FON 1: Introduction

on Nursing
DNIN 4113

DNIN 4113: INTRODUCTION ON NURSING

 UNIT 1
NURSING
PRINCIPLES
AND CONCEPT

COURSE TITTLE DNIN 4113: INTRODUCTION ON NURSING

LEARNING OUTCOMES

1. Explain knowledge of nursing history in relation to

Fundamental of Nursing.

2. Demonstrate the vital sign and patient

assessment procedure.

3. Explain the method of assessing patient in

providing nursing care.

DNIN 4113: INTRODUCTION ON NURSING

UNIT 1: NURSING
PRINCIPLES AND CONCEPTS
1. Introduction of Nursing
2. Global development of nursing
3. History of nursing in Malaysia
- Florence Nightigale (Environment)
- Virginia Henderson (14 activities of ADL)
- Orem
- Roper
- Rufaida Al-Aslamia
4. Maslow’s hierarchy of needs
5. Nurses as healthcare providers
6. Nursing as care provider
DNIN 4113: INTRODUCTION ON NURSING
INTRODUCTION ON
NURSING
DEFINITION OF A NURSE
A person , usually a woman, trained to care for the
sick. ( Kozier et.al, 1998)
DEFINITION OF NURSING
• Nursing is an art and science.
• Florence Nightingale has define nursing as the
act of utilizing an environment of the patient to
assist him in his recovery. ( Kozier et.al, 1998)
• Nursing is a diagnosis and treatment of human
responses to an actual or potential health problems
(ANA , 1980 )
DNIN 4113: INTRODUCTION ON NURSING
GLOBAL
DEVELOPMENT OF
NURSING
Economics
• Changes in economic climates
• Escalating of healthcare costs due to growing
aging population, insured and uninsured
persons, and increased use of technology.
Changing demands for nurses
• An increased number of nurses outside acute
care setting
• An increased need for highly technically skilled
nurses
DNIN 4113: INTRODUCTION ON NURSING
GLOBAL
DEVELOPMENT OF
NURSING
• Consumer Demands
• Consumer of nursing service become an increasingly
forces in changing of nursing practice.
• People are better educated and have more knowledge
about health illness than in the past
• Awareness in the needs of care
• Family Structures
• New family structure influencing the needs of
nursing services
• Separation among generations created a void in
care available to the young and the old
DNIN 4113: INTRODUCTION ON NURSING
GLOBAL
DEVELOPMENT OF
NURSING
Science and Technology
• Advance in science and technology affect
nursing practice
• Nurses acquire complementary knowledge
and skills as to adapt the new needs of clients
Legislation
• Changes in Legislation relating to health
• Example , PATIENT SELF DETERMINATION ACT
(PSDA ) 1991 every competent adult be inform in
writing upon admission to a health care institution
about their rights to accept or refuse treatment.
DNIN 4113: INTRODUCTION ON NURSING
GLOBAL
DEVELOPMENT OF
NURSING
Demography
• Study of population, including statistic distribution
of age, place, mortality (death)and morbidity
(diseases)
Nursing Association
• Malaysian Nursing Association – nurse practice act
• A group of professional nurses organized formally
to promote political action in the nursing and
healthcare setting

DNIN 4113: INTRODUCTION ON NURSING DNIN 4113: INTRODUCTION ON NURSING

HISTORY OF NURSING
IN MALAYSIA
• The history of nursing in Malaysia began from
about the year 1800 with the formation of the East
India Company when hospital for the sick were
established in Penang and Singapore.
• Nursing was carried out by Catholic nuns and later
on replaced by English nurses from England.
• Nursing practice in the pre-war period in Malaya
then was carried out by nurses who received ―on
the job training‖ with lectures given by expatriates
i.e. by European sisters, matrons and Doctors at
the hospital level.
DNIN 4113: INTRODUCTION ON NURSING
HISTORY OF NURSING
IN MALAYSIA
• After Independence, health services became mainly
a central government responsibility with delegation
of service delivery through state and district health
administrations.
• Prior to the war, each straits/settlement organized
and ran their own nursing services.
• All states were responsible to the director of
medical services.
• The nurses receives lectures in practice and theory
of nursing from the matron or assistant matron of
the hospital.
DNIN 4113: INTRODUCTION ON NURSING
HISTORY OF NURSING
IN MALAYSIA
• The doctors gave lectures to both nurses and
hospital assistant.
• They sat for their own state examination and the
standards varies from one state to another.
• On completion from training, nurses were
promoted to staff nurse and later in considered
suitable they become senior staff nurse.
• The expansion of medical and nursing services were
greatly hindered during the emergency situations.

