Nursing 105 – Second Term
(Oct. 17/07 – Nov/21, 07)
Oct. 17/07 – Defining Health
Health – A state of complete physical, mental, and social well-being, not merely the absence of disease
Wellness – is a subjective experience.
Community Health – The health of a community is a combination of many different factors, it relies on
people to be in a continual state of change and respond to the circumstances of their lives and
environment. The factors that contribute to a healthy community are parenting styles, family dynamics,
family finances, geographical mobility, health services, geographical mobility, health services, social
resources, education, political economic factors, neighborhood, culture, age, employability, biological
factors, and gender.
Illness – the subjective experience of loss of health
Medical Approach - Represents a stability orientation to health and has dominated Western thinking for
most of the 20th century. It emphasizes that medical intervention restores ill health.
Behavioural Approach - The 1974 Lalonde Report concluded that the traditional medical approach to
health care was inadequate and that "further improvements in the environment, reductions in self-
imposed risks, and a greater knowledge of human biology" are necessary to improve the health status of
Socio-environmental Approach - Approach within which health is closely tied to the social structure.
For example, poverty and unhealthy physical and social environments, such as air pollution, water
quality, and work hazards, can influence health directly.
- Ottawa Charter identified the prerequisites for health as peace, shelter, education, food, income, a
stable ecosystem, sustainable resources, social justice, and equality.
- Epp Report: Achieving Health for All.
- Ottawa Charter and Epp Report each reflect a socio-environmental approach in which health is seen as
more than just the absence of disease and engaging in healthy behaviours; rather, this approach
emphasizes connectedness, self-efficacy, and capacity to engage in meaningful activities.
Determinants of Health - According to the Lalonde Report (1974), health determinants are lifestyle,
environment, human biology, and the organization of health care. Key health determinants identified in
this document are: income and social status; social support networks; education; employment and
working conditions; physical environments; biology and genetic endowment; personal health practices
and coping skills; healthy child development; and health services. In 1996, Health Canada added gender,
culture, and social environments to this list. Note that the list includes both individual level (personal
health practices and coping skills, biology and genetic endowment) and population level (education,
employment, and income distribution) determinants.
Levels of Healthcare
Promotion - is directed toward increasing the level of well-being and self-actualization.
Prevention – is directed toward decreasing the probability of experiencing health problems.
Rehabilitation – a type of health promotion that works with people who are recovering from
injury or illness.
3 Levels of Prevention
Primary – includes activities that protect against a disease before signs and symptoms occur. Ex.
Secondary – includes activities that promote early detection of disease so that prompt treatment
can be initiated to halt disease and limit disability. Ex. Preventive screening for cancer, blood
pressure screenings to detect hypertension.
Tertiary – includes activities that minimize residual disability from disease and help the client
learn to live productively with limitation. Ex. cardiac rehabilitation program.
Oct. 22/07 – Health and Culture
Culture - consists of the totality of socially transmitted knowledge of values, beliefs, norms, and
lifestyles of a particular group that guides their thoughts and behaviors. Evolves over a period of time.
Passed down through the generations often through social and religious customs and intellectual and
artistic activities. Visible and Invisible components (p. 130)
-Elements such as: Language, Verbal and nonverbal communication, Nutrition, Religious practices,
Family structure, Views on health, ect.
Subculture - Have similarities with the dominant culture, they maintain their unique life patterns, values
and norms…i.e. Polish, Acadian.
Ethnicity – refers to individuals who have the same social and cultural heritage. May share common
values, language, history, similar physical characteristics. Members feel a sense of common identity
(Scottish, Irish, Vietnamese).
Race – refers to people that share some common characteristics such as facial features, body stature,
bone structure etc which are passed on through the genes (Blacks, Caucasian)
Emic World View – Inside or narrative perspective
Ethinic World View – Outside perspective
Enculturation – Socialization into one’s primary culture as a child.
Acculturation Ethnocentricism – The process of adapting and adopting characteristics of a new
Assimilation – When people give up their ethnic identity in favor of the dominant culture.
Multiculturalism – where immigrants and others maintain their culture and different cultures interact
peacefully within a nation.
Stereotyping – Generalizations about a particular group that prevent further assessment of unique
Cultural Imposition – use their own values and life ways as the absolute guide in dealing with client
Discrimination – Treating people unfairly based on their group membership.
Cultural Awareness – Being aware of one’s own background, involves an in-depth self examination to
recognize biases, prejudices, and assumptions (pg. 133).
Cultural Assessment Model -POSSIBLE ESSAY
1. Communication: Communication patterns reflect core cultural values of a society. Can be
verbal or nonverbal. Communication encompasses speaking, acknowledging one’s feelings
and attempts to understand what the other person is trying to convey. The need for sensitivity
to another person’s culture is important.
2. Space: a person’s space is the distance around them. Degree of comfort observed, proximity
to others, body movement, perception of space.
3. Social Organization: Cultural groups consist of units of organization delineated by kinship,
status hierarchy and appropriate roles for their members. Ex. nuclear vs. extended family.
4. Time: All cultures have past, present and future time orientations. Some are concerned about
the present while others are more concerned about the future.
