NLE Fundamentals of Nursing & the Nursing Process — Basic Nursing Care & ComfortRevision Notes

Exam Tips

• If a question asks for the 'most widely cited/quoted definition of nursing,' the answer is VIRGINIA HENDERSON.
• If a question asks who emphasized the ENVIRONMENT as the basis of nursing, the answer is FLORENCE NIGHTINGALE.
• ANA definition key phrase: 'diagnosis and treatment of human responses' — this is what separates nursing from other professions.
• Look for the words 'strength, will, knowledge' in NLE options — they always refer to Henderson.

Key Points

• Nursing is simultaneously a SCIENCE (evidence-based, theoretical) and an ART (compassionate, individualized, humanistic care).
• Florence Nightingale: Nursing is the act of putting the patient in the BEST CONDITION for NATURE to act — emphasis on ENVIRONMENT (ventilation, warmth, light, cleanliness, diet).
• Virginia Henderson's definition is the MOST WIDELY CITED: nursing assists the individual, sick or well, in performing activities contributing to health, recovery, or a peaceful death — activities the person would do unaided if they had the STRENGTH, WILL, or KNOWLEDGE.
• ANA definition: protection, promotion, and optimization of health; prevention of illness/injury; alleviation of suffering through diagnosis and treatment of HUMAN RESPONSES; and advocacy.
• Key phrase in Henderson's definition: 'strength, will, or knowledge' — this is a frequent NLE distractor. Know this verbatim.
• Nursing focuses on HUMAN RESPONSES to actual or potential health problems — this distinguishes nursing from medicine (which focuses on disease).

Definitions

Section Title

Defining Nursing: Science, Art, and Key Definitions

Common Mistakes

• Confusing Nightingale's definition (environment-focused) with Henderson's (needs/independence-focused) — they are frequently swapped in NLE distractors.
• Thinking the ANA definition is the most widely cited — it is NOT; Henderson's is.
• Forgetting that nursing focuses on HUMAN RESPONSES, not the disease itself.
• Mixing up 'strength, will, or knowledge' — all three must be present for independence; absence of any one creates a nursing need.

Exam Tips

• Remember: 1906 = First nursing school (Iloilo Mission Hospital); 1922 = PNA founded; 1860 = Nightingale's school; 1854 = Crimean War.
• Nightingale is associated with THREE key concepts: ENVIRONMENT, STATISTICS/RECORD-KEEPING, and SANITATION.
• If asked about the 'founder of modern nursing' or 'Lady with the Lamp,' always choose Florence Nightingale.
• PNA questions often test whether students know it is the PROFESSIONAL ORGANIZATION (not the regulatory body — that is the BON/PRC).

Key Points

• Global nursing history progresses through three main periods: Intuitive/Early → Religious/Apprentice → Nightingale Era and Modern Nursing.
• The 'Dark Ages of Nursing' occurred during the Reformation when religious orders disbanded and hospital care deteriorated sharply.
• Florence Nightingale worked during the CRIMEAN WAR (1854), reducing mortality through sanitation and statistical record-keeping — she is called the 'LADY WITH THE LAMP' and FOUNDER OF MODERN NURSING.
• Nightingale established the FIRST FORMAL NURSING SCHOOL at ST. THOMAS' HOSPITAL, LONDON in 1860.
• In the Philippines, traditional care was provided by the HERBOLARIO (herbalist) and HILOT (traditional birth attendant/healer).
• The ILOILO MISSION HOSPITAL SCHOOL OF NURSING (1906) is the FIRST NURSING SCHOOL IN THE PHILIPPINES — a critical NLE fact.
• The PHILIPPINE NURSES ASSOCIATION (PNA) was founded in 1922 — it is the accredited professional organization for nurses.
• The BSN degree and the NLE are the modern pathways to becoming a Registered Nurse (RN) in the Philippines under RA 9173.