DNIN 4113: INTRODUCTION ON NURSING

HISTORY OF NURSING
IN MALAYSIA
• In 1959, most of the states in Malaya become free
from communism and it marks the beginning of
the development of health services throughout the
country.
• By 1978, the element of Primary Health Care
(PHC) strategies enunciated at Alma-Ata were
already evident in the Malaysia Health Care
System. Concern for reduction in equity in access
to health care for increasing coverage formalized
in 1971 with the government 20 years perspective
plan.
DNIN 4113: INTRODUCTION ON NURSING
HISTORY OF NURSING
IN MALAYSIA
• 1923 – Introduction of legislation for the control of
the Practice of Midwifery and the training of
midwifes in the Straits Settlement and
subsequently in the other states of the Malay
Peninsular.
• 1950 – Nursing Legislation
• Nurses Act and the establishment of the Nurses
Registration Ordinance, to control the practice of
nursing which provided for the setting up of the
Nursing Board for controlling the training and
registration as regards to the practice of nursing.
DNIN 4113: INTRODUCTION ON NURSING
HISTORY OF NURSING
IN MALAYSIA

• Development of syllabus and curriculum for the

Basic Nurse Training.
• The regulation for the conduct of final
examination.
• The issuing of the Nurse Training Certificate.
• The Regulation to control the practice of nursing
though registration and issue of Nursing
Registration Certificate and Registration Badge.

DNIN 4113: INTRODUCTION ON NURSING

HISTORY OF NURSING
IN MALAYSIA
• 1956 – The Nurses Registration Regulation.
• 1961 – The first private nursing school in
Malaysia was established at the Assunta
Hospital. It was called the Tun Tan Cheng
Lock College of Nursing.
• 1969 – Extension of the Act to Sarawak.
• 1978 – Extension of the Act to Sabah.
• 1985 – Nurses Registration
Regulation 1985.
• Implementation of the Annual Practicing
Certificate.
DNIN 4113: INTRODUCTION ON NURSING
HISTORY OF NURSING
IN MALAYSIA
• 1966 – The Midwives Act 1966 establishes a
Midwifes Boards provides for the registration of
nurse-midwifes and regulates the practice of
midwifery in the country.
• 1971 – The Midwives (Registration)
Regulation, 1971, requiring all midwives to apply
for registration. (TBA, up to 1st August 1972)
• 1990 – Act Revised – 1990 (Reopened to TBA
within the next 10 years).

DNIN 4113: INTRODUCTION ON NURSING

DNIN 4113: INTRODUCTION ON NURSING
NURSING THEORIES

Nursing theories address and specify

relationship among four major concepts:

1. Person or client ( individual, family, community )

2. Environment ( Internal and External Surrounding)
3. Health / illness ( Client’s state of well being )
4. Nursing ( healthcare provider )

DNIN 4113: INTRODUCTION ON NURSING

DNIN 4113: INTRODUCTION ON NURSING
NURSING THEORIES
Nightingale’s Environmental
Theory (1960)
• First nursing theorist.
• Focused on Environment
• Linked to:
1. pure or fresh air
2. efficient drainage
3. cleanliness
4. light ( direct sunlight )
5. quiet

DNIN 4113: INTRODUCTION ON NURSING

NURSING THEORIES
NIGHTINGALE’S CONCEPT
1. Person:
• Patient who is acted on by a nurse.
• Affected by environment.
• Has reparative power.
2. Environment:
• Foundation of theory. Included everything,
physical, psychological, and social.

DNIN 4113: INTRODUCTION ON NURSING

NURSING THEORIES
NIGHTINGALE’S CONCEPT
3. Health:
• Maintaining well being by using a person’s
powers.
• Maintained by control of environment.
4. Nursing:
• Provided fresh air, warmth, cleanliness, good
diet, quiet to facilitate person’s reparative
process.
DNIN 4113: INTRODUCTION ON NURSING
NURSING THEORIES

Virginia Henderson’s Theory:

(1955,1966,1969,1978)
• The Nightingale of Modern
Nursing.
• “Modern-Day Mother of Nursing.
• Born in Kansas City, Missouri in
1897.
• She called her definition of
nursing her “concept” (Henderson
1991). DNIN 4113: INTRODUCTION ON NURSING
NURSING THEORIES

