JOYCE TRAVELBEE METAPARADIGM IN NURSING

Human-to-Human Relationship
Model
PERSON
“A nurse does not only seek to alleviate Person is defined as a human being.
physical pain or render physical care- she Both the nurse and patient are human
ministers to the whole person. The existence beings.
of suffering whether physical, mental or
spiritual is the proper concern of the nurse” HEALTH
Health is measured by subjective and
objective health. "A person's subjective
 Psychiatric nurse, educator and health status is an individually defined state
writer. of well-being in accord with self-appraisal of
 She was born in 1926 physical - emotional and spiritual status.
 In 1956 - Bachelor of Science degree
in nursing education at Louisiana ENVIRONMENT
State University.
She defined human conditions and
 And she completed her Master of life experiences encountered by all men as
Science Degree in Nursing from Yale sufferings, hope, pain and illness. These
University in 1959 conditions are associated to the
 She also started a doctoral program environment.
in Florida in 1973
 She passed away at the prime age of NURSING
47 after a brief sick.
Travelbee defined as an
 1952 - Psychiatric Nursing at DePaul interpersonal process whereby the
Hospital Affiliate School, New professional nurse practitioner assist and
Orleans. individual, family or community to prevent
 She taught Psychiatric Nursing at or cope with the experience of illness and
Charity Hospital School of Nursing in suffering and, if necessary, to find meaning
Louisiana State University, New York in these experiences.
University and University of
Mississippi. In 1970 - Project Director HUMAN-TO-HUMAN RELATIONSHIP MODEL
at Hotel Dieu School of Nursing in
New Orleans. How did Travelbee formulated her theory?
 Director - Graduate Education at  Experiences in nursing education
Louisiana State University School of
 Practice in Catholic charity
Nursing
institutions
 In 1963 - she started to publish Humanistic revolution- a return to focus on
various articles in nursing journals the caring function towards the ill person.
 FIRST book - Interpersonal Aspects of Ida Jean Orlando- the mentor of Joyce
Nursing. Travelbee
 SECOND book - Intervention in
Psychiatric Nursing: Process in the
One-to-One Relationship. "The nurse and the patient interrelate with
each other and by her description of the
purpose of nursing"

"Assist an individual, family, or community to

prevent or cope with the experience of illness
and suffering, and if necessary, to find
meaning in these experiences."
 SERIES OF INTERACTIONAL PHASES “A nurse is able to establish rapport because
she possesses the necessary knowledge and
skill required to assist ill person, and because
ORIGINAL ENCOUNTER
she is able to perceive, respond to, and
This is described as the first impressions by appreciate the uniqueness of the ill human
the nurse of the ill person and by the ill being."
person of the nurse.

The nurse and the patient perceive each

other in stereotyped roles.

EMERGING IDENTITIES
This is characterized by the nurse and the
patient perceiving each other as unique
individuals.

The bond of a relationship is beginning to

form. ACCEPTANCE BY THE NURSING COMMUNITY

PRACTICE
EMPATHY
The hospice is one good example in which
The ability to share in the other person's Travelbee's theory is applied.
experiences.

The hospice nurse attempts to build rapport

The result of the emphatic process is the
or a working relationship with the patient, as
ability to expect the behavior of the
well as with his significant others.
individual with whom or she empathized.

She stated that understanding illness and

TWO QUALITIES THAT ENHANCED THE
suffering enables the patient not only to
EMPATHY PROCESS
accept the sickness, but also to use it as a
1. Experience self-actualizing life experience.
2. The desire to understand another
person
EDUCATION
Nursing education appears to have
SYMPATHY identified the need to prepare nurses to
The nurse desire to alleviate the cause of the address the emotional and needs of the
patient's illness or suffering. patients.
The nurse create helpful nursing action as a
result of reaching the phase of sympathy. Travelbee's second book, “Intervention in
This helpful nursing action requires a Psychiatric Nursing: Process in One-to-One
combination of the disciplined intellectual Relationship, has been used in different
approach combined with the therapeutic nursing program.
use of self.
According to Travelbee's model, courses in
RAPPORT philosophy and religion would also be
helpful in preparing nursing students to
Described as the Nursing intervention that
fulfill the purpose of nursing student’s
lessens the patient's suffering.
sufficiency.
The ill person exhibits both trust and
confidence in the nurse.
The nurse and the sick person are relating as
human being to human being.
RESEARCH
Numerous sources in research studies have
cited some aspects of the One-to-One
relationship projected by Trvelbee. One
study by O'Connor, Wicker and Germino,
which is nearly related to some of Travebee
ideas, discovers how individuals who were
recently diagnosed with cancer described
their personal search for meaning

The researchers acknowledge nursing

interventions that would support this
process.
 IMOGENE M. KING
NOTABLE PUBLICATIONS
"INTERACTING SYSTEMS
FRAMEWORK AND GOAL
ATTAINMENT THEORY”  1964- Her First Theory Article
appeared in the Journal ‘Nursing
Science’ which was edited by Dr.
JANUARY 30, 1923-- NOVEMBER 24, 2007 Martha Rogers.

EDUCATIONAL BACKGROUND  1968- Her article “A Conceptual

Frame of Reference for Nursing” was
published in Nursing Research.
 1945- DIPLOMA IN NURSING at St.
John’s Hospital School of Nursing, St.
 1986- Her third book “Curriculum
Louis, Missouri.
and instruction in Nursing” was
published.
 1948- BACHELOR OF SCIENCE IN
NURSING EDUCATION at St. Louis
 1971- She published her book
University, Missouri
“Toward a Theory of Nursing:
General Concepts of Human
 1957- MASTER OF SCIENCE IN Behavior”. Her book was
NURSING at St. Louis University. subsequently awarded by the
American Journal of Nursing as the
 1961- DOCTOR OF EDUCATION at Book of the Year in 1973.
Teachers College, Columbia
University, New York.
 1981- The Manuscript of her book
entitled “A Theory for Nursing:
 1980- HONORARY PhD at Southern Systems, Concepts, Process” was
Illinois University published. She also authored several
book chapters and articles in
PROFESSIONAL BACKGROUND
professional journals.

 1945 to 1948- STAFF NURSE (variety ORGANIZATIONS

roles) at St. John’s Hospital.
 Member - American Nurses
 1961 to 1966- ASSOCIATE Association
PROFESSOR at Loyola University,
Chicago.  Member - Florida Nurses Association

 1966 to 1968- ASSISTANT CHIEF of

Research Grants Branch, Department  Member-Sigma Theta Tau
of Health, Education and Welfare of International
the United States of America.
 Founding Member -King
 1968 to 1972- DIRECTOR OF International Nursing Group (KING)
NURSING School of Ohio State
University, Columbus Recipient of JESSIE M. SCOTT AWARD in
1996
 NURSING METAPARADIGM Systems Model. The environment has a
direct exchange of information between the
internal and external environment.
The Model is composed of three
Interacting Systems; these are the Personal
NURSING
Interpersonal and Social Communication.
These are used to establish a Nurse-Patient - An act wherein the nurse interacts and
Relationship and utilized by the nurse to communicates with the client. The nurse
form a strong foundation for a dynamic and helps the client identify the existing health
interactive environment. King discussed the condition, exploring and agreeing on
three health needs of human beings: activities to promote health. The goal of the
nurse in King's Theory is to help the client
maintain health through health promotion
and maintenance, restoration, and caring for
 Need for Information,
the sick and dying.
 Need for care for illness prevention
and
 Need for total care when a person
doesn't have the capacity to help KING’S CONCEPTUAL FRAMEWORK
themselves

 Several Basic Assumptions

The Theory focuses on creating a positive  Three Interacting Systems
behavior that can be adapted both by the  Several concepts relevant for each
nurse and client to achieve goals established system
by the client with help of a nurse.
THE BASIC ASSUMPTIONS

PERSON
- an open system as spiritual being and  Nursing focus is the care of human
rational thinker who makes choices, selects being
alternative courses of action, and has the  Nursing Goal is the health care of
ability to record their own language and individuals and groups
symbols, unique. Holistic and have different  Human beings are OPEN SYSTEMS
need, wants and goals. interacting constantly with their
environment.
HEALTH
- ability of a person to adjust to the stressors INTERACTING SYSTEMS FRAMEWORK
that the internal and external environment
exposes to the client. It is the maximal use of • PERSONAL SYSTEM -how the nurse views
potentials that a person can perform to and integrates based from personal goals
achieve balance in one's health. Adjusting to and beliefs.
the environment bring the client back to
their usual roles (Activities of Daily Living)
before the reaction occurred. • INTERPERSONAL SYSTEM - how the nurse
interrelates with a co-worker or patient,
particularly in a Nurse Patient Relationship.
ENVIRONMENT
- the process of balance involving internal
and external interactions inside the social • SOCIAL SYSTEM- how the nurse interacts
system. Reactions from the interaction with co-workers, superiors, subordinates
between the internal and external and the client environment in general.
environment can be biological,
psychological, physical, social or spiritual.
External environment is the factor that exists
outside the boundary of the open system
while the Internal Environment is the exact
opposite as adapted by the Neuman's
 CONCEPTS FOR PERSONAL THE GOAL ATTAINMENT THEORY
SYSTEM
 PERCEPTION
The essence of this theory is that the
 SELF
nurse and the patient work together to
 GROWTH & DEVELOPMENT define and reach goals that they set
 BODY IMAGE together. The patient and nurse each
 SPACE perceive, judge, and act, and together the
 TIME patient and nurse react to each other and
interact with each other. At the end of this
process of communication and perceiving, if
a goal has been set a transaction is said to
CONCEPTS FOR have occurred.

