FUNDAMENTALS OF NURSING

Module 7: Concept Integration of Nursing as a Science

STEPS WITHIN THE STEPS
 Module 7: Concept Integration of Nursing as a Science

I. MODULE INTRODUCTION

There are various concepts in this world and you may have some ideas about certain
concepts but not as detailed as the others. Some people are better than us when it
comes to understanding certain branch of knowledge. Like for example, you want to to
start a good restaurant business, then you should talk to those who have experience
and knowledge about restaurant business and not an architect. If you want to build your
dream house, you will seek the expertise of an architect and not a businessman. So, if
people wants to be healthy and well, they will seek a health professional such as a
doctor or a nurse.

As a future nurse, you are expected to be knowledgeable about the concepts of health
and wellness. And in the process, you are being trained to embrace the theory
(knowledge) and practice (experience/skill) that governs the Nursing discipline.

To be able to craft our nursing care (art) and follow the standards of nursing practice
(profession), you should develop the knowledge, skills and attitude to practically decide
on what to do when faced with clients or situations pertaining to health, wellness and
illness. This is when nursing as a science come to play as it guides nurses with a
unique process of dealing with clients. The NURSING PROCESS will help you to
distinctly select ideas, actions and consequences that will bring about better health
outcomes for individuals/ families/ community under your care.

NURSING PROCESS embodies nursing as a science. It is unique from other

professions because the steps we follow is not similar (though related) to doctors,
midwives, medical technologists or any other health care professionals. Unique as it is,
nursing process is more efficient with the collaboration of others specially of our allied
health care team.

Take note that the concepts of nursing as an art, science and as a profession are all
interrelated. Meaning, we can only do nursing process efficiently if we follow the art of
nursing and adhere to the professional standards.

This module is an integration of all the steps within the steps of Nursing Process.
 Module 7: Concept Integration of Nursing as a Science

II. PURPOSE AND OBJECTIVES

Purpose:
This module integrates the most important concepts of nursing as a science to synthesize
student’s learning of the nursing process.

Objectives:
After this module, students are expected to write a nursing care plan:
a. Enumerate the steps of each phase of the nursing process.
b. Process assessment data and list actual and risk problems
c. Categorize, prioritize and state the nursing diagnosis/ses.
d. Create clear nursing goal/s and objectives
e. Develop quality nursing care interventions with rationale that is relevant to the
identified problems
f. Draft a comprehensive evaluation guide to measure the degree by which set goal/s
and objectives are met.
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II. CONCEPTS OF NURSING AS A SCIENCE

STEP 1. SCIENCE OF ASSESSMENT

The science of assessment suggests that there is a process to follow when doing assessment.
The process includes collection, organization, validation and documentation of client’s data.

Step 1.1. Data collection of subjective data– These are considered the cues to action for
nurses as it implies the felt need of the client. Nurses should listen carefully to the
statements of the client (and/or significant others) to understand the symptoms and relate
it to the signs present.

As a science, subjective data can be elicited from the conversations of the nurse, client and
or significant others. Efficiency in collecting subjective data is better with the use of
assessment tools and standard or institutional questionnaires.

Example: The client says “My head hurts” , therefore, the subjective data is “My head
hurts”. Then the nurse asks, from a scale of 1-10, 10 being very painful, which scale would
 Module 7: Concept Integration of Nursing as a Science

you describe it? “It (pain) is 7 (scale).” That gives you another subjective data which you
will write word for word: Pain scale: “It is 7”.

Step 1.2. Data collection of objective data – These are considered

the cues to action for nurses as it implies what is seen or
observed. Nurses needs to develop the skill of being meticulous
and inclusive in observation and examination of client.

Objective data are derived from physical assessment, use of

biophysical measures (thermometer, sphygmomanometer,
weighing scale, stethoscope, etc), data from records including
laboratory and radiologic results.

Example of objective data includes BP, heart rate, temperature, complete blood count
result, x-ray result, ECG result, and others.

The table below was captured from Kozier and Erb’s Fundamental of Nursing, 10th edition
book showing examples of subjective and objective data.

