Family Forms
Key Nursing Leaders
- Florence NightingaleLady with the Lamp; first nurse researcher/scientist-theorist; Environmental Theory
- Clara BartonOrganized the Red Cross
- Linda RichardsAmerica's first trained nurse; introduced nurse's notes & doctor's orders
- Mary MahoneyFirst African American professional nurse
- Lillian WaldFounder of public health nursing; Henry Street Settlement
- Margaret SangerFounder of Planned Parenthood
Roles of Professional Nurses
Caregiver • Communicator • Teacher • Counselor • Change Agent • Leader • Manager • Researcher • Client Advocate
Benner's Stages (Dreyfus Model)
| Theorist | Theory | Key Concept |
|---|---|---|
| Nightingale | Environmental | Environment affects healing; clean air/water/sanitation |
| Watson | Human Caring | 10 Carative Factors; caring & healing environment |
| Benner | Novice to Expert | 5 stages of clinical competence (Dreyfus Model) |
| Orem | Self-Care Deficit | Wholly, Partially, Supportive-Educative compensatory |
| King | Goal Attainment | Nurse-patient partnership; mutual goal-setting |
| Neuman | Systems Model | Stressors; Flexible/Normal/Lines of Resistance |
| Roy | Adaptation Model | 4 modes: Physiological, Self-Concept, Role, Interdependence |
| Peplau | Interpersonal | 4 Phases: Orientation, Identification, Exploitation, Resolution |
| Henderson | Nursing Need | 14 Components of basic needs; 3 nurse-patient levels |
| Abdellah | 21 Nursing Problems | Patient-centered; 4 categories of problems |
| Pender | Health Promotion | Health-promoting behavior; perceived benefits/barriers |
| Leininger | Culture Care | Transcultural; preservation, accommodation, repatterning |
| Hall | Care, Core, Cure | 3 interconnected circles of nursing |
| Johnson | Behavioral System | 7 subsystems of behavior |
| Travelbee | Human-to-Human | 5 phases; meaning in illness & suffering |
| Rogers | Unitary Human Beings | Energy Field, Openness, Pattern, Pandimensionality |
Filipino Nursing Theorists
Watson's 10 Carative Factors
- Formation of humanistic-altruistic system of values
- Installation of faith-hope
- Cultivation of sensitivity to self and others
- Development of helping-trust relationship
- Promotion & acceptance of positive/negative feelings
- Systematic use of scientific problem-solving for decision making
- Promotion of interpersonal teaching-learning
- Provision for supportive/protective/corrective environment
- Assistance with gratification of human needs
- Allowance for existential-phenomenological forces
Henderson's 14 Components of Basic Needs
3 Nurse-Patient Levels: (1) Substitutive (doing for) • (2) Supplementary (helping) • (3) Complementary (working with)
Abdellah's 21 Nursing Problems (4 Categories)
Rogers' Homeodynamic Principles
Orem's 3 Self-Care Requisites
(I) Universal • (II) Developmental • (III) Health Deviation
Self-Care Agency: Acquired powers to engage in self-care; affected by age, gender, health system, living pattern
Roy's 4 Adaptive Modes (Detailed)
Coping: Regulator (physiological) vs Cognator (mental). Levels: Integrated → Compensatory → Compromised
Johnson's 7 Behavioral Subsystems
1. Attachment/Affiliative (most critical; basis for social organization) • 2. Dependency • 3. Ingestive • 4. Eliminative • 5. Sexual (procreation & gratification) • 6. Aggressive (protection/self-preservation) • 7. Achievement (control/mastery of environment)
Structure: Drive/Goal • Set • Choices • Action. Functions: Protection • Nurturance • Stimulation
Neuman's Detailed Concepts
Pender's Health Promotion Model (Key Concepts)
Personal Factors: Biological (age, gender) • Psychological (self-image, motivation) • Sociocultural (ethnicity, SES)
Perceived Benefits vs Perceived Barriers • Self-Efficacy • Activity-Related Affect • Interpersonal/Situational Influences • Competing Demands/Preferences
Leininger's 3 Nursing Actions
1. Cultural Preservation/Maintenance • 2. Cultural Care Accommodation/Negotiation • 3. Cultural Care Repatterning/Restructuring
Margaret Newman — Health as Expanding Consciousness
Health & illness are synthesized as health. 9 Patterns of Interaction: Choosing, Communicating, Exchanging, Feeling, Moving, Knowing, Perceiving, Relating, Valuing. Key concepts: Pattern, Consciousness, Movement, Time, Space.