INTERPERSONAL SYSTEM

 INTERACTION
 COMMUNICATION
 TRANSACTION
 ROLE
 STRESS

CONCEPTS FOR SOCIAL SYSTEM

 ORGANIZATION The nurse and patient also decide on

 AUTHORITY a way to work toward the goal that has been
decided upon, and put into action the plan
 POWER
that has been agreed upon. King believes
 STATUS
that the main function of nursing is to
 DECISION MAKING increase or to restore the health of the
patient, so then, transactions should occur
to set goals related to the health of the
patient.

After transactions have occurred and

goals have been defined by the nurse and
patient together, both parties work toward
the stated goals This may involve
interactions with other systems, such as
other healthcare workers, the patient's
family, or larger systems.

After the transaction has occurred,

and the goal has been set, King believes that
it is important for good documentation to be
practiced by the nurse. She believes that
documenting the goal can help to streamline
the process of goal attainment, making it
easier for nurses to communicate with each
other and other healthcare workers involved
in the process. It also helps to provide a way
to determine if the goal is achieved. This
 assessment of whether or not the goal has
been successfully achieved plays an
ANALYSIS
important end-stage in King's goal
attainment theory. SIMPLICITY
- The theory was a result of a careful
research study. It was based on the
existing evidences during her study.
Simplicity was maiantained even if
the theory presented different
complex concepts.
GENERALITY
- It was criticized for having limited
application in areas of Nursing in
which patients are unable to interact
completely with the nurse.
EMPIRICAL PRECISION
- The theory was formulated based on
empirical data that are observed
within the boundaries of the nurse-
patient relationship. It was noted
that the theory can be used to
measure the effectiveness of Nursing
care provide to clients.
DERIVABLE CONSEQUENCES
- The theory focuses to all the aspect
of the Nursing Process, thus it is
ACCEPTANCE BY NURSING COMMUNITY greatly applied to all these steps-
Assessment, Planning,
PRACTICE implementation and Evaluation.
- Utilized by professionals in most
specialty areas.
- Developed the GOAL ORIENTED
NURSING RECORD (GONR)
EDUCATION
- Nursing curriculum development and
practice application in Ohio State and
other universities.
RESEARCH
- Her worked served as a theoretical
basis for various studies.
- Kemppainen (1990)
- Alligood, evans and Wilt (1996)
- Sharts-Hopko (1996)
- Mckinney & Dean (2000)
- Gerstle (2001)
 APPLICATION

ASSESSMENT

DIAGNOSIS

IMPLEMENTATION
 dysfunctional, and manipulative are not
ROSEMARIE RIZZO PARSE consistent with humanbecoming
• Humanbecoming and humanuniverse are
“HUMANBECOMING SCHOOL OF presented as one word (Parse, 2007b).
THOUGHT”  Joining the words creates one
concept and further confirms the
idea of indivisibility
INTRODUCING THE THEORIST HUMANBECOMING

Nursing is a scientific discipline, the

 Distinguished Professor Emeritus at
practice of which is a performing art
Loyola University Chicago

 Fellow in the American Academy of THREE ASSUMPTION ABOUT HUMAN

Nursing BECOMING
• Initiated and is immediate past
chair of the Nursing Theory-Guided
1. Human becoming is freely choosing
Practice Expert Panel
personal meaning in situation in the
intersubjective process of relating
 Founder and editor of Nursing value priorities.
Science Quarterly
2. Human becoming is co-creating
 President of Discovery International rhythmic patterns or relating in
mutual process in the universe
 Founder of the Institute of Human
becoming.
3. Human becoming is co-transcending
 Graduate of Duquesne University in multidimensionality with emerging
Pittsburgh possibilities.

PRINCIPLES
 Earned master's degree and
doctorate from the University of
Pittsburgh  Humans construct personal realities
with unique choosing arising with
illimitable human universe options
OVERVIEW
 Rhythmical human universe patterns
 Original work was named Man- of relating
Living-Health: A Theory of Nursing o Revealing-concealing,
(1981). Enabling-limiting,
Connecting-separating
• When the term mankind was
replaced with male gender in the dictionary
definition of man, the name of the theory  Humans are ever-changing, that is,
was changed to human becoming (Parse, moving on with the possibilities of
1992). their intended hopes and dreams.
o Powering, originating,
FUNDAMENTAL IDEA
transforming.

• Humans are indivisible, unpredictable, and

ever-changing
• Precludes any use of terms such as
physiological, biological, psychological, or
spiritual to describe the human.
• Other words often used to describe
people, such as noncompliant,
 HUMANBECOMING: THE ART

THE GOAL OF THE NURSE

Living the humanbecoming beliefs is
true presence in bearing witness and being
with others in their changing health
patterns.

HUMAN BECOMING NURSES

 Believe persons know their way and

live their health situations according
to their unique value priorities.
• Ask what is most important for the
moment
Explore meanings, wishes, intents,
and desires related to the situation from the
perspective of the recipients
 Humanbecoming nurses are with
persons in ways that honor their
wishes and desires

METAPARADIGM

PERSON
A major reason for nursing existence.

ENVIRONMENT
Man and environment interchange energy
to create what is in the world, and man
chooses the meaning given to the situations
he creates

HEALTH
A lived experience that is a process of being
and becoming

NURSING
Nursing Practice is directed toward
illuminating and mobilizing family
interrelationships in light of the meaning
assigned to health and its possibilities as
language in the co-created patterns of
relating.
 KEY THEME: FOCUS AND INTENTION OF NURSING

ANNE BOYKIN FOCUS OF NURSING

AND Persons living in caring and growing in caring

SAVINA O. SCHOENHOFER INTENTION OF NURSING

Nurturing persons living and growing in
caring.

NURSING ASACARING
A THEORY KEY THEME: NURSING SITUATION

THEORY ASSUMPTION
 A shared lived experience in which
caring between the nurse and
nursed enhances personhood
• Reflect a set of values and key themes that
provide a basis for understanding and • Involves values, intentions and
explicating the meaning of nursing. actions of two or more persons choosing to
live a nursing relationship
 Nursing is created in the "caring
ASSUMPTIONS OF NURSING AS CARING between"
 All knowledge of nursing is
 Persons are caring by virtue of their understood within the nursing
humanness. situation
 Persons are whole and complete in
the moment. KEY THEME: PERSONHOOD
 Persons live caring moment to
moment.
 Personhood is living grounded in
 Personhood is a way of living
grounded in caring. caring.
 Personhood is the universal human
 Personhood is enhanced through call.
participation in nurturing  Understanding communicates the
relationships with caring others. paradox of person as-person and
 Nursing is both a discipline and a person-in-communion all at once.
profession.

KEY THEME: CALL FOR NURSING

KEY THEME: CARING

 Call for acknowledgement and

 Altruistic, active expression of love affirmation of the person living and
 Intentional and embodied caring in specific ways in the
recognition of value and immediate situation (Boykin &
connectedness Schoenhofer, 1993,2009)
 Nursing uniquely focuses on caring as  Calls for nurturance through
its central value Illuminated in the personal expressions of caring
experience of caring and in reflection  Originates within persons
on that experience  Intentionality and authentic
presence open the nurse to hear calls
for nursing
KEY THEME: NURSING RESPONSE

 Specific expression of caring

nurturance to sustain and enhance
the "other" as he or she lives caring
and grows in caring in the situation of
concern
 Uniquely created for the moment
 Cannot be predicted or applied as
preplanned protocols

THE USEFULNESS OF THIS THEORY IS

PRACTICE

 Nursing practice intentionally

focused on coming to know a person
as caring and nurturing and
supporting those nursed as they live
caring leads to:
• Increased patient and nurse
satisfaction
• Increased retention of nurses
• Environment of care becoming
grounded in values of and respect for
person
 THREE PERSPECTIVES
MARGARET NEWMAN
1. UNITARY-TRANSFORMATIVE: a
“unitary, self-organizing field
THEORY OF HEALTH AS EXPANDING embedded in a larger self-organizing
CONSCIOUSNESS field. It is identified by pattern and by
interaction with the larger whole”
(Newman, Sime, & Corcoran-Perry,
BACKGROUND 1991, p4)

 Change is unpredictable
While caring for her mother, who had and unidirectional, always
amyotrophic lateral sclerosis, Newman moving toward a higher
realized that both her mother and Newman level of complexity.
encountered alterations in movement,
 Knowledge is arrived at
space, time, and consciousness. This
through pattern
realization led to her doctoral studies with
recognition and reflects
Martha Rogers at NYU.
both the phenomenon
EARLY INFLUENCES ON HEALTH AS viewed and the viewer.
EXPANDING CONCIOUSNESS (HEC) THEORY

2. PARTICULATE-DETERMINISTIC AND
 MARTHA ROGERS INTERACTIVE-INTEGRATIVE
 ITZHAK BETHOV generate data that are relevant to
 PERSONAL EXPERIENCE nursing.

