Foundations of Nursing

1. Ma. Tosca Cybil A. Torres, RN, MAN Definition of Nursing History of Nursing Fields of Nursing Roles of a Professional N urse Five Fold N ursing F unctions

2. DEFINITION OF NURSING, NURSE, AND PATIENT

3. NURSING: DEFINITIONS NURSING (as an art) Is the art of caring sick and well individual. It refers to the dynamic skills and methods in assisting sick and well individual in their recovery and in the promotion and maintenance of health. It involves the creative application of knowledge in the service of people NURSING (as a science) It is the “body of abstract knowledge” arrived through scientific research and logical analysis Is the scientific knowledge and skills in assisting individual to achieve optimal health. It is the diagnosis and treatment of human responses to actual or potential problem.

4. Nursing (as a profession) Profession- a calling in which its members profess to have acquired special knowledge by training or experience, or both so that they may guide, advise or save others in that special field. NURSING: DEFINITIONS

5. NURSING: DEFINITIONS FLORENCE NIGHTINGALE Nursing is the act of utilizing the environment of the patient to assist him in his recovery. VIRGINIA HENDERSON Nursing is the act of assisting the individual, sick or well, in the performance of those activities contributing to health or its recovery (or to a peaceful death) that he would perform unaided if he had the necessary strength, will, or knowledge, and to do this in such a way as to help him gain independence as rapidly as possible.

6. NURSING: DEFINITIONS CANADIAN NURSES ASSOCIATION (CNA) Nursing is a dynamic, caring, helping relationship in which the nurse assist the client to achieve and obtain optimal health. – 1987 THEMES THAT ARE COMMON TO THESE DEFINITION: Nursing is caring Nursing is an art Nursing is a science Nursing is client-centered Nursing is holistic Nursing is adaptive Nursing is concerned with health promotion, health maintenance, and health restoration Nursing is a helping profession

7. NURSING: DEFINITIONS AMERICAN NURSES ASSOCIATION (ANA) 1973 Nursing is direct, goal oriented, and adaptable to the needs of the individual, the family, and community during health and illness. 1980 Nursing is the diagnosis and treatment of human responses to actual or potential health problems. 1995 ANA acknowledges FOUR ESSENTIAL FEATURES OF CONTEMPORARY NURSING PRACTICE: Attention to the full range of human experiences and responses to health and illness without restriction to a problem-focused orientation. Integration of objective data with knowledge gained from understanding of the client or group’s subjective experience. Application of scientific knowledge to the processes of diagnosis and treatment. Provision of caring relationship that facilitates health and healing.

8. NURSE: DEFINITION NURSE Comes from a Latin word “to nourish” or “to cherish One who cares for the sick, the injured, and the physically, mentally, and emotionally disabled One who advise and instruct individuals, families, groups and communities in the prevention, treatment of illness and diseases and in the promotion of health. An essential member of a health team who cares for individuals, families and communities in disease and illness prevention and in the promotion of health and healthy environment.

9. PATIENT: DEFINITION PATIENT Comes from a Latin word, “to Suffer” or “to Bear” An individual who is in the state of physical, mental, and emotional imbalance An individual who seeks for nursing assistance, medical assistance, or for surgery due to illness or a disease. Is an individual who is waiting or undergoing medical or surgical care. One who is physically or mentally disabled.

10. HISTORY OF NURSING

11. PERIODS OF NURSING HISTORY Intuitive Period Apprentice Period Educative Period Contemporary Period

12. INTUITIVE PERIOD

13. INTUITIVE PERIOD Prehistoric  Early Christian Era More on intuition NOMADS – travel from one place to another Survival of the fittest “Best for the most” – motto Sickness is due to “voodoo” Performed out of feeling of compassion for others Performed out of desire to help Performed out of wish to do good Nursing is given by the WOMEN

14. INTUITIVE PERIOD SHAMAN – uses white magic to counteract the black magic They are the doctors during those time. TREPHINING – drilling the skull Used to treat Psychotic patients Psychotic patients are believed to be possessed by evil spirits. Growth of religion – most important thing that happened Growth of civilization Law of self preservation – inspire man in search of knowledge

15. Rise in Civilization

16. RISE IN CIVILIZATION From the mode of Nomadic life  agrarian society  gradual development of urban community life Existence of means of communication Start of scientific knowledge  more complex life  increase in health problems  demand for more nurses Nursing as a duty of SLAVES and WIVES. NURSING DID NOT CHANGE but there was progress in the practice of Medicine. Care of the sick was still closely allied with superstitions, religion and magic

17. RISE IN CIVILIZATION Near East – birth place of 3 religious ideologist: Judaism Christianity Mohammedism or Islam - Near East culture was adopted by the Greeks and Romans combined with the wonders of the Far East by returning crusaders and explorers improved and was carried to Europe during the Renaissance Period that resulted to greater knowledge then to the New World by the Early settlers.

