Basic Concepts of Nursing: A Translation

Translator's Note:

This text is excerpted from The Fundamentals of Nursing (护理学基础), Second Edition, edited by Li Xiaosong (李晓松), a manual on practical nursing published by the People’s Medical Publishing House in 2002. I found this book while studying for the entrance exam for a medical interpreting program. The standard of practice for interpreters requires the interpreter to stay as close as possible to the original voice, to speak as the text and not for the text. This is one of the reasons I chose to translate the text as literally as possible without compromising coherence. It is the most sincere way I can offer the reader how this text compelled me. My own gaps in understanding the jargon-filled text are part of what made the experience of reading this manual so mystical. The body becomes technical and therefore reducible but subsequently unapproachable. However, I did crop out sections that are more factual than expressive.

What also struck me reading this text was its wholeness (comprehensiveness?). I was surprised it covered the topics it did, being a “practical” manual. I think one of the biggest ways we protect ourselves from commitment (to a whole) is by compartmentalizing when we understand/interact. The Nurse rehabilitates the role of the Patient. The body changes from the dysfunction of some collection of parts into a functional and unified whole.

Lastly, I left 人 as 人， which means human or a person or a body, to avoid issues with grammar, gender, and flow in English.

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Chapter 3: Basic Concepts in Nursing

[...] 人， health, the environment, and nursing are the four basic concepts of the modern nursing discipline's framework. The contents of nursing work, practical categories, field of research, the function of the role of the nurse, and professional product are closely related to these four categories.

一、 The Concept of 人

The subject of nursing research and service is 人, and an understanding of 人 is the core of nursing theory and practice. It influences the development of the concept of nursing and determines the goal and nature of the work of the nurse.

I. 人 as a unified whole

人 is a unified body and mind, a coordinated internal and external, continuously developing and changing, unique, and organic whole, and includes various aspects of biology, psyche, spirit, society and culture. Any imbalance in any of these functions will cause some degree of loss of any of the other functions, as well as affecting the operation of the entire being. In contrast, regular function promotes the 人 performing maximally. To understand 人 as a whole is the core of the modern nursing theoretical system.

(i) The Dual Property of 人

人 has the dual property of being a biological and social being. The biological property of 人 is expressed in 人 as a biological, organic body, the same as any other animal and bound by the laws of biology. The social property of 人 is expressed in 人 assuming a role in the development of a society, that 人 has thought and feeling and engages in creative labor and social life. 人 is a unified whole of biology, psyche, spirit, society, and culture. Physical illness will influence 人's thoughts and spirits, and long-term stress or depression causes physical discomfort and leads to various illnesses. The same illness manifests differently in different people. Similarly, the same treatment and nursing methods will have different results. The nurse must evaluate the health concerns of the subject from biological, psychological, spiritual, social, and cultural perspectives, in order to best individualize care and achieve optimal results.

(ii) 人 as an open system

人 body as a biological system is made up of circulatory, nervous, musculoskeletal, respiratory, digestive, and various other subsystems, each subsystem engaged in a never-ending exchange of energy, material, and information. In the natural ecosystem, 人 is a subsystem, living in a complex natural and social environment with which it is engaged in a never-ending exchange of energy, material and information. 人's health depends on the balance and coordination of every subsystem within the organism, as well as the harmony between and adaptation of the organism and/to the environment. At the same time that the nurse is helping to maintain balance in the subject's internal environment, the nurse must attach importance to the effects of other elements in the environment, such as 人, the family, the community, etc., on the organism, and work to improve the conditions of the external environment and the adaptability of the individual body to the environment.

(iii) 人 as the target

With the development of nursing and the expansion of who the targets are and what nursing entails, the nurse no longer only emphasizes healing a patient but also maintaining the health of 人. The target of nursing has expanded to include all 人, not just the sick but also the healthy, and extends not only to the individual, but also to the family, the community and society.

