NCM 100 LECTURES

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Nursing as a Profession
Nursing is not simply a collection of
specific skills, and you are not simply a
person trained to perform specific tasks.
Nursing is a profession. No one factor
absolutely differentiates a job from a
profession, but the difference is important
in terms of how you practice. Profession
has been defined as an occupation that
requires extensive education or a calling
that requires special knowledge, skill and
preparation. To act professionally you
administer care in a conscientious and
knowledgeable manner, and you are
responsible to yourself and others. A
profession has the following primary
characteristics:
 A profession requires an extended education of its members, as well as a basic
liberal foundation.
 A profession has a theoretical body of knowledge leading to defined skills, abilities
and norms.
 A profession provides a specific service.
 Members of a profession have autonomy in decision making and practice.
 The profession as a whole has a code of ethics for practice.
Criteria of a Profession
 To provide a needed to service the society
 To advanced knowledge on its field
 To protect its members and make it possible to practice effectively
What is Nursing?
Nursing is an art and science. As a professional nurse, you will learn to deliver
care artfully with compassion, caring, and a respect for each client’s dignity and
personhood. As a science, nursing is based on a body of knowledge that is continually
changing with new discoveries and innovations. When you integrate the science and art of

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nursing into your practice, the quality of care you provide to your clients is at level of
excellence that benefits clients and their families.
Nursing is a profession within the healthcare sector focused on the care of
individuals, families, and communities so they may attain, maintain, or recover optimal
health and quality of life.
Nurses may be differentiated from other health care providers by their approach to
patient care, training, and scope of practice. Nurses practice in a wide diversity of practice
areas with a different scope of practice and level of prescriber authority in each.
Characteristic of Nursing
 Nursing is caring.
 Nursing involves close personal contact with the recipient of care.
 Nursing is concerned with services that take humans into account as physiological,
psychological, and sociological organisms.
 Nursing is committed to promoting individual, family, community, and national health
goals in its best manner possible.
 Nursing is committed to personalized services for all persons without regard to color,
creed, social or economic status.
 Nursing is committed to involvement in ethical, legal, and political issues in the
delivery of health care.
Focus: Human Responses
Human response is a way of looking at how individuals, families or communities
react to all areas of life that influence and impact them. The nurse focus on two types of
responses – reactions to actual health problems or illness (health – restoring responses)
and concerns about potential health problems (health supporting responses). More simply
the nurse focuses on the responses in both sick and well persons. Human responses are
dynamic or changing, as the patient progresses along the continuum between health and
illness.
Personal Qualities of a Nurse
 Must have a Bachelor of Science degree in nursing.
 Must be physically and mentally fit.
 Must have a license to practice nursing in the country.
 A professional nurse therefore, is a person who has completed a basic nursing
education program and is licensed in his country to practice professional nursing.

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Professional Qualities of a Nurse
Professional nurse therefore, is a person who has completed a basic nursing
education program and is licensed in his country to practice professional nursing.
History of Nursing
(History of Nursing in the World)
Periods of Nursing History
Intuitive Period
Apprentice Period
Educative Period
Contemporary Period
Intuitive Period/Medieval Period
Prehistoric → Early Christian Era
More on intuition
NOMADS - travel from one place to another
Survival to the fittest
“best of the most” – motto

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Sickness is due to “voodoo”
Performed out of feeling of compassion for others
Performed out of desire to help
Performed out of wish to do good
Nursing is given by the WOMEN
SHAMAN - uses white magic to counteract the black magic
They are the doctors during those time
TREPHINING - drilling the skull
Used to treat Psychotic patients.
Psychotic patients are believed to be possessed by evil spirits.
Growth of religion - most important thing that happened
Growth of cicilization
Law of preservation – inspire man in search of knowledge

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Rise in Civilization
 From the mode of Nomadic life → agrarian society → gradual development of urban
community life
 Existense of means of communication
 Start of scientific knowledge → more complex life → increase in health problems →
demand for more nurses
 Nursing as a duty of SLAVES and WIVES. NURSING DID NOT CHANGE but there
was progress in the practice of medicine.
 Care of the sick was still closely allied with superstitions, religion and magic
 Near East – birth place of 3 religious ideologist:
 Judaism
 Christianity
 Mohammedism or Islam
- Near East culture was adopted by the Greeks and Romans combined with the
wonders of the Far East by returning crusaders and explorers improved and was
carried to Europe during the Renaissance Period that resulted to greater knowledge
then to the New World by the Early settlers.
 New World – a tiny area known as a birth of monotheism that lies between tigris and
Euprates River in the Nile River arose the cultures of babylonia, Egypt and Hebrew.
 MONOTHEISM – believer of one God
Different Civilization
BABYLONIANS
CODE OF HAMMURABI
1st recording on the medical practice
Established the medical fees
Discouraged experimentation
Specific doctor for each disease
Right of patient to choose treatment between the use of charms, medicine, or
surgical procedure

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EGYPTIANS
ART OF EMBALMING
Mummification
Removing the internal organ of the
dead body
Instillation of herbs and salt to the
dead
Used to enhance their knowledge
of the human anatomy. Since work
was done and performed on the
dead, they learned nothing of
Philosophy
“THE 250 DISEASES”
Documentation about 250 diseases
and treatments
HEBREW
Teaching of MOSES
Created Leviticus
Father of sanitation
Practice the value of “Hospitality to
strangers” and the “Act of Charity” –
contained in the book of the old
Testament
Laws controlling the spread of
communicable diseases
Laws governing cleanliness
Laws on preparation of food
Purification of man and his food
The ritual of CIRCUMCISSION – on
the 8th day after birth
MOSAIC LAW
Meant to keep Hebrews pure so
that they may enter the sanctuary
without affronting God
Meant as a survival for health and
hygienic reason only

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CHINA
Use of pharmacologic drugs
“MATERIA MEDICA”
Book that indicates the pharmacologoc drugs used
for treatment
No knowledge on anatomy
Use of wax to preserve the body of the dead
Method of paper making
FACTOR THAT HAMPERED THE
ADVANCEMENT OF MEDICINE:
Prohibits dissecting of human body thus
thwarting scientific study
INDIA
SUSHURUTO
1st recording on the nursing practice
Hampered by Taboos due to social
strucures and practices of animal worship
Medicine men built hospitals
Intuitive form of asepsis
There was proficient practice of Medicine
and surgery
NURSES QUALIFICATIOS; Lay Brothers,
Priest Nurses, combination of Pharmacist,
Massers, PT, cooks
There was also decline in Medical practice
due to fall of buddhism – state religion of
India

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GREECE
AESCULAPUS
Father of medicine in Greek mythology
HIPPOCRATES
Father of modern medicine
1st to reject the idea that diseases are caused by evil spirits
1st to apply assessment
Practice medical ethics
CADUCEUS
Insignia of medicine
Composed of staff of travellers interwinedwith 2 serpent (the symbol of Aesculapusand
his healing power). At the apex of the staff are two wings of hermes (Mercury) for speed.
NURSES → function of untrained slaves
ROMANS
Proper turnover for the sick people
“if you’re strong, you’re healthy” – motto
Transition from Pagan to Christianity
FABIOLA—was converted to Christian and later she converted her home to a
hospital and used her wealth for the sick.
1st hospital in the Christian world

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Apprentice Period/Middle ages
11th century → 1836
 On-the-job training period
 Refers to a beginner (on-the-job
training). It means care
performed by people who are
directed by more experienced
nurses
 Starts from the founding of
Religious Orders in the 6th
century (1836 – when the
deaconesses School of Nursing
was established in Kaiserweith,
Germany by Pastor THEODORE
FLEIDNER)
 There was a struggle for religious,
political, and economic power
 Crusades took place in order to
gain religious, political, and
economic power or for adventure
 During th Crusade in this period, it happened as an attempt to recapture the Holy
Land from the Turk who obtained and gain control of the region as a result of power
stuggle. Christians were divided due to several religious war and Christians were
denied visit to The Holy Sepulcher.

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Military Religious Orders and their Works
KNIGHTS OF ST. JOHN OF JERUSALEM (ITALIAN)
 Also called as “Knights of the Hospitalers”
 Established to give care
TEUTONIC KIGHTS (GERMAN)
 Took subsequent wars in the Holy
Land
 Cared for the injured and established
hospitals in the military camps
KNIGHTS OF ST. LAZARUS
 Care for those who suffered Leprosy,
syphilis, and chronic skin diseases

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(Alexian Brothers School of Nursing)
 ALEXIAN BROTHERS
 A monasteric order founded in 1348. They established the Alexian Brothers
School of Nursing, the largest school under religious auspices exclusively in US
and it closed down in 1969.
 ST. VINCENT DE PAUL
 LOUISE de GRAS
The Dark Period of Nursing
 From 17th century – 19th century
 Also called the Period of Reformation
until the American Civil War
 Hospitals were closed
 Nursing were the works of the least
desirable people (criminals, prostitutes,
drunkards, slaves,and opportunists)
 Nurses were uneducated, fithy, harsh,
ill-fed, overworked
 Mass exodus for nurses

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(Martin Luther)
 The American civil war was led by Martin Luther, the war was a religious upheaval
that resulted to the destruction in the unity of Christians.
 The conflict swept everything connected to Roman Catholicism in schools,
orphanages, and hospitals
(Theodore Fliedner)
 THEODORE FLIEDNER
 (a pastor) reconstituted the deaconesses and later be established the School of
Nursing at Kaiserswerth, Germany where Florence Nightingale had her 1st
formal training for 3 months as nurse
 FLORENCE NIGHTINGALE
 Practiced her profession during the Crimena War
 “Lady with a lamp”
 From a well-known family
 Went to Germany to study

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Educative Period/Nightingale Era
(Florence Nightingale School of Nursing )
 Began in June 15, 1860 when Florence Nightingale School of Nursing opened at St.
Thomas Hospital in London England, where 1st program for formal education of
Nurses began and contributed growth of Nursing in the US
 FACTORS THAT INFLUENCED DEVELOPMENT OF NURSING EDUCATION:
 Social forces
 Trends resulting from war
 Emancipation of women
 Increased educational opportunities
 Florence Nightingale
 Mother of modern Nursing
 Lady with the Lamp
 Born on May 12, 1820 in Florence, Italy
 Her SELF-APPOINTED GOAL – to change the profile of Nursing
 She complied notes of her visit to hospitals, her observations of sanitation
practices and entered Deaconessess School of Nursing at Kaiserswerth
Germany for 3 months.

