Dlian’s

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 Theoretical Foundations
of Nursing
Nursing theories are organized bodies of knownedge to define what nursing is, what nurses do.
and why do they do it. Nursing theories provide a way to define nursing as a unique discipline that
is separate from other discipline (e.g. medicine). It is a framework of concepts and purposes
intended to guide the practice of nursing at a more concrete and specific level.

PHILOSOPHY - Bellefs an values that betine a way of thinking and are generally known and
understood by a group or discipline.

THEORY - These are beliefs, policy, or procedure proposed or followed as the basis of
action. It refers to a logical group of general propositions used as principles or explanation.
Theory are also used to describe, predict, or control phenomenon.

CONCEPT - are often called the building blocks of theories. They are primarily the vehicle
of thought that involve images.

MODELS - Models are representations of the interaction among and between the
concepts showing patterns. They present an overview of the thinking behind the tneory
and may demonstrate how theory can be introduced into practice.

CONCEPTUAL FRAMEWORK - conceptual framework is a group of related ideas,

statements, or concepts. It is often used interchangeably with a conceptual model and
with grand theories..

PROPOSITION - are statements that describe the relationship between the concepts.

DOMAIN - Is the perspective or territory of a profession or discipline

PROCESS - Processes are a series of organized steps, changes, or functions intended to

bring about the desired result. '

PARADIGM - refers to a pattern of shared understanding and assumptions about reality

and the world.

METAPARADIGM - Is the most general statement of discipline and functions as a

framework in which the more restricted structures or conceptual models develop. Much
of the theoretical work in nursing focus on articulating relationships amongst four major
concepts. (e.g. person environment, health and nursing.)
 Theoretical Foundations
History of Nursing Theory
of Nursing
Intuitive Period Ancient Greece
Nursing was “untaught” and instinctive. It was performed of -Nursing- the task of an untrained slave
compassion for others, out of the wish to help others. -Caduceus- insignia of the medical profession today was
introduced
Beliefs and Practices of Prehistoric Man -Hippocrates- “Father of Scientific Medicine” made major
- Nursing belonged to women taking care of the children, the advances by rejecting the belief that disease is caused by the
sick, and the aged. supernatural; developed assessment standards for clients,
- Illness causes from attack of evil spirit through the use of established overall medical standards and recognized a need for
black magic (voodoo) nurses.
- Medicine man (shaman) - witch doctor with white magic -Realization that doctors need nurses
- Trephining - drilling hole with a rock in the skull w/o Rome
anesthesia (drive away spirits) - maintains vigorous health (illness=weakness)
Contributions to Medicine and Nursing Babylonia - care of the ill was left to the Greek physicians or slaves who
- Code of Hammurabi- provided laws covering every facet of were inferior to Roman society.
Babylonian life
- medical practice; specific doctors per disease Apprentice Period
- patient’s right to choose from charms, medication or surg -Middle Ages; nursing care was done by crusaders, prisoners...
procedures -Nursing became the work of the least desirable of women–
Egypt prostitutes, alcoholics, prisoners
- introduced the ‘art of embalming’ -Florence Nightingale received her 3-month course of study in
- developed keen observation that left 250 records of nursing.
recognized disease -Founding of religious nursing orders to 1836 when Kaiserswerth
- slaves and patient’s families nursed the sick Institute for the training of Deaconesses in Germany was
Israel established (by Pastor Theodore Fliedner and his wife, Frederika)
- Moses, “Father of Sanitation,” wrote in Old Testament which: a. Period of “on the job” training
- (Genesis) emphasized the practice of hospitality to strangers b. Nursing care was performed without any formal education and
and acts of charity by people who were directed by more experienced nurses
China c. Religious orders of the Christian church were responsible for
-Belief: girl’s clothes for male babies drive evils away the development of this kind of nursing
-prohibited cadaver dissection as ancestral worship Crusades
-gave birth to pharmacology (materia medica) ● Military religious orders started hospitals ran with men
India ● Knights of Lazarus- founded primarily for the lepers in
-Men of medicine built hospitals, practiced an intuitive form of Jerusalem after being conquered by the Christians; Rise of
asepsis (exclusion of bacteria: i.e., sterile), and were proficient in Secular Orders
the practice of medicine and surgery ● Religious taboos and soc restrictions influenced nursing during
-Sushurutu- made the list of nurse’s functions and Religious Nursing orders
qualification w/c became the first reference to the nurse’s ● Older Nuns: prayed and cared for the sick. Younger Nuns:
taking care of patients. washed soiled linens in rivers.
-Now: the insertion of IV cannulas is for doctor’s task only ● 16th Century: hospitals (last resort) were established but
gloomy, cheerless, airless, and unsanitary
 Theoretical Foundations
Educated Period
of Nursing
-June 15, 1869, Florence Nightingale School of Nursing was -Herbmen or Herbicheros as one who practiced witchcraft
opened until WWII. -unidentified disease believed to be bewitched
1. The development of nursing was strongly shaped by trends
from wars, arousal of social awareness, freedom of women, and History and Philosophy of Science
increased opportunities opened to women. Rationalism
2. Popularization of the Nightingale System Philosophy ● Rationalism epistemology (scope of knowledge) emphasizes
-Importance of Nursing Ed PRIORI reasoning as the appropriate method of advancing
-Nurses teaching students knowledge
-Specialization developed ● The Rationalist view is evident with the work of Einstein, a
3. Facts: Florence Nightingale theoretical physicist made use of mathematical equation in
● Born: May 12, 1820, Florence, Italy developing theories
● “Lady with a Lamp”, “Mother of Modern Nursing” ● The theories constructed offered an imaginative framework
● Raised in England; Learned languages, lit, math, and soc ● If someone believes that science is a process of inventing
graces descriptions of phenomena, the appropriate approach to theory
● Self-appointed goal: “to change the profile of nursing” construction
● Led the nurses who cared of wounded during the Crimean War Empiricism
● 2 Published Books: Notes on Nursing / Notes on Hospitals ● The Empiricist view is based on the central idea that
scientific knowledge is derived from sensory experience
Contemporary Period ● Bacon believe that scientific truth was discovered through
-20th century; Post WWII to present generalizing observed facts, this approach is known as inductive
-Licensure of nurses started reasoning, based on the idea that the collection of facts
-Specialization of Hospital and diagnosis precedes attempts to formulate generalization
-Training of Nurses in diploma program Early 20th Century view
-Development of baccalaureate and advanced degree program ● During the first half of the century , Philosophers focus on
a. Scientific and technological developments; social changes the analysis of theory structure, Scientist focused on the
b. Establishment of WHO by the United Nation empirical approach
c. Use of atomic/nuclear energy for med Dx and Tx ● Positivism was first used by Comte, who emerged as the
d. Utilization of computers (utilized-data collection, teaching, dominant view of modern science. Positivists believed that
diagnosis, inventory, payrolls, record keeping, and billing.) empirical research and logical analysis ( deductive and inductive)
e. Use of advanced equipment for Dx and PT were approaches used to produce scientific knowledge
f. Health- fundamental human right Emergent views
g. Nursing involvement in community health is strengthened ● In the late 20th century, several authors presented analyses
h. Development of the expanded role of nurses challenging the positivist position. Offering a new perspective of
i. Professionalization of nursing science
● One of the perspectives in new philosophy emphasizes science as a
Nursing in the Philippines Early Beliefs and Practices process of continuing research rather than a product focused on
-Causation of disease (evil spirits, enemy or witch) findings.
-Evil spirits could be driven away by a person that can expel ● The emergent epistemology, the emphasis shifted to understanding
demons scientific discovery and process as theories change overtime
-Special gods of healing; priest-physician and Herbolarios ● Empiricist view phenomena objectively, collects data, and analyze it
to inductively proposed theory
 Theoretical Foundations
of Nursing
Coverage: Terminologies:
1. Introduction to nursing (Profession) • Professionalism
2. Terminologies - Refers to professional character, spirit,
3. Evolution of nursing or methods. It is a set of attributes, a way of life that
4. Metaparadigm implies responsibility and commitment.
• Professionalization
NURSING - Is the process of becoming professional,
As an Art that is, of acquiring characteristics considered to be
- As a professional nurse you will earn to deliver care professional.
artfully with compassion, caring, and respect for each
patient's dignity and personhood. Level of Proficiency Nurses (By Patricia Benner)
1. Novice
As a Science - Nursing student
- Nursing practice is based on a body of knowledge that - Entering new field
is continually changing with new discoveries and 2. Advanced beginner
innovations. - Have few experience
- Evidenced based practices nursing concept, theories, 3. Competent
science subjects - 2-3 years’ experience
4. Proficient
Profession - 3-5 years’ experience
- An occupation that requires extensive education or a - Can assist novice nurses
calling that requires special knowledge, skill, and - Can readily transfer knowledge gain
preparation. from multiple previous experiences.
- A profession is generally distinguished from other 5. Expert
kinds of occupations by: - A lot of experience
- Supervisor, head nurse
a) Its requirement of prolonged,,
specialized training to acquire a body of knowledge
Scope and Standards of Nursing Practices
pertinent to the role to be performed.
- Provide a specified service according to standards of
b) An orientation of the individual toward service,
practice and to follow a code of ethics (ANA, 2015)
either to a community or to an organization
- Professional practice includes knowledge from social
c) Ongoing research
and behavioral sciences, biological and physiological
d) Acodeofethics
sciences, and nursing theories.
e) autonomy
- Nursing practice incorporates ethical and social
f) Professional organization
values, professional autonomy, and a sense of
Discipline commitment and community (ANA,2010b)
- specific to academia; branch of educ, department of
learning, or domain of knowledge.
 Theoretical Foundations
of Nursing
a) Promote health and wellness 7. Forensic nurse
b) Preventing illness 8. Nurse entrepreneur
c) Restoring health 9. Military nurse
d) Caring for dying 10. Flight nurse

Professional Responsibilities and Roles: “Theory without practice is Empty; Practice without
1. Autonomy and accountability theory is blind.”
- This is an essential element of professional nursing that
involves the initiation of independent nursing Common terminologies:
intervention without medical orders. 1. Philosophy
2. Caregiver - Belieafs and values that define a way of thinking and
- Maintain/ regain health of the patient. are generally known and understood by a group or
3. Manager discipline.
4. Advocate 2. Nursing philosophy
- You protect your patient legal rights - Declaration of a nurse’s beliefs, values and ethics
and provide assistant in certain rights regardunf their care and treatment of patients while
5. Communicator they are in nursing profession.
- Good communicator Core values:
6. Educator • Social justice
- Explain concept, procedures and facts • Safe, compassionate and ethical care
about the health to patient • Health and well-being
Nursing education: • Respect
1. Licensed practical/ vocational nursing program • Accountability
- Assistant nurses 3. Theory
2. Registered nursing programs - A belief, policy or procedure proposed or followed as
- Baccalaureate degree programs the basis of action
3. Graduate nursing programs 4. Nursing theory
- Master’s Degree Program - Body of knowledge that describes or explain and is
- Doctoral Programs (PhD) used to support nursing practice.
4. Continuing education • Explains • Describes • Predicts
- Updating skills/ experience • Prescribes
5. Concepts
Expanded Career Plans: - Building blocks of theories
1. Nurse practitioner - They are primarily the vehicles of thought that
2. Nurse anesthetist involve images
3. Nurse educator 6. Models
4. Nurse midwife - Representations of the interactions among and
5. Nurse researcher between the concepts showing patterns.
6. Nurse administrator
 Theoretical Foundations
of Nursing
7. Conceptual framework
- A group of related ideas, statements or concepts What can actually Nursing theory do for a nurse?
- Set of interrelated concepts that symbolically represents 1. Improves nursing practice
and conveys mental image of a phenomenon 2. Strengthens the nursing focus of a care
3. Provides consistency to nursing communication and
activities
4. Improves the health and quality of life for;
a) Persons
b) Families
c) Communities

Components of nursing theory:

1. Phenomenon – issues, events, previous experience
2. Concepts -
3. Definition – giving definition/explanation in concepts
4. Relational statements – cause and effect, relationships
5. Assumptions – testing
8. Process
- Series of organized steps, changes or functions intended Concepts:
to bring about the desired result. Abstract concept
The Nursing Process: - General – grand theory
• Diagnosis – what is the problem Concrete concepts
• Planning – make a plan to solve the problem - Specific – middle range theory
• Implementation – putting the plan into action
• Evaluation – did the plan work?
• Assessment – data
9. Paradigm
- To a pattern of shared understanding and assumptions Abstract concepts Concrete Concepts
about reality and the world; worldview or widely accepted
value system. Source of concepts:
- concepts • Naturalistic concept
10. Metaparadigm - Seen in nature or in nursing practice.
- The most general statement of discipline and functions as • Research-based concept
a framework in which the more restricted structures of - The result of conceptual development that is grounded
conceptual models develop. in research processes through qualitative,
- Specific concepts • Person phenomenological or grounded theory approaches
• Health - Previous topic of research
• Nursing
• Environment
 Theoretical Foundations
of Nursing
Category of nursing theory: - The term Nurse – originated from the
(Accdg. to Martha Raile Alligood 2017) Latin word “Nutire” or Nurture in English – meaning
1. Nursing philosophy it’s to suckle or to feed the baby.
- Works of Nightingale, Watson, Ray, and Benner are - Wet nurses – the women who breastfeed somebody
categorized under this group. else baby.
2. Nursing conceptual models - Man was Doctors; Women was Caregiver
- Conceptual models of Levine, Rogers, Roy, King, and Orem are - Illness – considered to be a cursed from evil spirit;
under this group. they use physical harm to take away the evil spirit.
3. Grand nursing theories
- Are works derived from nursing philosophies, conceptual Egyptians Rites
models, and other grand theories that are generally - Health and healing beliefs of ancient civilization
not as specific as middle-range theories. - Superstition and magic\injuries from wars and other
tragic event.
Historical Sketch: - Injuries from wars and other tragic events.
1. Curriculum era - Repairing and suturing wound
- Focuses on what must be studied and learned to become a - Planning to decrease public health
nurse from hospital-based diploma program into college and problems.
nursing. - They started out a calendar method and
2. Research era the writing.
- Nurses started to be introduced and integrated in the nursing
curriculum. Palestinian Time
3. Graduate education era - Under the leadership of Moses, hydrous develop mosaic
- From BSN to master Program ( nursing models and nursing code which represented the one of the first organized
theory course) method of disease control prevention.
4. Theory era - It contain public loss that did not allowed to eat a
- Contemporary phase where the emphasis is on theory-based slaughtered animals longer than 3 days.
nursing practice and theory development. - Communicable disease – they are being isolated in the
public and only when the priest considered them healed is
EVOLUTION OF NURSING the only time that they can back home.
• Shiphrah and Puah - Home visit only
- They rescue baby moses
- They hid him in order to save his life Greek (Greece)
- Ditto nagsimula ang nursing. - 15 ~ 100 BC
- Greek mythology
Ancient Civilization - God Asclepius – god of medicine; pinatayuan sya ng
- Nursing was noted to be as old as time. temple na nagsisilbing hospital.
- Started from: instinct, human nature nurturing, caring • Athena
behavior • Zeus
• Poseidon
 Theoretical Foundations
Roman Empires
of Nursing
- During the military dictatorship wherein they try to slave • Order of the Deaconesses
physicians, they ask them to cure the ill people. - Founded in Kaiserwerth, Germany.
• Doctor Galen - Kaiserwerth – founded by Pastor Theodor Fliedner
- Greek physician and his wife Friederike Munster 1836.
- Expand his knowledge about - Recognized the role of women in taking care for the
anatomy and physiology, pathology, and medical therapeutics. sick
- Discover the importance of anatomy and physiology. - Initiated the establishment of training school for
nurses.
Middles Ages
- Women used herbs; men used linta FLORENCE NIGHTINGALE
- Most of the changes of health care were based on Christian - 1820 – 1910 (from Florence)
concepts and charity. - Mother of the modern nursing
- Wife’s emperor were the nurse and noble women in society. - An English lady from a wealthy family during the
- Women who are not trained as midwife Victorian era.
- they are forbidden to witness childbirth. - Crimean war
- “Lady with the Lamp”
Renaissance period - 1845 – she want to train to be nurse
- AD 1350 ~ AD 1650 - 1851 – her parents finally permitted her to pursue
- Rebirth of the sience of medicine (European country) nursing training
- Dark ages of nursing - 1860 – started her training in Kaiserweth (3 months
- first anatomy book published – long)
• Michelangelo and Leonardo da Vinci Prior to Florence Nightingale is the Dark Age for nursing
- Draws the human body. because...
- Development of the printing press allows knowledge to be Nursing was considered as...
spread to others. - A very low job in terms of social hierarchy
• Michael Servetus - A job for the uneducated and poor
- Describes the circulatory system in the lungs. - A desperate occupation
• Roger Bacon
- Promotes chemical remedies to treat disease Florence Nightingale changed the image of Nursing...
- Average lifespan was 30-40 years. - 1860 – Nightingale laid the foundation of professional
nursing when the first school of nursing was
Sisters of Charity established.
- Established by St. Vincent de Paul in France. - St. Thomas hospital
- Congregation for radical innovation during the 17th century. - This marked the birth of modern nursing
- At first they dedicated their nursing skills to the poor in their - 1854 – She started training the nurses.
homes. - During the Crimean war, she requested
- Hey eve recruited your women for training in nursing and to help in the military hospital.
develop educational programs and cared for the abandoned
children.
 Theoretical Foundations
of Nursing
Transformation of nursing into a profession Paul Reynolds
Nightingale describe Nursing as... - 1971
• Science – nursing is a body of scientific knowledge using - Labeled this approach theory then research
empirics. Albert Einstein
• Art – nursing has its own proper of doing things and - Rationalist view very evident in his work
applying knowledge. okay - Theoretical approach – that attempts to understand
the root cause of something and construct a predictive
Nursing as an Art model that explicitly say when the event will happen again.
- It is the art of caring sick and well individual. Francis Bacon
- It refers to the dynamic skills and methods in assisting - Believed that scientific truth was discovered through
sick and well individual in their recovery. generalizing observed facts in the natural world.
Nursing as a Science - Inductive reasoning – it aims to develop a theory based
- It is the body of abstract knowledge arrived through on evidences that you got
scientific research and logical analysis.
Nursing as a Profession Empiricism
- A calling in which its members profess to have acquired - Based on the central idea that scientific
special knowledge by training or experience or both so that knowledge can be derived only from sensory experience.
they may guide, advise or save others in the special field. - Specific to general
- According to American Association, Professional Nurses
and compasses upon a passion for increasing well- being Burrhus Frederic Skinner (B.F. Skinner)
for patients, a desire to provide specialized skills and grow - Asserted that advances in the science of phycology could
as a nurse. be expected if scientist would focus on the collection of
empirical data.
Significance of Nursing Theory: - Operant conditioning – ideas that behavior determined by
• Discipline consequences.
- is refers to a branch of education, a department of - Reward and punishment.
learning, or a domain of knowledge.
• Profession Early 20th century views of science and theory
- Refers to a specialized field of practice founded on the • First half of 20th century
theoretical structure of the science or knowledge of that - Philosophers focused on the analysis of theory structure.
discipline and accompanying practice abilities. - Scientist – focused on empirical research
- We need to follow the code of ethics - Positivism – term used by Auguste Comte emerged as the
dominant view of modern science.
History and Philosophy of Science - Believed that empirical research and logical analysis
Rationalism (deductive and inductive) were two approaches that would
- Emphasizes the importance of a priori reasoning as the produce scientific knowledge. (deductive reasoning –
appropriate method of advancing knowledge. proving)
• Priori Reasoning – use deductive logic by reason from the
cause to effect or from a generalization to a particular
instance.
 Theoretical Foundations
of Nursing
Late 20th century: - The care structure considered the person is spiritual,
Michael Foucault social and health care needs.
- Epistemology (knowledge) and Psychological tormented. - The person is empowered to manage his/her health and
- He stated that empirical knowledge was arranged in well-being with dignity and self-preservation with positive
different patterns at a given time and in a given culture personal connection.
and that humans were emerging as object of study.
- His book “The Order of Things: an Archaeology of the Health
Human Sciences” - Is defined as the degree of wellness or well-being that
Harold Brown the client experiences.
- Set forth a new epistemology challenging the empiricist - Characterized as one with multiple dimension in a
view proposing that theories play a significant role in constant state of motion.
determining what the scientist observes and how it is - Not mainly focus at physical aspect but the totality as a
interpreted. person.
- Each individual has its own interpretation of a certain
issue/experience, based on their exposure education and Environment
knowledge. - Is defined as the internal and externals
surrounds that affect the client.
NURSING METAPARADIGM - How a person continuously interacts with his/her
- The board conceptual boundaries of the discipline of surroundings is a very on health and wellness.
nursing, human beings, environment and health. - Physical and Social Factors:
• Economic conditions
• Geographic location
• Culture
• Social connection
• Technology

