THE NURSE AS A PROVIDER OF HEALTH CARE

Roles of the Nurse:

There are varied major roles nurses assume today. These are the:

Therapeutic role
The nurse has a healing or curative role. Nurses utilize techniques that
facilitate the natural processes of healing whether it is physical, psychological
and interpersonal.

Caring (comforting) role

The chief goal of the nurse in this role is to provide support. The nurse
supports the patient by attitudes and actions that show concern for patient
welfare and acceptance of the patient as a person, and not merely as a chart.
Nurses who comfort patients act to relieve anxiety, diminish pain and restore a
sense of well–being.
Caring activities also include those that preserve the dignity of the individual
and those often referred to as the “mothering behaviors” in nursing.

Communicating role
Communication is integral to all nursing roles. Actions related to
communication include collecting information, conveying information and
influencing others. The quality of a nurse’s communication is an important
factor in nursing care. The nurse must be able to communicate clearly and
accurately in order to meet the client’s health needs.

Teaching role
Nurses frequently act as teachers, imparting information and reinforcing
changes in behavior. For effective learning, a nurse must establish an
environment in which patients can learn, determine patient’s need to learn,
assess his/her readiness to learn and design teaching strategies for said
learning.

Planning role
Planning by nurses occur during all phases of the nursing process, including
assessment, planning, intervention and evaluation. Nurses plan with patients,
their families and other health team members.

Coordination role
Coordination is needed to achieve high–quality care. With efficient
communication among team members, unnecessary duplications and gaps in
services can be minimized.
Protecting role
This includes nursing activities that ensure safety of patients from injury or
complications.

Rehabilitating role
Rehabilitating activities are those that maximize a patient’s capacities and
minimize limitations. These activities often help patients to change and to gain
new skills
Socializing role
For patients who are separated from their families and normal activities,
socializing offers a distraction and respite from the focus on illness. Patients do
not always want a therapeutic conversation, sometimes they just want news of
another world and conversation they can enjoy. This is particularly true of
patients with long–term illness.
Counselor role
The nurse helps the client to recognize and cope with stressful psychologic or
social problems, to develop improved interpersonal relationship, and to
promote personal growth. The nurse helps those she serves to become aware of
their feelings and to deal with them in a constructive manner.
Leadership role
Nursing have expanded and now nurses assume leadership in health
maintenance and disease–prevention and rehabilitative programs. Patients look
up to nurses as authorities on the care they receive, thus, nurses use this
opportunity to help in the delivery of health care to individuals, families and
communities.
Administrative role
The nurse has an important role as the person who sees to it that nursing
services are organized, coordinated and dispensed to meet the patient’s
particular needs for nursing care.
Client advocate role
The may represent the client’s needs and wishes to other health professional by
just merely relaying
it to them. Nurses assist clients in exercising their rights and help them speak
up
MAINTAINING GOOD PERSONAL HEALTH KEY EXAMPLES & RELATED NOTES
POINTS
“Personal Health” means not only physical health
1. Accept your responsibility to yourself and others to keep as mental health as well. The WHO defines health as
healthy as possible. Staying in top physical condition is complete physical, mental and social well–being a
necessary when working with sick people. merely the absence of disease or infirmity.

2. Understand that keeping in good health requires daily Eating well–balanced meals and obtaining enough
attention to health needs. Obtain enough sleep and rest daily rest will help the body to resist infection and will le
to feel at top performance. effects of illness, if it comes.

3. Remember what foods are essential for good health. Start Malnutrition which is commonly defined as lack of
the day with a substantial breakfast. or appropriate food substances may result.
Sufficient water (about 6–8 glasses daily) is essenti
4. Make a check on the amount of water you drink daily. health.
Excess body weight predisposes people to chronic
5. If you are overweight or underweight take this problem to problems such as hypertension and diabetes melli
your health service, if available, or to your family doctor. Inadequate nutrition is associated with marked we
altered functional abilities, increased susceptibility
6. Bathe daily for health and social reasons. Use soap and infection, etc.
water generously to cleanse skin of perspiration and bacteria. Close contact with patients makes body freshness
Then use a good deodorant. Nurses must not omit feminine hygiene.
Oily hair may require daily shampoo. Dry hair and
a. Shampoo the hair regularly and frequently enough to keep be shampooed less often,
it in good using appropriate shampoo.
condition and free from odor. During the day the face is exposed to different sub
b. Give particular care to skin of the face. Cleanse often with from the atmosphere and to many things (particul
mild soap and skin cleanser. hands) which may transfer bacteria to it. A skin ke
7. Form a good habit of daily oral care. and oily deposit will not form blackheads and unsi
blemishes.
a. Brush teeth after eating or at least thrice daily, Regular visits to dentist, at least twice a year, are e
including after evening meal snack. keep teeth and gums in good condition. When una
brush after eating, wash mouth with water.
b. Use a mouthwash (table salt is good) after brushing
The use of mouthwash after eating onions or garlic
regularly.
advisable; brushing has only a temporary effect on
 Do not allow hands to become chapped.
8. Give special attention to the hands not only Breaks in skin invite infection. Use a good
for reasons of personal health and lotion or cream to keep it smooth.
appearance, but to prevent the possible
spread of disease– producing organism. Washing may be done:
a. Before eating or handling any food.
a. Wash hands thoroughly (using special b. After using the toilet.
techniques) many times throughout the day. c. After each contact with a patient and
b. Keep fingernails clean and trimmed to after handling articles used in patient
moderate length. care.
9. Take excellent care of those feet. They serve
you well. Long nails may injure the patient/and may
harbor dust and microorganisms.
a. When bathing, wash carefully and
dry thoroughly. Rubbing with lotion or alcohol (has drying
effect on the skin) or foot powder, as desired,
b. Trim toe nails straight across. will bring much relief to your feet.