• She emphasized the importance of

increasing the patient’s independence so
that progress after hospitalization would not
be delayed.
• She categorized nursing activities into 14
components, based on human needs.
• She described the nurse's role as
substitutive (doing for the person),
supplementary (helping the person),
complementary (working with the person),
with the goal of helping the person become
as independent as possible.
DNIN 4113: INTRODUCTION ON NURSING
NURSING THEORIES
14 Fundamental needs ( 1966 )
1. Breathing normally
2. Eating and drinking adequately
3. Eliminating Body waste
4. Moving and maintaining a position
5. Sleeping and resting
6. Selecting suitable clothes
7. Maintaining body temperature
8. Keeping the body clean and well groomed
9. Avoiding dangers and injury
10. Communicating with others
11. Worshipping according to one’s faith
12. Working in such a way that one feels a sense of
accomplishment
13. Playing or participating in forms of recreation
14. Learning, discovering, or satisfying the curiosity

DNIN 4113: INTRODUCTION ON NURSING

NURSING THEORIES
Dorothea Orem (1971)
Self Care Deficit Theory

-Organize nursing knowledge from pragmatic

framework.
-Focused on ―What is nursing‖ ;
―When do people need nursing care?‖

-From this she derived that people need

nursing when they are unable to care
for themselves.

DNIN 4113: INTRODUCTION ON NURSING

NURSING THEORIES
She presented the self-care deficit theory of
nursing which is problem oriented.

DNIN 4113: INTRODUCTION ON NURSING

NURSING THEORIES
• Nancy Roper was a practical theorist. She
produced a simple nursing theory, which has
actually helped bedside nurses.
• Nancy Roper, nurse educationalist: born
Wetheral, Cumberland 29 September 1918;
died Edinburgh 5 October 2004.
• During the 1970s, as she pursued her
graduate studies at The University of
Edinburgh in Scotland, Roper found the
―identifiable commonality‖ evident in every
patient.

DNIN 4113: INTRODUCTION ON NURSING

NURSING THEORIES
• It reminded the nurse to look at the whole
patient. Some activities were obvious, such
as eating and drinking, but she taught
nurses also to look further, and to expect,
and be prepared to cope with sexuality in
their patients and death and dying.
• In 1976, she discussed her beliefs about
nursing in the publication Clinical Experience
in Nurse Education.11

DNIN 4113: INTRODUCTION ON NURSING

 NANCY ROPER

WINIFRED W. LOGAN ALISON J. TIERNEY

DNIN 4113: INTRODUCTION ON NURSING

NURSING THEORIES
• Roper's research was a foundation for a
model centered in nursing.
• The model was refined by nurse educator
Winifred Logan, DSc, and nurse researcher
Alison Tierney, PhD.
• The R-L-T Model of Nursing applies the
nursing process—assessment, diagnosis,
planning, intervention, and evaluation—and
serves as a guide for the nurse to conduct a
holistic patient assessment that serves as a
basis for a care plan

DNIN 4113: INTRODUCTION ON NURSING

NURSING THEORIES
Concepts
• Activities of Living • Breathing
(ALs)
• Eating and drinking
• There are 12 activities,
some of which are • Elimination
essential such as • Washing and dressing
breathing and others • Controlling temperature
that which enhance the
quality of life. • Mobilization
• Maintaining a safe • Working and playing
environment • Expressing sexuality
• Communication • Sleeping
• Death and dying

DNIN 4113: INTRODUCTION ON NURSING

NURSING THEORIES
Rufaida Al Aslamia
• Rufaida Al-Aslamia introduced nursing to the
Muslim world 1, 200 years before Florence
Nightingale who is known as the founder of
modern nursing.
• Rufaida Al-Aslamia was recognized for her
work in medical and social circles in the
earliest days of Islam, and she was the first
female Muslim nurse.

DNIN 4113: INTRODUCTION ON NURSING

NURSING THEORIES

• Rufaida Al-Aslamia is a role

model for many women,
empathetic nurse and a good
organizer.
• With her clinical skills, she
trained other women to be
nurses and to work in the area
of health care.
• She also worked as a social
worker, helping to solve social
problems associated with the
disease.
DNIN 4113: INTRODUCTION ON NURSING
MASLOW’S HIERARCHY OF
NEEDS
• Psychologist Abraham Maslow defined basic human
needs as a hierarchy, a progression from simple
physical needs to more complex emotional needs
a. Types of Needs
(1) Physiological--food, shelter, water, sleep, oxygen.
(2) Safety--security, stability, order, physical safety.
(3) Love and belonging--affection, identification,
companionship.
(4)Esteem and recognition--self-esteem, self-respect,
prestige, success, esteem of others.
(5) Self-actualization--self-fulfillment, achieving one's
own capabilities.
(6) Aesthetic--beauty, harmony, spiritual.
DNIN 4113: INTRODUCTION ON NURSING
MASLOW’S HIERARCHY OF
NEEDS

DNIN 4113: INTRODUCTION ON NURSING

MASLOW’S HIERARCHY OF
NEEDS
• The four lower levels are grouped together as
deficiency needs associated with physiological
needs

• The top level is termed growth needs associated

with psychological needs. While deficiency needs
must be met, growth needs are continually shaping
behaviour.

