when making clinical judgments.
The primary and basic principles are
Respect for persons
Respect for autonomy
The secondary principles are
Respect for persons
According to ANA, the most fundamental principle of
professional behavior is the respect for persons.
This principle not only applies to the clinical settings but to
all life‟s situations.
This principle emphasizes that all people should treat others
as a worthy individual.
In nursing practice this principle should be simplified.
Thus, respect for persons generally means respecting a
Respect for autonomy
o Respecting a client‟s rights, values and choices is
synonymous to respecting a person‟s autonomy.
o Informed consent is a method that promotes and respects a
o For a client to make an autonomous decision and action, he or
she must be offered enough information's and options to
make up his or her mind free of coercion or external and
It means duty to do no harm.
Avoiding deliberate harm, risk of harm that occurs during the
performance of nursing actions.
Considering the degree of risk permissible
Determining whether the use of technological advances provides
benefits that outweigh risks.
It is doing or active promotion of good
Providing health benefits to the clients
Balancing the benefits and risks of harm
Considering how a client can be best helped.
It is the promotion of equity or fairness in every situation a nurse
Ensuring fair allocation of resources
Determining the order in which clients should be treated.
Secondary principles for ethical
Veracity – duty to tell
duty to respect
Fidelity – duty to
Values are freely chosen, enduring beliefs or attitudes
about the worth of a person, object, idea or action.
Freedom, courage, family and dignity are examples of
Values frequently derive from a person‟s cultural, ethnic
and religious background; from societal traditions; and
from the values held by peer group and family.
Values form a basis for behavior.
Once a person becomes aware of his/her values, those
values become an internal control for behavior; thus a
person‟s real values are manifested in consistent patterns
Values exist within a person and affect the person‟s relationship to
A value system is the organization of a person‟s values along a
continuum, that is from most important to least important.
Values form the basis of purposive behavior, which refers to actions
that a person performs "on purpose”, with the intention of reaching
some goal or bringing about a certain result.
Thus, purposive behavior is based on a person‟s decisions or
choices, and these decisions or choices are based on the person‟s
Values are that which we seek to achieve or maintain according to
our life as the standard of evaluation.
Values are the motive power behind purposeful action.
They are the ends to which we act. Without them, life would be
Life requires self generated action to sustain itself. Without values,
one could not act, and death would follow.
Values specifies a relationship between a person and a goal.
A value requires a valuer-a particular person who aims to
achieve or maintain something.
An object cannot have value in itself.
Value is relational, and so requires a person and a goal.
The goal to which one aims is called the value, but the
relationship is always required. This means an object cannot
be a value in itself.
Values are essential to ethics. Ethics are concerned with
human actions, and the choice of those actions.
Ethics evaluates those actions, and the values that underlie
It determines which values should be pursued, and which
Ethics is a code of values.
o Values clarification is a process by which people
identify, examine, and develop their own individual
o A principle of values clarification is that no, one set of
values is right for everyone.
o When people are able to identify their values, they can
retain or change them and thus act on the basis of freely
chosen rather than unconscious values.
o Values clarification promotes personal growth by
fostering awareness, empathy and insight.
o A widely used theory of values clarification was
developed in1966 by Raths, Harmin andSimon. This
valuing process includes cognitive, affective and
behavioral components, referred to as choosing, prizing
TYPES OF VALUES
There are 3 types of values. They are
A. Terminal values
B. Instrumental values
C. Professional values.
Family security (defined as taking care of loved ones).
ii. Happiness (defined as contentedness, freedom from
iii. A sense of accomplishment(defined as a feeling of
Honesty (defined as sincere, truthfulness)
ii. Responsible (defined as dependable and reliable)
iii. Intellectual (defined as intelligent and reflective)
Human dignity ( defined as awareness of a patient‟s
beliefs and values and to honor them)
ii. Equality (defined as the right to be treated equally
iii. Prevention of suffering( defined as freedom from pain
VALUES IN NURSING
Concern for the welfare of others “Equality”. „Having
the same rights, privileges or status‟. Nurses promote and
uphold the provision of quality nursing care for all people.
Qualities of objects, events and persons that provide
satisfaction. Nurses value the promotion of an
ecological, social and economic environment which
supports and sustains health and well being. Nurses respect
the rights of persons to make informed choices in relation
to their care.
Inherent worth and uniqueness of an individual. Nurses
respect person‟s individual needs, values and culture in the
provision of nursing care.
Upholding moral and legal principles. Nurses promote
and uphold the provision of quality nursing care for all
people and nurses hold in confidence any information
obtained in a professional capacity and use professional
judgment in sharing such information.
Faithfulness to fact or reality. Nurses respect the
accountability and responsibility inherent in their roles.
Act of arguing on behalf of a particular issue, idea or person;
pleading, supporting a cause.
A process of actions intended to bring about change in
of individuals, groups, institutions and
Ability to influence, transforms, mobilize and allocate
resources we do this every day.
Organized efforts and actions based on what is to make what
should be reality.
NEED FOR ADVOCACY
Empowerment to assist in being at the table
Educate others about patient care issues
Ultimate goal of positively impacting patient care
Doing the right thing for your patient
They are respected, needs met, have a voice when most vulnerable.
Speaking out to assure adequate resources available to perform job.
SITUATIONS FOR ADVOCACY
Patient safety issues
Patient acuity/staffing issues
Healthy work environment
Called to advocacy
NURSES TIP FOR ADVOCACY
Emphasis on partnering with / caring for patients/
Collaborate with other health care professionals to
promote community, national and international efforts.
Commit to continuous learning through education, skill
development, evidence base practice
Trusted, impeccable character, inspirational and
compassionate; held to higher standard.
BARRIERS OF ADVOCACY
Feelings of inadequacy;
knowledge, education, tools, strategy
Lack of time on part of advocates.