18. RISE IN CIVILIZATION New World – a tiny area known as birth of monotheism that lies between Tigris and Euphrates River in the Nile River arose the cultures of Babylonia, Egypt and Hebrew. MONOTHEISM – believer of one God

19. DIFFERENT CIVILIZATIONS

20. BABYLONIANS CODE OF HAMMURABI 1 st recording on the medical practice Established the medical fees Discouraged experimentation Specific doctor for each disease Right of patient to choose treatment between the use of charms, medicine, or surgical procedure

21. EGYPTIANS ART OF EMBALMING Mummification Removing the internal organs of the dead body Instillation of herbs and salt to the dead Used to enhance their knowledge of the human anatomy. Since work was done and performed on the dead, they learned nothing of Philosophy “THE 250 DISEASES” Documentation about 250 diseases and treatments

22. HEBREW Teachings of MOSES Created Leviticus Father of sanitation Practice the values of “Hospitality to strangers” and the “Act of Charity” – contained in the book of Genesis LEVITICUS – 3 rd book of the Old Testament Laws controlling the spread of communicable diseases Laws governing cleanliness Laws on preparation of food Purification of man and his food The ritual of CIRCUMCISION – on the 8 th day after birth MOSAIC LAW Meant to keep Hebrews pure so that they may enter the sanctuary without affronting God Meant as a survival for health and hygienic reason only

23. CHINA Use of pharmacologic drugs “MATERIA MEDICA” Book that indicates the pharmacologic drug used for treatment No knowledge on anatomy Use of wax to preserve the body of the dead Method of paper making FACTOR THAT HAMPERED THE ADVANCEMENT OF MEDICINE: Prohibits dissecting of human body thus thwarting scientific study

24. INDIA SUSHURUTO 1 st recording on the nursing practice Hampered by Taboos due to social structures and practices of animal worship Medicine men built hospitals Intuitive form of asepsis There was proficient practice of Medicine and Surgery NURSES QUALIFICATIONS: Lay Brothers, Priest Nurses, combination of Pharmacist, Masseurs, PT, cooks There was also decline in Medical practice due to fall of Buddhism – state religion of India

25. GREECE AESCULAPUS Father of medicine in Greek mythology HIPPOCRATES Father of modern medicine 1 st to reject the idea that diseases are caused by evil spirits 1 st to apply assessment Practice medical ethics CADUCEUS Insignia of medicine Composed of staff of travellers intertwined with 2 serpent (the symbol of Aesculapus and his healing power). At the apex of the staff are two wings of Hermes (Mercury) for speed. NURSES  function of untrained slaves

26. ROMANS Proper turnover for the sick people “If you’re strong, you’re healthy” – motto Transition from Pagan to Christianity FABIOLA Was converted to Christian and later she converted her home to a hospital and used her wealth for the sick. 1 st hospital in the Christian world

27. APPRENTICE PERIOD

28. APPRENTICE PERIOD 11 th century  1836 On-the-job training period Refers to a beginner (on-the-job training). It means care performed by people who are directed by more experienced nurses Starts from the founding of Religious Orders in the 6 th century through the Crusades in the 11 th century (1836 – when the deaconesses School of Nursing was established in Kaiserswerth , Germany by Pastor THEODORE FLEIDNER)

29. APPRENTICE PERIOD There was a struggle for religious, political, and economic power Crusades took place in order to gain religious, political, and economic power or for adventure During the Crusade in this period, it happened as an attempt to recapture the Holy Land from the Turk who obtained and gain control of the region as a result of power struggle. Christians were divided due to several religious war and Christians were denied visit to The Holy Sepulcher.