Step 1.3. Review health records - Checking for previous and existing health records will give
you more details about the client’s over-all condition. Previous health condition such as
having diabetes may not be reported by the client and vital signs do not explicitly show that
the patient has diabetes. If the nurse fail to recognize this condition, treatment for the
patient will not be complete. Existing health records should also be checked for any
updates such as new released laboratory results. A client who had a consistent low
hemoglobin in the past 3 days of hemoglobin monitoring may result to an already normal
hemoglobin due to a blood transfusion given 6 hours ago.

Step 1.4. Update, organize and validate data- Data collected can be organized and categorized
according to its relevance such as according to history, physical assessment, nutrition,
elimination, etc. Referring to nursing models can help nurses in organizing data like the
Gordon’s patterns of functioning, Orem’s self-care model, health belief model, and many
 Module 7: Concept Integration of Nursing as a Science

others. Some institutions adapt certain models in their standards so that this can already
be followed even at the beginning of nurse-client interaction.
Validating, verifying or double-checking the data is very important to make sure that it is
complete. Be careful in making inferences about the client condition by always referring
back to the cues to make sure that the goals of care will be relevant and adequate for the
client.

Step 1.5. Communicate data with the health care team – Documentation is very important as it is
the most efficient way of communicating data to all members of the health team throughout
the patient care. Examples on how to document and communicate assessment data is the
use of Nurse’s notes, Vital Signs or TPR sheet and Kardex.

STEP 2. SCIENCE OF DIAGNOSIS (Nursing Diagnosis)

The science of nursing

diagnosis suggests that there
is a process to come up with a
nursing diagnosis. The
process includes analysis and
synthesis of all data collected
identify client’s health
concerns.

Step 2.1 Review the signs,

symptoms and other
relevant data to identify
important
cues- All data from assessment should be reviewed, categorized and compared to the normal
standards of growth, development and functioning. Data is said to be vital if there is/are one or all
of the following: a) change in the normal health pattern of the client, b) a pattern that is unusual
compared to the general population, and c) a difference in the growth and development pattern
from the norm. All these data should be grouped and categorized according to relevance.

Step 2.2. Identify actual and risk problems- From the grouped data, identify if the
assessment data is an actual problem or a risk problem. Actual problems are based on the
signs and symptoms while risk problems are those reflected in the history, lifestyle and any
other data as long as it is NOT a sign NOR a symptom. Data about the strengths, weaknesses
and resources is also necessary to identify further diagnosis/es to ensure a holistic plan of
care.

Step 2.3. State the nursing diagnosis – Nursing diagnosis is different from a medical
diagnosis. Nursing diagnosis reflects either the physiological, psychological, cognitive,
emotional, and social response of the client to a certain illness (example: Deficient knowledge
related to lack of
 Module 7: Concept Integration of Nursing as a Science

recall on wound care) as it relates to the etiology. The medical/surgical diagnosis on the
other hand is the etiology of the disease or illness itself (example Superficial incisional
surgical site infection, right knee).

By stating the nursing diagnosis, all assessment data is synthesized to better understand the
condition of the client and determine which actions should be and should not be implemented by
the nurse. The way nursing diagnosis is stated reflects the problem and its etiology (2-part
statement), and sometimes the signs and symptoms are also mentioned (3-part statement).
A well-planned action by the nurse is what we call nursing interventions which will be the next
two steps of the nursing process after diagnosis.

Step 2.4. Analyze diagnostic decisions to prevent error – To make sure that the nursing
diagnosis truly encompasses the client’s needs which should be addressed, the nurse should
verify data with the client and health care team, acquire knowledge on the client’s response to
illness using reliable sources, check for standards of care and patterns.

In doing the analysis, it is helpful to make both scientific and situational analysis. Scientific
analysis reflects reference-based causes and consequences of anatomical and physiological
changes. Situational analysis is client-based analysis of the incidents leading to the occurrence
of the health problem which includes but not limited to risks factors that is present from the
client’s history.

STEP 3. SCIENCE OF PLANNING

The nursing science of planning ensures that nurses create goals and objectives to prevent,
reduce or resolve identified problems.

Step 3.1. List all actual and potential problems- Among all the nursing diagnosis statements
identified, determine whether it is an actual (based on signs and symptoms) or potential
problem (history, lifestyle, etc) and then group them together. hat may impair the normal
functioning of the client.