Changes in the professional capacities and role of the nurse have led to the nurse leaving the confines of the hospital and entering the family and the community to care for the health of every 人 as well as groups of 人．The ultimate goal of nursing is not only to maintain or improve the health of the individual 人, but more importantly to elevate the health level of 人society as a whole.

II. 人 have basic needs

Basic needs of 人 refer to the minimum biological and psychology needs of individuals required to maintain equilibrium and at the same time obtain livelihood, growth, and development. When the basic needs of the individual are met, the individual inhabits a balanced and healthy state. When the basic needs of the individual are not met, the individual falls into emotional states of nervousness, anxiety, rage, etc. and loses organic equilibrium, which leads to illness. The function of nursing is to help the target satisfy its basic needs in order to reach optimal health.

人 is an organism with complex needs. Its basic needs can fall generally into the following categories:

• Biological: Needs related to the maintenance of 人's regular biological functions, such as breathing, eating, resting, sleeping, excreting, etc. Its main function is maintaining equilibrium in an organism's metabolism. If not satisfied, 人 cannot survive or procreate.
• Social: Refers to the individual fitting in with society's role expectations and satisfying its needs in interacting with other 人 or groups, such as communication, exchange, friendship, being acknowledged, being affirmed, being loved, etc. Its main function is to maintain equilibrium in the individual's spirit and psyche. If it is not satisfied, feelings of discomfort or unhappiness arise.
• Emotional: Refers to psychological experiences produced by external stimulation. 人 need various emotions of delight, anger, grief, happiness, etc. Happy events lead to happiness, contentment. The opposite may produce emotional reactions of anxiety, fear, terror, anger, etc.
• Cognitive: Refers to the individual's needs in terms of cognition, thinking, and ability, such as the individual's capacity for continuous learning, critical thinking, and problem-solving. Its main function is the realization of the inherent value of existence. If not satisfied, it produces feelings of inferiority, weakness, helplessness and impotence.
• Spiritual: Refers to needs of 人 regarding spiritual beliefs and reliances, such as religious beliefs, prayer, etc. Its main function is the search for spiritual consolation. If not satisfied, it can lead to spiritual hollowness.

Needs are the forces which cause the individual to undertake activities, the compass for the individual's actions, urging 人 to engage in all arenas of activity.

According to the functions of needs, the nurse, when serving the target, must not only help the target fulfill its basic needs but also strengthen the target's understanding of health, stimulating confidence in the target in its own power to attain its health needs, correctly acknowledging the function of the individual in the rehabilitation process, encouraging it to fully exercise subjective initiative, actively participate in the nursing action, and achieve good cooperation with medical personnel.

III. 人 growth and development

[...]

二、The Concept of Health

Health is the normal state of the 人 in life, is the reflection of the quality of life, is the basis of professional success and happiness in life, is the guarantee of social progress, economic development, and national prosperity, is the 人's greatest wealth. Raising the level of health is one of society's greatest goals, and the duty of the nurse.

I. The Concept of Health

(i) Perspectives on Health

[...]

(ii) Models for Understanding Health

Health is not absolute. Illness does not mean the complete loss of health. Currently there are two models for understanding health.

1. Health-Illness Spectrum Model: This model believes health is a relative concept, referring to a process of maintaining equilibrium while continuously adapting to changes in internal and external environments, maintaining homeostasis regarding biological, psychological, social and other aspects of life. Illness, then, is the deviation from health of any particular function of a 人. Health and illness exist on the same spectrum, with optimal health and death at the two extremes. Any point on the health-illness spectrum refers to a comprehensive phenomenon combining the individual's physical, psychological and social dimensions. Every 人 at any time exist dynamically somewhere on this spectrum. There is no clear delineation between health and illness. [...]
2. Optimal Health Model: This model believes health is a relatively stable state in which illness is absent and 人 is in harmony with the environment, exhibiting a phenomenon of relative equilibrium. 人 should attempt to reach optimal health, in order to perform to one's best ability every function and develop every potentiality in full. The optimal health model puts more emphasis on activities that promote health and prevent illness, activities which also exceed simply rehabilitative activities. As such, the nurse can utilize the optimal health model to help the service target perform activities which engage the organism's greatest ability and potential, achieving a state of optimal health

(iii) Factors Influencing Health

[...]

