1. Chapter 1
Nursing Today

2. Historical Perspective Highlights
• Nurses:
•
•
•
•
Respond to needs of patients
Actively participate in policy
Respond and adapt to challenges
Make clinical judgments and decisions about patients’
health care needs based on knowledge, experience, and
standards of care
• Nursing:
• Care is provided according to standards of practice and
a code of ethics.

3. Florence Nightingale
• First practicing epidemiologist
• a person who specializes in disease that can affect a
community or population of people.
• Organized first school of nursing
• Improved sanitation in battlefield hospitals
• Her practices remain a basic part of nursing today.

4. Civil War to the Beginning of the
Twentieth Century
• The growth of nursing in the United States:
• Clara Barton founded the American Red Cross.
• Dorothea Lynde Dix
• Mother Bickerdyke
• Harriet Tubman
• Mary Mahoney
• Isabel Hampton Robb
• Lillian Wald and Mary Brewster: Henry Street
Settlement

5. The Twentieth Century
• Movement toward scientific, research-based
practice and defined body of knowledge
• 1901: Army Nurse Corps established
• 1906: Mary Adelaide Nutting, first professor
of nursing at Columbia University
• 1908: Navy Nurse Corps established
• 1920-1923: Study of nursing education
• 1940s and 1950s: Associations emerged
• 1970: Emergency Room Nurses Organization

6. The Twenty-First Century
• Nursing code of ethics
• Changes in curriculum
• Nursing in multiple care
settings
• Advances in technology and
informatics
• End-of-life care

7. Influences on Nursing
• Changes in society lead to changes in
nursing:
• Health care reform
• Demographic changes
• Medically underserved
• Threat of bioterrorism
• Rising health care costs
• Nursing shortage

8. Nursing as a Profession
• A profession has characteristics:
• Requires an extended education
• Requires a body of knowledge
• Provides a specific service
• Has autonomy
• Incorporates a code of ethics

9. Scope and Standards of Practice
• Nursing: Scope and Standards of Practice
• 1960: Documentation began
• Standards of Practice
• Standards of Professional Performance
• Goal
• To improve the health and well-being of all
individuals, communities, and populations
through the significant and visible
contributions of registered nursing using
standards-based practice

10. Standards of Practice
• Nursing standards provide the guidelines for
implementing and evaluating nursing care.
• Six standards of practice:
• Assessment
• Diagnosis
• Outcomes identification
• Planning
• Implementation
• Evaluation

11. Standards of Professional Performance
Ethics
Quality of
Practice
Professional
Practice
Evaluation
Education
Communication
Resources
EvidenceBased Practice
and Research
Leadership
Environment
al Health
Collaboration

12. Code of Ethics
• A code of ethics is the philosophical ideals
of right and wrong that define principles
used to provide care.
• It is important for you to incorporate your
own values and ethics into your practice.
• Ask yourself: How do your ethics, values,
and practice compare with established
standards?

13. Quick Quiz!
1. Nursing is defined as a profession
because nurses
A. Perform specific skills.
B. Practice autonomy.
C. Utilize knowledge from the medical discipline.
D. Charge a fee for services rendered.
Answer: B. Practice Autonomy

14. Autonomy in Nursing
• BACKGROUND:
• Professional autonomy means having the authority to make decisions and the freedom
to act in accordance with one's professional knowledge base. An understanding of
autonomy is needed to clarify and develop the nursing profession in rapidly changing
health care environments and internationally there is a concern about how the core
elements of nursing are taken care of when focusing on expansion and extension of
specialist nursing roles.
• RESULTS:
• The nurses' descriptions of their experiences of autonomy in work situations emerged
as four themes: 'to have a holistic view', 'to know the patient', 'to know that you know'
and 'to dare'. To be knowledgeable and confident was found to be the coherent
meaning of autonomy in nursing practice.
• CONCLUSIONS:
• Authority of total patient care, the power to make decisions in a relationship with the
patient and next of kin and the freedom to make clinical judgements, choices and
actions seem to be connected to the meaning of autonomy in nursing practice.
• RELEVANCE TO CLINICAL PRACTICE:
• To gain autonomous practice, nurses must be competent and have the courage to take
charge in situations where they are responsible. This study shows the challenges in
handling this autonomous practice.
14