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 Became the Superintendent of the Establishment for Gentle Women during the
illness (refers to the ill governess or instructors of Nursing)
 She disapproved restriction on admission of patient and considered this
unchristian and contrary to health care.
 Upgraded the practice of Nursing and made Nursing a honorable profession
 Led other nurses in taking care of the wounded and sick soldiers during the
Crimean War
 She was designated as Superintendent of the Female Establishment of English
General Hospital in Turkey during the Crimean War
 She reduced the casualties of war by 42% - 2% thru her effort by improving the
practice of sanitation techniques and procedure in the military barracks
 THE CONCEPT OF FLORENCE NIGHTINGALE ON NURSING SCHOOL:
 School of Nursing should be self – supporting not subject to the whimps of the
Hospital.
 Have decent living quarters for students and pay Nurse instructors
 Correlate theories to practice
 Support Nursing research and promote continuing education for nurses
 Introduce teaching knowledge that disease could be eliminated by cleanliness
and sanitation and Florence Nightingale likewise did not believed in the
GermTheory of Bacteriology.
 Opposed central registry of nurses
 Wrote Notes on hursing, “What is ang What it is not.”
 Wrote notes on hospitals

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 OTHER SCHOOLS OF NURSING
 LINDA RICHARDS – the first graduate nurse in
United States Graduated in September 1, 1873
 2 NUSING ASSOCIATION / ORGANIZATION THAT
UPGRADED NURSING PRACTICE IN US:
 American Nurses Association
 National League for Nursing Education
Contemporary Period
 World War II – present
 This refers to the period after World War I and the changes and ddevelopment in
the trends and practice of Nursing occuring since 1945 after World War II.
 Includes scientific and technological development, social changes occuring after the
war.
 Nursing offered in College and Universities
 DEVELOPMENT AND TRENDS:
 W.H.O established by U.N to fight diseases by providing health information,
proper nutrition, living standards, environmental conditions.
 The use of Atomic energy for diagnosis and treatment.
 Space Medicine and Aerospace Nursing
 Medical equipment and machines for diagnosis and treatment

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 Health related laws
 Primary Health Care – Nurses involvement in CHN
 Utilization of computers
 Technolgy advances such as development of disposable equipment and suplies
that relieved the tedious task of Nurses.
 Development of the expanded role of Nurses
FACTORS AFFECTING NURSING TODAY:
 Economics
 Consumer’s demand
 Family structure
 Information and Telecommunications
 Legislations
History of Nursing in the Philippines
 EARLY BELIEFS AND PRACTICES
 Beliefs about Causation of diseases:
 Caused or inflicted by other person (enemy or witch)
 Evil spirits
 Beliefs that evil spirits could be driven off by person with powers to expel bad
spirits:
 Believed in Gods of Healing
 Word doctors – priest physicians
HERBULARIOS – herb doctors

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 EARLY CARE FOR THE SICK
 HERBICHEROS – herbmen who practice
witchcraft
 MANGKUKULAM / MANGANGAWAY – a
person suffering from disease without any
identified cause and were believed
bewitched by such
 Difficult child birth and some diseases
attributed to (NONO) midwives
 Difficult child birth, witches were supposed
to be the cause, gunpowder exploded from
a bamboo pole close to the head of the
mother to drive evil spirits

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 EARLY HOSPITALS:
Hospital Real de Manila – 1577
 1st hospital established
 Gov. Francisco de Sande
 To give service to the king’s
Spaniard soldiers
San Lazaro Hospital – 1578
 Fray Juan Clemente
 Named after the Knights of
St. Lazarus
 Hospital for the lepers
Hospital de Indios – 1586
 Franciscan Orders
 Hospital for the poor Filipino people
Hospital de Aguas Santas - 1590
 Fray Juan Bautista
 Named after its location (near
spring) because people
believed that spring has a
healing power.
San Juan de Dios Hospital – 1596
 For poor people
 Located at Roxas Boulevard

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PERSONAGES
Dona Hilaria de Aguinaldo
 1st wife of Emilio Aguinaldo
 Established Philippine Red Cross – February, 17 1899
Dona Maria Agoncillo de Aguinaldo
 2nd wife of Emilio Aguinaldo
 1st president of Philippine Red Cross (Batangas Chapter)
Josephine Bracken
Helped Rizal in treating sick people
Melchora Aquino
 Took care of the wounded Katipuneros
Anastacia Giron Tupas
 Founder of Filipino Nurses Association – established on October 15, 1922
 1st Filipino chief nurse of PGH
 1st Filipino Superintendent of Nurses in the Philippines
Cesaria Tan
 1st Filipino to receive Masteral Degree in Nursing abroad

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Socorro Sirilan
 Pioneer in social service at San Lazaro Hospital
 Also the Chief Nurse
Francisco Delgado
 1st president of Filipino Nurses Association
Socorro Diaz
 1st editor of PNA magaziine called, “The Message”
Conchita Ruiz
 Full time editor of the PNA newly named magazine, “The Filipino Nurse”
Sor Ricarda Mendoza
 Pinoneer in Nursing Education
Loreto Tupaz
 “Dean of the Philippine Nursing”
 Florence of Iloilo

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 EARLY NURSING SCHOOLS
 Iloilo Mission Hospital School of Nursing
 Established in 1906 under the supervision of Rose Nicolet (American)
 Nursing course – 3 years
 Produced 1st batch of nursing graduates in 1909 – 22 nurses
 1st TRAINED NURSES
- Nicasia Cada
- Felipa dela Pena
- Dorotea Caldito
 April 1946 – 1st nursing board exam at Iloilo Mission Hospital
 Mary Johnson School of Nursing
 PGH School of Nursing – 1907
Hospitals and School of Nursin
1. Ilo-ilo Mission Hospital School of
Nursing (Ilo-ilo City, 1906)
 Ran by the baptist forreign mission
society of America.
 Miss Rose Nicolet, graduate of New
England. Hospital for women and
children. In Boston, Masachusetts
was the first superintendent for
nurses. It moved to its present
location in Garo road, Ilo-ilo city
1929.
 Miss Flora Ernst, an American
nurse,
took charge of the school in 1942.
2. St. Paul’s Hospital School of
Nursing (Manila, 1907)
 The hospital was established by the
Archbishop of Manila, the most
Reverend, Jeremiah harty under the
supervision of the sisters of St. Paul the charters.
 Located in the Intramuros, and it provided general hospital services.

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 1908 – operated its training school
for nurses with Rev. Mother Melanie
as superintendent and Miss E
Chambers as principal.
3. Philippine General Hospital
School of Nursing (1907)
 Anastacia Giron Tupas – first
Filipino nurse to occupy the position of chief nurse and superintendent.
4. St. Luke’s Hospital School of Nursing
(Quezon city, 1907)
 1907 – the school opened with
three Filipino girls admitted. These
girls had their firdt year in
combinedclasses with the PGH
Hospital School of Nursing and
St. Paul’s Hospital School of
Nursing.
 Vitaliana Beltran was the first
Filipino superintendent of nurse.
First Colleges of Nursing in the Philippines
 University of Santo Tomas
College of Nursing
 February 11, 1941 – the college began
as the UST school of nurisng education
 Sor Taciana Trinanes was its first
Directress.

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 Manila Central University
College of Nursing
 In 1947, offered the BSN course
 Miss Consuelo Gimeno was its
first principal.
 University of the Philippines
College of Nursing
 The idea of opening the college began
in conference between Miss Julita
Soteja and the UP President Gonzales
 In 1948, the university council approved
the curriculum, and the board of regents
recognized the profession as having
equal standing as medicine, law,
engineering, etc.
 Miss Julita Sotejo was its first dean.
Growth of Professionalism
Carper’s 4 patterns of Knowing
Ethics: The components of moral knowledge
 Guides and directs how nurses conduct their practice
 Requires:
 Experiential knowledge of social values
 Ethical reasoning
 Focus is on:
 Matters of obligation , what ought to be done
 Right, wrong and responsibility
 Ethical codes of nursing
 Confronting and resolving conflicting values, norms, interests or principles

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Sources of Ethical knowing
 Nursing’s ethical codes and professional standards
 An understanding of different philosophical positions
 Consequentalism
 Deontology
 Duty
 Social justice
Personal Knowing: Acceptance of self that is grounded in self knowledge and confidence
 Concerned with becoming self aware
- self awareness that grows over time through interactions with others
 Used when nurses engage in the therapeutic use of self in practice
- scientific confidence, moral/ethical , practice, insight, and experience of personal
knowing.
 Personal knowing needs to be integrated or reconciled with professional
responsibilities.
 Personal knowing is the basis of the therapeutic use of self in the nurse – patient
relationship.
- perceiving self feelings, and prejudices within the situation
Aesthetic Knowing: The art of nursing
 Expressed through :
 Actions, bearing, conduct, attitudes, narratives and interaction.
 Knowing what to do without conscious deliberation
 Involves :
 Deep appreciation of the meaning of a situation
 Moves beyond the surface of a situation
 Often shared without conscious exchange of words
 Transformative art/acts
 Brings together all the elements of a nursing care situation to create a
meaningful whole
 Perceiving the nature of a clinical situation and interpreting this information
 To respond with skill action
 It uses the nurses intuition and empathy
 Is based on the skill of the nurse
Empirics: the science of nursing.Based on the assumption that what is known is
accessible through the physical senses :
 seeing, touching and hearing.
- reality exists and truths about it can be understood
 A pattern of knowing that draws on traditional ideas of science
 Expressed in practice as scientific competence
 Positivist Science
 Science is systematically organized into general laws and theories