Orlando's Deliberative Nursing Process
5 Concepts: Function of Professional Nursing • Presenting Behavior • Immediate Reaction • Nursing Process Discipline • Improvement/Resolution. Patient behavior = potential cry for help.
Travelbee's 5 Phases (Detailed)
1. Original Encounter (first impression) • 2. Emerging Identities (relationship begins) • 3. Sympathy (desire to lessen suffering) • 4. Empathy (sharing the experience) • 5. Rapport (human-to-human)
Swanson's 5 Caring Processes
Katie Eriksson — Caritative Caring
Core: Love & charity (caritas), dignity, invitation, suffering. 3 Forms of Health: Related to Illness, Related to Care, Related to Life. Axiom: Caring is human by nature, a call to serve in love.
Filipino Theorists (Expanded)
Agravante's CASAGRA: Care Complex (nucleus of care experiences) • Three-fold: Servant-Leader Spirituality, Self-Mastery, Special Expertise
Kuan's Graceful Aging: Concepts: Retirement, Role, Role Discontinuous, Health Status, Income, Work Status, Family Constellation, Self-Preparation
Laurente: Communication & family as entry point. Concepts: Anxiety, Presence, Concern, Stimulation. Factors: Predisposing (age, sex, education, experience) & Enhancing (communication, beliefs, caring experience)
Locsin: 3 Dimensions of Technological Value • Process: Knowing → Mutual Designing → Participative Engaging → Verifying Knowledge
Sullivan's Interpersonal Theory (Details)
Dynamisms: Disjunctive (Malevolence) • Isolating (Lust) • Conjunctive (Intimacy). Self-System: Security operations: Dissociation & Selective Inattention. Personifications: Bad/Good Mother • Good-me/Bad-me/Not-me • Eidetic (imaginary friends). Cognitive: Prototaxic → Parataxic → Syntaxic
Sources of Law
Constitution → Legislation (Statutes/Nurse Practice Acts) → Administrative Law → Common Law (Stare Decisis)
Torts
6 Elements: Duty, Breach, Foreseeability, Causation, Harm, Damages
Informed Consent
Must be voluntary, by someone with capacity, with enough information. Nurse witnesses signature, does NOT explain the procedure.
Key Cases
Parsons' 4 Aspects of Sick Role
Rights: (1) Not held responsible (2) Excused from social roles. Obligations: (3) Try to get well (4) Seek competent help.
Suchman's 5 Stages of Illness
Symptom Experiences → Assumption of Sick Role → Medical Care Contact → Dependent Client Role → Recovery/Rehabilitation
Self-Concept
Personal Identity • Body Image • Role Performance • Self-Esteem (Global & Specific)
Erikson's 8 Psychosocial Stages
| Stage | Age | Crisis | Virtue |
|---|---|---|---|
| 1 | 0-18 mo | Trust vs. Mistrust | Hope |
| 2 | 19 mo-3 yr | Autonomy vs. Shame/Doubt | Willpower |
| 3 | 3-5 yr | Initiative vs. Guilt | Purpose |
| 4 | 5-11 yr | Industry vs. Inferiority | Competence |
| 5 | 11-18 yr | Identity vs. Confusion | Fidelity |
| 6 | 18-40 yr | Intimacy vs. Isolation | Love |
| 7 | 40-65 yr | Generativity vs. Stagnation | Care |
| 8 | 60+ yr | Integrity vs. Despair | Wisdom |
Kohlberg's Moral Development
Preconventional (4-10): Obedience → Individualism. Conventional (10-13): Good Boy/Girl → Law/Order. Postconventional: Social Contract → Universal Principles.
Maslow's Hierarchy
Physiologic → Safety → Love/Belonging → Self-Esteem → Self-Actualization (→ Self-Transcendence)
7 Components of Wellness (Anspaugh, Hamrick, Rosato)
1. Environmental • 2. Social • 3. Emotional • 4. Physical • 5. Spiritual • 6. Intellectual • 7. Occupational
Health Locus of Control
Internals: Believe health is self-determined; more likely to take initiative, keep appointments, maintain diets. Externals: Believe health is controlled by chance or powerful others.