3. UNITARY-TRANSFORMATIVE
THE THREE PERSPECTIVES
PARADIGM generates data that are
essential to nursing (the knowledge
 Particulate-deterministic: of the discipline)
Phenomena are isolatable,
deterministic, and measurable. THE CONCEPT OF PATTERN
- Relationships between entities are
orderly, predictable, linear, and
causal.  Constantly unfolding and evolving as
- Health has clearly defined the person interacts with the
characteristics: healthy or unhealthy environment. Pattern is information
change occurs in a predictable, that depicts the whole of a person’s
casual way. relationship with the environment
and gives an understanding of the
FIRST ENUNCIATION OF HEC THEORY meaning of the relationship all at
once (Endo, 1998; Newman, 1994a)
 Pattern is a manifestation of
 Health is an expansion of consciousness.
consciousness.
 “The responsibility of the nurse is not THE NURSE-CLIENT RELATIONSHIP
to make people well, or to prevent
their getting sick, but to assist people
to recognize the power that is within  Patient, in chaos caused by trauma,
them to move to higher levels of cannot see past or future clearly.
consciousness.” (Newman,1978) Nurse-patient partnership helps
patient gain insight for action, how to
get on with life.
 EXPANDING CONSCIOUSNESS

 Consciousness is the information of

the system. The capacity of the
system to interact with the
environment.
 Not only all the thigs we normally
associate with consciousness, such as
thinking and feeling, but also all the
information embedded in the
nervous system, the immune system,
the genetic code, and on.
 The information of these and other
systems reveals the complexity of
the human system and how the
information of the system interacts
with the information of the
environmental system (Newman,
1994a p 33)

APPLYING HEC

 The nurse should ask clarifying

questions to come to an
understanding of the patient.
 The nurse should be open, caring,
and non-judgmental in this
clarification process.
 The nurse understands rather
than predicts cause and effect.
 Be fully present in unconditional
acceptance.
 Caring relationship of pattern
recognition makes it possible to
understand meaning.
 Be open to new
perspective/possibilities.
 Pattern is characterized by meaning
and is a manifestation of
consciousness.
 THE “CALL” FOR NURSING
JOSEPHINE PATTERSON
AND  The call for nursing is the call from
humanity to maintain the
LORETTA ZDERAD humanness in the health-care
system.
 The context of Humanistic Nursing
“HUMANISTIC NURSING THEORY” Theory is humans.
 The basic question it asks of nursing
ORIGINS OF THE THEORY practice is: Is this particular
intersubjective-transactional nursing
event humanizing or dehumanizing?
 Arose from collaborative work
related to “existential
phenomenology” by
PROCESS OF HUMANISTIC NURSING
o DR. JOSEPHINE PETERSON-
focus on education, public  CALL AND RESPONSE
health nursing, doctoral
study of comfort
o DR. LORETTA ZDERAD- focus CALL
on education, mental health
- From a person, a family, a
nursing, doctoral study of
community, or from humanity for
empathy.
help with a healthcare issue
 Further developed and brought to
nursing situations by AND REPRESENTS THE NURSING
o SUSAN KLEINMAN- former
student.
RESPONSE
- By a nurse or a community of nurses
HUMANISTIC NURSING THEORY in a manner that is intended to help
the caller with the health-related
need.
 Born out of Paterson’s and Zderad’s
search for ways to make things PHASES OF HUMANISTIC INQUIRY
better for nurses and patients.
 Originally formulated to define
nursing as nurses respond to the call Each phase is interwoven as the constant
of a human need. flow between phases emanates toward a
 Illuminate the values and meanings centre that is nursing:
central to nursing experiences
1. Preparation of the nurse knower
 Multidimensional
2. Nurse knowing the other intuitively
 Speaks to the essence of nursing
3. Nurse knowing other scientifically
 Embraces the dynamics of being, 4. Nurse complementarily synthesizing
becoming, and change known others
 Interactive theory of nursing that 5. Succession within the nurse from the
provides a methodology for many to the paradoxical one.
reflection and articulation of nursing
essences.
 Theory that provides a
methodological bridge between
theory and practice by providing a
broad guide for nursing “dialogue” in
a myriad of settings.
HUMANISTIC NURSING THEORY:
APPLICATION EXAMPLES

 PRACTICE: clinical supervision

 RESEARCH: The lived experience
 Policy: Developing a community of
nurses
 IDA JEAN ORLANDO MAJOR COMPONENTS
 NURSING PROCESS
 UNDERSTANDING THE MEANING
INTRODUCING THE THEORIST  NURSE-PATIENT INTERACTION
 PROFESSIONAL NURSES

 First book was The Dynamic Nurse-

Patient Relationship: Function,
 The human transaction between the
Process, and Principles (1961)
nurse and the patient in any setting
 Second book was The Discipline and
holds the greatest value.
Teaching of Nursing Process (1972)
 National Institute of Mental Health
funded study to improve education PRACTICE APPLICATIONS
of nurses about concepts and
interpersonal relationships.  Is used to study nursing practice
 Method of study was qualitative and  Underpins the nursing practice
inductive, using the naturalistic  States what nursing is or should be
inquiry method. today
 First theory of nursing practice  Serve as philosophy as well as a
theory

EDUCATIONAL BACKGROUND THE DYNAMIC NURSE-PATIENT

RELATIONSHIP
 Ida Jean Orlando, born 1926 in New
York  Conceptualized The Dynamic Nurse-
 Earned diploma in nursing from New Patient Relationship Model
York Medical College School of  She believed that the nurse helps
Nursing patients meet a perceived need that
 Earned Bachelor of Science the patient cannot meet for
degree in Public Health Nursing form themselves.
St. John’s University in 1951  Orlando observed that the nurse
 Earned Master’s degree in nursing provides direct assistance to meet an
from Columbia University 1954 immediate need for help in order to
avoid or to alleviate distress or
helplessness
 She emphasized the importance of
THEORY OF DYNAMIC NURSE-
validating the need and evaluating
PATIENT RELATIONSHIP
care based on observable outcome.
 To interact with clients to meet
immediate needs by identifying
 Nursing is concerned with providing
client behaviours, nurse’s reactions,
direct assistance to individuals in
and nursing actions to take
whatever setting they are found for
the purpose of avoiding, relieving,
diminishing or curing the individual’s
sense of helplessness (Orlando,1972)
 Practice should be based on the
needs of the patient.
 Communication is essential to
understanding needs and providing
effective nursing care.
 METAPARADIGM

PERSON
- Unique individual behaving verbally
nonverbally. Assumption is that
individuals are at times able to meet
their own needs and at other times
unable to do so
ENVIRONMENT
- Not defined but assumed as a nursing
situation when there is a nurse-
patient contact and that both nurse
and patient perceive, think, feel, and
act in the immediate situation

HEALTH
- Not defined
- Assumption is that freedom
from/being without emotional or
physical discomfort and having a
sense of well-being contribute to a
healthy state.

NURSING
- Professional nursing is
conceptualized as finding out and
meeting the client’s immediate need
for help
- Providing direct assistance to
individuals in whatever setting for
the purpose of avoiding, relieving,
diminishing, or curing the person’s
sense of helplessness.
 interpretations and social
MADELEINE LEININGER interactions in a particular physical,
ecological, socio-political and/or
“TRANSCULTURAL THEORY” cultural setting.

Care is the heart of nursing; Care is power, HEALTH

Care is essential to healing; Care is curing; - Health is a seen as being universal
and Care is the central and dominant focus across cultures but distinct within
of nursing and transcultural nursing each culture in a way that represents
decisions and actions. the beliefs, values, and practices of
the particular culture.
THE LIFE OF MADELEINE LEININGER NURSING

Influence in DEVELOPING THE THEORY - It is a studied scientific and

humanistic profession and discipline
 In the mid-1950’s, she went through that centres on human care activities
what she relates to as a cultural that assist, support, facilitate, or
shock while she was a nurse in a enable individuals or groups to
child guidance home in the maintain or regain their well-being
Midwestern United States. (or health) on culturally meaningful
 While working as a clinical nurse and beneficial ways, or to help
specialist with distributed children people face handicaps or deaths.
and their parents, she observed
recurrent behavioural differences TRANSCULTURAL THEORY
among the children and concluded
that these differences had a cultural
base. CULTURE CARE DIVERSITY AND UNIVERSITY
 She identified a lack of knowledge of - First presented in 1985.
the children’s cultures as the missing - Claimed that:
chain in nursing to understand the “Different cultures perceive,
variations in care of clients. know, and practice care in
 This experience led her to become different ways yet there are
the first professional nurse in the some commonalities about
world to earn a doctorate in care among all cultures of the
anthropology, and led to the world.”
development of the new field of - Universality (Commonalities)
Transcultural Nursing as a subfield of - Diversity (differences)
nursing.

