SPLBE REVIEW PNA

BAHRAIN
FUNDAMENTALS OF NURSING

Gilbert T. Salacup RN, MSN

FLORENCE NIGHTINGALE
Birthplace. Italy

Training ground: Germany

Greatest contribution: environmental

theory & training of RNs in Crimean War

School: St. Thomas School of Nursing

NURSING THEORY
FLORENCE NIGHTINGALE
Environmental Model

SiFlorence Mahilig sa environment

kaya ang theory nya ay.
Environmental Model
 HILDEGARD PEPLAU
 SiHildegard Peplau ang kanyang trabaho ay gard anung
ginagarddan nya (NPR) Nurse Patient Relationship, ang
tawag kc natin dyan ay (Interpersonal Relations in
Nursing)
They identified the roles of the nurse as:
 Stranger

 Resource person

 Teacher

 Leader,

 Surrogate

 Counselor.
 VIRGINIA HENDERSON
Si Virginia Henderson ay nadisvirgin siya
nuong 14 years old siya, kc sabi nya Basic
Needs ito eh. Kaya ngaun ang theory nya
ay 14 Basic Needs of Clients.

14 Basic Needs of Clients - Depending on the
condition of the patient, the nurse has to assist the
patient to regain the ability to perform these basic
needs.
Henderson, 1966. The 14 basic client needs are:
1. Breathe normally.
2. Eat and drink adequately.
3. Eliminate body wastes.
4. Move and maintain desirable postures.
5. Sleep and rest.
6. Select suitable clothes-dress and undress.
7. Maintain body temperature within normal range by adjusting clothing and
modifying environment
8. Keep the body clean and well groomed and protect the integument
9. Avoid dangers in the environment and avoid injuring others.
10. Communicate with others in expressing emotions, needs, fears, or opinions.
11. Worship according to one’s faith.
12. Work in such a way that there is a sense of accomplishment.
13. Play or participate in various forms of recreation.
14. Learn, discover, or satisfy the curiosity that leads to normal development and
health and use the available health facilities.
 LYDIA HALL
 Si (Lydia Hall) kc – My 3L sa pangalan nya ngaun naisip nya na
dapat ang theory ko ay my 3C – ito na ung Care-Core-Cure
Model
 Hall enumerated three aspects of the person as patient: the person
(care), the body (core), and the disease (cure).
 CARE

 bodily care (e.g., bathing, feeding, toileting, positioning, moving,

dressing, undressing, and maintaining a healthful environment).
 CORE
 This area emphasizes the social, emotional, spiritual, and
intellectual needs of the patient in relation to family, institution,
community, and the world (Hall, 1955, 1958, 1965).
 CURE
 The nurse may assume medical functions, or help the patient with
these through comforting and nurturing.
 ERNESTINE WEIDENBACH
Si Ernestine Weidenbach may sakit, ang sakit nya ay magugulatin
at ng gugulat kc pag Binangit mo ang name name nya Dapat ay
Weydenbaaah! Kaya sabi nya para gumaling ang sakit dpat my
Prescription kaya ang theory nya Prescriptive Theory
 Prescriptive Theory

 IN SHORT: The primary motivation of the nurse is to care;

 The nurse’s central purpose in nursing. It constitutes the nurse’s

professional commitment.
 The prescription. It indicates the broad general action that the
nurse deems appropriate to fulfillment of her central purpose.
 The realities. They are the aspects of the immediate situations that
influence the results the nurse achieves through what she does
(Wiedenbach, 1970, p. 3).
 DOROTHEA OREM
 Si Dorothea Orem ay mahilig kumanta, ng _______ Habang
ng lilinis sya ng kanyang katawan. Kaya ang nagging Theory
nya ay Theory of Self-Care.
Theory of Self-Care: Self-care is an activity done by the patient.
When the patient is unable to perform this task, the nurse takes
over.
Three categories of self-care requisites:
 Universal self-care requisites are common to all human beings
and include both physiological and social interaction needs.
 Developmental self-care requisites are the
needs that arise as the individual grows and develops.
 Health-deviation self-care requisites result from the needs
produced by disease or illness states.
 DOROTHY JOHNSON
 Si
(Dorothy Johnson) nung nagaaral palang
sya Behave sya kaya ginawa nya ang
Behavioral System Model.