Nursing
- The attributes, characteristics and actions of the nurse
providing care on behalf of or in conjunction with the client.
Person - Main goal: to improve patient care
- Also referred to as client or human beings - Skills: medical knowledge, technical
- The recipient of nursing care and may include: skills and nursing care.
• Patients
• Groups
• Families
• Communities
- Each person is treated and regarded as unique and
autonomous.
 Theoretical Foundations
of Nursing
Maslow’s Hierarchy of Needs
Nursing metaparadigm of Different Nurse Theorist:

Florence Nightingale - The Environmental Theory

a. Person
- A multidimensional being, that includes biological,
psychological, social and spiritual components (Selanders,
2010)
b. Health
- Viewed as the combined result of environmental,
psychological and physical factors, not just the absence of Psychological needs
disease (Parker, M. E., 2005). - Necessary for survival
c. Environment - Highest priority and must be met first - Includes:
- “What nursing has to do is to put the patient in best food, water, breathing, homeostasis, nutrition, air,
condition for nature to act upon him.” temperature regulation, shelter clothing, sleep/rest,
d. Nursing sex
- Nightingale’s writings reflect a community health model in
which all that surrounds human beings is considered in Safety
relation to their state of health. - Contributes largely to the behavior at this level.
- Includes: financial security, freedom from harm,
Orem psychological safety and physical safety.
a. Person
- Humans are defined as “men, women, and children cared Love/Belonging
for either singly or as social units.” And are the “material - A need to form or maintain social connections.
object” of nurses and others who provide direct care. - Includes: friendship, romantic attachment family,
b. Health social groups and religious groups
“Being structurally and functionally whole or sound.”
c. Environment Esteem
- The environment has physical, chemical, and biological - People need to sense that they are valued and by others.
features. It includes the family, culture, and community. And feel that they are making contribution to the world.
d. Nursing - Includes: self-esteem, personal worth, need for
- Nursing is an art through which the practitioner of appreciation, respect
nursing gives specialized assistance to persons with
disabilities which makes more than the ordinary assistance Self-actualization
necessary to meet needs for self-care. - Involves the need to fulfill your total potential and to
become the best that you can possibly be.
How to prioritize the patient and prioritize the problem:
- By using your Maslow’s Hierarchy of needs and ABC
- ABC – A-Airway, B-Breathing and C- Circulation
(gagamitin to pag parehas sila ng physiological needs at d mo
alam kung sino uunahin mo)
 Theoretical Foundations
Patricia Benner
of Nursing
• Patricia Benner was born in Hampton, Virginia and spent her • Proficient- Nurses at this level demonstrate a new ability to
childhood in California, where she received her early and see changing relevance in a situation, including recognition and
professional education. implementation of skilled responses to the situation as it evolves.
• She obtained a baccalaureate of arts degree in nursing from • Nurses are more confident with their knowledge and
Pasadena College in 1964. abilities
• In 1970 she earned a master’s degree in nursing, with major • Expert- Nurses have an intuitive grasp of the situation, and
emphasis in medical surgical nursing from University of as being able to identify the region of the problem without losing
California, San Francisco School of Nursing time considering a range of alternative diagnoses and solutions.
• Her PhD in stress, coping and health was conferred in 1982 at • Expert nurses “know the patient”
the University of California,, Berkeley, and her dissertation was • Key aspect of expert nurse
published in 1984. Benner has a rang of clinical experience, 1. Demonstrating a clinical grasp and resource based practice
including acute medical surgical, critical care and home health 2. Possessing embodied know how
care. 3. Seeing the big picture
Novice to Expert Theory 4. Seeing the unexpected
• Benner adapted Hubert Dreyfus Model of skill acquisition.
Benner applied it to her work “ From novice to Expert” Metaparadigm
Benner’s model is situational and describes five levels of skill • Nursing - Described nursing as a caring relationship, an
acquisition and development. enabling condition of connection and concern
Caring is primary because caring sets up the possibility of
giving help and receiving help.
Nursing is viewed as a caring practice whose science is guided by
the moral art and ethics of care and responsibility
• Person- The body of a person has 5 dimensions, Benner pointed
out that nurses should attend to all these dimensions of the body
and seek too understand the role of embodiment in particular
Major Concepts and Definition situation of health illness and recovery
• Novice- The person has no background experience of the • Health- is defined as what can be assessed, whereas well being
situation in which he or she is involved. Context free rules is the human experience of health or wholeness. Health is
and objectives attributes must be given to guide performance. described as not just the absence of disease and illness. A person
• Advanced Beginner- The person can demonstrate may have the disease and not experienced illness, because illness
marginally acceptable performance, having coped with is thee human experience of loss or dysfunction, whereas disease
enough real situations to note, or to have pointed out by a is what can be assessed at the physical level
mentor, the recurring meaningful components of the • Situation- Benner and Wrubel use the term situation rather
situation. Nurses functioning at this level are guided by rules than environment, because situation conveys a social environment
and are oriented by task completion. with social definition and meaningfulness. The person’s past,
• Competent- Consistency, predictability and time management present, and future, which include her or his own personal
are important in competent performance. meanings, habits, and perspectives, influence the current
• Recognize patterns • Prioritize situation.
• Devise new rules and plan • Less supervision
• High Anxiety
 Theoretical Foundations
Jean Watson
of Nursing
"We are the light in institutional darkness, and in this model we get to return to the light of our humanity." -Dr. Jean Watson
• Educated: BSN, University of Colorado, 1964, MS, University of The ten caritas processes
Colorado, 1966, PhD, University of Colorado, 1973 1. Cultivating the practice of loving- kindness and
• Distinguished Professor of Nursing and Chair in Caring Science equanimity toward self and other as foundation to caritas
at the University of Colorado Health Sciences Center. consciousness
• Fellow of the American Academy of Nursing. 2. Being Authentically Present- Enabling, sustaining, and
• Dean of Nursing at the University Health Sciences Center and honoring faith, hope, and deep belief system and the inner
President of the National League for Nursing subjective world of self/other
• Undergraduate and graduate degrees in nursing and 3. Cultivation of one’s own spiritual practices and
psychiatric-mental health nursing and PhD in educational transpersonal self, going beyond ego-self
psychology and counseling. 4. Development and sustaining a helping trust caring
• Six (6) Honorary Doctoral Degrees. relationship
• Research has been in the area of human caring and loss. 5. Being present to, and supportive of, the expression of
• In 1988, her theory was published in “nursing: human science positive and negative feelings
and human care”. 6. Creative use of self and all ways knowing as part of the
The Theory of Transpersonal Caring caring process; engage in the artistry of caritas nursing
Watson bases her theory for nursing practice on the following 10 7. Engage in genuine teaching-learning experience that
carative factors. Each has a dynamic phenomenological component attends to unity and being and subjective meaning-
that is relative to the individuals involved in the relationship as Attempting to stay within other’s frame of reference
encompassed by nursing. 8. Creating a healing environment at all levels
10 9. Administering sacred nursing acts of caring healing by
Elements of
Carative
Theory Factors tending to basic human needs
10. Opening and attending to spiritual/mysterious and
existential unknowns of life-death.
Human
Caring
Transpersonal Caring The seven assumptions
Occasion/Caring
Caring
Moment 1. Caring can be effectively demonstrated and practiced
Relationships
only interpersonally.
2. Caring consists of carative factors that result in the
satisfaction of certain human needs.
3. Effective caring promotes health and individual or family
growth.
4. Caring responses accept person not only as he or she is
now but as what he or she may become.
5. A caring environment is one that offers the development
of potential while allowing the person to choose the best
action for himself or herself at a given point in time.
6. Caring is more “healthogenic” than is curing. A science of
caring is complementary to the science of curing.
7. The practice of caring is central to nursing.
 Theoretical Foundations
of Nursing
Jean Watson
Transpersonal Caring Theory Metaparadigm • Nursing
• Person “Nursing is concerned with promoting health, preventing
Watson uses interchangeably the terms human being, person, life, illness, caring for the sick and restoring health”
personhood, and self. She views the person as “a unity of mind/ • According to Watson, the word nurse is both a
body/spirit/nature” noun and a verb. To her, nursing consists of “Knowledge,
thought, values, philosophy, commitment and action with
Watson states, “I make the point to use mind, body, soul or unity some degree of passion”
within an evolving emergent world view-connectedness of all,
sometimes referred to as Unitary Transformative Paradigm-
Holographic thinking.

• Health
She defined health as “unity and harmony within the mind, body,
and soul”; associated with the “degree of congruence between the
self as perceived and the self as experienced”

Watson’s definition of health has evolved. The positive state of

physical, mental and social well being with the inclusion of 3
elements;
1. A high level of overall physical, mental and social functioning
2. A general adaptive maintenance level of functioning
3. Absence of illness

• Environment
Watson speaks to the nurse’s role in the environment as
“attending to supportive, protective, and or corrective mental,
physical, societal, and spiritual environments”

She emphasizes the person and the environment has a connection,

nurses are part of the patient’s environment and once a nurse
enters the patient’s room an expectation is already present.
 Theoretical Foundations
of Nursing
Katie Eriksson The Act of Caring
THEORY OF CARATATIVE CARING • contains the caring elements (faith, hope, love, tending,
• Born on Nov 18, 1943 in Jakobstad, Finland playing, and learning)
• She belongs to the Finland Swedish minority in Finland, and her • Involves the categories of infinity and eternity, and invites to
native language is Swedish deep communion
• She is a 1965 graduate of the Helsinki Swedish School of • The act of caring is the art of making something very special
Nursing, and in 1067 she completed her public health nursing out of something less special
specialty education in the same institution
• After taking nursing instructor at Helsinki Swedish Medical Caritative Caring Ethics
Institute • Comprises the ethics of caring, the core of which is determined
• She currently works as a professor of health sciences at Abo by the caritas motive.
Akademi University in Vaasa • Caring ethics deals with the basic relation between the patient
• A master's degree program in health sciences, and a 4-year • It is about the approach we have toward the patient caring
postgraduate studies program leading to a doctoral degree in ethics deals with the basic relation between the patient and the
health sciences nurse the way in which the nurse meets the patient in an ethical
sense
Eriksson's Contribution to Nursing Theory: Theory Caritative • It is about the approach we have toward the patient
Caring • Caring ethics deals with the basic relation between the patient
• This model of nursing distinguishes between caring ethics, the and the nurse the way in which the nurse meets the patient in
practical relationship between the patient and the nurse, and an ethical
nursing ethics. • It is about the approach we have toward the patient
• Nursing ethics are ethical principles that guide a nurse's
decision-making abilities Dignity
• Caritative caring consists of love and charity which is also • Constitutes one of the basic concepts of
known as caritas, and respect and reverence for human • Human dignity is partly absolute dignity,
holiness and dignity Invitation
• According to the theory, suffering that occurs as a result of • Refers to the act that occurs when the caregiver welcomes the
a lack of caritative care is a violation of human dignity patient to the caring communion
Suffering
Major concepts and definition • Suffering is an ontological concept described as a human being’s
• Caritas struggle between good and evil in a state of becoming
Means love and charity. In caritas, eros and agape are united, • suffering implies in some sense
and caritas is by nature unconditional love.
Caritas, which is the fundamental motive of caring science, also
constitutes the motive for all caring.
 Theoretical Foundations
of Nursing
Suffering Related to Illness, to Care, and to Life • When the human being is entering the caring context, they
3 different forms of suffering become a patient in the original sense of the concept--a
• Suffering related to illness is experienced in connection with suffering human being
illness and treatment
• Not to be taken seriously, not to be welcome, being blamed Environment
• Being subjected to the exercise of power are various forms of • The ethos of caring science, as well as
suffering related to care consists of the idea of love and charity and respect and honor
of the holiness and dignity of the human being
The Suffering Human Being • Ethos is the sounding board of all caring, there is an "inner
• The suffering human being is the conc describe the patient ought to," a target of caring
• The patient is a suffering being who suffers and patiently • Ethos originally refers to home, or to the place where a human
endures being feels at home
• The suffering human being is a concept that uses to describe • Ethos and ethics belong together, and in the caring culture,
the patient they become one
• The patient is a suffering human being, or a human being who
suffer and patiently endures Health
• Health as soundness, freshness, and well-being.
Reconciliation • Implies being whole in body, soul, and spirit
- Refers to the drama of suffering • Health means as a pure concept wholeness and holiness
- Implies a change through which a new wholeness is formed of • Different dimensions of health as "doing", "being", and becoming
the life the human being has lost in suffering with a wholeness that is unique to human
- Reconciliation is a prerequisite of caritas
Nursing
Caring Culture Caritas constitutes the inner force that is connected with
Is the concept that Eriksson (1987) uses instead of environment. mission to care
- It characterizes the total caring reality and is based on • A caregiver beams forth what at Eriksson calls caritas, or
cultural elements such as traditions, rituals, and basic values the strength and light of beauty
• The fundamentals of natural caring are constituted by the
Metaparadigm idea of motherliness, which implies cleansing and nourishing, and
Person spontaneous and unconditional love
• She emphasizes that the human being is fundamentally a • Emphasizes that caritative caring relates to the innermost
religious being core of nursing
• The human being is fundamentally holy • She distinguishes between caring nursing from nursing care
• The human being is seen as in constant becoming; they are • she means that nursing care is based on the nursing care
constantly changing and therefore never in a state of full process
completion
• The human being is fundamentally dependent on communion;
they are dependent on another, and it is in the relationship
between a concrete other human being and abstracted other
(some form of god)
Midterms
Coverage:
Martha Rogers : Science of unitary Human Beings : Grand Theory
Dorothea Orem : Self Care Deficit : Conceptual Model
Imogene King : Goal Attainment Theory : Middle-Range Theory
Dorothy Johnson : Behavioral System Model : Conceptual Model
Sister Calista Roy : Roy Adaptation Model : Conceptual Model
Betty Neuman : Neuman Model System : Conceptual Model
Hildegard Peplau : Interpersonal Relations Theory :
lda Jean Orlando : Nursing Process Theory : Middle-Range Theory
Virginia Henderson : Need Theory : Grand Theory
Faye Abdellah : 21 Nursing Problems :
Joyce Travelbee : Human-to-Human Relationship Model : Grand Theory
Madeleine Leininger : Transcultural Nursing Theory : Middle-Range Theory
Rosemarie Rizz0 Parse : Human Becoming Theory : Grand Theory
Myra Levine : Conservation Model : Conceptual Model
Lydia Hall : Care, Core, Cure Theory : Conceptual Framework
Margaret Newman : Health as Expanding Consciousness : Grand Theory
 Coverage Midterm Exam
Roger, Orem, King, Johnson, Roy, Neuman, Peplau, Orlando, Henderson, Leininger, Parse, Abdellah, Travelbee, Hall, Levine,
Newman

Hildegard Peplau: Interpersonal Relation Theory

Phases of Interpersonal Relations: Identification, Orientation, Exploitation, Resolution
Nurse Role: Counselor, stranger, & etc.