15. Nursing Education
• Professional registered nurse education
• 2-year associate’s degree
• 4-year baccalaureate degree
• Graduate education
• Master’s degree, advanced practice RN
• Doctoral degrees
• Continuing and in-service education

16. Case Study
• Ming graduated with an associate’s degree in
nursing last year and currently works in a longterm care facility. Although Ming enjoys his work
and has been promoted to shift supervisor on his
unit, he finds that he’d like to pursue a nursing
career that offers a regular schedule and more
autonomy than he currently experiences at the
long-term care facility.
• Ming considers returning to school for an
advanced degree.

17. Case Study (cont’d)
• Ming is particularly drawn to the idea of becoming an advanced
practice registered nurse (APRN).
• Ming’s career options for becoming an APRN
include which of the following?
(Select all that apply.)
A. Physician assistant (PA)
B. Clinical nurse specialist (CNS)
C. Certified nurse midwife (CNM)
D. Certified RN anesthetist (CRNA)

18. Case Study (cont’d)
• If Ming decides to pursue a career as an APRN,
which patient populations may he serve?
(Select all that apply.)
A. Adult-gerontology
B. Prison inmates
C. Neonatology
D. Psychiatric mental health

19. Case Study (cont’d)
• If Ming decides to choose a career as a
critical care CNS, then his specialty is
identified by which means?
A. Population
B. Setting
C. Disease specialty
D. Type of care
E. Type of problem

20. Nursing Practice
• Nurses practice in a variety of settings.
• Nurses:
• Protect, promote, and optimize our
patients’ health
• Prevent illness and injury
• Alleviate suffering through the diagnosis
and treatment of human responses
• Advocate for the care of our patients

21. Nursing Practice
• Nurse Practice Acts
• Licensure and certification
• Science and art of nursing practice
• Benner’s stages of nursing proficiency:
• Novice
• Advanced beginner
• Competent
• Proficient
• Expert

22. Professional Responsibilities
• Nurses are responsible for obtaining
and maintaining specific knowledge
and skills.
• In the past:
• To provide care and comfort
• Now:
• To provide care and comfort and to
emphasize health promotion and
illness prevention

23. Professional Roles
Autonomy and Accountability
• Caregiver
• Advocate
• Educator
• Communicator
• Manager

24. Career Development
• Nursing provides
an opportunity
for you to
commit to
lifelong learning
and career
development.

25. Professional Nursing Organizations
• National League for Nursing (NLN)
• American Nurses Association (ANA)
• International Council of Nursing (ICN)
• National Student Nurses Association
(NSNA) or Canadian Student Nurses
Association (CSNA)
• Other professional organizations focus on
specific areas.

26. Quick Quiz!
The NLN and the ANA are professional
organizations that deal with:
A. Nursing issues of concern.
B. Political and professional issues affecting
health care.
C. Financial issues affecting health care.
D. All of the above issues.

27. Quality and Safety Education
for Nurses (QSEN)
Competency:
Patient-Centered Care
Teamwork and Collaboration
Evidence-Based Practice
Quality Improvement
Safety
Informatics

28. Additional Nursing Trends
•Genomics
•Public perception of nursing
•Impact of nursing on politics
and health policy
•Future trends

29. Chapter 15
Critical Thinking in Nursing
Practice

30. Critical Thinking Defined
• Critical thinking is:
• A continuous process characterized by openmindedness, continual inquiry, and
perseverance, combined with a willingness to
look at each unique patient situation and
determine which identified assumptions are
true and relevant
• Recognizing that an issue exists, analyzing
information, evaluating information, and
making conclusions

31. Clinical Decisions in Nursing Practice
• Clinical decision making requires critical
thinking.
• Clinical decision-making skills separate
professional nurses from technical and
ancillary staff.
• Patients often have problems for which no
textbook answers exist.
• Nurses need to seek knowledge, act quickly,
and make sound clinical decisions.