METAPARADIGM She defined CULTURE as

the “learned, shared, and transmitted
PERSON values, beliefs, norms and lifeways of a
particular group that guides their thinking,
- Human Beings are believed to be decisions, and actions in patterned way”
caring and capable of being
concerned about the desires, - Culture can be seen in the actions,
welfare, and continued existence of words, rules and standards, symbols
others. and behaviour patterns of people.
- Culture is learned and THEN HANDED
ENVIRONMENT DOWN FROM GENERATION TO
- Environment framework is defined GENERATION.
as being the totality of an event,
situation, or experience that gives
meaning to human expression,
 KEY COMPONENTS
CULTURE CARE
CULTURAL DIVERSITY The subjectively and objectively
obtained values, beliefs, and outlines of the
By recognizing the variations the nurse can
lifeways that assist, support, facilitate, or
avoid:
empower another individual or group to
 The problem of stereotyping (using maintain well-being, health, and deal with
general standards) illness, handicaps, or death.
 Assuming that all people will react to
WORLDVIEW
the same nursing care
The method people seem to look out
CULTURAL UNIVERSALITY
on the world and/or universe to form a
 “to discover similarities and picture or value perception about their life
differences about care and its impact or world around them.
on the health and well-being of CULTURAL AND SOCIAL STRUCTURE
groups” DIMENSIONS
THE SUNRISE MODEL The changing patterns related to the
arrangement or organizational factors of a
particular culture (subculture or society),
 Developed to give a holistic and which includes religious, kinship (social),
comprehensive conceptual picture of political (and legal), economic, educational,
the major factors held as important technological, and cultural values and ethno
to the Theory of Culture Care historical factors.
Diversity and Universality.
 The model is a conceptual visual TECHNOLOGICAL FACTORS
guide depicting multiple factors - Refers to the use of electrical,
predicted to influence culturally mechanical, or physical (nonhuman)
congruent care with people of objects used in the service of
different cultures. humans.
 The model essentially serves as a
cognitive guide for the researcher to RELIGION AND SPIRITUAL FACTORS
visualize and reflect on different - Refers to the supernatural and
factors predicted to influence natural beliefs and practices that
culturally based care in the discovery guide individual and group thoughts
process. and actions toward the good or to
improve one’s lifeways.
KINSHIP AND SOCIAL FACTORS
- Refers to family intergenerational
linkages and social interactions
based on cultural beliefs, values, and
recurrent lifeways over time.
ENVIRONMENTAL CONTEXT
The summation of an event, situation, or
particular experience that gives meaning to
human expression, particularly physical,
ecological, socio-political and/or cultural
situations.
\ETHNOHISTORY HEALTH
- Past facts, events and experiences of The state of well-being that is defined
individuals, groups, and various through cultures valued and practiced, and
cultures and institutions that are reflects the ability of individuals to
mainly people centered (ethics) and performed their daily role activities in
that explains, and interprets human culturally expressed, beneficial and
life ways within particular cultural patterned styles.
trends.
POLITICAL FACTORS
- Refers to authority and power over
others that regulates or influences INDIVIDUALS, FAMILIES, COMMUNITIES
another’s actions, decisions, or AND INSTITUTIONS IN DIVERSE HEALTH
behaviour. CONTEXT

ECONOMIC FACTORS
GENERIC (FOLK OR LAY) CARE SYSTEM
- Refers to the production,
distribution, and use of negotiable Cultural studied and given
material or consumable productions indigenous (or traditional), folk (community
held valuable to humans or in need and home-based) knowledge and skills used
by humans. to provide assistive, supportive, enabling, or
facilitative acts toward or for another
EDUCATION FACTORS individuals, groups, or institution with
- Refers to formal and informal modes evident or anticipated needs to ameliorate
of learning or acquiring knowledge or improve a human lifeway or health
about specific and diverse subject condition (or well-being), or to deal with
matter domains. handicaps and death situations.

PROFESSIONAL CARE SYSTEM

Formally educated, and instructed
professional care, health, illness, and
practices skills that exist in professional
institution usually with multidisciplinary
personnel to give service to clients.

CULTURAL CARE PRESERVATION

MAINTENANCE
Caring skilled actions and decisions
that people of a certain culture retain
important care values so that they can keep
up their well-being, remove from illness, or
face handicaps or deaths.

CULTURE CARE ACCOMODATION

NEGOTIATION
The supporting, facilitative, or
enabling specialized action and decisions
that help people of designated culture to
adapt to others for a beneficiary or satisfying
health outcome with professional care ANALYSIS OF THE THEORY
providers.
CULTURAL CARE REPATTERNING
SIMPLICITY
RESTRUCTURING
- Has a wide and holistic standpoint of
The assistive, sustaining, facilitative,
human population and is
or enabling professional actions and
transcultural and universal in scope.
decisions that help clients greatly change
- Requires Transcultural Nursing
their lifeway for new, different, and
knowledge and fitting research
beneficial health care patterns while
methods to explain the phenomena.
regarding the clients cultural values and
- Applicable worldwide
benefits and still giving a beneficial or
healthier lifeway before the changes were
lead out with the clients.
GENERALITY
- The Transcultural Theory does not
CULTURAL CONGRUENT CARE demonstrate the criteria of
generality.
The cognitively-based assistive,
- In fact, Transcultural Nursing theory
caring, facilitative, or empowering acts or
addresses nursing care from a
decisions that are made to fit with individual,
multicultural and worldwide
group, or institutional cultural values,
perspective.
beliefs, and satisfying healthcare or well-
- Findings from the theory are being
being services.
used presently in client care.
EMPIRICAL PRECISION
ACCEPTANCE BY THE NURSING
COMMUNITY - Researchable and qualitative
research has been primary paradigm
to discover largely unknown
PRACTICE
phenomena of care and health in
Prepares the nurse to prevent diverse cultures
culture shock and conflicts as they practice - This qualitative approach differs
in the different places with different from the traditional quantitative
cultures. research method, which renders
measurement goals of research.
- Provides human care and health
- Ongoing and future research will lead
behaviours as background
to additional care and health findings
knowledge to understand nursing
and implications for ethno nursing
phenomena.
practices and education to fit specific
EDUCATION cultures and universal features.

- Helps produce a well-qualified DERIVABLE CONSEQUENCES

faculty prepared in Transcultural
- Has important outcomes for nursing
nursing to teach and guide students.
- Rendering culture-specific care is an
- Education in Transcultural nursing
essential goals in nursing
leads to culturally competent nursing
- Highly useful, applicable, and
care.
essential to nursing practice,
RESEARCH education, and research.
- Means to establish a sound and
- Used by many nurses these days
defensible discipline and profession,
because the theory is the only one in
guiding practice to meet a
nursing focused on culture care.
multicultural world because it has a
- Includes research
broad and multicultural focus.
method/techniques of ethno-
nursing to examine theories.
 CARMELITA DIVINAGRACIA COMPOSURE is a set of behaviors
determined by Dr. Divinagracia that would be
COMPOSURE MODEL demonstrated by advanced nurse
practitioners to see how it would affect the
ABOUT THE THEORIST recovery of the patients in the Coronary Care
Unit of the Philippine Heart Center.
◦ Dr. Carmelita Divinagracia is one of the COMPOSURE is an acronym that stands for
most influential nurses in the country Competence, Presence and Prayer, Open-
◦ Divinagracia was part of the pioneer class mindedness, Stimulation, Understanding,
of University of Ramon Magsaysay Respect and Relaxation, Empathy
Medical Center Inc. – College of Nursing in
1962. COMPETENCE
◦ In 1975, she earned her Master’s Degree Nurses should be equipped with
in Nursing from the University of the knowledge and expertise in consistency in
Philippines. caring for their patients.
◦ In 2001, she received her Doctoral Degree
PRESENCE NAD PRAYER
Pertains to the availability of the
from the same University.
nurse in time of need not only physically but
◦ She was a former President of the also holistically. Utilization of therapeutic
Association of Deans of Philippine communication techniques are also included
Colleges of Nursing. OPEN MINDEDNESS
Nurses should be receptive to different
ABOUT THE THEORIST ideas such as opinions and preferences
◦ Divinagracia worked as a staff nurse and regarding the patient’s medical status. It also
conveys the manner of being flexible to
clinic nurse.
accommodate the views of others.
◦ She started to work in UERMMM- CON as STIMULATION
faculty member where later on she was Stimulation is an act of providing
assigned as the College Dean. encouragement and appreciation that
◦ She was once a member of the Board of delivers hope and guidance in the form of
positive encouraging remarks.
Nursing and Commission on High
Education’s Technical Committee in COMPOSURE BEHAVIORS
Nursing. UNDERSTANDING
ADVANCED NURSE PRACTITIONERS’ - It is an approach that conveys interest and
COMPOSURE BEHAVIOR AND PATIENTS’ acceptance to the patient’s holistic being.
WELLNESS OUTCOME RESPECT
Nursing is one of the fundamental and - Acknowledging the presence of the
essential parts of the healthcare profession. patients and showing positive regard
Formulation of necessary techniques in order RELAXATION
to help in the recovery of patients in the
health care setting was explored to help them - Entails a form of exercise that involves
achieve their optimum level of functioning alternate tension and relaxation of
selected group of muscles.
ASSUMPTION EMPATHY
The wellness outcome of a patient will - The empathic nurse perceives the current
depend on the intervention the nurse has positive thought and feelings and
when administering the client communicates by putting himself in the
patient’s place.

