Reviewer in Basic Concept
economic, and vocational areas of their lives.
Health Care Delivery Systems
 Health Care System – is the totality of services
offered by all health disciplines.
o The major purpose is to provide care to people
who are ill or injured.
Types of Health care services:
 Primary prevention:
oHealth promotion – staying healthy and
avoiding illness.
 Activities emphasize the important role
clients play in maintaining their own health
and encourage them to maintain the highest
level of wellness they can achieve.
o Illness prevention
 May be directed at the client or the
community and involve such practices as
providing immunizations, identifying risk
factors for illnesses, and helping people take
measures to prevent these illnesses from
occurring.
 Example:
o Smoking cessation campaign that both
assist individuals to stop smoking and
protect the public from ill effects of
secondhand smoke.
 Includes environmental program that
reduce incidence of illness.
 Secondary Prevention: Diagnosing and
treatment.
o Have also evolved and serve ever growing
numbers of client
o Included as health promotion service is early
detection of disease, accomplished through
routine screening of the population and
focused screening of those at increased risk for
developing certain condition.
 Example:
 Regular dental exams
 Bone density studies for women.
 Mammograms and education regarding
early detection of cancer of breast
 Voluntary HIV testing
 Tertiary Prevention: the goal is to help people
move to their previous level of health or to the
highest level they are capable of given their
current health status.
o Rehabilitative care – emphasizes the
importance of assisting clients to function
adequately in the physical, mental, social,
o Palliative care – an end-of-life care.
Healthy People 2020 – project of WHO.
1. Increase quality and years of healthy life.
2. Achieve health equity and eliminate health
disparities.
3. Creates health environments for everyone.
4. Promote health and quality life across the life
span.
Types of Health Care Agencies and Services
 Public Health – established at local, state, and
federal levels to provide public health services.
It varies according to the needs of the area.
 Physician’s Order – for routine health screening,
illness diagnosis, and treatment.
 Ambulatory Care Centers – provide services to
people who require minor surgical procedures
that can be performed outside the hospital. It is
synonymous with clinics in many places.
 Occupational Health Clinics – setting for
employee health care.
 Hospitals – private and public.
 Subacute Care Facilities – variation of inpatient
care designed for someone who has an acute
illness, injury, or exacerbation of disease.
 Extended Care Facilities – formerly called
nursing homes.
 Retirement and Assisted Living Centers –
consists of separate houses, condominiums, or
apartment for residents.
 Rehabilitation Centers – Usually are
independent community centers or special units.
 Home Health Care Agencies
 Day Care Centers
 Rural Care
 Hospice Services – interprofessional health care
service for the dying.
 Crisis Centers – Provide emergency services to
clients experiencing life crises.
 Mutual Support and Self-Help Groups – these
group may be for the client or for the friends
and family of the client, who also needs
education.
Concept of Health
 Health
o Defined in terms of the presence or
absence of disease.
o Florence Nighingale – defined health as
a state of being well and using every
power the individual possesses to the
fullest extent.
o WHO (1948) – takes a more holistic view
off health. “a state of complete physical,
mental, and social well-being, and not
merely the absence of disease or
infirmity.
o US President’s Commission on Health
Needs of the Nation – “Health is not a
condition; it is an adjustment. It is not a
state but a process. The process adapts
the individual not only to our physical
but also to our social environment.
o ANA (2010) – “health and illness are
human experiences. The presence of
illness does not preclude health, nor
does optimal health preclude illness.
 Wellness – state of well-being
o Basic aspect of wellness:
 Self-responsibility
 Ultimate goal
 Dynamic, growing process
 Daily decision making in the
areas of nutrition, stress
management, physical fitness,
preventive health care, and
emotional health
 The whole being of the
individual.
o 7 components of wellness by Anspaugh,
Hamrick, and Rosato (2011):
 Environmental – ability to
promote health measures that
improve the standard of living
and quality of life in the
community.
 Social – the ability to intercat
successfully with people within
the environment which each
person is a part, to develop
respect and tolerance for those
with different opinions and
beliefs.