32. Critical Thinking Skills
Interpretation
Analysis
Inference
Evaluation
An example of inference is a scientist guessing
at the result of an experiment using things he's
already learned. A “Gut Feeling”
a diagnosis or diagnostic study of a
physical or mental condition
Self-regulation
Explanation
Self-regulation means that the
government has granted a professional
group, such as registered nurses, the
privilege and responsibility to regulate
themselves.

33. Thinking and Learning
• Learning is a lifelong process.
• Intellectual and emotional growth involves
learning new knowledge, as well as refining
the ability to think, solve problems, and
make judgments.
• The science of nursing continues to grow.
Nurses need to be flexible and open to new
information.

34. Concepts for a Critical Thinker
• Truth seeking
• Open-mindedness
• Analytic approach
• Systematic approach
• Self-confidence
• Inquisitiveness
• Maturity

35. Critical Thinking Competencies
Scientific method
Problem solving
Decision making
Diagnostic
reasoning and
inference
Clinical decision
making
Nursing process as
a competency

37. Five Components of Critical Thinking
Knowledge base
Experience
Nursing process competencies
Attitudes
Standards

38. Nursing Process
• The nursing process is a five-step
clinical decision-making approach:
“ADPIE”
Assessment
Diagnosis
Planning
Implementation
Evaluation

39. Attitudes a Nurse Needs
Confidence
Perseverance
Independence
Creativity
Fairness
Curiosity
Responsibility
Integrity
Risk taking
Discipline
Humility

40. Developing Critical Thinking Skills
Reflective Journaling:
A tool used to clarify concepts through reflection
by thinking back or recalling situations
Concept Mapping:
A visual representation of patient problems and
interventions that illustrates an interrelationship

41. Critical Thinking and Delegation
• Effective communication is needed between
registered nurses (RNs) and nursing assistive
personnel (NAP) for giving feedback and clarifying
tasks and patient status.
• When patients’ clinical conditions change,
warranting attention by RNs, clear directions are
necessary to avoid missed care.
• Applying critical thinking can help an RN make the
decision about when to appropriately delegate
care.

42. Reflective Journaling
The Circle of Meaning
model adapted to
nursing encourages
concept clarification and
a search for meaning in
nursing practice.
The Circle of Meaning
model uses a series of
questions to help you
through a clinical
experience and to find
meaning.

43. Caring for Groups of Patients
• Identify the nursing diagnoses and collaborative problems
of each patient.
• Decide which are most urgent.
• Consider the time it will take to care for those patients.
• Consider the resources that you have to manage each
problem.
• Consider how to involve the patients as participants in
care.
• Decide how to combine activities.
• Decide which nursing care procedures to delegate.
• Discuss complex cases with the health care team.

44. Meeting With Colleagues
• When nurses have a formal means to
discuss their experiences such as a staff
meeting or a unit practice council, the
dialogue allows for questions, differing
viewpoints, and sharing of experiences.
• When nurses are able to discuss their
practices, the process validates good
practice and offers challenges and
constructive criticism.

45. Five-Step Nursing Process Model

46. Components of Critical Thinking in
Nursing
• I. Specific knowledge base in nursing
• II. Experience
• III. Critical thinking competencies
• IV. Attitudes for critical thinking
• V. Standards for critical thinking
• A. Intellectual standards
• B. Professional standards

47. Synthesis of Critical Thinking With the
Nursing Process Competency

48. Critical Thinking Synthesis
A reasoning process used to reflect on and analyze
thoughts, actions, and knowledge
Requires a desire
to grow intellectually
Requires the use of nursing process
to make nursing care decisions

49. Chapter 24
Communication

50. Communication and Nursing Practice
• A lifelong learning process for
nurses
• An essential attribute of
professional nursing practice
• Builds relationships with patients,
families, and multidisciplinary
team members

51. Communication and Interpersonal
Relationships
Communication is the means to establish helpingtrust relationships.
The ability to relate to others is important for
interpersonal communication.
Developing communication skills requires an
understanding both of the communication
process and of
ones own communication experience.