Step 3.2. Prioritize problems (High, intermediate, low)- Among all the list of actual and
potential problems, categorize them if it has high, intermediate or low priority. Life threatening
problems should be the highest priority followed by health threatening conditions as intermediate
or medium priority. Low priority problems include developmental needs which do not need
much of nursing assistance.

Take note of the changes in priorities (threatening condition is always #1 priority) which may be
caused by client’s beliefs, values, resources, client’s own felt priorities and the treatment plan.
 Module 7: Concept Integration of Nursing as a Science

Step 3.3. Establish

long and/or short
term goals and
SMART objectives-
Short-term goals are
those which are set
to meet immediate
and physiologic
needs.
Goals in acute care
settings (emergency
room, ICU, clinics,
dialysis center, etc) are
usually short term while long-term care settings (home care, chronic care hospitals, rehabilitation
centers, hospice care, respite care) have long-term goals. When developing goals, the desire
outcome should be clear by considering the client’s problem, unhealthy response, desired
observable response and what the client should demonstrate to show positive response.

Goals and objectives should follow the S-M-A-R-T guide, S-specific, M-measurable, A-
attainable. R-realistic, and T-time bounded. Specific which means the statement should clearly
state what the client will do and not what the nurse hopes that the client will do. Measurable
means that there is a way to count or weigh the extent by which the actions are demonstrated.
Attainable and realistic goals and objectives are those that are possible to do with considerations
to time, resources and client capability. Time-bounded which directs the nurse’s and/or client’s
action to accomplish a certain goal/objective.

Step 3.4. State the objectives in relation to the goal (CAP/KSA) – Objectives should follow
the S-M-A-R-T guide, S-specific, M-measurable, A-attainable. R-realistic, and T-time bounded.
“Specific” which means the statement should clearly state what the client will do and not what the
nurse hopes that the client will do. “Measurable” means that there should be a way to count or
weigh the extent by which the actions are demonstrated. Attainable and realistic goals and
objectives are those that are possible to do with considerations to time, resources and client
capability. Time-bounded which directs the nurse’s and/or client’s action to accomplish a certain
goal/objective.

Objectives in the nursing process should be based on etiology and address cognitive (knowledge),
affective (attitude) and psychomotor (skills) abilities of the client

Step 3.5. Write and communicate NCP – For entry level nurses such as student nurses,
nursing care plan (NCP) is required to ensure preparation before client interaction. It also serves
as the supervisor’s reference to check if the care plan is adequate and appropriate for the client.
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More experienced nurses have advance skills in the nursing process and they are able to perform
interventions following the 5-step process of assessment, diagnosis, planning, implementation
and evaluation without a written NCP. Nurse leaders also have established written NCPs in the
form of Manuals of Practice or Standard Operating Procedures by which nurses modify depending
on the client’s needs. Newly made NCPs that tailors the unique need of the client is always the
best NCP. Ready made NCPs are available in print or in the internet but these NCPs do not
address the need of your client. It only serve as examples but will not exactly work for your client.

The format below is used by FEU-IN in writing NCPs for each client.

STEP 4. SCIENCE OF IMPLEMENTATION

The science of nursing implementation includes the process of carrying out the planned nursing
care interventions.

Step 4.1. Prepare self – Know the who, what, when, where, why and how the care should
be rendered – Before an intervention can be carried out, the nurse who will render the
intervention must know WHO the patient is, WHAT the intervention will be, WHEN should the
intervention should take place, WHERE should it be rendered, WHY the intervention is needed
and HOW the intervention should be carried out.
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Knowing who the patient is, the gender, age, cognitive abilities, physical abilities, values, beliefs
will help the nurse to carry out efficiently the intervention. Knowing the what, how and why of the

intervention ensures that the nurse is knowledgeable about the intervention including the
methods and the rationale behind such interventions which is needed to lessen the anxiety of the
client and build more trusting relationship. The location of the intervention, the environment such
as the noise, light, ventilation and the like should all be controlled prior to the implementation of
intervention to ensure patient’s safety and comfort as the intervention is given.

Step 4.2. Prepare client, patient care team and materials- In preparing the client, it is
necessary that the nurse build rapport to minimize anxiety, re-assess client’s condition and needs
to modify priority if needed. Explanation of the intervention before it is carried out is very
important to ensure cooperation of the client. The patient care team which includes the client’s
significant others, doctors, other nurses and nurse assistants should be aware that you are about
to perform intervention to reduce distraction and/or encourage support and for the client as well
as to the nurse implementing the intervention. The materials needed should be complete and
prepared prior to carrying out intervention to save time and effort and ensure efficiency.