Virginia Henderson: 14 Components of Human Needs

Ida Jean Orlando: Deliberative Nursing Process

Stages of Nursing Process: Assessment (subjective & objective), Diagnosis, Planning, Intervention, Evaluation

Martha Rogers Theory

Major Concepts: Energy field, openness, pattern, pandimensionality
Critical thinking pattern: pattern appraisal, mutual patterning, evaluation
Principle of Homeodynamics: Integrality, resonancy, helicy

Dorothea Orem Theory

Self care deficit,
Self care requisite: Universal, Developmental, & Health Deviation.
Nursing System: wholly compensatory, partly compensatory, supportive educative
Nursing agency, & etc.

Imogene King Theory: Goal Attainment

Proposition of Goal Attainment
Action, Reaction, & etc
Metaparadigm,

Lydia Hall Theory: The Core, Care, Cure (person, body, disease)

Myra Levine Theory: Conservation Model

3 major concepts & assumptions: Conservation, adaptation, wholeness
4 Conservation principles: Conservation of energy, structural integrity, personal integrity, social integrity
External environment: Perceptual, Operational, Conceptual
Internal environment: homeorrhesis, homeostasis

Betty Newman Theory: Neuman System Model

Level of prevention: primary (preventive measure ex. handwashing), secondary, tertiary
Flexible line of defense, reconstitution, line of resistance
& etc.

& Others,,, coverage CU7 - CU11. Goodluck!

 Nursing Conceptual Model
Homeodynamic principles
Martha Rogers Resonance is an arrangement for human and environment that
Science of Unitary Human Beings: Grand Theory undergo transformation; the continuous change of human being.
• Martha E. Rogers was born in 1914 in Dallas, Texas. Helicy is the nature of change is unpredictable, continuous and
• She received her nursing diploma from the Knoxville General innovative.
Hospital School of Nursing in 1936, then earned her Public Health Integrality is the energy fields of human and environment in a
Nursing degree from George Peabody College in Tennessee in 1937. continuous mutual interaction; reciprocity; have good & bad
• Her Master’s degree was from Teachers College at Columbia aftermath.
University in 1945, and her Doctorate in Nursing was earned at Nursing Metaparadigm
from Johns Hopkins University in Baltimore in 1954. Rogers died on 1. The life process of the unitary human being is one of
March 13, 1994. wholeness and continuity as well as dynamic and creative
• Rogers worked as a professor at New York University’s School of change.
Nursing. 2. Environment defines as irreducible pan dimensional energy
• She was also a Fellow for the American Academy of Nursing. field identified by pattern and manifesting characteristics
• Her publications include: Theoretical Basis of Nursing (1970), different from those of the parts
Nursing Science and Art: A Prospective (1988),Nursing: Science of 3. Health symbolize wellness and the absence of disease and
Unitary, Irreducible, Human Beings Update (1990), and Vision of major illness
Space Based Nursing (1990). 4. Nursing is both art and science and the nurse is a factor in
healing environment
Assumptions
Wholeness Implications of Rogers Theory
• Human being is considered as united whole Nursing Practice
Openness • Evaluative and diagnostic phase includes determining the
• A person and his environment are continuously exchanging patients’ and their family’s well-being status at the time.
energy with each other • Interventive how the nurse will go about implementing nursing
Unidirectionality interventions for the patient.
• The life process of human being evolves irreversibly and Education
unidirectional i.e from birth to death • That students have individual personalities and patterns to
Pattern and Organization their work.
• Pattern identifies individuals and reflects their innovative • They are all unitary human beings and should be interacted
wholeness. i.e young-adulthood-elderly; development. with differently.
Sentence and Thought • Culture, family, and experiences affect their reasons and
• Humans are the only organisms able to think, imagine, have motives to become a nurse.
language and emotions. • Beings focuses on “the integrality of person and environment,
the individual’s active participation in change, and each person’s
individual pattern.
Research
• It was found that the theory applies to any environment that
contains human beings.
• Her theory focuses nursing interventions on the patient
well-being overall and not just their disease state.
• It encourages the use of guided imagery, relaxation,
therapeutic touch, and meditation.
 Nursing Conceptual Model
Martha Rogers
Analysis of the Theory
Clarity – It is difficult-to-understand principles, lack of 4. The visible rhythmical pattern is a manifestation of peace
operational definitions, and inadequate tools for measurement (Mary) and a human environmental manifestation of anxiety
model has passed the test of time for the development of nursing in husband.
science as nursing matured as a science. 5. The unknown and preparation for loss is the focus. The
Simplicity - when the model is examined in total perspective, some pattern appraisal is ongoing.
still classify it as complex. With its continued use in practice, 6. Harmony is noted in her relationship with her husband and
research, and education, nurses will come to appreciate the family and with her sense of how she has progressed through
model’s elegant simplicity. this disease process.
Generality - Rogers’ conceptual model is abstract and therefore
generalizable and powerful. It is broad in scope, providing a Terminologies:
framework for the development of nursing knowledge through the Hospice care - focuses on the the care, comfort, and
generation of grand and middle-range theories. quality of life of a person with a serious illness who is
Importance - Rogers’ science has the fundamental intent of approaching the end of life.
understanding human evolution and its potential for human
betterment. The science “coordinates a universe of open systems
to identify the focus of a new paradigm and initiate nursing’s
identity as a science”.

Application to Nursing
Mary is a 53-year-old woman who is in end stage leukemia. She
has had two failed bone marrow transplants and three rounds of
chemotherapy. She is moving into hospice home care, and the
family and Mary become your client. Mary is the mother of four
children: 25, 23, 20, and 17. One child lives at home. Pattern
appraisal includes: Mary—frail, quiet, almost translucent in
appearance, resting comfortably in hospital bed in living room,
nasal O2 in place Tom—husband, quiet, pacing Home—clean,
orderly, many personal articles, large window facing north and
looking into the yard. Noise level low. Dog sleeping on floor.

Analysis
1. End of life is a process of merging of the past, present, and
future.
2. Nursing care for Mary offers the opportunity to incorporate a
variety of patterning.
3. As Mary nears and prepares for the end of her life, many
patterning concerns must be addressed for peaceful closure to
her life and the change to another energy form.
 Nursing Conceptual Model
Dorothea Orem • The theory of dependent-care, which explains how family
Self Care Deficit: Nursing Conceptual Model members and/or friends provide dependent-care for a
• Dorothea E. Orem (1914-2007), one of the prime US theorists person who is socially dependent.
born in Baltimore, Maryland. • The theory of self-care deficit, which describes and
• Obtain her basic diploma in nursing at School of Nursing explains why people can be helped through nursing.
Washington, BSN (1939) and MSN in 1945 from Catholic • The theory of nursing systems, which describes and
University of America, and Doctorate degrees (honorary explains relationships that must be brought about and
Doctorates awarded from different Universities). maintained for nursing to be produced.
• She began her nursing career at Providence Hospital School of
Nursing in Washington, DC, where she received a diploma of Theory of Self Care
nursing in the early 1930s. “Self –care comprises the practice of activities that maturing
• She published her theory in 1959 for the first time and revised and mature persons initiate and perform, within time frames,
in 1971, 1983, 1987, and 2001. Her contributions enabled her to on their own behalf in the interest of maintaining life,
achieve Excellency from prominent societies like Sigma Theta Tau healthful functioning, continuing personal development and
International Society, the National League for Nursing, and the well-being through meeting known requisites for functional
American Academy of Nursing. and developmental regulations.
The Theory of Self-Care has three components: universal
Orem Philosophy self-care needs, developmental self-care needs and health
“Nursing is the ability to care for another human being, most deviation.
importantly when they are unable to care for themselves. The 3 Components of Self Care
ultimate goal is achieving an optimal level of health and wellness • Universal Self Care Needs: Air, food, water, elimination/
for our patients”. Orem (1971) excretion, activity & rest, solitude /social interaction,
functioning/well being, normalcy.
Concepts of Orem’s Model • Developmental Self Care Requisites: more specific to the
1. The Self-Care Deficit Theory developed as a result of working process of growth and development and are influenced by
toward her goal of improving the quality of nursing in general what is happening during the life cycle, It can be positive or
hospitals in her state. negative.
2. The model interrelates concepts in such a way as to create a • Health Deviation Self Care Requisites: When a condition
different way of looking at a particular phenomenon. permanently or temporarily alters structural, physiological or
3. The theory is relatively simple, but generalizable to apply to a psychological function.
wide variety of patients. Self Care
4. It can be used by nurses to guide and improve practice, but 1. Self Care Agent provides the foundation for understanding
it must be consistent with other validated theories, laws and the action requirements and action limitations of persons who
principles. may benefit from nursing.
2. Theory of dependent care “explains how the self-care
Concepts and Definition system is modified when it is directed toward a person who is
The self-care deficit nursing theory is a general theory socially dependent and needs assistance in meeting his or her
composed of the following four related theories self-care requisites”
3. Therapeutic self-care demand is the totality of self-care
• The theory of self-care, which describes why and how people actions to be performed for some duration in order to meet
care for themselves self-care requisites by using valid methods and related sets of
operations and actions.
 Nursing Conceptual Model
Examples of self-care requisites are:
Dorothea Orem Wound care
Basic Conditioning Factors Activities of Daily Living
The basic conditioning factors affects the value of the Bowel program
therapeutic use of therapeutic self care demands: Glucose monitoring
• Age
• Gender Theory of Nursing Systems
• Developmental state: psycho social, cognitive, psycho sexual 1. Wholly compensatory support - patient is unable to complete
• Health state; disability due to health condition any self-care independently; nursing compensates for patient’s
• Pattern of living: extended family, nuclear family inability to perform self-care.
• Healthcare system: home care, hospital, LTCU 2. Partial compensatory support - patient is able to perform self-
• Socio cultural orientation – about education care tasks with partial or no assistance from nursing.
• External environmental factors: living in rural area, items used 3. Supportive/educative compensatory - patient able to perform
for ADL tasks independently. Nursing provides ongoing education and
support.
Theory of Dependent Care
Dependent care refers to the care that is provided to a person Four major Concepts of Orem
who, because of age or related factors, is unable to perform the Health is a state characterized by soundness or wholeness of
self-care needed to maintain life, healthful functioning, developed human structures and of bodily and mental
continuing personal development, and well-being. functioning.
Dependent-Care Demand: Summation of care measures at a People is viewed biologically, symbolically and socially but still as a
specific point in time or over a duration of time for meeting the whole person. This person is considered to be able to provide
dependent’s therapeutic self-care demand when his or her self- self-care.
care agency is not adequate or operational. Nursing is how a healthcare professional develops a plan of care
Self-Care Agency: The self-care agency is a complex acquired to meet the patient’s self-care needs.
ability of mature and maturing persons to know and meet their Environment is the physical, chemical, biologic and social factors
continuing requirements for deliberate, purposive action to that make up who a person is.
regulate their own human functioning and development.
Dependent-Care Agency: Refers to the acquired ability of a Significance of the Theory
person to know and meet the therapeutic self-care demand of Nursing Practice
the dependent person and/or regulate the development and has achieved a significant level of acceptance by the international
exercise of the dependent’s self-care agency. nursing community, as evidenced by the magnitude of published
material and presentations at the International Orem Society World
Theory of Self-Care Deficit Congresses.
1. A self-care deficit occurs when an individual cannot carry Education
out self-care requisites. The SCDNT was introduced as the basic structure for nursing
2. Orem identifies method of helping: management in German hospital DRG (diagnosis-related group)
Acting for and doing for others implementation. The movement toward SCDNT-based nursing
Guiding and directing management.
Providing Physical and Psychological support The influence of Orem’s SCDNT has continued at the
Environment of promoting personal development international level through the translation of Nursing Concepts of
Teaching Practice into several languages.
 Nursing Conceptual Model
Dorothea Orem
Research
using the SCDNT or components, Biggs (2008) found more His family is worried whether he would be able to regain control
than 800 references. Berbiglia identified selected practice of his life or not. They are also worried whether they would be
settings and SCDNT conceptual foci from a review of more able to provide him the care he needs when he is discharged from
than 3 decades of use of the SCDNT in practice and research hospital.
and publicized selected international SCDNT practice models
for the twenty-first century Apply the case utilizing
1. Universal Self care requisite
Analysis of the Theory 2. Health deviant self care
Clarity - Orem defined the term and elaborated the 3. Development of self care requisite
substantive structure of the concept in a way that is unique
while also congruent with other interpretations. Terminologies:
Simplicity - Orem’s theory is expressed in a limited number of Psychosocial - an individual's mental health and social well-
terms. These terms are defined and used consistently in the being.
expression of the theory. Orem’s general theory, the SCDNT, Cognitive development - refers to how a person perceives,
comprises the following four constituent theories: self-care, thinks, and gains understanding of his or her world through the
dependent-care, self-care deficit, and nursing systems. interaction of genetic and learned factors.
Generality - As a general theory, it serves nurses engaged in Extended family - a family that extends beyond the nuclear
nursing practice, in development and validation of nursing family, including grandparents, aunts, uncles, and other
knowledge, and in teaching and learning nursing. relatives, who all live nearby or in one household.
Accessibility - As a general theory, the SCDNT provides a Nuclear family - refers to the core members of a family,
descriptive explanation of why persons require nursing and usually parents and children.
what processes are needed for the production of required Activities of Daily Living (ADLs) - Activities of daily living are
nursing care. activities related to personal care. They include bathing or
The SCDNT differentiates the focus of nursing from other showering, dressing, getting in and out of bed or a chair,
disciplines. Although other disciplines find the theory of self- walking, using the toilet, and eating.
care helpful and contribute to its development, the theory of
nursing systems provides a unique focus for nursing.

Application to Nursing
Mr. Shoaib is a 62 years old male patient admitted to a medical
ward. He has right ischemic Cerebro Vascular Accident (CVA)
and a resultant left sided body paralysis. He has no sensations
or movement in the left side of the body. He has lost his gag
reflux and is unable to swallow food. A nasogastric (N/G) tube
is placed for providing him nutrition. Mr. Shoaib is not able to
change his position and is dependent on care givers for
changing his position. He is also not able to carry out his
routine daily life activities.
 Nursing Conceptual Model
Imogene King Assumptions
GOAL ATTAINMENT THEORY: Middle-Range Theory 1. Basic Assumptions of goal attainment theory is that the
• Theorist : Imogene King - born in 1923. nurse and patient communicate information, set mutual goal
• Bachelor in science of nursing from St. Louis University in 1948. act to achieve these goals it is the basic assumption of
• Master of science in nursing from St. Louis University in 1957. Nursing Process.
• Doctorate from Teacher’s college, Columbia University. 2. Each human being perceives the world as a total person in
• Theory describes a dynamic, interpersonal relationship in which making transaction with individual and things in the
a person grows and develops to attain certain life goals. environment.
• Factors which affects the attainment of goal are: roles, stress,
space & time. Nurse Patient Transaction Model
1. Action is a means of behavior or activities that are towards
Kings Open System Framework the accomplishments of certain act. It is both physical and
1. Nursing Focus is the care of human being. mental.
2. Nursing Goal is the health of the individual and health care for 2. Reaction is a form of reacting or a response to a certain
the group. stimuli.
3. Human Beings are open system in constant interaction with the 3. Interaction is any situation wherein the nurse relates and
environment. deals with a clientele or patient.
4. Transaction is a unique observable in which human being
Interacting systems in the Theory of Goal Attainment communicate with the environment.
Personal System
1. Perception Metaparadigm
2. Self 1. Person existing in an open system who makes choices and
3. Growth and Development select alternative action.
4. Body Image 2. Health as continuous adjustment to stress in the internal
5. Time and external environment.
6. Space 3. Environment as the process of balance involving internal
Interpersonal system and external interactions inside the social system.
• How the nurse interrelates with a co-worker or patient, 4. Nursing is an observable behavior found in the health care
particularly in a nurse-patient relationship systems in society”. The goal of nursing “is to help individuals
• Interaction - a form of communication maintain their health so they can function in their roles”.
• Communication - i.e having a conversation
• Transaction - action & reaction, process of interaction Significance
• Role - set of behavior that is determined by gender or etc. Nursing Practice
• Stress - dynamic state, human interacting with environment. • Individualized the plans of care while encouraging active
Social system participation from clients.
• An organized system of social role, behavior and practices • The profession of nursing function through individuals and
• Organization groups within the environment.
• Authority Education
• Power; i.e power to educate • It is used in curriculum design in nursing programs
• Status
• Decision Making
 Nursing Conceptual Model
Imogene King
• It provides a systematic means of viewing nursing as This example shows that nurses and physicians need to give
profession, an organize body of knowledge and clarifying high priority to the establishment of effective communication
nursing as discipline. with patients to help them make wiser decisions to retain
Research their own health as their main goal. Moreover, they need to
It is design and conducted to implement this system in allow patients articulate their perceptions of their illnesses,
hospital, ambulatory, community and home care nursing. personal illness-related experiences, and the level of their
stress. It is only in this way that nurse and patient can help
Analysis of the theory each other and create a favorable environment for decision-
1. Clarity - Theory of Goal Attainment is the ease with which it making.. Consequently, the goal of health is attained when
can be understood by nurses. Concepts are concretely defined both sides of relationship properly interact with each other
and illustrated. and collaboratively work together to attain their goals.
2. Simplicity - King’s definitions are clear and are conceptually
derived from research literature.
3. Generality - It has been criticized for having limited
application in areas of nursing in which patients are unable to
interact competently with the nurse.
4. Accessibility - A descriptive study was conducted to identify
the characteristics of transaction and whether nurses made
transactions with patients
5. Importance - middle-range Theory of Goal Attainment
focused on all aspects of the nursing process: assessment,
planning, implementation, and evaluation. The body of literature
clearly establishes King’s work as important for knowledge
building in the discipline of nursing.