5. Environmental Control: The individuals perception of his or her ability to control factors in
their environment. Perceptions of the cause of illness, use of healing modalities.
6. Biological Variations: Must identify client health risks related to sociocultural and
biological history. Biological differences exist between people in different ethnic groups.
Oct. 29/07 – Caring
Sister Simone Roach’s Theoretical Perspectives
Six C’s of Caring – 1. Compassion – an awareness of and a willingness to participate in the human
experience of others; to give of oneself; being moved and changed by the
2. Competence – the knowledge, judgement, skills, energy, experience, and
3. Confidence – if we are confident in our abilities we are more able to share with
others – empowering clients with knowledge and choice.
4. Conscience – a state of moral awareness, like an arrow directing ones
5. Commitment – a convergence of ones desire and ones obligation. An
investment of the self in tasks…
6. Comportment – how we present ourselves: dress, language, etc.
Oct. 31/07 – Nursing Theory
Nursing Theory – provides a nurse with a framework from which to practice and from which to raise
- used for the purpose of describing explaining, predicting and/or prescribing
- is like a road map – it highlights important areas and guides the way
- defines what nursing is – there is NO ONE theory!
Four Metaparadigm Concepts –
1. Person – Individual, family, group or community.
2. Environment – social, cultural, economic, and physical.
3. Health – World Health Organization defines – “A state of complete physical, mental, and
social well-being, not merely the absence of disease or infirmity.”
4. Nursing – the actions taken by nurses in collaboration with the client.
Orem’s Theory – Is a theory that seeks to explain when nursing is needed.
Orem’s Central Concepts – 1. Self-care – A right and responsibility of every adult
- Taking care of the self in the interest of maintaining life,
healthful functioning continual personal development and
2. Self-care Agency – Individual’s capability for performing self-care
- The ability to understand, acquire knowledge, make
choices and act on choices.
3. Self-care Requisites – Goals to be achieved
- The reason for which self-care actions are performed
- Comprise an individual’s Therapeutic Self-care Demand
-Affected by: age, gender, developmental state, health
state, socio-cultural orientation, healthcare system factors,
family system, pattern of life, environmental factors,
*Universal self-care requisites (USCR)
-Maintaining intake of air
-Maintaining intake of water
-Maintaining intake of food
-Activity and rest
-Solitude & social interaction
*Developmental self-care requisites (DSCR)
-Prevention of interference to development
*Health deviation self-care requisites (HDSCR)
-Securing appropriate medical attention
-Attending to the affects of pathological
-Caring out treatment therapies
-Coping with the effects of treatment
-Adjusting self-concept & accepting oneself
-Living with the effects of pathological
Nov. 5/07 – Ethical Issues in Nursing
Ethics - Principles or standards that govern proper conduct as they apply to professional issues or
Morals - Morals or morality are the private, personal standards of what is right and wrong based on
social mores or customs.
Values – A strong personal belief about the worth of a given idea or behaviour.
Cultural Values – Are those values adopted as a result of a person’s social setting.
Deontology - Study that proposes a system of ethics that defines actions as right or wrong based on their
"right-making characteristics such as fidelity to promises, truthfulness, and justice" (Beauchamp and
Bioethics - Field of study that guides the often complicated negotiations that characterize contemporary
decisions about health care.
Ethics of Care - Delivery of health care based on ethical principles and standards of care.
Relational Ethics - Attempts to go beyond bioethics to explain some of the complexities of the nurse's
moral obligation to the client; it focuses on how we treat others. Relational ethics theory proposes that
our ethical understandings are formed in, and emerge from, our relationships with others.
Utilitarianism – Proposes that the value of something is determined by its usefulness.
Primary Values to the Code of Ethics –
1. Safe, Competent and Ethical Care
-must follow certain ethical principles:
1. Beneficence - The doing or active promotion of doing good.
2. Non-maleficence – To do no harm to another person.
3. Autonomy – Clients ability to decide for themselves.
4. Justice – fair
-Nurses value the ability to provide safe, competent and ethical care that allows
them to fulfill their ethical and professional obligations to the people they serve.
2. Health and Wellbeing
-Nurses value health promotion and well being and assist persons to achieve their
optimum level of health in situations of normal health, illness, injury, disability or
at the end of life.
-Nurses respect and promote the autonomy of clients and help them to express
their health needs and values, and to obtain appropriate into and service so they
can make informed decisions.
-Nurses recognize and respect the inherent worth of each person and advocate for
respectful treatment of all persons.
-Nurses safeguard the trust of clients that information learned in the contest of a
professional relationship is shared outside the health care team only with the
clients permission or as legally required or where failure to disclose would cause
-Nurses apply and promote principals of equity and fairness to assist clients in
receiving unbiased treatment (social justice) and a share of health services and
resources proportionate to health.
-Nurses act in a manner consistent with their professional responsibilities and
standards of practice and are answerable for their practice.
8. Quality Practice Environment
-Nurses value and advocate for practice environments that have organizational
structures and resources necessary to ensure safety, support and respect for all
persons in the work setting.