52. Communication and Interpersonal
Relationships (cont’d)
• Therapeutic communication occurs within a
healing relationship between a nurse and a
patient.
• The nurse’s communication can result in
both harm and good.
• Skilled communication empowers others
and enables people to know themselves
and to make their own choices.

53. Developing Communication Skills
Critical thinking
Perseverance and creativity
Self-confidence
Fairness and integrity
Humility

54. Developing Communication Skills
(cont’d)
• Thinking is influenced by perception
• Five senses
• Culture
• Education
• Perceptual bias

55. Quick Quiz!
1. Match the levels of communication.
1. Intrapersonal
A. One-to-one interaction between
two people
2. Interpersonal
B. Occurs within an individual
3. Transpersonal
C. Interaction with an audience
4. Small group
D. Interaction within a person’s
spiritual domain
5. Public
E. Interactions with a small
number of people
Copyright line.

56. Levels of Communication
Answer to matching quiz:
1. Intrapersonal
2. Interpersonal
3. Transpersonal
4. Small group
5. Public
B. Occurs within an individual
A. One-to-one interaction between
two people
D. Interaction within a person’s
spiritual domain
E. Interactions with a small number
of people
C. Interaction with an audience

57. Basic Elements of the Communication
Process

58. Quick Quiz!
3. Match the basic elements of communication.
1. Referent
A. One who encodes and one
who decodes the message
2. Sender and receiver
B. The setting for sender-receiver
interactions
3. Message
C. Message the receiver returns
4. Channels
D. Motivates one to
communicate with another
5. Feedback
E. Means of conveying and
receiving messages
6. Interpersonal variables
F. Factors that influence
communication
7. Environment
G. Content of the message

59. Basic Elements of the Communication
Process
1. Referent
D. Motivates one to communicate with
another
2. Sender and receiver
A. One who encodes and one who
decodes the message
3. Message
G. Content of the message
4. Channels
E. Means of conveying and receiving
messages
5. Feedback
C. Message the receiver returns
6. Interpersonal variables F. Factors that influence communication
7. Environment
B. The setting for sender-receiver
interactions

60. Forms of Communication
• Verbal aspects of communication:
Vocabulary
Intonation
Denotative and Clarity and
connotative
brevity
meaning
Pacing
Timing and
relevance

61. Forms of Communication
(cont’d)
• Nonverbal
• Personal appearance
• Posture and gait
• Facial expressions
• Eye contact
• Gestures
• Sounds
• Territoriality and personal space

62. Forms of Communication
(cont’d)
• Symbolic
• The verbal and nonverbal symbolism used
by others to convey meaning
• Metacommunication
• A broad term that refers to all factors that
influence communication

63. Nurse-Patient Relationship
1. Preinteraction phase: occurs before
meeting the patient
2. Orientation phase: when the nurse and the
patient meet and get to know each other
3. Working phase: when the nurse and the
patient work together to solve problems and
accomplish goals
4. Termination phase: occurs at the end of a
relationship

64. Professional Nursing Relationships
Nurse-patient helping relationships
Nurse-family relationships
Nurse-health team relationships
Nurse-community relationships

65. Elements of Professional Communication
Appearance, demeanor,
and behavior
Courtesy
Use of names
Trustworthiness
Autonomy and
responsibility
Assertiveness

66. Nursing Process: Assessment
• Through the patient’s eyes
• Gather information, synthesize, apply
critical thinking
• Physical and emotional factors
• Developmental factors
• Sociocultural factors
• Gender

67. Nursing Process: Diagnosis
• Nursing diagnosis for communication
• Many patients experience difficulty with
communication:
• Lacking skills in attending, listening,
responding, or self-expression
• Inability to articulate, inappropriate
verbalization
• Difficulty forming words
• Difficulty with comprehension

68. Nursing Process: Planning
• Goals and outcomes
• Specific and measurable
• Setting of priorities
• Teamwork and collaboration

69. Case Study (cont’d)
• During her visit, Roberto tells Suzanne, “I
really want to go visit my uncles in New
York, but I’m not sure I’m up for the trip.”
• Suzanne is understanding: “It sounds like
you miss your family. Let’s talk about your
options for maintaining contact.”
• As they talk, Suzanne helps Roberto to
identify two methods of communicating
with his family in New York.