Application to Nursing
1. Communication between nurse and patient is the cornerstone
of the interpersonal system and the most important prerequisite
for transaction to occur. It can be established both verbally and
nonverbally.
2. A middle-aged female patient referred to the emergency room
with weakness and feebleness. The attending physician gave the
diagnosis of acute pulmonary edema. Emergency staffs needed to
start invasive interventions to manage her acute condition.
However, they failed to understand her conditions and did not
provide her with adequate treatment-related information. She
did not give consent for treatments and treatments were not
administered.
 Nursing Conceptual Model
Dorothy Johnson Behavioral System Model
Concepts and Definition
Behavior as expressed by the behavioral and biological
• Dorothy Johnson was born on August 21, 1919, in Savannah, scientists; that is, the output of intra organismic structures
Georgia. and processes as they are coordinated and articulated by
• She was the youngest of seven children. Her father was the and responsive to changes in sensory stimulation.
superintendent of a shrimp and oyster factory, and her mother
was very involved and enjoyed reading. A system is a whole that functions as a whole by virtue of
• In 1938, she finished her associate’s degree at Armstrong the interdependence of its parts, that there is
Junior College in Savannah, Georgia. Due to the Great “organization, interaction, interdependency, and integration
Depression, she took a year off from school to be a governess, of the parts and elements.
or teacher, for two children in Miami, Florida.
• This was when she began to realize her love for children, A behavioral system is a patterned, repetitive, and
nursing, and education. purposeful ways of behaving. These ways of behaving form
• Dorothy Johnson’s professional nursing career began in 1942 an organized and integrated functional unit that determines
when she graduated from Vanderbilt University School of and limits the interaction between the person and his or her
Nursing in Nashville, Tennessee. environment and establishes the relationship of the person to
• She was the top student in her class and received the the objects, events, and situations within his or her
prestigious Vanderbilt Founder’s Medal. environment.
• In 1948, she received her master’s in public health from
Harvard University in Boston, Massachusetts. A subsystem is “a mini system with its own particular goal
and function that can be maintained as long as its
Introduction relationship to the other subsystems or the environment is
• Johnson’s theory and her related writings reflect her not disturbed”
knowledge about both development and general systems theories.
• The combination of nursing, development, and general systems Stressor
introduces some of the specifics into the rhetoric about nursing Internal or external stimuli that produce tension and result
theory development that make it possible to test hypotheses and in a degree of instability
conduct critical experiments
Subsystem of Behaviors
4 Goals of Nursing • Subsystem are parts of the behavioral system.
• To assist the patient whose behavior is proportional to social • It carry out specialized task/function needed to maintain
demands. the integrity of the whole system
• To assist the patient who is able to modify his behavior in ways • It has a set of behavioral responses that re developed
that it supports biological imperatives. through motivation, experience and learning
• To assist the patient who is able to benefit to the fullest extent
during illness from the physician’s knowledge and skill.
• To assist the patient whose behavior does not give evidence of
unnecessary trauma as a consequence of illness.
 Nursing Conceptual Model
Dorothy Johnson Application to Nursing
By elderly people, those from the age of 65 and above, most of
which have retired. These people are normally seen as a bother
to their loved ones as their needs increase from the normal.
They thus need more care which cannot be provided at home so
they are often taken to nursing homes where they can get the
proper care. Because of old age and stress from retirement.
These people have difficulty coping with the changes around
them and their behavior changes. Some become aggressive while
Subsystem 4 structural components others develop mental problems making long-term nursing homes
• The goal of a subsystem is defined as the desired result or the best to take proper care of these individuals.
consequence of the behavior
• The behavioral set is a predisposition to act in a certain way • Nurses have to pay keen attention to such aggressive behavior
in a given situation and identify which of the seven subsystems is not functioning
• Choice refers to the individual’s repertoire of alternative properly thus help these patients restore balance in their
behaviors in a situation that will best meet the goal and attain systems.
the desired outcome • It could be dependence, the attachment, or the aggressive
• The concern is with the efficiency and effectiveness of the causing a change in behavior. The dependence in the sense that
behavior in goal attainment. Actions are any observable the patient who was used to taking care of himself now finds it
responses to stimuli. frustrating when he has to rely on others for all his needs.
• The attachment comes in when the patient struggles to form
Functional Subsystem new relationships at the care facilities and being kept away
• Protection from noxious stimuli influences with which the from the existing relationships.
system cannot cope • Normally the patient plays a role in the behavioral system
• Nurturance through the input of appropriate supplies form model of treatment but in dealing with mental complications,
environment especially the ones accompanied by aggressive behavior. Most of
• Stimulation to enhance growth and prevent stagnat the effort is required from the part of the nurse who has to be
patient with the patient.
Metaparadigm Concepts
Human being as having two major systems, the biological system
and the behavioral system. It is role of the medicine to focus on
biological system where as Nursing's focus is the behavioral
system.
Environment is any factor influencing the behavioral subsystem
manipulated by the nurse to achieve health.
Health is the lack of balance in the structural or functional
requirements of the subsystems leads to poor health.
Nursing is an external regulatory force which acts to preserve the
organization and integration of the patient’s behaviors at an
optimum level under those conditions in which the behaviors
constitutes a threat to the physical or social health, or in which
illness is found.
 Nursing Conceptual Model
Sister Caista Roy Roy Adaptation Model
• Contextual Stimuli are present to contribute to the behavior
• Sister Callista L. Roy (born October 14, 1939) is a nursing caused or precipitated by the focal stimuli
theorist, professor, and author. • Residual Stimuli are factors that may be affecting behavior but
• She is known for her groundbreaking work in creating the whose efforts are not validated
Adaptation Model of Nursing.
• She received her Bachelor of Arts Major in Nursing from Coping Processes “are innate or acquired ways of interacting
Mount Saint Mary’s College in Los Angeles in 1963 and her with the changing environment”
master’s degree in nursing from the University of California in
1966. Innate Coping Mechanisms “are genetically determined or
• After earning her nursing degrees, she began her sociology common to the species and are generally viewed as
education, receiving both a master’s degree in sociology in 1973 automatic processes; humans do not have to think about
and a doctorate in sociology in 1977 from California. them”
• She developed the model’s basic concepts while she was a
graduate student at the University of California from 1964 to Acquired coping mechanisms “are developed through
1966. strategies such as learning. The experiences encountered
• She was an associate professor and chairperson of the throughout life contribute to customary responses to
Department of Nursing at Mount Saint Mary’s College until particular stimuli”
1982 and was promoted to the professor’s rank in 1983 at both
Mount Saint Mary’s College and the University of Four Adaptation Modes
Portland.
• The RAM focuses on the inter relatedness of four adaptive
systems
• It focuses on persons coping(adaptative)abilities in response to
constantly to changing environment ( Lopes, Pagliuca,
Araujo,2006)
• Nursing can promote effective coping by asking “How can I Subsystem
modify this patient’s environment to facilitate his adaptation?” Regulator subsystem is a major coping mechanism which
(Chitty & Black, 2011) responds automatically through physiological adaptive
mode, responds automatically through neural,
Major Concepts and Definition chemical, and endocrine coping processes
A system is “a set of parts connected to function as a whole for The cognator is a major coping subsystem responds to
some purpose and that does so by virtue of the interdependence complex processes of perception and information
of its part processing, judgement and emotions
“Adaptation level represents the condition of the life processes
described on three levels as integrated, compensatory, and Implication to Nursing Practice, Education and Research
compromised” Nursing Practice
• Features of the discipline provides direction for practice
Types of Stimuli • It considers goals, values, the client and practitioner
• Focal Stimulus is the degree of change or stimulus more intervention
immediately confronting the person and the one to which the • Uses the steps in Nursing Process of used: Assessment,
person must make adaptive response Nursing Diagnosis, The goal is set, Intervention and
Evaluation
 Nursing Conceptual Model
Sister Caista Roy
Education
• The model is a valuable to analyze distinctions between
nursing and medicine
• The model has been implemented as basis of curriculum
development in Associate degree program, baccalaureate and
higher degree program
Research
The model generates many testable hypothesis tested to
practice and theory

Metaparadigm
People, both individually and in groups, as holistic adaptive
systems, complete with coping processes acting to maintain
adaptation and to promote person and environment
transformations.
Health is the reflection of personal and environmental
interactions that are adaptive.
Environment are conditions, circumstances, and influences
surrounding and affecting the development and behavior of
individuals and groups
The goal of nursing was the first major concept of her
nursing model to be described. She identifies the unique
function of nursing in promoting health

Application to Nursing
A 23-year-old male patient is admitted with a fracture of C6
and C7 that has resulted in quadriplegia. He was injured during
a football game at the university where he is currently a
senior. His career as a quarterback had been very promising. At
the time of the injury, contract negotiations were in progress
with a leading professional football team.
1. Use Roy’s criteria to identify focal and contextual stimuli for
each of the four adaptive modes.
2. Consider what adaptations would be necessary in each of the
following four adaptive modes: (1) physiological, (2) self-
concept, (3) interdependence, and (4) role function.
 Nursing Conceptual Model
Bey Neuman Model System
Wholistic Approach
Concepts and Definition

• Betty Neuman was born in 1924 near Lowell, Ohio. • Clients are viewed as wholes whose parts are in dynamic
• She grew up on a farm which later encouraged her to interaction.
help people who are in need. • The model considers all variables simultaneously affecting the
• Her father was a farmer who became sick and died at the client system: physiological, psychological, sociocultural,
age of 36. developmental, and spiritual.
• Her mother was a self-educated midwife that led the Open System
young Neuman to be always influenced by the commitment that A system is open when there is a continuous flow of input and
took her away from home from time to time. processes, output, and feedback. Stress and reaction to stress
• In 1957, she received a baccalaureate degree in public health are basic components of an open system.
and psychology with honors. Function or Process
• She also earned a master’s degree in mental health, public The client as a system exchanges energy, information, and
health consultation in 1966 from the University of California, matter with the environment as well as other parts and
Los Angeles (UCLA). subparts of the system as it uses available energy resources to
• After her graduation, she was hired as a department chair in move toward stability and wholeness.
the UCLA School of Nursing graduate program Input and Output
• In 1985, Betty Neuman concluded a doctoral degree in clinical For the client as a system, input and output are the matter,
psychology at Pacific Western University. She was a pioneer of energy, and information that are exchanged between the client
nursing involvement in mental health. and the environment.
Feedback
Neuman Systems Model as “a unique, open-system-based System output in the form of matter, energy, and information
perspective that provides a unifying focus for approaching a serves as feedback for future input for corrective action to
wide range of concerns.” change, enhance, or stabilize the system.
• A system acts as a boundary for a single client, a group, or Client System
even several groups; The client system is a composite of five variables (physiological,
• it can also be defined as a social issue. psychological, sociocultural, developmental, and spiritual) in
• A client system in interaction with the environment interaction with the environment.
delineates the domain of nursing concerns.”
5 types of stressor
Betty Neuman’s Systems Model • Physiological stressors
• Neuman System Model focuses on the different stressors • Psychological stressors
patients have and ways to relieve the stress from the different • Socio-cultural stressors
stressors. • Developmental stressors
• The model also focus on how the patient may react to the • Spiritual stressors
stress.
• Internal and external affects the patient are stressors 1 • Asses the stressor and patients response to the stressor
• The role of the nurse is the to keep the system stable 2 • Identify nursing diagnosis
through out the three level of prevention; primary, secondary, 3 • Plan patient centered care
and tertiary. 4• Implement interventions
5 • Evaluate the patients response
6 • Determine if the stressor is resolved
 Nursing Conceptual Model
Bey Neuman There was no history of orthopnea or paroxysmal nocturnal
dyspnea [PND] or cough or hemoptysis, but complained of some
epigastric discomfort. He also complained of loss of appetite and
wheezing. However there was documented weight loss
Comprehensive nursing care was provided by a team of nursing
personnel posted in COVID unit. Nursing care was given to the
patient as per the identified stressors and his reaction to the
stressors.
Identify the stressors and reactions of Mr. ABC to COVID-19. as
to physiological, psychological, developmental,socio- cultural and
Level of Prevention spiritual
BASIC ASSUMPTIONS
> Primary Prevention
> Secondary Prevention
> Tertiary Prevention

Major Assumptions
Nursing is concerned with the whole person. She views nursing
as a “unique profession in that it is concerned with all of the
variables affecting an individual’s response to stress

Health as a continuum of wellness to illness that is dynamic in

nature and is constantly changing.

The client system is a dynamic composite of interrelationships

among physiological, psychological, sociocultural, developmental,
and spiritual factors

Environment as all the internal and external factors that

surround and influence the client system. Stressors
(intrapersonal, interpersonal, and extrapersonal)

Application to Nursing
Mr ABC, a 47 year old male was admitted in COIVD -19 ward,
was admitted though emergency department after being
referred from a private hospital. The presenting chief
complaints of the patient were fever for 9 days associated
with chills and rigors and shortness of breath for 6 days.
 Nursing Theorists
Phases of Nurse-Patient Relationship
Hildegard Peplau A. Orientation Phase
• Pennsylvania - flu * Get acquainted phase of the nurse-patient relationship.
• 1931- Pennsylvania School of Nursing * Preconceptions are worked through
• 1943- Bachelors in Interpersonal Psychology * Parameters are established and met early levels of trust are
• 1947- M.A. Psychiatric Nursing developed
• 1953- Ed.D in Curriculum development * Roles begin to be understood
• 1950-70's- Clinical Specialist in Psychiatric Nursing B. Identification Phase
• Career * The client begins to identify problems to be worked on within
- Army Cops Nurse, Professor, Advisor to WHO, USSG, US Air relationship
Force, NIMH, and US policy. * The goal of the nurse: help the patient to recognize his/her
- Nursing Profession own interdependent/participation role and promote
(Petiprin, 2016: Sitzman & Eicchelberger, 2017) responsibility for self
C. Exploitation Phase
Interpersonal Relations Theory *Client's trust of nurse reached full potential
- Emphasized the nurse-client relationship as the foundation of *Client making full use of nursing services
nursing practice * Solving immediate problems
- The interpersonal model emphasizes the need for a partnership *Identifying and orienting self to [discharge] goals
between nurse and client as opposed to the client passively D. Resolution Phase
receiving treatment (and the nurse passively acting out * Client met needs
doctor's orders). * Mutual termination of relationship
- shared experience - Nurses could facilitate this through * Sense of security is formed
observation, description, formulation, interpretation, validation, * Patient is less reliant on nurse
and intervention * Increased self-reliance to deal with own problems

Metaparadigm Interpersonal Therapeutic Process

Person This type of process is based on the theory proposed by Peplau
A man who is an organism that lives in an unstable balance of and particularly useful in helping psychiatric patients become
a given system. receptive for therapy. Often referred as "Psychological
Health Mothering," it includes the following steps:
Symbolizes movement of the personality and other ongoing • The patient is accepted unconditionally as a participant in a
human processes that directs the person towards creative, relationship that satisfies his needs;
constructive, productive and community living. • There is recognition of and response to the patient's
Environment readiness for growth, as his initiative; and
Forces outside the organism and in the context of the socially- • Power in the relationships shifts to the patient, as the
approved way of living, from which vital human social patient is able to delay gratification and to invest in goal
processes are derived such as norms, customs and beliefs. achievement.
Nursing
Significant, therapeutic interpersonal process. It functions
cooperatively with human processes that present health as a
possible goal for individuals.
 Nursing Theorists
NURSING ROLES Assessment:
• Stranger role •Data collection and analysis [continuous].
> Receives the client the same way one meets a stranger in •May not be a felt need.
other life situations; Provides an accepting climate that builds Nursing diagnosis Planning:
trust. •Mutually set goals.
• Resource role Implementation:
> Answers questions, interprets clinical treatment data, gives •Plans initiated towards achievement of mutually set goals.
information. •May be accomplished by patient, nurse or family.
• Teaching role Evaluation:
> Gives instructions and provides training; involves analysis •Based on mutually expected behaviors
and synthesis of the learner's experience. •May led to termination and initiation of new plans
• Counseling role Orientation:
> Helps client understand and integrate the meaning of current X Non continuous data collection
life circumstances: provides guidance and encouragement to X Felt need
make changes. X Define needs
• Surrogate role Identification:
> Helps client clarify domains of dependence, interdependence, Interdependent goal setting
and independence and acts on clients behalf as advocate. Exploitation:
• Active leadership role •Patient actively seeking and drawing help
> Helps client assume maximum responsibility for meeting •Patient initiated
treatment goals in a mutually satisfying way. Resolution:
• Technical expert role •Occurs after other phases are completed successfully.
> Provides physical care by displaying clinical skills; Operates •Leads to termination.
equipment

Assumptions:
> Nurse and patient can interact.
> Both the patient and nurse mature as the result of the
therapeutic interaction.
> Communication and interviewing skills remain fundamental
nursing tools.
> Nurses must clearly understand themselves to promote their
client's growth and to avoid limiting client's choices to those
that nurses value.