Definitions

Section Title

History of Nursing: Global and Philippine Context

Common Mistakes

• Confusing PNA (1922, professional organization) with BON (Board of Nursing, the regulatory body under PRC).
• Stating that Nightingale founded her school in 1854 — it was 1860. The Crimean War was 1854.
• Forgetting that the 'Dark Ages of Nursing' is NOT ancient times but the POST-REFORMATION period when care declined.
• Listing Philippine General Hospital or St. Paul's as the FIRST nursing school — the answer is Iloilo Mission Hospital (1906).
• Confusing the herbolario (herbalist) and hilot (birth attendant/healer) — these are distinct roles.

Exam Tips

• Memory aid for function types: I-D-I — Independent (nurse-driven), Dependent (doctor-ordered), Interdependent (team-shared).
• When an NLE question asks 'which action requires a physician's order?' — the answer involves medications or prescribed treatments (DEPENDENT).
• When asked 'which is an independent nursing action?' — look for health teaching, positioning, assessment, or nursing diagnosis.
• Know that HEALTH TEACHING is the MOST IMPORTANT independent function — it appears in almost every NLE area.
• RA 9173 key numbers to remember: BON members = 5 (chairperson + 4 members), term = 3 years, age requirement for BON membership = Filipino citizen with active practice.

Key Points

• RA 9173 (Philippine Nursing Act of 2002) is the primary law governing nursing practice in the Philippines — know its key provisions.
• The Board of Nursing (BON) under the PRC administers the NLE, promulgates the Code of Ethics for Filipino Nurses, and regulates nursing practice.
• Key Nurse Roles: Caregiver (central/direct care), Communicator, Teacher/Health Educator, Advocate, Counselor, Manager/Coordinator, Change Agent, Collaborator, Researcher, Leader.
• NURSING FUNCTIONS — Three types: (1) INDEPENDENT — nurse-initiated, no physician order needed; (2) DEPENDENT — requires a physician's order; (3) INTERDEPENDENT/COLLABORATIVE — shared with other health professionals.
• Independent functions under RA 9173 include: HEALTH TEACHING, nursing assessment, positioning, hygiene care, NURSING DIAGNOSIS, and care during pregnancy/labor/delivery.
• Dependent functions include: administering medications (as ordered by physician), carrying out prescribed treatments.
• Interdependent functions include: implementing standing orders/protocols, multidisciplinary care planning, and collaborative procedures.
• RA 9173 requires CONTINUING PROFESSIONAL DEVELOPMENT (CPD) for license renewal — nurses must accumulate CPD units.
• RA 9173 defines grounds for license revocation: unprofessional/unethical conduct, incompetence, conviction involving moral turpitude.
• The DATA PRIVACY ACT is RA 10173 — do not confuse with RA 9173 (Nursing Act). Both are testable.

Definitions

Section Title

Roles, Functions, and Legal Scope of Nursing Practice (RA 9173)

Common Mistakes

• Confusing RA 9173 (Nursing Act) with RA 10173 (Data Privacy Act) — a classic NLE distractor. Know both numbers.
• Classifying health teaching as a DEPENDENT function — it is INDEPENDENT and legally mandated under RA 9173.
• Thinking medication administration without a physician's order is acceptable — it is ILLEGAL under Philippine law (dependent function requires an order).
• Confusing the ROLE of ADVOCATE (protecting patient rights) with COUNSELOR (supporting coping/decision-making) — these are distinct roles.
• Assuming CPD is optional — RA 9173 mandates CPD for license renewal.

Exam Tips

• Memory aid: 'PEHN' — Person, Environment, Health, Nursing — the four pillars of nursing's worldview.
• NLE questions often ask: 'Which concept does [theorist X] emphasize most?' Know each theorist's primary focus.
• If a question describes a theory focused on 'the surroundings of the patient,' think Nightingale/Environment.
• If a theory focuses on 'the patient's ability to care for themselves,' think Orem/Person-Self-Care.