 Emotional – ability to manage
stress, and to express emotions
appropriately.
 Physical – Ability to carry out
daily task, achieve fitness,
maintain adequate nutrition and
proper body fat, avoid
substance abuse.
 Spiritual – believe in some force
that serves to unite human
beings and provide meaning
and purpose to life.
 Intellectual – ability to learn and
use information effectively for
personal, family, and career
development.
 Occupational – ability to
achieve a balance between work
and leisure time.
o Well-being – subjective perception of
vitality and feeling well.
 Illness
o It is a highly personal state in which the
person’s physical, emotional,
intellectual, social, developmental, or
spiritual functioning is thought to be
diminished.
o An individual could have a disease and
not feel ill.
o A person can feel ill yet have no
discernible disease.
 Disease
o Alteration in body functions resulting in
a reduction of capabilities or a
shortening of the normal life span
o Etiology – causation of a disease or
condition
o Acute illness – typically characterized
by symptoms of relatively short
duration. Symptoms appear abruptly
and subside quickly.
o Chronic illness – one that lasts for an
extended period usually 6 months or
longer, and often for the person’s life.
 Remission – when symptoms
disappear.
 Exacerbation – when symptoms
reappear.
Health-Illness Models
 Host-Agent-Environment (Etiologic Model)
o Originated in the community health
work of Leavell and Clark (1965)
o Expanded into General Theory of
Multiple Causes of Disease.
 o Used in predicting illness rather than
promoting wellness.
a) Agent – any environmental
factor or stressor that by its
presence or absence can lead to
illness or disease.
b) Host – Person who may or may
not be at risk of acquiring a
disease.
c) Environment – all factors
external to the host that may or
may not predispose the person
to the development of disease.
 Physical – includes
climate, living
conditions, sound and
economic levels.
 Social – interaction with
others and life events
such as deaths.
 Illness-Wellness Continuum
o Ranges from optimal health to
premature death.
o Illustrates two arrows pointing in
opposite directions and joined at a
neutral point.
o Movement to right indicates increasing
levels of health and well-being for an
individual
o Movement to the left, indicates
progressively decreasing levels of death.
o Believed that it is possible to be
physically ill and at the same time
oriented toward wellness or be
physically healthy
 Dunn’s High Level of Wellness
o Describe a health grid; health axis and
environment axis that intersect.
o The grid demonstrates the interaction of
the environment with the illness-
wellness continuum.
o Health – extends from peak wellness to
death.
o Environment – extends from very
favorable to very unfavorable.
o Interaction of the two axes forms four
quadrant of health & wellness:
a) High-level wellness in a
favorable environment – person
who implements lifestyle
behaviors.
b) Emergent high-level wellness in
an unfavorable environment –
woman who has knowledge to
implement health lifestyle
practices but does not
implement adequate self-care
practice.
c) Protected poor health in a
favorable environment – ill
person whose needs are met by
the health care system and who
has access to appropriate
medications, diet, and health
care instruction.
d) Poor health in an unfavorable
environment – young child who
is starving drought stricken
country.
Nursing as a Profession
 Profession – job that require special skills,
education, or training
o Occupation that requires extensive
education or a calling that requires
special knowledge, skill, and
preparation.
1. Criteria of a professional nurse:
 Specialized education
 Body of knowledge
 Service orientation
 Ongoing research
 Code of ethics
 Autonomy
 Professional organization.
 Nursing – assists client, sick or well, in
performance of activities contributing to health,
its recovery and peaceful death, that clients will
perform unaided if they had the necessary will,
strength or knowledge.
1. Art and science
2. Diagnosis and treatment of the human
responses to actual or potential health
problems.
3. Act of utilizing the environment of
patient to assist him in his recovery.
 Human response:
1. Promotion of health and wellness.
2. Promotion of safety and quality of care.
3. Care and self-care procedures
4. Physical, emotional, and spiritual
comfort, discomfort and pain.
 5. Adaptation to physiologic and
pathophysiologic process.