• The basic concept is that the higher needs in this

hierarchy only come into focus once all the needs
that are lower down in the pyramid are mainly or
entirely satisfied.

DNIN 4113: INTRODUCTION ON NURSING

MASLOW’S HIERARCHY OF
NEEDS

DNIN 4113: INTRODUCTION ON NURSING

Henderson’s theory and the four major
concepts

1. Individual
• Have basic needs that are component of health.
• Requiring assistance to achieve health and
independence or a peaceful death.
• Mind and body are inseparable and interrelated.
• Considers the biological, psychological,
sociological, and spiritual components.
• The theory presents the patient as a sum of parts
with bio-psychosocial needs.

DNIN 4113: INTRODUCTION ON NURSING

Henderson’s theory and the four major
concepts
2. Environment
• Settings in which an individual learns unique pattern for
living.
• All external conditions and influences that affect life and
development.
• Individuals in relation to families
• Minimally discusses the impact of the community on the
individual and family.
• Basic nursing care involves providing conditions under
which the patient can perform the 14 activities unaided
DNIN 4113: INTRODUCTION ON NURSING
Henderson’s theory and the four major
concepts
3. Health
• Definition based on individual’s ability to function
independently as outlined in the 14 components.
• Nurses need to stress promotion of health and
prevention and cure of disease.
• Good health is a challenge -affected by age, cultural
background, physical, and intellectual capacities,
and emotional balance Is the individual’s ability to
meet these needs independently.

DNIN 4113: INTRODUCTION ON NURSING

Henderson’s theory and the four major
concepts
4. Nursing
• Temporarily assisting an individual who lacks the
necessary strength, will and knowledge to satisfy 1
or more of 14 basic needs.
• Assists and supports the individual in life activities
and the attainment of independence.
• Nurse serves to make patient ―complete‖ ―whole", or
"independent."
• The nurse is expected to carry out
physician’s therapeutic plan Individualized care is
the result of the nurse’s creativity in planning for
care.
DNIN 4113: INTRODUCTION ON NURSING
Nurses as health Care Provider

Health care Delivery System

• Is a service offered by all health disciplines

• A Patient’s Bill of Rights ( AHA, 1973 )
- Respectful care
- Privacy for the client
- Communications regarding their care
- Right decission making for their care

DNIN 4113: INTRODUCTION ON NURSING

Nurses as health Care Provider

Types of Health Care Services

• Primary Service
( Health Promotion, preventive care, continuing
care, Referral)

• Secondary care
( Surgery and services by specialist )

• Tertiary Care
(Advance Specialized diagnostic, therapeutic and
rehabilitative care)
DNIN 4113: INTRODUCTION ON NURSING
Nurses as health Care Provider

Providers Of Health Care

• Nurse
• Dentist
• Pharmacist
• Dietitian or Nutritionist
• Physiotherapist
• Respiratory therapist
• Occupational therapist
• Paramedical technologist
• Social Worker

DNIN 4113: INTRODUCTION ON NURSING

Nurses as health Care Provider
Nursing Organization Structure

NURSE MANAGER
NURSE EDUCATOR
UNIT MANAGER UNIT MANAGER
REGISTERED NURSE REGISTERED NURSE

DNIN 4113: INTRODUCTION ON NURSING

Nurses as health Care Provider
Role of Nurses

Caregiver
Educator
Advocate
Leader and manager
Researcher

DNIN 4113: INTRODUCTION ON NURSING

Nurses as health Care Provider
Role of Nurses: Nurses as a caregiver

• Provide support physically

and psycho socially
• Provides holistic care not
only to an individual but also
to the family and
community

DNIN 4113: INTRODUCTION ON NURSING

Nurses as health Care Provider
Role of Nurses: Nurses as an Educator

• Providing information
and explain with a
very effective
communication skill
• Continuous
improvement in
upgrading knowledge
in patient care

DNIN 4113: INTRODUCTION ON NURSING

Nurses as health Care Provider
Role of Nurses: Nurses as an Advocator

• Making the right

decision for patient

• Respect patient’s
right in the decision
making

DNIN 4113: INTRODUCTION ON NURSING

Nurses as health Care Provider
Role of Nurses: Nurses as a leader and manager

• Leading and
managing the
patient care

• Leading and
managing the
health care system
providers

DNIN 4113: INTRODUCTION ON NURSING

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