Interpersonal Theory and Nursing Process

*Both are sequential and focus on therapeutic relationship.
*Both use problem solving techniques for the nurse and patient
to collaborate on, with the end purpose of meeting the patients
needs.
*Both use observation communication and recording as basic
tools utilized by nursing.
 Nursing Theorists
Ida Jean Orlando - The patient cannot state the nature and meaning of his
> Ida Jean Orlando (1926-2007) distress for his need without the nurses help or without her
> 1947- Diploma in nursing from New York Medical College, first having established a helpful relationship with him.
Flower Fifth Avenue Hospital School of Nursing - Any observation shared and observed with the patient is
› 1951- Bachelor of Science in Public Health from St. Johns immediately useful in ascertaining, and meeting his need or
University, Brooklyn. finding out that he is not in need at that time.
> 1954- Master of Arts in Mental Health consultation in - Nurses are concerned with needs that patients cannot meet
Columbia University Teachers College. on their own.

Nursing Process Theory

> Nursing Process discipline is rooted in the interaction between
a nurse and a patient at a specific time and place
> The nurse then decides on an appropriate action to resolve
the need in cooperation with the patient.
> This action is evaluated after it is carried out.
> If the patient behavior improves, the action was successful
and the process is completed.
> If there is no change or the behavior gets worse, the process
recycles with new efforts. Major Dimensions of Orlando's theory
Function of Professional Nursing Organizing Principle
Assumptions > Finding out and meeting the patients immediate needs for
- When patients cannot cope with their needs without help, help
they become distressed with feelings of helplessness. > "Nursing is responsive to individuals who suffer or
- Nursing, in its professional character, does add to the anticipate a sense of helplessness, it is focused on the
distress of the patient. process of care in an immediate experience, it is concerned
- Patients are unique and individual in their responses. with providing direct assistance to individuals in whatever
- Nursing offers mothering and nursing analogous to an adult setting they are found for the purpose of avoiding, relieving,
mothering and nurturing of a child. diminishing or curing the individuals sense of helplessness.”
- Nursing deals with people, environment and health. - Orlando
- Patient need help in communicating needs, they are
uncomfortable and ambivalent about dependency needs. Presenting Behavior - Problematic Situation
- Human beings are able to be secretive or explicit about their > To find out the immediate need for help the nurse must
needs, perceptions, thoughts and feelings. first recognize the situation as problematic.
- The nurse - patient situation is dynamic, actions and > The presenting behavior of the patient, regardless of the
reactions are influenced by both nurse and patient. form in which it appears, may represent a plea for help.
- Human beings attach meanings to situations and actions that > The presenting behavior of the patient, the stimulus,
are not apparent to others. causes an automatic internal response in the nurse, and the
- Patient's entry into nursing care is through medicine. nurses behavior causes a response in the patient.
 Nursing Theorists
Presenting Behavior - Problematic Situation "The nurse initiates a process of exploration to ascertain
Patient Behavior how the patient is affected by what she says or does.
This sets the nursing process discipline in motion. The nurse can act in two ways: automatic or deliberative.
All patient behavior, no matter how insignificant, must be Only the second manner fulfills her professional function.
considered an expression of need for help until its > Automatic actions are "those decided upon for reasons other
meaning to a particular patient in the immediate situation is than the patient's immediate need,” whereas
understood. > Deliberative actions ascertain and meet this need.
Distress
The patient's behavior reflects distress, when the patient Criteria for Deliberative Actions:
experiences a need that he cannot resolve, a sense of > Deliberative actions result from the correct identification of
helplessness occurs. patient needs by validation of the nurse's reaction to patient
Some categories of patient distress are: "physical behavior.
limitations, ... adverse reactions to the setting and > The nurse explores the meaning of the action with the patient and
experiences which prevent the patient from communicating its relevance to meeting his need.
his needs" > The nurse validates the action's effectiveness immediately after
completing it.
Nurse Reaction > The nurse is free of stimuli unrelated to the patient's need when
The patient behavior stimulated a nurse reaction, which she acts.
marks the beginning of the nursing process discipline.
This reaction is comprised of three sequential parts Major Dimensions of Orlando's theory
(Orlando, 1972). Immediate reaction - internal response
> First, the nurse perceives the behavior through any • Person perceives with any one of his five sense organs an object
of her senses. or objects
> Second, the perception leads to automatic thought. • The perceptions stimulate automatic thought
> Finally, the thought produces an automatic feeling. • Each thought stimulates an automatic feeling
• Then the person acts
Three criteria to ensure that the nurse's exploration of • The first three items taken together are defined as the person's
her reaction with the patient is unsuccessful: immediate reaction
1. What the nurse says to the individual in the contact
must match any or all of the items contained in the Nursing process discipline - investigation
immediate reaction, and what the nurse does nonverbally • Any observation shared and explored with the patient is
must be verbally expressed and the expression must match immediately useful in ascertaining and meeting his need or finding
one or all of the items contained in the immediate out that he is not in need at that time
reaction. • The nurse does not assume that any aspect of her reaction to
2. The nurse must clearly communicate to the individual the patient is correct, helpful or appropriate until she checks the
that the item being expressed belongs to herself. validity of it in exploration with the patient
3. The nurse must ask the individual about the item • The nurse initiates a process of exploration to ascertain how the
expressed in order to obtain correction or verification patient is affected by what she says or does.
from that same individual. • When the nurse does not explore with the patient her reaction it
Nurse's Action seems reasonably certain that clear communication between them
Orlando (1990) includes "only what she [the nurse] says or stops
does with or for the benefit of the patient" as professional
nursing action.
 Nursing Theorists
Improvement - resolution Implementation
> It is not the nurses activity that is evaluated but rather > the nurse begins using the nursing care plan {Independent,
its result : whether the activity serves to help the patient Dependent, Collaborative}
communicate her or his need for help and how it is met. Evaluation
> each contact the nurse repeats a process of learning how > the nurse looks at the progress of the patient toward the goals
to help the individual patient. set in the nursing care plan.
> E.g Met or Not Met
Major Concepts
Human Being
> Humans in need are the focus of nursing practice.
Health
> Health is replaced by a sense of helplessness as the
initiator of a necessity for nursing.
She stated that nursing deals with individuals who require
help.
Environment
> not defined directly but implicitly in the immediate context
for a patient
Nursing
> as unique and independent in its concerns for an
individual's need for help in an immediate situation.
> The efforts to meet the individual's need for help are
carried out in an interactive situation and in a disciplined
manner that requires proper training.

Steps in Nursing Process

Assessment
> the nurse completes a holistic assessment of the patient's
needs. This is done without taking the reason for the encounter
into consideration. The nurse uses a nursing framework to
collect both subjective and objective data about the patient.
Diagnosis
> the nurse's clinical judgment about health problems. The
diagnosis can then be confirmed using links to defining
characteristics, related factors, and risk factors found in the
patient's assessment.
Planning
> each of the problems identified in the diagnosis is given a
specific goal or outcome, and each goal or outcome is given
nursing interventions to help achieve the goal. By the end of
this stage, the nurse will have a nursing care plan.
 Nursing Theorists
Virginia Henderson 12. Work in such a way that there is a sense of accomplishment.
13. Play or participate in various forms of recreation.
> The nightingale of Modern Nursing 14. Learn, discover, or satisfy the curiosity that leads to normal
> Modern-Day Mother of Nursing development and health, and use the available health facilities.
> The 20th century Florence Nightingale
> Virginia Henderson was born on November 30, 1897 in
Kansas City, Missouri, and was the fifth of eight
children in her family.
> In 1921, Henderson graduated from the Army School
of Nursing at Walter Reed Hospital in Washington, D.C.
In 1932, she earned her Bachelor's Degree and in
1934 earned her Master's Degree in Nursing Education,
from Teachers College at Columbia University.
> Henderson died on March 19, 1996
> Introduced the "The Nature of Nursing Model (definitions Assumptions of the Need Theory
and components of nursing") > Nurses care for patients until they can care for themselves once
> Identified 14 basic needs on which nursing care is based again. Although not precisely explained,
> Unique function of the nurse is to assist the clients, sick > Patients desire to return to health.
or well, in the performance of activities contributing to > Nurses are willing to serve, and "nurses will devote themselves to
health or to its recovery the patient day and night."
> Nursing involves assisting clients to gain independence, & > Henderson also believes that the "mind and body are inseparable
achieve peaceful death and are interrelated."
> Henderson defined nursing as "doing things for patients Concepts
that they would do for themselves if they could, that is if > Person - individual requiring assistance to achieve health and
they were physically able or had the required knowledge” independence and peaceful death
> She believed that patient-focused nursing was the most > Environment - all external conditions and influences that affect
beneficial kind of nursing life and development
> Health - equated with independence, in terms of the client's ability
14 Components of Virginia Henderson's Nursing Need Theory to perform 14 components of nursing care unaided
1. Breathe normally. > Nursing - assist and support the individual in life activities &
2. Eat and drink adequately. attainment of independence
3. Eliminate body wastes. In the Nature of Nursing, nurse role is to get inside the patient's
4. Move and maintain desirable postures. skin and supplement his strength, will, or knowledge according to
5. Sleep and rest. his needs."
6. Select suitable clothes; dress and undress. The nurse is and should be legally , an independent practitioner
7. Maintain body temperature within a normal range by and able to make independent judgements
adjusting clothing and modifying the environment. Values and Beliefs
8. Keep the body clean and well groomed and protect the > She believed nursing as primarily complementing the patient by
integument. supplying what he needs
9. Avoid dangers in the environment and avoid injuring others. > Strongly believes in getting inside the skin of her patients
10. Communicate with others in expressing emotions, needs, > “I believed that the function the nurse performs is primarily and
fears, or opinions. independent one- that of acting for the patient when he lacks
11. Worship according to one's faith. knowledge, physical strength, or the will to act for himself”
(Henderson, 1966)
 Nursing Theorists
Faye Abdeah 11 Nursing Skills
● Introduced “Patient-Centered Approaches in Nursing Model” 1. Observation of health status
● Identified 21 nursing problems which determines nursing care 2. Skills of communication
● Nursing as service to individuals and families, therefore to 3. Application of knowledge
society 4. Teaching of patients and families
● Conceptualized nursing as an art and science 5. Planning and organization of works
6. Use of resource materials
Patient-Centered Approaches to Nursing 7. use of personnel services
- Patient-centered approach to nursing was developed by Faye 8. Problem solving
G. Abdellah. Developed inductively from her practice and is 9. Direction of work of others
considered a human needs theory. 10. therapeutic use of the self
- This theory was created to assist with nursing education, and 11. Nursing procedures
is most applicable to the education of nurses.
- The intension was to guide care of patients in the hospital, it Three major categories
also has relevance for nursing care in community settings. 1. Physical sociological and emotional needs of the client
- According to Faye, nursing is based on an art and science 2. Types of interpersonal relationships between the nurse
that mould the attitudes, intellectual competencies, and and the patient
technical skills of the individual nurse into the desire and ability 3. Common elements of client care
to help people, sick or well, cope with their health needs
Classification of the 21 Nursing Problems
• Nursing is the use of problem-solving approach with key Basic to all patients
nursing problems related to the health needs of people ● To maintain good hygiene and physical comfort
• Abdellah and colleagues developed a list of 21 nursing problems, ● To promote optimal activity ; rest, exercise, sleep
• They identified 10 steps to identify the client's problems and 11 ● To promote safety
nursing skills to be used in developing a treatment typology ● To maintain good body mechanics

10 Ways to Identify a Client's Problem Sustenal Care needs

Learn to know the patient ● To facilitate the maintenance of a supply of oxygen
• Sort out relevant and significant data ● To facilitate the maintenance of nutrition
Analyze and make generalizations about available data ● To facilitate the maintenance of elimination
Identify the therapeutic plan ● To facilitate maintenance of fluid and electrolyte balance
• Test generalizations with the patient and make additional ● To recognize the physiological responses of the body to
generalizations disease
Validate the patient's conclusion about his nursing problems ● To facilitate the maintenance of regulatory mechanisms &
Continue to observe and evaluate the patient over time to functions
identify any attitudes and clues affecting his behavior ● To facilitate maintenance of sensory function
Explore the patient's and family's reaction to the therapeutic
plan and involve them in the plan Remedial care needs
Identify how the nurse feels about the patient's nursing ● To identify and accept positive and negative
problems expressions, feelings, and reactions
Discuss and develop a comprehensive nursing care plan ● To identify and accept interrelatedness of emotions and
organic illness
 Nursing Theorists
Faye Abdeah 14. To facilitate the maintenance of effective verbal and
nonverbal communication
● To facilitate the maintenance of effective verbal & 15. To promote the development of productive interpersonal
nonverbal communication relationships
● To promote the development of productive interpersonal 16. To facilitate progress toward achievement of personal
relationships spiritual goals
● To facilitate progress toward achievement of personal 17. To create and maintain a therapeutic environment
spiritual goals 18. To facilitate awareness of self as an individual with varying
● To create or maintain a therapeutic environment physical, emotional, and developmental needs
● To facilitate awareness of self as an individual with varying 19. To accept the optimum possible goals in light of physical and
physical, emotional, & developmental needs emotional limitations
20. To use community resources as an aid in resolving problems
Restorative care needs arising from illness.
● To accept the optimum possible 21. To understand the role of social problems as influencing
goals in the light of limitations, physical, & emotional factors in the cause of illness.
● To use community resources as an aid in resolving problems
that arise from illness Abdellah’s 21 problems are actually a model describing the "arenas"
● To understand the role of social problems as influencing or concerns of nursing, rather than a theory describing
factors in the case of illness relationships among phenomena. In this way, the theory
distinguished the practice of nursing, with a focus on the 21
Abdellah's Typology of Nursing Problems nursing problems, from the practice of medicine, with a focus on
1. To promote good hygiene and physical comfort disease and cure.
2. To promote optimal activity, exercise, rest, and sleep
3. To promote safety through prevention of accidents, injury, Person
or other trauma and through the prevention of the spread of People having 21 physical, emotional and sociological nursing
infection problems. The patient's needs may be overt which is obvious and
4. To maintain good body mechanics and prevent and correct consist of physical needs or covert, hidden and concealed
deformities because it is emotional, sociological and interpersonal in nature.
5. To facilitate the maintenance of a supply of oxygen to all Health
body cells It is not clearly specified, although total health needs and a
6. To facilitate the maintenance of nutrition of all body cells healthy state of mind is comprehensively included in her concept
7. To facilitate the maintenance of elimination of nursing.
8. To facilitate the maintenance of fluid and electrolyte balance Nursing
9. To recognize the physiologic responses of the body to disease Nursing is an art or science aiming to help people cope with
conditions health needs. It involves service to an individual. family and
10. To facilitate the maintenance of regulatory mechanisms and society. Professionalization of nursing requires nurses to
functions identify nursing problems that depends on the nurses' use of
11. To facilitate the maintenance of sensory function her capacity to conceptualize and make some decision.
12. To identify and accept positive and negative expressions, Environment
feelings, and reactions The focus is on individual, family and society. Although, individuals
13. To identify and accept the interrelatedness of emotions and are the main focus of nursing service. Society is served by
organic illness serving individuals.
 Nursing Theorists
Joyce Travelbee - A human being is a unique, irreplaceable individual who is in
Human-to-Human Relationship Model continuous process of becoming, evolving and changing.
- Joyce Travelbee was born in 1926 and is known for her Health
work as a nursing theorist. In 1956, Travelbee earned her - Health is subjective and objective.
Bachelor of Science in Nursing degree from Louisiana State - Subjective health—is an individually defined state of well
University. She was given a Master of Science in Nursing being in accord with self-appraisal of physical-emotional-
degree in 1959 from Yale University and her career dealt spiritual status.
predominantly with psychiatric nursing and education. - Objective health—is an absence of discernible disease,
- Travelbee developed the Human – to – Human Relationship disability of defect as measured by physical examination,
Model and presented in her book, Interpersonal Aspects of laboratory tests and assessment by spiritual director or
Nursing (1966, 1971). psychological counselor.
Environment
“ A nurse does not only seck to alleviate physical pain or render - Environment is not clearly defined.
physical care - she ministers to the whole person, The existence - She defined human conditions and life experiences
of the suffering whether physical, mental or spiritual is the encountered by all men as sufferings, hope, pain and illness.
proper concern of the nurse. ”- Joyce Travelbee Illness – being unhealthy, but rather explored the human
experience of illness.
Travelbee's Assumptions of Theory Suffering – is a feeling of displeasure which ranges from
1. The nurse-patient relationship is the essence of the purpose simple transitory mental, physical or spiritual discomfort to
of nursing. extreme anguish and to those phases beyond anguish—the
2. relationships are established when both partners perceive malignant phase of dispairful “not caring” and apathetic
each others uniqueness. indifference.
3. Nurse- patient relationships are based on perceiving the
patient as an illness or nursing as a task. Basic Concepts
4. Human beings are motivated to search for and understand Suffering - "An experience that varies in intensity, duration
the meaning of all life experiences. and depth. A feeling of unease, ranging from mild, transient
5. Illness and sufferings are not only physical encounters for mental, physical or mental discomfort to extreme pain and
human beings, they are emotional and spiritual encounters as extreme tortured.
well. Pain - is not observable. A unique experience. Pain is a lonely
6. Communication is a process that can enable the nurse to experience that is difficult to communicate fully to another
establish a nurse- patient relationship and there by fulfill the individual.
purpose of nursing. Hope - the desire to gain an end or accomplish a goal combined
with some degree of expectation that what is desired or sought is
Central Theme attainable
A sick person finding meaning in illness and suffering and Hopelessness - being devoid of hope
human-to-human relationship.
Hope
Nursing Metaparadigm Nurse's job is to help the patient to maintain hope and avoid
Person hopelessness. Hope is a faith that can and will be change that
- Person is defined as a human being. would bring something better with it. Hope's core lies in a
- Both the nurse and the patient are human beings. fundamental trust the outside world, and a belief that others
will help someone when you need it.
 Nursing Theorists
Joyce Travelbee > It has five phases which include: the inaugural meeting or
Six important factors characteristics of hope are: original encounter; visibility of personal identities/ emerging
• It is strongly associated with dependence on other people. identities; empathy; sympathy; and establishing mutual
• It is future oriented. understanding and contact/ rapport
• It is linked to elections from several alternatives or
escape routes out of its situation. Interactional Phases of Human-to-Human Relationship Model:
• The desire to possess any object or condition, to complete 1. Original Encounter
a task or have an experience. - First impression by the nurse of the sick person and vice-
• Confidence that others will be there for one when you versa.
need them. - Stereotyped or traditional roles
• The hoping person is in possession of courage to be able to 2. Emerging Identities
acknowledge its shortcomings and fears and go forward - the time when relationship begins
towards its goal. - the nurse and patient perceives each others uniqueness
3. Empathy
Nursing - the ability to share in the person’s experience
- Nursing is an interpersonal process whereby the 4. Sympathy
professional nurse practitioner assists an individual, - when the nurse wants to lessen the cause of patient’s
family or community to prevent or cope with experience or suffering.
illness and suffering, and if necessary to find meaning in - it goes beyond empathy—“When one sympathizes, one is
these experiences.” involved but not incapacitated by the involvement.”
- therapeutic use of self
The critical work of psychiatric nursing is to help people 5. Rapport
develop a sense of self through a healing interpersonal - Rapport is described as nursing interventions that lessens
relationship. the patient’s suffering.
The instrument for the delivery of interpersonal nursing is - Relation as human being to human being
the therapeutic use of self. - “A nurse is able to establish rapport because she possesses
the necessary knowledge and skills required to assist ill
Therapeutic use of self persons and because she is able to perceive, respond to and
The ability to use one's personality consciously and in full appreciate the uniqueness of the ill human being.”
awareness in an attempt to establish relatedness and to
structure nursing interventions.
Refers to the nurse's presence, "a psychological being with
a patient for the purpose of meeting the patient's
health care needs."

