Welcome to the beginning of your nursing education! Fundamentals of Nursing is the first nursing class you will take to begin the nursing program. The skills you learn in this course will provide the foundation for the many nursing responsibilities you will assume throughout your career as both a nurse and a student. As you review the syllabus for this course, you might say to yourself, “OMG, how on earth am I supposed to learn all of this in a semester.” Stay calm and take it one day (and one section) at a time. It will take some time to adjust to the demands of the nursing program. Over time, you will develop study skills and confidence, and before you know it, you will be a pro at studying.
Let’s chat a little about what this course is all about. Fundamentals of nursing introduces you to the thorough assessment of patients, the nursing process, communication between nurse and patient, cultural differences, functional health patterns, and the overall framework of nursing practice. Think of it this way: When you build a house, you start with the foundation and then move to the framework, walls, and so on. I think you get the point. This class is the foundation for nursing, the beginning point. It gives you an overview of what to expect when working as a nurse.
It will take some time to learn the skills needed to assess patients; do not feel discouraged if you do not grasp the concepts right away. I found myself struggling at the beginning of the course. I felt overwhelmed, my mind was on overload from all the information, and I was nervous about performing the assessments in front of my classmates. I was not one for failure, but boy, did I feel like one at the beginning of this class. My test scores were poor, and my nervousness was undermining my assessment skills. I began to change my thinking. I studied day and night, went to study groups, and my grades began to improve. It is like the old saying: “Hard work does pay off.” I developed my study skills during this course, which helped me through the other courses, as well. You, too, will develop and improve your study skills as you progress through the course. So let’s jump to it and get started! We will begin with the history of nursing.
- Fundamentals of Nursing: HISTORY OF NURSING
- Fundamentals of Nursing: THERAPEUTIC COMMUNICATION
- Fundamentals of Nursing: Phases of Communication
- Fundamentals of Nursing: Tips on What Not to Do During Communication
- Fundamentals of Nursing: Developing Communication Skills
- THE NURSING PROCESS (NURSING CARE PLANS)
- Fundamentals of Nursing: Assessment
- Fundamentals of Nursing: Diagnosis
- Fundamentals of Nursing: Planning
- Fundamentals of Nursing: Implementation
- Fundamentals of Nursing: Evaluation
- PATIENT EDUCATION
- CARE ACROSS A LIFE SPAN
- FURTHER READING/STUDY:
- NCLEX-RN: Oncology Nursing
- NCLEX-RN: Disaster Nursing: Bioterrorism
- NCLEX-RN: Pharmacology
- NCLEX: MUSCULOSKELETAL DISORDERS
- NCLEX: Gerontologic care
- NCLEX-RN: Nutritional Management
- NCLEX-RN: Management Principles and Legal Issues
Fundamentals of Nursing: HISTORY OF NURSING
We could talk all day about the history of nursing. Many books have been written describing the great works of the nurses who built the foundation for the nursing profession. Without their knowledge and perseverance, we would not have the growing field we do today. This chapter covers only a few details from the history of nursing. To be honest, very little of this historical information was tested, and I would not spend too much time trying to remember dates and exact timelines. Follow your professors’ key points and highlight any information they emphasize. You will be required to know the influence of Florence Nightingale and her role in nursing.
- Florence Nightingale laid the foundation for professional nursing practice through her work in the Crimea in the 1850s. She later established her own nursing school. Through her teaching and emphasis on sanitary care of patients, the nursing field progressed.
- Nightingale was the first nurse epidemiologist.
- The Civil War (1860–1865) furthered the expansion of the nursing field. Nurses were needed to tend to patients’ wounds, and the field began to grow as additional women were trained. It was also during this time that the American Red Cross was founded.
- Between 1860 and 1900, Nightingale established 400 nursing training schools and helped improve the conditions of hospital-based care.
- In 1956, the first Health Amendment Act gave nurses the financial aid needed for training and school.
This short outline summarizes the points to focus on when studying nursing history. The most frequently tested information was on Florence Nightingale and her influence. Refer to your classroom notes and what the professor highlights for more in-depth information. The following chapters will focus directly on patient care and assessments.
