NUR 016: THEORETICAL FOUNDATION OF NURSING

MODULE 1:
FIRST SEMESTER l S.Y. 2023-2024 TRANSCRIBED BY: NATHALIE KIM E. ALMEDORA
LECTURER: MS. MICHELLE TIANGSON DIZON

OUTLINE OF THE TOPICS CURRICULUM ERA: 1900 TO 1940S

➢ Introduction to Nursing Theory

➢ History and Philosophy of Nursing as Science
● Major Question
➢ Stucture of Nursing Knowledge ○ What curriculum content should nurses
study to be nurses?
● Emphasis
HISTORY OF NURSING THEORY
○ Courses included in nursing programs
● Outcomes
➢ This was dated way back when Florence
○ Standardized curricula for diploma
Nightingale began to assume the great
programs
significance of providing a clean and healthy
● Emerging Goal
environment to achieve recovery of patients
○ Develop specialized knowledge and
and continues up to present.
higher education
○ She also envisioned nurses as a body of
educated women who organized service
RESEARCH ERA: 1950 TO 1970S
and caring for wounded in wartime
(Crimean War) and establishment of
Nursing school in London (St. Thomas ● Major Question
Hospital) pioneering activities in nursing ○ What is the focus for nursing research?
practice and education. ● Emphasis
➢ Nursing evolved through different eras. ○ Role of nurses and what to research
Profession did not start as what it seemed to ● Outcomes
be. It started as a vocational course offering ○ Problem studies and studies of nurses
only skills during their time. ● Emerging Goal
○ Isolated studies do not yield unified
NURSING AS A SCIENCE: knowledge

APPRENTICESHIP MODEL GRADUATE EDUCATION ERA: 1950 TO 1970S

● Nursing practice was based on principles and ● Major Question

traditions that were handed down through ○ What knowledge is needed for the
practice seen by Florence during her time. practice of nursing?
● Other references note that this is a practice era ● Emphasis
dated before the curriculum era where to be a ○ Carving out an advanced role and basis
nurse can have a diploma for only 2 years for nursing practice
under vocational. ● Outcomes
○ Nurses have an important role in health
HISTORICAL ERAS OF NURSING’S SEARCH FOR
care
SPECIALIZED KNOWLEDGE ● Emerging Goal
○ Focus graduate education on knowledge
development
 THEORY ERA: 1980 TO 1990S interchangeably; however, they are not the
same. It is important to note their differences
● Major Question and specific meaning.
○ How do these frameworks guide
research and practice? DISCIPLINE
● Emphasis
○ There are many ways to think about ★ Specific to academia and refers to a branch of
nursing education, a department of learning or a
● Outcomes domain of knowledge.
○ Nursing theoretical works shift the focus ★ Branch of education; theoretical works leading
to the patient to higher levels of education and practice.
● Emerging Goal ★ Functional Focus (what nurses do) – knowledge
○ Theories guide nursing research and focus or what nurses know and how they use
practice them for thinking and decision making while
taking care of a patient. (example: Nursing)
THEORY UTILIZATION ERA: 21ST CENTURY ★ Knowledge of persons, health and environment
forms the basis for nursing as a discipline.
● Major Question ★ Kuhn – stated, “the study of paradigms is what
○ What new theories are needed to mainly prepares the student for membership in
produce evidence of quality care? a particular scientific community with which he /
● Emphasis she will practice. By studying and practicing
○ Nursing theory guides research, with them, the clients or community involved
practice, education, and administration learn their trade."
● Outcomes
○ Middle-range theory may be from PROFESSION
quantitative or qualitative approaches
● Emerging Goal ★ Refers to a specialized field of practice founded
○ Nursing frameworks produce knowledge on the theoretical structure of the science or
(evidence) for quality care knowledge of the discipline and accompanying
practice abilities.
★ Knowledge of that discipline and accompanying
practice abilities.
➢ Fawcett classified nursing models as paradigms ★ Recognition and respect for their scholarly
with in a more organized / specialized meta- disciplined contribution to the health of society.
paradigm of:
○ Person CRITERIA FOR THE DEVELOPMENT OF THE
○ Environment PROFESSIONAL STATUS OF NURSING:
○ Health
○ Nursing Concepts 1. Utilizes in its practice a well-defined and
well organized body of specialized
SIGNIFICANCE OF NURSING THEORY knowledge.
2. Constantly enlarges the knowledge it uses
➔ At the beginning of the 20th century, nursing and improves its techniques of education
was not recognized as an academic discipline and service through scientific method.
or a profession. The accomplishments of the 3. Entrusts the education of its practitioners to
past century led to the recognition of nursing in universities/ colleges.
both areas. The terms discipline and profession 4. Applies knowledge in practical services
are interrelated and some may even use them important to community welfare.
 5. Functions autonomously in developing
hospital readmission, "not all"
professional policy.
6. Attracts individuals with intellectual and ➔ Empiricism
personal qualities of intensifying service. ◆ Way of looking at reality using the five
7. Strives to compensate nurses by providing senses.
freedom of action, opportunity for ◆ An object is real in so far as seen, felt,
continuous professional growth and smelled, tasted, heard
◆ A theory which states that knowledge
economic security. comes only or primarily from sensory
experience
HISTORICAL VIEWS OF THE NATURE OF ◆ Fundamental part of scientific method
SCIENCE (experimentations)
◆ Knowledge is based on experience; ex.
EPISTEMOLOGY physical assessment
◆ Gather information more and observe
facts before finally saying a theory
● (episteme – knowledge; logos – study of)
exists.
○ meaning knowledge, understanding ◆ Reynolds, “research-then-theory
○ concerned with the theory of knowledge strategy”
in philosophical inquiry or how ◆ It is inductive. (specific to general)
knowledge came to be. ◆ Ex. collect data → diagnose
○ What is real is also considered
knowledge.
○ Branch of philosophy concerned with the
HISTORY OF NURSING SCIENCE
nature & scope of knowledge.
○ It is the study of knowledge & justifies ● Early 20th century views
beliefs. ○ Positivism emerged as the dominant
○ It questions what knowledge is & how it view of modern science.
can be acquired. ○ Modern logical positivists believed that
○ This aims to discover the meaning of empirical research and logical analysis
were two approaches that would
knowledge, & called it the true beginning
produce scientific knowledge.
of philosophy. ■ Philosopher focused on the
analysis of theory structure.
■ Scientists focused on empirical
research.
PHILOSOPHICAL FOUNDATIONS OF SCIENCE
■ Increasing use of computers
➔ Rationalism which permits the analysis of
◆ Priori reasoning -utilizes deductive; large data.
cause to effect or general to particular
◆ Use use of the rational senses in ● Interdependence of theory and research
ensuring the truthfulness of a ○ In constructing theory, theorists must
phenomenon be knowledgeable about available
◆ Understand the whole first before you empirical findings and able to take
can appreciate the lesser parts these into account, because theory is
◆ Regards reason as the chief source & concerned with organizing and
test of knowledge formalizing available knowledge of a
◆ Any view appealing to reason as a given phenomenon.
source of knowledge or justification ○ The theory is subject to revision or
(theory-the-research approach) maybe abandoned in favor of an
◆ Criterion of truth is not sensory but alternative explanation for new
intellectual & deductive (general to information.
specific)
◆ ex: lack of social support will lead to
● Emergent of science and theory in the organized as an abstract representation of
late 20th century some phenomenon (Powers & Knapp).
○ Phenomenological Approach reduces
observations or text to the meanings of ● An internally consistent group of relational
phenomena independent of their statements (concepts, definitions &
particular context. This approach propositions) that present a systematic view
focuses on the lived meaning of about a phenomenon & which is useful for
experiences. description, explanation, prediction & control
■ Several authors presented (Bodie & Chitty).
analysis challenging the
positivist position, thus offering ● Scientifically theory implies that something
the basis for a new perspective has been proven and is generally accepted
in science. as being true.
■ Empiricists view phenomena
objectively, collect data and ● A creative & rigorous structuring of ideas
analyze it to inductively propose that project a tentative, purposeful &
theory. systematic view of phenomenon. Validation
of existing knowledge as well as discovery of
● Science as a social enterprise new knowledge. We apply theory to
○ "Human beings do science" - Gale. It describe, explain, predict, or prescribe
might be anticipated that social, nursing practice.
economic, or political factors may
influence scientific enterprise. It ● The general principles or ideas that relate to
depends on the funds, popularity of principles or ideas that relate to a particular
certain ideologies. subject.
○ Science progresses by the diversity of
dialogue within the discipline of Ex. Theory of Evolution
nursing. The creation of a merged
paradigm from many paradigms is
debated in relationship to the
advancement of nursing.

THEORY DEVELOPMENT PROCESS

THEORY

● Usually means “mere guess” or unproved CATEGORIES OF THEORY COMPONENTS:

● Literally means “a vision” or “a beholding
scene” CONCEPTS
● Greek word “theoria”

● Scientifically, theory implies that something ● are words or phrases that are used to represent
has been proven and is generally accepted the phenomenon observed or experienced
as being true. An idea or set of ideas that is ● are the building blocks of theories, “ideas”
intended to explain facts or events. ● describe & classify phenomena

● An idea that is suggested or presented as

possibly true but that is not known or proven CATEGORIES OF CONCEPTS
to be true.
● Abstract
● A set of statements that tentatively describe, ○ independent of a certain time and
explain, or predict relationships among place
concepts that ■ Ex. CHS
have been systematically selected &
 ● Concrete THEORETICAL STATEMENTS
○ more specific time or place
■ Ex. Nursing, Pharmacy ● Relate concepts to one another; permit analysis

● Discrete
○ they belong or not belong to a OPERATIONAL STATEMENTS
particular categories or classes of
phenomena ● Relate concepts to measurements
■ Ex. patients, nurses,
environment
LINKAGES AND ORDERING:
● Continuous
○ Concepts - classifications of ➢ Linkages of theoretical statements
dimensions or gradations of a ○ provide rationale of why theoretical
phenomenon across a continuum statements are linked; add plausibility
○ Degrees or levels in a given continuum
■ Ex. pain, health – illness ➢ Linkages of operational statements
continuum ○ provides rationale for how
measurement variables are linked;
● Theoretical Definitions permit testability
○ establish meaning (dictionary)
■ Ex. dictionary meaning ➢ Organization of concepts and definitions
into primitive and derived terms
● Operational Definitions ○ eliminates overlap (tautology)
○ how these concepts are used or will be
used within the context of the ➢ Organization of statements and linkages
phenomenon into premises and derived hypotheses
■ Ex. provide measurement and equations
○ eliminates inconsistency
10 PHASES OF CONCEPT BUILDING PROCESS:

1. Write a meaningful practice story. SCIENTIFIC LAW VS. THEORY

2. Name the central phenomenon in the practice
story. ➢ Scientific Laws
3. Identify a theoretical lens for viewing the ○ A statement of fact that aims to
explain, in brief and simple terms, an
phenomenon.
action or set of actions
4. Link the phenomenon to existing literature. ○ Generally accepted to be true and
5. Gather a story from someone who has lived the universal and can occasionally be
phenomenon. expressed in terms of a single
6. Reconstruct the shared story and create mathematical equation
mini-saga that captures its message ○ SIMPLE, TRUE, UNIVERSAL &
7. Identify the core qualities of the phenomenon. ABSOLUTE
○ Governs a single action, foundations
8. Use the core qualities to create a definition.
for all science
9. Create a model of the phenomenon ○ Statement based on repeated
10. Write a mini synthesis that integrates the experimental observations that
phenomenon with a population to suggest describes some aspects of the
research direction. universe
○ Always applies under same conditions,
& implies that there is a causal
RELATIONAL STATEMENTS
relationship involving its elements
○ ex. Law of Universal Gravitation by
● Statements in a theory may state definitions or Newton
relations among concepts
 ➢ Theory
○ More complex & dynamic; maybe
replaced
○ Explains an entire group
○ Can be changed or improved without
changing the overall truth
○ Developed from the scientific method
○ ACCEPTED AT TRUE & PROVED

❖ Hypothesis
➔ an educated guess based
upon observation
➔ can be supported or
proven false by
experimentation or
continued observation
➔ an idea or theory that is not
proven but leads to further
study or discussion
➔ an assumption made for
the sake of argument\
➔ HAS NOT BEEN PROVED
➔ ex. watching excessive
amounts of TV reduces a
person’s ability to
concentrate; smoking
leads to lung cancer

CONTEMPORARY ISSUES IN NURSING THEORY

DEVELOPMENT

● Theoretical Boundaries and Levels to Advance

Nursing Science
○ proposed framework now used without
reference to the author for the
development of nursing science
● Nursing Theory, Practice and Research
○ Theory-testing research may lead one
nursing theory to fall aside as a new
theory is developed that explains
nursing phenomena more adequately;
must continue to advance the discipline.
 NUR 016: THEORETICAL FOUNDATION OF NURSING
MODULE 2:
FIRST SEMESTER l S.Y. 2023-2024 TRANSCRIBED BY: NATHALIE KIM E. ALMEDORA
LECTURER: MS. MICHELLE TIANGSON DIZON

THE CRIMEAN WAR

OUTLINE OF THE TOPICS

➢ Florence Nightingale’s Environmental Theory ● In March 1853, the Crimean War broke out
➢ Jean Watson’s Philosophy and Theory of between Russia and Turkey. It was during this
Transpersonal Caring
war where Florence Nightingale volunteered
her services and was eventually given
NURSING PHILOSOPHIES permission to take a group of 38 nurses to
Turkey.
● sets for the meaning of nursing phenomena ● She found the conditions as:
through analysis, reasoning and logical ○ soldiers lay in filth straw pallets in
argument. Are works that provide broad crowded hallways
understanding that advances the discipline and ○ rats and insects crawled the floors and
its professional application. walls
○ hospitals lack basic supplies, such as
The history of nursing theory was dated way back cots, mattresses, bandages,
when Florence Nightingale began to assume the washbasins, soap, and towels
great significance of providing a clean and healthy ○ water was rationed, and available in
environment to achieve faster recovery of patients totally inadequate amounts
and continues up to present. ○ wounded armies were wearing
unwashed uniforms that were stiff with
FLORENCE NIGHTINGALE dirt and gore
○ diseases such as typhus, cholera, and
● Nightingale’s (1859-1992) Notes on Nursing dysentery were the primary reasons why
presents the nursing theory that focuses on the the death rate was high
manipulation of the environment for the benefits ● She recognized that overcrowding, filth, and
of the patient. poor ventilation all contributed to the illness of
● Although Nightingale did not present her work the soldiers.
as a nursing theory, it has directed nursing ● At night, she carried a lamp through the
practice for over 140 years. She is known as corridors, stopping to help the suffering of the
the Mother of Modern Nursing. wounded soldiers, for this, she was nicknamed,
● Daughter of William Nightingale of Embley “The Lady with the Lamp”
Park, Hampshire and was born in Italy, on the
12th day of May, 1820. POST-WAR CONTRIBUTIONS

● Nightingale returned to England as a national

heroine in 1856
● She published two books: Notes on Hospital
(1859) and Notes on Nursing (1859)
● She raised enough funds and used this to
establish the Nightingale School and Home
for Nurses at St. Thomas Hospital.
● Nightingale’s work greatly influenced John ● Management. The nurse is actually in control of
Stuart Mill’s book on women’s rights. the environment, physically, and
administratively. The nurse is responsible for
ENVIRONMENTAL THEORY controlling the environment so that the patient is
protected from physical and psychological
● “Nursing is the art of utilizing the patient’s harm.
environment for his or her recovery.”
Nightingale believed that the nurse continuously
ENVIRONMENT controlled the environment even if she is physically
absent from caring for the patient because she is
➔ defined as the external conditions and still responsible for supervising the other members
influences affecting the life and development of of the health team who worked on her patient
an organism and capable of preventing, during her absence.
suppressing, or contributing to disease,
accidents, or deaths.

COMPONENTS OF ENVIRONMENT: THEORY IN VIEW OF METAPARADIGMS

● Nursing
● Proper Ventilation. Nightingale believed that ○ Nightingale’s view of nursing was
nurses have the responsibility to keep the air comparable to that of motherly
that the patient breathes pure as the external instincts. She believed that every
air without necessarily chilling him. She woman would be a nurse because
recognized the possibility that inadequate nursing is having the responsibility for
ventilation may be the source of disease. someone else’s health – a
characteristic shared by women,
● Adequate Light. Direct sunlight has quite as
especially mothers. Her “Notes On
real and tangible effects on the human body Nursing” provided guidelines to women
who has not observed the purifying effect of who wanted to become nurses and
light, and especially of direct sunlight. gave advice on how to think like a
● Cleanliness. She advocated taking a bath daily nurse. Nursing is a vocation that needs
and that nurses should also bathe daily while formal learning and application of
scientific principles in the care of
keeping their duty uniforms clean and their
patients. Nursing personnel were thus
hands washed clean. having more skill in terms of
● Warmth. Nightingale outlined a procedure for assessment and reporting of the
measuring the body’s temperature through patient’s health status. At the same
palpation of, or feeling for the extremities in time, the nurse is also able to perform
order to assess for heat loss. One of the nurse’s nursing interventions that will allow the
roles is to manipulate the environment. patient to heal and recover.
● Person
Positioning the patient, opening the windows,
○ The person is the patient himself.
and regulating the room temperature are ways Patients are the recipient of our care. A
of maintaining this balance. passive patient is a patient who
● Quiet. Nightingale described unnecessary depends wholly on the nurse for tasks
noise can actually be harmful to the patient who and control of his environment. The
is ill. nurse is totally in control of the patient
● Diet. Nightingale maintained that one of the and his environment. Nightingale
viewed the patient as a person who
nurse’s roles is to assess both the meal
needed nursing care regardless of the
schedule and its effect on the patient, in patient’s social worth.
addition to assessing the patient’s dietary ● Health
intake. ○ Nightingale viewed health as being
well. Health is also living up to one’s
 1990s, research studies that tested and
potential to the fullest extent. Disease
and illness are viewed as reparative expanded nursing theory were numerous.
processes that are instituted by Mother
Nature herself when the person did not WATSON'S PHILOSOPHY & THEORY OF
attend to his personal health concerns. TRANSPERSONAL CARING
Nightingale emphasized the promotion
and maintenance of health and
prevention of diseases through prudent ➔ “Nursing is the human science of persons and
control of the environment and social human health – illness experiences that are
responsibility. mediated by professional, personal, scientific,
● Environment aesthetic, and ethical human care transactions.”
○ The environment was viewed as “those
elements external to and which affect
JEAN WATSON
the health of the sick and healthy
person” and included “everything from
the patient’s food and flowers to the ● born and grew up in a small town of Welch
patient’s verbal and nonverbal West Virginia; youngest of the eight children
interactions.” Central to Nightingale’s ● began developing her theory while she was
theory is the concept of a therapeutic assistant dean of the undergraduate program at
environment that will enhance the University of Colorado
comfort and recovery of the patient.
● in 1978-1981, she served as coordinator and
director of the PhD program
APPLICATION TO NURSING ● worked from 11 curative factors to formulate her
10 carative factors
● Nursing Practice: Ventilation, warmth, quiet, ● modified 10 factors slightly over time and
diet, and cleanliness are still important aspects developed the caritas processes, which have a
of nursing care. We, nurses, thus need to spiritual dimension and use a more fluid and
maintain adequate ventilation, promote evolutionary language
adequate and appropriate nutrition, maintain ● authorized 11 books which reflect the evolution
normal homeostatic body temperature, and of her theory of caring
observe basic hygiene and comfort measures, ○ 1st book – Nursing: The Philosophy
including environmental sanitations. and Science of Caring (1979), use 10
● Nursing Education: Nightingale had established carative factors but evolved to include
the St. Thomas Hospital and King’s College “caritas” (connection between caring
Hospital in London, which was able to provide a and love)
framework for the establishment of nursing ○ 2nd book – Nursing: Human Science
training schools through a universal template and Human Care – A Theory of
that contains principles of nursing training. She Nursing (1985), addressed her
also advocated the separation of nursing conceptual and philosophical problem in
training from the hospital to a more appropriate nursing
learning environment in the school or university
setting.
● Nursing Research: Nightingale is considered
the mother of nursing research because of her
interest in the scientific methods of inquiry and
statistics. She was able to gather and analyze
data efficiently and resourcefully. She was the
first to use polar diagrams in presenting study
data. The concepts of Nightingale’s theory still
serve as a basis for current research. In the
 TRANSPERSONAL CARING RELATIONSHIP
spirit of self and the
one-being-cared-for.
● foundational of her theory; it is a special kind of
human care relationship Creative problem- Creative use of self and all
● a union with another person-high regard for the solving ways of knowing as part of
whole person and their being in the world caring process the caring process to
engage in
● “Caritas” originates from the Greek vocabulary,
artistry of caring-healing
meaning to cherish and to give special loving practices.
attention
● Watson uses the term “carative” instead of Transpersonal Engaging in genuine
curative teaching- teaching-learning
learning experience that attends to
10 ELEMENTS OF CARATIVE FACTORS
unity of being and meaning,
attempting to stay within
other’s frames of reference.
➢ Watson introduced the concept of clinical
caritas process, which have replaced her Supportive, Creating a healing
carative factors. The following are the protective, environment at all levels
translation of the carative factors into clinical and/or corrective (physical as well as
caritas processes. mental, non-physical), subtle
physical, societal, environment of energy and
and consciousness, whereby
spiritual wholeness, beauty, comfort,
CARATIVE CLINICAL PROCESSES environment dignity, and peace are
FACTORS potentiated.