PATIENT WELLNESS OUTCOME

.  BEHAVIORAL OUTCOME
Physical
Emotional
COMPOSURE BEHAVIORS Intellectual
Spiritual
  PHYSIOLOGIC OUTCOME
Vital Signs • A significant difference exists in the pre-
Chest pain test and post- test scores of the
Hemoglobin wellness outcome after the
COMPOSURE behaviour intervention in
SYSTEM VALUES the three (3) groups.
health - not taking health for granted. The
health of the patient is valued.
• The nursing profession can actively
deliver quality care through bio-
intervention - action taken to improve a behavioural caring interventions like
situation, especially a medical disorder. the COMPOSURE behaviors regardless
wellness - becoming aware of and making of creed, social class, gender, age, and
choices toward a healthy and fulfilling life. nationality. Each one needs humane
caring spiritually- oriented
MAIN UNITS interventions that can facilitate
Aim of nursing wellness
Divinagracia would like to prove the
worth of Nursing as a healthcare profession
of being par in quality with other healthcare
professionals.
Client / Patient
Her study population consisted of
Adult Cardiac Patients admitted and confined
at the Philippine Heart Center, Coronary Care
Unit.
Role of Nurses
Nurses, specifically Advance Nurse
Practitioners are to use the COMPOSURE
behavior when administering the client.
Source of problems
There are clients who do not receive
quality care thus resulting in poor wellness
outcome.
Focus of Interventions
The intervention focuses on patients
in the Coronary Care Unit which should
receive quality care by the use of
COMPOSURE behavior from Advanced Nurse
Practitioners.
Ways of intervention
Divinagracia’s COMPOSURE behavior
is used when providing care to the patient to
achieve wellness.
Results
The nursing profession can actively
deliver quality care through caring
interventions like the COMPOSURE behavior.
Regardless of creed, social class, gender, age
and nationality, each one needs humane,
caring, spirituality-oriented intervention that
can facilitate wellness.

FINDINGS AND RECOMMENDATIONS

• The socio demographic characteristics
of the participants specifically gender
and are are related to the wellness
outcome of adult cardiac patients.
 CECILIA LAURENTE Enhancing & Predisposing Factors

Theory of nursing practice and career Enhancing Factors

 One's caring experience, beliefs and
Background attitude.
Cecilia Laurente is a Filipino Nursing  Feeling good about work
theorist whose works focused primarily on  Learning caring at school
helping a patient through support systems,  What patients tell about the nurse
specifically the family. coping mechanism to problems
Published a paper titled "Categorization encountered.
of Nursing Activities as Observed in Bedical-
Surgical Ward Units in Selected Government Predisposing Factors
and Private Hospitals in Manila". Age
Sex
Background Civil Status
1967- Graduate Bachelor of Science in Educational Background
Nursing at University of the Philippines. Length of work
1973- Masters of Nursing Experience
1968-1969- Staff Nurse
1970-1972- Head Nurse Background
1973-1976- Nursing Supervisor at Philippine Communication is key when getting
General Hospital nurses to engage patients and families in
1977-1979- Metropolitan Hospital at their care.
Michigan USA. Research to develop the guide found that
1979- Instructor at University of the communication gaps between patients
Philippines College of Nursing. and caregivers can occur when hospitals do
1996-2002- Dean of College of Nursing UP not address the issues that patients
Manila think are most important. Another factor is
the availability at few tools are to give
Theory of nursing practice and career health providers insights into patients' needs
and concerns.
Overview As a result, efforts by patients,
The theory was from her study, the families and health providers to
Categorization of Nursing Activities as communicate more effectively with each
Observed in Bedical-Surgical Ward Units in other can fall short of their goal. Each
Selected Government and Private Hospitals in strategy includes educational tools and
Metro Manila, which was conducted from resources for patients and families, training
January to June year 1987. materials for health care professionals and
real-world examples that show how
Anxiety strategies are being implemented in hospital
A mental state of fear or nervousness about settings.
what might happen The strategies describe how patients
and families, working with hospital staff, can:
Nurses Caring Behavior that affect the patient be advisors; promote better communication
anxiety: at the bedside to improve quality; participate
in
PRESENCE bedside shift reports; and prepare to leave
- person to person contact between the client the hospital.
and the nurses
CONCERN Nursing Theory
- development in the time through mutual "Categorization of Nursing Activities as
trust nurse and the patient. Observed in Medical- Surgical Ward Units in
STIMULATION Selected
-nurse stimulation through words tops the Government and Private Hospitals in Metro
powerful resources of energy of person for Manila"
healing. • Theory of nursing practice and career
In the recent study of Laurente she
states that the another entry
point of helping the patient is though the
family, when nurses can
be of great assistance to prevent at the very
beginning serious
complications. The nurse can help strengthen
the family’s term of
knowledge, skills, and attitude through
effective
communication. Employed informative,
psychotherapeutic,
modeling, behavioral, cognitive-behavioral,
and/or hypnotic
techniques are summarized and evaluated
 DR. ROZZANO LOCSIN • Technological Competency as Caring
in Nursing
Technological Competency as Caring in • The Evolution of the Theory of
Nursing Technological Competency as Caring
“My commitment to service in nursing is in Nursing
evident in my current and future endeavours.
I sustain a program of service that includes • Nursing Robots; Robotic Technology
teaching and research in various settings, and Human Caring for the Elderly.
particularly in the international arena. I
believe that the smallness of the world has Awards
created a more diverse global citizenry. • Fulbright Scholar Award Florida
Appreciating this diversity further one’s Center for the International Exchange
commitments to knowing others as
of Scholars, Washington, D.C.
participants in the drama of what it is to be
in this world. Further, I exercise my vision of • Excellence in Undergraduate
service in nursing as the appreciation of the Teaching Florida Atlantic University,
integral nature and value of globalization.” Boca Raton, Florida 2003

Biography • Julita V. Sotejo Medaliion of Honor;

 Born in March 25, 1954, Manila Lifetime Achievement Award,
Philippines University of the Philippines, Nursing
 He is a registered nurse, a native of Alumni International Inc., Los
Dumaguete City Angeles, California 2003
 known for the Technological
Competency as Caring in Nursing • Edith Moore, Copeland Award for
 practiced his nursing profession at Excellence in Creativity (Founder’s
Tokushima University, Japan as a Award) Signma Theta Tau
professor of nursing International Honor Society of
 Professor emeritus in Florida Atlantic Nursing-Indianapolis (37th Biennial
University in Boca Raton, Florida, US Convention) 2003
 In 1991, Locsin joined Florida Atlantic
Universtiy Kristin College of Nursing • University Research of the Year-
where he was a tenured professor of Professor, Scholarly and Creative
nursing and now a professor of works, FAU 2003Academic Excellence
Emeritus. Award, Philippine American Society,
 Earned his PhD in Nursing from 2010
University of the Philippines in 1988
Assumptions
 Earned his MA in Nursing and
Bachelor of Science in Nursing from Technological Competency as Caring in
Siliman University in 1978 and 1976 Nursing
respectively in the Philippines
 Multi-awarded nurse scholar and is a middle range theory grounded in
educator. Nursing as Caring (Boykin & Schoenhofer,
 Fellow of the American Academy of 2001). It is illustrated in the practice of
Nursing and Philippine-American nursing grounded in the harmonious
Academy Science and Engineering coexistence between technology and caring
in nursing.
Published Books
The assumptions of the theory are:
• Technology and Nursing; Practice,
Concepts and Issues • Persons are caring by virtue of their
humanness (Boykin & Schoenhofer, 2001).
• Advancing, Technology, Caring and
Nursing • Persons are whole or complete in the
moment (Boykin & Schoenhofer, 2001).
• A Contemporary Nursing Process; The
(Un)Bearable Weight of Knowing in • Knowing persons is a process of nursing
Nursing that allows for continuous appreciation of
persons moment to moment (Locsin, 2005).
• Technology is used to know wholeness of DESIGNING
persons moment to moment (Locsin, 2004).
⁃ Both the nurse and the one nursed
• Nursing is a discipline and a professional (patient) plan mutual care process
practice (Boykin & Schoenhofer, 2001). from which the nurse can organize a
rewarding nursing practice that is
Dimensions of Technological Value in the responsive to the patient’s desire for
Theory care.
• Technology as completing human PARTICIPATION IN APPRECIATION
beings.
⁃ The simultaneous practice of
• Technology as machine technologies. conjoined activities which are crucial
to knowing persons.
• Technologies that mimic human
beings and human activities VERIFYING KNOWLEDGE
⁃ The continuous, circular process
Technological Competency as Caring in
demonstrates the ever-changing,
Nursing
dynamic nature of knowing in
• Technological competency as caring nursing.
in nursing is the harmonious Metaparadigm
coexistence between technologies
and caring in nursing. PERSON

• The harmonization of these concepts Defines a human being as that of a

places the practice of nursing within “whole” person, complete in the moment
the context of modern healthcare and continually growing, changing in
and acknowledges that these response to unique personal conditions and
concepts can co-exist. experiences. He believes that a person is
appreciated through his or her component
• Technology brings the patient closer parts, including sensory data about a person
to the nurse. obtained through technology.
• Technology can increase the gap ENVIRONMENT
between the nurse and nursed.
Environment centers mainly on the
• When technology is used to know technological world, Technology use allows
persons continuously in the moment, greater insights of the whole state of health.
the process of nursing is lived.
HEALTH
Health, according to Locsin, is the
“enhancing of personhood” allowing each
person to develop and progress moment.
Humanity is preserve by technology.