70. Nursing Process: Implementation
• Therapeutic communication
techniques
• are specific responses that encourage the expression of
feelings and ideas and convey acceptance and respect.
• Active listening
• means being attentive to what a patient is saying both
verbally and nonverbally.
• Use “SOLER”: Sit facing the patient; Observe an open
posture, Lean toward the patient, Establish and
maintain intermittent eye contact; Relax

71. Nursing Process: Implementation
(cont’d)
• Therapeutic communication techniques
• Nontherapeutic communication
techniques
• Adapting communication techniques

72. Adapting Communication Techniques
• Patients who cannot speak clearly
• Cognitive impairment
• Hearing impairment
• Visual impairment
• Unresponsive
• Patients who do not speak English (or your
language)

73. Nursing Process: Evaluation
• Through the patient’s eyes
• Patient outcomes
• Nurses and patients need to determine whether
the plan of care has been successful.
• Nursing interventions are evaluated to
determine which strategies or interventions
were effective.
• If expected outcomes are not met, the plan of
care needs to be modified.

74. Chapter 25
Patient Education

75. Standards for Patient Education
• The Joint Commission (TJC) sets standards for
patient and family education.
• Successful accomplishment of standards requires
collaboration among health care professionals.
• All state Nurse Practice Acts recognize that
patient teaching falls within the scope of nursing
practice.

76. Purposes of Patient Education
• To help individuals, families, or
communities achieve optimal levels of
health
• Patient education includes:
• Maintenance and promotion of health
and illness prevention
• Restoration of health
• Coping with impaired functioning

77. Teaching and Learning
• Teaching
• An interactive process that promotes learning
• Learning
• The purposeful acquisition of knowledge, skills,
behaviors, and attitudes

78. Role of the Nurse in
Teaching and Learning
Teach information that
the patient and the family need to make informed
decisions regarding their care.
• Determine what patients need to know.
• Identify when patients are ready to learn.

79. TJC’s Speak Up Tips
• Speak up if you have questions or concerns.
• Pay attention to the care you get.
• Educate yourself about your illness.
• Ask a trusted family member or friend to be your
advocate.
• Know which medicines you take and why.
• Use a health care organization that has been
carefully evaluated.
• Participate in all decisions about your treatment.

80. Teaching as Communication
• Closely parallels the communication
process
• Depends partly on effective interpersonal
communication
• The learning objective describes what the
learner will be able to accomplish after
instruction is given.

81. Domains of Learning
Cognitive
Includes all intellectual behaviors
and requires thinking
Affective
Deals with expression of feelings
and acceptance of attitudes,
opinions, or values
Psychomotor
Involves acquiring skills that require
integration of mental and muscular
activity
Copyright line.

82. Domains of Learning
• Different teaching methods are appropriate for
each domain of learning.
• Cognitive: discussion (one-on-one or group),
lecture, question-and-answer session, role play,
discovery, independent project, field experience
• Affective: role play, discussion (one-on-one or
group)
• Psychomotor: demonstration, practice, return
demonstration, independent projects, games

83. Basic Learning Principles
Motivation to learn
Addresses the patient’s desire
or willingness to learn
Ability to learn
Depends on physical and
cognitive abilities,
developmental level, physical
wellness, thought processes
Learning
environment
Allows a person to attend to
instruction
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Slide 83

84. Motivation to Learn
•
•
Attentional set: the mental state that allows the
learner to focus on and comprehend a learning
activity
Motivation: a force that acts on or within a
person (e.g., idea, emotion, physical need) to
cause the person to behave in a particular way

85. Motivation to Learn (cont’d)
Use of theory to enhance motivation
and learning
 Self-efficacy: refers to a person’s
perceived ability to successfully
complete a task.