Humanistic- Practice of loving kindness Human needs Assisting with basic needs,
altruistic system and equanimity assistance with an intentional caring
(self-control/composure) consciousness,
within context of caring administering
consciousness. “human care essentials”,
which potentiate alignment
Faith-hope Being authentically present, of mind-body-spirit,
and enabling and sustaining wholeness, and unity of
the deep belief system and being in all aspects of care,
subjective life world of self tending to both the
and the embodied spirit and
one-being-cared-for. evolving
spiritual emergence.
Sensitivity to self Cultivation of one’s own
and spiritual practices and Existential- Opening and attending to
others transpersonal self, going Phenomenological spiritual-mysterious and
beyond ego self, opening to -spiritual forces existential dimensions of
others with sensitivity and one’s own life-death; soul
compassion. care for self and the
one-being-cared-for.
Helping- Developing and sustaining
trusting, human a helping-trusting, authentic
care relationship caring relationship. Transpersonal caring relationship characterizes
a special kind of human care relationship that
Expressing Being present to, and depends on:
positive and supportive of, the ● the nurse’s moral commitment in protecting
negative feelings expression of positive and and enhancing human dignity as well as the
negative feelings as a
deeper/higher self
connection with a deeper
 ● the nurse’s caring consciousness human art and acts or intentional caring-
communicated to preserve and honor the healing modalities.
embodied spirit, therefore, not reducing the ● Caring-healing modalities within the context of
person to the moral status of an object transpersonal caring/ caritas consciousness
● the nurse’s caring consciousness and potentiate harmony, wholeness and unity of
connection having the potential to heal being by releasing some of the disharmony.
since experience, perception, and ● Ongoing personal & professional development
intentional connection are taking place and spiritual growth.
● Nurse’s own life history, previous experiences
The term “transpersonal” means to go beyond etc. Are valuable teachers for this work.
one’s own ego and the here and now, as it allows ● Other facilitators are personal growth
one to reach deeper spiritual connections in experiences such as psychotherapy and other
promoting the patient’s comfort and healing. Finally, models for spiritual awakening.
the goal of a transpersonal relationship ● Continuous growth for developing and maturing
corresponds to protecting, enhancing, and within a transpersonal caring model is ongoing.
preserving the person’s dignity, humanity,
wholeness, and inner harmony.
THEORY IN VIEW OF METAPARADIGMS
A caring occasion is the moment (focal point in
space and time) when the nurse and another ● Nursing
person come together in such a way that an ○ Nursing is the human science of
persons and human health – illness
occasion for human caring is created. Assistance
experiences that are mediated by
with the gratification of human needs describes the professional, personal, scientific,
role of the nurse in promoting wellness and health aesthetic, and ethical human care
through the achievement of basic human needs transactions.
according to Maslow’s hierarchy of needs. ● Person
○ Personhood (human being)
● a unity of mind/body/spirit/nature
THEORY ASSERTIONS
● Unitary Transformative
Paradigm-Holographic thinking:
● The theory acknowledges the unity of the “...unity within an evolving emergent
person’s mind-body-spirit. world view-connectedness of all...”
● The mind is the point of access to the body and ● three words: Mind, Body, Soul
the spirit. ● “... humans cannot be treated as
objects and that humans cannot be
● The spirit relates to a person’s soul, the inner
separated from self, other, nature,
self, the essence of the person, the spiritual and the larger universe.”
self. ● Health
● It is the spirit that allows the person to ○ “...illness is not necessarily disease;
transcend the “here and now” coexisting with [instead it is a] subjective turmoil or
past, present, and future, all at once through disharmony within the spheres of the
creative imagination and visualization. person, for example, in the mind, body,
and soul, either consciously or
● Watson ascertains that the care of the soul
unconsciously.”
remains the most powerful aspect of the art of ● Environment
caring in nursing. ○ Society – provides the values that
determine how one should behave and
MAJOR ASSUMPTIONS what goals one should strive toward.
Watson stated, “Caring (and nursing)
● Nurse’s ability to connect with another at this has existed in every society. Every
society has had some people who
transpersonal spirit to spirit level is translated
have cared for others. A caring attitude
via means of communication, into nursing
 is not transmitted from generation to
generation by genes. It is transmitted
by the culture of the profession as a
unique way of coping with its
environment.”

APPLICATION TO NURSING

● Nursing Practice (Administration & Leadership):

It calls for administrative practices and embrace
caring, even in a health care environment of
increased acuity levels of hospitalized
individuals, short hospital stays, increasing
complexity of technology, and rising
expectations in the task of nursing.
● Nursing Education: Watson’s writings focus on
educating graduate nursing students and
providing them with ontological, ethical, and
epistemological bases for their practice, along
with research directions. Watson’s caring
framework has been taught in numerous
baccalaureate nursing curricula.
● Nursing Research: Watson’s theory to reduce
distress experienced by infertile women. Her
theory and the application of theory of clinical
practice hospital organizations have been their
major weakness of research. Nelson and
Watson report on studies carried out in seven
countries.

IMPLICATIONS OF THE THEORY

● One major implication of the theory is in the

realm of bedside nursing where nurses of today
have particularly begun to neglect. The essence
of nursing is in the caring aspect and caring is
taking the wholeness, the totality, of the patient
in consideration.
● More importantly, nurses of today should try to
care for a patient for who he is. After all, all of
us were created equal and in His likeness.
 NUR 016: THEORETICAL FOUNDATION OF NURSING
MODULE 3:
FIRST SEMESTER l S.Y. 2023-2024 TRANSCRIBED BY: NATHALIE KIM E. ALMEDORA
LECTURER: MS. MICHELLE TIANGSON DIZON

DREYFUS MODEL
OUTLINE OF THE TOPICS

➢ Patricia Benner’s Stages of Nursing Expertise ➔ is situational that describes the five levels of
➢ Marilyn Anne Ray’s Bureaucratic Caring skill acquisition and development:
◆ Novice (0 to 1 year)
PATRICIA BENNER: CARING, CLINICAL WISDOM ◆ Advanced Beginner (1 to 2 years)
AND ETHICS IN NURSING PRACTICE ◆ Competent (2 to 3 years)
◆ Proficient (3 to 5 years) – intuitive
● born in Hampton, Virginia ◆ Expert (>5 years) – clinical eye
● obtained a baccalaureate of arts degree from
Pasadena College in 1964 ➔ The model proposes that, as a person improves
● earned Master’s degree in Nursing with major in skill level, there is a corresponding change in
emphasis in medical-surgical nursing from the performance of a given skill. These are:
University of California, San Francisco, School ◆ Movement from reliance on abstract
of Nursing principles and rules to use of past,
● has a wide range of clinical experience, concrete experience.
including acute medical-surgical, critical care ◆ Shift from reliance on analytical,
and home health care rule-based thinking to intuition.
● noted that experience-based skill acquisition is ◆ Change in the learner’s perception of
safer and quicker when it is founded on a sound the situation from viewing it as a
educational base compilation of equally relevant pieces to
viewing it as an increasingly complex
whole in which some parts stand out as
more or less relevant.

Passage from a detached observer, standing

outside the situation, to one of a position of
involvement, fully engaged in the situation. Skill

I
refers to nursing interventions and clinical judgment
skills in actual clinical situations. Expertise is
developed when the clinician tests and modifies
➢ “Nursing is a caring relationship and practice principle-based expectations in the actual setting.
that cares for and studies the lived experiences
of patients on health, illness, and disease, and
NOVICE STAGE
the relationships among these three elements.”
➢ "The Nurse - Patient Relationship is not a
● characterized by a person who lacks
uniform, professionalized blueprint but rather a
background experience of the situation he or
Kaleidoscope of intimacy and distance in some
she is involved in
of the most dramatic, poignant, and mundane
● in order to guide the performance, simple rules
moments of life".
and objectives, attributes should be given
because the novice will usually have difficulty
 differentiating relevant and irrelevant aspects of EXPERT NURSE
a situation
● examples are nursing students and professional ● does not rely anymore on the analytical
nurses who have been assigned to an area principles of rules, guidelines, and maxims to
totally different from the one they are connect her understanding of the situation to an
accustomed to appropriate action
● when the novice has already started coping ● characterized by the following vital traits:
with enough real situations and has allowed ○ demonstrate a clinical grasp and
him/her to demonstrate minimally acceptable resource-based practice
performance within a given situation, his/her ○ possess embodied know-how
skill level also advances to that of an advanced ○ see the big picture
beginner ○ see the unexpected

ADVANCE BEGINNER COMPETENCY

● defined as an interpretively defined area of
● has enough experience to grasp aspects of a skilled performance identified and described by
situation but not within the context of the its intent, functions, and meanings.
situation
● should be guided by rules and are oriented by
EXPERIENCE
the completion of tasks
● feels highly responsible for managing patient ● the active process of refining and changing
care but will still need the help of other nurses preconceived theories, notions, and ideas when
who are more experienced than her confronted with actual situations; it reflects that
● examples are newly registered professional there is communication between what is found
nurses in practice and what is expected.
● progresses into a competent level of skill
acquisition by learning from actual practice MAXIM
situations and by following the actions of others.
● a mysterious description of skilled
COMPETENT NURSE performance.
● It requires a certain level of experience to
● considerable conscious and deliberate planning recognize the implications of the instructions.
which determines the important aspects of ● Paradigm case is a clinical experience that
present and future situations. stands out.
● exhibits a sense of mastery, increased level of ● It alters the way the nurse will perceive and
efficiency, consistency, predictability, and time understand and open new clinical viewpoints
management. and alternatives.

PROFICIENT NURSE HERMENEUTICS

● already has a holistic view of a particular ● interpretive; it describes meaningful human

situation activities or phenomena in a careful and
● the nurse’s performance is guided by maxims detailed manner.
by this stage ● The description is free from analytical
● can already show an intuitive grasp of the assumptions. It is based purely on practical
situation based on background understanding understanding of the phenomena.
● can see changing relevance in a given situation
including recognition and implementation of
skilled responses to the situation as it evolves
 ■ Illness is the human lived
THEORY IN VIEW OF METAPARADIGMS experience of loss of function or
dysfunction.
● Nursing ■ A disease is a state that can be
○ Described as a caring relationship and assessed physically.
practice that cares for and studies the ● Environment
lived experiences of patients on health, ○ Benner talked about situations instead
illness, and disease, and the of environment. Situation is described
relationships among these three as the social environment with a social
elements. definition and meaningfulness. Each
● Person person’s past, present, and future,
○ It is viewed as a self-interpreting being. including their own personal meanings,
The person does not come into the habits, and perspectives, influence the
world predefined. He gets defined in present situation.
the course of living a life. He has an
effortless and non-reflective
APPLICATION OF THE THEORY
understanding of the self in the world.
He is a participant in common
meanings and he is embodied. ● Benner’s contribution to the nursing profession
○ Embodiment refers to the body’s is the use of phenomenal approaches to
capacity to respond to meaningful nursing practice.
situations with 5 dimensions: ● Phenomenal approaches have resulted in the
■ The unborn complex – the
development of clinical promotion ladders, new
fetus and newborn baby does
not yet have any signs of the graduate orientation programs, and clinical
effects of culture knowledge development seminars.
■ The habitual skilled body – ● Her model is instrumental in differentiating
refers to the body language of a knowledge development and career
person as he learned through progression in nursing. This allowed nursing
time by the processes of educators to realize that learning needs at the
identification, imitation, and trial
early stages of clinical knowledge development
and error
■ The projective body – refers are different from those required at later or
to the predetermined action of higher stages.
the body in response to a ● It is important to understand that different
situation; for example, walking employees will have different levels of skills.
or running ● It is important to emphasize the importance of
■ The actual projected body – learning the skill of involvement and caring
refers to the body’s capacity to
fit or be skilled in a given through practical experience, articulation of
situation; for example, driving knowledge with practice, and the use of
an automobile narratives in undergraduate education.
■ The phenomenal body – ● It is important for nursing students and
refers to the body’s awareness professional nurses alike to learn through
of itself and its ability to imagine experience or by experiential learning.
and describe touch sensations
● Learning by experience will allow you to gain
● Health
○ This is defined as what can be mastery of a given skill.
assessed. Well-being is the human
experience of health or wholeness. MARILYN ANN RAY
Wellbeing and being ill are understood
as distinct ways of being in the world. ● 1958 – went to LA, CA work at OB-Gyn, ER,
Health is not merely the absence of CCU
disease or illness. A person may also
● 1960 – US Citizen, US Air Force- flight nurse,
have a disease but not an illness.
clinician, administrator, educator, researcher
 with a rank of Colonel. The first nurse to go to response to suffering and need and justice or
the Soviet Union with the Aerospace Medical fairness of what to be done)
association ● Spirituality – involves creativity and choice and
● 1965 – BSN-MSN in MCN at the University of is revealed in attachment, love, and community
Colorado; Dr. Madeleine Leininger, a nurse ○ Spiritual - Ethical caring for nursing
anthropologist, influenced Ray's life. focuses on the facilitation of choices for
● 1973 – went back to Canada to be with her the good of others
family, faculty in McMaster University ● Educational – formal and informal educational
● 1989 – appointed as an Eminent Scholar at programs, use of audiovisual media to convey
Florida Atlantic University and continues as information and other forms of teaching and
Professor Emeritus sharing information
● Her research interests continue to focus on ● Physical – related to the physical state of
nurses, nurse administrators and patients in being, including biological and mental patterns
critical care and intermediate care, and in (mind and body)
nursing administration in complex hospital ● Social-Cultural – ethnicity & family structures,
organizational cultures intimacy with friends and family,
communication; social interaction and support.
● Legal – meaning of caring include responsibility
and accountability; rules and principles to guide
behaviors such as policies, procedures
informed consent; right to privacy
● Technological – nonhuman resources, like
machinery to maintain the physiological
well-being of the patient, diagnostic tests,
knowledge and skills needed to utilize these
resources
THEORETICAL SOURCES ● Economic – includes money, budget, insurance
systems, limitations and guidelines imposed by
● Dr. Leininger – transcultural nursing and managed care organizations, allocation of
ethnographic-ethnonursing research methods. human and material resources to maintain
● Hegel – posited the interrelationship among services
thesis, antithesis, and synthesis. ● Political – power structure within health care
● Chaos Theory – describes simultaneous order administration, pattern of decision making in the
and disorder, and order within disorder. Ray organization; role and gender stratification
compares change in complex organizations among health care providers; competition for
with this creative process and challenges scarce human and material resources
nurses to step back and renew their
perceptions of everyday events, to discover the MAJOR ASSUMPTIONS
embedded meanings.
● The meaning of caring is highly differential,
MAJOR CONCEPTS AND DEFINITIONS depending on its structures (social-cultural,
educational, political, economic, physical,
● Holography – everything is a whole in one technological, legal)
context and a part in another, with each part ● Caring is bureaucratic as well as spiritual/
being in the whole and the whole being in the ethical, given the extent to which meaning can
part be understood in relation to the organizational
● Caring – a complex transcultural, relational structure
process grounded in an ethical, spiritual context ● Caring is the primordial construct and
(charity and right action, love as compassion in consciousness of nursing
 nurses to utilize
THEORY IN VIEW OF METAPARADIGMS
phenomenological-hermeneutics through the
lens of caring
● Nursing
○ holistic, relational, spiritual and ethical
caring that seeks the good of self and
others in complex community, IMPLICATIONS OF THE THEORY
organizational and bureaucratic
cultures ● Clarity
● Person ○ major structures are defined clearly,
○ a spiritual and cultural being. are consistent with definitions commonly
created by God, the Mystery of Being used by practicing nurses
and engage co-creatively to find ● Simplicity
meaning and value. ○ the theory simplifies the dynamics of
● Health complex bureaucratic organizations
○ provides a pattern of meaning for ● Generality
individuals, families, and communities. ○ the theory addresses the nature of
Beliefs and caring practices about nursing as caring, "What is the nature
illness and health are central features of caring in nursing?”, "What is the
of culture. nature of nursing practice as caring?".
● Environment Philosophies are broad and provide
○ a complex spiritual, ethical, ecological, direction for the discipline
and cultural phenomenon. It embodies ● Accessibility
knowledge and conscience about the ○ has undergone continued revisions
beauty of life forms and symbolic based largely on research, empirical
systems or patterns of meaning. These precision is high with concepts
patterns are transmitted historically and grounded in observable reality
are preserved or changed through ● Importance
caring values, attitudes, and ○ issues that confront nurses today
communication. include economic constraints in the
managed care environment and the
effects of these constraints (staffing
APPLICATION TO NURSING ratio) on the nurse patient
relationship
● Nursing Practice (Administration & Leadership):
The theory of Bureaucratic Caring has direct
application for nursing. We are challenged to
integrate knowledge, skills and caring. This
synthesis of behaviors and knowledge reflects
the holistic nature of the theory. This shows that
nurses, patients, and administrators value the
caring intentionality that is co-created in the
nurse-patient or administrator-nurse
relationship. This can transform the working
environment, fostering ethical choices, respect,
and trust, resulting to successful organizations
● Nursing Education: Useful in nursing education
in terms of its broad focus on caring in nursing
and its conceptualization of the health care
system. Interconnectedness of all things
● Nursing Research: Particularly significant
because it is grounded in the philosophy of
humanism and caring, and it encourages
 NUR 016: THEORETICAL FOUNDATION OF NURSING
MODULE 4:
FIRST SEMESTER l S.Y. 2023-2024 TRANSCRIBED BY: NATHALIE KIM E. ALMEDORA
LECTURER: MS. MICHELLE TIANGSON DIZON

OUTLINE OF THE TOPICS

whether nurses were “moving away” from the
sickbed, whether caring for the ill and infirm was
➢ Kari Martisen’s Philosophy of Caring disappearing with the advent of increasingly
➢ Katie Eriksson’s Caritative Caring Theory technical care and treatment, and whether
nurses were becoming administrators and
KARI MARTINSEN’S PHILOSOPHY OF CARING researchers who increasingly relinquished the
concrete execution of care to other
➢ “Nursing is founded on caring for life, on occupational groups.
neighborly love, ... At the same time, it is ● Based on this work, she attained the doctor of
necessary that the nurse is professionally philosophy degree from the University of
educated...” Bergen in 1984.