30. MILITARY RELIGIOUS ORDERS AND THEIR WORKS

31. MILITARY RELIGIOUS ORDERS AND THEIR WORKS KNIGHTS OF ST. JOHN OF JERUSALEM (ITALIAN) Also called as “Knights of the Hospitalers ” Established to give care TEUTONIC KNIGHTS (GERMAN) Took subsequent wars in the Holy Land Cared for the injured and established hospitals in the military camps KNIGHTS OF ST.LAZARUS Care for those who suffered Leprosy, syphilis, and chronic skin diseases

32. ALEXIAN BROTHERS A monasteric order founded in 1348. They established the Alexian Brothers School of Nursing, the largest School under religious auspices exclusively in US and it closed down in 1969 ST. VINCENT DE PAUL He organized the charity group called the “La Charite” and the “Community of Sisters of Charity” composed of women dedicated in caring for the sick, the poor, orphaned, and the widowed. He founded the “Sisters of Charity School of Nursing” in Paris, France where Florence Nightingale had her 2 nd formal education in Nursing. LOUISE de GRAS Was the 1 st Superior and co-founder of the Community of Sisters of Charity

33. NURSING SAINTS

34. NURSING SAINTS ST. CLAIRE OF ASSISI Took vows of poverty, obedience to service and chastity Founded the 2 nd order of St. Francis of Assisi “the poor Claire” ST. ELIZABETH OF HUNGARY The patroness of Nursing A princess Sees her calling to give care for the sick Fed thousands of hungry people St. CATHERINE OF SIENA “Little Saint” – took care of the sick as early as 7y/o “1 st Lady with a Lamp”

35. RISE OF RELIGIOUS NURSING ORDER

36. RISE OF RELIGIOUS NURSING ORDER Orders of St. Francis of Assisi 1 st order – founded by St. Francis 2 nd order “the poor Claire” – founded by St. Claire 3 rd “the tertiary order” Beguines Oblates Benedictines Ursulites Augustinians

37. THE DARK PERIOD OF NURSING

38. DARK PERIOD OF NURSING From 17 th century – 19 th century Also called the Period of Reformation until the American Civil War Hospitals were closed Nursing were the works of the least desirable people (criminals, prostitutes, drunkards, slaves, and opportunists) Nurses were uneducated, filthy, harsh, ill-fed, overworked Mass exodus for nurses The American Civil War was led by Martin Luther, the war was a religious upheaval that resulted to the destruction in the unity of Christians. The conflict swept everything connected to Roman Catholicism in schools, orphanages, and hospitals

39. DARK PERIOD OF NURSING THEODORE FLIEDNER (a pastor) reconstituted the Deaconesses and later be established the School of Nursing at Kaiserswerth , Germany where Florence Nightingale had her 1 st formal training for 3 months as nurse FLORENCE NIGHTINGALE Practiced her profession during the Crimean War “Lady with a Lamp” From a well-known family Went to Germany to study

40. EDUCATIVE PERIOD

41. EDUCATIVE PERIOD Florence Nightingale era Began in June 15, 1860 when Florence Nightingale School of Nursing opened at St. Thomas Hospital in London England, where 1 st program for formal education of Nurses began and contributed growth of Nursing in the US FACTORS THAT INFLUENCED DEVELOPMENT OF NURSING EDUCATION: Social forces Trends resulting from war Emancipation of women Increased educational opportunities FLORENCE NIGHTINGALE Mother of Modern Nursing Lady with the Lamp Born on May 12, 1820 in Florence, Italy Her SELF-APPOINTED GOAL – to change the profile of Nursing She compiled notes of her visits to hospitals, her observations of sanitation practices and entered Deaconesses School of Nursing at Kaiserswerth , Germany for 3 months.

42. EDUCATIVE PERIOD FLORENCE NIGHTINGALE Became the Superintendent of the Establishment for Gentle Women during the Illness (refers to the ill governess or instructors of Nursing She disapproved restriction on admission of patient and considered this unchristian and contrary to health care. Upgraded the practice of Nursing and made Nursing a honorable profession Led other nurses in taking care of the wounded and sick soldiers during the Crimean War She was designated as Superintendent of the Female Establishment of English General Hospital in Turkey during the Crimean War She reduced the casualties of war by 42%-2% thru her effort by improving the practice of sanitation techniques and procedure in the military barracks