Key Points

• The METAPARADIGM is the broadest level of nursing knowledge — the global perspective shared by all nursing theories.
• The FOUR METAPARADIGM CONCEPTS are: (1) PERSON, (2) ENVIRONMENT, (3) HEALTH, (4) NURSING.
• PERSON — the recipient of care; may be individual, family, community, or population.
• ENVIRONMENT — all internal and external conditions, circumstances, and influences surrounding the person.
• HEALTH — not merely absence of disease; a dynamic state of well-being across the health-illness continuum.
• NURSING — the actions, attributes, and characteristics of the nurse providing care.
• Each theorist INTERPRETS these four concepts differently — this is the basis for distinguishing theories in NLE questions.
• NIGHTINGALE emphasized ENVIRONMENT most strongly.
• HENDERSON emphasized PERSON (14 basic needs) and independence.
• ROY emphasized HEALTH through ADAPTATION.
• WATSON emphasized NURSING as human caring.
• PEPLAU emphasized the NURSE-PATIENT relationship (nursing and person interaction).

Definitions

Section Title

The Nursing Metaparadigm: Four Central Concepts

Common Mistakes

• Listing only 3 metaparadigm concepts — always remember all FOUR: Person, Environment, Health, Nursing.
• Thinking 'health' means only absence of disease — in nursing, health is a dynamic, positive state of well-being.
• Confusing the theorist who emphasizes each concept — use the association table strategy to keep them sorted.
• Forgetting that 'person' can mean family, community, or population — not just the individual patient.

Exam Tips

• THEORIST QUICK MATCH: Nightingale=Environment, Henderson=14 Needs/Independence, Orem=Self-Care Deficit, Roy=Adaptation (4 modes), Watson=Human Caring, Peplau=Interpersonal/Phases, Leininger=Transcultural, Benner=Novice to Expert, Neuman=Systems/Lines of Defense.
• For Orem: if the patient is UNCONSCIOUS → Wholly Compensatory; if the patient is recovering from surgery → Partly Compensatory; if the patient needs DIABETES EDUCATION → Supportive-Educative.
• For Roy: Physiologic mode = vital signs/breathing; Self-concept = how patient feels about their diagnosis; Role function = patient can no longer work; Interdependence = patient feels isolated.
• For Peplau: ORIENTATION = 'Hello, I'm your nurse, let's identify your problem'; WORKING = implementing care; RESOLUTION = discharge planning, patient independent.
• Watson's 'Caritas' comes from the Latin for 'to cherish' — connects to compassion-based nursing care.
• Benner's EXPERT nurse relies on INTUITION (deep pattern recognition) — not just rules or steps.