NURSING
Locsin expressed that compassion,
confidence, commitment and conscience are
all essential components of caring in nursing”
THE PROCESS OF NURSING
KNOWING Nurses value technological
⁃ The process of knowing person is competency as an expressed of caring in
guided by technological knowing in nursing”
which persons are appreciated as
participants in their care rather than
as objects of care.
⁃ The nurse enters the world of the
other.
 ACCEPTANCE BY NURSING COMMUNITY
 Practice
 Education
 Research

ACCURACY
Technology continues to evolve and
encompasses the majority of functional
activities that nurses are expected to
perform, especially in a clinical setting.
SIMPLICITY
The relationships noted in Locsin’s theory
include three main components of “caring in
nursing, human beings as person and
technological competence”.
SCOPE
The scope of Locsin’s theory is narrow
using technology, caring and knowing
persons.
SOCIO-CULTURAL
Nursing occurs in critical care settings
when technologies are used competently
with the genuine purpose to know patients
wholly.
 SISTER LETTY G. KUAN THE THEORY: SUMMARY
EDD, RN, MAN, MSN
The Theory of Sister Letty G. Kuan is
“ I have grown and sown and now I about “Graceful Aging”. Her interest in old
can reap the reward and blessing of people initiated her to formulate a theory for
a life lived in joy and love, for I too the purpose of knowing the reasons and
have made others grow.” variables on how to make people happy at
retirement by conceptualizing a framework:
Acquisition, Struggles and Legacy.
BIOGRAPHIC SKETCH
Sister Letty Kuan was born on November
19, 1936 in Katipunan-Dipolog,
Zamboanga Del Norte.
Kuan’s Retirement and Role Discontinuities
She obtained her basic nursing degree from
Background, Conceptual Model, &
the Southern Islands Hospital, School of
Metaparadigm
Nursing and studied her supplemental
Basic Assumptions and Concepts, &
baccalaureate nursing degree at St. Paul
Determinants
College Manila.
Findings and Recommendations
Application & Analysis and Evaluation
She obtained her Master of Arts in Nursing
in 1975, Master of Science in Cousellor
Background
Education in 1979, and Doctor of Education
Retirement is an inevitable change in
major in Guidance Counselling in 1985, all
one’s life. It is evident in the increase
from the University of the Philippines.
statistics of aging population accompanied by
related disabilities and increase dependence.
She obtained high honors and academic
This development stage, even at the later
excellence in all her academic
part of life, must be considered desirable and
accomplishments.
satisfying through the determination of
factors that will help the person enjoy his
Additionally, Kuan did not stop to expand
remaining years of life. It is of primary
her expertise, she attended various trainings,
importance to prepare early in life by
seminars, and fellowships in Neurosciences
cultivating other rile options at the age of 50
focusing on Neuro-Gerontology from several
to 60 in order to have a rewarding retirement
hospitals abroad including La Salpetriere
period even amidst the presence of role
Hospital in Paris and University Hospital of San
discontinuities experiment by this age group.
Diego in California.

She serves as a Consultant to various

schools in the development or revision of
curricula or progams related to Gerontology,
Neuro-Psychology, Counseling, Bioethics.

She also continues to serve as Thesis and

Dissertation Adviser or Panel Member and a
Visiting Faculty in many schools in the
Philippines.

METAPARADIGM

GERONE
Given to people who are old but
gracefully able to function as useful citizen at
home and in the community and an exemplar
in fidelity to prayer life.
HEALTH SELF-PREPARATION
Defined as aging. It is a slow process Act of getting oneself ready for the
of growth towards the maturity of the mind, possible outcomes of one’s life.
body and spirit.
Findings and Recommendations
NURSING Health status dictates that capacities
Is preparing the person to have and the type of role one takes, both for the
present and for the future. It fits for everyone
fulfillment in their retirement years and
to maintain and promote health at all ages
assisting them in their elderly years in leaving
because only proper care of the mind and
a legacy. body is needed to maintain health in all age.
PERSON Family constellation is a positive
index regarding retiring positively and also in
Elderly- Is a classification of age group reaching two role discontinuities. In the
to any person that reach the mind of 70’s up Philippines, the family undoubtedly stands as
to the 80’s. the security or the trusting bank where all of
the members young and old can always run
and get help.
Basic Assumptions and Concepts
Income has a high correlation with
 PHYSIOLOGICAL AGE both the perception of the retirement and
The endurance of cells and tissues to reactions toward role discontinuous. Since
withstand the wear-and-tear phenomenon income is one of the factors that secure the
of the human body. outlook of individual, effort must be exerted
 ROLE to save and spend money wisely why still
Refers to the set of shared actively earning in order to have some
expectations focused upon a particular reserve when one grows old.
position.
 CHANGE OF LIFE Work status goes hand in hand with
The period between near retirement economic security that generates
and post-retirement years where there is compensation. For the retired, it implies that
readjustment to the tempo of life. retirement should not be conceptualized as a
 RETIREE period of no work because capabilities the
An individual who has left the function get sharpening defined as they
position occupied for the past years of practice it and a regular basis.
productive life.
 ROLE DISCONTINUITY Self-preparation which is said to be
The interruption in the line of status broth therapeutic and recreational in
enjoyed or role performed. essence pays its worth in old age. This is not
 COPING APPROACHES only account professionalism or expertise but
The interventions applied to a also benevolent work as in charitable actions
problematic situation to restore and with the colleagues.
maintain equilibrium and normal functioning.
To cope with the changes brought
Determinants by retirement, one must cultivate interest
HEALTH STATUS and recreation activities to channel feelings
Physiological and mental state of the of depression or isolation and facing realities
respondents. (sickly, healthy) through confrontation with some issues.
INCOME (ECONOMIC LEVEL)
Financial affluence of the To receive retirement positively, it
respondent. (poor, moderate, rich) requires early socialization with the various
WORK STATUS roles we take in life. The best place to start is
Employment Status at home extending the school slavery the
community and society in general. In
FAMILY CONSTELLATION retirement, their fellow retirees are their
Type of family composition (close own best advocates.
knit/extended, distanced, nuclear)
 Government agency to construct “ I have grown and sown and now I can reap
holistic pre-retirement preparation program the reward and blessings of a life lived in joy
which take care of the retirees finances, and love, for I too have made others grow.”
psychological, emotional; and social needs. Prof. Letty Gurdiel Kuan, RN, RGC, EdD

Retirement should be recognized as a

fulfillment of every individual’s birth right ANALYSIS/ EVALUATION
and must be lived meaningfully.
SIMPLICITY
APPLICATION OF THE THEORY Kuan’s theory possessed simplicity
At age 52. Bridget Fisher became a first because variables are clearly defined and
time grandmother. She work in human determinants were clearly known as it relates
resources (HR) at the scientific research to the outcome of fruitful retirement and
company, a job she’d held for 20 years. She aging.
had raised 2 children, divorced first husband,
remarried, and survived a cancer scare. GENERALITY
The study can be applied not only in
Her fast paced job required her to travel dealing with people undergoing retirement,
around the country, setting up meetings and but also individuals who are experiencing
conferences. The company did not offer role transition.
retirement benefits. Bridget had seen many
employees put in 10, 15 or 20 years of service EMPIRICAL PRECISION
only to get laid off when they were A study done by Reitzens and Mutran
considered to old. Because law against age (2004),Where self concepts, continuity of
discrimination, the company executives were roles, and bridge identities were determined
careful to prevent any records from as it can lead to a more satisfying and fulfilling
suggesting age as the reason of the lay offs. experience.
As supported to the theory of Letty
Seeking to avoid the crisis she would face if Kuan, they only can recognized positive
she were laid off, Bridget went into action. determinants that could lead to a fruitful
She took advantage of the companies policy retirement and aging.
to put its employee through college if they
continued work 2 years past graduation. DERIVABLE CONSEQUENCES
Completing evening classes in nursing at the The study focuses to much on the
local technical school, she became a positive determinants. Retirement
registered nurse after years. She worked two adjustment is clearly a multidimensional
more years, then quit her job in HR, and process but the study only used a single
accepted a part-time nursing job at a family indicator which is the positive determinants
clinic. Her job offered retirement benefits. to retirement.
Bridget no longer had to travel to work and
she was able to spend more time with her
family and to cultivate new hobbies.

Today Bridget Fisher 62, is a wife, mother

of two, grand mother of three, part time
nurse, master gardener, and quit club
member. She enjoys golfing and camping
with her husband and taking terriers to the
local dog park. She does not expect to retire
from the work force for five or ten years, and
though the government bouncing her
grandchild considers her a senior citizen, she
doesn’t feel old. In fact, while bouncing her
knee, Bridget tells her daughter, 38, “ I never
felt younger.”
SR. CAROLINA S. AGRAVANTE, SPC, PHD, RN The servant-leader formula prescription
includes a spiritual retreat that goes through
CASAGRA Transformative Leadership Model the process of awareness, contemplation,
storytelling, reflection, and finally
“Focus on the type of leadership in Nursing commitment to become servant-leader in
that can challenge the values and change the the footsteps of Jesus.
world”
Self-mastery
Sr. Carolina Agravante studied Consist of a vibrant care complex
nursing in St. Paul College Manila where she possessed to a certain degree by all who have
graduated as Magna cum Laude in 1964. In been through formal studies in care giving
the same year, she took licensure profession such us nursing
examination for nurses and placed first in top
10. Special Expertise
Sister Agravante eraned her masters It is the level shown in a creative,
degree in Nursing Education from Catholic caring, critical, contemplative and collegial
University of America in 1969. teaching of the nurse faculty who is directly
In April 2002 she earned her Doctoral involved with the formation of the nursing.
Degree in Nursing from the University of the
Philippines in Manila The transformative teacher is
She served as the President of St. Paul basically the one who looks into herself vis-à-
Iloilo where she handled research subjects vis her profession, sees her assumptions and
She is also a former President of the feelings in the light of the nursing profession
Association of deans of Philippine Colleges of in modern days, how her own philosophy of
Nursing life affects her professional life and her
Sister Agravante is one of the founding student
members of the integrated Registered
Nurses of the Philippines FINDINGS and RECOMMENDATIONS