43. EDUCATIVE PERIOD THE CONCEPTS OF FLORENCE NIGHTINGALE ON NURSING SCHOOL: School of Nursing should be self-supporting not subject to the whimps of the Hospital. Have decent living quarters for students and pay Nurse instructors Correlate theories to practice Support Nursing research and promote continuing education for nurses Introduce teaching knowledge that disease could be eliminated by cleanliness and sanitation and Florence Nightingale likewise did not believed in the Germ Theory of Bacteriology. Opposed central registry of nurses Wrote Notes on Nursing, “What it is and what it is not.” Wrote notes on hospitals

44. EDUCATIVE PERIOD OTHER SCHOOLS OF NURSING Bellevue Training School for Nurses – New York City Alexian Brothers Hospital School of Nursing in US exclusively for men. It opened in 1348 and it closed down in 1969. LINDA RICHARDS – the first graduate nurse in US. Graduated in September 1, 1873. 2 NURSING ASSOCIATION / ORGANIZATIONS THAT UPGRADED NURSING PRACTICE IN US: American Nurses Association National League for Nursing Education

45. CONTEMPORARY PERIOD

46. CONTEMPORARY PERIOD World War II – present This refers to the period after World War I and the changes and development in the trends and practice of Nursing occurring since 1945 after World War II. Includes scientific and technological development, social changes occurring after the war. Nursing is offered in College and Universities

47. CONTEMPORARY PERIOD DEVELOPMENT AND TRENDS: W.H.O established by U.N to fight diseases by providing health information, proper nutrition, living standard, environmental conditions. The use of Atomic energy for diagnosis and treatment. Space Medicine and Aerospace Nursing Medical equipment and machines for diagnosis and treatment Health related laws Primary Health Care – Nurses involvement in CHN Utilization of computers Technology advances such as development of disposable equipment and supplies that relieved the tedious task of Nurses. Development of the expanded role of Nurses

48. CONTEMPORARY PERIOD FACTORS AFFECTING NURSING TODAY: Economics Consumer’s Demand Family Structure Information and Telecommunications Legislation

49. HISTORY OF NURSING (PHILIPPINE SETTING)

50. HISTORY OF NURSING (PHILIPPINE SETTING) EARLY BELIEFS AND PRACTICES Beliefs About Causation of Diseases: Caused or inflicted by other person (enemy or witch) Evil spirits Beliefs That Evil Spirits Could Be Driven Off By Person With Powers To Expel Bad Spirits: Believed in Gods of healing Word doctors – priest physicians Herbolarios – herb doctors

51. HISTORY OF NURSING (PHILIPPINE SETTING) EARLY CARE OF THE SICK HERBICHEROS – herbmen who practice witchcraft MANGKUKULAM / MANGANGAWAY – a person suffering from disease without any identified cause and were believed bewitched by such Difficult child birth and some diseases attributed to (NONO) midwives Difficult birth, witches were supposed to be the cause, gunpowder exploded from a bamboo pole close to the head of the mother to drive evil spirits

52. HISTORY OF NURSING (PHILIPPINE SETTING) EARLY HOSPITALS: Hospital Real de Manila – 1577 1 st hospital established Gov. Francisco de Sande To give service to the king’s Spaniard soldiers San Lazaro Hospital – 1578 Fray Juan Clemente Named after the Knights of St. Lazarus Hospital for the lepers

53. HISTORY OF NURSING (PHILIPPINE SETTING) EARLY HOSPITALS: Hospital de Indios – 1586 Franciscan Orders Hospital for the poor Filipino people Hospital de Aguas Santas – 1590 Fray Juan Bautista Named after its location (near spring) because people believed that spring has a healing power. San Juan de Dios Hospital – 1596 For poor people Located at Roxas Boulevard

54. HISTORY OF NURSING (PHILIPPINE SETTING) PERSONAGES: Dona Hilaria de Aguinaldo 1 st wife of Emilio Aguinaldo Established Philippine Red Cross – February 17, 1899 Dona Maria Agoncillo de Aguinaldo 2 nd wife of Emilio Aguinaldo 1 st president of Philippine Red Cross (Batangas Chapter) Josephine Bracken Helped Rizal in treating sick people

55. HISTORY OF NURSING (PHILIPPINE SETTING) PERSONAGES: Melchora Aquino Took care of the wounded Katipuneros Anastacia Giron Tupaz Founder of Filipino Nurses Association – established on October 15, 1922 1 st Filipino chief nurse of PGH 1 st Filipino Superintendent of Nurses in the Philippines Francisco Delgado 1 st president of Filipino Nurses Association