Rosenstock & Becker's Health Belief Model
Perceived Susceptibility + Perceived Seriousness = Perceived Threat. Modified by demographics, sociopsychological variables, structural variables, and cues to action. Leads to Likelihood of Action (benefits minus barriers).
Health Care Adherence
Extent to which behavior coincides with medical advice. To enhance: ensure ability, understanding, willingness; demonstrate caring; use positive reinforcement; establish therapeutic relationship.
4 Dimensions of Self-Concept
Self-Knowledge (insight into abilities/limitations) • Self-Expectation (realistic or unrealistic) • Social Self (how perceived by others) • Social Evaluation (appraisal vs. others/situations)
Acute vs Chronic Illness
Acute: Short duration, abrupt onset, often resolves with/without treatment. Chronic: ≥6 months, slow onset, periods of remission & exacerbation.
Types of Exercise
Effects of Immobility
- Musculoskeletal: Disuse atrophy, contractures, foot drop, osteoporosis
- Cardiovascular: Orthostatic hypotension, thrombus formation, dependent edema
- Respiratory: Atelectasis, hypostatic pneumonia, pooling of secretions
- Urinary: Renal calculi, urinary stasis/retention/infection
- GI: Constipation
Client Positions
Fowler's (45-60°) • Semi-Fowler's (15-45°) • High Fowler's (60-90°) • Orthopneic • Supine • Prone • Lateral • Sims'
Crutch Gaits
Four-point • Three-point • Two-point • Swing-to • Swing-through. Stairs: Up = good leg first. Down = crutches + affected leg first.
10 Rights of Medication Administration
- Right Patient (2 identifiers)
- Right Medication
- Right Dosage
- Right Route
- Right Time
- Right Documentation (AFTER giving)
- Right Client Education
- Right to Refuse
- Right Assessment
- Right Evaluation
Drug Dosage Formula
Injection Routes
Sterile Field Rules
- Sterile objects touched by unsterile objects = unsterile
- Out of sight or below waist = unsterile
- Edges of sterile field = unsterile (2.5 cm margin)
- Moisture through sterile object draws microorganisms
- Skin cannot be sterilized
Chain of Infection
Infectious Agent → Reservoir → Portal of Exit → Mode of Transmission → Portal of Entry → Susceptible Host
Heat Loss Mechanisms
Pulse Sites
Temporal • Carotid (cardiac arrest adults) • Apical (5th ICS, left MCL; infants) • Brachial (BP; infant arrest) • Radial (most common) • Femoral • Popliteal • Post. Tibial • Dorsalis Pedis
4 Areas of Nursing Practice
Patient Classification Levels
| Level | Type | Description | NCH/day | Prof:Non-Prof |
|---|---|---|---|---|
| 1 | Self/Minimal Care | Can bathe, feed, perform ADLs | 1.5 | 55:45 |
| 2 | Moderate/Intermediate | Needs some assistance, up & about for short periods | 3 | 60:40 |
| 3 | Total/Intensive | Completely dependent on nursing personnel | 4.5 | 65:35 |
| 4 | Highly Specialized/Critical | Continuous treatment, VS q15-30 min, hourly output | 6.7+ | 70:30 to 80:20 |
Recipients of Nursing Care
Expanded Career Roles
Nurse Practitioner • Clinical Nurse Specialist • Nurse Anesthetist • Nurse Midwife • Nurse Researcher • Nurse Administrator • Nurse Educator • Nurse Entrepreneur • Forensic Nurse
Additional Historical Figures
- Harriet Tubman (1820-1913)"Moses of Her People"; Underground Railroad; nursed the sick during the Civil War
- Sojourner Truth (1797-1883)Abolitionist, preacher, women's rights advocate; nurse for 4+ years during Civil War
- Dorothea Dix (1802-1877)Union's Superintendent of Female Nurses during the Civil War
- Mary BreckenridgeFounded the Frontier Nursing Service in Kentucky (1925); family-centered primary care to rural populations
- Lavinia Dock (1858-1956)Nursing leader & suffragist; women's right to vote (1920)
Men in Nursing
- Luther Christman (1915-2011)First man to be dean of a university school of nursing; first man elected to American Academy of Nursing; ANA Hall of Fame
- Steve Miller (1971)Organized "Men in Nursing" group in Chicago; later renamed AAMN
Barriers: Femininity image of nursing • Lack of male role models • Suspicion surrounding intimate touch
Goal: AAMN's "20 x 20 Choose Nursing" — increase male enrollment from 10% to 20% by 2020
Credentialing
Standards of Care
Legal Roles of Nurses
Delegation
Transfer of responsibility while retaining accountability. 5 Rights: Right Task • Right Circumstance • Right Person • Right Direction/Communication • Right Supervision
Good Samaritan Acts
Protects HCPs offering emergency aid from malpractice claims. Guidelines: Limit to first aid within competence • Do not force help • Do not leave until safe • Do not accept compensation
Incident Reports
Agency record of unusual occurrence. Include: client ID, date/time/place, factual description, client's account in quotes, witnesses, equipment/medication details. File promptly per agency policy.