THEORETICAL SOURCES

● In analysis of profession of nursing in the early

1970s, she looked to three philosophers in
particular:
○ Karl Marx, the German philosopher,
politician, and social theorist
○ Edmund Husserl, the German
philosopher and founder of
SUMMARY OF CREDENTIALS AND phenomenology
BACKGROUND ○ Maurice Merleau-Ponty, the French
philosopher and phenomenologist of the
● From 1972 to 1974, she attended the body
Department of Philosophy at the University of
Bergen
MAJOR CONCEPTS AND DEFINITIONS
● In her work for the graduate degree in
philosophy (Magister Artium), she grappled ● Care
philosophically with questions that had ○ This “forms not only the value base of
disturbed her as a citizen, a professional, and a nursing, but is a fundamental
healthcare worker precondition for our lives. Care is the
positive development of the person
● The dissertation Philosophy and Nursing: A
through the Good”.
Marxist and Phenomenological Contribution ○ Care is a trinity: relational, practical,
created an instant debate and received much and moral simultaneously. Caring is
critical attention directed outward toward the situation of
● Period from 1976 to 1986 can be described as the other. In professional contexts,
a historical phase in her work & published caring requires education and training.
several historical articles ○ “Without professional knowledge,
concern for the patient becomes mere
● Published a “lit torch” of a book with the
sentimentality”. She is clear that
provocative title, Caring Without Care? In this guardianship negligence or
book, they raised important questions about
 sentimentality are not expressions of preconditions for care, simultaneously
care. as caring actions are necessary
● Professional judgment and discernment conditions for the realization of
○ It is through the exercise of sovereign life utterances in the
professional judgment in practical, concrete life.
living contexts that we learn clinical ● The untouchable zone
observation. It is “training not only to ○ This refers to a zone that we must not
see, listen and touch clinically, but to interfere with in encounters with the
see, listen and touch clinically in a other and encounters with nature. It
good way”. refers to boundaries for which we must
○ “Because perception has an analogue have respect.
character, it evokes variation and ○ The untouchable zone creates a
context in the situation”. certain protective distance in the
○ Discretion expresses professional relation; it ensures impartiality and
knowledge through the natural senses demands argumentation, theory, and
and everyday language. professionalism. In caring, the
● Moral practice is founded on care untouchable zone is united with its
○ “Moral practice is when empathy and opposite, which is openness, in which
reflection work together in such a way closeness, vulnerability, and motive
that caring can be expressed in have their correct place.
nursing”. Morality is present in concrete ○ Openness and the untouchable zone
situations and must be accounted for. constitute a unifying contradiction in
Our actions need to be accounted for; caring
they are learned and justified through ● Vocation
the objectivity of empathy. ○ a demand life makes to us in a
○ This means in concrete terms to completely human way, is given as a
discover how the other will best be law of life concerning neighborly love
helped. Sincerity and judgment enter which is foundationally human
into moral practice. ○ an ethical demand to take care of
● Person-oriented professionalism neighbor, so nursing requires a
○ This is “to demand professional personal refinement in addition to
knowledge which affords the view of professional knowledge
the patient as a suffering person, and ● The Eye of the Heart
which protects his integrity. It ○ the concept stems from the parable of
challenges professional competence good Samaritan
and humanity in a benevolent ○ the heart says something about the
reciprocation, gathered in a communal existence of the whole person, about
basic experience of the protection and being touched or moved by the
care for life... It demands an suffering of the other and the situation
engagement in what we do, it is about the other experiences
having an understanding of one’s ● The Registering Eye
position within a life context that ○ objectifying, the perspective is that of
demands something from us, and the observer; concerned with finding
about placing the other at the centre, connections, systematizing, ranking,
about the caring encounter’s classifying and placing in a system
orientation toward the other”. ○ represents alliance between modern
● Sovereign life utterances natural science, technology and
○ These are phenomena that accompany industrialization
the Creation itself. They exist as
pre-cultural phenomena in all societies;
THEORETICAL ASSERTIONS
they are present as potentials.
○ They are beyond human control and
influence. Sovereign life utterances are ➢ People are created dependent and relational.
openness, mercy, trust, hope, and love. The person is fundamentally dependent upon
○ Sovereign life utterances are community and the creation.
➢ To the created belong the sovereign life
comfort always.
utterances. ● Environment
➢ These are phenomena present in the service of ○ Space and situation – a person is
life. always in a particular situation in a
➢ They create life, they release life's possibilities. particular space. In space are found
time, ambience, and power.
■ Our interaction with each other,
THEORY IN VIEW OF METAPARADIGMS use of objects, words,
knowledge, our
● Nursing being-in-the-room- all set the
○ Caring is fundamental to nursing. tone and color the situation and
○ Trinity of Caring: the space.
■ Relational means that caring ■ Our challenge is to give
requires at least two people. patients and each other dignity
One has concern for the other. in these spaces.
One suffers, the other will
"grieve" and provides for the
alleviation of pain. Caring is the APPLICATION TO NURSING
most natural and fundamental
aspect of the person's ● Nursing Practice: Caring is practically relevant
existence. as an overarching/general philosophy of
■ Practical is about concrete and nursing. It is clearly articulated and
practical action. Caring is
trained and learned through its encompasses a precise formulation of how to
practice. understand and approach patients and nursing.
■ Moral refers to "if caring is to The ability to promote reflection upon nursing
be genuine, must relate to the practice in different contexts.
other from an attitude which ● Nursing Education: Most nursing colleges make
acknowledges the other in light good use of her texts, and works form part of
of his situation”. Must NOT
the curriculum at a variety of educational levels.
overestimate or underestimate
his ability to help himself. ● Nursing Research: Countless dissertations
● Person based on practical, concrete, and more
○ This means bearing fellowship of theoretical issues discuss the relationship
tradition that turns the individual into a between empirical experience in light of her
person. terminology and philosophy.
■ Parallel between the person
and the body
■ Bodies that we relate to IMPLICATIONS OF THE THEORY
ourselves, to others and to the
world. It is the unit of soul and ● Clarity
flesh, or spirit and flesh. ○ Clearly states that life has been
■ As bodies, we both perceive created and given to us. Created in
and understand. dependence on each other and on
● Health nature. Caring for each other and for
○ Health does not only reflect the nature is fundamental.
condition of the organism. It is also an ● Simplicity
expression of the current level of ○ She used a poetic and philosophical
competence in medicine. The rather than a scientific mode of
tendencies of the modern concept of speaking. Wrote general phenomena
health are such that if one has an that affect us all, and that could easily
unnecessary 'defect' or an organ which be recognized in our personal lives,
'could' be better, one is not completely occupational or daily lives.
healthy. ● Generality
■ IMPORTANT is to cure ○ This seems to be relevant for all
sometimes, help often and patients who, because of illness or
 ● She was born on November 18, 1943, in
other reasons, need help and
assistance. Jakobstad, Finland.
● Accessibility
○ The patient's and the nurse's worlds of THEORETICAL SOURCES
experience are diverse, nuanced, and
multifaceted. A nuanced and varied ● Her leading thoughts have been not only to
language is required to deal with a develop the substance of caring, but also to
multifaceted reality. This enables us to
develop caring science as an independent
perform situation- dependent, good
nursing - a professional moral practice. discipline.
● Importance ● She wanted to go back to the Greek classics by
○ Caring community is not dictatorial, nor Plato, Socrates, and Aristotle, from whom she
is it society's passive arm.It exists only found her inspiration for the development of
to the extent that we struggle for its both the substance and the discipline of caring
existence. we must form it through science.
solidarity, through morally responsible
action, through the fight for greater ● From her basic idea of caring science as a
equality and for community and social humanistic science, she developed a
integration. Caring is an active and meta-theory that she refers to as “the theory of
radical concept. science for caring science”.

KATIE ERIKSSON’S CARITATIVE CARING THEORY

MAJOR CONCEPTS AND DEFINITIONS
➔ “Caritative caring means that we take “caritas”
into use when caring for the human being in ● Caritas
health and suffering...Caritative caring is a ○ Caritas means love & charity. In
caritas, eros and agapé are united, and
manifestation of the love that ‘just exists’...
caritas is by nature unconditional love.
Caring communion, true caring, occurs when ○ → Caritas, which is the fundamental
the one caring in a spirit of caritas alleviates the motive of caring science, also
suffering of the patient.” constitutes the motive for all caring.
○ → It means that caring is an endeavor
to mediate faith, hope, and love
through tending, playing, and learning.
● Caring communion
○ It is a form of intimate connection that
characterizes caring. Caring
communion requires meeting in time
and space, an absolute, lasting
presence.
○ This is characterized by intensity and
SUMMARY OF CREDENTIALS AND
vitality, and by warmth, closeness, rest,
respect, honesty, and tolerance. It
BACKGROUND
cannot be taken for granted but
pre-supposes a conscious effort to be
● From 1972 to 1974, she attended the with the other.
Department of Philosophy at the University of ○ Caring communion is seen as the
Bergen. source of strength and meaning in
● She is one of the pioneers of caring science in caring.
● The act of caring
the Nordic countries. She has the ability from
○ This contains the caring elements
the beginning to design caring science as a (faith, hope, love, tending, playing, and
discipline, while bringing to life the abstract learning), involves the categories of
substance of caring. infinity and eternity, and invites deep
communion.
 ○ The act of caring is the art of making experienced as suffering related to life.
something very special out of ● The suffering human being
something less special. ○ This is the concept that Eriksson uses
● Dignity to describe the patient. The patient
○ This constitutes one of the basic refers to the concept of patiens (Latin),
concepts of caritative caring ethics. which means “suffering”.
Human dignity is partly absolute ○ The patient is a suffering human being,
dignity, partly relative dignity. or a human being who suffers and
○ Absolute dignity is granted the human patiently endures.
being through creation, while relative ● Reconciliation
dignity is influenced and formed ○ It refers to the drama of suffering.
through culture and external contexts. Reconciliation implies a change
○ A human being’s absolute dignity through which a new wholeness is
involves the right to be confirmed as a formed of the life the human being has
unique human being. lost in suffering.
● Invitation ○ In reconciliation, the importance of
○ This refers to the act that occurs when sacrifice emerges. Having achieved
the carer welcomes the patient to the reconciliation implies living with an
caring communion. imperfection with regard to oneself and
○ The concept of invitation finds room for others but seeing a way forward and a
a place where the human being is meaning in one’s suffering.
allowed to rest, a place that breathes ○ Reconciliation is a prerequisite of
genuine hospitality, and where the caritas.
patient’s appeal for charity meets with ● Caring culture
a response. ○ Concept that Eriksson uses instead of
● Suffering environment. It characterizes the total
○ This is an ontological concept caring reality and is based on cultural
described as a human being’s struggle elements such as traditions, rituals,
between good and evil in a state of and basic values.
becoming. ○ It transmits an inner order of value
○ Suffering implies in some sense dying preferences or ethos.
away from something, and through ○ Respect for the human being, dignity
reconciliation, the wholeness of body, and holiness, forms the goal of
soul, and spirit is re-created, when the communion and participation in a
human being’s holiness and dignity caring culture.
appear. ○ The origin of the concept of culture is
○ Suffering is a unique, isolated total to be found in such dimensions as
experience and is not synonymous with reverence, tending, cultivating,
pain. andcaring; these dimensions are
● Suffering related to illness, to care, and central to the basic motive of
to life preserving and developing a caring
○ This is related to illness and is culture.
experienced in connection with illness ● Use of empirical evidence
and treatment. When the patient is ○ Established it in empiricism by
exposed to suffering caused by care or systematically employing a
absence of caring, the patient hermeneutical and hypothetical
experiences suffering related to care, deductive approach. In conformity with
which is always a violation of the a human science and hermeneutical
patient’s dignity. way of thinking, Eriksson developed a
○ Not to be taken seriously, not to be caring science concept of evidence.
welcome, being blamed, and being ○ Her main argument for this is that the
subjected to the exercise of power are concept of evidence in natural science
various forms of suffering related to is too narrow to capture and reach the
care. In the situation of being a patient, depth of the complex caring reality.
the entire life of a human being may be ○ Her concept of evidence is derived
 derives its origin from the ethos
from Gadamer’s Concept of Truth,
which encompasses the true, the of love, responsibility, and
beautiful, and the good. sacrifice, namely, caritative
ethics.
■ Health means a movement in
MAJOR ASSUMPTIONS
becoming, being, and doing
while striving for wholeness and
➢ Eriksson distinguishes between two kinds of
holiness, which is compatible
major assumptions:
with endurable suffering.
○ Axioms as fundamental truths in
■ Caring implies alleviation of
relation to the conception of the world.
suffering in charity, love, faith,
These are as follow:
and hope. Natural basic caring is
■ The human being is
expressed through tending,
fundamentally an entity of body,
playing, and learning in a
soul, and spirit.
sustained caring relationship,
■ The human being is
which is asymmetrical by nature.
fundamentally a religious being.
➢ These kinds of major assumptions had their
■ The human being is
validity tested through basic research.
fundamentally holy. Human
➢ Axioms and theses jointly constitute the
dignity means accepting the
ontology of caring science and therefore also
human obligation of serving with
are the foundation of its epistemology.
love, of existing for the sake of
others.
■ Communion is the basis for all
humanity. Human beings are THEORY IN VIEW OF NURSING
fundamentally interrelated to an
abstract and/or concrete other in ● Nursing
○ Love and charity, or caritas, as the
a communion. basic motive of caring, principal idea.
■ Caring is something human by The foundation of the caring
nature, a call to serve in love. professions through the ages has been
■ Suffering is an inseparable part an inclination to help and minister to
of life. Suffering and health are those suffering. Caring is something
each other’s prerequisites. natural and original. Eriksson thinks
that the substance of caring can be
■ Health is more than the absence
understood only by a search for its
of illness. Health implies origin. This origin is in the origin of the
wholeness and holiness. concept and in the idea of natural
■ The human being lives in a caring. The fundamentals of natural
reality that is characterized by caring are constituted by the idea of
mystery, infinity, and eternity. motherliness, which implies cleansing
○ Theses are fundamental statements and nourishing, and spontaneous and
unconditional love.
concerning the general nature of caring
● Person
science. These are as follow: ○ The conception of the human being in
■ Ethos confers ultimate meaning Eriksson’s theory is based on the
on the caring context. axiom that the human being is an entity
■ The basic motive of caring is the of body, soul, and spirit. The human
caritas motive. being is fundamentally holy, and this
■ The basic category of caring is axiom is related to the idea of human
dignity, which means accepting the
suffering. human obligation of serving with love
■ Caring communion forms the and existing for the sake of others. The
context of meaning of caring and
 human being is seen as constantly caring culture, reflects the prevailing
becoming; he is constantly in change. priority of values through which the
The dual tendency of the human being basic foundations of ethics and ethical
also emerges in his effort to be unique, actions appear.
while he simultaneously longs for
belonging in a larger communion. The
APPLICATION TO NURSING
human being is fundamentally
dependent on communion; where he
can give and receive love, experience ● Nursing Practice: Eriksson’s thinking and
faith and hope, and be aware that his process model of caring are general, the
existence now has meaning. the nursing care process model has proved to be
human being we meet in care is applicable in all contexts of caring, from acute
creative and imaginative, has desires
clinical caring and psychiatric care to
and wishes, and is able to experience
phenomena; So, a human being only in health-promoting and preventive care.
terms of his needs is insufficient. When ○ It has been influential in nursing
the human being is entering the caring leadership and nursing administration,
context, he becomes a patient in the where the caritative theory of nursing
original sense of the concept — a forms the core of the development of
suffering human being. nursing leadership at various levels of
● Health
the nursing organization.
○ Defines health as soundness,
freshness, and well-being. Implies ○ Her ideas about caring and her nursing
being whole in body, soul, and spirit. care process model work in practice has
Health means as a pure concept been verified by everything from a
wholeness and holiness. She sees multiplicity of essays and tests of
health as both movement and learning in clinical practice to master’s
integration. theses, licentiates’ theses, and doctoral
○ Health as movement implies a change;
a human being is being formed or dissertations produced all over the
destroyed, but never completely; health Nordic countries.
is movement between actual and ● Nursing Education: Eriksson’s theory has been
potential; health is movement in time integrated into the education of nurses at
and space; health as movement is various levels, and her books have been
dependent on vital force and on vitality included continuously in the examination
of body, soul, and spirit; the direction of
requirements in various forms of nursing
this movement is determined by the
human being’s needs and desires; the education has been based entirely on
will to find meaning, life, and love Eriksson’s ideas, and her caritative caring
constitutes the source of energy of the theory forms the core of the development of
movement; and health as movement substance in education and research.
strives toward a realization of one’s ○ Development of the caring
potential. science–centered curriculum and caring
● Environment
didactics continued in the educational
○ Good caring and true knowledge
become visible through ethos. Ethos and research program in caring science
originally refers to home, or to the didactics offered as part of continuing
place where a human being feels at education for those who work in clinical
home. It symbolizes a human being’s practice.
innermost space, where he appears in ○ Sees caring science not as profession
his nakedness. oriented but as a “pure” academic
○ Ethos means that we feel called to
serve a particular task. This ethos she discipline, it has aroused interest among
sees as the core of caring culture. students in other disciplines, that
Ethos, which forms the basic force in genuine interdisciplinary cooperation is
 needed between caring science and
○ Eriksson’s thinking as a whole has
medicine. reached an understanding that extends
○ Most nursing colleges make good use of to other disciplines and professions.
her texts, and works form part of the She has developed a language and a
curriculum at a variety of educational rhetoric that has reached researchers
levels. as well as practitioners in the human
● Nursing Research: Countless dissertations scientific field. The empirical precision
of Eriksson’s theory demonstrated in
based on practical, concrete, and more multiple deductive testing manifests a
theoretical issues discuss the relationship combination of the clarity, simplicity,
between empirical experience in light of her and generality of the theory combined
terminology and philosophy. with a rich substance and clearly
formulated ethos.
● Importance
○ Eriksson’s work on developing her
IMPLICATIONS OF THE THEORY caritative caring theory for 30 years
has been successful, and particularly in
● Clarity the Nordic countries there is abundant
○ Every new concept becomes a part of evidence that her thinking is of great
an ever more comprehensive whole in importance to clinical practice,
which an element of internal logic can research, and education, and also to
be seen clearly. Her main thesis has the development of the caring
always been that basic conceptual discipline. By her development of the
clarity is needed before developing the caritative theory of care, Eriksson
contextual features of the theory. Used created her own caring science
concept analysis and analysis of ideas tradition, a tradition that has grown
as central methods, which has led to strong and has set the tone for nursing
semantic and structural clarity. advancement and caring science.
● Simplicity
○ The theoretical clarity of Eriksson’s
theory reflects the simplicity of the SUMMARY
theory by showing the general in a
clear and logical conceptual entirety. ● She has been a guide and visionary who has
The hermeneutic approach has gone before and “ploughed new furrows” in
deepened the understanding of the theory development. Eriksson’s caritas-based
substance and thus contributed to the
theory and her whole caring science thinking
simplicity of the theory formulates this
process by the statement that “ideals have developed over years. Characteristic of
reach reality and reality reaches the her thinking is that while she is working at an
ideals”. abstract level developing concepts and theory,
● Generality rooted in clinical reality and teaching.
○ The theory is general in the sense that ● The whole caritative theory and the caring that
it aims at creating an ontological and are built up around the theoretical core get their
ethical basis of caring, while at the
same time it constitutes the core of the distinctive character and deeper meaning. The
discipline and thus involves ultimate goal of caring is to alleviate suffering
epistemology as well. It was stressed and serve life and health.
the importance of describing the core ● Knowledge formation, which Eriksson sees as a
concepts on an optimal level of hermeneutic spiral, starts from the thought that
abstraction in order to include all of the ethics precedes ontology. In a concrete sense,
complex caring reality that
this implies that the thought of human holiness
simultaneously carries a wealth of
signification that opens up and dignity is always kept alive in all phases of
understanding in various caring the search for knowledge. Ethics precedes
contexts. ontology in theory as well as in practice.
● Accessibility
● Eriksson’s caring science tradition and
discipline of caring science form a basis for the
activity at the Department of Caring Science.
Eriksson’s caritative caring theory and the
discipline of caring science have inspired many,
and they are used as the basis for research,
education, and clinical practice.
 NUR 016: THEORETICAL FOUNDATION OF NURSING
MODULE 5:
FIRST SEMESTER l S.Y. 2023-2024 TRANSCRIBED BY: NATHALIE KIM E. ALMEDORA
LECTURER: MS. MICHELLE TIANGSON DIZON