Fundamentals of Nursing: THERAPEUTIC COMMUNICATION
E-mails, text messages, Instagram, Facebook, WhatsApp, and Twitter are all forms of communication that we use in our daily lives. When communicating one on one with a patient, we must use compassion and care. Also, take into consideration the age and culture of the patients. It is unlikely that your 88-year-old patient will know the new lingo of “LOL” or “OMG.” However, this may be just what is needed to connect with your younger patients. Communication in nursing is so important. Patients and families are often scared or worried, and you are often their source of information and comfort. When entering a patient’s room, smile and introduce yourself to both the patient and the patient’s family. Make them feel comfortable and well taken care of.
There are two types of communication: (a) verbal, which involves speaking to the patient, and (b) nonverbal, which involves the use of facial expressions, eye contact, and therapeutic touch. Remember, culture also plays a role in communication, which will be discussed in further detail in the next section.
Fundamentals of Nursing: Phases of Communication
There are three basic phases of communication: (a) introductory, (b) working, and (c) termination. You will use these three phases to understand your patient’s problems and come up with solutions. In the introductory phase, you will introduce yourself, discuss any problems, and establish a relationship with your patient. Remember not every patient is cheery and upbeat. You will also have patients who are scared, angry, or discouraged. It will be your job to think of ways to establish an amicable relationship. Also, if a language barrier is present, this would be the best time to contact a translator.
The working phase is where you identify the patient’s problem. For example, suppose the patient diagnosis is abdominal pain. In this phase, you would look further into why the patient is having abdominal pain using labs, scans, or physician notes. You would look for any resolution to the problems. Did the doctor prescribe pain medications? Was a CT scan performed? Is surgery necessary? The working phase is where the problem is identified and measures are taken to help the patient.
The last phase, the termination phase, is where the problem is being resolved. In the preceding example, if the patient was given pain medication as ordered and the problem has resolved, the nurse’s communication with the patient would come to an end.
When thinking about the phases of communication, consider how you communicate when chatting with a friend, family member, or coworker who has a problem. They call you and state their problem. You talk about the problem and figure out ways to make it better. By the end of the conversation, your friend feels better because a resolution has been achieved or is in the making. Similarly, your patients are talking with you in the role of their problem solver, the one who makes them better. For all of you nervous nellies who are uncomfortable speaking with people, now is the time to practice and muster up some confidence. Communication is the key to nursing; it involves constant talking with patients, families, and physicians.
Fundamentals of Nursing: Tips on What Not to Do During Communication
When communicating with patients, there are some pitfalls you need to avoid. Do not be judgmental or abrupt, or speak down to patients. Avoid leading questions that may discourage or embarrass the patient. Do not crack jokes or speak about topics that may cause a patient to become offended. If language barriers are present, do not ignore these patients because you cannot understand them: Use an interpreter to communicate with the patient and try to avoid using family members to translate.
Fundamentals of Nursing: Developing Communication Skills
There are several ways to create a great relationship with patients. Most important is to provide privacy when speaking with the patient—for example, by closing the door or shutting the curtain. Introducing yourself is the next step. Sit down, if possible, when talking—patients feel more comfortable when you are speaking to them at eye level. Listen carefully, and strive to make a comfortable environment for the patient.
Use open-ended questions. Avoid yes/no answers to encourage your patients to give you details when discussing their health problems. You want as much information as possible, including anything about their past medical history.
Be compassionate. Being in the hospital is scary for both patients and families. Emotional support is often needed. For patients who are confused or unable to respond, the use of touch is therapeutic. As a nurse, you will create ways of your own to make communication comfortable for you and the patient.
THE NURSING PROCESS (NURSING CARE PLANS)
Along with communication techniques, nurses rely on the nursing process when caring for patients. The nursing process is a five-step systematic approach to problem solving. It allows the nurse to obtain both subjective and objective information to determine the health care problem. The five steps are (a) assessment, (b) diagnosis, (c) planning, (d) implementation, and (e) evaluation, which can be remembered using the mnemonic “ADPIE (A Delicious PIE).” Based on these steps a care plan is conducted for each patient.