 The patient exists as a behavioral system which

interacts with the environment and its systems
(e.g. interpersonal, cultural, physical).
 FAYE GLENN ABDELLAH
Ay nako Problema nmn ito Si Faye Glenn
Abdellah ang pinaka problemadong
Theorist kaya nagawa ang 21 Nursing
problem areas.
21 Nursing Problem Areas
IN SHORT: An expansion of the 14 Needs
of the Patient.
 MYRA ESTRIN LEVINE
Si (Myra Estrin Levine) hilig nya ang pagconserve or
preserve, sa pangalan nyang MYRA may 4 na letra kay
naisip nya bakit di kaya ako gumawa ng 4 na principles of
conservation.
 Four Principles of Conservation : The patient is considered as a holistic human being and in caring
for one,.
1. Conservation of Energy: “The individual requires a balance of energy and a
constant renewal of energy to maintain life activities” (Levine, 1990, p. 197).
2. Conservation of Structural Integrity: “Structural integrity is concerned with the
processes of healing . . . to restore wholeness and continuity after injury or illness”
(Levine, 1989, p. 333).
3. Conservation of Personal Integrity: “Everyone seeks to defend his or her identity
as a self, in both that hidden, intensely private person that dwells within and in the
public faces assumed as individuals move through their relationships with others”
(Levine, 1989, p. 334).
4. Conservation of Social Integrity: “No diagnosis should be made that does not
include the other persons whose lives are entwined with that of the individual” (Levine, 1989,
p. 336).
 IMOGENE KING
 Si Imogene ang favorite song nya ay ang Kantang Imogene.
Lets sing(Imagine there's no heaven, It's easy if you try,
Imagine all the people Living for today.. I hope someday
you'll join us and the world will be as one.) Bakit nya
kinakanta ito? Kc Goal Met sya sa buhay nya – sabi nya Ah
Goal-Attainment.
 Goal-Attainment Theory

 Summary : Achieving a favorable outcome equates to effective

nursing care.
 The goal of nursing care is to help individuals maintain health or
regain health (King, 1990). Goal attainment represents
outcomes. Outcomes indicate effective nursing care. Nursing
care is a critical element to provide quality care that is also cost-
effective.
MARTHA ROGERS
 Si (Martha Rogers) Pinsan nya pala si Kenny Rogers
Ng tinanung Si Keny rogers ng pinsan nyang si
Martha Rogers what is the secret of your success
ang sagot nya ay….. its all about Science of Unitary
Human Being
 Science of Unitary Human Being
 Summuary: Nursing is an art! It is in the nurse's creativity to use
her knowledge to best bring back the health of the patient.
 Si (Martha Rogers) Pinsan nya pala si Kenny Rogers

 "Nursing is a learned profession: a science and an art. A science is

an organized body of abstract knowledge. The art involved in
nursing is the creative use of science for human betterment”
(Rogers, 1990, p. 198).
SISTER CALLISTA ROY
 Si (Sister Callista Roy) ang trabaho nya pala dati ay Tga
LISTA, Pero ang lagging nililista nya ay Adaptive System/
Adaptation Model.
Adaptation Model
 Summary: The nurse assists the patient in adapting to the patient's
new situation (diseased state).
 A person is “an adaptive system . . . a whole comprised of parts that
function as a unity for some purpose. The world around and within
(the person as an adaptive system) is called the environment and
includes all conditions, circumstances, and influences that surround
and affect the development and behavior of the person” (Andrews
& Roy, 1991, p. 4, 18).
 JEAN WATSON
 Si Jean Watson Siya pala ang may ari ng Watson
dept. store sa SM, anu ba ang meron sa loob ng store
na ito For Caring of your body – ang tawag dito ay
Transpersonal Caring.
 Theory of Transpersonal Caring