> Human-to-Human Relationships begin with the original

encounter and then progress through stages of emerging
identities, developing feelings of empathy, and later feelings
of sympathy.
 Nursing Theorists
Madeleine Leininger CULTURALLY CONGRUENT NURSING CARE
TRANSCULTURAL NURSING THEORY • Culturally congruent nursing care occurs when nurses
WHAT IS TRANSCULTURAL NURSING? integrate information from individuals, family, community, or
• ”A discipline of study and practice focused on comparative institution based on cultural:
culture care differences and similarities among and between • beliefs
cultures in order to assist human beings to attain and maintain • values
meaningful and therapeutic health care practices that are • norms
culturally based" (Leininger, 2008, p.9). • patterns/lifeways
• practices
PHILOSOPHICAL ROOTS OF LEININGER'S THEORY • to provide appropriate and meaningful nursing care.
• Leininger states that the philosophical roots of her theory are:
• extensive and diverse nursing experiences METAPARADIGM CONCEPTS:
• anthropological insights CARING
• life experiences and values • essence of nursing
• reflection upon spiritual insights and beliefs • universal concept within all cultures
• assisting, supporting, or enabling behaviors to improve a
• The theorist created a theory to develop "new practices for person's condition
nursing to meet diverse cultural needs and to provide therapeutic • essential for survival, development, ability to deal with
care with comprehensive and holistic care practices in a caring life's events
discipline" Leininger, 2008, p.10) • greater level of wellness is achieved when caring is in line
with patient's cultural values and beliefs
TRANSCULTURAL NURSING THEORY CONCEPTS PERSON
• Transcultural nursing theory incorporates research from • Some cultures do not recognize the concept of "person".
numerous scientific disciplines: • Leininger's definition includes:
1. Nursing • individuals
2. Medicine • families
3. Education • groups
4. Psychology • communities
5. Public Health ENVIRONMENT
6. Epidemiology • The environmental context includes any events:
• physical
INTERRELATIONSHIP • ecological
Culturally Competent Nursing Care • sociopolitical
• promote human rights and quality health care through cultural • cultural
awareness
• centered on universal aspect of human caring as defined within Leininger's Metaparadigm:
each culture Person
• assess cultural needs and integrate nursing care that is > "Humans are universally caring beings who survive in a
congruent with cultural values diversity of cultures through their ability to provide
Transcultural Nursing Research universality of care in a variety of ways according to
• address cultural conflicts within healthcare beliefs differing cultures, needs and settings” (Nursing Theories,
• nursing care that is beneficial and meaningful to all cultures 2012).
• increase knowledge base to improve cultural competence > Includes physical, spiritual, emotional, and social aspects.
 Nursing Theorists
Madeleine Leininger VIEW
Environment • The transcultural nursing model can be used in all aspects
> "Included events with meanings and interpretations given to of nursing care, but proper use of the model can only be
them in particular physical, ecological, sociopolitical or cultural achieved if the patient's values are known and meaningfully
setting. Existing forces outside the organism and in the context used in an appropriate way by the nurse with the patient.
of culture" (Nursing Theories, 2012).
> Behaviors & health are influenced by culture
> Assessment of patient's environment crucial
Health
> "Encompasses a broad spectrum of conditions, including well-
being, illness, disability, and handicap" (University of the
Philippines Open University, 2011).
> Health is universal across cultures but specific to each
individual culture.
> Nurses must be sensitive to beliefs, values, and practices of
each culture.
Nursing
> "a learned humanistic and scientific profession and discipline
that focuses on phenomena and activities of human care in
order to assist, support, facilitate, or enable individuals or
groups to maintain or regain their well-being, in culturally
meaningful and beneficial ways” (University of the Philippines
Open University,2011).

CLARIFICATION OF ORIGIN
• Originally developed in 1950s
• Leininger's 1st book, Cultural Care Diversity and Universality -
Published 1991
• Transcultural Nursing (2nd ed.) - Published 1995
• Transcultural Nursing (3rd ed.) - Published 2002

CONTENT
• Human being - Nurses need humanistic and scientific
transcultural knowledge in order to adequately care for patients
in the 21st century.
• Environment - Care values are influenced by many things
including worldview, spirituality, and environment.
• Health - Care specific to one's culture promotes health, as valued
and defined by each culture.
• Nursing - Since 1989 nurses have been able to receive global
certification in transcultural nursing,
 Nursing Theorists
Rosemarie Rizzo Parse “Nurses live the art of human becoming in true presence with
Human Becoming Theory the unfolding of illuminating meaning, synchronizing rhythms,
• Graduated from Duquesne University in Pittsburgh, where and mobilizing transcendence.” (Cody and Bournes, 2010)
she later served as the dean of nursing.
• Master’s and Doctorate from the University of Pittsburgh. MEANING
• Professor and Coordinator of the Center for Nursing • “Structuring meaning is the imaging and valuing of languaging”
Research at Hunter College of the City of New York (Cody and Bournes, 2010)
(1983-1993) • People coparticipate in creating what is real for them through
• Professor and Niehoff Chair at Loyola University Chicago self-expression in living their values a chosen way.
(1993-2006). RHYTHMICITY
• Configuring rhythmical patterns of relating is the revealing-
ORIGIN OF THE HUMAN BECOMING THEORY concealing and enabling-limiting of connecting-separating.
• Originally Published in 1981 and was entitled “Man-living- • Living moment to moment one shows and does not show self as
health” opportunities and limitations emerge in moving with and apart
• Renamed in 1992 to remove the word “man” which was from others.
formerly in the dictionary as human kind. TRANSCENDENCE
• Developed as a human science nursing theory in the tradition • “Co-transcending with possibles is the powering and originating
of Dilthey, Heidegger, Sartre, Merleau-Ponty and Gadamer. of transforming”
• Assumptions were synthesized from works of European • Moving beyond the “now” moment is forging a unique personal
philosophers: Heidegger, Sartre, Merleau-Ponty path for oneself in the midst of ambiguity and continuous change.
• Along with the works of American nurse theorist Martha PRINCIPLES
Rogers. • Structuring meaning is the imaging and valuing of languaging.
• Called a “School of Thought” because it encompasses: otology, • Configuring rhythmical patterns is the revealing-concealing
epistemology and methodology and enabling-limiting of connecting-separating.
• Contransceding with possibles is the powering and originating
ASSUMPTIONS of transforming.
The human is:
• Coexisting while co-constituting rhythmical patterns. NURSING PARADIGMS AND PARSE’S THEORY
• Open, freely choosing meaning with situation, bearing Person
responsibility for decisions. • Open being who is more than and different from the sum of
Becoming is: the parts.
• Human-living-health Environment
• Rhythmically co-constituting human universe • Everything in the person and his experiences
• Human’s value priority patterns • Inseparable, complimentary to and evolving with.
• Transcending with possibles Health
• Human’s emerging • Open process of being and becoming, involves synthesis of
values.
BASIC CONCEPTS OF THE HUMAN BECOMING THEORY • Health is not static but, rather, is ever-changing as humans
• Meaning choose ways of living.
• Rhythmicity Nursing
• Transcendence • A human science and art that uses an abstract boy of
knowledge to serve people.
 Nursing Theorists
Rosemarie Rizzo Parse
THEORY OVERVIEW: PARSE SCHOLARS BELIEFS
• Quality of Life from patient’s perspective
• Diagnostic practice fails to respect humankind
• Standardized nursing interventions disregard human dignity
• Understanding human experience= individual freedom
• Humans are change with the process of living
• Inherent freedom is to be honored by nurses

THEORY OVERVIEW: REAL WORLD EXAMPLE

• Chronic Pain
• Nurses should ask patient to describe pain in detail

Physiological, psychological, situational factors:

• Nurses should be aware of patient’s life situation
• By listening to patients, pain can be improved
• Treatment plan can be developed
• Patients feel closer to nurses who listen
 Nursing Theorists
Myra Estrine Levine CONSERVATION, the product of adaptation. Conservation is
from the Latin word conservatio, meaning "to keep together".
CONSERVATION MODEL Conservation describes the way complex systems are able to
- After eaming an MS in nursing at Wayne State University in continue to function even when severely challenged. Through
1962. conservation, individuals are able to confront obstacles,
- She authored 77 published articles which included "An adapt accordingly, and maintain their uniqueness. The goal of
Introduction to Clinical Nursing" with multiple publication years conservation is health and the strength to confront disability
on 1969, 1973 & 1989. as the rules of conservation and integrity hold in all situation
- She also received an honorary doctorate from Loyola University in which nursing is requires"
in 1992. PERSON
- She died on 1996. The person is a holistic being who constantly strives to
CONSERVATION MODEL preserve wholeness and integrity and one "who is sentient,
- The core of the conservation model is to improve a person's thinking, future-oriented, and past-aware." The wholeness
physical and emotional well-being by considering the four (integrity) of the individual demands that the "individual life
domains of conservation she set out. has meaning only in the context of social life" The person is
- Nursing's role in conservation is to help the person with the also described as a unique individual in unity and integrity,
process of "keeping together" the total person through the least feeling, believing, thinking and whole system of system.
amount of effort. ENVIRONMENT
The environment completes the wholeness of the individual.
MAJOR CONCEPTS The individual has both an internal and external environment.
ADAPTATION is the process of change, and conservation is the Internal Environment:
outcome of adaptation. Adaptation is the process whereby the > Homeostasis - Stable state normal alterations in physiologic
patient maintains integrity within the realities of the environment. parameters respond to environmental changes; an energy
Three Characteristics of Adaptation: sparing state, a state of conservation.
1. Historicity - Adaptation is a historical process. Responses are > Homeorrhesis - Homeorhesis is the orchestrated or
based on past experiences both personal and genetics term. coordinated control in metabolism of body tissues necessary to
2. Specificity - Adaptation is also specific. It refers to the support a physiological state.
individual responses and their adaptive pattern, which varies on External Environment:
the basis of specific genetic structure. > Perceptual - The perceptual environment consists of
> Each system has particular responses. The physiologic information that is recorded by the sensory organs.
responses that "defend oxvgen supply to the brain are distinct > Operational - The operational environment consists of the
from those that maintain the appropriate blood glucose levels undetected natural forces and that impinge on the individual.
(Levine, 1989) > Conceptual - The conceptual environment is influenced by
3. Redundancy - represents the fail-safe options available to the language, culture, ideas, and cognition.
patient to ensure continued adaptation. HEALTH
Levine (1991) clarified what she meant by health as: “the
WHOLENESS, Levine stated that "the unceasing interaction of the avenue of return to the daily activities compromised by ill
individual organism with its environment does represent an health. It is not only the insult or the injury that is repaired
'open and fluid' system, and a condition of health, wholeness, but the person himself or herself. It is not merely the healing
exists when the interaction or constant adaptations to the of an afflicted part. It is rather a return to self hood, where
environment, permit ease-the assurance of integrity...in all the the encroachment of the disability can be set aside entirely,
dimensions of life.” and the individual is free to pursue once more
his or her own interests without constraint."
 Nursing Theorists
Myra Estrine Levine Assumptions About Individuals
NURSING Each individual "is an active participant in interactions with
Nursing involves engaging in "human interactions" “The the environment...constantly seeking information from it."
nurse enters into a partnership of human experience where (Levine, 1969)
sharing moments in time-some trivial. some dramatic-leaves The individual "is a sentient being, and the ability to interact
its mark forever on each patient". The goal of nursing is to with the environment seems ineluctably tied to his sensory
promote adaptation and maintain wholeness (health). organs."
• Disease is "unregulated and undisciplined change and must "Change is the essence of life, and it is unceasing as long as
be stopped or death will ensue". life goes on.
PERSON AND ENVIRONMENT Change is characteristic of life." (Levine, 1973)
Person and the environment become congruent over time. It
is the fit of the person with his or her predicament of time Assumptions About Nursing
and space. The specific adaptive responses make "Ultimately, the decisions for nursing intervention must be
conservation possible occur on many levels; molecular, based on the unique behavior of the individual patient."
physiologic, emotional, psychologic, and social.
"Patient-centered nursing care means individualized
CONSERVATION OF ENERGY nursing care. It is predicated on the reality of common
> Refers to balancing energy input and output to avoid excessive experience: every man is a unique individual, and as such he
fatigue. It includes adequate rest, nutrition and exercise. requires a unique constellation of skills, techniques, and
> Examples: Availability of adequate rest; Maintenance of ideas designed specifically for him." (Levine, 1973)
adequate nutrition
CONSERVATION OF STRUCTURAL INTEGRITY:
> Refers to maintaining or restoring the structure of body
preventing physical breakdown and promoting healing.
> Examples: Assist patient in ROM exercise; Maintenance of
patient's personal hygiene
CONSERVATION OF PERSONAL INTEGRITY
> Recognizes the individual as one who strives for recognition,
respect, self awareness, selfhood and self determination.
> Example: Recognize and protect patient's space needs
CONSERVATION OF SOCIAL INTEGRITY
> An individual is recognized as some one who resides, with in a
family,: a community, a religious group, an ethnic group, a
political system and a nation.
> Example: Help the individual to preserve his or her place in a
family, community, and society.
 Nursing Theorists
Lydia Eloise Ha > Patient may explore and share feelings with the nurse.
CARE, CORE, CURE THEORY > When functioning in the care circle, the nurses apply knowledge
> Was born in new York city on September 21, 1906. of the natural and biological sciences.
> Basic nursing education in 1927. > The patient views the nurse as potential comforter, one who
> Bachelor in public health nursing in 1937. provides care and comfort through the lying of hands.
> Master's in teaching natural sciences in 1942.
> First director of leob centre for nursing. The Core
> Nursing experience in clinical, education, research and > Patient care is based on social sciences.
supervisor role. > Involves therapeutic use of self and is shared with other team
members.
Lydia Hall's Nursing Theory > By developing interpersonal relationship with the patient, the
As Hall (1965) says; "To look at and listen to self is often too nurse is able to help the patient verbally express feelings
difficult without the help of a significant figure (nurturer) regarding the disease process and its effects.
who has learned how to hold up a mirror and sounding board > Patient is able to gain self-identity and further develop
to invite the behaver to look and listen to himself. maturity.
If he accepts the invitation, he will explore the concerns in > Patient is able to make conscious decision.
his acts and as he listens to his exploration through the
reflection of the nurse, he may uncover in sequence his The Cure
difficulties, the problem area, his problem, and eventually the > Cure based on pathological and therapeutic sciences
threat which is dictating his out-of-control behavior." > Application of medical knowledge by nurses.
> Nurse assisting the doctors in performing different procedures.
3 CIRCLES (3Cs) > Nurse is patient advocate in this circle.
Care > The cure aspect is different from the care circle because
many of nurse's actions changes from a negative quality of
Core Cure avoidance of pain rather than a positive quality of comfort.
> Nurses role changes to positive qualtty to negative quality.
3 ASPECTS OF NURSING
Care (The Body) Hall's Nursing Paradigm
> Represents nurturance & exclusive to nursing INDIVIDUAL
Core (The Person) - Persons who are more than 16 years old and in the long-term
> Involves therapeutic use self & the use of reflection illness are the focus of Hall's wok.
Cure (The Disease) - Hall emphasizes the importance of an individual as unique,
> Nurses related to physician's order {seeing the patient and capable of growth, learning and requiring a total person
family through medical care} approach.
HEALTH
The Care - Inferred to be a state of self-awareness with conscious
> Nurturing component of care and is exclusive to nursing. selection of behaviors.
> Motherly care and comfort of patient. - Hall stresses the need to help the person explore the meaning of
> Provides teaching and learning activities. his or her behavior to identify and overcome problems through
> Nurses goal is to give care and comfort to the patient. developing self-identity and maturity.
> Nurses provides bodily care for the patient.
 Nursing Theorists
Lydia Eloise Ha
NURSING
- Identifies and consisting participation in the care, core and
cure aspects of patient care.
- Care is the sole function of nurses.
- Major purpose of care is to achieve an interpersonal
relationship with the individual.