Step 4.3. Implement nursing care with adequate interpersonal, cognitive and technical
skills (ICT)- Interpersonal skills is very important when dealing with client. A good interpersonal
skills encourage cooperation and adherence to treatment. It requires the skill of therapeutic
communication, rapport building as well as the ability to consider the cultural beliefs, values and
attitudes of the client.
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Cognitive and technical skills are the most important attributes of nurses as it exhibit the highest
standards of nursing care which delineates us from other disciplines such as medicine, midwifery
and others.

Step 4.4. Document and communicate the care rendered- Any intervention that is not
documented is considered not done. All interventions should be recorded after it has been
carried out. Recording of such intervention should not be recorded as done before it is carried
out as it will create confusion to the health care team and injury to the client. The Nurse’s Notes
is the primary document which nurses are required to accomplish and reflect all assessments,
diagnosis/ses, plan of care, intervention and evaluation. It serves as a legal document needed
for reference, proceedings in legal cases among others.

Aside from writing such care, verbally reporting interventions specially during endorsement
(change of shift / change of nurses) is vital for the incoming nurse to validate what is written in the
documents.

STEP 5. SCIENCE OF EVALUATION

The science of evaluation of nursing care measures the degree to which nursing goals and
objectives are met. It is also a means to identify which factors influences the success or
struggles of goal achievement.

Step 1. Collect subjective and objective data – Evaluation also gathers subjective and
objective data but it is more a focused assessment as it is targets the indicators based on the
written goals and objectives.
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Step 2. Compare data before and after nursing intervention- To determine whether the
goals and objectives are achieved, baseline data is compared to the recent subjective and
objective data. Determining signs of progress towards the normal or desired outcome is the aim
of comparison.

Step 3. Identify the structure, process and outcomes which are important in achieving the
set goals- with a clear set of SMART goals and objectives, relevant analysis of client condition,
well- justified interventions, evidence-based goal success is possible.

Integration of Client-response And Outcome Evaluation

Vital to evaluation of client care response is to measure the OUTCOME of care. Based from
actual and risk problems, the client’s physiologic (functional ability), psychological (behavior),
psychomotor (demonstrated physical abilities) and client’s knowledge should be compared from
baseline data to current data.

Integration of Quality Assurance And Process Evaluation

It is important to take note that when evaluating the PROCESS of nursing care, each objectives
are evaluated as to: a) effectiveness which reflects improved health outcomes, b) efficiency which
proves that the standards of care were followed, c) adequacy or the satisfaction of client’s needs,
d) appropriateness which reflects relevance of intervention to client’s needs, and e) acceptability
or the demonstration of cooperation and adherence of client to the intervention.

Integration of Quality Improvement And Structure Evaluation

Aside from process evaluation, STRUCTURE evaluation should also be taken into account to
determine strengths, weaknesses, opportunities and threats in the implementation of nursing
interventions. The physical facilities, equipment, organizational standards (pattern), quality of
service provision, health care team’s competence and adequacy of health care staff in relation to
the implementation of intervention are also evaluated.

Step 4. Decide whether to continue, modify or terminate the intervention – From the result
of evaluation, an intervention can be continued if desired outcomes are partially met but there
are resounding beneficial health outcomes to the client. Modification of interventions is needed if
the outcomes are partially met and portions of the objectives needs to be revised to better meet
the client’s need. Interventions are terminated either due to: a) met desired outcomes, or b)
negative outcomes resulted from the interventions given.

Step 5. Document and communicate evaluation- Recording results of evaluation is

important for future decision making, accreditation purposes, planning for future programs and
improving services. Strengths, weakness, threats and opportunities can be derived from such
evaluation and is essential for leadership and management purposes.
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NURSING CARE PLAN FORMAT

Name of Patient: _________Age:_____ Sex: ______ Civil Status: _______ Room/Bed No. ________
Medical /Surgical Diagnosis:________ Assessment date: ____________ Intervention date: __________
Prepared by: ____________________ Section/Grp No. ____________ CI/Supervisor:_______________
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