OUTLINE OF THE TOPICS

2. Conservation of Structural Integrity – all
body systems decline with aging; chronic illness
➢ Myra E. Levine’s Conservation Model also produces bodily structural changes
➢ Martha E. Roger’s Science of Unitary Human ● maintaining or promoting mobility
Being Conceptual Models of Nursing
● preventing injury
● preventing infection
MYRA E. LEVINE’S CONSERVATION MODEL ● maintaining skin integrity

➢ “Nursing is a human interaction that promotes 3. Conservation of Personal Integrity –

adaptation and maintains wholeness either by self-identity is intrinsically bound to wholeness
acting in the therapeutic sense or by providing and all individuals cherish the sense of self; it
supportive care in order to influence adaptation includes recognition of the holiness of each
favorably, or toward renewed social wellbeing.” person
○ This is focused on the preservation of ● respecting one’s privacy and property
the individual’s wholeness or totality. ● enhancing self-esteem through good
○ She believed that nursing activities were personal hygiene, grooming and
conservation activities, a keeping- dressing
together function that promotes ● fostering independence through choice
wholeness in the patient. and rehabilitation
● promoting self-identity for those who are
cognitively impaired
● obtaining advance directives for
treatment

4. Conservation of Social Integrity – individual

life has meaning only in the context of social life
● providing meaningful social activities for
residents and staff, considering the
family and resident as a unit

MAJOR CONCEPTS AND DEFINITIONS

FOUR PRINCIPLES
● Conservation
1. Conservation of Energy – all physiologic and ➔ describes the way complex systems are
psychological processes that sustain life able to continue to function even when
depend on the body’s energy balance severely challenged
● adjusting to life in the nursing home ➔ it is through conservation that man is
● improving nutritional status, balancing able to confront obstacles, adapt
resident activity accordingly, and maintain their
● controlling resident anxiety and pain uniqueness and individuality, from Latin
word conservation which means “to
keep together”
● Wholeness ➢ Operational level – refers to
➔ emphasizes a sound, organic, things that physically affect the
progressive, mutuality between individual but may not be
diversified functions and parts within an perceived by the individual
entirety, the boundaries of which are himself. An example of these are
open and fluent microorganisms. We can get an
➔ it connotes integrity – the oneness of infection because of a
persons, highlighting their capacity to microorganism but we cannot
respond in an integrated and singular really perceive what a
fashion to environmental challenges microorganism really is.
➢ Conceptual level – the
● Adaptation environment is the product of
➔ the process of change wherein the cultural patterns, characterized
person is able to keep his integrity within by spirituality, and moderated by
situations and circumstances of his language, history, and thought.
environment, both internal and external
➔ it is the bridge; the process by which ● Organismic response
individuals fit the environments in which ➔ refers to the person’s ability to adapt to
they live his or her environment and is made up
➔ health and disease are patterns of of four levels of integration
adaptive change ➢ Fight or flight – the most
➔ the goal of adaptive change is the primitive response; the person
conservation of wholeness (health) and either “fights” or “flies away” from
integrity a perceived stressor in order to
➔ the result of adaptation is conservation ensure his own safety and
which has 3 characteristics: well-being
➢ Historicity – patterned ➢ Inflammatory response – body
responses passed on through defense mechanism that protects
genetics the body tissue from insults in an
➢ Specificity – unique adaptive unfriendly environment
responses to specific ➢ Response to stress – refers to
environmental challenges the wear and tear of body tissues
➢ Redundancy – availability of that reflect the body’s continued
multiple adaptive responses response and adaptation to
➔ Levine suggests “the possibility exists stressful situations; it is
that aging itself is a consequence of characterized by irreversibility
failed redundancy of physiological and and influences the way the
psychological processes” patients respond to nursing care
➢ Perceptual awareness /
● Environment Sensory response – it occurs
➔ Internal environment – composed of as the person experiences life
the physiologic and pathophysiologic and the world around him;
domains of the person individuals are constantly
➔ External environment has three levels: immersed in an environmental
➢ Perceptual level – includes all background of sensory input that
aspects of the world wherein the never cases, even during sleep,
person is able to intercept and prompts to maintain safety and
interpret with his sense organs. seek wholeness
● Trophicognosis ➢ Conservation principles have been used as a
➔ a scientific method of reaching a nursing framework for numerous practice settings by
care judgment; an alternative identifying the activities it encompasses and
recommendation of Levine to Nursing giving the scientific principles behind them.
Diagnosis
MARTHA E. ROGER’S SCIENCE OF UNITARY
HUMAN BEING CONCEPTUAL MODELS OF
THEORY IN VIEW OF METAPARADIGMS
NURSING
● Nursing
○ “Nursing intervention must be founded ➢ “Nursing is an art and science that seeks to
not only on scientific knowledge, but promote symphonic interaction between the
specifically on recognition of the environment and man, to strengthen the
individual’s behavioral responses
coherence and integrity of the human beings,
which indicate the nature of the
adaptation taking place.” and to direct and redirect patterns of interaction
○ The goal of nursing care is to support between man and his environment for the
adaptation and the strong drive of the realization of maximum health potential.”
individual to seek wholeness. Because ○ This theory provides a radical vision of
of the uniqueness of each individual, nursing reality.
nursing care for each patient must be ○ It provides a framework for nursing
highly individualized. Nursing
practice, education, and research that
interventions are both therapeutic and
supportive. promises a move away from the
○ Therapeutic focuses on enhancing previous predominant medical model
adaptation and improving well-being approach to the delivery of nursing care.
while supportive interventions are used ○ Rogers formulated five basic
when nursing care is unable to improve assumptions that describe man and the
the adaptive response or fail to halt a life process in man.
downhill course including nursing care
○ These assumptions or “building blocks”
for the dying patient.
underlay the conceptual framework and
● Person consist of the concepts of wholeness,
○ This refers to holistic being; wholeness openness, unidirectionality, pattern and
is integrity. Integrity means a person organization, and sentience and
has a freedom of choice and thought.
movement. The word patient comes
○ According to Rogers, a person is an
from the Latin “to suffer” while the word
client comes from Latin means “to irreducible whole, the whole being
follow”. greater than the sum of its parts.
○ Man is a dynamic energy field in
● Health constant exchange with environmental
○ This is the ability to function in a energy fields.
reasonable manner. ○ Four “critical elements” that are basic in
the theory:
● Environment
○ This is not a passive backdrop, the ■ Energy fields
individual actively participates in his ■ Open system
environment. The process of ■ Pattern
interaction is adaptation. ■ Pan-dimensionality – was
previously known as
multidimensionality, and prior to
APPLICATIONS TO NURSING that, four-dimensionality
 MAJOR CONCEPTS AND DEFINITIONS ➔ holds that energy fields are infinite,
open, and integral with one another
● Wholeness
➔ refers to the state in which the human ● Pattern
being is regarded as a unified whole ➔ is the “distinguishing characteristic of the
which is more than and different from energy field perceived as a single
the sum of the parts wave”, which gives identity to the field
➔ human behavior can be regarded as
● Openness manifestations of changing pattern
➔ where the individual and the ➔ the pattern is constantly changing and
environment are continuously might be regarded as an indication of
exchanging matter and energy with each pain, illness or disease
other ➔ sentience and thought states that all of
life, human beings are the only ones
● Open systems (openness) capable of abstraction and imagery,
➔ describe the open nature of the fields, language and thought, sensation and
the preferred terminology being that emotion
there is a “continuous process” without
the mention of energy or matter ● Pan-dimensionality
➔ is a nonlinear domain without spatial or
● Unidirectionality temporal attitudes; it describes an
➔ refers to where the life process exists infinite domain without limits
along an irreversible space time ➔ it short, it is a unitary whole
continuum
➔ pattern and organization identify THEORY ASSERTIONS
individuals and reflect their innovative
wholeness ➢ Rogers viewed the person as an open system
in constant process with the open system of the
● Energy fields environment.
➔ are the “fundamental unit of the living ➢ She added that man is a unified whole
and the non-living” possessing his own integrity and manifesting
➔ they consist of the human energy field characteristics more than and different from the
and the environment energy field sum of his parts.
➢ In continuously exchanging matter and energy
● The human field with the environment, identified by pattern and
➔ an “irreducible, indivisible, organization and reflects his innovative
pan-dimensional energy field identified wholeness.
by pattern and manifesting ➢ This is characterized by the capacity for
characteristics that are specific to the abstraction and imagery, language and thought,
whole and which cannot be predicted sensation, and emotion.
form knowledge of the parts”
THEORY IN VIEW OF METAPARADIGMS
● The environmental field
➔ is integral with the human field; each ● Nursing
environmental field is specific to its ○ A learned profession and is both a
given human field science and an art.

● Person
● Universe of open system
 ○ An open system in continuous process
with the open system that is the
environment.

● Health
○ Passive health – to symbolize wellness
and the absence of disease and major
illness.

● Environment
○ Associated to open systems.

8 CONCEPTS IN ROGER’S NURSING THEORY

● energy field
● openness
● pattern
● pan-dimensionality
● hemodynamic principles
● resonance
● helicy
● integrality
 NUR 016: THEORETICAL FOUNDATION OF NURSING
MODULE 6:
FIRST SEMESTER l S.Y. 2023-2024 TRANSCRIBED BY: NATHALIE KIM E. ALMEDORA
LECTURER: MS. MICHELLE TIANGSON DIZON

OUTLINE OF THE TOPICS 1. Wholly Compensatory System – nurse

provides total care
➢ Dorothea Orem’s Self-Care Deficit Model 2. Partially Compensatory System – nurse &
➢ Imogene King’s Interacting Systems Framework patient share responsibility for care
and Goal Attainment Theory
3. Supportive-Educative System – client has
primary responsibility for personal health,
DOROTHEA OREM’S SELF-CARE DEFICIT with nurse acting as a consultant
MODEL
WHOLLY COMPENSATORY SYSTEM
➢ “Nursing is a helping profession of assisting
patients overcome or compensate for their ● Accomplishes patient’s therapeutic self-care
health-associated limitations and engaging in ● Compensates for the patient’s inability to
actions to regulate their own functioning and engage in self-care
development or that of their dependents.” ● Supports and protects the patient
○ The model is a collection of three
interrelated theories. PARTIALLY COMPENSATORY SYSTEM
○ These are nursing systems, self-care,
and self-care deficit. Nurse Actions:
○ The focus of Orem’s model is to ● Performs some self-care measures for the
enhance the person’s ability for self-care patient
and this also extends to the care of ● Compensates for self-care limitations of the
dependents. patient
○ A person’s self-care deficits are the ● Assists the patient as required
result of environmental situations.
○ Theoretical sources – philosophical Nurse-Patient Actions:
system of moderate realism. ● Performs some self-care measures
● Regulates self-care agency
● Accepts care and assistance from nurse

SUPPORTIVE-EDUCATIVE SYSTEM

● Accomplishes self-care
● Regulates the exercise and development of
self-care agency

● The basic premise of the model is that

individuals can take responsibility for their
health and the health of others.
There are three systems that exist within this ● In a general sense, individuals have the
professional nursing practice model: capacity to care for themselves or their
dependents.
● It is based upon the philosophy that all
 These require medical
“patients wish to care for themselves”.
● When an individual is unable to meet his intervention and management.
own self-care requisites, a self-care deficit
occurs. ● Therapeutic self-care demand
● It is the duty and obligation of the ➔ This is composed of the totality of
professional nurse to recognize and identify nursing care measures important at
these deficits in order to define a support certain times or over a period of time for
modality or intervention.
meeting all of the individual’s known
self-care requisites.
MAJOR CONCEPTS AND DEFINITIONS ➔ It uses methods appropriate for
managing the factors identified in the
● Self-care requisites and fulfilling the activity
➔ It is composed of the practice of element of the requisite.
activities that maturing and mature
individuals initiate and perform, within ● Nursing agency
time periods, on their behalf. This is to ➔ It refers to the developed capabilities of
ensure maintaining life, healthful nurses that empower them to meet the
functioning, continuing personal therapeutic self-care demands of the
development, and well-being. patient.
➔ Self-care requisites are formulated and
expressed insights about actions to be ● Self-care agency
performed which are known to be ➔ This is a complex acquired ability of
relevant and vital to human functioning. mature & maturing individuals to know &
1. Universal self-care requisites – meet their continuing requirements for
those needs that all people have; deliberate & purposive action to regulate
include air, water, food, their own human functioning and
elimination, activity and rest, development.
solitude and social interaction,
hazard prevention, and ● Dependent-care agent
promotion of normal functioning ➔ This is a maturing adolescent who
2. Developmental self-care accepts and fulfills the responsibility to
requisites – those needs that know and meet the therapeutic self-care
relate to the development of the demand of significant others who are
individual; include conditions that socially dependent on them.
promote development,
engagement in ● Nursing systems
self-development, and ➔ These are series and sequences of
prevention of or overcoming deliberate practical actions of nurses
effects of human conditions and performed at times.
life situations that can adversely
affect human development THEORY ASSERTIONS
3. Health deviation requisites –
those needs that arise as a result ➢ Nursing systems are action systems formed by
of a patient’s condition; include nurses through the exercise of their nursing
all pathologic conditions or agency for persons with health-derived or
disorders which include defects, health-associated limitations in self-care or
deformities, and disabilities. dependent care.
➢ It includes deliberate action, intentionality, IMOGENE KING’S INTERACTING SYSTEMS
diagnosis, prescription, and regulation. FRAMEWORK AND GOAL ATTAINMENT THEORY
➢ “Self-care is a regulatory function by man. It is
deliberate and is performed by the person ➢ “Nursing is an observable behavior found in the
himself or have them performed by another health care systems in society that aims to help
person or them in order to maintain life, health, individuals maintain their health so they can
development, and well-being.” function in their roles.”

THEORY IN VIEW OF METAPARADIGMS

● Nursing
○ Nursing is an art through which the
practitioner of nursing gives specialized
assistance to persons with disabilities,
making more than ordinary assistance
necessary to meet self-care needs.
The nurse also intelligently participates
in the medical care the individual
receives from the physician.
INTERACTING SYSTEM FRAMEWORK
● Person
○ Humans are defined as “men, women, ➢ This theory emphasizes the importance of the
and children cared for either singly or
interaction between the nurse and patients.
as social units” and are the “material
object” of nurses and others who ➢ It views this interaction as an open system
provide direct care. which is in constant interaction with a variety of
environmental factors.
● Health ➢ There are three interrelated systems that
○ Health is “being structurally and represent the domain of nursing:
functionally whole or sound”. Also, 1. Personal systems – composed of body
health is a state that encompasses
image, growth and development,
both the health of individuals and
groups, and human health is the ability perception, self, space, and time.
to reflect on oneself, symbolize ● When two or more persons
experience, and communicate with interact, they form an
others. interpersonal system.
2. Interpersonal system – composed of
● Environment
the concepts of communication,
○ The environment has physical,
chemical, and biological features. It interaction, role, stress, and transaction.
includes the family, culture, and ● A comprehensive interacting
community. system is composed of groups
that make up a society. This
APPLICATIONS TO NURSING results in the social system.
3. Social system – composed of the
➢ What is clear in the model of Orem is the concepts of authority, decision-making,
emphasis on education and supportive organization power, and status.
measures. It becomes clear that nurses today
should not move away from this very important
aspect of clinical nursing – health teachings.
 GOAL ATTAINMENT THEORY 8. If nurses with special knowledge and skills
communicate appropriate information to clients,
➢ This is a middle-range theory that is the product then mutual goal setting and goal attainment
of developments from her first Interacting will occur.
Systems Framework.
➢ The theory stated that mutual goal-setting MAJOR CONCEPTS AND DEFINITIONS
between a nurse and a client is based on:
○ nurse’s assessment of a client’s ● Perception
concerns, problems, and disturbances in ➔ a process in which data obtained
health through the senses and from memory
○ nurse’s & client’s perceptions of the are organized, interpreted, and
interference transformed
○ nurse’s & client’s sharing of information
wherein each functions to help the client ● Stress
attain the goals identified ➔ an ever changing condition in which an
➢ The theory also maintained that nurses interact individual, through environmental
with family members when clients cannot interaction, seeks to keep equilibrium to
verbally participate in the goal-setting. support growth and development and
➢ As such, this theory is focused on the activity
interpersonal system and the interactions that ➔ an organization is made up of
take place between individuals, more individuals who have prescribed roles
specifically in the nurse-client relationship. and positions and who make use of
➢ The system is an open one in that it allows resources to meet goals-both personal
feedback because each phase of the and organizational.
nurse-patient activity has the potential to
influence perception. ● The self
➔ made up of thoughts and feelings
8 PROPOSITIONS RELATED TO THE related to one’s awareness of being a
GOAL ATTAINMENT THEORY person separate from others and
influencing one’s view of who and what
1. If perceptual accuracy is present in the he or she is
nurse-client interactions, then transactions will
occur. ● Growth and development
2. If a nurse and client make transactions, then ➔ processes in people’s lives through
goals will be attained. which they move from potential for
3. If goals are attained, then satisfaction will occur. achievement to actualization of self
4. If goals are attained, then effective nursing care
will occur. ● Body image
5. If transactions are made in nurse-client ➔ includes both the way one perceives
interactions, then growth and development will one’s body and others’ reactions to
be enhanced. one’s appearance
6. If role expectations and role performance as
perceived by nurse and client are congruent, ● Space
then transactions will result. ➔ the physical area known as territory and
7. If role conflict is experienced by nurse and by the behaviors of those who occupy it
client or both, then stress in nurse-relationship
interactions will occur.
● Interactions THEORY ASSUMPTIONS
➔ observable behaviors of two or more
persons in mutual presence ➢ The focus of nursing is the care of the human
being (patient).
● Communication ➢ The goal of nursing is the health care of both
➔ verbal and non-verbal situational, individuals and groups.
perceptual, transactional, irreversible, or ➢ Human beings are open systems interacting
moving forward in time, personal, and with their environments constantly.
dynamic ➢ The nurse and patient communicate
➔ Transactions are a series of exchanges information, set goals mutually, and then act to
between human beings and the achieve those goals. This is also the basic
environment that include observable assumption of the nursing process.
behaviors that seek to reach goals of ➢ Patients perceive the world as a complete
worth to the participants person making transactions with individuals and
things in the environment.
● Role ➢ The transaction represents a life situation in
➔ characterized by reciprocity in that a which the perceiver and the thing being
person may be a giver at one time and a perceived are encountered. It also represents a
taker at another time, with the life situation in which a person enters the
relationship between two or more situation as an active participant. Each is
individuals who are functioning in two or changed in the process of these experiences.
more roles that are learned social,
complex, and situational THEORY IN VIEW OF METAPARADIGMS

● Authority ● Nursing
➔ refers to the active, reciprocal process of ○ Nursing is a process of action,
transaction in which the actors’ reaction, and interaction whereby
nurse and client share information
experience, understanding, and values
about their perceptions in the nursing
influence the meaning, legitimacy and situation. The nurse and client share
acceptance of those in organizational specific goals, problems, and concerns
positions associated with authority and explore how to achieve a goal.