End-of-Life Legal Issues
Controlled Substances & Impaired Nurse
Risk factors: Access • Stress • Lack of education • Attitude. Action: Report suspicions to protect patients. "The only wrong thing to do about an impaired nurse is to do nothing."
Key Definitions
Basic Concepts
Holism: Mind, body, spirit, relationships, environment are equal • Humanism: Mind & body indivisible • Balance: Physical, mental, spiritual, environmental • Energy: Grounding + Centering
Systematized Health Care Practices
Herbal Warnings
| Herb | Warning |
|---|---|
| Echinacea | May reduce effectiveness of immunosuppressants |
| Feverfew | May increase anticoagulant effects of aspirin |
| Garlic/Ginger/Ginkgo | May increase anticoagulant effects (risk of bleeding) |
| St. John's Wort | May potentiate antidepressants (serotonin syndrome risk) |
| Valerian | Increases sedative effects of antianxiety medications |
Manual & Mind-Body Therapies
Aromatherapy & Others
Aromatherapy: Essential oils absorbed for physiological/psychological benefits; do NOT ingest. Homeopathy: "Law of Similars" (Samuel Hahnemann); serial dilution. Naturopathy: Health maintenance lifestyle; no emergency care.
Burnout Prevention
Exercise regularly • Eat well • Sleep • Self-reflection • Ask for help • Practice breath awareness & centering
Host Susceptibility — 6 Factors
Types of Immunity
Types of Microorganisms
Bacteria (most common) • Viruses (need living cells: rhinovirus, hepatitis, HIV) • Fungi (yeasts/molds: Candida albicans) • Parasites (protozoa, helminths, arthropods)
PPE Donning & Doffing
Physiological Barriers (First Line of Defense)
Intact skin & mucous membranes • Skin acidity inhibits bacterial growth • Nasal cilia trap organisms • Alveolar macrophages ingest organisms • Saliva flow prevents infection • Tears contain lysozyme • Vaginal pH 3.5-4.5 inhibits growth • Urine flow flushes bacteria
Types of Nursing Education
Research Designs
Protection of Study Participants' Rights
Right not to be harmed • Right to full disclosure • Right to self-determination • Right to privacy
Heart Anatomy
Apex: 5th ICS, left MCL. AV Valves: Tricuspid & Mitral. Semilunar: Pulmonic & Aortic.
Electrical Conduction
SA Node (60-100) → AV Node (40-60) → Bundle of His → Bundle Branches → Purkinje Fibers (20-40)
Heart Sounds
Cardiac Output
Ejection Fraction: Normal = 50-75%
Assessment Order (Exception!)
Inspection → Auscultation → Percussion → Palpation
Key Signs
Auscultation
Start at RLQ clockwise. Bowel sounds: 5-34/min. Borborygmi: Loud rumbling. Bruits: Turbulent blood flow. Venous Hum: Cirrhosis. Friction Rub: Inflamed surface.
Liver Span: MCL 6-12 cm; MSL 4-8 cm.
Eyes
Ears
Conductive loss: External/middle ear. Sensorineural: Cochlea/nerve. Air > Bone conduction = normal.
Breast & Axilla
Abnormal Findings
Prostate
Normal: non-tender, rubbery, 2 lobes, median sulcus. BPH: Enlarged, smooth, no sulcus. Cancer: Hard, fixed, irregular.