II. The Concept of Illness

With a deepening understanding of health, understanding of illness has also changed qualitatively. Illness is no longer considered a result of purely biological factors (heredity, bacteria, viruses, parasites, etc.), but a complex process occurring in the organism under the influence of many factors.

(i) Modern Perspectives on Illness

Modern perspectives on and understandings of illness include not only the functions of the body's organs and organizational structures, but also the relationship between the organs and systems, the relationship between the psyche and the body, and the relationship between the human body and the external environment.

1. The definition of illness: Illness is when, under the influence of certain external factors, changes occur in the organism, affecting the organizational form, metabolism, and function, presenting as a whole damage and anti-damage pathological process, involving the break-down of the equilibrium between an organism's internal and external environments or the process of the organism deviating from a normal state.
2. Characteristics of illness
   1. Illness is the corresponding phenomenon to health in life and the process of an organism's reaction in its entirety.
   2. Illness is the presentation of barriers in an organism's homeostatic harmony, as well as the harmony among the systems within the organism and between the organism and the external environment, leading to the deviation of life's activities from the norm.
   3. Illness is an organism's failure to adapt to internal and external environments.
   4. Illness is the result of the action and influence of mind and body on each other.

(ii) Illness and Its Effects

Illness is an important life event and affects the organisms in multiple ways. The nurse should establish a good personal relationship with the target, understand the trauma brought by illness, look for ways to help the patient adjust to illness, and prevent harmful moods or behaviors.

1. A changed role: Everyone plays a certain role in the family and in society. Under the influence of illness, the patient can temporarily be relieved from certain familial and social roles, and enter into the role of the patient to recuperate.
2. Changes in mood and behavior: Changes in mood and behaviour are related to the nature and severity of the illness. Usually, short term, non-terminal illness will not cause obvious changes in mood or behavior. Serious illnesses, especially terminal illnesses, can cause strong reactions in mood or behavior, such as anger, fear, anxiety, disappointment, helplessness, etc.
3. Effects on personal autonomy and lifestyle: Many patients are willing to forfeit their lifestyle and habits to seek rehabilitation and exhibit more obedient or respectful behavior towards the doctor.
4. Effects on image: Some illnesses can cause changes in image, leading to a series of psychological reactions from the patient. Examples include amputations, paralysis, weight gain following steroid treatment, hair loss following chemotherapy, etc. Reactions usually follow the process of shock, denial, gradual acknowledgment and then acceptance.
5. Effects on personal conception: Especially in cases of chronic illness or illnesses with social stigma such as mental illness or STIs, the patient's self-respect is altered and he or she finds it difficult to return to the original roles occupied.
6. Effect on the family’s finances: Going to the hospital, receiving outpatient service or inpatient treatment, and even needing surgery, all place a burden on the family’s expenses, and present a problem for families with limited income. If the patient usually carries the burden of the family’s expenses, illness creates problems in income as well as placing a burden on expenses.

III. Health and Illness

1. Health and illness mutually transform under certain conditions: Health and illness are a pair of conflicts in the continuity and unity of life, and this conflict is always changing, and the pair can also mutually transform under certain conditions. For example, in the competitive state of the present, 人's physical and mental capacities are overworked for long periods of time, and the major organs of the body strain to meet the requirements of abnormal conditions, leading to malfunction and is a cause of illness overlook. On the other hand, patients with chronic illnesses, once their conditions stabilize, can also participate in social activities and gradually recover.
2. There is no clear delineation between health and illness: At any time, a 人's health status is relative, and there is no such thing as complete health, and there exists between health and illness a state of suboptimal health. Health and illness are dynamic, not absolute. Discomfort can be a result of fatigue and place the individual in suboptimal health, which is not the result of illness, though it is often the first indicator of it. Someone in the early stages of cancer can appear symptomless while the illness is already in the body and steadily progressing.

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