 IN SHORT: The patient is a holistic human being made

up of the mind, body, and soul .
 Caring is the essence of nursing and the most central and
unifying focus of nursing practice. The goal of nursing
“is to help persons gain a higher degree of harmony with
the mind, body, and soul.”
MADELEINE LEININGER
Si(Madeleine Leininger) Mahilig syang
magluto, sa kultura nila my lagging sahog
na GINGER ang luto nila, kc nasa
kultura nila ito. Kaya ang theory ay
Transcultural Nursing..
 Transcultural Nursing
 IN SHORT: Nursing transcends culture; in that,
there are certain unique aspects of care that each
culture can relate to.
 ROSEMARIE RIZZO PARSE
 Si(Rosemarie Rizzo Parse) sya lang ang theorist na
walang Kwento, basta Sabi nya ay Change and
Become Human, Sakanya ang human becoming.
 Theory of Human Becoming
 Summary: Health is in constant change and nurses must help the
patient be prepared for that change.
 Health is a “constantly changing process of becoming that
incorporates values. Because it is not a state, health cannot be
contrasted with disease.” Parse (1987, p. 169) states that “the
practice of nursing . . . is a subject-to-subject interrelationship, a
loving, true presence with the other to promote health and quality
of life.”
BETTY NEUMAN
 Ngayon Narinig Ni Betty and sabi ni Parse, Sabi nya nakaka
sakit at Stress ka Human Becoming. Alam mo kung
nagkakasakit ka dapat Piliiin mo and pupuntahan mo Kung
Primary, Secondary, tertiaty. Ang tawag mo dito ay Health
Care System Model
 Health Care System Model

 Summary: Disease and illness is a stressor and the nurse

provides interventions to relieve this stress.
 This model of nursing focuses attention on the response of the
client system to actual or potential environmental stressors, and
the use of primary, secondary, and tertiary nursing prevention
interventions for retention, attainment, and maintenance of
optimal client system wellness. (Betty Neuman, 1996)
 JOYCE TRAVELBEE
 Si (Joyce Travelbee) niloloko nilang Pinsan nya si Jolibee kasi
Magkasing laki sila ng shoes ni jollibee. Sabi ni Joyce you should
feel Sympathy, empathy, and rapport. Ito ang Sinasabi ni Betty
neuman at Human Becoming Parse na human-to-human
relationship. At tinawag nya itong Interpersonal Aspects of
Nursing.
 Interpersonal Aspects of Nursing

 IN SHORT: The nurse puts his/herself in the patient's shoes to

understand better how to care for the patient.
 Sympathy, empathy, and rapport help the nurse to comprehend and
relate to the uniqueness of others. Travelbee stressed on the
human-to-human relationship and on finding meaning in
experiences such as pain, illness, and distress.
NURSING
PROCESS
“the cornerstone of
the nursing
profession"
 SYSTEMATIC
S
ORGANIZED
O

G–O GOAL – ORIENTED

EFFICIENT – EFFECTIVE
EF – EF

HU - CARE HUMANISTIC CARE

 PHASES OF THE NURSING
PROCESS
A - ssessment S –ubjective
A - ssessment
D- iagnosis O - bjective
D- iagnosis A – ssessment date
O - utcome Identification
P- lanning P- lanning
P- lanning
I - mplementation I - mplementation
I - mplementation
E - valuation E – valuation
E - valuation
R - evision
S –ubjective F – ocus
O - bjective D - ata
A – nalysis A – ction
P- lanning R - esponse
I - mplementation
E – valuation
 ASSESSMENT
1. C - OLLECT DATA
2. V -ALIDATE DATA
3. O - RGANIZE DATA
4. R - ECORDING DATA

Assessment involves reorganizing and

collecting CUES:
Objective Data
Subjective Data
 COMMUNICATION
 A process in which people affect one another through exchange
of information, ideas, and feelings.

COMPONENTS OF COMMUNICATION

Message
MODES OF COMMUNICATION
Verbal Communication
- Uses spoken or written words.

Non-verbal Communication
- Uses gestures, facial expression, posture/gait, body movements,
physical appearance (also body language), eye contact, tone of
voice.
PURPOSES OF CLIENT’S RECORD /CHART
1. C - ommunication
2. L - egal Documentation
3. E - ducation
4. A - udit and Quality Assurance
5. R - esearch
6. S - tatistics
7. P - lanning Client Care
8. R - eimbursement
 TYPES OF RECORDS
A. Source Oriented Medical Record
“traditional client record”
FIVE BASIC COMPONENTS:
1. Admission sheet
2. Physician’s order sheet
3. Medical history
4. Nurse’s notes
5. Special records and reports
B. Problem-oriented medical record (POMR)
- arranged according to the source of information.