The Casagra Transformative Leadership Nurses in the practicing field take

Model: different roles in providing care to clients. Sr.
Aggravate put emphasis on how nurses
Background should take on lead with utmost care and
Nursing Education in the Philippines is compassion. Senior nurses also serve as
constantly being developed to be at par with educators not only to their clients but also to
the global standard. the nurses beginning their careers. The
servant-leader formula is a useful tool to
Basic Assumptions and Concepts enable nurses to lead and educate in
The theory “CASAGRA accordance to the principles given by the
Transformative Leadership” is a psycho- Lord, Jesus Christ.
spiritual model designed to lead to radical
change from apathy or indifference to The theory of the Transformative
spiritual person. It is coined after the name of Leadership Model can be useful for nursing
the investigator, Sr. CArolina S. AGRAvante educators to show willingness to impart
knowledge to their students and colleagues
Three-fold Transformative Leader Concept in a selfless way and be passionate about
Special their craft. It will help them achieve the
vision-mission as a network of innovative,
Servant-leadership spirituality competent empowered educators towards
Is prescribed to run parallel to the generic excellence in national and global
elements of the transformative leadership development.
model.
This formula consists of a spiritual
exercise, the determination of the vitality of
the care complex in the personality of an
individual and finally a seminar workshop on
transformative teaching.
 SYNCHROCINITY IN HUMAN-SPACE-TIME engagement affirming and celebrating
THEORY OF NURSING ENGAGEMENT IN human beings as persons.
A GLOBAL COMMUNITY
DESCRIPTION OF THE SYNCHRONICITY IN HST
NURSING THEORISTS THEORY OF NURSING ENGAGEMENT
The HST theory is a study of caring,
FRESLYN LIM-SACO, RN, MN HST, and the perspective of synchronicity and
ดSiliman University College of Nursing, nursing engagement.
Dumaguete City, Philippines
This theory aims to enlighten nurses
CLIFORD MASAYON KILAT, RN, MA in their practice through an innovative
ดSt. Paul University Dumaguete, Dumaguete demonstration of nursing care processes
City,Philippines grounded on authentic intentions of caring
transcending extant reductionist
ROZZANO LOCSIN, RN, PhD, FAAN approaches.
ดFlorida Atlantic University, Boca Raton,
Florida Furthermore, SynHSTTNE is a useful
theoretical base for future research that aims
ดTokushima University, Tokushima, Japan
to describe the meaningful connectedness in
human experiences of transcendence,
SYNCHRONICITY IN HUMAN-SPACE-TIME
interconnectivity, emancipation, and
Synchronicity in the Human-Space-
equitability with humanistic approaches in
Time Theory of Nursing undergirds the
the discipline of nursing
innovative process of nursing engagement
expressed as interpersonal relating,
ASSUMPTIONS
technological knowing, rhythmical
The assumptions of the SynHSTTNE and
connecting, and transformational engaging.
their relationship with the nursing
engagement process. Synchronicity in the
The philosophical and theoretical
HST consciousness, interconnectivity of
perspectives declare the evolutionary
persons, and nonlinearity of human caring
designing affirming the meaningful human
experiences in nursing are all integrated into
caring experiences within nursing practice.
an equity-oriented healthcare system.
Within this framework, nursing praxis has
Moreover, theory-based practice
transcended the traditional medical-oriented
sustains the human science view of
view. Furthermore, human beings are viewed
wholeness of persons while focusing on the
as integral to space- time and their
inclusion of the coexistence between
experiences
technology and caring in nursing.
Nursing theory, research, and practice
have been advancing together with the
The practice of nursing approaches
progress demanded from within the HST, in
human caring beyond the customary,
which nursing praxis unfolds in a unitarily
fragmented, and routinary healthcare
developing pattern.
commitment.
The irreducibly evolving lived experiences
and energy fields foster human
PURPOSE
transcendence between the nurse and the
The purposes of this theoretical
nursed.
article are to describe SynHSTTNE,
Moreover, meaningful connectedness
emphasizing the process of nursing in guiding
within the HST consciousness of radiating
disciplinary nursing praxis and to rationalize
energy fields and the development of nursing
theory-based nursing as essential to the
praxis are pan dimensionally transforming
appreciation of nursing as a discipline of
in an open and nonlinear pattern
knowledge and a practice profession.
By exemplifying nursing as integral to
human health and well-being in a global
community, an equity oriented healthcare
system is underscored as the nurse and the
person being nursed participate in
a synchronistic healthcare practice in which
SynHSTTNE delineates a practice process of
 1. HST is a metaphysical sphere of The Principles of the Synchronicity
caring experiences among persons with Theory: Application of the Nursing
patterns of occurrence viewed as meaningful Engagement
for both the nurse and the nursed. The HST Process
conscious ness of caring experiences is The 4 life principles of the Synchronicity
similar to Watson’s caring moment in the
that transcends space and time(Watson, Human-Space-Time Theory of Nursing
2007) as well as Parse’s human universe Engagement (SHSTTNE)
viewpoint that is indivisible, unpredictable,
and ever-changing in concreting reality of 1. Interconnectivity
becoming (Parse, 2013). the connectedness of beings and system

2. Equitability
2. Nursing unfolds in a unitarily pattern of
is a principle of human
wholeness integrated within the HST
processes. Humans are assimilating their interconnectedness of energy
lives with technology, instigating the nursing 3. Emancipation
profession toward transformations. The the liberation from oppressive
conceptualization of caring, nursing, and situations or human health conditions.
technology by Locsin (2015) elucidates the
nursing profession as continually evolving 4. Human transcendence
here, now, and beyond. the ability to go beyond the limits of
HST boundaries or the transformation of
3. The nurse-nursed HST consciousness is persons beyond their biologic nature,
irreducibly evolving thus co-creating human social norms, and universal perspectives
transcendence. The individual experiences
and perspectives of the nurse and the one These principles guide nurses in living
being nursed are not deductively viewed caring within the HST, in health and well-
apart from the whole nurse- nursed being of their patients
relationship. This is summarily illustrated, for
The following processes elucidate caring
instance, in the practice of nursing in disaster
within the milieu of synchronicity in
occasions
the HST:
[Link] a pan dimensionally
 Interpersonal Relating (IR),
transforming process of interconnectedness
 Technological Knowing (TK),
among humanity and beyond infinity. Based
 Rhythmical Connecting (RC), and
on the tenets of the Rogerian Science of
Unitary Human Beings, pan dimensionality  Transformational Engaging(TE),
The nurse and the nursed are immersed
is viewed as “a nonlinear domain without
in meaningful connectedness as
spatial or temporal attributes” (Watson &
transcendent persons within the HST.
Smith, 2002), and transformation is the
outcome of the ever-evolving human
Application of the Synchronicity in the HST
transcendence.
Theory in Practice
Interpersonal Relating
• Cecilia Laurente is a Filipino Nursing
IR is the nurturance of a relationship that
theorist whose works focused
appreciates the self and others as whole and
primarily on helping a patient
transcendental beings, connecting to the
through support systems, specifically
nursed illuminated in the dance of caring
the family.
persons (Boykin & Schoenhofer,2013) in
• Published a paper titled
which synchronicity is founded.
"Categorization of Nursing Activities
as Observed in Bedical-Surgical Ward
•Synchronicity is enhanced through
Units in Selected Government and
optimism, perseverance, and keen intuition,
Private Hospitals in Manila".
while excessive levels of anxiety, depression,
anger, and resentment preclude it (Davidson,
2016).

•Acknowledging the self and the other as a

caring person is revealing an appreciation of
IR.
•Caring is manifested when the nurse
interconnects with the nursed in a
metaphysical presence (Shearer, 2015)
through therapeutic communication aimed
at nurturing the wholeness of the self and the
nursed.
Technological knowing
Adapted from Locsin (2015) Theory of
Technological Competency as Caring in
Nursing,
TK is focused on providing authentic and
humane caring.

Guided by technology, TK is the process that

leads the nurse in sensing relevant data and
pattern information about the nursed in
interaction as persons and not as objects of
care (Locsin & Purnell, 2017).
Rhythmical connecting
RC means dancing to the cadence of
treatments and nursing activities where each
meaningful, caring experience is not merely
an encounter, but a fit into a rhythmical
pattern through which the interconnectivity
of persons within the HST is nurtured.

•In this process, open communication

enables the nurse, and the nursed to
interconnect.

•RC is also the interconnectivity of persons

that espouses synchronicity in the HS
through the capacity to knowingly participate
in change and co-creating lived realities at
the moment in furtherance of a therapeutic
nurse
Transformational Engaging
TE refers to the process of intimately
concurring with the recognized improvement
of the caring moment and human health
experiences, a continuous evaluation and
infinite reflection of wholeness by both the
nurse and the nursed.

•In TE, there is a constant process of

transformation.