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 Source of this knowledge :
 Research
 Theory
Overview of the Professional Nursing Practice
Level of Proficiency according to Benner
Benner’s Level of Proficiency
Novice
Beginner with no experience.
Performance is limited, inflexible, and governed by context-free rules and regulations
rather than experience.
Advanced Beginner
Demonstrates marginally acceptable performance.
Recognizes the meaning “aspects” of a real situation.
Has experienced enough in real situations to make judgments about them.
Competent
Have 2 or 3 years of experience.
Demonstrates organizational and planning abilities
Differentiates important factors from less important aspects of care.
Coordinates multiple complex care demands.
Proficient
Have 3 or 5 years of experience.
Perceives situations as wholes rather than in terms of parts as in stage II.
Uses maxims as guides for what to consider in a situation
Has holistic understanding of the client, which improves decision making focuses on
long-term goals.
Expert
Performance is fluid, flexible, and highly proficient.
No longer requires rules, guidelines, or maxims to connect an understanding of the
situation to appropriate action.Demonstrates highly skilled intuitive and analytic ability in
new situation Is inclined to take a certain action because “it felt right”.

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Roles and Responsibility of a Professional Nurse
 Caregiver
The caregiver role has traditionally included those activities that assist the client
physically and psychologically while preserving the client’s dignity. The required
nursing actions may involve full care for the completely dependent client, partial care
for the partially dependent client, and supportive-educative care to assist clients in
attaining their highest possible level of health and wellness.
 Communicator
Communicator is integral to all nursing roles. Nurses communicate with the client,
support persons, other health professional, and people in the community. In the role of
communicator nurses identify client problems and then communicate these verbally or
in writing to other members of the health care team.
 Teacher
As a teacher, the nurse helps clients learn about their health and the health care
procedures they need to perform to restore or maintain their health. The nurse

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assesses the client’s learning needs and readiness to learn, sets specific learning goals
in conjunction with the client, enacts teaching strategies, and measures learning.
 Client Advocate
A client advocate acts to protect the client. In this role the nurse may represent the
client’s needs and wishes to other health professionals, such as relaying the client’s
wishes for information to the physician.
 Counselor
Counseling is the process of helping a client to recognize and cope with stressful
psychological or social problems, to develop improved interpersonal relationships, and
to promote personal growth. It involves providing emotional, intellectual, and
psychological support.
 Change Agent
The nurses as a change agent when assisting clients to make modification in their
behavior Nurses also often act to make changes in a system, such as clinical care, if it
is not helping a client return to health.
 Leader
A leader influences other to work together to accomplish a specific goal. The leader
role can be employed at different levels: individual client, family, groups of clients,
colleagues, or the community.
 Manager
The nurse manages the nursing care of individuals, families, and communities.The
nurse manager also delegates nursing activities to ancillary workers and other nurses,
and supervises and evaluates their performance.
 Case Manager
Nurse care managers work with the multidisciplinary health care team to measure the
effectiveness of the care management plan and to monitor outcomes. Each agency or
unit specific the role of the nurse case manager.
 Research Consumer
Nurses often use research to improve client care. In a clinical area, nurses need to
have some awareness of the process and language of research. Be sensitive to issues
related to protecting the rights of human subjects. Participate in the identification of
significant researchable problems. Be a discriminating consumer of research findings.

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Expanded Roles of the Nurses
 Nurse Practitioner
A nurse who has an advanced education and is a
graduate of a nurse practitioner program. These nurses are
certified by the American Nurses Credentialing Center in
areas such as adult nurse practitioner, family nurse
practitioner, school nurse practitioner, pediatric nurse
practitioner, or gerontology nurse practitioner. They are
employed in health care agencies or community-based
settings. They usually deal with nonemergency acute or
chronic illness and provide primary ambulatory care.
 Clinical Nurse Specialist
A nurse who has an advanced degree or expertise and
is considered to ba an expert in a specialized area of
practice. The nurse provides direct client care. Educates
others, consults, conducts research, and manages care.
The American Nurses Credentialing Center provides
national certification of clinical specialists.
 Nurses Anesthetist
A nurse who has completed advanced education in
an accredited program in anesthesiology. The nurse
anesthetist carries out preoperative visits and
assessment, and administers general anesthetics for
surgery under the supervision of a physician prepared in
anesthesiology. The nurse anesthetist also assesses the
postoperative status of clients.
 Nurse Midwife
An RN who has completed a program in midwifery
and is certified by the American College of Nurse
Midwives. The nurse gives prenatal and postnatal care
and manages deliveries in normal pregnancies. The
midwife practices in associated with a health care agency
and can obtain medical services if complications occur.
The nurse midwife may also conduct routine papanicolaou
smears, family planning, and routine breast examinations.

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 Nurse Researcher
Nurse researchers investigate nursing problems to improve nursing care and to
refine and expand nursing knowledge. They are employed in academic institutions,
teaching hospitals, and research centers such as the National Institute for nursing
Research in Bethesda, Maryland. Nurse researchers usually have advanced education
at the doctoral level.
 Nurse Administrator
The nurse administrator manages client care, including the delivery of nursing
services. The administrator may have a middle management position, such as head
nurse or supervisor, or a more senior management position, such as director of nursing
services. The functions of nurse administrator include budgeting, staffing, and planning
programs. The educational preparation for nurse administrator positions is at least a
baccalaureate degree in nursing and frequently a master’s or doctoral degree.
 Nurse Educator
Nurse educators are employed in nursing
programs, at educational institutions, and in hospital
staff educator. The nurse educator usually has a
baccalaureate degree or more advanced
preparation and frequently has expertise in a
particular area of practice. The nurse educator is
responsible for classroom and often clinical
teaching.
 Nurse entrepreneur
A nurse who usually has an advanced degree
and manages a health related business. The nurse
may be involved in education, consultation, or
research.

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Scope of Nursing
Scope of Nursing Practice based on RA 9173:
Sec. 28 Scope of Nursing Practice – As independent practitioners, nurses is
primarily responsible for the promotion of health and prevention of illness. As members
of the health team, nurses shall collaborate with other health care givers for the curative,
prevention, and rehabilitative aspects of care, restoration of health, alleviation of
suffering, and when recovery is not possible, towards a peaceful death.
Code of Ethics for Nurses
The code of ethics is the philosophical ideals of right and wrong that define the
principles you will use to provide care to your clients. A code of ethics is a set of guiding
principles that all members of a profession accept. It is a collective statement about the
group’s expectations and standards of behavior. Codes serve as guidelines to assist
professional groups when questions arise about correct practice or behavior.
American Nurses Association Code of Ethics
 The nurse, in all professional relationships, practices with compassion and respect for
the inherent dignity, worth, and uniqueness of every individual, unrestricted by
considerations of social or economic status, personal attributes or the nature of health
problems.
 The nurse's primary commitment is to the patient, whether an individual, family, group,
or community.
 The nurse promotes, advocates for, and strives to protect the health, safety, and rights
of the patient.
 The nurse is responsible and accountable for individual nursing practice and determines
the appropriate delegation of tasks consistent with the nurse's obligation to provide
optimum patient care.
 The nurse owes the same duties to self as to others, including the responsibility to
preserve integrity and safety, to maintain competence, and to continue personal and
professional growth.
 The nurse participates in establishing, maintaining, and improving health care
environments and conditions of employment conducive to the provision of quality health
care and consistent with the values of the profession through individual and collective
action.
 The nurse participates in the advancement of the profession through contributions to
practice, education, administration, and knowledge development.
 The nurse collaborates with other health professionals and the public in promoting
community, national, and international efforts to meet health needs.
 The profession of nursing, as represented by associations and their members, is
responsible for articulating nursing values, for maintaining the integrity of the profession
and its practice, and for shaping social policy

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Basic Principles to Maintain
Advocacy – refers to the support of a cue. As a nurse, you advocate for the health, safety
and rights of the clients.
Responsibility – refers to a willingness to respect obligations and to follow through on
promises.
Accountability - refers to the ability to answer for one’s own actions.
Confidentiality – protection of client’s personal health information. The legislation defines
the rights and priveledges of clients for protection of privacy without diminishing access to
quality care.
Filipino Patient’s Bill of Rights
1. The patient has the right to considerate and respectful care irrespective of socio-
economic status.
2. The patient has the right to obtain from his physician complete current information
concerning his diagnosis, treatment and prognosis in terms the patient can reasonably
be expected to understand. When it is not medically advisable to give such information
to the patient, the information should be made available to an appropriate person in his
behalf. H has the right to know by name or in person, the medical team responsible in
coordinating his care.
3. The patient has the right to receive from his physician information necessary to give
informed consent prior to the start of any procedure and/or treatment. Except in
emergencies, such information for informed consent should include but not necessarily
limited to the specific procedure and or treatment, the medically significant risks
involved, and the probable duration of incapacitation. When medically significant
alternatives for care or treatment exist, or when the patient requests information
concerning medical alternatives, the patient has the right to such information. The
patient has also the right to know the name of the person responsible for the procedure
and/or treatment.
4. The patient has the right to refuse treatment/life – giving measures, to the extent
permitted by law, and to be informed of the medical consequences of his action.
5. The patient has the right to every consideration of his privacy concerning his own
medical care program. Case discussion, consultation, examination and treatment are
confidential and should be conducted discreetly. Those not directly involved in his care
must have the permission of the patient to be present.
6. The patient has the right to expect that all communications and records pertaining to
his care should be treated as confidential.
7. The patient has the right that within its capacity, a hospital must make reasonable
response to the request of patient for services. The hospital must provide evaluation,