FOUR BASIC COMPONENTS:

1. Database
2. Problem list
3. Initial list f orders or care plans
4. Progress notes:
 Nurse’s notes
 (SOAPIE)
 Flow sheets
 Discharge notes or referral summaries
 KARDEX
 Concise method of organizing
and recording data.
 Readily accessible to health
care team.
 Series of Flip cards

 Ensure continuity of care

 Tool for change of shift report

 For planning &

communication purposes.
 PARTS OF A KARDEX
 Personal Data
 Basic needs
 Allergies
 Diagnostic tests
 Daily Nursing Procedures
 Medications and IV therapy, BT.
 Treatments like O2, steam inhalation, suctioning, change of
dressings, mechanical ventilation.
 PAIN AND COMFORT
Definitions of PAIN - is an unpleasant sensory and emotional
experience associated with actual or potential tissue damage. 
- It is sometimes referred to as the FIFTH vital sign.
 In many aspects, pain is the most common reason for seeking
health care 
 - is a subjective sensation to which people respond in different
ways.
 - Pain indicate that the stimulus is causing damage or injury to the
tissues 
CATEGORY OF PAIN ACCORDING TO ITS ORIGIN
 Cutaneous pain—originates in the skin or subcutaneous tissue.
 Deep somatic pain—arises from ligaments, tendons, bones, blood vessels, and nerves

 Visceral Pain—results from stimulation of pain receptors in the abdominal cavity,

cranium and thorax. 

Category of pain according to its ONSET

 Acute pain—following acute injury, disease or some type of surgery, sudden or slow
onset, varies from mild to severe.
 some may last up to 6 months
 Impulses usually travel through the type A delta fibers and this pain is easily localized. 

 Chronic malignant pain—associated with cancer or other progressive disorder.

 Chronic nonmalignant pain—in the persons whose tissue injury is non progressive
or healed 
 Chronic Pain last 6 months or longer and often limits normal functioning.

 It is sometimes called dull pain, slow pain and delayed pain. Impulses travel in the
type C fibers and are not easily localized. 
CHRONIC PAIN CANCER-RELATED PAIN
 Radiating pain—perceived at the source of the pain and extends to
the nearby tissues
 Referred pain— felt in a part of the body that is considerably
removed from the tissues causing the pain. 
 Intractable pain- highly resistant to relief

 Phantom pain—painful perception perceived in a missing body part

or in a body part paralyzed from a spinal cord injury 
 Pain related terms - Hyperalgesia—excessive sensitivity to pain

 Painthreshold—is the amount of pain stimulation a person requires in

order to feel pain.
 Pain tolerance—maximum amount and duration of pain that an
individual is willing to endure
 Nociceptors—pain receptors

 Pain perception—the point which the person becomes aware of the

pain 
 These nociceptors pain receptors can be stimulated by: Serotonin,
histamine, potassium ions, acids, Substance P. 