86. Motivation to Learn (cont’d)
• Psychosocial adaptation to illness
• Difficult for patients to accept
• Need to grieve
• Learning occurs in the acceptance stage.
• Active participation
• Learning occurs when the patient is
actively involved in the educational
session.

87. Ability to Learn
• Developmental capability
• Cognitive development
• Prior knowledge
• Learning in children
• Developmental stage

88. Ability to Learn (cont’d)
• Adult learning
• Self-directed
• Patient-centered
• Physical capability
• Level of personal development
• Physical health
• Fatigue

89. Learning Environment
Well lit
Good ventilation
Appropriate
furniture
Comfortable
temperature
Quiet
Private

90. Integrating the Nursing
and Teaching Processes
• The nursing process and the teaching
process are not the same.
• The nursing process focuses on the patient’s total
health care needs.
• The teaching process focuses on the patient’s
learning needs and ability to learn.
• When education becomes part of the care
plan, the teaching process begins.

91. Nursing Process: Assessment
• See through the patient’s eyes.
• Teaching is patient-centered.
• Assess the patient’s learning needs.
• Ask questions to identify motivation to learn.
• Determine the patient’s physical and cognitive ability to
learn.
• Provide an appropriate teaching environment.
• Assess the readiness and ability of a family caregiver or
other learning resource.
• Assess health literacy/learning disabilities.

92. Nursing Process: Assessment (cont’d)
• Health literacy: the cognitive and social
skills that determine the motivation and
ability of individuals to gain access to,
understand, and use information in ways
that promote and maintain good health.
• Health literacy includes patients’ reading
and mathematics skills, comprehension,
and decision-making and functioning skills
with regard to health care.

93. Nursing Process: Nursing Diagnosis
• Nursing diagnoses for patient education
• Deficient knowledge (affective, cognitive,
psychomotor)
• Ineffective health maintenance
• Impaired home maintenance
• Ineffective family therapeutic regimen
management
• Ineffective self-health management
• Noncompliance (with medications)

94. Nursing Process: Planning
• Determine goals and expected outcomes
that guide the choice of teaching strategies
and approaches with a patient:
• Set priorities.
• Select timing to teach.
• Organize the teaching materials.
• Use teamwork and collaboration.

95. Nursing Process:
Implementation
• Maintain learning
attention and
participation.
• Build on existing
knowledge.
• Select teaching
approach.
• Incorporate teaching
with nursing care.

96. Nursing Process: Implementation
(cont’d)
• Select appropriate instructional methods:
• Group instruction
• One-on-one discussion
• Preparatory instruction
• Demonstration
• Analogy
• Role playing
• Simulation

97. Nursing Process: Implementation
(cont’d)
• Illiteracy and other
disabilities
• Cultural diversity
• Using different teaching
tools
• Special needs of children
and older adults

98. Nursing Process: Evaluation
• See through the patient’s eyes.
• Have the patient’s learning needs been met?
• Evaluate a patient’s learning by observing
performance of expected learning behaviors
under desired conditions.
• Discontinue, adjust, or amend the plan.
• Patient outcomes:
• Legal responsibility
• Documentation

99. Chapter 37
Stress and
Coping

100. Scientific Knowledge Base
• Fight-or-flight
response
• Neurophysiological
responses:
• Medulla oblongata
• Reticular formation
• Pituitary gland

101. General Adaptation Syndrome (GAS)
• An immediate physiological response of the
whole body to stress; involves several body
systems, especially the autonomic nervous
and endocrine systems, and includes
immunological changes
• A three-stage reaction to stress:
• Alarm reaction
• Resistance stage
• Exhaustion stage

102. Quick Quiz!
You are a nurse working in the college student
health center. You receive a call that an athlete
has just fallen and has been injured. You know
that according to the general adaptation
syndrome, the athlete will be exhibiting:
A. An increased appetite.
B. An increased heart rate.
C. A decrease in perspiration.
D. A decrease in respiratory rate.