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service and/or referral as indicated by the urgency of care. When medically permissible
a patient may be transferred to another facility only after he has received complete
information concerning the needs and alternatives to such transfer. The institution to
which the patient is to be transferred must first have accepted the patient for transfer.
8. The patient has the right to obtain information as to any relationship of the hospital to
other health care and educational institutions in so far as his care is concerned. The
patient has the right to obtain as to the existence of any professional relationship
among individuals, by name who are treating him.
9. The patient has the right to be advised if the hospital proposes to engage in or perform
human experimentation affecting his care or treatment. The patient has the right to
refuse or participate in such research project.
10.The patient has the right to expect reasonable continuity of care; he has the right to
know in advance what appointment times the physicians are available and where. The
patient has the right to expect that the hospital will provide a mechanism whereby he is
informed by his physician or a delegate of the physician of the patient’s continuing
health care requirements following discharge.
11.The patient has the right to examine and receive an explanation of his bill regardless of
source of payment.
12.The patient has the right to know what hospital rules and regulation apply to his
conduct as a patient.
Legal Aspects of Nursing
Nursing practice is governed by many legal concepts. It is important for nurses to
know the basics of legal concepts, because nurses are accountable for their professional
judgments and actions accountability is an essential concept of professional nursing
practice and the law. Knowledge of laws that regulate and effect nursing practice is
needed for two reasons:
1. To ensure that the nurse’s decisions and actions are consistent with current legal
principles.
2. To protect the nurse from liability.
General Legal Concepts
Law can be defined as “the sum total of rules and regulations by which a society is
governed. As such, law is created by people and exists to regulate all persons” (Guido,
2006).

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Functions of the Law in Nursing
The law serves a number of functions in nursing:
 It provides a framework for establishing which nursing actions in the care of clients are
legal.
 It differentiates the nurse’s responsibilities from those of other health professionals.
 It helps establish the boundaries of independent nursing action.
 It assists in maintaining a standard of nursing practice by making nurses accountable
under the law.
Sources of Law
The legal system in the United States has its origin in the English common law system.
Constitutional Law
The Constitution of the United States is the supreme law of the country. It establishes the
general organization of the federal government, grants certain powers to the government,
and places limits on what federal and state governments may do. The constitution creates
legal rights and responsibilities and is the foundation for a system of justice. For example,
the constitution ensures each U.S. citizen the right to due process of law.
Legislation (Statutory Law)
Laws enacted by any legislative body are called statutory laws. When federal and state
laws conflict, federal laws.
The regulation of nursing is a function of state law. State legislatures pass statutes
that define and regulate nursing, that is, nurse practice acts. These acts, however, must be
consistent with constitutional and federal provisions.
Administrative Law
When a state legislature passes a statute, an administrative agency is given the authority
to create rules and regulations to enforce the statutory laws. For example, state boards of
nursing write rules and regulations to implement and enforce a nurse practice act, which
was created through statutory law (Guido, 2006).
Common Law
Laws evolving from court decisions are referred to as common law. In addition to
interpreting and applying constitutional or statutory law, courts also are asked to resolve
disputes between two parties. Common law is continually being adapted and expanded. In

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deciding specific controversies, courts generally adhere to the doctrine of stare decisis---
“to stand by things decided”—usually referred to as “following precedent.”In other words, to
arrive at a ruling in a particular case, the court applies the same rules and principles
applied in previous, similar cases.
Types of Laws
Laws can be further classified into different types. The two main types are public law and
private or civil law.
Public law refers to the body of law that deals with relationships between individual and
the government and governmental agencies. An important segment of public law is
criminal law, which deals with actions against the safety and welfare of the public.
Examples are homicide, manslaughter, and theft. Crimes can be classified as either
felonies or misdemeanors, which are described in more detail later in this chapter.
Private law, or civil law, is the body of law that deals with relationships among private
individuals. It can be categorized into a variety of legal specialties such as contract law and
tort law.
Contract law involves the enforcement of agreements among private individuals or the
payment of compensation for failure to fulfill the agreements. Tort law defines and enforces
duties and rights among private individuals that are not based on contractual agreements.
Some examples of tort laws applicable to nurses are negligence and malpractice, invasion
of privacy and assault and battery, which are discussed in more detail later in this chapter.
Kinds of Legal Actions
There are two kinds of legal actions: civil or private actions and criminal actions. Civil
actions deal with the relationships among individuals in society; for example, a man may
file a suit against a person who he believes cheated him. Civil actions that are of concern
to nurses include the torts and contracts listed. Criminal actions deal with disputes
between an individual and the society as a whole; for example, if a man shoots a person,
society brings him to trial. The major difference between civil and criminal law is the
potential outcome for the defendant. If found guilty in a civil action, such as malpractice,
the defendant will have to pay a sum of money. If found guilty in a criminal action, the
defendant may lose money be jailed, or be executed and, if a nurse, could lose his or her
license. The action of a lawsuit is called litigation, and lawyers who participate in lawsuits
may be referred to as litigators.

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The Civil Judicial Process
The judicial process primarily functions to settle disputes peacefully and in accordance
with the law. A lawsuit has strict procedural rules. There are generally five steps:
1. A document, called a complaint, is filed by a person referred to as the plaintiff, who
claims that his or her legal rights have been infringed on by one or more other persons or
entities, referred to as defendants.
2. A written response, called an answer, is made by the defendants.
3. Both parties engage in pretrial activities, referred to as discovery, in an effort to obtain
all the facts of the situation.
4. In the trial of the case, the entire relevant are presented to a jury or only to a judge.
5. The judge renders a decision, or the jury renders a verdict. If the outcome is not
acceptable to one of the parties, an appeal can be made for another trial.
During a trial, a plaintiff must offer evidence of the defendant’s wrongdoing. This duty of
proving an assertion of wrongdoing is called the burden of proof.
Nurses as Witnesses
A nurse may be called to testify in a legal action. It is advisable that any nurse who is
asked to testify in such a situation seek the advice of an attorney before providing
testimony. In most cases, the attorney for the employer will provide support and counsel
during the legal case. If the nurse is the defendant, however it is advisable for the nurse to
retain an attorney to protect the nurse’s own interest.
A nurse may also be asked to provide testimony as an expert witness. An expert witness
has special training, experience, or skill in a relevant area and is allowed by the court to
offer an opinion on some issue within his or her area of expertise. The nurse’s credentials
and expertise help a judge or jury understand the appropriate standard of care. The nurse
expert, thus, has the ability to analyze the facts or evidence and draw inferences (e.g., was
the standard of care met).
Regulation of Nursing Practice
Protection of the public is the legal purpose for defining the scope of nursing practice,
licensing requirements, and standards of care. Nurses who know and follow their nurse
practice act and standards of care provide safe, competent nursing care.
Nurse Practice Acts
Each state has a nurse practice act, which protects the public by legally defining and
describing the scope of nursing practice. State nurse practice also legally control nursing

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practice through licensing requirements. For advanced nursing practice, many states
require a different license or have an additional clause that pertains to actions that may be
performed only by nurses with advanced education. For example, an additional license
may be required to practice as a nurse midwife, nurse anesthetist, or nurse practitioner.
The advanced practice nurse also requires a license to prescribe medication or order
treatments from physical therapists or other health professionals.
Nurse practice acts, while similar, do differ from state to state. For example, they
may differ in their scope of practice definition and in licensing and license renewal
requirements. It is the nurse’s responsibility to know the nurse practice act of the state in
which he or she practices nursing. A state’s nurse practice act is easily accessed at the
specific state board or nursing’s website.
Credentialing
Credentialing is the process of determining and maintaining competence in nursing
practice. The credentialing process is one way in which the nursing profession maintains
standards of practice and accountability for the educational preparation of its members.
Credentialing includes licensure, certification, and accreditation.
Licensure
A license is a legal permit that a government agency grants to individuals to engage in the
practice of a profession and to use a particular title. Nursing licensure is mandatory in all
states. For a profession or occupation to obtain the right to license its members, it
generally must meet three criteria:
1. There is a need to protect the public’s safety or welfare.
2. The occupation is clearly delineated as a separate, distinct area of work.
3. There is a proper authority to assume the obligations of the licensing process, for
example, in nursing, state boards of nursing.
Each state has a mechanism by which license can be revoked for just cause (e.g.,
incompetent nursing practice, professional misconduct, or conviction of a crime such as
using illegal drugs or selling drugs illegally). In each situation, a committee at a hearing
reviews all the facts. Nurses are entitles to be represented by legal counsel at such a
hearing. If nurse’s license is revoked as a result of the hearing, either the nurse can appeal
the decision to a court of law or, in some states, an agency is designated to review the
decision before any court action is initiated.
Mutual Recognition Model
Historically, licensure for nurses has been state based; that is, the state’s board of nursing
has licensed all nurses practicing in the state. Changes, however, in health care delivery