56. HISTORY OF NURSING (PHILIPPINE SETTING) PERSONAGES: Cesaria Tan 1 st Filipino to receive Masteral Degree in Nursing abroad Socorro Sirilan Pioneer in Social Service at San Lazaro Hospital Also the chief nurse Rosa Militar Pioneer in nursing education Socorro Diaz 1 st editor of PNA magazine called, “The Message” Conchita Ruiz Full time editor of the PNA newly named magazine, “The Filipino Nurse

57. HISTORY OF NURSING (PHILIPPINE SETTING) EARLY NURSING SCHOOLS Iloilo Mission Hospital and School of Nursing Established in 1906 under the supervision of Rose Nicolet (American) Nursing course – 3yrs. Produced 1 st batch of Nursing graduates in 1909 – 22 nurses 1 st TRAINED NURSES: Nicasia Cada Felipa Dela Pena Dorotea Caldito April 1944 – 1 st Nursing Board Exam at Iloilo Mission Hospital

58. HISTORY OF NURSING (PHILIPPINE SETTING) EARLY NURSING SCHOOLS PGH School of Nursing – 1907 St. Paul School of Nursing – 1907 St. Luke’s School of Nursing – 1907 UST – 1946 Fatima – 1947

59. Fields of Nursing

60. Nursing in Primary Care S etting Public health nursing Occupational nursing Clinic nursing School nursing Private duty nursing Military nursing Ambulatory care nursing Nursing in correctional facilities Nursing in primary care setting Primary- initial health care for general complaints Usually the person’s 1 st contact with the health care delivery system Managing current health care needs, and preventing further problems.

61. Nursing in Secondary C are Setting Institutional nursing: Hospital nursing Director of nursing Clinical coordinator Head nurse Staff nurse OB- Gyne nursing Pediatric nursing Orthopedic nursing OR nursing Med-surgical nursing Psychiatric nursing ER nursing Critical care nursing Flight nurse Infection-surveillance nurse

62. Nursing in Tertiary Care Setting Skilled care setting Rehabilitation setting Advanced practice nursing (APN) Clinical nurse specialist Nurse anesthetist Nurse educator Nurse administrator Nurse researcher

63. ROLES OF A NURSE

64. Role A goal directed act or behavior that is considered acceptable to the culture of given situation

65. ROLES OF A NURSE Caregiver Communicator Teacher Client Advocate Counselor Change Agent Leader Manager Case Manager Research Consumer Role Model Administrator Expanded Career Roles

66. ROLES OF A NURSE Caregiver Primary goal TYPES OF CARE: Full Care  for completely dependent patient Partial Care  for partially dependent patient Supportive-Educative care  to assist clients in attaining their highest possible level of health and wellness; for learnings Communicator Integral to all nursing roles Nurses communicate with the client, support persons, other health professionals, and people in the community Nurses identify client problems and then communicate these verbally or in writing to other members of the health team

67. ROLES OF A NURSE Teacher Nurses help clients learn about their health and the health care procedure they need to perform to restore or maintain their health. Nurses assesses the client’s learning needs and readiness to learn, sets specific learning goals in conjunction with the client, enacts teaching strategies, and measures learning. Nurses also teaches unlicensed assistive personnel to whom they delegate care, and they share their expertise with other nurses and health professionals. Client Advocate Acts to protect the client Nurse may represent the client’s needs and wishes to other health professionals, such as relaying the client’s wishes for information to the physician. Nurses assist clients in exercising their rights and help them speak up for themselves

68. ROLES OF A NURSE Counselor Helping a client recognize and cope with stressful psychologic or social problems, to develop improved interpersonal relationships, and to promote personal growth. Involves providing emotional, intellectual and psychologic support. Nurses counsel primarily healthy individuals with normal adjustment difficulties and focuses on helping the person develop new attitudes, feelings, behaviors by encouraging the client to look at alternative behaviors, recognizing the choices, and develop sense of control. Change Agent Assisting others to make modifications in their own behavior. Nurses also often act to make changes in a system if it is not helping client return to health.