● Status ● Person
➔ the relationship of one’s place in a group ○ Individuals are social beings who are
rational and sentient. Humans
to others in the group or of a group to
communicate their thoughts, actions,
other groups customs, and beliefs through language.
Persons exhibit common
● Decision-making characteristics such as the ability to
➔ a changing and orderly process through perceive, think, feel, choose between
which choices related to goals are made alternative courses of action, set goals,
among toward the goal select the means to achieve goals, and
make decisions.
● Time ● Health
➔ an interval between the two events that ○ Health is a dynamic life experience of a
is experienced differently by each human being, which implies continuous
person adjustment to stressors in the internal
and external environment through
optimum use of one’s resources to
 achieve maximum daily living potential.

● Environment
○ The environment is the background for
human interactions. It is both external
to, and internal to, the individual.
 NUR 016: THEORETICAL FOUNDATION OF NURSING
MODULE 7:
FIRST SEMESTER l S.Y. 2023-2024 TRANSCRIBED BY: NATHALIE KIM E. ALMEDORA
LECTURER: MS. MICHELLE TIANGSON DIZON
○ The line of resistance is further
OUTLINE OF THE TOPICS
surrounded by two lines of defense.
■ First line of defense is the
➢ Betty Neuman’s Systems Model person’s state of equilibrium or
➢ Sister Callista Roy’s Adaptation Model of Nursing the state of adaptation
➢ Dorothy Johnson’s Behavioral Systems Model
developed and maintained over
time and which is considered
BETTY NEUMAN’S SYSTEMS MODEL normal for the person.
■ Second line of defense is
➢ “Nursing is a unique profession that is flexible, dynamic, and can be
concerned with all of the variables affecting an readily and rapidly changed over
individual’s response to stress.” a short period of time.
○ A unique, systems-based perspective ○ She classified stressors as
that provides a unifying focus for intrapersonal, interpersonal, and
approaching a wide range of nursing extrapersonal stressors.
concerns. ○ Man’s reaction to stress is dependent on
○ A comprehensive guide for nursing the integrity of the lines of resistance
practice, research, education, and and defense.
administration that is open to creative ○ When the line of defense fails, man’s
implementation. reaction will now depend on the lines of
○ It has the potential for unifying various resistance.
health-related theories, clarifying the ○ Because of the reaction, man can adapt
relationships of variables in nursing care to a stressor This is called
and role definitions at various levels of reconstitution.
nursing practice. ○ Therefore, nursing interventions focus
○ Based on the person’s relationship to on keeping or maintaining the stability of
stress, his reaction to it, and the open system. These interventions
reconstitution factors that are dynamic in can be carried out on the three levels of
nature. prevention: primary, secondary, and
○ considers the person as an open system tertiary.
which is composed of a basic structure
of energy resources.
○ These resources include physiologic,
psychologic, sociocultural,
developmental, and spiritual.
○ The basic structure, or central core, is
surrounded by two concentric
boundaries or rings called the lines of
resistance.
○ These lines represent the internal
factors that aid the person defend
against a stressor.
 MAJOR CONCEPTS AND DEFINITIONS ➔ normal line of defense reflects the
client’s stability which serves as the
➢ In a holistic approach, the client as a whole, guide to assess deviations from the
whose parts are in dynamic interaction with client’s usual wellness
itself and the environment. It strongly advises
the consideration of all variables that ● Flexible line of defense
simultaneously affect the client system. ➔ a protective layer for preventing
stressors from breaking through the
● Open system usual wellness state
➔ characterized by elements that are in 1. Intrapersonal factors occur
continuous exchange within a complex within the individual
organization 2. Interpersonal factors occur
➔ these exchanges may be in the form of between one or more individuals
information or energy 3. Extrapersonal factors occur
➔ basic to this is stress and stress reaction outside the individual

● Created environment ● Preventive interventions

➔ developed unconsciously by the client in ➔ purposeful actions to help the client
order to express the wholeness of the retain, attain, or maintain the stability of
system by using symbols the client system and carried out when a
stressor is either suspected or identified
● Client system
➔ composed of the five system variables
ORDER: LEVELS, DEFINITION,
interacting with the environment. EXAMPLES
1. Physiologic variables are body
structure and function ➢ Primary
2. Psychological variables include ○ This is carried out when a
mental processes in interaction stressor is suspected or
identified. The degree of risk
with the environment is already known but the
3. Sociocultural variables are the reaction of the client may not
effects and influences of social yet be visible.
and cultural conditions ■ Teaching a person
4. Developmental variables are about weight
age-related processes and reduction to
decrease the client’s
activities throughout life
chances of
5. Spiritual variables are beliefs and developing diabetes.
influences related to spirituality
➢ Secondary
● Basic client structure ○ This is carried out when
➔ composed of a central core surrounded symptoms from stress have
by concentric rings already occurred. It
involves activities that
➔ the core reflects basic survival factors or
“treat” the symptoms.
energy resources of the client ■ Parents that have a
disabled child.
● Lines of resistance Initially they may
➔ represents resources that help the client feel they can never
defend against a stressor accept this situation.
However, they are
 able to draw on intrapersonal or extrapersonal.
resources they were
unaware of and STEP 2: DIAGNOSIS, PLANNING,
eventually find IMPLEMENTATION
themselves coping
well. ● The next step addresses the nursing
diagnosis, which describes the context of the
➢ Tertiary whole client as a system.
○ This occurs after the active ● Goals are then determined in collaboration
treatment. It readjusts the with the client.
client system toward ● Interventions are determined relative to the
optimum levels of stability. goals, and are carried out at three levels:
The goal is to strengthen primary, secondary, and tertiary prevention.
resistance to stressors in
order to prevent recurrence STEP 3: EVALUATION
or reaction or regression.
■ Referring the newly ● The next step involves nursing outcomes
diagnosed diabetic which refers to evaluation of the
client to the Diabetic effectiveness of interventions.
Resource Nurse. ● This includes assessing changes in
intrapersonal, interpersonal, and
extrapersonal factors.
● Reconstitution ● Any changes in the nature of the stressors
➔ occurs following the treatment of are examined, as change in these areas
stressor reactions; marks the return of determine the success of the nursing
the client system to stability interventions.
● If change has not occurred, more data
collection is required and the nursing
● Level of stability process is repeated.
➔ after reconstitution, may be higher or
lower than the previous level before the
THEORETICAL ASSERTIONS
invasion of the stressor

NEUMAN EMPLOYES A THREE-STEP NURSING

➢ Each client system is unique, a composite of
PROCESS factors and characteristics within a given range
of responses.
➢ Many known, unknown, and universal stressors
STEP 1: ASSESSMENT exist. Each differs in its potential for disturbing a
client’s usual stability level or normal line of
● In the initial assessment, the nurse looks at
the client’s basic make-up and the known, defense. The particular interrelationships of
unknown and universal stressors. client variables at any point in time can affect
● When examining the client’s basic makeup, the degree to which a client is protected by the
predispositions are considered. They are flexible line of defense against possible reaction
important because they affect how the client to stressors.
will deal with stressors. ➢ Each client/client system has evolved a normal
● The nurse also looks at Neuman’s five
range of responses to the environment referred
variables: physiological, psychological,
sociocultural, developmental and spiritual. to as a normal line of defense. The normal line
The nurse uses these variables to examine of defense can be used as a standard from
the person’s predispositions and stressors. which to measure health deviation.
● The client’s perception of these stressors is ➢ When the flexible line of defense is no longer
discussed and the nurse provides input. capable of protecting the client/client system
● Stressors are identified as interpersonal,
 against an environmental stressor, the stressor SISTER CALLISTA ROY’S ADAPTATION MODEL
breaks through the normal line of defense. OF NURSING
➢ Whether in a state of wellness or illness, the
client is a dynamic composite of the variables’ ➢ The model assumes that systems of matter and
interrelationships. Wellness is on a continuum energy progress to higher levels of complex
of available energy to support the system in an self-organization.
optimal system stability state. ➢ Consciousness and meaning comprise person
➢ Implicit within each client system are internal and environment integration while awareness of
resistance factors known as lines of resistance, self and environment is rooted in thinking and
which function to stabilize and realign the client feeling.
to the usual wellness state. ➢ System relationships include acceptance,
protection and fostering of independence
➢ Man and his environment have common
THEORY IN VIEW OF METAPARADIGMS
patterns and integral relationships and
● Nursing transformations are created in human
○ Nursing’s primary concern is to define consciousness.
the appropriate action in situations that ➢ Integration of man and environment meanings
are stress-related or concerning result in adaptation.
possible reactions of the client or client
➢ Roy’s model of nursing is best exemplified in
system to stressors. Nursing
interventions aim to help the system the nursing process.
adapt or adjust and retain, restore, or
maintain some degree of stability
between the client system variables
and environmental stressors, focusing
on conserving energy.

● Person
○ Humans are defined as “men, women,
and children cared for either singly or
as social units” and are the “material
object” of nurses and others who
provide direct care.
➢ The nursing process is a problem solving
● Health
○ Health is defined as the condition or approach for gathering data, identifying the
degree of system stability and is capacities and needs of the human adaptive
viewed as a continuum from wellness system, selecting and implementing
to illness. When system needs are met, approaches for nursing care, and evaluating the
optimal wellness exists. When needs outcome of care provided. It includes the
are not satisfied, illness exists. When following steps:
the energy needed to support life is not
available, death occurs.
ASSESSMENT The first step of the nursing
● Environment OF process which involves
○ The environment is a vital arena that is BEHAVIOR gathering data about the
germane to the system and its function. behavior of the person as an
The environment may be viewed as all adaptive system in each of
factors that affect and are affected by the adaptive modes
the system. In Neuman Systems Model
identifies three relevant environments: ASSESSMENT The second step of the
(1) internal, (2) external, and (3) OF nursing process which
created. STIMULI involves the identification of
 living organisms. These are the actual
internal and external stimuli
that are influencing the processes put in motion by the regulator
person’s adaptive behaviors. subsystem.
Stimuli are classified as: ● This mode’s basic need is composed of
● Focal – those most the needs associated with oxygenation,
immediately confronting nutrition, elimination, activity and rest, and
the person protection.
● Contextual – all other
stimuli present that are ● This model’s complex processes are
affecting the situation associated with the senses, fluid and
● Residual – those electrolytes, neurologic function, and
stimuli whose effect on endocrine function.
the situation is unclear
2. Self-Concept Group Identity Mode
NURSING Step three of the nursing
DIAGNOSIS process which involves the ● The goal of coping is to have a sense of
formulation of statements that unity, meaning the purposefulness in the
interpret data about the universe, and a sense of identity integrity.
adaptation status of the This includes body image and self-ideals.
person, including the behavior
and most relevant stimuli 3. Role Function Mode
GOAL SETTING The fourth step of the nursing ● This focuses on the primary, secondary,
process which involves the and tertiary roles that a person occupies
establishment of clear in society and knowing where they stand
statements of the behavioral as a member of society.
outcomes for nursing care
4. Interdependence Mode
INTERVENTION The fifth step of the nursing
process which involves the ● This mode focuses on attaining relational
determination of how best to integrity through the giving and receiving
assist the person in attaining of love, respect and value. This is
the established goals achieved with effective communication
and relations.
EVALUATION The sixth and final step of the
nursing process which
MAJOR CONCEPTS AND DEFINITIONS
involves judging the
effectiveness of the nursing
intervention in relation to the ● Health
behavior after the nursing ➔ a state and process of being and
intervention in comparison becoming integrated and whole that
with the goal established reflects person and environmental
mutuality
FOUR ADAPTIVE MODES
● Adaptation
➢ These are how the regulator and cognator ➔ the process and outcome whereby
mechanisms are manifested; in other words, thinking and feeling persons, as
they are the external expressions of the above individuals and in groups, use conscious
and internal processes. awareness and choice to create human
and environmental integration
1. Physiological-Physical Mode
● Physical and chemical processes are ● Adaptive responses
involved in the function and activities of
 ➔ responses that promote integrity in THEORY IN VIEW OF METAPARADIGMS
terms of the goals of the human system,
that is, survival, growth, reproduction, ● Nursing
mastery, and personal and ○ In the Adaptation Model, nurses are
environmental transformation facilitators of adaptation. They assess
the patient’s behaviors for adaptation,
promote positive adaptation by
● Ineffective responses enhancing environment interactions
➔ responses that do not contribute to and helping patients react positively to
integrity in terms of the goals of the stimuli. Nurses eliminate ineffective
human system coping mechanisms and eventually
lead to better outcomes.
● Adaptation levels
● Person
➔ represent the condition of the life
○ Based on Roy, humans are holistic
processes described on three different beings that are in constant interaction
levels: integrated, compensatory, and with their environment. Humans use a
compromised. system of adaptation, both innate and
acquired, to respond to the
THEORY ASSERTIONS environmental stimuli they experience.
Human systems can be individuals or
groups, such as families,
➢ Roy’s model views the person as an adaptive
organizations, and the whole global
system with coping processes. community.
➢ She described the person as a whole
comprising parts and which functions as a unity ● Health
for some purpose. ○ Health is defined as the state where
➢ It includes people as individuals or in groups humans can continually adapt to
(families, organizations, communities, nations, stimuli. Because illness is a part of life,
health results from a process where
and society as whole).
health and illness can coexist. If a
➢ The person is an adaptive system with cognator human can continue to adapt
and regulator subsystems acting to maintain holistically, they will maintain health to
adaptation in the four adaptive modes. reach completeness and unity within
➢ The environment is viewed as all conditions, themselves. If they cannot adapt
circumstances, and influences surrounding and accordingly, the integrity of the person
affecting the development and behavior of can be affected negatively.
persons and groups with particular ● Environment
consideration of mutuality of person and earth ○ The environment is defined as
resources. conditions, circumstances, and
➢ Nursing is the science and practice that influences that affect humans’
expands adaptive abilities and enhances development and behavior as an
person and environment transformation. adaptive system. The environment is a
stimulus or input that requires a person
➢ The goals of nursing are to promote adaptation
to adapt. These stimuli can be positive
for individuals and groups in the four adaptive or negative.
modes, thus contributing to health, quality of
life, and dying with dignity.
APPLICATION OF THE THEORY
➢ This is done by assessing behavior and factors
that influence adaptive abilities and by
● Nursing process is cyclical in nature –
intervening to expand those abilities and to
beginning with assessment, diagnosis,
enhance environmental interactions.
planning, implementation, and evaluation – the
 evaluation may also serve as the assessment ● She is proud to receive the 1975 Faculty Award
findings for another set of nursing problems. from graduate students.
● It means that the assessment component of the ● She was an early proponent of nursing as a
nursing process is the stimuli or the input and science as well as an art; also believed nursing
the planning and implementation are the had a body of knowledge reflecting both the
throughput processes. science and the art.
● The output is the evaluation which then ● Johnson (1959) proposed that the science of
provides the necessary feedback to the goal of nursing necessary for effective nursing care
care. included a synthesis of key concepts drawn
● The nurse then decides what necessary actions from basic and applied sciences.
should be taken next, in the light of the patient’s ● In 1961, she proposed that nursing care
response to the nursing interventions. This facilitated the client’s maintenance of a state of
action by the nurse is adaptation in its simplest equilibrium.
terms. ● She also proposed that clients were “stressed”
● Patients adapt, too. The nursing interventions by a stimulus of either an internal or external
we perform ultimately elicits a response from nature.
our patients, our patients may or may not ○ These stressful stimuli created such
actually adapt according to our expectations. disturbance, or “tensions”, in the patient
that a state of disequilibrium occurred.
DOROTHY JOHNSON’S BEHAVIORAL SYSTEMS ● She identified 2 areas that nursing care should
MODEL be based in order to return the client to a state
of equilibrium:
➢ “Nursing is an external force that acts to ○ Reduce stressful stimuli
preserve the organization of the patient’s ○ Support natural and adaptive processes
behavior by means of imposing regulatory
mechanisms or by providing resources while THEORETICAL SOURCES
the patient is under stress.”
● Johnson’s behavioral system theory springs
from Nightingale’s belief that nursing’s goal is to
help individuals prevent or recover from disease
or injury.
● The “science and art” of nursing should focus
on the patient as an individual and not on the
specific disease entity. The model is patterned
after a systems model; a system is defined as
consisting of interrelated parts functioning
together to form a whole.
● She stated that a nurse should use the
CREDENTIALS AND BACKGROUND OF behavioral system as their knowledge base.
JOHNSON The reason Johnson chose the behavioral
system model is the idea that “all the patterned,
● Born August 21, 1919 in Savannah, Georgia. repetitive, purposeful ways of behaving that
● Graduated BSN from Vanderbilt University in characterize each person’s life make up an
Nashville, Tennessee and her M.P.H. from organized and integrated whole, or a system”.
Harvard University in Boston.
● She was a staff nurse at the
Chatham-Savannah Health Council
(1943-1944).
 7 SUBSYSTEMS OF HUMAN BEHAVIOR 7. Eliminative – have to do with when, how, what,
how much, and under what conditions we
➢ The ultimate goal for each subsystem is eliminate
expected to be the same for all individuals.
● These responses are a set of behavioral
1. Attachment – probably the most critical, responses or tendencies that share a common
because it forms the basis for all social goal developed through experience and
organization learning and are determined by numerous
● provides survival & security; its physical, biological, psychological, and social
consequences are social inclusion, factors.
intimacy, & formation and maintenance ● Each subsystem has three functional
of a strong social bond requirements:
○ Each subsystem must be “protected
2. Achievement – attempts to manipulate the from noxious influences with which the
environment with its function is control or system cannot cope”.
mastery of an aspect of self or environment to ○ Each subsystem must be “nurtured
some standard of excellence through the input of appropriate supplies
● areas of achievement behavior include from the environment”.
intellectual, physical, creative, ○ Each subsystem must be “stimulated for
mechanical, & social skills use to enhance growth and prevent
stagnation”.
3. Aggressive – function is protection & ● As long as the subsystems are meeting these
preservation which holds that aggressive functional requirements, the system and the
behavior is not only learned, but has a primary subsystems are viewed as self-maintaining and
intent to harm others self-perpetuating.
● however, society has placed limits when
dealing with self-protection and that
MAJOR CONCEPTS AND DEFINITIONS
people & their properly be respected
and protected
● Behavior
➔ the output of intra-organismic structures
4. Dependence – promotes helping behavior that
and processes as they are coordinated
calls for a nurturing response
and articulated by & responsive to
● its consequences are approval,
changes in sensory stimulation
attention, or recognition, and physical
assistance
● System
● dependency behavior develops from the
➔ a whole that functions as a whole by
complete reliance on others for certain
virtue of the interdependence of its parts
resources essential for survival
characterized by organization,
● an imbalance produces tension, which
interaction, interdependency, &
results in disequilibrium
integration of the parts & elements

5. Sexual – has dual functions of procreation &

● Behavioral system
gratification that begins with the development of
➔ encompasses the patterned, repetitive,
gender role identity & includes the broad range
& purposeful ways of behaving
of sex role behaviors
➔ the system is flexible enough to allow
influence that affect it
6. Ingestive – have to do with when, how, what,
how much, and under what conditions we eat
● Subsystems 4. “System balance reflects adjustments
➔ mini-systems with its own particular goal and adaptations that are successful in
& function that can be maintained as some way and to some degree.”
long as its relationship to the other
subsystems or the environment is not ➔ Assumptions about structure
changed or disturbed 1. “From the form the behavior takes and
the consequences it achieves can be
● Equilibrium inferred what ‘drive’ has been stimulated
➔ a stabilized but more or less transitory, or what ‘goal’ is being sought.”
resting state where the person is in 2. Each person has a “predisposition to act
harmony with himself & with his concerning the goal, in certain ways
environment rather than the other ways.” This
predisposition is called a “set.”
● Tension 3. Each subsystem has a repertoire of
➔ the state of being stretched or strained choices called a “scope of action.”
can be viewed as an end-product of a 4. The individual patient’s behavior
disturbance in equilibrium produces an outcome that can be
observed.
● Stressor
➔ a stimulus, either internal or external, ➔ Assumptions about functions
that produce tension and result in a 1. The system must be protected from
degree of instability toxic influences with which the system
cannot cope.
THEORY ASSUMPTIONS 2. Each system has to be nurtured through
the input of appropriate supplies from
➢ These are in three categories: assumptions the environment.
about system, assumptions about structure, 3. The system must be stimulated for use
and assumptions about functions. to enhance growth and prevent
stagnation.
➔ Assumptions about system
1. There is “organization, interaction,
THEORY IN VIEW OF METAPARADIGMS
interdependency and integration of the
parts and elements of behaviors that go ● Nursing
to make up the system.” ○ This is viewed as an external force that
2. A system “tends to achieve a balance acts to preserve the organization of the
among the various forces operating patient’s behavior by means of
imposing regulatory mechanisms or by
within and upon it, and that man strives
providing resources while the patient is
continually to maintain a behavioral under stress. Nursing activities are not
system balance and steady-state by dependent on medical authority, rather,
more or less automatic adjustments and nursing is complementary to the
adaptations to the natural forces practice of medicine.
occurring on him.”
3. A behavioral system, which requires and ● Person
○ This is a behavioral system with
results in regularity and constancy in patterned, repetitive, and purposeful
behavior, is essential to man. It is ways of behaving that link the person
functionally significant because it serves to his environment. The person is a
a useful purpose in social life and the system of interdependent parts that
individual. requires some regularity and
 adjustment to maintain balance or
equilibrium. A person’ attempt to regain
balance may require an unnecessary
use of energy.