Key Points

• FLORENCE NIGHTINGALE (Environmental Theory): Manipulate the ENVIRONMENT (ventilation, warmth, light, cleanliness, diet, quiet) to allow nature to heal the patient. First theorist; laid groundwork for infection control and evidence-based practice.
• VIRGINIA HENDERSON (Need Theory/14 Basic Needs): 14 basic needs (breathing, eating, elimination, movement, sleep, clothing, temperature, hygiene, safety, communication, worship, work, play, learning). Nurse helps the patient achieve INDEPENDENCE. Substitutive (does for), supplementary (helps), complementary (assists) assistance.
• DOROTHEA OREM (Self-Care Deficit Theory): Three interrelated theories — Self-Care, Self-Care Deficit, Nursing Systems. Nursing is needed when a SELF-CARE DEFICIT exists. Three nursing systems: WHOLLY COMPENSATORY (nurse does all — e.g., comatose), PARTLY COMPENSATORY (nurse and patient share), SUPPORTIVE-EDUCATIVE (patient can self-care with teaching/guidance). KEY: promote self-care AGENCY.
• SISTER CALLISTA ROY (Adaptation Model): Person is an ADAPTIVE SYSTEM responding to stimuli. Three types of STIMULI: FOCAL (immediate cause), CONTEXTUAL (contributing factors), RESIDUAL (unknown/background factors). Four ADAPTIVE MODES: PHYSIOLOGIC, SELF-CONCEPT, ROLE FUNCTION, INTERDEPENDENCE. Nursing promotes adaptation across all four modes.
• JEAN WATSON (Theory of Human Caring): CARING is the essence and moral ideal of nursing. Focus on TRANSPERSONAL CARING RELATIONSHIP and CARATIVE FACTORS (later called Caritas Processes). KEY: humanistic, holistic caring and the 'caring moment.'
• HILDEGARD PEPLAU (Interpersonal Relations Theory): 'MOTHER OF PSYCHIATRIC NURSING.' Nurse-patient relationship in PHASES: ORIENTATION → IDENTIFICATION (working) → EXPLOITATION → RESOLUTION. Simplified: Orientation → Working → Termination. Nurse roles: stranger, resource person, teacher, leader, surrogate, counselor. KEY: nursing is a therapeutic INTERPERSONAL PROCESS.
• MADELEINE LEININGER (Transcultural Nursing/Culture Care Theory): Culture care is the basis of nursing. Three modes of cultural care: preservation, accommodation, repatterning. KEY: CULTURALLY CONGRUENT CARE. Highly relevant to multilingual, multicultural Philippine setting.
• PATRICIA BENNER (Novice to Expert): Five stages of clinical competence: NOVICE → ADVANCED BEGINNER → COMPETENT → PROFICIENT → EXPERT. Based on skill acquisition through EXPERIENCE and education.
• BETTY NEUMAN (Systems Model): Client as an OPEN SYSTEM with lines of defense (flexible, normal) and lines of resistance. Stressors (intrapersonal, interpersonal, extrapersonal) penetrate defenses. Nursing prevents stressor penetration and restores stability.
• FAYE ABDELLAH (21 Nursing Problems): Patient-centered approach; 21 nursing problems guide care. Shift from disease-centered to PATIENT-CENTERED nursing.
• LYDIA HALL (Care, Core, Cure): Three overlapping circles — CARE (nurse's unique role, bodily care), CORE (patient's inner feelings, therapeutic use of self), CURE (medical treatment, nurse collaborates with physician).

Definitions

Section Title

Major Nursing Theorists: High-Yield Summary

Common Mistakes

• Mixing up Orem's THREE NURSING SYSTEMS — 'wholly compensatory' is for patients who CAN DO NOTHING for themselves; 'supportive-educative' is for those who CAN DO EVERYTHING but need teaching.
• Confusing Roy's THREE STIMULI (focal, contextual, residual) with her FOUR ADAPTIVE MODES — these are separate concepts within the same theory.
• Calling Peplau the 'founder of modern nursing' — that title belongs to NIGHTINGALE. Peplau is the 'mother of PSYCHIATRIC nursing.'
• Forgetting the correct order of Benner's stages — Novice → Advanced Beginner → Competent → Proficient → Expert (NOT 'intermediate' or 'skilled').
• Confusing Henderson's 14 needs with Maslow's hierarchy — they are related but different frameworks. Henderson has 14 specific needs; Maslow has 5 levels.
• Stating Leininger's theory is about 'cultural sensitivity' — the correct term is CULTURALLY CONGRUENT CARE and she identifies THREE MODES of care (preservation, accommodation, repatterning).

Exam Tips

• Memory aid: 'A-BNJ-VFC' — Autonomy, Beneficence, Nonmaleficence, Justice, Veracity, Fidelity, Confidentiality.
• When an NLE scenario asks about respecting patient refusal of treatment → AUTONOMY.
• When a scenario asks about giving a patient false hope or withholding a terminal diagnosis → VERACITY and AUTONOMY conflict — the NLE answer usually favors truth-telling with compassionate communication.
• FIDELITY in nursing includes maintaining professional standards, honoring care commitments, and following through on nursing care plans.
• Remember: RA 9173 = Nursing Act (practice law); RA 10173 = Data Privacy Act (confidentiality law) — both protect patients.