6. Emotions related to the experience of
birth, growth, and development, health,
illness, disease and death.
7. Meanings ascribed to health and illness.
8. Linguistic and cultural sensitivity.
9. Health literacy.
10. Decision processes within relationships.
11. Social policies and their effects on
health.
12. Health care systems and their
relationship to access, cost, and quality
of health care.
13. The environment and the prevention of
disease.
 Common definition of nursing:
1. Nursing is caring
2. A science
3. Client centered
4. Holistic
5. An art
6. Adaptive
7. Concerned with health
8. Promotion, health maintenance and
restoration
9. Helping profession.
 Personal and professional qualities of a nurse.
1. Interest willingness to work and learn
with individuals/groups in a variety of
setting.
2. Warm personality and concern for
people.
3. Resourcefulness and creative as well as
a well-balanced emotional conditions.
4. Capacity and ability to work
cooperatively with others.
5. Initiative to improve self and service.
6. Competence in performing work
through the use of nursing process.
7. Skills in decision making,
communicating, and relating with
others and being research oriented.
8. Active participation in issues
confronting nurses and nursing.
 Classification of nurses
o According to field of nursing
 Institutional nurse – also known
as hospital nurse.
 Public health nurse –
community health nursing.
 Community health
nurse.
 School nurse
 Occupational nurse
 Maternal and child
nurse
 Tuberculosis nurse
 Nurse educator.
o According to types of duty
 General duty nurse
 Private duty nurse
o According to types of position
 Administrator or assistant
administrator
 Consultant
 Clinical specialist
 Supervisor or assistant
supervisor
 Instructor
 Head nurse
 Change nurse
 General duty nurse/staff nurse
o According to professional status
 Active
 Inactive
 Levels of proficiency according to Benner
o Novice: beginning nursing student, or
any nurse entering a situation in which
there is no previous level of experience.
o Advanced beginner: nurse who has had
some level of experience prior to the
situation.
o Competent: nurse who has been in the
same clinical position for 2-3 years.
o Proficient: greater than 2-3 years in the
same clinical position.
o Expert: with adverse experience who
has an intuitive grasp of an existing or
potential clinical program.
 Roles of professional nurse
o Caregiver
o Advocate/client advocate – promotes
what is best for the client.
o Educator – provides health teaching to
effect behavior change.
o Communicator – communicates with
client’s support person
o Manager – plans, gives direction,
develops staff, monitor operations, gives
rewards fairly, and represents both staff
members and administration as needed.
o Clinician
o Counselor – help the client to recognize
with stressful psychologic or social
problems
 o Change agent – initiates change and
assist the client make modification in
the lifestyle to promote health.
o Leader – helps client make decision in
establishing and achieving goals to
improve his well-being.
o Case manager
o Researcher – participates in scientific
investigation and use research findings.
 Professional Responsibilities of a Nurse
o Responsibility to patient – to carry out
doctor’s order concerning patient’s
treatment to give facts or information
which the patient or the family are
entitled to know.
o Responsibility to the physician – to
carry out accurately all legitimates order
of a physician concerning the treatment
of a patient under his medical care.
o Duty to the public – the nurse must take
part in enlightening the public on the
dangers of communicable and
preventable diseases.
o Duty to colleagues/co-workers – nurses
should work together in harmony of the
advancement of the profession and for
public interest.
o Duty to the profession – the nurse
should be committed in his/her
professional growth by keeping abreast
with the latest trends in nursing.
 Nursing Ethics
o Ethics
 System of moral principle or
moral standards governing
conduct.
 Particular system of principles
and rules concerning duty.
 Study of the moral conduct or
principle underlying the
desirable types of human
conduct.
o Nursing ethics
 System or principle governing
the conduct of nurses; it deals
with the relationship of a nurse
to the patient, patient’s family,
her associates, fellow nurses,
and society at large.
o Code of nursing ethics in the PH
 Adopted and promulgated on
march 21, 1973 on the code of
nurses adopted by the national
representative of the
international council of nurses
in Mexico city in May 1973.
o Ethical concepts of PNA
 Health is a basic right to every
individual.