Arteries vs Veins
| Feature | Arteries | Veins |
|---|---|---|
| Carries | Oxygenated blood (away from heart) | Deoxygenated blood (to heart) |
| Walls | Thick, strong | Thin |
| Pressure | High pressure system | Low pressure |
| Blood Volume | 10% of total | 70% of total |
| Pulse | Has pulse | No pulse |
| Diameter | Smaller (Aorta ~25mm) | Larger (Vena Cava ~35mm) |
Arterial vs Venous Insufficiency
Stroke Volume Components
Neck Vessels
JVP = CVP: Normal CVP 2-6 mmHg. Elevated JVP = fluid overload/heart failure. Low JVP = dehydration. Assess at 30-45° elevation on right side.
Lymphatic System
Drains excess fluid & plasma proteins • Part of immune system • Absorbs fats from small intestine • Composed of lymphatic capillaries, vessels, and lymph nodes
Capillaries & Fluid Exchange
Hydrostatic force: pushes fluid out of capillaries into tissue. Osmotic pressure: pulls fluid back into capillaries. Capillaries = smallest vessels (5-10 micrometers).
Glasgow Coma Scale (GCS)
| Component | Response | Score |
|---|---|---|
| Eye Opening | Spontaneous | 4 |
| To voice | 3 | |
| To pain | 2 | |
| None | 1 | |
| Verbal | Oriented | 5 |
| Confused | 4 | |
| Inappropriate words | 3 | |
| Incomprehensible sounds | 2 | |
| None | 1 | |
| Motor | Obeys commands | 6 |
| Localizes pain | 5 | |
| Flexion withdrawal | 4 | |
| Abnormal flexion (decorticate) | 3 | |
| Extension (decerebrate) | 2 | |
| None | 1 |
Max: 15 (normal) • Min: 3 • ≤8 = Severe/Coma • 9-12 = Moderate • 13-15 = Mild
Cranial Nerves (12 Pairs)
Key Cranial Nerve Tests
Posturing
Breath Sounds
Adventitious (Abnormal) Sounds
Chest Assessment
Normal AP:Lateral ratio: 1:2. Barrel chest (1:1) = COPD/emphysema. Clubbing = chronic hypoxia. Tactile fremitus ↑ = consolidation. Tactile fremitus ↓ = pneumothorax/effusion.
Skin Lesions
6 Steps
1st Level Assessment → 2nd Level Assessment → Prioritization → Goals/Objectives → Interventions → Evaluation
1st Level Assessment — "The What"
2nd Level Assessment — "The Why"
Assessment Tools
Sum all 4 criteria. Max = 5. Highest total = first priority.
| Criterion | Weight | Highest | Scoring |
|---|---|---|---|
| Nature | 1 | 3 | Wellness/Deficit = 3 • Threat = 2 • Stress = 1 |
| Modifiability | 2 | 2 | Easily = 2 (4 factors) • Partially = 1 (1-3) • Not = 0 |
| Preventive Potential | 1 | 3 | High = 3 • Moderate = 2 • Low = 1 |
| Salience | 1 | 2 | Immediate = 2 • Not immediate = 1 • Not perceived = 0 |
Modifiability Factors (4)
Knowledge/Technology • Family Resources • Nurse Resources • Community Resources
Preventive Potential Factors
Gravity (inverse) • Duration • Current Management (direct) • Vulnerable Group (increases potential)
Do NOT use: Know, Think, Appreciate, Accept, Feel
Behavioral Verbs
5 Vectors of Intervention
- Recognize the Problem — enhance knowledge of magnitude, causes, consequences
- Decide on Health Actions — explore available courses & consequences of inaction
- Provide Nursing Care — develop commitment through demonstration & practice
- Enhance Home Environment — teach environmental modification
- Utilize Community Resources — facilitate maximum use of available resources
Nurse-Family Contact Methods
Evaluation Outcomes
Family Coping Index — 9 Areas
Scoring: 1 = No Competence • 3 = Moderate • 5 = Complete
- Physical Independence
- Therapeutic Independence
- Knowledge of Health Condition
- Application of Hygiene
- Health Attitude
- Emotional Competence
- Family Living
- Physical Environment
- Use of Community Facilities
4 Family Functions
Duvall's 8 Developmental Stages
| Stage | Name | Developmental Task |
|---|---|---|
| 1 | Beginning Family | Establishing satisfying home & relationship; preparing for children |
| 2 | Childbearing (1st child to 2½ yrs) | Adjusting to child-rearing demands |
| 3 | Preschoolers (2½-6 yrs) | Coping with school entrance, meeting developmental needs |
| 4 | School-Age (6-13 yrs) | Recognizing achievements, promoting productivity |
| 5 | Teenagers (13-20 yrs) | Allowing independence with guidance from parents |
| 6 | Launching Center | Releasing young adults; accepting new ways of relating |
| 7 | Empty Nest | Renewing marriage relationship; maintaining ties with children's families |
| 8 | Aging Family | Adjusting to retirement; coping with death of spouse |
5 Family Health Tasks (Freeman)
- Recognizing health needs or problems early
- Seeking appropriate healthcare services
- Caring for sick or dependent family members
- Maintaining a safe, clean, and healthy home environment
- Participating in community health programs
Characteristics of a Healthy Family
Good Interaction • Appreciation • Problem Solving • Spiritual Growth • Strong Relationships • Support & Respect • Set Priorities
Family as Client vs Family as System
Nursing Diagnosis Formulation
Example: Inability to utilize community resources for health care due to inadequate family resources (financial, manpower, time)
Barriers to Joint Goal Setting (Freeman)
Evaluation — 4 Core Components
Interview Principles (2nd Level)
Validation: Relate verbal responses with non-verbal cues. Etiology Focus: If family gives negative answer, always explore WHY. Refining: Final product = nursing diagnosis stating the unhealthful response + factors maintaining it.