● Health
○ Health as an elusive, dynamic state
influenced by biological, psychological,
and social factors. A lack of balance in
the structural or functional
requirements of the subsystems leads
to poor health.

● Environment
○ The environment consists of all the
factors that are not part of the
individual’s behavioral system, but that
influence the system. The nurse may
manipulate some aspects of the
environment so the goal of health or
behavioral system balance can be
achieved for the patient.

APPLICATION OF THE THEORY

➢ The subsystems are interactive and

interdependent, restoration in one subsystem
could bring about restoration of behavior in
another or others. This means that healthcare
practitioners must direct all efforts,
interventions, or actions to all the subsystems.
➢ As nurses, we should provide the highest level
of quality care to our patients by taking into
consideration the whole person and trying to
understand the interrelatedness of its individual
component parts.
 NUR 016: THEORETICAL FOUNDATION OF NURSING
MODULE 8:
FIRST SEMESTER l S.Y. 2023-2024 TRANSCRIBED BY: NATHALIE KIM E. ALMEDORA
LECTURER: MS. MICHELLE TIANGSON DIZON

OUTLINE OF THE TOPICS

● Her seminal book is recognized as the first
nursing theory textbook since Nightingale’s
➢ Hildegard Peplau’s Theory of Interpersonal work in the 1850s. Peplau is credited for the
Relationship following in nursing profession:
➢ Ida Jean Orlando’s Theory of Deliberative Nursing
Process ○ promotion of professional standards and
regulation through credentialing
○ introduced the concept of advanced
HILDEGARD PEPLAU’S THEORY OF
nursing practice
INTERPERSONAL RELATIONSHIP
○ stressed the importance of
psychodynamics in nursing practice
➢ “Nursing is the interpersonal therapeutic
○ proponent of the nurse’s unique ability to
process of functioning cooperatively with other
understand his or her own behavior in
human processes that make health possible for
order to help others identify their
individuals in communities through education
perceived difficulties
that aims to promote forward movement of
● She discussed four psychobiological
personality.”
experiences that compel destructive or
constructive patient responses, as follows:
needs, frustrations, conflicts, and anxieties.

4 PHASES OF THE NURSE-PATIENT

RELATIONSHIP (WHICH PEPLAU IDENTIFIED):

● Orientation – the phase in the nurse-patient

interaction where the client seeks help and the
nurse assists the client to understand the
problem and the extent of the help
● Identification – characterized by the client who
CREDENTIALS AND BACKGROUND OF THE
assumes a posture of dependence,
THEORIST
interdependence, or independence in relation to
the nurse; the nurse’s focus is to assure the
● She is considered as the “Mother of Psychiatric
person that the nurse understands the
Mental Health Nursing” and “Nurse of the
interpersonal meaning of the client’s situation
Century”.
● Exploitation – the client derives full value from
● She served as Executive Director and President
what the nurse offers through the relationship;
of the American Nurses Association (ANA).
client uses available services based on self-
● Peplau taught the first classes for graduate
interest and needs; power shifts from the nurse
psychiatric nursing students at Teachers
to the client
College, Columbia University.
● Resolution – old needs and goals are set aside
● Contributed to the advancement of the nursing
and new ones are adopted; once older needs
profession was more than what she gave for
are resolved, newer and more mature one
this special area of clinical nursing.
become evident.
 6 PROPOSED NURSING ROLES
educated to recognize and to respond
to the need for help.”
1. Stranger Role – is exemplified by the nurse
receiving the client in the same way one meets ● Person
a stranger in other life situations. The nurse ○ Peplau defines man as an organism
provides an accepting climate that builds trust. that “strives in its own way to reduce
2. Resource Role – the nurse answers questions, tension generated by needs.” The
client is an individual with a felt need.
interprets clinical treatment data, and gives
information. ● Health
3. Teaching Role – the nurse gives instructions ○ Health is defined as “a word symbol
and provides training. She also involves that implies forward movement of
analysis and synthesis of the learner’s personality and other ongoing human
experience. processes in the direction of creative,
4. Counseling Role – the nurse helps clients constructive, productive, personal, and
community living.”
understand and integrate the meaning of
current life circumstances and provides ● Environment
guidance and encouragement to make ○ Although Peplau does not directly
changes. address society/environment, she does
5. Surrogate Role – the nurse helps clients clarify encourage the nurse to consider the
domains of dependence, interdependence, and patient’s culture and mores when the
patient adjusts to the hospital routine.
independence and acts on client’s behalf as
advocate.
6. Active Leadership Role – the nurse helps the IDA JEAN ORLANDO’S THEORY OF
client assume maximum responsibility for DELIBERATIVE NURSING PROCESS
meeting treatment goals in a mutually satisfying
way. ➢ “Nursing is a profession that seeks to find out
and meet the patient’s immediate need for
THEORETICAL ASSERTIONS help.”

➢ Nurse and the patient can interact.

➢ Peplau emphasized that both the patient and
nurse mature as the result of the therapeutic
interaction.
➢ Communication and interviewing skills remain
fundamental nursing tools.
➢ Peplau believed that nurses must clearly
understand themselves to promote their client’s
growth and avoid limiting their choices to those
that nurses value. CREDENTIALS AND BACKGROUND OF THE
THEORIST

THEORY IN VIEW OF METAPARADIGMS

● Developed her theory from a study conducted
● Nursing at the Yale University School of Nursing,
○ Hildegard Peplau considers nursing to integrating mental health concepts into basic
be a “significant, therapeutic, nursing curriculum.
interpersonal process.” She defines it ● She was one of the first nursing leaders to
as a “human relationship between an identify and emphasize the elements of the
individual who is sick, or in need of
nursing process and the critical importance of
health services, and a nurse specially
 the patient’s participation in the nursing inferences are congruent with the patient’s need
process. (Schmieding, 2006).
● Orlando’s theory focuses on how to produce ➢ Abraham (2011) used Orlando’s theory to help
improvement in the patient’s behavior. Evidence nurses achieve more successful patient
of relieving the patient’s distress is seen as outcomes such as fall reduction. Orlando’s
positive changes in the patient’s observable theory remains a most effective practice theory
behavior. that is especially helpful to new nurses as they
● Orlando analyzed the content of 2000 begin their practice.
nurse-patient contacts and created her theory
based on analysis of these data. NURSING PROCESS THEORY
● She was one of the early thinkers in nursing
who proposed that patients have their own ➢ the nursing process is an interaction of three
meanings and interpretations of situations and basic elements.
therefore nurses must validate their inferences ○ The behavior of the patient
and analyses with patients before drawing ○ The reaction of the nurse
conclusions. ○ The nursing actions which are designed
for the patient’s benefit.
THEORY DESCRIPTION
● The role of the nurse is to find out and meet the
➢ Ida Jean Orlando’s theory developed patient’s immediate need for help.
observations she recorded between a nurse ● Nursing process helps the nurse find out the
and patient. Orlando’s nursing theory stresses nature of the distress and what helps the
the reciprocal relationship between patient and patient.
nurse. What the nurse and the patient say and ● The use of this theory keeps the nurse’s focus
do affects them both. on the patient.
➢ According to Orlando (1961), persons become ● The strength of the theory is that it is clear,
patients who require nursing care when they concise and easy to use.
have needs for help that cannot be met
independently because they have physical MAJOR CONCEPTS AND DEFINITIONS
limitations, have negative reactions to an
environment, or have an experience that ➢ Nurse’s responsibility is composed of whatever
prevents them from communicating their needs. help the patient may require for his needs to be
➢ Patients experience distress or feelings of met. The nurse may either give this need for
helplessness as the result of unmet needs for help directly herself or indirectly employing the
help (Orlando, 1961). aid of other members of the healthcare team.
➢ Orlando proposed a positive correlation
between the length of time the patient ● Need
experiences unmet needs and the degree of ➔ is a situationally defined requirement of
distress. Therefore, immediacy is emphasized the patient which relieves or diminishes
throughout her theory. his immediate distress if this is supplied
➢ In Orlando’s view, when individuals are able to
meet their own needs, they do not feel distress ● Presenting behavior of patient
and do not require care from a professional ➔ any observable verbal and nonverbal
nurse. behavior of the patient
➢ Orlando emphasizes that it is crucial for nurses
to share their perceptions, thoughts, and ● Immediate reactions
feelings so they can determine whether their ➔ the nurse’s and patient’s individual
perceptions, thoughts, and feelings
● Nursing process discipline established a helpful relationship with the
➔ includes the nurse communicating to the patient.
patient his or her own immediate ● Any observation shared and observed with the
reaction patient is immediately helpful in ascertaining
➔ made in order to ask for validation, and meeting his or her need or finding out that
clarification, or correction from the he or she is not in need at that time.
patient ● Nurses are concerned with the needs the
➔ once referred to as the “deliberative patient is unable to meet on his or her own.
nursing process”
THEORY IN VIEW OF METAPARADIGMS
● Automatic nursing actions
➔ nursing activities that are decided upon ● Nursing
for reasons other than the patient’s ○ Orlando speaks of nursing as unique
immediate need and independent in its concerns for an
individual’s need for help in an
immediate situation. The efforts to
● Deliberative nursing actions meet the individual’s need for help are
➔ those decided upon after ascertaining a carried out in an interactive situation
need and then meeting this need and in a disciplined manner that
requires proper training.
THEORY ASSUMPTIONS
● Person
● When patients cannot cope with their needs on ○ Orlando uses the concept of human as
she emphasizes individuality and the
their own, they become distressed by feelings dynamic nature of the nurse-patient
of helplessness. relationship. For her, humans in need
● In its professional character, nursing adds to the are the focus of nursing practice.
distress of the patient.
● Patients are unique and individual in how they ● Health
respond. ○ In Orlando’s theory, health is replaced
by a sense of helplessness as the
● Nursing offers mothering and nursing
initiator of a necessity for nursing. She
analogous to an adult who mothers and stated that nursing deals with
nurtures a child. individuals who require help.
● The practice of nursing deals with people, the
environment, and health. ● Environment
● Patients need help communicating their needs; ○ Orlando completely disregarded the
they are uncomfortable and ambivalent about environment in her theory, only
focusing on the patient’s immediate
their dependency needs.
need, chiefly the relationship and
● People can be secretive or explicit about their actions between the nurse and the
needs, perceptions, thoughts, and feelings. patient (only an individual in her theory;
● The nurse-patient situation is dynamic; actions no families or groups were mentioned).
and reactions are influenced by both the nurse The effect that the environment could
and the patient. have on the patient was never
● People attach meanings to situations and mentioned in Orlando’s theory.
actions that aren’t apparent to others.
● Patients enter into nursing care through APPLICATION OF THE THEORY
medicine.
● The patient cannot state the nature and ● Since the premise of Orlando’s theory is in the
meaning of his or her distress without the immediacy of help needed by patients, this
nurse’s help or him or her first having framework will be important for nurses who are
 assigned in special clinical areas that require
quick decision making and critical thinking skills.
Such areas are the OR, ER, and ICU/Critical
Care Unit.
● Orlando's theory stresses the reciprocal
relationship between patient and nurse remains
a most effective practice theory that is
especially helpful to new nurses as they begin
their practice.
 NUR 016: THEORETICAL FOUNDATION OF NURSING
MODULE 9:
FIRST SEMESTER l S.Y. 2023-2024 TRANSCRIBED BY: NATHALIE KIM E. ALMEDORA
LECTURER: MS. MICHELLE TIANGSON DIZON

OUTLINE OF THE TOPICS

● Also, she taught at Charity Hospital School of
Nursing in Louisiana State University, New York
➢ Joyce Travelbee’s Human-to-Human Relationship University and University of Mississippi.
Model of Nursing ● 1970, the Project Director of Graduate
➢ Ernestine Wiedenbach’s Helping Art of Clinical
Nursing Theory Education at Louisiana State University School
of Nursing until her death.

JOYCE TRAVELBEE’S HUMAN-TO-HUMAN

PUBLICATIONS
RELATIONSHIP MODEL OF NURSING

● 1963, started to publish articles and journals in

➢ “...human-to-human relationship is the means
nursing.
through which the purpose of nursing is
● 1966 and 1971, publication of her first book
fulfilled.”
entitled Interpersonal Aspects of Nursing.
● 1969, when she published her 2nd book
Intervention in Psychiatric Nursing: Process in
the One-to-One Relationship.

THEORY CONCEPTS

● Travelbee believed the spiritual values a person

holds will determine to a great extent, his
perception of illness. The spiritual values of the
nurse or her philosophical beliefs about illness
LIFE STORY
and suffering will determine the degree to which
he or she will be able to help ill persons find
● A psychiatric nurse, educator and writer born in
meaning, or no meaning, in these situations.
1926.
● Travelbee extended the interpersonal
● 1956, she completed her BSN degree at
relationship theories of Peplau and Orlando, but
Louisiana State University
greatly emphasized on the therapeutic human
● 1959, she completed her Master of Science
relationship between the nurse and the patient.
Degree in Nursing at Yale University
● Her model emphasizes: empathy, sympathy,
● She started a Doctoral program in Florida in
rapport, and emotional aspects of nursing.
1973. Unfortunately, she was not able to finish it
Sympathy and empathy are both acts of feeling.
because she died later that year. She passed
● The establishment of a nurse-patient
away at the prime age of 47 after a brief
relationship and the experience that rapport is
sickness.
the end of all nursing endeavors.
● Travelbee’s other contributions to the nursing
WORKING EXPERIENCE
profession included her works on illness,
suffering, pain, hope, communication,
● 1952, Psychiatric Nursing Instructor at DePaul
interaction, empathy, sympathy, rapport, and
Hospital Affiliate School, New Orleans.
therapeutic use of self.
 THEORETICAL SOURCES physical, mental or spiritual is the proper
concern of the nurse.”
● Catholic charity institutions
● Ida Jean Orlando, her instructor— “The nurse ● Therapeutic use of self
is responsible for helping the patient avoid and ➔ ability to use one’s personality
alleviate the distress of unmet needs.” The consciously and in full awareness in an
nurse and patient interrelate with each other. attempt to establish relatedness and to
● Viktor Frankl, a survivor of Auschwitz and structure nursing intervention
other Nazi concentration camps—proposed the
theory of logotherapy in which a patient is ● Communication
actually confronted with and reoriented toward ➔ the vehicle through which nurse-patient
the meaning of his life. relationships are established

MAJOR CONCEPTS AND DEFINITIONS ● Nurse-patient interaction

➔ refers to any contact between a nurse
● Rapport and an ill person
➔ is experienced when nurse and patient ➔ an experience or series of experiences
has progresses through the four between nurse and patient
interlocking phases preceding rapport (4 ➔ means thru which the purpose of
phases of experience): nursing is accomplished
1. Original encounter – first
impressions ● Logical form
2. Emerging identities – ➔ an inductive theory that uses specific
perceiving each other’s nursing situations to create general
uniqueness ideas
3. Empathy – ability to share in the
person’s experience; to
THEORY IN VIEW OF METAPARADIGMS
emphasize is to gain an
intellectual understanding of the ● Nursing
mental world & psychological ○ An interpersonal process whereby the
state of another professional nurse practitioner assists
4. Sympathy – when the nurse an individual, family, or community to
prevent or cope with the experience of
wants to lessen the cause of
illness and suffering and if necessary
patient’s suffering; “When one to find meaning in these experiences.
sympathizes, one is involved but
not incapacitated by the ● Person
involvement.” ○ a unique irreplaceable individual - a
➔ “A nurse is able to establish rapport one time being in this world- like yet
because she possesses the necessary unlike any person who has ever lived
or ever will live
knowledge and skills required to assist ill
○ a unique, irreplaceable individual who
persons and because she is able to is in continuous process of becoming,
perceive, respond to and appreciate the evolving and changing
uniqueness of the ill human being.” | “A ○ patients are only individual human
nurse does not only seek to alleviate beings in need of care, services and
physical pain or render physical care – assistance of other human beings who
can render the assistance that is
she ministers to the whole person. The
needed
existence of the suffering whether
● Health
 ● Nursing Education: Teaches nurses to
○ Subjective and objective
■ Subjective health – an understand the meaning of illness and suffering.
individually defined state of ● Nursing Research: Applied in the theory of
well-being in accord with caring for cancer patients.
self-appraisal of
physical-emotional-spiritual ANALYSIS OF THE THEORY
status
■ Objective health – absence
of discernible disease, CLARITY
disability or defect as ➢ is not consistent in clarity and origin
measured by physical ○ definition of terms came from
examination, laboratory tests dictionaries and books etc.
and assessment by spiritual ○ used different terms for the same
director or psychological definition
counselor ○ focus more on adult individuals
who are sick and the nurse’s role
● Environment in helping them to find meaning in
○ This can be indirectly equated to the their sickness and suffering
environment. She defined human ○ deals in families and their needs
conditions and life experiences but not in the community
encountered by all men as illness,
sufferings, pain and hope. SIMPLICITY
■ Illness – being unhealthy, but ➢ not simple; contains different variables
rather explored the human
experience of illness GENERALITY
■ Suffering – is a feeling of ➢ has wide scope of application but
displeasure which ranges applicable only to those patients in
from simple transitory mental, distress and life changing events
physical or spiritual
discomfort to extreme EMPIRICAL PRECISION
anguish and to those phases ➢ low measures of empirical soundness
beyond anguish; the ○ result of lack of simplicity
malignant phase of disdainful ○ defines concepts theoretically but
“not caring” and apathetic does not define them operationally
indifference ○ the model has not been tested
■ Pain – is not observable,
unique experience; is a lonely IMPORTANCE
experience that is difficult to ➢ development of quality of caring
communicate fully to another ○ it is useful because of its ability to
individual describe, explain, predict and
■ Hope – the desire to gain an control a phenomenon
end or accomplish a goal ○ explains the variables that affect
combined with some degree the establishment of a therapeutic
of expectation that what is relationship between nurses and
desired or sought is attainable patients
■ Hopelessness – being ○ lack of empirical precision also
devoid of hope creates lack of usefulness

ERNESTINE WIEDENBACH’S HELPING ART OF

APPLICATION TO NURSING
CLINICAL NURSING THEORY

● Nursing Practice: Hospice – self-actualizing life

➢ “Nursing is the art of nurturing or caring for
experience. Assumption of the sick role.
someone in a motherly fashion.”
Meaning of life and sickness and death.
 3. Practice – are those observable nursing
actions that are affected by beliefs and feelings
about meeting the patient’s need for help.