 Basic to nursing is
understanding of man.
 Basic to nursing is respecting for
the lives, dignity and right of
man.
 Nurse must respect to change.
 Standards of practice vary.
Communication and Nurse Client Relationship
 Communicating
o Communication – is the interchange of
information between two or more
people; exchange of ideas and thoughts.
o Intrapersonal communication – is the
communication that you have with
yourself; self-talk.
 Communication process
o Sender
 Person or group who wishes to
communicate a message to
another; can be considered the
source-encoder.
 Encoding – involves the
selection of specific signs or
symbols to transmit the
message, such as which
language and words to use,
how to arrange the words, and
what tone of voice and gesture
to use.
o Message
 It is what actually said or
written, the body language that
accompanies the words, and
how the message is transmitted.
o Receiver
 Is the listener, who must listen,
observe, and attend.
 This person is the decoder , who
must perceive what the sender
intended.
 Decode – means to relate the
message perceived to receiver’s
storehouse of knowledge and
 experience and to sort out the
meaning of the message.
o Response
 Is the message that the receiver
returns to the sender; also called
as feedback.
 Feedback – can either be verbal
or non-verbal, or both.
 Modes of communication
o Verbal communication – is largely
conscious because people choose the
words they use; wide variety of feelings
can be transmitted when people talk.
 Pace and intonation – manner of
speech, rate or rhythm, and
tone.
 Simplicity – use commonly
understood words, brevity and
completeness.
 Clarity and brevity – direct and
simple.
 Clarity – saying
precisely.
 Brevity – using fewest
words necessary.
 Timing and relevance – needs to
appropriate.
 Adaptability – adjustment;
alters spoken message in
accordance with behavioral cues
from the client.
 Credibility – worthiness of
belief, trustworthiness and
reliability.
 Humor – positive and powerful
tool in the nurse-client
relationship
 Helps clients adjusts to
difficult and painful
situations.
o Non-verbal communication – sometimes
called body language; often tells more
about what the person is feeling than
what is actually being said.
 Personal appearance – clothing
and adornment can be sources
of information about a person.
 How a person dress is
often how the person
feels.
 Posture and gait – way people
walk and carry themselves.
 Erect posture and an
active purposeful stride
suggest a feeling of
well-being.
 Slouch posture and a
slow, shuffling gait
suggest depression or
physical discomfort.
 Tense posture and a
rapid, determined gait
suggest anxiety or
danger.
 Facial expression
 Gestures – may emphasize or
clarify the spoken word, or they
may occur without words to
indicate a particular feeling or
to give a sign.
o Electronic communication
 Email – most common form of
electronic communication.
Factors Influencing the Communication Process
1. Development – language, psychosocial, and
intellectual development move through stages
across the lifespan.
a. Will allow the nurse to modify the
message accordingly.
2. Gender
a. Girls tend to use language to seek
confirmation, minimize difference, and
establish intimacy
b. Boys use language to establish
independence and negotiate status
within a group.
3. Values and perception
a. Values are standards that influence
behavior.
b. Perception – are the personal view of an
event.
4. Personal space – is the distance people prefer in
interaction with others.
a. Proxemics – study of distance between
people in their interaction.
i. Intimate: 0-1.5 feet
ii. Personal: 1.5-4 feet
iii. Social: 4-12 feet
iv. Public: 12 and beyond.
b. Intimate – characterized by body
contact, heightened sensation of body
 heat and smell, and vocalizations that
are low.
c. Personal distance – overwhelming than
intimate distance.
d. Social distance – characterized by a clear
visual perception of the whole person.
e. Public distance – requires loud, clear
vocalizations with careful enunciation.
5. Territoriality – concept of space and things that
an individual considers as belonging to the self.
6. Roles and relationship –
a. Roles such as nursing student and
instructor
7. Environment – extremes can interfere with
communication.
8. Congruence – congruence communication when
the verbal and non-verbal aspects of the
message match
9. Interpersonal attitudes – convey beliefs,
thoughts, and feelings about people and events