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and telecommunication technology advances (e..g., telehealth) have raised questions
about the state-based model. Telehealth is the delivery of health services over distances
and is used to describe the wide range of services delivered by all health-related
disciplines (Greenberg, 2000, p. 220). Thus, according to the state-based model, a nurse
who electronically interacts with a client in another state to provide health information or
intervention is practicing across state lines without a license in the other state.
In response, the National Council of State Boards of Nursing (NCSBN) developed a
new regulatory model named the mutual recognition model, which allows for multistate
licensure. With mutual recognition, a nurse who is not under discipline can practice in
person or electronically across state lines under one license. For example, a nurse who
lives on the border of a state can practice in both states under one license if the adjoining
states have an interstate compact. A nurse who practices nursing in a state other than his
or her primary state of residence must still contact the other state’s board of nursing and
provide proof of licensure.
An interstate compact called the Nurse Licensure Compact (NLC) (an agreement
between two or more states) is the mechanism used to create mutual recognition among
states. The state legislature initiates and decides on the establishment of an inter-state
compact or NLC. As of 2006, 20 states have implemented the Nurse Licensure Compact
for RNs and LVN/LPNs and two states are pending implementation. Only those states who
have adopted the RN and LPN/LVN Nurse Licensure Compact may implement a compact
for advanced practice registered nurses (APRNs). Utah and Iowa have adopted the APRN
compact as of 2006. The NCSBN website provides current information about the number
of states that have passed NLC legislation.
Certification
Certification is the voluntary practice of validating that an individual nurse has met
minimum standards of nursing competence in specialty areas such as maternal-child
health, pediatrics, metal health, gerontology, and school nursing. National certification may
be required to become licensed as an advanced practice nurse. Certification programs are
conducted by the American Nurses Association (ANA) and by specialty nursing
organizations.
Civil and Common Law Issues in Nursing Practice
TORTS
A tort is a civil wrong made against a person or property. Classifications for torts include
intentional, quasi-intentional, or unintentional. Intentional torts are willful acts that violate
another’s rights, such as assault, battery and false imprisonment. Quasi-intentional torts

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are acts where intent is lacking but volitional action and direct causation occur, such as
found with invasion of privacy and defamation of character. The third classification of tort is
the unintentional tort, which includes negligence or malpractice.
Intentional Torts
Assault – is any intentional threat to bring about harmful offensive contact. No
actual contact is necessary. The law protects clients who are afraid of harmful
contact. It is an assault for a nurse to threaten to give a client an injection or to
threaten to restrain a client for an x-ray procedure when the client has refused
consent. The key issue is the client’s consent. In an assault lawsuit, if the client’s
give consent, the nurse is not responsible for assault.
Battery- is any intentional touching without consent. The contact can be harmful to
the client and cause an injury or it can be harmful to the client and cause an injury,
or it can be merely offensive to the client’s personal dignity. A battery always
includes an assault, which is why the terms assault and battery are commonly
combined.
False Imprisonment- the tort of false imprisonment occurs with unjustified
restraining of a person without legal warrant. For example, this occurs when nurses
restrain a client in a bounded area to keep the person from freedom.
Quasi-intentional Torts
Invasion of Privacy – the tort of invasion of privacy protects the client’s right to be free
from unwanted intrusion into his or her private affairs. The four types of invasion of privacy
torts are; intrusion on seclusion, appropriation of name or likeness, publication of
private or embarrassing facts and publicity placing one in a false light in the public
eye. Example: in a classic case, reporters published photographs of female client in her
hospital room without her consent. Courts upheld a claim for invasion of privacy. This case
is an example of intrusion on seclusion or publication of private, embarrassing facts.
Release of a client’s medical information to an unauthorized person, such as a member of
the press or the client’s employer. The information that is in a client’s medical record is a
confidential communication. You share it with health care providers for the purpose of
medical treatment only.
A client’s medical record is confidential. Do not dissolve the client’s confidential medical
information without the client’s consent. For example, respect the wish not to inform the
client’s family of a terminal illness similar, do not assume that a client’s history, particularly

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with respect to private issues such as mental illness, medications, pregnancy, abortion,
birth control or sexually transmitted diseases.
Defamation of Character
Defamation of Character – is the publication of false statements that result in
damage to a person’s reputation. The statements must be polished with malice in
the case of a public official or public figure. Malice means that the person publishing
the information known it is false and publishes it anyway or publishes it with
reckless disregard as to the truth. Slander occurs when one verbalizes the false
statement. For example, if a nurse tells people erroneously that a client has
venereal disease and the disclosure affects the client’s business, the nurse is liable
for slander. Libel is the written defamation of character. Charting false entries is
another example of defamation.
Unintentional Torts
 Negligence – is conduct that falls below
a standard of care the law established the
standard of care for the protection of
other against an unreasonably great risk
for harm.
 Malpractice – malpractice is one type of negligence and often referred to as
professional negligence. When nursing care falls below a standard of care, nursing
malpractice results. To establish nursing malpractice, there are certain criteria: (1)
the nurse (defendant) owed a duty to the client (plaintiff), (2) the nurse did not carry
out that duty, (3) the client was injured, and (4) the nurse’s failure to carry out the
duty caused the injury. Even though nurses do not intend to injure clients, some
clients file claims of negligence if nurse give care does not meet the appropriate
standard.

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The best way for nurses to avoid negligence is to follow standards of care, give competent
health care, and communicate with other health care providers. You will also avoid
negligence by developing a caring rapport with the client and documenting assessments,
interventions, and evaluations fully.
The four Elements of Malpractice
Duty
The plaintiff must first show that the nurse had a duty to provide care for the plaintiff. The
element of duty is usually straightforward and relatively easy for the plaintiff to prove
because once nurses undertake care for their patients they have a clear duty to provide
care for that patient in a competent and reasonable manner. Nurses owe a clear duty of
care to all of their patients.
Breach of Duty
When applied to nursing, a breach of a duty occurs when a nurse does, or does not do,
what a reasonable nurse would have done under the same, or similar, circumstances. This
would mean that the nurse’s care fell below the acceptable standard of care. The standard
of care is a legal concept which reflects how a nurse is expected to act professionally. It
incorporates the expectation that nurses conduct themselves with the degree of care, skill
and knowledge that reasonably competent nurses would exhibit in a similar situation. It is
important to remember that the standard represents a minimum level of practice to which
nurses must adhere in order to avoid being found negligent. In other words, nurses do not
have to exert heroic efforts to perform their job satisfactorily; they are expected to exercise
their good judgment, education and training to the best of their ability, under the
circumstances. Nursing care that falls below the acceptable standard of care may result in
a medical
malpractice lawsuit against the nurse.
Injury
To prove the element of injury the plaintiff must be able to establish that, in addition to pain
and suffering, they have experienced a physical injury, lost money or have an actual
reduction in the quality of their life. The injury which the plaintiff suffered will help to
determine the monetary damages that will be awarded if the plaintiff succeeds at trial.

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Causation
Causation is often the most difficult element of medical malpractice to prove. In order to
prove that the defendant caused their injury, loss or harm, the plaintiff must show that the
defendant's act or omission either caused, or was a substantial factor in causing, harm to
the plaintiff. If the defendant proves that the harm would have occurred anyway,
irrespective of the defendant’s act or omission, then the negligence action will fail for lack
of causation.
Consent
A signed consent form is required for all routine treatment, hazardous procedures such as
surgery, some treatment programs such as chemotherapy, and research involving clients.
If a client is deaf, illiterate, or speaks a foreign language, there needs to be an official
interpreter to explain the terms of consent. A family member or acquaintance who speaks
client’s language should not interpret health information. Make every effort to assist the
client in making an informed choice.
Informed Consent
Is a person’s agreement to allow something to happen, such as surgery or an invasive
diagnostic procedure, based on a full disclosure of risks, benefits, alternatives. And
consequences of refusal.
Telephone Order
A telephone order involves a physician’s or health care provider’s stating prescribed
therapy over the phone to a registered nurse. A verbal order may be accepted when there
is no opportunity for a physician or health care provider to write the order, as an
emergency situation.
Good Samaritan Law
Nurses act as Good Samaritans by providing emergency assistance at an accident scene.
All states have Good Samaritan Laws enacted to encourage health care professionals to
assist in emergencies. Although provisions vary among states, these laws limit liability and
offer legal immunity for nurses who help at the scene of an accident.
Negligence in Nursing Practice
(Three Doctrines)
 Doctrines of Res Ipsa Loquitor-" things speak for itself"- and no further proof is
required.
 Doctrines of Respondeat Superior-"let the master answer the act of the subordinates"
 Doctrines of Force Majeure-"irresistible force that is unforeseen and inevitable.

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Ethics
Ethics is the study of conduct and character. It is concerned with determining what is good
or valuable for individuals, for groups of individuals, and for society at large. Acts that are
ethical reflect a commitment to standards beyond personal preferences – standards that
individuals, professions, and societies strive to meet. When it comes to decision making in
health care, however, differing values between individuals cause intense disagreement
about the right thing to do. Understandable conflict occurs between health care providers,
families, clients, friends, and people in the community about the right thing to do when
ethics, values, and decisions about health care collide.
Basic Terms in Health Ethics
Autonomy
Respect for autonomy refers to the commitment to include clients decisions about all
aspects of care. For example, the consent that clients read and sign before surgery
illustrates this respect for autonomy. The signed consent ensures that the health care team
obtained permission from the client before proceeding with the surgery.
Beneficence
Refers to taking positive actions to help others. The practice of beneficence encourages
the urge to do good for others. The agreement to act with beneficence also requires that
the best interests of the client remain more important than self-interest. A child may ask pill
to be crushed and mixed with favorite food, even though you know the child is able to
swallow pills whole. Your commitment to do good for others guides you to comply with the
child’s wishes, even if you are having a busy day.
Nonmalaficence
Maleficence refers to harm or hurt; thus nonmaleficence is the avoidance of harm or hurt.
In health care, ethical practice involves not only the will to do good, but also the equal
commitment to do no harm. The health care professional tries to balance the risks and
benefits of a plan of care while striving to do the least harm possible.
Justice
Refers to fairness. Health care providers agree to strive for justice in health care. The term
often is used in discussions about health care resources. What constitutes a fair
distribution of resources is not always clear.