c. See to it that hose is large enough Damp areas, especially in interdigital spaces,
and longer than foot. can invite fungus to thrive

d. Wear well–fitting rubber-soled Careful trimming and care of toe nails can
shoes with proper support and heels. prevent painful ingrown nails.

e. Alternate daily between two pairs of Too small hose can compress legs and so with
shoes, if possible. underlying blood vessels.

10. Check your posture and if help is needed This causes less jar to the body. Also, they
consult a health service to work out a definite reduce the irritation brought about by noise.
program to correct your faulty habits.
Alternating pairs of shoes is good for the feet
11. Try to keep an even, keen, emotion. Seek and makes the shoes last longer.
help for ways to better understand yourself
and others, if necessary. Good posture is necessary for the body to
function at its best. Think of good posture as
12. Become interested in some type of sports good body alignment and balance in all
game, or hobby that gives real pleasure to positions and activities.
you. Join with others in an organization of
choice. Emotional stress can produce negative and
nonconstructive feeling about self.
13. Keep an open mind and use it to keep up–
to–date in a fast-changing world. Activities or hobbies that take you outdoors
are especially good. Walking, swimming,
dancing and cycling are excellent exercises and
all can be carried on into later life with great
benefit to both physical and social wellbeing.
Keep self-updated by reading, attending
seminars and continuing education
PRESENTING A GOOD APPEARANCE KEY EXAMPLES & RELATED NOTES
POINTS
In addition to being well–groomed the
1. When you feel good about your student nurse should have a pleasing
appearance, your work, and your personal appearance in keeping with the job of caring
relationships, your whole day is likely to go for sick people.
better, because you think well of yourself.
Uniform should be given good repair, with all
2. If possible, give yourself the mirror test buttons in place. The length of the slip should
before reporting for duty. Look at yourself in be shorter than the length of the uniform.
a full-length mirror.
Good posture gives an impression of poise
3. Start the day in a spotlessly clean, well- and self–confidence which sparks a feeling of
fitting uniform. You are expected to wear a well–being and success on the job.
fresh uniform each day. Wear an Being in close contact with the patients all
underclothing that is washed daily and in day require special attention to clean and
good repair. eliminating odors of any kind. Nurse should
not omit feminine hygiene. This is very
4. Be clean, look clean, and feel clean. important.

5. Check the way you stand and how you A skin kept from dirt and oily deposits will
walk. Set out to correct faulty posture habits, not form blackheads and unsightly blemishes.
if any.
Highly scented toilet preparations are often
6. Bathe daily and use an effective deodorant offensive to patients and should be avoided.
especially under the arms, to protect against
being offensive to patients and others. Perfumes should never be used on duty. Use
an effective lotion or cream to prevent
7. Give the face special skin care. It should be breaks in skin.
impressively clean.
Heavy makeup is never appropriate for duty.
8. Use cosmetics with restraint. Apply light Well–kept hair does not obstruct vision and
lipstick and use only mild colognes. prevents spread of microorganisms with
frequent touching.
9. Keep hair in neat arrangement and in
keeping with good taste for work. The nurse’s
hair should be in keeping with the practices
of the particular hospital or agency.