69. ROLES OF A NURSE Leader Influences others to work together to accomplish a specific goal. Can be employed at different levels: individual client, family, groups of clients, colleagues, or the community Case Manager Work with the multidisciplinary health care team to measure the effectiveness of the case management plan and to monitor outcomes. Works with primary or staff nurses to oversee the care of a specific caseload. Primary nurse or provides some level of direct care to the client and family Helps ensure that care is oriented to the client, while controlling costs.

70. ROLES OF A NURSE Research Consumer Often use research to improve client care Have some awareness of the process and language of research Be sensitive to issues related to protecting the rights of human subjects Participate in the identification of significant researchable problems Be a discriminating consumer of research findings Role Model Has good physical appearance Practices proper hygiene Practices healthy lifestyle

71. ROLES OF A NURSE Administrator Assumes middle management position Connects the patient to other services of the hospital Expanded Career Roles Nurse practitioner, clinical nurse specialist, nurse midwife, nurse educator, nurse researcher, and nurse anesthetist All of which allow greater independence and autonomy.

72. CONCEPT OF PROFESSION (Marie Jahoda) An organization of an occupational group based on the application of special knowledge which establishes its own rules and standards for the protection of the public and the professionals. A profession implies that the quality of work done by its members is of greater importance in its own eyes and the society than the economic rewards they earn. Serves all of society and not the specific interests of a group

73. CHARACTERISTICS AND ATTRIBUTES OF A PROFESSIONAL PERSON Is concerned with quality.-ksa Is self-directed, responsible and accountable for his actions. Is able to make independent and sound judgment including high moral judgment. Is dedicated to the improvement of human life Is committed to the spirit of inquiry.

74. NURSING AS A PROFESSION Primary Characteristics: Education Theory Service Autonomy Code of Ethics Caring

75. Professional Nursing art and science, dominated by an ideal of service in which certain principles are applied in skillful care of the well and ill, and through relationship with the client, significant others and other members of the health team. Professional Nurse A person who has completed a basic nursing education program and is licensed in his country or state to practice professional nursing.

76. QUALITIES AND ABILITIES OF A PROFESSIONAL NURSE Has faith in the fundamental values that underlie the democratic way of life: Respect for human dignity Self sacrifice for the common good. Strong sense of responsibility for sharing in the solution of the problems of the society. Has a sense of responsibility for understanding those with whom he works or associates with through the use of skills:

77. Has the basic knowledge, skills and attitudes necessary to address present day social problems, realistic and well organized thoughts through the use of critical thinking Has skills in using written and spoken language, both to develop own thoughts and to communicate them to others. Appreciates and understands importance of good health Has emotional balance. Accepts and tries to understand people of all sorts, regardless of race, religion and color.

78. Five fold N ursing F unctions

79. Promoting Health and Wellness Preventing Illness Pain/suffering alleviation Restoring Health Creation of a spiritual environment Five fold nursing functions

80. PROMOTING HEALTH AND WELLNESS Wellness – state of well-being. Engaging in attitudes and behavior that enhance the quality of life and maximize personal potential For both healthy and ill. Involve individual and community activities to enhance healthy lifestyle, such as improving nutrition and physical fitness, preventing drug and alcohol misuse, restricting smoking, and preventing accidents and injury in the home and workplace. Five fold nursing functions

81. PREVENTING ILLNESS The goal is to maintain optimal health by preventing diseases Nursing activities includes immunizations, prenatal and infant care, and prevention of sexually transmitted disease. Five fold nursing functions

82. P ain/suffering Alleviation The goal is to provide relief from pain to promote comfortable healing process Five fold nursing functions

83. RESTORING HEALTH Focuses on the ill client Extends from early detection of disease to helping the client during the recovery period NURSING ACTIVITIES: Providing direct care to the ill person: administering medications, baths, and specific procedures and treatments Providing diagnostic and assessment procedures: measuring BP and examining feces for occult blood Consulting with other health care professionals about client’s problems Teaching clients about recovery activities: exercise that will accelerate recovery after a stroke Rehabilitating clients to their optimal functional level following physical or mental illness, injury, or chemical addiction Five fold nursing functions

84. Creation of a spiritual environment Provision of spiritual care Involves comforting and caring for people of all ages who are dying Includes helping clients live as comfortable as possible until death and helping support persons cope with death. Work in homes, hospitals, and extended care facilities Hospices are specifically designed for this purpose. Five fold nursing functions