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Fidelity
Refers to the agreement to keep promises. A commitment to fidelity supports the
reluctance to abandon clients, even when disagreement occurs about decisions that a
client makes. The standard of fidelity also includes an obligation to follow through with care
offered to clients.
Accreditation/Approval of Basic Nursing Education Programs
One of the functions of a state board of nursing is to ensure that schools preparing nurses
maintain minimum standards of education. Depending on the state, a state board of
nursing must either approve or accredit a nursing program. This is a legal requirement.
Nursing programs can also choose to seek voluntary accreditation from a private
organization such as the National League for Nursing accrediting Commission (NLNAC)
and the Commission of Collegiate Nursing Education (CCNE). Maintaining voluntary
accreditation is a means of informing the public and prospective students that the nursing
program has met certain criteria.
All states require approval/accreditation by the state board of nursing. Some states
require that nursing programs be both state approved/accredited and accredited by a
national accrediting agency such as NLNAC or CCNE.
Standards of Care
The purpose of standards of care is to protect the consumer. Standards of care are the
skills and learning commonly possessed by members of a profession (Guido, 2006, p. 55).
These standards are used to evaluate the quality of care nurses provide and, therefore,
become legal guidelines for nursing practice.
Nursing standards of care can be classified into two categories: internal and
external standards. Internal standards of care include “the nurse’s job description,
education, and expertise as well as individual institutional policies and procedures (Guido,
2005, p. 64).
External standards consist of the following:

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● Nurse practice acts
● Professional organizations (e.g., ANA)
● Nursing specialty-practice organizations (e.g., Emergency Nurses Association, Oncology
Nursing Society)
Legal Aspects of Nursing
11 Key Areas of Responsibility
1. Safe and Quality Nursing Care
Core Competency 1:
Demonstrates knowledge base on the health/illness status of individual/groups
Indicators
• Identifies the health needs of the clients (individuals, families, population groups and/or
communities)
• Explains the health status of the clients/ groups
Core Competency 2:
Provides sound decision making in the care of individuals / families/groups considering
their beliefs and values
Indicators
• Identifies clients’ wellness potential and/or health problem
• Gathers data related to the health condition
• Analyzes the data gathered
• Selects appropriate action to support/enhance wellness response; manage the health
problem
• Monitors the progress of the action taken
Core Competency 3:
Promotes safety and comfort and privacy of clients
Indicators
• Performs age-specific safety measures in all aspects of client care
• Performs age-specific comfort measures in all aspects of client care
• Performs age-specific measures to ensure privacy in all aspects of client care
Core Competency 4:
Sets priorities in nursing care based on clients’ needs
Indicators
• Identifies the priority needs of clients
• Analyzes the needs of clients
• Determines appropriate nursing care to address priority needs/problems

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Core Competency 5:
Ensures continuity of care
Indicators
• Refers identified problem to appropriate individuals / agencies
• Establishes means of providing continuous client care
Core Competency 6:
Administers medications and other health therapeutics
Indicators
• Conforms to the 10 golden rules in medication administration and health therapeutics
Core Competency 7:
Utilizes the nursing process as framework for nursing
7.1 Performs comprehensive and systematic nursing assessment
• Obtains informed consent
• Completes appropriate assessment forms
• Performs appropriate assessment techniques
• Obtains comprehensive client information
• Maintains privacy and confidentiality
• Identifies health needs
7.2 Formulates a plan of care in collaboration with clients and other members of the
health team
• Includes client and his family in care planning
• Collaborates with other members of the health team
• States expected outcomes of nursing intervention maximizing clients’ competence
• Develops comprehensive client care plan maximizing opportunities for prevention of
problems and/or enhancing wellness response
• Accomplishes client-centered discharge plan
7.3 Implements planned nursing care to achieve identified outcomes
• Explains interventions to clients and family before carrying them out to achieve
identified outcomes
• Implements nursing intervention that is safe and comfortable
• Acts to improve clients’ health condition or human response
• Performs nursing activities effectively and in a timely manner
• Uses the participatory approach to enhance client-partners empowering potential for
healthy life style/wellness
7.4 Evaluates progress toward expected outcomes
• Monitors effectiveness of nursing interventions
• Revises care plan based on expected outcomes

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2. Management of Resources and Environment
Core Competency 1:
Organizes work load to facilitate client care
Indicators
• Identifies tasks or activities that need to be accomplished
• Plans the performance of tasks or activities based on priorities
• Verifies the competency of the staff prior to delegating tasks
• Determines tasks and procedures that can be safely assigned to other members of
the team
• Finishes work assignment on time 6
Core Competency 2:
Utilizes financial resources to support client care
Indicators
• Identifies the cost-effectiveness in the utilization of resources
• Develops budget considering existing resources for nursing care
Core Competency 3:
Establishes mechanism to ensure proper functioning of equipment
Indicators
• Plans for preventive maintenance program
• Checks proper functioning of equipment considering the:
- intended use
- cost benefits
- Infection control
- Safety
- Waste creation and disposal storage
• Refers malfunctioning equipment to appropriate unit
Core Competency 4:
Maintains a safe environment
Indicators
• Complies with standards and safety codes prescribed by laws
• Adheres to policies, procedures and protocols on prevention and control of infection
• Observes protocols on pollution-control (water, air and noise)
• Defines steps to follow in case of fire, earthquake and other emergency situations.
3. Health Education
Core Competency 1:
Assesses the learning needs of the client partner/s
Indicators
• Obtains learning information through interview, observation and validation
• Analyzes relevant information
• Completes assessment records appropriately
• Identifies it needs

P a g e | 47
Core Competency 2:
Develops health education plan based on assessed and anticipated needs
Indicators
• Considers nature of learner in relation to: social, cultural, political, economic,
educational and religious factors.
• Involves the client, family, significant others and other resources in identifying learning
needs on behavior change for wellness, healthy lifestyle or management of health
problems
• Formulates a comprehensive health education plan with the following components:
objectives, content, time allotment, teaching learning resources and evaluation
parameters
• Provides for feedback to finalize the plan
Core Competency 3:
Develops learning materials for health
Indicators
• Develops information education materials appropriate to the level of the client
• Applies health education principles in the education development of information
education materials
Core Competency 4:
Implements the health education plan
Indicators
• Provides for a conducive learning situation in terms of time and place
• Considers client and family’s preparedness
• Utilizes appropriate strategies that maximize opportunities for behavior change for
wellness/healthy life style
• Provides reassuring presence through active listening, touch, facial expression and
gestures
• Monitors client and family’s responses to health education
Core Competency 5:
Evaluates the outcome of health education
Indicators
• Utilizes evaluation parameters
• Documents outcome of care
• Revises health education plan based on client response/outcomes
4. Legal Responsibility
Core Competency 1:
Adheres to practices in accordance with the nursing law and other relevant legislation
including contracts, informed consent.
Indicators
• Fulfills legal requirements in nursing practice

P a g e | 48
• Holds current professional license
• Acts in accordance with the terms of contract of employment and other rules and
regulations
• Complies with required continuing professional education
• Confirms information given by the doctor for informed consent
• Secures waiver of responsibility for refusal to undergo treatment or procedure
• Checks the completeness of informed consent and other legal forms
Core Competency 2:
Adheres to organizational policies and procedures, local and national
Indicators
• Articulates the vision, mission of the institution where one belongs
• Acts in accordance with the established norms of conduct of the institution /
organization/legal and regulatory requirements
Core Competency 3:
Documents care rendered to clients
Indicators
• Utilizes appropriate client care records and reports.
• Accomplishes accurate documentation in all matters concerning client care in
accordance to the standards of nursing practice.
5. Ethico-moral Responsibility
Core Competency 1:
Respects the rights of individual / groups
Indicators
• Renders nursing care consistent with the client’s bill of rights: (i.e. confidentiality of
information, privacy, etc.)
Core Competency 2:
Accepts responsibility
Indicators
• Meets nursing accountability requirements as embodied in the job description and
accountability forown decision and actions
• Justifies basis for nursing actions and judgment
Core Competency 3:
Adheres to the national and international code of ethics for nurses
• Adheres to the Code of Ethics for Nurses and abides by its provision
• Reports unethical and immoral incidents to proper authorities
6. Personal and Professional Development
Core Competency 1:
Identifies own learning needs
Indicators
• Identifies one’s strengths, weaknesses/ limitations

P a g e | 49
• Determines personal and professional goals and aspirations
Core Competency 2:
Pursues continuing education
Indicators
• Participates in formal and non-formal education
• Applies learned information for the improvement of care
Core Competency 3:
Gets involved in professional organizations and civic activities
Indicators
• Participates actively in professional, social, civic, and religious activities
• Maintains membership to professional organizations
• Support activities related to nursing and health issues
Core Competency 4:
Projects a professional image of the nurse
Indicators
• Demonstrates good manners and right conduct at all times
• Demonstrates congruence of words and action
• Behaves appropriately at all times
Core Competency 5:
Possesses positive attitude towards change and criticism
Indicators
• Listens to suggestions and recommendations
• Tries new strategies or approaches
• Adapts to changes willingly
Core Competency 6:
Performs function according to professional standards
Indicators
• Assesses own performance against standards of practice
• Sets attainable objectives to enhance nursing knowledge and skills
• Explains current nursing practices, when situations call for it
7. Quality Improvement
Core Competency 1:
Gathers data for quality improvement
Indicators
• Identifies appropriate quality improvement methodologies for the clinical problems
• Detects variation in specific parameters i.e vital signs of the client from day to day
• Reports significant changes in clients’ condition/environment to improve stay in the
hospital 9
• Solicits feedback from client and significant others regarding care rendered
Core Competency 2:
Participates in nursing audits and rounds