Leavell & Clark's 3 Levels
7 Roles of the CHN
Clinician • Educator (major) • Advocate • Manager • Collaborator • Leader • Researcher
Philippine Health Levels
RHU Personnel Ratios
MHO: 1:20,000 • PHN: 1:20,000 • RHM: 1:5,000 • BHW: 1:20 households
Primary Health Care (LOI 949)
Alma-Ata 1978: "Health for All by 2000." 4 Cornerstones: Active community participation • Intra/Inter-sectoral linkages • Appropriate technology • Support mechanisms
1. Safe Motherhood
Min. 4 prenatal visits. Iron 60mg + Folate 400µg × 180 days. TT1→TT5 schedule (0-3-5-10-Lifetime).
2. Essential Newborn Care ("Unang Yakap")
Immediate Drying (30s) → Skin-to-Skin → Cord Clamping (1-3 min) → Breastfeeding
3. Newborn Screening (RA 9288)
Basic 6: CH, CAH, Galactosemia, G6PD, PKU, MSUD
4. IMCI
Target: 0-5 yr. Pink=Severe Yellow=Treatment Green=Home
5. First 1000 Days (RA 11148)
| Law | Title | Key Point |
|---|---|---|
| RA 9173 | Nursing Act | Scope of practice; independent practitioners |
| RA 7305 | Magna Carta PHW | Rights, benefits, 40-hr week, hazard pay |
| PD 856 | Sanitation Code | Water, food, waste, sewage standards |
| RA 8749 | Clean Air Act | Pollution control |
| RA 11332 | Notifiable Diseases | Mandatory surveillance/reporting |
| RA 9165 | Dangerous Drugs | 1st offense = rehab; sale = life |
| RA 6675 | Generics Act | Generic names on prescriptions |
| RA 7875 | PhilHealth | National health insurance |
| RA 7610 | Child Abuse | Mandatory reporting |
| RA 9262 | VAWC Act | Protection orders (BPO, TPO, PPO) |
| RA 10121 | DRRM Act | Disaster preparedness & response |
| RA 10354 | RH Law | Contraception & RH education access |
| RA 10152 | Immunization Act | Mandatory vaccines for infants |
- Safe & Quality Nursing Care: Sound decision-making, safety, comfort, privacy
- Management of Resources & Environment: Workload organization, equipment maintenance
- Health Education: Assess learning needs, develop education plans
- Legal Responsibility: Adherence to nursing laws, documentation
- Ethical-Moral Responsibility: Respect client rights (right to refuse), accountability
- Personal & Professional Development: Continuing education, positive attitude toward criticism
- Quality Improvement: Data gathering, participation in nursing rounds
- Research: Research-based formulations to solve client problems
- Records Management: Accurate, updated documentation
- Communication: Establishing rapport, therapeutic communication
- Collaboration & Teamwork: Relationships with health team
Nursing Core Values
Caring (6 Cs): Compassion • Competence • Confidence • Conscience • Commitment • Comportment
Integrity: Respecting dignity without conditions. Respect for Diversity: Affirming uniqueness of persons, ideas, ethnicities.