3 types of stimuli that can stimulate pain receptors

1.Mechanical 2. Thermal 3. Chemical 
 Pain fibers The precise mechanism of pain transmission
and perception is unknown. 
Pain fibers There are two separate pathways that
transmit pain impulses to the brain:
 (1) Type A-delta fibers are associated with fast, sharp,
acute pain.
 (2) Type C fibers are associated with slow, chronic,
aching pain 
 Gate Control Theory by Melzack and Watt
 According to the gate control theory, peripheral nerve fibers
carrying pain to the spinal cord can have their input modified at the
spinal cord level before transmission to the brain. 
 Gate Control theory Small-diameter nerve fibers carry the pain
stimuli through the same gate Large diameter fibers that carry the
non- pain impulses go through the same gate and inhibit the
transmission of those pain impulses- that is close the gate. 
 Gate Control Theory The pain gate situated in the substantia 
gelatinosa cells in the dorsal horn of the spinal cord can be shut in
several ways:
 Gate Control Theory Release of endogenous opioids produce
include enkephalins, endorphins and dynorphins, which are
morphine-like in actions.
 PAIN SYNDROMES 
 Psychogenic Pain - has been used to describe pain for which no
pathologic condition has been found or in which the pain appears to
have a greater psychologic basis than a physical one. 
 Neurologic Pain - Pain in the neurologic system occurs in different
forms.
 Neuralgia is sharp, spasm-like pain along the course of one or more nerves.
Two common areas of neuralgia
1. Trigeminal nerve in the face and the sciatic nerve in the lower trunk. 2.
Causalgia, a form of neuralgia, is severe burning pain associated with injury
to a peripheral nerve in the extremities. 
 Phantom limb pain - This is pain or discomfort perceived by the
person to be occurring in an extremity that has been amputated
 Intractable pain - This type of pain is a chronic pain that is resistant
to cure or relief.  
NON PHARMACOLOGIC
INTERVENTIONS
 Non-pharmacologic nursing activities can assist in pain relief

 Not a substitute for medication

 Combining nonpharmacologic interventions with medications

may be the most effective way to relieve pain
 CUTANEOUS STIMULATION AND
MASSAGE
 The gate control theory of pain proposes that stimulation of
fibers that transmit nonpainful sensations can block or decrease
the transmission of pain impulses

 Rubbing the skin and using heat & cold are based on this theory
 Massage is a generalized cutaneous stimulation of the
body that often concentrates on the back and shoulders

 Massage have an impact in the descending control system

and does not merely stimulate nonpain receptors

 Promotes comfort through muscle relaxation

 THERMAL THERAPIES
 Proponents believe that ice and heat stimulate the nonpain
receptors in the same receptor field as the injury

 Ice should be placed on the injury site immediately after injury or

surgery

 Ice therapy after joint surgery can significantly reduce the amount
of analgesic medication required
 Assess skin first before applying ice

 Ice should be applied on an area for no longer than 15 to 20

minutes at a time and should be avoided in clients with
compromised circulation

 Application of heat increases circulation to an area and

contributes to pain reduction by speeding healing
 Both ice and heat therapy must be applied carefully and
monitored closely to avoid injuring the skin

 Neither therapy should be applied to areas with impaired

circulation or used in clients with impaired sensation
 TRANSCUTANEOUS ELECTRICAL
NERVE STIMULATION (TENS)
 Uses a battery-operated unit with electrodes applied to the skin
to produce a tingling, vibrating, or buzzing sensation in the area
of pain

 Decreases pain by stimulating the nonpain receptors in the same

area as the fibers that transmit pain
 DISTRACTION
 Involves focusing the client’s attention on something other
than the pain

 Thought to reduce the perception of pain by stimulating the

descending control system

 Effectiveness depends on the client’s ability to receive and

create sensory input other than pain
 Examples are watching TV, listening to music, complex
physical and mental exercises

 Stimulation of sight, sound, and touch is likely to be more

effective than the stimulation of a single sense
 RELAXATION TECHNIQUES
 Believed to reduce pain by relaxing tense muscles that
contribute to the pain

 Consists of abdominal breathing at a slow, rhythmic rate

 The client may close both eyes and breathe slowly and
comfortably
 GUIDED IMAGERY
 Using one’s imagination in a special way to achieve a
specific positive effect

 May consist of combining slow, rhythmic breathing with a

mental image of relaxation and comfort

 The client is asked to practice guided imagery for about 5

minutes, three times a day
 HYPNOSIS
 Has been effective in relieving or decreasing the amount of
analgesic agents required in clients with acute and chronic
pain

 Mechanism is unclear

 Induced by specially skilled people

 MUSIC THERAPY
 An inexpensive and effective therapy for the reduction of
pain and anxiety
PAIN ASSESSMENT
 Obtain a Pain History

 Allow the client to describe the pain to establish a trust

relationship between you and the client

 Discover the effects of pain on the client's quality of life

 Assess for emotional and spiritual distress and coping abilities

 Ask about previous pain experience and what measures
have been effective as well as those who have not

 Use WHAT’S UP format or PQRST or OLDCART in

assessing pain
 W – where is the pain? Be specific. Use drawing of body if
necessary

 H – how does the pain feel? Is it shooting, burning, dull, sharp?