P a g e | 50
Indicators
• Shares with the team relevant information regarding clients’ condition and significant
changes in clients’ environment
• Encourages the client to verbalize relevant changes in his/her condition
• Performs daily check of clients’ records / condition
• Documents and records all nursing care and actions implemented
Core Competency 3:
Identifies and reports variances
Indicators
• Reports to appropriate person/s significant variances/changes/occurrences
immediately
• Documents and reports observed variances regarding client care
Core Competency 4:
Recommends solutions to identified problems
Indicators
• Gives an objective and accurate report on what was observed rather than an
interpretation of the event
• Provides appropriate suggestions on corrective and preventive measures
• Communicates solutions with appropriate groups
8. Research
Core Competency 1:
Gather data using different methodologies
Indicators
• Specifies researchable problems regarding client care and community health
• Identifies appropriate methods of research for a particular client / community problem
• Combines quantitative and qualitative nursing design through simple explanation on
the phenomena observed
Core Competency 2:
Analyzes and interprets data gathered
Indicators
• Analyzes data gathered using appropriate statistical tool
• Interprets data gathered based on significant findings
Core Competency 3:
Recommends actions for implementation
Indicators
• Recommends practical solutions appropriate to the problem based on the
interpretation of significant findings
Core Competency 4:
Disseminates results of research findings
Indicators
• Shares/presents results of findings to colleagues / clients/ family and to others

P a g e | 51
• Endeavors to publish research
• Submits research findings to own agencies and others as appropriate
Core Competency 5:
Applies research findings in nursing practice
Indicators
• Utilizes findings in research in the provision of nursing care to individuals / groups /
communities
• Makes use of evidence-based nursing to enhance nursing practice 10
9. Records Management
Core Competency 1:
Maintains accurate and updated documentation of client care
Indicators
• Completes updated documentation of client care
• Applies principles of record management
• Monitors and improves accuracy, completeness and reliability of relevant data
• Makes record readily accessible to facilitate client care
Core Competency 2:
Records outcome of client care
Indicators
• Utilizes a records system ex. Kardex or Hospital Information System (HIS)
• Uses data in their decision and policy making activities
Core Competency 3:
Observes legal imperatives in record keeping
Indicators
• Maintains integrity, safety, access and security of records
• Documents/monitors proper record storage, retention and disposal
• Observes confidentially and privacy of the clients’ records
• Maintains an organized system of filing and keeping clients’ records in a designated
area
• Follows protocol in releasing records and other information
10. Communication
Core Competency 1:
Establishes rapport with client, significant others and members of the health team
Indicators
• Creates trust and confidence
• Spends time with the client/significant others and members of the health team to
facilitate interaction
• Listens actively to client’s concerns/significant others and members of the health team

P a g e | 52
Core Competency 2:
Identifies verbal and non-verbal cues
Indicators
• Interprets and validates client’s body language and facial expressions
Core Competency 3:
Utilizes formal and informal channels
Indicators
• Makes use of available visual aids
• Utilizes effective channels of communication relevant to client care management
Core Competency 4:
Responds to needs of individuals, family, group and community
Indicators
• Provides reassurance through therapeutic touch, warmth and comforting words of
encouragement
• Provides therapeutic bio-behavioral interventions to meet the needs of clients
Core Competency 5:
Uses appropriate information technology to facilitate communication
Indicators
• Utilizes telephone, mobile phone, electronic media
• Utilizes informatics to support the delivery of healthcare
11. Collaboration and Teamwork
Core Competency 1:
Establishes collaborative relationship with colleagues and other members of the health
team
Indicators
• Contributes to decision making regarding clients’ needs and concerns
• Participates actively in client care management including audit
• Recommends appropriate intervention to improve client care
• Respect the role of other members of the health team
• Maintains good interpersonal relationship with clients, colleagues and other members
of the health team
Core Competency 2:
Collaborates plan of care with other members of the health team
Indicators
• Refers clients to allied health team partners
• Acts as liaison / advocate of the client
• Prepares accurate documentation for efficient communication of services.

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Communication Skills
Effective Communication
Communication is the interchanged of information between two or more people; in
other words, the exchange of ideas and thought. Communicating may have a more
personal connotation than the interchange of ides and thoughts. It can be a transmission of
feelings or a more personal and social interaction between people. Frequently, one
member of a couple comments that the other is not communicating.
The intent of communication is to elicit a response. Thus communication is a
process. It has two main purposes: To influence others and to obtain information.
Communication can be described as helpful or unhelpful. The former encourages a
sharing of information, thoughts, and feelings between two or more people. The latter
hinders or blocks the transfer of information and feelings.
Nurses who communicate effectively are better able to collect assessment data,
initiate intervention, evaluate outcomes of intervention, initiate change that promote health,
and prevent legal problem associated with nursing practice. The communicating process is
built on a trusting relationship with a client or support persons. Effective information is
essential for the establishment of a nurse client relationship. Communication can occur on
an intrapersonal level within a single individual as well as on interpersonal and group
levels. Intrapersonal communication is the communication that you have with yourself;
another name is self-talk. Both the sender and the receiver of a message usually engage
in self- talk. It involves thinking about the message before it is sent, and it occurs
constantly. Consequently, Intrapersonal communication can interfere with a person’s ability
to hear a message as the sender intended.
Components of Communication
Face-to-face communication involves a sender, a message, a receiver, and a
response, or feedback. In its simplest form, communication is a two-way process involving
the sending and the receiving of a message. Because the intent of a communication is to
elicit a response, the process is ongoing; the receiver of a message then becomes the
sender of a response, and the original sender then becomes the receiver.

P a g e | 54
Sender
The sender, a person or group who wishes to convey a message to another, can be
considered the source-encoder. This term suggest that the person or group sending
the message must have an idea or reason for communicating (source) and must put
the idea or feeling into a form that can be transmitted. Encoding involves the selection
of specific signs or symbol (codes) to transmit the message, such as which language
and words to use, how to arrange the words, and what tone of voice and gestures to
use.
Message
The second component of communication process is the message itself what is
actually said or written, the body language that accompanies the words, and how the
message is transmitted. The medium use to convey the message is the channel, and it
can target any of the receiver’s senses. It is important for the channel to be appropriate
for the message and it should help make the intent of the message clearer.
Talking face to face with a person may be more effective in some instances than
telephoning or writing a message. Recording message on tape or communicating by
radio or television may be more appropriate for larger audience. Written communication
is often appropriate for long explanation or a communication that needs to be
preserved. The nonverbal channel of touch is often highly effective.
Receiver
The receiver, the third component of the communication process, is the listener, who
must listen, observe, and attend. This person is the decoder, who must perceive what
he sender intended (interpretation). Perception uses all the senses to receive verbal
and nonverbal messages. To decode means to relate the message perceived to the
receivers storehouse to knowledge and experience and to sort out the meaning of the

P a g e | 55
message. Whether the message is decoded accurately by the receiver according to the
receiver’s intent, depends largely on their similarities in knowledge and experience and
socio cultural back ground. If the meaning of the decoded message matches the intent
of the sender, then the communication has been effective. Ineffective communications
occur if the message sent is misinterpreted by the receiver.
Response
The fourth component of the communication process, the response, is the message
that the receiver returns to the sender. It is also called feedback. Feedback can be
either verbal, nonverbal, or both. Nonverbal examples are a nod of the head or a yawn.
Either way, feedback allows the sender to correct or reword a message.
Modes of Communication
Communication is generally carried out in two different modes: verbal and nonverbal.
Verbal communication uses the spoken or written word; nonverbal communication
uses other forms, such as gestures of facial expressions, and touch. Another form of
communication has evolved with technology – electronic communication. The most
common form of electronic communication is e-mail where an individual can send a
message, by computer, to another person or group of people.
Verbal Communication
Verbal communication is largely conscious because people choose the words they use.
The words used vary among individuals according to culture, socioeconomic background,
age and education. As a result, countless possibilities exist for the way ideas are
exchange. An abundance of words can be used to form messages. In addition, a wide
variety of feelings can be conveyed when people talk.
When choosing words to say or write, nurses need to consider pace and intonation,
simplicity, clarity and brevity. Timing and relevance, adaptability, credibility and humor.
PACE AND INTONATION. The manner of speech, as in the pace or rhythm and
intonation, will modify the feeling and impact of the message. The intonation can
express enthusiasm, sadness, anger, or amusement. The pace of speech may
indicate interest, anxiety, boredom or fear.
SIMPLICITY. Simplicity includes the use of commonly understood words, brevity,
and completeness. Nurses need to learn to select appropriate, understandable
terms based on the age, knowledge, culture, and education of the client.
CLARITY AND BREVITY. A message that is direct and simple will be more
effective. Clarity is saying precisely what is meant, and brevity is using the fewest
words necessary.
TIMING AND RELEVANCE. The timing needs to be appropriate to ensure that
words are heard. More - over, the messages need to relate to the person or to the
person’s interest and concerns.

P a g e | 56
ADAPTABILITY. Spoken messages need to be altered in accordance with
behavioral cues from the client. This adjustment referred to as adaptability. What
nurse says and how it is said must be individualized and carefully considered.
This requires astute assessment and sensitivity on the part of the nurse.
CREDIBILITY. Credibility means worthiness of belief, trustworthiness, and
reliability. Nurses foster credibility by being consistent, dependable and honest.
The nurse needs to be knowledgeable about what is being discussed and to have
accurate information. Nurses should convey confidence and certainty in what they
are saying, while being able to acknowledge their limitations.
HUMOR. The use of humor can be positive and powerful tool in the nurse-client
relationship, but it must be used with care. Humor can be used to help clients
adjust to difficult and painful situations. When using humor, it is important to
consider the client’s perception of what is considered humorous. Timing is also
important to consider
Nonverbal Communication
Nonverbal communications sometimes called body language. It includes gestures, body
movements, use of touch, and physical appearance, including adornment. Non verbal
communication often tell others more about what a person is feeling than what is actually
said, because nonverbal communication either reinforces or contradicts what is said
verbally.
PERSONAL APPEARANCE. Clothing and adornments can be sources of
information about a person. How a person dresses is often an indicator of how the
person feels. Someone who is tired or ill may not have the energy or the desire to
maintain their normal grooming. When a person known for immaculate grooming
becomes lax about appearance, the nurse may suspect a loss of self-esteem or a
physical illness. The nurse must validate these observed nonverbal data by asking
the client.
POSTURE AND GAIT. The ways of people walk and carry themselves are often
reliable indicators of self-concept, current mood, and health. Erect posture and an
active, purposeful stride suggest a feeling of well-being. Slouched posture and a
slow, shuffling gait suggest depression or physical discomfort. Tense posture and a
rapid, determine gait suggest anxiety or anger. The posture of people when they are
sitting or lying can also indicate feelings or mood. Again, the nurse clarifies the
meaning of the observed behavior by describing to the client what the nurse sees
and then asking what it means or whether the nurse’s interpretation is correct.
FACIAL EXPRESSIONS. No part of the body is as expressive as the face. Feelings
of surprise, fear, anger, disgust, happiness, and sadness can be conveyed by facial
expressions. Although the face may express the person’s genuine emotions, it is
also possible to control these muscles so the emotion expressed does not reflect
what the person is feeling. When the message is not clear, it is important to get
feedback to be sure of the intent of the expression.