Key Points

• The CODE OF ETHICS FOR FILIPINO NURSES is promulgated by the Board of Nursing (BON) under RA 9173.
• Core BIOETHICAL PRINCIPLES (Beauchamp & Childress): AUTONOMY, BENEFICENCE, NONMALEFICENCE, JUSTICE.
• Additional ethical principles: VERACITY (truth-telling), FIDELITY (keeping promises/commitments), CONFIDENTIALITY (protecting patient information).
• AUTONOMY: Respect for the patient's right to make informed decisions about their own care (basis for INFORMED CONSENT).
• BENEFICENCE: Do good — act in the patient's best interest.
• NONMALEFICENCE: Do no harm — avoid causing unnecessary pain, injury, or suffering.
• JUSTICE: Fairness in distributing care — no discrimination in treatment (relevant to Philippine UHC/Kalusugan Pangkalahatan context).
• VERACITY: Always tell the truth to patients; deception undermines trust.
• FIDELITY: Keep professional commitments and promises to patients and colleagues.
• CONFIDENTIALITY: Patient information is protected by both the Code of Ethics AND the Data Privacy Act (RA 10173).
• Grounds for license revocation/suspension under RA 9173: unprofessional/unethical conduct, incompetence, conviction of offense involving MORAL TURPITUDE.
• Moral turpitude = an act of baseness, vileness, or depravity contrary to accepted moral standards (e.g., fraud, theft, serious crimes).

Definitions

Section Title

Ethical and Legal Foundations of Nursing

Common Mistakes

• Confusing BENEFICENCE (do good) with NONMALEFICENCE (do no harm) — beneficence is ACTIVE (doing good); nonmaleficence is PREVENTIVE (avoiding harm).
• Mixing up VERACITY (truth-telling) with FIDELITY (promise-keeping) — both are about honesty but in different contexts.
• Thinking confidentiality only applies to serious information — ALL patient health information is protected.
• Forgetting that the Code of Ethics is promulgated by the BON, not the PNA or DOH.
• Confusing RA 9173 grounds for revocation — 'moral turpitude' is a specific legal term, not just 'bad behavior.'

Exam Tips

• Memory aid for prevention levels: 'PER' — Primary (Prevent), sEcondary (Early detect), teRtiary (Rehab/disability limit).
• Memory aid for learning domains: 'CAP' — Cognitive (knows), Affective (feels/values), Psychomotor (does/performs).
• NLE questions on health teaching often ask: 'What should the nurse do FIRST?' → Always ASSESS READINESS/LEARNING NEEDS first.
• The BEST WAY to evaluate PSYCHOMOTOR learning = RETURN DEMONSTRATION (patient performs the skill back to the nurse).
• When unsure if an intervention is primary or secondary, ask: 'Has the disease started yet?' No = Primary; Disease has started but early = Secondary; Disability prevention/rehab = Tertiary.

Key Points

• THREE LEVELS OF PREVENTION (Leavell and Clark framework — widely used in Philippine public health/NLE):
• PRIMARY PREVENTION: Prevent disease BEFORE it occurs. Examples: immunization (EPI program), health teaching on proper nutrition, family planning counseling, mosquito net distribution.
• SECONDARY PREVENTION: EARLY DETECTION and PROMPT TREATMENT of existing disease. Examples: BP screening, Pap smear, sputum microscopy for TB (DOTS program), newborn screening.
• TERTIARY PREVENTION: Limiting DISABILITY and promoting REHABILITATION after disease. Examples: physical therapy after stroke, prosthetic fitting after amputation, pulmonary rehabilitation for COPD.
• Philippine DOH programs: EPI (vaccines = PRIMARY), TB-DOTS (sputum screening = SECONDARY; treatment completion = SECONDARY to TERTIARY), maternal-child health programs across all three levels.
• HEALTH TEACHING (an independent nursing function) must: assess readiness and learning needs FIRST; address THREE LEARNING DOMAINS: COGNITIVE (knowledge), AFFECTIVE (attitudes/feelings), PSYCHOMOTOR (skills); use patient's language and literacy level; evaluate through TEACH-BACK or RETURN DEMONSTRATION.
• In the Philippine multilingual setting, nurses must assess language preference and provide teaching in a language the patient understands (Tagalog, Bisaya, Ilocano, etc.) — principle of culturally congruent care (Leininger).
• The best method to EVALUATE learning is RETURN DEMONSTRATION (for skills) or TEACH-BACK (for knowledge).