10. Take particular care of your hands, for

health reasons as well as appearance.

a. Keep clean, wash thoroughly,

several times during the day as necessary.
 Long nails are out of place in caring for sick
b. Keep hands chap–free and smooth. people. Sharp nails may injure the patient.
c. Keep nails clean. File or trim to They also can harbor microorganisms.
moderate length. Moccasins or flats without heels give a
careless impression and do not give the feet
11. Wear well–fitting shoes. Keep shoes proper support.
clean, polished and in good repair. Pay Avoid circular garters or rolled hoses for
attention to run down heels and have them health reasons as well as for appearance’s
replaced as soon as needed. sake.
Jewelry can harbor pathogenic
12. Wear clean hose or socks daily. Hose microorganisms.
should be free from unsightly runs. Be in Other people will respect the nurse better if
good taste when in uniform. she acts with proper decorum

13. Earrings, rings, and other forms of jewelry

should not be worn while on duty (except for
wedding bands by married individuals).

14. Gum chewing makes an unfavorable

impression with patients, watchers and
others.

15. Lounging in undignified positions and

talking in loud, boisterous voices are
damaging to the nurse’s poise and
composure.
Nursing-
Florence Nightingale- act of utilizing environment of the patient to assist him
in his recovery
Virginia Henderson-assist the individual, sick or well, in the performance of
those activities contributing to helth that he would perform unaided if he had
the necessary strength, will or knowledge..
Nursing is connected to = Caring, helping, Client-centered, holistic, adaptive,
art and science
Jean Watson- Nursing is caring
Holistic- as a whole, spiritual, physical, psychological, mental
Adaptive- flexible adjust to the environment
Art and science- concerned with skills and proficiency
Characteristics of nursing
a. NUSING is caring
b. involves close, personal contact with the recipient of care
c. concerned with services that considers man as multifaceted being
d. commited to promoting individual, family, community, and national health
goals in the best manner possible.
e. commited to involvement in ethical, legal, and political issues in the delivery
of health care
f. utilizes research to improve quality of human life
Think of the patient as an individual who:
- Needs help
- Have fears and worries about their illness or injury
- Has to be allowed to maintain identity
- Should be given privacy, dignity and maintain self-esteem
- Can continue to practice his own religious faith, customs and patterns of
his nationality
- Should be allowed to continue in his ways, habits, rituals and
idiosyncrasies
- Should know what you are going to do
To give care to the patient means to
1. Help patient maintain or improve physical fitness
2. Provide a comfortable atmosphere
3. Help in the prevention of injuries and accidents
4. Help prevent patient from contacting a new illness

Hospital Team
Medical Staff
- Doctor/Specialist, Medical students (interns, clerks)
House case- has no previous doctors; thus doctor who is present at that time
will be his/her client
Private case- has a previous doctor and choose that doctor to aid him/her

Nursing staff- Nurse, Nursing aides

Social Service- Social workers

Ancillary services- Laboratory, Radiology, Pharmacy—Rehabilitation,

Nutrition and maintenance --- Spiritual services, Chaplain, Nuns/Sisters

Admitting in a Health Care Agency

Admission- administrative process that covers period from the time the patient
enters the institution door to the time the patient is settled

Inpatient- longer than 24 hours (usually in IV,2 to 3 days)

- Elective admission- admission itself may be delayed until time is
convenient for the client and the doctor; scheduled admission
- Emergency admission- occurs through the emergency department. The
client may be admitted to a floor, a specialized unit, or a
holding(observation unit.
 - Direct admission- the client does now feel well, goes directly to the
hospital and was advised to be admitted or has spoken to or seen the
doctor, who feels the need that the client should be admitted
Outpatient- Less than 24 hours
- Same-day surgery or out patient procedure-technically, this is not an
admission, with same-day surgery or ambulator surgery, the doctor will
be scheduling a procedure that will be performed at the hospital. The
client will be ad home the same day after the procedure
- Observational -head injury, premature labor, unstable vital signs

Admission procedure- it depends on the policy of the health care facility, in

some healthcare facilities the patient is taken directly to the room and the
actual admission process begins. In larger facilities however, the admission
process stars in the admitting office.

Responsibilities of admitting department

- Gather info for billing initiate medical record
- PREPAPRE BRACELET IS THE SINGLE MOST EFFECTIVE WAY OF
IDENTIFYING THE PATIENT
- MAY BYPASS IN EMERGENCY SITUATION
- AN ADDRESSOGRAPH CARD IS MADE
- CONSENT FORMS ARE SIGNED, EG, LIVING WILL, DIRECTIVES,
WAIVERS INITIAL ORDERS OBTAINED
- VERBAL REPORT GIVEN TO FLOOR RN
- TO PATIENT IS ESCORTED

Different Areas of Admission

- ICU(Intensive care unit)- reserved for the sickest people, those who
require nursing supervision, or those who require a ventilator to help
them breath
- Coronary care unit- ICU for individuals who has heart problem
- Surgical Intensive care unit- for people who have done surgery
- Pediatric Intensive care unit- for children
- Neonatal intensive care unit- for newborns
- Surgery floor- general floor for people who need surgery
- Medical floor- a general floor for medical care
- Neurological or neurosurgery care unit- people who suffered stroke
- Oncology unit- people with cancer
- Orthopedic unit- people with fracture/ individuals that are having
problems that includes their bones
 Prepare room
Provide personal care item Bed in High pos if arrived in Gurney
Suction Bed in low pos if arrived in W/c
Oxygen Blue pads if NEC
IV Pole