P a g e | 57
GESTURES. Hand and body gestures may emphasize and clarify the spoken word,
or they may occur without words to indicate a particular feeling or to give a sign. For
people with special communication problems, such as the deaf, the hands are
invaluable in communication. Many people who are deaf learn sign language. Ill
persons who are unable to reply verbally can similarly devise a communication
system using the hands. The client may be able to raise an index finger once for
“yes” and twice for “no.” Other signals can often be devised by the client and the
nurse to denote other meanings.
Electronic Communication
E-MAIL. E-mail is the most common form of electronic communication. It is important for
the nurse to know the advantage and disadvantages of e-mail and also other guidelines to
ensure client confidentiality.
Advantages. It is a fast, efficient way to communicate and it is legible. It provides a
record of the date and time of the message that was sent or received.
Disadvantage. The negative aspect of e-mail is the risk to client confidentiality. Another is
one of socioeconomics. Not everyone has a computer. While there may be available
access to a computer, not everyone has the necessary computer skills. E-mail may
enhance communication with some clients but not all clients. Other forms of
communication will be needed for clients who have limited abilities with speaking
English, reading, writing, or using computer.
When Not to Use E-mail.
 When the information is urgent and the client’s health could be in jeopardy if he or
she doesn’t read it immediately.
 Highly confidential information (e.g., HIV status, mental health, chemical
dependency).
 Abnormal lab data. If the information is confusing and could not prompt may
questions by the client, it is better to either see or telephone the person.
Factors Influencing the Communication Process
Development
Language, psychosocial, and intellectual development move through stages across the life
span. Knowledge of a client’s developmental stage will allow the nurse to modify the
message accordingly.
Gender
Females and males communicate differently. Girls tend to use language to seek
confirmation, minimize differences, and establish intimacy. Boys use language to establish

P a g e | 58
independency and negotiate status within a group. These differences can continue into
adulthood so that the same communication may be interpreted differently by man and
women.
Personal Space
Personal space is the distance people refer in interactions with others. Proxemics is the
study of distance between people in their interactions. Communication thus alters in
accordance with four distances, each with a close and a far phase. List of the following:
1. intimate: touching to 1½ feet
2. personal: 1½ to 4 feet
3. social: 4 to 12 feet
4. public: 12 to 15 feet
Intimate distance communication is characterized by body contact, heightened
sensations of body heat and smell, and vocalizations that are low.
Personal distance voice tones are moderate, and body heat and smell are noticed less.
Physical contact such as handshake or touching a shoulder is possible
Social distance is characterized by a clear visual perception of the whole person. Body
heat and odor are imperceptible, eye contact is increased, and vocalizations are loud
enough to be overheard of others. Communication is therefore more formal and is limited
to seeing and hearing.
Public distance requires loud, clear vocalizations with careful enunciation. Although the
faces and forms of people are seen at public distance, individuality is lost. Instead, the
perception is of the group of people or the community.
Territoriality
Territoriality is the concept of the space and things that an individual considers as
belonging to the self. Territories marked off by people may be visible to others.
Roles and Relationships
Roles such as nursing student and instructor, client and primary care provider, or parent
and child affect the content and responses in the communication process. Choice of
words, sentence structure, and tone of voice vary considerably from role to role.
Environment
People usually communicate most effectively in a comfortable environment. Temperature
extremes, excessive noise, and a poorly ventilated environment can all interfere with
communication. Also, lack of privacy may interfere with a client’s communication about
matters the client considers private.

P a g e | 59
Congruence
In congruent communication, the verbal and nonverbal aspects of the message match.
Clients more readily trust the nurse when they perceived the nurse’s communication as
congruent. This will also help to prevent miscommunication.
Interpersonal Attitudes
Attitude conveys beliefs, thoughts, and feelings about people and events. Attitudes are
communicated convincingly and rapidly to others. Attitudes such as caring, warmth,
respect and acceptance facilitate communication, whereas condescension, lack of interest,
and coldness inhibit communication.
Elder speak is a speech style similar to babytalk that gives the message of dependence
and incompetence to older adults.
Therapeutic Communication
Therapeutic communication promotes understanding and can help establish a
constructive relationship between the nurse and the client. Unlike the social relationship,
where they may not be a specific purpose or direction, the therapeutic helping relationship
is client and goal directed.
Nurses need to respond not only to the content of client’s verbal message but also
the feeling expressed. It is important to understand how the client views the situation and
feels about it before responding. The content of the client’s communication is the words of
thoughts, as distinct from the feelings. Sometimes people can convey a thought in words
while their emotions contradict the words; that is, words and feelings are incongruent.
Purpose of Therapeutic Communication
 Establishing a therapeutic provider-client relationship.
 Identify client’s concerns and problem.
 Assess client’s perception of the problem.
 Recognize client’s needs.
 Guide client towards a satisfying and socially acceptable solution
Attentive Listening
Attentive listening is listening actively, using all the senses, as opposed to listening
passively with just the ear. It is probably the most important technique in nursing and is
basic to all other techniques. Attentive listening is an active process that requires energy
and concentration. It involves paying attention to the total message, both verbal and

P a g e | 60
nonverbal, and noting whether this communication is congruent. Attentive listening means
absorbing both the content and the feeling the person is conveying, without selectivity. The
listener does not select or listen solely to what the listener wants to hear; the nurse
focuses not on the nurse’s owns need but rather on the client’s need. Attentive listening
conveys an attitude of caring and interest, thereby encouraging the client to talk
Attentive listening also involves listening or key themes in the communication. The
nurse might be careful not to react quickly to the message. The speaker should not be
interrupted and the nurse (the responder) should take time to think about the message
before responding. As a listener, the nurse also should ask questions either to obtain
additional information or to clarify.
Nurses need to be aware of their own biases. A message that reflect different values or
belief should not be discredited or the reason. According to Rondeau (1992), the message
sender (i.e., the client) should decide when to close the conversation, the client may
assume that the nurse consider the message unimportant.
In summary, attentive listening is a highly develop skill but fortunately it can be learn
with practice. A nurse can convey attentiveness in listening to clients in various ways.
Therapeutic Communication Technique
TECHNIQUE DESCRIPTION EXAMPLES
Using Silence Accepting pauses or silence that
may extend for several seconds
or minutes without interjecting
any verbal response
Sitting quietly (or walking
with the client) and waiting
attentively until the client
is able to put thoughts and
feelings into words
Providing
General leads
Using statements or questions
that( a) encourage the client to
verbalize, (b) choose a topic of
conversation, and (c) facilitate
continued verbalization
Can you tell me how is it
for you Perhaps you
would like to talk about
Would it help to discuss
your feelings?
Where would you like to
begin?
And then what?
Being specific
and tentative
Making statements that are
specific rather than general, and
tentative rather than absolute
Rate your pain on scale 0-
10 (specific statement)
Are you in pain? (general
statement)
You seem unconcerned
about your diabetes
(tentative statement)
You don’t care about you

P a g e | 61
diabetes and you never
will (absolute statement)
Using open-
ended
question
Asking broad question that lead
or invite the client to explore
(elaborate, clarify, describe,
compare, or illustrate) thoughts or
feelings. Open ended questions
specify only the topic to be
I’d like to hear more about
that
Tell me about …
How have you been
feeling lately? What
brought you to the
hospital?
What is your opinion?
Discussed and invite answer that
is longer than one or two words.
You said you were
frightened yesterday. How
do feel now?
Using touch Providing appropriate forms of
touch to reinforce caring feelings.
Because tactile contacts vary
considerably among individuals,
families, and cultures, the nurse
must be sensitive to the
differences in attitude and
practices of client and self.
Putting an arm on client’s
shoulder. Placing your
hands over the client’s
hand
Restating or
paraphrasing
Actively listening for the client’s
basic message and then
repeating then repeating those
thoughts and/or feelings in similar
words. This conveys that the
nurse has listened and
understood the client’s basic
message and also offers clients a
clearer idea of what they have
said.
Client: I couldn’t manage
to eat any dinner last night
not even the dessert
Nurse: you have difficulty
of eating yesterday
Client: Yes, I was very
upset after my family left.
Client: I have trouble
talking to strangers.
Nurse: You find it difficult
talking to people you do
not know?
Seeking
clarification
A method of making the client’s
broad over all meaning of the
message more understandable. It
is used when par phrasing is
difficult or when the
communication is rambling or
garbled. To clarify the message,
the nurse can restate the basic
message or confess confusion
and ask the client to repeat or
restate the message. Nurses can
also clarify their own message
with statements.
I’m puzzled
I’m not sure I understand
that Would you please say
that again?
Would you tell me more?
I meant this rather than
that
I’m sorry that wasn’t very
clear. Let me try to explain
another way
Perception
checking or
A method similar to clarifying that
verifies the meaning of specific
Client: My husband never
gives me any present

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