Ethical Dilemma – is a conflict between two sets of human values, both of which are judged to be good
but which can’t both be fully served. Ethical dilemmas can cause distress and confusion for clients and
Steps to Process and Ethical Dilemma
1. Is this an ethical dilemma? If a review of scientific data does not resolve the question, the
question is perplexing, and the answer will have profound relevance for several areas of
human concern, then an ethical dilemma may exist.
2. Gather all of the information relevant to the case. To be sure it is a true dilemma, it will be
important to review all pertinent information. Occasionally an overlooked fact may provide
quick resolution. At this point, client, family, institutional, and social perspectives are
important source of relevant information.
3. Examine and determine your own values on the issues. Values clarification provides a
foundation for clarity and for confidence during decisions that will be necessary for
resolution of a dilemma.
4. Verbalize the problem. A clear, simple statement of the dilemma may not always be easy, but
it is essential for the next step to take place.
5. Consider possible courses of action. To respect all sides of the issue, it is helpful to list
potential actions, especially when the list will reflect opinions that conflict.
6. Negotiate the outcome. Sometimes courses of action that seem unlikely at the beginning of
the process take on new possibility as they are out to rational and respectful consideration.
Negotiation requires a confidence in one’s own point of view and a deep respect for the
opinions of others.
7. Evaluate the action.
Nursing Standards – Describes the desirable and achievable level of performance expected of
registered nurses in their practice against which performance can be measured. Helps ensure that nurses
provide safe, competent, and ethical care.
6 Nursing Standards –
2. Continuing Competence
3. Application of knowledge, skills and judgment
4. Professional relationships and advocacy
5. Professional leadership
Why are the six standards of nursing are important?
The six standards of nursing are important throughout the nursing career as way of being the best nurse
you can be. With the changing heath care system it is important to continue your education on new
medical treatments, ideas as well as equipment. It is acting appropriately and keeping professional and
trusting relationships with your health care team and as well with your clients., keeping yourself and
others accountable for their actions.
Nov. 7/07 – Legal Issues in Nursing
Tort - Act that causes injury for which the injured party can bring civil action. Can be unintentional or
Negligence (malpractice) - Careless act of omission or commission that results in injury
Assault – Unlawful threatening or inflicting of harm on another.
Battery – Legal term for touching of another's body without consent.
Defamation of Character –
False Imprisonment – Use of restraints without doctors orders.
Invasion of Privacy –
Nov. 12/07 – Introduction to the Nursing Process and Therapeutic Communication
Elements of Professional Communication
-Courtesy – hello, goodbye, knock, self-introduction, state your purpose, address people by
name, say please and thank you, apologize for inadvertently making an error or causing a patient
distress. It sets up barriers between nurse and client and causes friction among team members.
-Use of Names – Addressing others by name conveys respect. You should use last name first, but
later may be able to call my clients first name if requested by them.
-Privacy and Confidentiality –
-Trustworthiness – trust is relying on someone without doubt or question. To foster trust the
nurse communicates warmth and demonstrates consistency, reliability, honesty, integrity, and
competence. Without trust a nurse-client relationship rarely progresses beyond social interaction
and superficial care.
-Autonomy and Responsibility – self-directed and independent.
-Assertiveness – allows individuals to act in their own best interest without infringing on or
denying the rights of others.
Boundaries – includes the notion of limits, lines or borders. Professional requirements for practice are
met when the registered nurse demonstrates the knowledge, skills and attitudes of therapeutic behavior
which are outlined in the practice standards and competencies.
Professional Boundaries – are the defining lines which separate the therapeutic behavior of a registered
nurse from any behavior which, well intentioned or not, could reduce the benefit of nursing care to
patients, clients, families, and communities.
READ BOUNDARIES DOCUMENT!
Nov. 14/07 – Nursing Process: Step 1 – Assessment (*note no essay from this portion)
Objective Data - Data relating to a client's health problem that are obtained through observation or
Subjective Data - Data relating to a client's health problem that are given in the client's own words, or
from a family member.
Nov. 19/07 – Nursing Process: Step 2 – Diagnosis
Nursing Diagnosis – a label that reflects the clients self-care deficits, self-care strengths, or both in
response to actual or potential health status changes, life processes of life events.
-Nursing judgment that leads to selection of nursing therapies.
Medical Diagnosis – Physicians clinical judgment of disease that leads to selection of medical
Types of Nursing Diagnosis
1. Actual Problem – real, exists in the “here and now.”
Ex. anxiety, acute pain, caregiver role strain, body image disturbance, sleep pattern
2. Risk/High Risk – client at significant risk of a problem. Don’t have defining
characteristics since they don’t exist yet.
Ex. injury risk for, self abuse risk for, suicide risk for.
3. Wellness – Growth, development across lifespan. One or two part statements.
(PG 809- Carpenito)
Writing Diagnostic Statement
Problem Related To Etiology (can be more then one) As Evidenced By Symptom
Read Nursing Care Plan Guidelines!!!
Nov. 21/07 – Nursing Process: Step 3-5 – Planning, Implementation and Evaluation
How to write a goal and expected outcomes – Possible Essay