Definitions

Section Title

Levels of Prevention and Patient/Family Teaching

Common Mistakes

• Classifying TB-DOTS treatment as PRIMARY prevention — sputum screening is SECONDARY (early detection); treatment is SECONDARY (prompt treatment) progressing to TERTIARY if disability prevention is involved.
• Confusing COGNITIVE and AFFECTIVE domains — cognitive is KNOWLEDGE; affective is FEELINGS/ATTITUDES.
• Forgetting that ASSESSING READINESS is the FIRST step in health teaching — you cannot teach effectively without knowing if the patient is ready and willing to learn.
• Stating that verbal questioning alone evaluates PSYCHOMOTOR learning — it does NOT; return demonstration is required.
• Placing IMMUNIZATION in secondary prevention — vaccines are PRIMARY prevention (given BEFORE disease occurs).

Exam Tips

• NLE questions about community nursing often reference RHU or BHS settings — know the difference and the nurse's role in each.
• For licensure pathway questions: BSN → NLE → Oath → PRC License → CPD for renewal — this is the standard sequence under RA 9173.
• Know that the PNA is the ACCREDITED professional organization — membership is encouraged but not required for licensure.
• Questions about 'scope of nursing practice' always refer to RA 9173 — use it as your primary legal reference.

Key Points

• NURSING AS A PROFESSION meets all hallmarks: defined body of knowledge, formal education (BSN), code of ethics, autonomy and accountability, service orientation, professional organization (PNA), and regulation through licensure (RA 9173, BON/PRC).
• NLE PATHWAY under RA 9173: Complete BSN → Pass the NLE → Take the Professional Oath → Receive PRC ID/License → Renew with CPD units.
• FIELDS OF NURSING PRACTICE under RA 9173: Hospital/institutional nursing, Community/public health nursing, School nursing, Occupational health nursing, Military nursing, Private-duty nursing, Nursing education (clinical instructor/faculty — with required qualifications), Nursing research, Nursing administration/leadership.
• Community nursing settings in the Philippines: Rural Health Units (RHUs), Barangay Health Stations (BHS), city health centers — nurses implement DOH programs (EPI, TB-DOTS, maternal-child health, family planning).
• The Philippine healthcare system is organized into PRIMARY (RHU, BHS), SECONDARY (district/provincial hospitals), and TERTIARY (regional/national hospitals) levels — nurses practice at ALL levels.
• INTERDISCIPLINARY TEAM: nurses collaborate with physicians, pharmacists, physical/occupational therapists, medical technologists, nutritionist-dietitians, social workers.
• Nurse-to-patient ratio guidelines are set by DOH and BON — relevant for safe staffing discussions.
• Advanced practice includes specialty certification through professional organizations and specialty boards.

Definitions

Section Title

Characteristics of a Profession and Nursing Practice Settings

Common Mistakes

• Thinking nurses can only work in hospitals — RA 9173 defines a wide range of practice settings including community, school, occupational, and military.
• Forgetting CPD is MANDATORY under RA 9173 for license renewal — not optional.
• Confusing RHU (municipal level) with BHS (barangay level) — RHU supervises the BHS.
• Assuming all nursing specialties require the same qualifications — advanced practice and clinical instructor roles have specific requirements under RA 9173.