Social Justice & Health Equity
eHealth & New Technologies
9 Essential Public Health Functions
- Health situation monitoring & analysis
- Epidemiological surveillance & disease prevention
- Development of policies & planning
- Strategic management of health systems
- Regulation & enforcement for public health
- Human resource development & planning
- Health promotion, social participation, empowerment
- Ensuring quality of personal & population-based services
- Research & innovative solutions
Philippine PHN History (Extended)
Interprofessional Care (IPC)
Multiple health workers from different backgrounds working together with patients & families (WHO). Benefits: Empowers members, closes communication gaps, reduces readmission, promotes patient-centered care.
WHO 6 Building Blocks of a Health System
- Service Delivery: Effective, safe, quality interventions
- Health Workforce: Responsive, sufficient, well-trained
- Health Information Systems: Reliable, timely data
- Access to Essential Medicines: Equitable, safe, cost-effective
- Financing: Adequate funds, financial protection
- Leadership & Governance: Strategic policy, oversight, accountability
Elements of PHC (ELEMENTSDAM)
Education • Locally endemic disease control • Expanded immunization • Maternal & child health • Essential drugs • Nutrition • Treatments • Safe water/sanitation • Dental health • Access to Sentrong Sigla • Mental health
PHC Principles (PRAMIS)
Provision of quality services • RA 7160 (Decentralization) • A's of health (Acceptable, Affordable, Available) • Mobilization • Increase community participation • Self-reliance
DOH National Family Planning Program
Methods: Natural (Standard Days, LAM, BBT, Cervical Mucus, Symptothermal) • Artificial (Condoms, Injectables, Pills, IUD, Implants) • Permanent (Vasectomy, BTL)
AHDP (Adolescent Health)
Target: 10-19 years. Goal: Comprehensive care in adolescent-friendly environment. Focus: Nutrition, Mental Health, HIV/STI prevention, Tobacco/Alcohol control, Violence/Injury prevention.
Additional Philippine Health Laws
Micronutrient Supplementation
Vitamin A: 6-59 months, postpartum women within 1 month. Iron: Pregnant/lactating, LBW babies, Grade 7-10 girls. Iodine: Women of reproductive age. Calcium: Pregnant women.
Filipino Core Values (Extended)
Pakikisama: Getting along with all people • Hospitality: Warmth, generosity to guests • Hard Work/Resilience: Dedication, humor during hardship • Compassion: Genuine concern for others • God-Fearing: ~91-93% Christian; spirituality is central
Records & Filing
Ink Convention: Home visits = Blue ink; Clinic visits = Red ink. Filing: Alphabetical, Numerical, Geographical, Index Cards. Family folder = basic unit of service.
Original (1956) — Nouns
Knowledge → Comprehension → Application → Analysis → Synthesis → Evaluation
Revised (2001) — Verbs
Remembering → Understanding → Applying → Analyzing → Evaluating → Creating
| Level | Verbs |
|---|---|
| Remembering | Define, List, Name, Recall |
| Understanding | Explain, Summarize, Interpret, Classify |
| Applying | Execute, Implement, Calculate, Use |
| Analyzing | Compare, Differentiate, Organize |
| Evaluating | Judge, Critique, Verify, Defend |
| Creating | Design, Construct, Develop, Reorganize |
3 Domains
3 Determinants
Learning Needs (what) • Readiness to Learn (when) • Learning Style (how)
Types of Learners
8 Principles of Learning
- Motivated
- Reinforced
- Requires practice
- Requires readiness
- Enhanced by feedback
- Influenced by prior experience
- Active involvement
- Meaningful & relevant = more permanent
Key Strategies
Formative vs. Summative
Gagne's 9 Events
Gain Attention → Inform Objectives → Prior Learning → Present Content → Guidance → Practice → Feedback → Assess → Retention/Transfer
Objective Frameworks
- Clear Learning Objectives — Tell students what they will learn and why
- Strong Subject Knowledge — Accurate, current health information
- Effective Communication — Simple language, examples, visuals
- Engaging Strategies — Group discussions, role-plays, case studies
- Positive Classroom Environment — Safe, respected, encouraged
- Feedback & Assessment — Quick quizzes, open questions, corrective encouragement
- Adaptability — Adjust methods if something isn't working
- Use of Technology/Resources — Visuals, videos, interactive tools, models
- Role Modeling — Practice what you teach
- Encourages Critical Thinking — Thinking beyond memorization
Implementation
Process of carrying out planned teaching strategies & learning activities. Ensures lessons are delivered effectively; encourages active participation.