4. Art – this includes:

● Understanding patient’s needs and
concerns
● Developing goals and actions intended
to enhance patients’ ability
● Her contributions to the nursing profession ● Directing activities related to the medical
reiterated the helping role of the nurse in terms plan to improve patient’s condition
of providing direct care to patients needing
help. WAYS TO IDENTIFY PATIENTS’ NEED FOR HELP
● Her definition of nursing is rooted in her
experience in the field of maternity nursing. ● Observing behavior consistent or inconsistent
with their comfort
4 ELEMENTS IN THE ART OF NURSING ● Exploring the meaning of their behavior
● Determining the cause of their discomfort or
1. Philosophy – is what motivates the nurse to incapacity
act in a certain way. ● Determining whether they can resolve their
● includes major concepts of her problems or have a need-for-help
philosophy:
○ patient – need for help MAJOR CONCEPTS AND DEFINITIONS
○ nurse – purpose, philosophy,
practice (knowledge, judgment, ● The patient
skills), administration, validation, ➔ is any person who has entered the
coordination (reporting, consulting, healthcare system and is receiving help
conferring), art (stimulus, of some kind, such as care, teaching, or
preconception, interpretation, advice.
actions, rational, reactionary, ➔ The patient need not be ill since
deliberative) someone receiving health-related
● the nurse’s philosophy is their attitude education would qualify as a patient.
and belief about life and how that
affected reality for them ● Need-for-help
● 3 essential components associated with ➔ is defined as any measure desired by
nursing philosophy: the patient that has the potential to
○ Reverence for life restore or extend the ability to cope with
○ Respect for the dignity, worth, various life situations that affect health
autonomy and individuality of each and wellness.
human being.
○ Resolution to act on personally ● Clinical judgment
and professionally held beliefs ➔ represents the nurse’s likeliness to
make sound decisions.
2. Purpose – is that which the nurse wants to
accomplish through what she does. ● Sound decisions
● It is all of the activities directed towards ➔ are based on differentiating facts from
the overall good of the patient. assumption and relating them to cause
and effect. It is the result of disciplined
 functioning of mind and emotions, and
mentioned in Orlando’s theory.
improves with expanded knowledge and
increased clarity of professional
purpose.

● Nursing skills
➔ are carried out to achieve a specific
patient-centered purpose rather than
completion of the skill itself being the
end goal.

● Skills
➔ are made up of a variety of actions, and
characterized by harmony of movement,
precision, and effective use of self.

THEORY IN VIEW OF METAPARADIGMS

● Nursing
○ Orlando speaks of 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.

● Person
○ Orlando uses the concept of human as
she emphasizes individuality and the
dynamic nature of the nurse-patient
relationship. For her, humans in need
are the focus of nursing practice.

● Health
○ In Orlando’s theory, 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
○ Orlando completely disregarded the
environment in her theory, only
focusing on the patient’s immediate
need, chiefly the relationship and
actions between the nurse and the
patient (only an individual in her theory;
no families or groups were mentioned).
The effect that the environment could
have on the patient was never
 NUR 016: THEORETICAL FOUNDATION OF NURSING
MODULE 10:
FIRST SEMESTER l S.Y. 2023-2024 TRANSCRIBED BY: NATHALIE KIM E. ALMEDORA
LECTURER: MS. MICHELLE TIANGSON DIZON

OUTLINE OF THE TOPICS

7. Personal cleansing and dressing
8. Maintaining body temperature
➢ Joyce Travelbee’s Human-to-Human Relationship 9. Working and playing
Model of Nursing 10. Sleeping
➢ Ernestine Wiedenbach’s Helping Art of Clinical
Nursing Theory 11. Expressing sexuality
12. Dying

NANCY ROPER-WINIFRED LOGAN-ALISON

5 MAIN FACTORS THAT INFLUENCED THE ADLS
TIERNEY'S MODEL OF NURSING BASED ON
ACTIVITIES OF LIVING
● Biological
● Psychological
➢ “Nursing is the practice of assisting patients live
● Sociocultural
through life.”
● Environmental
● Politico-economic

● This model incorporates a life span approach

wherein the characteristics of the person are
considered with respect to prior development,
current level of development, and likely future
development.
● In conjunction with the life span approach an
independence/dependence continuum is used.
● The model then incorporates a set of 12
activities of living which represent those
activities engaged in by individuals whether sick
or well.

12 ACTIVITIES OF LIVING

➢ together these elements are referred to as a

“model of living”

1. Maintaining a safe environment

2. Breathing
3. Communication
4. Mobilizing
5. Eating and Drinking
6. Eliminating
● The model has been a significant guide towards ● The Theory of the Elements of Nursing: A
advancing nursing practice, research, and Model Based on a Model of Living
education in that it places great emphasis on emphasizes the importance of developmental
the nurse’s ability to perform continuous patient assessment and of individualizing patient care.
assessment, provide assistance in the ● No two patients can have similar reactions to a
performance of activities of living and particular disease condition or illness state
individualizing patient care. because of the concept of individuality of living.
● Health is viewed as a reflection of the person’s ● The first vital step towards high quality patient
ability to perform the activities of living in the care is for the nurse to individualize patient care
light of the five factors that influence its degree and to make a thorough nursing and health
of performance and within the context of the assessment.
person’s developmental age.
LYDIA HALL’S CARE, CURE, CORE THEORY OF
MAJOR CONCEPTS AND DEFINITIONS NURSING

● Individuality of living ➢ “Nursing is a distinct body of knowledge that

➔ the way in which the person attends to provides nursing care to patients who are in
his activities of living with respect to his need of nursing care in support of medical
developmental age or his place in the interventions, in collaboration with other
life span, on the members of the health team, or exclusively and
dependence-independence continuum, independently by the nurse herself.”
and as influenced by biological,
psychological, environmental, and
politico-economic factors

● The activities of living

➔ describe the person in the complex
process of living from the perspective of
an amalgam of activities

● Life span
➔ refers to the concept of continuous LIFE STORY
change from birth until death and may
refer to developmental age ● Born in New York City September 21, 1906
● Graduated from York Hospital School of
● The dependence-independence continuum Nursing in Pennsylvania
➔ relates to the factors and activities of the ● Bachelor of Science & Master of Arts from
person Teachers College, Columbia University
➔ the continuum ranges from full ● Died February 27, 1969 of heart disease in
incapacitation to having the ability to Queens Hospital of New York
achieve activities of living
➔ both concepts occur at anticipated INTERESTS AND RESEARCH FOCUS
points across the lifespan and at
unexpected times throughout life ● Research in the field of rehabilitation of
chronically ill patient’s brought her to develop
the Care, Cure, Core Theory
APPLICATION OF THE THEORY ● Interested in rehabilitative nursing and the role
that the professional nurse played and the
 patient’s recovery and welfare (Alligood & THEORY ASSUMPTIONS
Tomey 2010)
● She became the founder and first director of ● The motivation and energy necessary for
the Loeb Center for Nursing and Rehabilitation healing exist within the patient, rather than in
at the Montefiore Medical Center in Bronx, New the healthcare team.
York ● The three aspects of nursing should not be
viewed as functioning independently but as
THEORY DESCRIPTION interrelated.
● The three aspects interact, and the circles
● This theory defines Nursing as the “participation representing them change size, depending on
in care, core and cure aspects of patient care, the patient’s total course of progress.
where CARE is the sole function of nurses,
whereas the CORE and CURE are shared with MAJOR CONCEPTS AND DEFINITIONS
other members of the health team.”
● The major purpose of care is to achieve an ● Nursing theory in line with Lydia Hall is nothing
interpersonal relationship with the individual short of revolutionary.
that will facilitate the development of the core. ● In the 1960s, she put down in her own simple
● As Hall says; “To look at and listen to self is words, her thoughts about nursing.
often too difficult without the help of a significant ● She did not consider herself a nurse theorist but
figure (nurturer) who has learned how to hold instead talked about her transparent thoughts
up a mirror and sounding board to invite the and remarkable ideas of nursing care as she
behavior to look and listen to himself. If he learned it over the years.
accepts the invitation, he will explore the ● These lead to the development of her “Care,
concerns in his acts and as he listens to his Cure, Core Theory” also known as the “Three
exploration through the reflection of the nurse, Cs of Lydia Hall”.
he may uncover in sequence his difficulties, the ● She believed that patients should receive care
problem area, his problem, and eventually the only from professional nurses.
threat which is dictating his out-of-control ● Nursing involves interacting with a patient in a
behavior.” complex process of teaching and learning.
● She was not pleased with the concept of team
nursing.

CARE
● Limited to helping the patients or families
deal with the measures instituted by the
physician
● Exclusive to nursing
● Explains the role of nurses and focused
on performing that noble task of the
nurturing patients
● Component of this model is the “motherly
care” provided by the nurses (George, J.B
2000)
● This may include:
○ Comfort measures
○ Patient instructions
○ Helping patients meet their needs
where help is needed
○ Major purpose of care is to
achieve an interpersonal
 ● The size of each circle constantly varies and
relationship with the individual that
will facilitate the development of depends on the state of the patient.
the core (Texas Woman’s
University)

CURE
● Refers to medical interventions that are
performed on the patient
● The foundation of this concept stems from
pathological and therapeutic sciences that
include microbiology, parasitology,
pharmacology, and pathology
● It includes nursing activities that are
dependent upon the orders of the
physician
● Applying medical knowledge
● Limited to helping the patients or families
deal with the measures instituted by the THE CARE CIRCLE
physician ● Nurses are focused on performing the
● Interventions or actions geared toward noble task of nurturing patients.
treating the patient for whatever illness or ● This circle solely represents the role of
disease he or she is suffering from nurses, & focused on performing the task
(George, J.B 200) of nurturing patients.
● Nurturing involves using the factors that
CORE
make up the concept of mothering (care
● Refers to the person or recipient of care;
and comfort of the person) and provide for
includes the use of therapeutic self to
teaching-learning activities.
relate with the patient
● The care circle defines the primary role of
● It is anchored in the social sciences, using
a professional nurse such as providing
the self in relationship to the patient
bodily care for the patient and helping the
● Shared with social workers, psychologist,
patient complete such basic daily
clergy, and other professions
biological functions as eating, bathing,
● The person or patient to whom nursing
elimination, and dressing. When providing
care is directed and needed
this care, the nurse’s goal is the comfort
● Involves the therapeutic use of self, and
of the patient.
empathizes the use of reflections (Texas
● Moreover, the role of the nurse also
Woman’s University)
includes educating patients, and helping a
● The core has goals set by himself and not
patient meet any needs he or she is
by any other person
unable to meet alone. This presents the
● Behaves according to his or hers feelings
nurse and patient with an opportunity for
and values (George, J. B 200)
closeness. As closeness develops, the
● Interventions or actions geared toward
patient can share and explore feelings
treating the patient for whatever illness or
with the nurse.
disease he or she is suffering from
(George, J.B 200) THE CURE CIRCLE
● The cure as explained in this theory is the
SUBCONCEPTS aspect of nursing which involves the
administration of medications and
treatments. Hall explains in the model that
● Lydia Hall’s theory has three components which
the cure circle is shared by the nurse with
are represented by three independent but other health professionals, such as
interconnected circles. The three circles are: the physicians or physical therapists.
care, the cure, and the core. ● In short, these are the interventions or
actions geared toward treating the patient
 for whatever illness or disease he or she recipient, not the health care provider.
is suffering from. During this aspect of ○ Hall emphasizes the importance of the
nursing care, the nurse is an active individual as unique, capable of growth
advocate of the patient. and learning, and requiring a total
person approach.
THE CORE CIRCLE
● The core is the patient receiving nursing ● Health
care. The core has goals set by him or ○ Health can be inferred to be a state of
herself rather than by any other person self-awareness with a conscious
and behaves according to his or her selection of behaviors that are optimal
feelings and values. This involves the for that individual. Hall stresses the
therapeutic use of self and is shared with need to help the person explore the
other members of the health team. meaning of his or her behavior to
● This area emphasizes the social, identify and overcome problems
emotional, spiritual, and intellectual needs through developing self-identity and
of the patient in relation to family, maturity.
institution, community and the world. This
is able to help the patient verbally express ● Environment
feelings regarding the disease process ○ The concept of society or environment
and its effects by the use of the reflective is dealt with in relation to the individual.
technique. Through such expression, the Hall is credited with developing the
patient is able to gain self-identity and concept of Loeb Center because she
further develop maturity. assumed that the hospital environment
during treatment of acute illness
● Reflective technique is used by the creates a difficult psychological
professional nurse in a way that he or she experience for the ill individual. Loeb
acts as a mirror to the patient to help the Center focuses on providing an
latter explore his or her own feelings environment that is conducive to
regarding his or her current health status self-development.
and related potential changes in lifestyle. ■ In such a setting, the focus of
● Motivations are discovered through the the action of the nurses is the
process of bringing into awareness the individual, so that any actions
feelings being experienced. With this taken in relation to society or
awareness, the patient is now able to environment are for the
make conscious decisions based on purpose of assisting the
understood and accepted feelings and individual in attaining a
motivation. personal goal.

STRENGTHS
THEORY IN VIEW OF METAPARADIGMS
➢ This model appears to be completely and
● Nursing simply logical. Her work may be viewed as the
○ Nursing is identified as consisting of philosophy of nursing.
participation in the care, core, and cure ➢ The three C’s in this theory were unique. In all
aspects of patient care.
the circles of the model, the nurse is present,
● Person although focus of the nurse’s role is on the care
○ The individual human who is 16 years circle.
of age or older and past the acute
stage of long-term illness is the focus WEAKNESSES
of nursing care in Hall’s work.
○ The source of energy and motivation ➢ This model is considered to be plain and simple
for healing is the individual care
in its presentation. However, the receptiveness
 and resilience necessary for its utilization and ● Nurses are able to carry out nursing
function may not be so simple for nurses whose interventions independently, dependently, or
personality, educational preparation, and interdependently.
experience have not prepared them to function ● The core aspect of the theory maintains that it
with minimal structure. This and the is our responsibility to make sure that the
self-imposed age and illness requirements limit patient receives the highest level of care
the generalizability. possible from all concerned health professions.
➢ The age requirement for the application of her ● The role of the nurse is in the collaboration,
theory which is 16 years of age and above coordination, and cooperation with other
limits the theory since it cannot be disregarded members of the health care team on matters
that nurses are faced with pediatric clients that pertain to the patient’s welfare.
every now and then. ● The cure aspect of the theory clearly delineates
➢ The concept of a patient aggregate such as nursing functions that are dependent on the
having families and communities as the focus of members of the medical profession.
nursing practice was not tackled. It is purely on ● Examples of these include medication
the individual himself. Although, the role of the administration, performance of diagnostic
family or the community within the patient’s procedures, and some other interventions that
environment was modestly discussed. need a written order from the doctor.
● The care domain of the theory refers to the
HOW DO NURSES RELATE? independent roles and functions of the nurse
insofar as her knowledge and skills about the
● She proposed many ideas of professional patient’s condition will allow her to carry on with
practice, such as the nursing process her responsibilities.
● Improvement of nurses to meet the needs of
the patient with better professional nursing care CONCLUSION
● Management of nursing care
● Establishment of nurse-patient relationship
● Hall believed patients should only receive care
● Collaboration with other health professionals
from professional nurses.
● Deliverance of care to ill patients
● Hall defined her philosophy on the basis of the
patient.
THEORY ASSERTIONS
● Hall believed that patients come to the hospital
in a biological crisis (acute episode of a
● Nursing is viewed as a distinct body of
disease) and that medicine does a great job at
knowledge that provides nursing care to
treating this crisis, but fails to treat the chronic
patients who are in need of nursing care.
underlying disease. This is where she felt
● Care of patients can be performed in support of
nursing could make a significant difference.
medical interventions, in collaboration with
● Hall felt that taking over this sub-acute phase
other members of the health team, or
was the way for nursing to legitimize itself into a
exclusively and independently by the nurse
true profession.
herself. Nursing is described as interacting with
a patient in a complex process of teaching and
learning.
● The patient or person, in this case, is the
recipient of care which may come from three
different domains.