Admission procedure- clients unit

A. Before a patient is admitted, make sure the rom is ready for his/her arrival
B. Help the patient become familiar with the new surroundings- explain the
facility’s policy on visitors, when is the meal time is served-aske about the
patients daily routine
Identify self
- Makes patients feel secure
- Makes patients feel welcome
- Alleviates anxiety/fear
C. Screen or curtain off the bed or close the door to a private room
- Ask the patient to put on a hospital gown, or a gown or pajamas brought
from home
- Assist the patient as needed
- If the patient wants a family member to be present, invite the person in.
Gather information
Nurse will gather info about
- Medical orders
- Treatments
- Labs
- Tests
- Diet
- Activity
- Physical Assessment within 24 hours
D. Assess the patient’s general physical condition, appearance, and behavior as
the admission process is continued

Observe the patient for unusual conditions

Cuts and Bruises
Loss of function
Signs of weakness
Any prosthesis
Other physical complaints the patient may have
E. Record vital signs and note for any unusualities from the baseline VS and
refer.

F. Ask about previous hospitalizations, allergies, or diseases other than the one
for which the patient is being admitted

G. Record all information and observations on the admissions checklist.

H. Records taken during admission should be thorough with as much

pertinent information about the patient as possible

I. In acute care hospitals, the patient must provide a urine specimen

*Assist the patient to the bathroom, or offer the bedpan or urinal as needed.
*Collect the urine specimen from the patient, and replace the cap
*Label the specimen with the patient's name doctor's name and room number,
and send it to the laboratory along with the requisition for the admission urine
test.
*Always wash your hands after handling urine specimens
J. Make the patient comfortable:

*If the patient is ambulatory, he/she may wish to sit up and visit with family
members.
*In an acute care hospital, the patient is put to bed.
*Raise the side rails if the nursing supervisor orders it, and it also ensures the
safety of the patient admitted-side rails may be needed if the patient cannot or
should not get out of bed unassisted, or if the patient's bed is not in the lowest
position.
*Give the patient water If it is allowed.
*Make sure the patient can reach the signal cord and anything else he/she
might need while
Remove the screen or curtains surrounding the patient, or open the door so
others will know you are not in the room you are finished.
*Tell family members they may return to the patient's room.
Appearance How to help
Exhibits Separation Anxiety. Acknowledge feelings.
Sad Provide explanations and instructions
before performing procedures
Worried Inquire about stress due to
children/pets/spouse at home.
Restless O Reassure. Separation Anxiety can
cause the elderly to be confused and
disoriented.
Reduced Appetite
Insomnia
Anxiety

Discharge
Termination of care from a health care agency
METHOD
Meds-educate the (route, frequency, and schedule)
Environment -depends on the situation/ clean if ever pt is from ICU
Treatment-
Health Teaching- newly diagnosed as diabetic
Outpatient Referral- from therapy- refer to PT
Diet
AMA (Against Medical Advice
-Patient leaves prior to obtaining a written order. Nurse requests patient to sign
form. If refuses, nurse must let the patient leave and note refusal to sign AMA
in chart.

Transfer
 DISCHARGING A PATIENT FROM ONE UNIT OR AGENCY AND
ADMITTING THEM TO ANOTHER UNIT

 INFORMS PATIENT/FAMILY
 COMPLETE TRANSFER SUMMARY

 SPEAKS WITH NURSE ON TRANSFER UNIT

 TRANSPORTS PATIENT/BELONGINGS/SUPPLIES & CHART

 CHECKS ORDERS/MAKES NEW ADDRESSOGRAPH CARD W/NEW

ROOM #
 Setting Standards
 The American nurse’s association sets the standard for patient care and
documentation for RN
 Do nut use “seems” or “appears” in documentation. Implies doubt and
lack of knowledge

Patient Chart
- Patients complete clinical data and medical history; systematic
documentation of patients medical history
Initial/admitting diagnosis and Final Diagnosis
Medication
Laboratory
Progress
Notes
Improvements- cause of death
Person to contact in case of emergency
Patients Data sheet
How the person is delivered-

Purposes
1. To evaluate progress
2. Permanent record that can be used for future care
3. Evaluate the effectiveness treatment given; research purposes

Documentation is very important- writing should be legible

Consent for procedures

Clinical History- for surgical green (medical/surgical), white for pediatric,

yellow obstetric

Laboratory results
For privacy- write the doctors name, room number