Evaluation
Assessing whether learning objectives were achieved. Provides feedback to identify strengths & areas for improvement.
Learner Engagement
Lesson Plan Components
Before Class: Identify objectives → Plan activities → Plan assessments → Sequence with Gagne's 9 Events → Create timeline → Plan closure
During Class: Present plan, outline agenda, explain goals & activities
After Class: Reflect on what worked, revise for improvement
Assessment of Learning Needs — 9 Steps
- Identify the learner
- Choose the right setting
- Collect data about the learner
- Collect data from the learner
- Involve healthcare team members
- Prioritize needs
- Determine availability of resources
- Assess organizational demands
- Consider time-management issues
Criteria for Prioritizing Learning Needs
Mandatory → Desirable → Possible
7 Methods to Assess Learning Needs
Informal Conversations • Structured Interview • Focus Groups • Questionnaires • Tests • Observation • Documentation
Developmental Stages of Learners
| Stage | Age | Learning Characteristics |
|---|---|---|
| Infancy | 0-12 mo | Senses & motor; trust & bonding; safe environment |
| Toddler/Preschool | 1-5 yr | Play, imitation, hands-on; concrete & literal thinking |
| School-Age | 6-11 yr | Logical thinking; structured tasks; peer influence |
| Adolescence | 12-19 yr | Abstract thinking; sensitive to peer acceptance; real-life connections |
| Young Adult | 20-40 yr | Peak cognitive ability; self-directed; problem-solving |
| Middle Adult | 41-64 yr | Life experience based; goal-oriented; slower pacing preferred |
| Older Adult | 65+ yr | Clear, simple instructions; repetition; calm environment |
Special Learner Types
Sensory Disabilities • Learning Disabilities • Physical Disabilities • Mental Disabilities/Illness • Learners with Chronic Illness
| Nutrient | kcal/g | Composition | Key Functions |
|---|---|---|---|
| CHO | 4 | C, H, O | Primary fuel (brain); protein-sparing; prevents ketoacidosis |
| Protein | 4 | C, H, O, N | Build/repair tissue; antibodies; enzymes; osmotic pressure |
| Fat | 9 | C, H, O | Concentrated energy; organ cushion; absorbs ADEK |
CHO Classification
Protein-Energy Malnutrition
Lipoproteins
VLDL: Triglycerides. LDL: "Bad" — cholesterol to tissues. HDL: "Good" — removes excess.
Fat-Soluble (A, D, E, K)
Water-Soluble (C, B-complex)
Digestive Pathway
Mouth (amylase) → Esophagus (peristalsis) → Stomach (HCl, pepsin → chyme) → Small Intestine (95% absorption) → Large Intestine (water) → Rectum → Anus
Accessory Organs
Energy Calculation
DBW (Tanhausser's)
AMDR: CHO 45-65% • Fat 20-35% • Protein 10-35%
10% loss = illness. 20% loss = death.
Holliday-Segar Method
Fluid Imbalances
Pitting Edema
+1: 2mm • +2: 2-4mm • +3: 5-7mm • +4: >7mm
Enteral vs. Parenteral
Dietary Reference Intakes (DRIs)
5 Characteristics of a Healthful Diet
1. Adequate (enough energy, nutrients, fiber) • 2. Moderate (right amount) • 3. Nutrient-Dense (high nutrients, low calories) • 4. Balanced (right proportions) • 5. Varied (many different foods)
5 Components of Food Labels
- Statement of Identity (name of food)
- Net Contents (weight/volume/count)
- Ingredient List (highest to lowest amount)
- Name & Address of Manufacturer
- Nutrition Information (Nutrition Facts Panel)
%DV: Based on 2,000-calorie diet. "High": ≥20% DV. "Low": ≤5% DV.
Appetite vs Hunger
Appetite: Psychological desire to eat (sight, smell, thought). Hunger: Physiological need for food (low energy, empty stomach).
Nutrition Tools
Food Pyramid/Guide: Recommended servings by age group. Eatwell Guide: Proportions of food groups. RENI: Philippine nutrient intake guidelines. Food Exchange List: Groups with similar CHO/protein/fat/calories; for diabetic meal planning.