 A – aggravating and alleviating factors. What makes the pain

better? Worse?

 T – timing. When did the pain start? Is it intermittent?

Continuous?
 S – severity. How bad is the pain on a 0 to 10 (0 to 5; faces)
scale

 U – useful other data. Are you experiencing any other

symptoms associated with the pain or pain treatment? Itching,
nausea, sedation, constipation?

 P – perception. What is the client’s perception of what caused

the pain?
P – provoked

 Q- quality

R – region/radiation

S – severity

T - timing
O – onset
L – location
D – duration
C – characteristic
A – aggravating factors
R – radiation
T – treatment
SAMPLE (PQRST)
With continuous, drilling,
bilateral knee pain that occurs
upon ambulation; rated as 8/10 in
the numeric pain rating scale,
with 0 as no pain and 10 as
excruciating pain.
SAMPLE (OLDCART)
 With continuous, penetrating, right flank pain that occurred
1 hour prior to admission while client was consuming fried
dried fish; rated as 9/10 in the numeric pain rating scale
with 0 as no pain and 10 as excruciating pain in the pain
rating scale; radiating on the left shoulder; aggravated with
ambulation and consumption of salty foods such as dried
fish and corned beef and alleviated with rest, deep
breathing exercises, and guided imagery.
 DAILY PAIN DIARY
 For clients who experience chronic pain
 May help the client and nurse identify pain patterns and
factors that exacerbate or mediate pain
 The record can include: time or onset of pain, activity
before pain, pain-related positions or behaviors, pain
intensity level, use of analgesics or other relief measures,
duration of pain, time spent in relief activities.
 VISUAL ANALOGUE SCALES
 Useful in assessing the intensity of pain
 Includes a horizontal 10cm line, with anchors indicating
the extremes of pain
 The client is asked to place a mark indicating where the
current pain lies on the line
 Left: none or no pain

 Right: severe or worst possible pain

 FACES PAIN SCALE
 This instrument has six faces depicting expressions that
range from contented to obvious distress

 The client is asked to point to the face that most closely

resembles the intensity of his or her pain
 VITAL SIGNS
 Purpose: to monitor functions of the body
 Reflect changes in bodily functions that might not otherwise
be observed
 T. P. R. B/P pain level (0 – 10) Zero – no pain; 10 – the worst
pain
 Pulse oxymetry may be taken with vital signs, check the
institution’s policy
 VS should be performed with thoughtful scientific assessment
while evaluating the patient’s present and prior health status.
 Not automatic as if performing on auto-pilot, but with critical
thinking and evaluation of the client’s condition, comparing
previous vital signs and what is normal for the client.
WHEN TO ASSESS VITAL SIGNS:
 On admission
 Change in client’s health status

 Client reports symptoms of chest pain, feeling hot, or fainting

 Pre and post surgery/or invasive procedure

 Pre and post medication administration that could affect CV

system, or respiratory system. (Example: before administering
Digitalis)
 Pre and post nursing intervention that could affect vital signs
(ambulation, physical therapy, bathing clients who were on
bedrest)
 THERE ARE TWO KINDS BODY
TEMPERATURE
 Core temperature – deep body tissue temperature that
remains relatively constant, (abdominal cavity, pelvic
cavity)
 Surface temperature – skin subcutaneous and body fat
tissue; which changes in response to the environment
Metabolism produces heat
Heat balance: is when the amount of heat produced =
the amount of heat lost
 TEMPERATURE - Body Temperature as fever: Febrile –is the
term used for having fever
Intermitten f. – alternates at reg. intervals
Remittent f. – fever occurs with wide fluctuations as seen in
colds & flues
Relapsing f. – fevers occurring in short periods of 1 or 2 days
constant f. – usually remains constant with minimal fluctuations;
( as seen in typhoid)
fever spike – a rapid rise in fever level followed by normal temp.;
seen in bacterial
blood infections
 Pyrexia - is fever above the usual range

 Hyperpyrexia – very high fever; hyperthermia