ENVIRONMENT
- The concept of society/environment is dealt with in relation
to the individual. Hall is credited with developing the concept of
Loeb Center because she assumed that the hospital environment
during treatment of acute illness creates a difficult
psychological experience for the ill individual.
- In such a setting, the focus of the action of the nurses is
the individual, so that any actions taken in relation to society or
environment are for the purpose of assisting the individual in
attaining a personal goal.

Assumptions
> The motivation and energy necessary for healing exist
within the patient, rather than in the health care team.
> The three aspects of nursing should not be viewed as
functioning independently but as interrelated.
> The three aspects interact, and the circles representing
them change size, depending on the patient's total course of
progress.
 Nursing Theorists
Margaret Newman PATTERN
Health as Expanding Consciousness A person is identified by her or his pattern, which reflects
- Born on October 10, 1933 the pattern of the person within the larger pattern of the
- Bachelor's Degree- University of Tennessee in 1962 environment. Pattern recognition emerges from a process
- Master's Degree- University of California in 1964 of uncovering meaning in a person's life. Meaning is
- Doctorate- New York University in 1971 inherent in pattern, and vice versa.
- She worked in - University of Tennessee, New York University,
Pennsylvania State University. CONSCIOUSNESS
> Consciousness is both the informational capacity of the
Theoretical Sources system (Human Being) and the ability of the system to
Martha Rogers ‘Theory of Unitary Human Beings’ interact with its environment (Newman, 1994).
> The health of a Human being is unitary phenomenon, an > Includes not only cognitive and affective awareness, but
evolving pattern of Human- Environment. also the "interconnectedness of the entire living system”
Itzhak Bento's Concept of the Evolution of Consciousness which includes physiochemical maintenance and growth
> Life is the process of expanding consciousness. The processes as well as the immune system.
informational capacity of the system (Human Being} and can Three Correlates of Consciousness
be seen in the quality of interaction of the system with the - Time
environment. - Movement
Arthur Young's Theory of Process - Space
> Theory of human evolution pinpointed the role of pattern > views the expansion of consciousness as what life and
recognition for Newman. She explained that Young's ideas health is all about, and the sense of time is an indicator in
provided impetus for her to integrate the basic concepts of the changing level of consciousness.
her new theory, movement, space, time, and consciousness, Consciousness

into a dynamic portrayal of life and health

David Bohm's Theory of Implicate as she developed her model of
nursing. Movement Space

> Theory of implicate order supports Newman's postulate that

disease is a manifestation of the pattern of health. Time
The model also addresses the interrelatedness of time, space,
- The Theory of Health as Expanding Consciousness (HEC) was and movement. Time and space are the temporal pattern of the
stimulated by concern for those for whom health as the absence patient, and have a complementary relationship. People are
of disease or disability is not possible. constantly changing through time and space, which is
- The theory asserts that every person in every situation, no movement, which shows a unique pattern of reality.
matter how disordered and hopeless it may seem, is part of the
universal process of expanding consciousness PERSON
- Humans are open to the whole energy system of, the universe
MAJOR CONCEPTS and constantly interacting with the energy.
HEALTH - Persons as individuals are identified by their individual
Rogers' insistence that health and illness are simply patterns of consciousness (Newman, 1986) and defined as
manifestations of the rhythmic fluctuations of the life process "centers of consciousness within an overall pattern of
is the foundation for viewing health and illness as a unitary expanding consciousness" (Newman, 1986, p. 31).
process moving through variations in order-disorder.
 Nursing Theorists
Margaret Newman PRACTICE
HEALTH Newman's Model of Health is useful in the practice of
- Is the major concept of Newman's theory of expanding nursing because it contained concepts used by the
consciousness. A fusion of disease and nondisease creates a profession. Movement and Time are an intrinsic part of
synthesis regarded as health (Newman, 1979, 1991, 1992). nursing intervention, that is Range-of-motion, ambulation,
- Disease and non-disease each reflect the larger whole; coughing, turning and deep breathing.
therefore, a new concept states that pattern recognition is
the essence of emerging health. "Manifest health, EDUCATION
encompassing disease and nondisease, can be regarded as the Newman did not advocate one model as the sole basis for
explication of the underlying pattern of person- curriculum. Rather, students should have the opportunity to
environment" (Newman, 1994, p. 11) study various approaches to health and nursing and to
choose what is relevant to them in their practice and
NURSING research.
- emphasizes the primacy of relationships as a focus of nursing,
both nurse-client relationships and relationships within clients' RESEARCH
lives (Newman, 2008). - Some researchers have attempted to test Newman's
> "The emphasis of this process is on knowing/caring through propositions of time, space and movement.
pattern recognition" Cooperative inquiry or interactive, integrative participation
> Newman stated that research should center on
ENVIRONMENT investigations that are participatory in which client-subjects
- Although environment is not explicitly defined, it is described as are partners and co-researchers in the search for health
being the larger whole, which contains the consciousness of the patterns.
individual.
- The pattern of person consciousness interacts within the
pattern of family consciousness and within the pattern of
community interactions (Newman, 1986).

Newman's theory makes six assumptions

1.Health encompasses conditions heretofore described as illness, or,
in medical terms, pathology.
2. These pathological conditions can be considered a manifestation of
the total pattern of the individual patient.
3. The pattern of the individual patient that eventually manifests
itself as pathology is primary, and exists prior to structural or
functional changes.
4. Removal of the pathology in itself will not change the pattern of
the individual patient.
5. If becoming ill is the only way an individual patient's pattern can
manifest itself, then that is health for that individual patient.
6. Health is an expansion of the consciousness
 Finals
I am done with all course unit task. Unit exam will be publish at 2pm All lecture in CANVAS. Scope of Quiz
Rozzano Locsin
Casagra Transformative Leadership theory
Carmelita Divinagracia Composure Model
Letty Kuan Role Discontinues and Retirement ang graceful aging
Carmencita Abaquin Prepare Me theory
Cecilia Laurente
Nursing Practice Career Theory.
 Theories Relavant to The Nursing
Practice
Maslow's Hierarchy of Needs > If these needs are not satisfied the human body cannot function
• Maslow's hierarchy of needs is a motivational theory in psychology optimally. Maslow considered physiological needs the most important as
comprising a five-tier model of human needs, often depicted as all the other needs become secondary until these needs are met.
hierarchical levels within a pyramid. 2. Safety needs - Once an individual's physiological needs are satisfied,
the needs for security and safety become salient. People want to
experience order, predictability and control in their lives. These needs
can be fulfilled by the family and society (e.g. police, schools, business
and medical care).
> For example, emotional security, financial security (e.g. employment,
social welfare), law and order, freedom from fear, social stability,
property, health and wellbeing (e.g. safety against accidents and injury).
3. Love and belongingness needs - after physiological and safety needs
have been fulfilled, the third level of human needs is social and involves
feelings of belongingness. The need for interpersonal relationships
motivates behavior
• Needs lower down in the hierarchy must be satisfied before > Examples include friendship, intimacy, trust, and acceptance, receiving
individuals can attend to needs higher up. From the bottom of the and giving affection and love. Affiliating, being part of a group (family,
hierarchy upwards, the needs are: physiological, safety, love and friends, work).
belonging, esteem, and self-actualization. 4. Esteem needs - are the fourth level in Maslow's hierarchy - which
• Maslow (1943) initially stated that individuals must satisfy lower level Maslow classified into two categories: (i) esteem for oneself (dignity,
deficit needs before progressing on to meet higher level growth achievement, mastery, independence) and (ii) the desire for reputation
needs. However, he later clarified that satisfaction of a needs is not or respect from others (e.g., status, prestige). 
an "all-or-none" phenomenon, admitting that his earlier statements > Maslow indicated that the need for respect or reputation is most
may have given "the false impression that a need must be satisfied important for children and adolescents and precedes real self-esteem
100 percent before the next need emerges" (1987, p. 69). or dignity.
• When a deficit need has been 'more or less' satisfied it will go 5. Self-actualization needs are the highest level in Maslow's hierarchy,
away, and our activities. and refer to the realization of a person's potential, self-fulfillment,
seeking personal growth and peak experiences. Maslow (1943) describes
this level as the desire to accomplish everything that one can, to become
the most that one can be.

1. Physiological needs - these are biological requirements for human

survival, e.g. air, food, drink, shelter, clothing, warmth, sex, sleep. 
 Theories Relavant to The Nursing
Practice
‘Good Me’ or ‘Bad Me'— The Suivan approach to infant has a generalized feeling of "good me." On the other hand, if the

personality caretaker is anxious, tense and rejecting, this too is commu nicated to the
infant, who experiences a general ized feeling of "bad me." The
The work of Harry Stack Sullivan, generally regarded as America's caretaker communi cates to the infant primarily by means of a process
most original psychiatrist, is only now beginning to win widespread which Sullivan calls "empathy." This is not partic ularly mysterious—all
recognition. Sullivan died in 1949. Today interest in Sullivanian of us communicate through empathy. When someone says that a tense,
treatment and training methods is growing; more and more fidgety person "makes me nervous," he is talking about empathy.
references to him are appearing in the professional literature, and his
books are doing better than ever. Sullivan was among the first to recognize that the therapist is not a
disembodied spirit but rather affects the patient in significant ways that
Sullivan believed that Freud did not go far enough with this idea have to be taken into consideration. The therapist must be a "participant
because he left the illness, the neurosis, within the individual as an observer" in the sense that he must both interact with the patient and, at
encapsulated entity. Sullivan argued forcefully that mental illness had the same time, monitor the interaction from the standpoint of an outside,
to do with the ways in which people deal with people and was, objective observer.
therefore, "interpersonal" and not "intrapersonal." Even when we are
alone, our thinking and behavior always relates to other people, real With an understanding of this principle, one can begin to appreciate the
or imaginary. What Sullivan wanted to do was to reformulate the communica tion difficulties which occur when any two people engage in
problems and concepts of psychiatry from this interpersonal conversation. In any such situation the maintenance of self-esteem is
perspective. always an un derlying Issue where true intimacy does not exist. Each
individual is constantly moni toring the other's communica tions to
For example, a classic category of neurosis like hysteria. This was determine what they indicate about himself. But the lines of communication
always defined in terms of repression of sexual impulses, with are far from clear and there is a great deal of distortion or "noise" in the
symptoms such as hysterical blindness or paralysis. Sullivan wanted to system. 
substitute for these formulations descriptions of interpersonal behavior
that made for difficulties in living, such as the "negativistic" person, The closest most of us come to true communication is what Sullivan called
who feels insecure and inadequate and who accentuates his own the "syntaxic" mode, the situation when both individuals are using the same
significance by constantly disagreeing with others. "Self-absorbed" words to mean the same things. But this type of com munication is impeded
people, in Sullivan's scheme, are those who relate to others on an all- by two other modes of interpreting another person's meaning. What the
or-nothing basis: "People whom I like are all good while people whom other individual says is always interpreted in the context of how he says it
I dislike are all bad." In each case the person must be described by —his facial expression, tone of voice and gestures. This mode of
his typical ways of relating to other people, not by a list of self- interpretation Sulli van calls "prototaxic." In ad dition, what the other indi
contained symptoms. vidual says is also interpreted in terms of who he is—the same words
coming from a child and from an adult are interpreted in quite different
Sullivan wanted psychiatry to emphasize man's humanness, the fact ways. When a remark is so interpreted, Sullivan speaks of the "parataxic"
that man's feelings, motives, thoughts and values are uniquely human mode.
and have no counterpart at the animal level.
Psychotherapy seeks to help people over come their prototaxic and
In Sullivan's view, the child's sense of self evolves gradually during parataxic distortions so that they can arrive at a correct, or syntaxic,
the first year of life, primarily as a consequence of the ministrations understanding of other persons' expressions. The process of arriving at
of the person who takes care of the child. If this caretaker is loving, this correct understanding of other people is what Sullivan called
comforting and meets the infant's needs, the "consensual validation."
 Theories Relavant to The Nursing
Practice
The aim of therapy is to do the same thing and thus help the pa tient Principles of General system theory and its application in Nursing
refurbish his sense of self-esteem and respect. While the treatment 1. The principle of wholeness: It is the core of General system theory,
process is obvi ously more complex than what has been described This principle provides the guidance or methodology to us in order that
here, its aim is always to help the individual to the point where his we can study all kinds of objects effectively.
sense of positive self- regard outweighs his sense of being worthless 2. The principle of optimization: The principle of optimization of a system
and un human. is to achieve an optimal state in certain condition and to perform its best

General Systems Theory

function by organization and coordination.
The principle of modeling. Modeling is to design a model similar to a
• General Systems Theory was introduced in the 1930s by Ludwig von real system first , then to describe and understand the characterization
Bertalanffy. and level of real system by studying the model .
• Presumes that there are universal principles of organization which hold a. Concrete model : is to reproduce a prototype by using a similar model
for all systems, whether they are physical, chemical, biological, mental, in some degree and forms eg. CPR model
social, etc. b. Abstract model : is the reflect the similar relation of a prototype of a
• Considered to be a "grand" theory because of its universal relevancy system by non objective forms of language, symbol and diagram, such
and applicability as Nursing diagnosis
• General system theory (science of wholeness) The principle of modeling is composed of 3 aspects
• describes " how to break whole things into parts and 1. Principle of similarity : A model should be an imitation and abstract of
• then to learn how the parts work together in systems". an actual system.
• General system theory is known by different names - Systems theory, 2. The Principle of simplicity : A model with lose its function if there is no
theory of open systems, systems model, and family systems theory. reality we should be good at grasping key contradiction, neglecting the
• The author of General system theory was Ludwig Von Bertalanffy secondary factors to achieve simplicity under the precondition of ensuring
• General system theory describes how to break the whole apart and then necessary precision.
learn how the parts work together. 3. The principle of objectivity: The relations of similarity and simplicity
• Emphasizes the relationships between parts between a model and a prototype may result in completely consistency in
• Describes how parts function and behave. data and production provided by model and the situation of a real system.
The Revolution of General system theory to Nursing
General System Theory > To look at a person with systematic view point
Von Bertalanffy (1969 - 1976) developed general system theory > The human being is the object of Nursing. The human being is a system
which assumes the following: that is composed of many elements, such as physiological, psychological,
All systems must be goal directed. social , spiritual and cultural elements
A system is more than the sum of its parts. > The human being is a natural system
A system is ever-changing, and any change in one parts affects the a. A basic condition of life activities and heath of human being is hormony
whole. and equilibrium of internal and external environment in the human body.
Bounders are implicit, and human systems are open and dynamic. b. A human being is an open and dynamic system
A human being exchanges the energy, matter, and information with its
Basic concepts of General system theory environment constantly, as well as within its body to maintain life and
• Concept of system : health.
• A system is a set consisting of integrated, interesting parts or c. A Human being is an system with a subjective activity
components that function as a whole. Each part is necessary to make a > A human being is conscious and able to supervise and control his / her
complete and meaningful whole. state of functions
 Theories Relavant to The Nursing
Practice
To understand nursing with a systematic viewpoint. - The Change Theory has three major concepts: driving forces,
a. Nursing system is system with complicated structure restraining forces, and equilibrium.
b. Nursing system is an open system > Driving forces are those that push in a direction that causes change to
c. Nursing system is dynamic system occur. They facilitate change because they push the patient in a desired
d. Nursing system is with the function of decisionmaking and feedback direction. They cause a shift in the equilibrium towards change.
> Restraining forces are those forces that counter the driving forces. They
Nursing theory has drawn from the work of von bertalanffy on hinder change because they push the patient in the opposite direction.
systems theory. They cause a shift in the equilibrium that opposes change.
1. Newman's system theory, Rogers theory, Roy's adaptation model, > Equilibrium is a state of being where driving forces equal restraining
Imogene king theory, Orem's self care deficit theory, Johnsons forces, and no change occurs. It can be raised or lowered by changes
behavior system theory. that occur between the driving and restraining forces.