103. General Adaptation Syndrome
• Psychological stress
• Primary appraisal
• Secondary appraisal
• Coping
• Personal characteristics that influence response
to a stressor:
• Level of personal control
• Presence of a social support system
• Feelings of competence

104. General Adaptation Syndrome (cont’d)
• Primary appraisal: evaluating an event for
its personal meaning
• Secondary appraisal: focuses on possible
coping strategies
• Coping: the person’s effort to manage
psychological stress
• Ego-defense mechanisms: regulate
emotional distress and give a person
protection from anxiety and stress

105. Types of Stress
• Chronic
• Chronic stress occurs in stable conditions
and results from stressful roles.
• Acute
• Time-limited events that threaten a
person for a relatively brief period
provoke acute stress.

106. Types of Stress
• Posttraumatic stress disorder:
• An acute stress disorder that begins
when a person experiences,
witnesses, or is confronted with a
traumatic event
• May include flashbacks = Recurrent
and intrusive recollections of the
event

107. Types of Crises
• Developmental
• Developmental crises occur as a person moves through
the stages of life.
• Situational
• External sources such as a job change, motor vehicle
crash, death, or severe illness provoke situational crises.
• Adventitious
• A major natural or man-made disaster or a crime of
violence can create an adventitious crisis.

108. Quick Quiz!
2. A patient comes into the emergency department
complaining of chest pain. When discussing
possible reasons why the chest pain has
occurred, the nurse learns that the patient is
depressed because of the loss of a job. This type
of crisis can be classified as:
A. Maturational.
B. Situational.
C. Sociocultural.
D. Posttraumatic.
31 - 108

109. Nursing Knowledge Base:
Nursing Theory and Role of Stress
• Neuman systems model:
• Based on the concepts of stress and
reaction to stress
• Nurses develop interventions to prevent
or reduce stress on patients or to help
them cope.

110. Nursing Knowledge Base: Nursing
Theory and Role of Stress (cont’d)
• Neuman systems model
• Primary prevention promotes patient wellness by stress
prevention and reduction of risk factors.
• Secondary prevention occurs after symptoms appear.
• Tertiary prevention begins when the patient’s system
becomes more stable and recovers.

111. Nursing Knowledge Base:
Factors Influencing Stress and Coping
• Situational factors
• Arise from job changes, illness, caregiver stress
• Maturational factors
• Vary with life stages
• Sociocultural factors
• Environmental, social, and cultural stressors perceived by children,
adolescents, and adults

112. Critical Thinking
• Keep in mind the neurophysiological
changes the patient may be experiencing.
• Use clear communication principles.
• Be confident.
• Utilize the Standards of Care for Psychiatric
Mental Health Nursing Practice (ANA).

113. Nursing Process (ADPIE)
• Assessment
• Nursing diagnosis
• Planning
• Implementation
• Evaluation

114. Nursing Process: Assessment
• See through the patient’s eyes:
• Gather information (including patient’s perception).
• Synthesize the information.
• Apply critical thinking.
• Subjective findings
• Objective findings

115. Nursing Process: Nursing Diagnosis
• Nursing diagnoses for stress:
• Coping
• Ineffective coping
• Multiple diagnoses

116. Nursing Process: Planning
• Goals and outcomes
• Desirable outcomes frequently include
• Effective coping, family coping, caregiver
emotional health, and psychosocial adjustment:
life change
• Setting priorities
• Teamwork and collaboration

117. Nursing Process: Implementation
• Health promotion
• Regular exercise
• Support systems
• Time management
• Guided imagery and
visualization
• Progressive muscle relaxation
• Assertiveness training
• Journal writing
• Stress management in the
workplace

118. Nursing Process: Implementation (cont’d)
• Crisis: When stress overwhelms a person’s usual
coping mechanisms and demands mobilization of all
available resources, the situation becomes a crisis.
• Acute care
• Crisis intervention
• Restorative and continuing care

119. Nursing Process: Evaluation
• Through the patient’s eyes:
• Has stress been reduced?

120. Nursing Process: Evaluation
• Patient outcomes:
• Measure outcomes for each diagnosis.
• Maintain communication.
• Continually assess needs for additional support.