•Transformational learning in this process is

flourished by the engagement of caring
attributes, knowledge, and skills. TE must
occur during and after the nurse–nursed
therapeutic interaction through which
transformational learning consequently
transpires in the immediate HST
consciousness.
“Prepare me” Interventions and the Quality of  Spiritual
Life and Advance Progressive Cancer Patients BACKGROUND

“To Nursing… may be able to provide the care During the past decade, the incidence
that our clients need in maintaining their of cancer has significantly increased not only
quality of life and being instrumental in in the Philippines but also worldwide. Cancer
birthing them to external life.”
has been associated with multifaceted issues
~ CARMENCITA M. ABAQUIN, RN,PHD, MSN and concerns regardless of stages of
development. For patients with advanced
BIOGRAPHICAL SKETCH progressive cancer, these problems are
 1962- she obtained her Nursing compounded, thus the need to develop
Degree. interventions that can address the needs
 1969- she completed her especially those concerning the ability to be
baccalaureate nursing degree.
in control and maintaining their dignity.
 1975- she finished her Master of
Science in Nursing. BASIC ASSUMPTIONS AND CONCEPTS
 2000- she pursued her Doctorate
Degree. “PREPARE ME” (Holistic Nursing
 35 years- were spent as professor at Interventions)
the University of the Philippines.
 Are the provided nursing
 November 2006-January 2016- she
interventions to address the multi-
was a chairman of the Board of
Nursing. dimensional problems of cancer
-led the board to develop the National patients.
Nursing Care Compentencies.
 It is given in any setting where
 She worked on establishing linkages
with other countries to globalize the patients choose to be confined.
nursing curriculum.
 A program that emphasizes a holistic
 She was engaged in professional,
approach to nursing care.
socio-civic and religious activities
such as participation in CHED- “PREPARE ME” Components:
Technical Committee in Nursing and a
leadership role in UP-PGH School of 1. Presence and Prayer- Refers to being
Nursing Alumni Association. with another person during times of
need.
Dissertation: Retirement and Role
Discontinuities 2. Reminisce Therapy- This is the recall
Prepare me Conceptual Model
of the past to facilitate adaptation to
Holistic Nursing Intervention
present circumstances.
“PREPARE ME”
 Presence 3. Relaxation Breathing- Techniques to
 Reminisce Therapy encourage and elicit relaxation to
 Prayer decrease the undesirable signs and
 Relaxation Activities
symptoms.
 Meditation
 Value Clarification 4. Meditation- Encourages an elicit form
Terminally-ill Patients (Cancer) of relaxation to alter the patient’s
 Physical level of awareness by focusing on an
 Psychological image or thought to facilitate inner
 Social sight which helps establish
 Religious connection and relationship with
 Level of independence
God.
 Environment
 5. Values Clarification- Assisting another
individual to clarify his own values
about health and illness in order to
facilitate effective decision making
skills.

FINDINGS & RECOMMENDATIONS

 Terminally-ill patients require holistic

approach of nursing that
encompasses the different aspects of
man, namely, physical, psychological
social, religious, level of
independence, environment, and
spiritual.
 “PREPARE ME” Interventions can be
further applied to those patients with
acute and chronic diseases and those
with prolonged hospital stays.
 The utilization of the intervention as a
basic part of care given to cancer
patients is recommended , as well as
its incorporation in the basic nursing
curriculum in the care of these
patients. The “PREPARE ME”
components must be introduced and
focused during the training of nurses
both in the academe and practice.
 Development of training programs for
care providers, as well as health care
professionals where intervention is a
part of treatment modalities.
 For patients, an honest view and
feedback regarding their illness and
management , and obtaining their
perceptions can lead to improvement
of services and communication
between patients with advanced
progressive cancer, their families and
health team.
 Healthcare professionals and family
members should provide a venue
with supportive environment, where
patients with advanced progressive
cancer and the terminally-ill patients
can attain dignity of dying with peace
while families cope up with it.

CORE VALUES OF FILIPINO

NURSES
 Within the context of the Philippine - We need to excel in the profession
society, nursing education with caring as its and able to perform the task without
foundation, subscribes to the following core guidance or less supervision as much
values which are vital components in the as possible
development of a professional nurse and are - Committed in becoming discipline
emphasized in the BSN program: individual persons who has integrity
and trustworthy.
- Be professionals who are able to
LOVE OF GOD conduct themselves in the field of
nursing.

- Being able to know and appreciate as LOVE OF PEOPLE

well as to be aware there is a
Supreme Being.
- It is the person that the nursing
caring for and it is a must for us to
CARING AS THE CORE OF NURSING possess this appreciation of the
people because without these
- A must for us to exhibit this individuals we care for us as a
charactive behaviour since our profession will be nothing.
profession is rooted in the practice of - Respect for the dignity of each
nursing. person regardless of creed, colour,
gender and political affiliation.
5 C’s

1. COMPASSION LOVE OF COUNTRY

- Being able to serve without asking in
return.
PATRIOTISM (civil duty, social responsibility
and good governance)
2. COMPETENCE
- Necessary to possess the necessary
skills, knowledge and attitude in PRESERVATION AND ENRICHMENT OF THE
terms of handling along with caring ENVIRONMENT AND CULTURE HERITAGE
the client.

3. CONFIDENCE COMPETENCY STANDARD

- Being a nurse we need to become
confident in all the task we do
FOR NURSING PRACTICE
especially in the field of practicing IN THE PHILIPPINES
and nursing service.

SITUATIONS THAT GAVE WAY FOR THE

4. CONSCIENCE CREATION OF CORE COMPETENCIES
- Taking as a descriptive manner. An
inner feeling or voice that is viewed
as an acting guide to do what is right  Emerging expectations for
and preventing the things that are contemporary nursing practice
wrong. competencies.
 Escalating complexity of
globalization
5. COMMITMENT (commitment to a  Dynamics of health science and
culture of excellence, discipline, information technology,
integrity and professionalism) demographic changes,
  Healthcare policy reforms MISSION
 Increasing and exacting demands
To deliberately, scientifically and
from the consumers of health care.
consistently determine the competence of
 Surge of overseas employment professionals through the provision of
opportunities for Filipino nurses
professional standards and judicious
creates depletion in the reservoir of issuance of professional license.
competent professionals to serve the
heath needs of the country.

COMMISIOM ON HIGHER EDUCATION

R.A. 722
The Higher Education Act of 1994

The Commission on Higher Education of

the Philippines, more popularly known as
CHED, is one of the three agencies of the
Philippine government governing the
education sector. It is primarily responsible
QUASI-JUDICIAL
for the oversight and supervision of both
public and private higher education - Serves as a court which hears and
institutions as well as degree-granting investigates certain infractions or
programs in all tertiary educational problems as well as case filed in the
institutions in the Philippines. board of nursing.
QUASI-LEGISLATIVE

VISION - Formulates rules, laws and

ordinances which needs to be
A key leader and effective partner in
followed by the professionals in the
transforming HEIs (higher education
said governing board.
institutions) toward producing highly
competent and productive professionals EXECUTIVE
through dynamic excellent and client
- It has the right or power to institute
oriented services.
and promulgate certain loss through
the passage of organizes and orders
of memorandum coming from board
PROFESSIONAL of nursing.

REGULATION COMMISSION

VISION
PRC is the instrument of the Filipino
people in securing for the nation a reliable,
trustworthy and progressive system of
determining the competence of
professionals by credible and valid licensure
BOARD OF NURSING
examinations and standards of professional
practice that are globally recognized.
VISION
 The BON under the guidance of the
Almighty, with its unquestionable integrity
and commitment, envisions itself to be the
ultimate authority in regulating the nursing Serves as unifying framework for nursing
profession in the Philippines and to lead practice, education, and regulation.
nursing development to its highest level of
- Guide in nursing curriculum
excellence for the health and safety of the
development.
public.
- Framework in developing test
syllabus for nursing profession
entrants
- Tool for nurses’ performance
evaluation
- Basis for advanced nursing practice,
specialization
- Framework for developing nursing
training curriculum
- Public protection from incompetent
practitioners
- Yardstick for unethical,
unprofessional nursing practice.

PHASES OF DEVELOPING
- Creation of the Committee on Core COMPETENCY
Competency Standards STANDARDS
Development by PRC-BON in
collaboration with CHED-TCNE
1ST PHASE
o Develop the competency
standards for nursing practice - Competency identification through
in the country. DACUM
- Conceptualized April 2001. - Series of FGD with the participation
- Initial draft-JUNE 2003 of the nurse experts and consumers
- Refinement in JANUARY 18, 2005 by of nursing practice
integrating comments, suggestions
2nd PHASE
and recommendations for the
improvement of the standards. - Verification of identified
competencies.
3rd PHASE
LEGAL BASIS - Pilot testing
(Senior student in 8 nursing colleges)
- Article 3 Sec. 9 (c) of R.A.9173
“Philippine Nursing Act 2002” 4th PHASE
- Board shall monitor and enforce
- Benchmarking with exiting standards
quality standards of nursing practice
from 3 countries + ICN
necessary to ensure the
maintenance of efficient, ethical and
technical, moral and professional
standards in the practice of nursing
taking into account the health needs
of the nation.
 COMPETENCY-BASED THE COMPETENCY BASED
APPROACH TO THE BSN TEST FRAMEWORK
CURRICULUM

PATIENT CARE COMPETENCIES

- A cluster of key areas of
responsibility which serves as the
core competencies which includes
o Safe and Quality Care (SQC)
o Communication
o Collaboration and teamwork
o Health Education
EMPOWERING COMPETENCIES
- A cluster of key areas of
responsibility that mandate
compliance to the standards of legal NURSE LICENSURE
responsibilities, ethic-moral-spiritual
responsibilities and personal and EXAMINATION
professional development.
ENABLING COMPETENCIES
- A cluster of key areas of
responsibility that provide support to
the effective and efficient
performance of the patient care
competencies which includes
management of resources,
environment and record
management.
ENHANCING COMPETENCIES
- A cluster of key areas of
responsibility that ensures excellent
performance of patient care
competencies which includes
research and quality improvement.