Fundamentals of Nursing: Assessment
Begin your assessment by asking the patient about the problem, signs, and symptoms that he or she has been experiencing. If the patient is unable to speak, ask a family member if present what has been going on with the patient. During an assessment, two types of data are obtained: subjective and objective. Subjective data are symptoms that the patient describes to you (e.g., “My arm feels itchy and has little red bumps all over” or “I feel like there is a ton of bricks sitting on my chest.”) Objective data are findings that are observed, assessed, and documented by the nurse (e.g., “There is a quarter size rash located on the right arm with redness” or “The patient’s respirations are increasing, and he is huddled over in pain.”) Objective data are any signs that can be observed, and vital signs are a type of objective data.
The first step is to assess the areas that can help you formulate a diagnosis. A patient can have numerous problems that can result in more than one diagnosis. For instance, a patient may have high blood pressure and a constant headache. The diagnosis would be hypertension and pain. Information can be obtained from the patient, medical records, family members, and physical examination.
Fundamentals of Nursing: Diagnosis
A diagnosis is obtained on the basis of the patient’s assessment findings. A nursing diagnosis is the statement of a problem based on the actual signs and symptoms the patient is experiencing. For example, consider a patient who is admitted with pneumonia. One diagnosis for this patient might be “ineffective airway clearance related to accumulation of secretions.” This diagnosis indicates that patient is experiencing shortness of breath due to a productive cough. In simple terms, the nursing diagnosis is the statement of the patient’s problems and the causes. During your clinical experience, your professor will ask you to compile a list of nursing diagnoses based on the patient you have assessed. Typically, two or three nursing diagnoses are requested. This would be a great time to invest in a nursing diagnosis book to familiarize yourself with these types of diagnostic statements. Diagnosing the patient will help with planning care for this particular patient and will help you focus on the problems at hand.
Fundamentals of Nursing: Planning
Once the nursing diagnoses are obtained, it is time to start planning patient care and interventions. Based on the diagnoses, the next step is to formulate goals and outcomes for the patient. For example, take the patient who was admitted with pneumonia. The nursing diagnosis is ineffective airway clearance related to accumulation of secretions. The corresponding nursing interventions are to perform chest physiotherapy to help loosen and bring up the secretions, to elevate the head of the bed to aid breathing, and to obtain the oxygen saturation level every hour. The nursing interventions are what you as a nurse can do to help the patient.
Fundamentals of Nursing: Implementation
Once the patient is assessed, the diagnoses are made, and the planning is in place, you are ready to implement the steps of the nursing care plan. It is important to establish a realistic time frame for the patient to meet the identified goals and interventions. In this section of the care plan, you should provide scientific rationales to explain your diagnoses in further detail. Refer to your textbook and online resources for all scientific rationales. You should have a rationale for each intervention. For example, for the patient with pneumonia, the scientific rationale for patient positioning is that an upright position facilitates normal anatomical position and allows greater lung expansion for proper oxygen exchange. This gives support to the diagnosis based on facts and research.
Fundamentals of Nursing: Evaluation
We have arrived at the last step in the ladder of “ADPIE”! This is the completion of the nursing care plan. The patient has been assessed and diagnosed, planning is in place, implementation is complete, and evaluation of the patient’s response to these actions is underway. It is during this step that the patient goals are met or close to being met as a result of nursing interventions. The nursing process is important in patient care. It is a system to help nurses identify patient problems and, along with doctors, develop a plan to help the patient. You will use this process in nursing school and as a nurse. It is an essential part of patient care and recovery. It is not important to memorize each approved nursing diagnosis; you will not be tested on your knowledge of each one. Instead, use your nursing diagnosis book to help you as you construct your patient care plan.
From the time a patient is first admitted up to the day of discharge, patient education is very important. It is important for the patient to know and be aware of nursing care each step of the way. Explain patients’ medical diagnoses and provide printouts for them to review and read. Obtain information on any allergies. Explain each medication and make sure patients have a proper understanding of what it does and how it is going to help them. Maintain privacy and follow HIPAA guidelines when educating patients and families. Patients and their families feel most comfortable when they know what is going on and why. Discharge education is important to provide patients with the information needed for self-care at home. The information you provide to patients can help them on their journey to recovery at home. Most institutes provide materials for patients that you can print out and provide during their hospital stay and upon discharge.
CARE ACROSS A LIFE SPAN