Characteristic of systems three stages

1. Systems refer specifically to self regulating systems - Unfreezing is the process which involves finding a method of making it
2. Systems are self correcting through feedback possible for people to let go of an old pattern that was somehow
3. System have structure that is defined by its process and parts. counterproductive. It is necessary to overcome the strains of individual
4. Systems are generalization of reality. resistance and group conformity.
5. The various parts of a system have functional as well as > There are three methods that can lead to the achievement of
structural relations between each others. unfreezing. The first is to increase the driving forces that direct behavior
6. System tends to function in the same way away from the existing situation or status quo. Second, decrease the
7. Every living organism is essentially an open system restraining forces that negatively affect the movement from the existing
  equilibrium. Thirdly, finding a combination of the first two methods.
- The change stage, which is also called "moving to a new level" or
"movement," involves a process of change in thoughts, feeling, behavior,
or all three, that is in some way more liberating or more productive.
- The refreezing stage is establishing the change as the new habit, so
that it now becomes the "standard operating procedure." Without this
final stage, it can be easy for the patient to go back to old habits.

Change Theory
The Change Theory of Nursing was developed by Kurt Lewin,
who is considered the father of social psychology. This theory is
his most influential theory. He theorized a three-stage model of
change known as unfreezing-change-refreeze model that
requires prior learning to be rejected and replaced.
 Theories Relavant to The Nursing
Practice
3) uneven or incomplete development in any important life domain can lead
to serious life problems. It is important to identify and correct developmental
delays while they are first occurring and as soon as possible, so as to
minimize the cumulative damage that delays while they are first occurring
and as soon as possible, so as to minimize the cumulative damage that
delays may cause.
Developmental Theories
Four areas of Theory Development
- Biophysical Development
- Psychoanalytic/ psychosocial development

Developmental Theories
- Cognitive development
- Moral development
- Developmental theories present systematic ways of thinking about
how human beings grow from babies to adolescents to adults to
elderly people, and the various changes they undergo as they make
this passage. Different developmental theories describe different
types of changes.
- Developmental theories view development as progress from
simple to more complex understandings of the self and the world
over time. Progress may be continuous in nature, or occurring in
stages, but the momentum is most always forward toward greater,
more complex understandings.
> For example, prior to achieving "object permanency", babies do
not understand that objects (toys, people) continue to exist even when Piaget's Theory of Cognitive Development
out of sight. Instead of looking for a toy now covered with a blanket, Age Range Description of Stage Developmental Phenomena
they instead quickly lose interest in the toy as though it never existed. Birth-2 Sensorimotor - Experiencing the Object permanence
> As they grow, babies come to master the idea of object world through senses and actions Stranger anxiety
permanency, and thereafter will begin looking for objects hidden 2-6 years Preoperational - Representing things Pretend play
from their view. According to developmental theories, this sort of with words and images Egocentrism
learning to see the world in increasingly complicated ways Language development
continues to occur throughout the lifespan. 7-11 vears Concrete Operational - Thinking Conservation
logically about concrete events and Mathematical transformation

key insights from developmental theories grasping concrete analogies,

1) development is best understood as progress through an ordered 12 - Formal Operational - Thinking about Abstract logic
series of increasingly complex progressive stages, adulthood hypothetical scenarios and Potential for mature moral
2) early developmental delays (interrupting progress towards a processing abstract thoughts reasoning
particular stage) threaten the developing person's overall progress.
 Theories Relavant to The Nursing
Practice
Freud: Psychoanalytic Theory Moral Development
Sigmund Freud: Viennese Physician and Founder of Psychoanalytic The gradual development of an individual's concept of:
Theory - right or wrong,
> Psychoanalytic theory - focus on development and dynamics of - conscience,
personality - religious values,
> Emphasis on humans being driven by motive and emotions of which - social attitudes,
we are unaware - and certain behavior.
> Belief that we are shaped by earliest experiences in life Process by which children learn their moral beliefs and develop moral
> Theory far less influential than in the past reasoning for making decisions regarding what is right or wrong.
Instincts and Unconscious Motives
> Instincts - inborn biological forces that motivate behavior - Psychologist Lawrence Kohlberg (1927– 1987) extended upon the
> Unconscious motivation- instinctive and inner force influences beyond foundation that Piaget built regarding cognitive development. Kohlberg
our awareness control believed that moral development, like cognitive development, follows a
> Emphasis on nature (biological instincts) series of stages.
- Kohlberg reviewed people's responses and placed them in different
stages of moral reasoning. According to Kohlberg, an individual
progresses from the capacity for pre-conventional morality (before age
9) to the capacity for conventional morality (early adolescence), and
toward attaining post- conventional morality (once formal operational
thought is attained), which only a few fully achieve.
- Kohlberg identified three levels of moral reasoning: pre-conventional,
conventional, and post-conventional: Each level is associated with
increasingly complex stages of moral development.
Theories Relavant to The Nursing
Practice
 Theoretical Foundations
of Nursing
Carolina Agravante mirror the behavior and personality of the modern
CASGARA Transformative Leadership Model professional nurse who will challenge the demands of these
- Sister Carolina S. Agravante, SPC, RN, PhD critical times in the society today. The model shows how
Born with the heart of a true servant-leader, Sr. Carolina S. servant- leadership spirituality, self-mastery (care complex),
Agravante is the famous first Filipina theorist who wrote the and special nursing expertise (transformative teaching) are
CASAGRA Transformative Leadership Model. which is also derived related and affects the leadership behavior of the nursing
from her name. CArolina S. AGRAvante and was published in 2002. faculty. This will help to explain and predict the continuous
- Sr. Carol Agravante finished high school at St. Paul University - formation of nursing leadership behavior in the nursing
Manila (formerly known as St. Paul College - Manila), where she faculty that will eventually affect their teaching roles
graduated as a class salutatorian.
- In the same school, 1964, she pursued her baccalaureate degree 1. The Servant-Leadership Spirituality in this paradigm is
in Nursing and become a graduate with Latin honors, magna cum prescribed to run side by side with the general components
laude to be exact. Later that year, she also passed the nurse of the transformative leadership model. This formula
licensure examinations as topnotcher. consists of:
- She completed her Master's Degree at the Catholic University of a. a spiritual exercise,
America as a full-fledged scholar from 1967 to 1969. b. the resolution of the care complex in the personality
of an individual; and
The CASAGRA Transformative Leadership Model is derived from the C. a seminar-workshop on transformative teaching.
concept of leadership from a psycho-spiritual point of view. This 2. The Self-Mastery is expressed in care complex variable
was formulated to lead to a radical change from apathy or possessed to a certain degree by an individual that have been
indifference to becoming a spiritual person. Based on the study, through formal studies in a caregiving profession such as
the care complex personality of the nursing faculty is correlated to nursing. Thus, it involves a person's self-awareness of the
their leadership behavior. Since the care complex was given as a nursing faculty.
stimulant to the two groups tested, it was evident on the two- 3. The Special-Expertise level is the enactment of caring and
posttest period of the study that their leadership behavior after being proactive in face of challenges for the profession. It is
going through the servant-leadership program had increased than shown in 5C’s of transformational leadership namely:
the pre-test. Moreover, a strong Catholic foundation in one's creative, caring, critical, contemplative and collegial teaching
bachelor's education, a graduate degree of either Master's or of the nurse faculty who is directly involved with the
Doctorate, membership in a nursing association or other national formation of the nursing. It is the guide designed to form the
union, and attendance in lecture conferences on the nursing new professional nurses.
profession were the variables that contributed to the leadership
behavior of the nursing faculty to become a transformative leader. Servant-leadership behavior is the manner of the nursing
faculty manifested through the ability to model the servant-
Assumptions leadership qualities to students. It is an ability that assists to
Sr. Carolina Agravante's model is a Three-Fold Transformation bring out the best in students, competence in nursing skills,
Leadership Concept comprises of servant-leadership spirituality, commitment to the nursing profession and a sense of
self-mastery (care complex), and special nursing expertise collegiality with the school, other health professionals and
(transformative teaching), which are put together to help us the local community.
 Theoretical Foundations
of Nursing
Carmencita Abaquin Prayer is a solemn expression of feelings through deliberate
PREPARE ME Holistic Nursing Interventions communication directed towards a deity.
- Carmencita Matias-Abaquin is a professional nurse with a
Master's Degree in Nursing (1975), and Doctorate degree Relaxation-Breathing are techniques which aid to stimulate
(2000) obtained from the University of the Philippines College of relaxation, in order to avoid any undesirable signs and
Nursing. symptoms
- She is also an expert in Medical-Surgical Nursing with a
subspeciality in Oncologic Nursing which made her know both Meditation evokes relaxation to help alter a patient's level of
abroad and local. awareness by concentrating on a thought or image to promote
- She served the University of the Philippines College of Nursing an insight, which in turn, aids in forming a rapport and
as a faculty member for 35 years and as a Secretary of the relationship with God. This could be done through music, and
College of Nursing. other relaxation techniques.
- Her latest appointment as Chairman of the Board of Nursing,
from November 2006 to January 2016 speaks of her Values Clarification facilitates another person in clarifying his
competence and integrity in the field she has chosen. own values regarding health and illness to promote an effective
decision making skills. This helps the patient develop an open
Abaquin developed the theory called "PREPARE ME Interventions mind that will encourage acceptance of disease state.
and Quality of Life Advance Progressive Cancer Patients". The
theory serves as a structure on a non- pharmacologic and non-
surgical approach of care to advance progressive cancer
patients. Its center of interest is not on curing the patient's
disease but on aiding them to have peace of mind and benevolence
as one is faced with a life and death situation
Nurses should not solely be perceived as caregivers but also as
facilitators of peaceful acceptance of the condition.

Assumptions
PREPARE ME (Holistic Nursing Intervention) are nursing
interventions given at any setting to address multidimensional
problems of cancer patients. This is specific to be a holistic
approach to nursing care, and has the following components

Presence is having the presence of another person in times of

hardship. Presence involves therapeutic communication, active
listening, and touch.

Reminisce Therapy is thinking back on events, feelings, or

thoughts that happened in the past to ease adaptation to the
current situation.
 Theoretical Foundations
of Nursing
Carmelita Divinagracia Open- Mindedness to various ideologies such as opinions and
- Dr. Carmelita C. Divinagracia is a Filipino cardiologist nurse, perceptions, and flexibility to accomodating the views of others
she has been should be equipped by nurse.
praised for developing the art and competency of teaching
nursing. Stimulation provides encouragement and appreciation through
- She is a graduate of Bachelor of Science in Nursing at words that may bring hope and guidance.
University of East Ramon Magsaysay Memorial Medical Center,
Inc. (UERMMMC) in 1962. Understanding the patient's holistic being should be equipped by
- She earned her Master Degree in Nursing at the University of nurses through the manner of conveying interests and
the Philippines in 1975. acceptance.
- She obtained her PhD from UP in 2001.
- Former President of the Association of the Philippine Colleges Respect refers to recognizing patient's presence. Relaxation
of Nursing (ADPCN). includes alleviating tension in the body.

Advanced Nurse Practitioners' Composure Behavior and Empathy makes nurses distinguish positive thoughts and
Patients' Wellness Outcome feelings, and reaches a patient out through putting themselves
on the patient's situation.
Nursing is a profession that goes beyond time. Starting from the
time a patient is admitted to the time of their discharge, the The COMPOSURE Behaviors Model results into patient's wellness
nurse and the patient develops a meaningful relationship that outcome, that can manifest into physiologic and behavioral
involves mutual trust and acceptance that will lead to outcomes.
satisfaction on both sides. Nursing profession can actively
deliver quality care through caring interventions similar to the
COMPOSURE BEHAVIORS.

COMPOSURE Behaviors Model, known as a set of nursing

behaviors, is introduced in her dissertation that should be
exhibited by nurses. The acronym COMPOSURE stands for
COMpetence, Presence and Prayer, Open-mindedness,
Stimulation, Understanding, Respect and Relaxation, and
Empathy. She conducted a study using the COMPOSURE
Behaviors to determine its effects on the recovery of the
patients, specifically the selected patients at the Philippine Heart
Center.

COMpetence should be consistently equipped by nurses alongside knowledge

and expertise in giving care to the patient

Presence and Prayer refers to the availability of the nurses holistically.

This includes therapeutic communication techniques.
 Theoretical Foundations
of Nursing
Cecilia Laurente
- Cecilia Laurente is born in the Philippines Laurente stated that there are factors that alleviate a
- She is a Filipino Nursing theorist who primarily focused on patient's anxiety. It is called Enhancing Factors, namely:
helping patients to have support systems such as their families
- She graduated Bachelor of Science in Nursing at University of - One's caring experience, beliefs, and attitude
the Philippines in 1967. - Feeling good about work
- After a year, she worked as a staff nurse at the Philippine - Learning about caring at school
General Hospital until 1969. - What other patients tell about the nurse coping
- She worked as a head nurse at the Philippine General Hospital mechanism to problems encountered.
during 1970-1972. - Communication
- In 1973, she finished her master's degree in nursing at the
University of the Philippines. She also stated Predisposing Factors that triggers
- During 1973-1976, she worked as a nursing supervisor at the anxiety of the patient, namely:
Philippine General Hospital. - Age
- Sex
Theory of Nursing Practice and Career as found in her study - Civil Status
Categorization of Nursing Activities as Observed in Medical- - Educational Background
Surgical Ward Units in Selected Government and Private Hospitals - Length of work
in Manila. - Experience

Laurente believed that a nurse's intervention can affect a

patient's anxiety. Anxiety, a major factor in her theory, refers
to the mental state of fear or nervousness about what might
happen. There are three Nurse Caring Behavior that affects
patient anxiety:

Presence refers to the person to person contact between

the client and the nurses.

Concern refers to the development in time through mutual

trust between the nurse and the patient.

Stimulation refers to the nurse stimulation through

utilization of words that helps more than the powerful
resources of energy of person for healing.
 Theoretical Foundations
of Nursing
Rozzano Locsin
Advancing the Theory of Technological Competency as Caring in
Nursing: The Universal Technological Domain
"Technological competency as caring is the skilled demonstration
of intentional, deliberate, and authentic activities by experienced
nurses who practice in environments requiring technological
expertise."
Four Phase of Nursing Process:
KNOWING
• Understanding of the Patient as participant rather than
options of their care, Technology is use to gain further
knowledge essentially become a representation of a real version
but only in a moment of time
DESIGNING
• Both Nurse and Patient usually plan care activities in respond
of the patient desired
IMPLEMENTING & EVALUATING
• Is where the nurse follows through on the decided plan of
action. This plan is specific to each patient and focuses on
achievable outcomes, as for Evaluating the nurse applies all that
is known about a client and the client's condition, as well as
experience with previous clients, to evaluate whether nursing
care was effective.
VERYFYING KNOWLEDGE
• The ways knowing a person is made known through the use of
technology and nursing, the nurse gave a appreciation of
expertise and economy and knowledge of persons in a moment
 Theoretical Foundations
Ley G. Kuan
of Nursing
Retirement and Role Discontinuities Theory Change of Life is the period between near retirement and post
- Sister Letty G. Kuan is a nurse with Master’s Degree in retirement years. In medico-physiologic terms, this equates
Nursing and Guidance Counseling. with the climacteric period of adjustment and readjustment to
- Born on Nov. 25 another tempo of life.
- She also holds a Doctoral Degree in Education. For her vast Retiree is an individual who has left the position occupied for the
contributions to the University of the Philippines College of past years of productive life because he/she has reached the
Nursing faculty and academic achievements, she is now prescribed retirement age of has completed the required years
Professor Emeritus, a title awarded only to a few who met the of service.
strict criteria. Role Discontinuity is the interruption in the line of status enjoyed
- She had two Master’s Degrees, MA in Nursing and MS Education, or role performed. The interruption may be brought about by an
Major in Guidance Counseling, culminating in Doctor of Education accident, emergency, and change of position or retirement.
(Guidance and Counseling). Coping Approaches refer to the interventions or measures applied
In Kuan’s theory of retirement and role discontinuities, she to solve a problematic situation or state in order to restore or
values the effect of retirement as a phase of one’s life and its maintain equilibrium and normal functioning.
accompanying adjustments. She identified the determinants of
positive perceptions in retirement and positive reactions toward Determinants of positive perceptions in retirement and positive
role discontinuities. Health status, income, work status, family reactions toward role discontinuities:
constellation and self-preparation are identified. I think that 1. Health Status – refer to physiological and mental state of the
the most determinant factor of which is the self-preparation respondents, classified as either sickly or healthy.
considering that all the factors are also important. Self 2. Income – (economic level) refers to the financial affluence of
preparation is important especially in dealing with difficult life the respondent which can be classified as poor, moderate or
transitions. It is our way of preparing for the adjustments that rich.
we need to deal with in entering to a new stage of life. 3. Work Status
4. Family Constellation – means the type of family composition
About her Theory: “Retirement and Role Discontinuities” described either close knit or extended family where three more
Basic Assumptions and Concepts: generations of family members live under one roof; or distanced
Physiological Age is the endurance of cells and tissues to family, whose member live in separate dwelling units; or nuclear
withstand the wear-and-tear phenomenon of the human body. type of family where only husband, wife and children live
Some individuals are gifted with strong genetic affinity to stay together.
young for a long time. 4. Self-Preparation
Role refers to the set of shared expectations focused upon a
particular position. These may include beliefs about what goals or
values the position incumbent is to pursue and the norms that
will govern his behavior. It is also the set of shared expectations
from the retiree’s socialization experiences and the values
internalized while preparing for the position as well as the
adaptations to the expectations socially defined for the position
itself. For every social role, there is complementary set of roles
in the social structure among which interaction constantly
occurs.