APPLICATION OF THE THEORY

 NUR 016: THEORETICAL FOUNDATION OF NURSING
MODULE 11:
FIRST SEMESTER l S.Y. 2023-2024 TRANSCRIBED BY: NATHALIE KIM E. ALMEDORA
LECTURER: MS. MICHELLE TIANGSON DIZON

OUTLINE OF THE TOPICS

● She is well known for her development of her
theory that has interrelated the concepts of
➢ Faye Glenn Abdellah’s 21 Nursing Problems health, nursing problems, and problem-solving.
Theory ● She views nursing as an art and a science that
mold the attitude, intellectual competencies,
FAYE GLENN ABDELLAH’S 21 NURSING and technical skills of the individual nurse into
PROBLEMS THEORY the desire and ability to help individuals cope
with their health needs, whether they are ill or
➢ “Nursing is based on an art and science that well.
molds the attitudes, intellectual competencies, ● She used Henderson’s 14 basic human needs
and technical skills of the individual nurse into and nursing research to establish the
the desire and ability to help people, sick or classification of nursing problems.
well, cope with their health needs.”
EDUCATION

● Faye Abdellah earned a nursing diploma from

Fitkin Memorial Hospital’s School of Nursing,
now known as Ann May School of Nursing.
● It was sufficient to practice nursing during her
time in the 1940s, but she believed that nursing
care should be based on research, not hours of
care.
● Abdellah went on to earn three degrees from
Columbia University: a bachelor of science
LIFE STORY degree in nursing in 1945, a master of arts
(MARCH 13, 1919 - PRESENT) degree in physiology in 1947 and a doctor of
education degree in 1955.
● She was born on March 13, 1919 in New York ● With her advanced education, Abdellah could
to a father of Algerian heritage and Scottish have chosen to become a doctor. However, as
mother. Her family subsequently moved to New she explained in one of her interviews that she
Jersey where she attended high school. wanted to be an M.D. because she could do all
● She is a pioneer in nursing research who she wanted to do in nursing, which is a caring
developed the Twenty-One Nursing profession.
Problems. Her model of nursing was
progressive for the time in that it refers to a AS AN EDUCATION
nursing diagnosis during a time in which nurses
were taught that diagnoses were not part of ● In her early twenties, she worked as a health
their role in health care. nurse at a private school and her first
● She was the first nurse officer to earn the administrative position was on the faculty of
ranking of a two-star rear admiral and the first Yale University from 1945-1949.
nurse and the first woman to serve as a Deputy ● At that time, she was required to teach a class
Surgeon General. called “120 Principles of Nursing Practice” using
 a standard nursing textbook published by the education for professional nurses; and
National League for Nursing. The book included development of nursing leaders from
guidelines that had no scientific basis which underserved groups.
challenged her to explain everything to what
she called the “brilliant” students. MAJOR CONCEPTS AND DEFINITIONS

AS A RESEARCHER ● Individual
➔ She describes nursing recipients as
● In 1949, she met Lucile Petry Leone who was individuals (and families), although she
the first Nurse Officer and decided to join the does not delineate her beliefs or
Public Health Service. Her first assignment was assumptions about the nature of human
with the division of nursing that focused on beings.
research and studies. They performed studies
with numerous hospitals to improve nursing ● Health
practice. ➔ The achieving of it, is the purpose of
● She was an advocate of degree programs for nursing services. Although Abdellah
nursing. Diploma programs, she believes, were does not define health, she speaks to
never meant to prepare nurses at the “total health needs” and “a healthy state
professional level. Nursing education, she of mind and body.”
argued, should be based on research; she ➔ Health may be defined as the dynamic
herself became among the first in her role as an pattern of functioning whereby there is a
educator to focus on theory and research. Her continued interaction with internal and
first studies were qualitative; they simply external forces that results in the optimal
described situations. As her career progressed, use of necessary resources to minimize
her research evolved to include physiology, vulnerabilities.
chemistry, and behavioral sciences.
● Society
THEORY DESCRIPTION ➔ It is included in “planning for optimum
health on local, state, and international
● The patient-centered approach to nursing was levels.” However, as Abdellah further
developed from her practice, and the theory is delineates her ideas, the focus of
considered a human needs theory. It was nursing service is clearly the individual.
formulated to be an instrument for nursing
education, so it is most suitable & useful in that ● Nursing Problems
field. ➔ The client’s health needs can be viewed
● The nursing model is intended to guide care in as problems, overt as an apparent
hospital institutions, but can also be applied to condition, or covert as a hidden or
community health nursing, as well. concealed one.
➔ Because covert problems can be
THEORY ASSUMPTION emotional, sociological, and
interpersonal in nature, they are often
● This relates to change and anticipated changes missed or misunderstood. Yet, in many
that affect nursing; the need to appreciate the instances, solving the covert problems
interconnectedness of social enterprises and may solve the overt problems as well.
social problems; the impact of problems such
as poverty, racism, pollution, education, and so ● Problem Solving
forth on health and health care delivery; ➔ Quality professional nursing care
changing nursing education; continuing requires that nurses be able to identify
 and solve overt and covert nursing
the interrelatedness of
problems. emotions and organic illness;
➔ The problem-solving process can meet facilitate the maintenance of
these requirements by identifying the effective verbal and
problem, selecting pertinent data, non-verbal communication;
formulating hypotheses, testing promote the development of
hypotheses through collecting data, and productive interpersonal
relationships; facilitate
revising hypotheses when necessary progress toward achievement
based on conclusions obtained from the of personal spiritual goals;
data. create and maintain a
therapeutic environment; and
SUBCONCEPTS facilitate awareness of the
self as an individual with
varying physical, emotional,
FOUR DESCRIPTION and developmental needs.
CATEGORIES
Restorative These include the
Basic Needs They are to maintain good Care Needs acceptance of the optimum
hygiene and physical possible goals in light of
comfort; promote optimal limitations, both physical and
health through healthy emotional; the use of
activities, such as exercise, community resources as an
rest and sleep; promote aid to resolving problems that
safety through the prevention arise from illness; and the
of health hazards like understanding of the role of
accidents, injury or other social problems as influential
trauma and through the factors in the case of illness.
prevention of the spread of Abdellah’s work, which is
infection; and maintain good based on the problem-solving
body mechanics and prevent method, serves as a vehicle
or correct deformity. for delineating nursing
(patient) problems as the
Sustenal Care These facilitate the patient moves toward a
Needs maintenance of a supply of healthy outcome. The theory
oxygen to all body cells; identifies ten steps to identify
facilitate the maintenance of the patient’s problem and 11
nutrition of all body cells; nursing skills used to develop
facilitate the maintenance of a treatment typology.
elimination; facilitate the
maintenance of fluid and
electrolyte balance; ABDELLAH’S TYPOLOGY OF 21 NURSING
recognize the physiological PROBLEMS
responses of the body to
disease conditions; facilitate ➢ these fall into three categories: (1) physical,
the maintenance of sociological, and emotional needs of patients;
regulatory mechanisms and
functions; and facilitate the (2) types of interpersonal relationships between
maintenance of sensory the patient and nurse; and (3) common
function. elements of patient care.

Remedial Care These are to identify and 1. To maintain good hygiene and physical comfort.
Needs accept positive and negative 2. To promote optimal activity: exercise, rest, sleep
expressions, feelings, and
reactions; identify and accept
3. To promote safety by preventing accidents, ● Make generalizations about available data
injuries, or other trauma and preventing the concerning similar nursing problems presented
spread of infection. by other patients.
4. To maintain good body mechanics and prevent ● Identify the therapeutic plan.
and correct the deformity. ● Test generalizations with the patient and make
5. To facilitate the maintenance of a supply of additional generalizations.
oxygen to all body cells. ● Validate the patient’s conclusions about his
6. To facilitate the maintenance of nutrition for all nursing problems.
body cells. ● Continue to observe and evaluate the patient
7. To facilitate the maintenance of elimination. over a period of time to identify any attitudes
8. To facilitate the maintenance of fluid and and clues affecting his or her behavior.
electrolyte balance. ● Explore the patient and their family’s reactions
9. To recognize the physiologic responses of the to the therapeutic plan and involve them in the
body to disease conditions—pathologic, plan.
physiologic, and compensatory. ● Identify how the nurses feel about the patient’s
10. To facilitate the maintenance of regulatory nursing problems.
mechanisms and functions. ● Discuss and develop a comprehensive nursing
11. To facilitate the maintenance of sensory care plan
function.
12. To identify and accept positive and negative 11 NURSING SKILLS TO DEVELOP A TREATMENT
expressions, feelings, and reactions. TYPOLOGY
13. To identify and accept interrelatedness of
emotions and organic illness. ● observation of health status
14. To facilitate the maintenance of effective verbal ● skills of communication
and nonverbal communication. ● application of knowledge
15. To promote the development of productive ● the teaching of patients and families
interpersonal relationships. ● planning and organization of work
16. To facilitate progress toward achievement and ● use of resource materials
personal spiritual goals. ● use of personnel resources
17. To create or maintain a therapeutic ● problem-solving
environment. ● the direction of work of others
18. To facilitate awareness of self as an individual ● therapeutic uses of the self
with varying physical, emotional, and ● nursing procedure
developmental needs.
19. To accept the optimum possible goals in the ABDELLAH ALSO EXPLAINED NURSING AS A
light of limitations, physical and emotional. COMPREHENSIVE SERVICE, WHICH INCLUDES:
20. To use community resources as an aid in
resolving problems that arise from an illness. ➢ Recognizing the nursing problems of the patient
21. To understand the role of social problems as ➢ Deciding the appropriate course of action to
influencing factors in the cause of illness. take in terms of relevant nursing principles
➢ Providing continuous care of the individual’s
10 STEPS TO IDENTIFY THE PATIENT’S total needs
PROBLEMS
➢ Providing continuous care to relieve pain and
discomfort and provide immediate security for
● Learn to know the patient. the individual
● Sort out relevant and significant data. ➢ Adjusting the total nursing care plan to meet the
patient’s individual needs
➢ Helping the individual to become more needs, she seems to swing the pendulum to the
self-directing in obtaining or maintaining a opposite pole, from the disease orientation to
healthy state of body and mind nursing orientation, while leaving the client
➢ Instructing nursing personnel and family to help somewhere in the middle.
the individual do for himself that which he can
within his limitations THE THEORY AND THE NURSING PROCESS
➢ Helping the individual to adjust to his limitations
and emotional problems ASSESSMENT
➢ Working with allied health professions in ➢ The nursing problems implement a
planning for optimum health on local, state, standard procedure for data collection. A
national, and international levels principle underlying the problem-solving
➢ Carrying out continuous evaluation and approach is that for each identified
research to improve nursing techniques and to problem, pertinent data is collected. The
overt or covert nature of problems
develop new techniques to meet people’s
necessitates a direct or indirect approach,
health needs respectively.

NURSING DIAGNOSIS
➢ The results of data collection would
determine the client’s specific overt or
covert problems.
➢ These specific problems would be
grouped under one or more of the broader
nursing problems.
➢ This step is consistent with that involved
in nursing diagnosis

PLANNING
➢ The statements of nursing problems most
closely resemble goal statements. Given
that these problems are called nursing
problems, then it becomes reasonable to
PATIENT-CENTERED APPROACHES TO NURSING conclude that these goals are basically
nursing goals.
● Faye Abdellah’s work is a set of problems
NURSING INTERVENTIONS
formulated in terms of nursing-centered ➢ Using the goals as the framework, a plan
services used to determine the patient’s needs. is developed and appropriate nursing
The nursing-centered orientation to client care interventions are determined.
appears to be contradicting the client-centered
approach that Abdellah professes to support. EVALUATION
➢ Takes place after the interventions have
This can be observed by her desire to move
been carried out.
away from a disease-centered orientation. ➢ According to the American Nurses’
● The nursing-centered orientation to client care Association Standards of Nursing
seems contrary to the client-centered approach Practice, the plan is evaluated in terms of
that Abdellah professes to uphold. The the client’s progress or lack of progress
apparent contradiction can be explained by her toward the achievement of the stated
desire to move away from a disease- centered goals.
➢ The most convenient evaluation would be
orientation.
the nurse’s progress or lack of progress
● In her attempt to bring nursing practice to its toward the achievement of the goals
proper relationship with restorative and established in the planning phase.
preventive measures for meeting total client
 THEORY ANALYSIS generalizable to clients with specific health
needs and specific nursing.
● With the aim of Faye Abdellah in formulating a ➢ Also, Abdellah’s framework is inconsistent with
clear categorization of patient’s problems as the concept of holism. The nature of the 21
health needs, she rather conceptualized nurses’ nursing problems attests to this. As a result, the
actions in nursing care which is contrary to her client may be diagnosed as having numerous
aim. Nurses' roles were defined to alleviate the problems that would lead to fractionalized care
problems assessed through the proposed efforts, and potential problems might be
problem-solving approach. overlooked because the client is not deemed to
● The problem-solving approach introduced by be in a particular stage of illness.
Abdellah has the advantage of increasing the
nurse’s critical and analytical thinking skills CONCLUSION
since the care to be provided would be based
on sound assessment and validation of
● Abdellah ‘s typology of 21 nursing problems is a
findings.
conceptual model mainly concerned with
patient’s needs and the role of nurses in
STRENGTHS
problem identification using a problem analysis
approach.
➢ The problem-solving approach is readily
● According to the model, patients are described
generalizable to the client with specific health
as having physical, emotional, and sociological
needs and specific nursing problems.
needs. People are also the only justification for
➢ With the model’s nature, healthcare providers
the existence of nursing. That is, without
and practitioners can use Abdellah’s
people, nursing would not be a profession since
problem-solving approach to guide various
they are the recipients of nursing.
activities within the clinical setting. This is true
● However, Abdellah rather conceptualized
when considering nursing practice that deals
nurses’ actions in nursing care which is contrary
with clients who have specific needs and
to her aim of formulating a clear categorization
specific nursing problems.
of a patient's problems as health needs. Nurses
➢ The language of Faye Abdellah’s framework is
roles were defined to alleviate the problems
simple and easy to comprehend.
assessed through the proposed
➢ The theoretical statement greatly focuses on
problem-solving approach.
problem-solving, an activity that is inherently
● As a whole, the theory is intended to guide care
logical in nature.
not just in the hospital setting, but can also be
applied to community nursing, as well. The
WEAKNESSES
model has interrelated concepts of health and
nursing problems, as well as problem-solving,
➢ The major limitation to Abdellah’s theory and
which is an activity inherently logical in nature.
the 21 nursing problems is their very strong
● Furthermore, the 21 nursing problems
nurse-centered orientation. She rather
progressed to a second-generation
conceptualized nurses’ actions in nursing care
development referred to as patient problems
which is contrary to her aim.
and patient outcomes. Abdellah educated the
➢ Another point is the lack of emphasis on what
public on AIDS, drug addiction, violence,
the client is to achieve was given in terms of
smoking, and alcoholism. Her work is a
client care.
problem-centered approach or philosophy of
➢ Framework seems to focus quite heavily on
nursing.
nursing practice and individuals. This somewhat
limits the ability to generalize although the
problem-solving approach is readily
 NUR 016: THEORETICAL FOUNDATION OF NURSING
MODULE 12:
FIRST SEMESTER l S.Y. 2023-2024 TRANSCRIBED BY: NATHALIE KIM E. ALMEDORA
LECTURER: MS. MICHELLE TIANGSON DIZON

THEORY DESCRIPTION
OUTLINE OF THE TOPICS

➢ Virginia Henderson’s Nursing Need Theory ➢ She emphasized the importance of increasing
the patient’s independence so that progress
after hospitalization would not be delayed
VIRGINIA HENDERSON’S NURSING NEED
(Henderson,1991).
THEORY
➢ "...assisting individuals to gain independence in
relation to the performance of activities
➢ “The unique function of the nurse is to assist
contributing to health or its recovery"
the individual, sick or well, in the performance
(Henderson, 1966)
of those activities contributing to health or its
➢ She categorized nursing activities into 14
recovery (or to peaceful death) that he would
components, based on human needs.
perform unaided if he had the necessary
➢ She described the nurse's role as substitutive
strength, will or knowledge. And to do this in
(doing for the person), supplementary (helping
such a way as to help him gain independence
the person), complementary (working with the
as rapidly as possible.”
person), with the goal of helping the person
become as independent as possible.

14 COMPONENTS OF THE NURSING NEEDS

THEORY

PHYSIOLOGICAL COMPONENTS
1. Breathe normally
2. Eat and drink adequately
3. Eliminate body wastes
4. Move and maintain desirable postures
LIFE STORY 5. Sleep and rest
6. Select suitable clothes – dress and
➢ She is known to be as follows: undress
○ “The Nightingale of Modern Nursing” 7. Maintain body temperature within normal
○ “Modern-Day Mother of Nursing” range by adjusting clothing and modifying
○ "The 20th Century Florence Nightingale" environment
8. Keep the body clean and well-groomed
○ “The First Lady of Nursing”
and protect the integument
➢ Born in Kansas City, Missouri, in 1897 and died 9. Avoid dangers in the environment and
on March 19, 1996 avoid injuring others
➢ Diploma in Nursing from the Army School of
Nursing at Walter Reed Hospital, Washington, PSYCHOLOGICAL ASPECTS OF
D.C. in 1921 COMMUNICATING AND LEARNING
10. Communicate with others in expressing
➢ Worked at the Henry Street Visiting Nurse
emotions, needs, fears, or opinions.
Service for 2 years after graduation 11. Learn, discover, or satisfy the curiosity
➢ In 1923, started teaching nursing at the Norfolk that leads to normal development and
Protestant Hospital in Virginia health and use the available health
 facilities. ○ Requiring assistance to achieve health
and independence or a peaceful death.
SPIRITUALS AND MORAL ○ Mind and body are inseparable and
12. Worship according to one’s faith interrelated.
○ Consider the biological, psychological,
SOCIOLOGICALLY ORIENTED TO sociological, and spiritual components.
OCCUPATION AND RECREATION ○ The theory presents the patient as a
13. Work in such a way that there is sense of sum of parts with biopsychosocial
accomplishment needs.
14. Play or participate in various forms of
recreation ● Health
○ Definition based on an individual's
THEORY ASSUMPTIONS ability to function independently as
outlined in the 14 components.
○ Nurses need to stress promotion of
● Nurses care for patients until patients can care health and prevention and cure of
for themselves once again. Patients desire to disease.
return to health, but this assumption is not ○ Good health is a challenge – affected
explicitly stated. by age, cultural background, physical,
● Nurses are willing to serve and that “nurses will and intellectual capacities, and
devote themselves to the patient day and night. emotional balance Is the individual’s
ability to meet these needs
● A final assumption is that nurses should be
independently.
educated at the university level in both arts and
sciences. ● Environment
○ Settings in which an individual learns a
unique pattern for living.
THEORY IN VIEW OF METAPARADIGMS
○ All external conditions and influences
that affect life and development.
● Nursing
○ Individuals in relation to families.
○ Temporarily assisting an individual who
○ Minimally discusses the impact of the
lacks the necessary strength, will and
community on the individual and family.
knowledge to satisfy 1 or more of 14
○ Basic nursing care involves providing
basic needs.
conditions under which the patient can
○ Assists and supports the individual in
perform the 14 activities unaided.
life activities and the attainment of
independence.
○ Nurse serves to make the patient THE THEORY AND THE NURSING PROCESS
“complete”, “whole", or “independent".
○ The nurse is expected to carry out the
physician's therapeutic plan ASSESSMENT
Individualized care is the result of the ➢ Henderson’s 14 components
nurse’s creativity in planning for care.
○ Nurses should have knowledge to NURSING DIAGNOSIS
practice individualized and human care ➢ Analysis: Compare data to knowledge
and should be a scientific problem base of health and disease
solver.
○ In the Nature of Nursing Nurse role is, PLANNING
“to get inside the patient’s skin and ➢ Identify an individual's ability to meet their
supplement his strength, will or own needs with or without assistance,
knowledge according to his needs”. taking into consideration strength, will or
knowledge
● Person
NURSING INTERVENTIONS
○ Have basic needs that are components
➢ Document how the nurse can assist the
of health.
 ● The nurse as a substitute for the patient – doing
individual, sick or well
➢ Assist the sick or well individual in to for the patient (Substitutive)
performance of activities in meeting ● The nurse as a helper to the patient – helping
human needs to maintain health, recover the patient (Supplementary)
from illness, or to aid in peaceful death ● The nurse as a partner with the patient –
➢ Implementation based on the working the patient (Complementary)
physiological principles, age, cultural
background, emotional balance, and
physical and intellectual capacities
➢ Carry out treatment prescribed by the
physician

EVALUATION
➢ Henderson’s 14 components and
definition of nursing
➢ Use the acceptable definition of nursing
and appropriate laws related to the
practice of nursing
➢ The quality of care is drastically affected
by the preparation and native ability of the
nursing personnel rather that the amount
of hours of care
➢ Successful outcomes of nursing care are
based on the speed with which or degree
to which the patient performs
independently the activities of daily living

CHARACTERISTICS OF HENDERSON’S THEORY

1. There is interrelation of concepts.

2. Concepts of fundamental human needs,
biophysiology, culture, and interaction,
communication are borrowed from other
disciplines (ex: Maslow’s theory).
3. Her definition and components are logical and
the 14 components are a guide for the
individual and nurse in reaching the chosen
goal.
4. Relatively simple yet generalizable.
5. Applicable to the health of individuals of all
ages.
6. Can be the bases for hypotheses that can be
tested.
7. Assist in increasing the general body of
knowledge within the discipline.
8. Her ideas of nursing practice are well accepted.
9. Can be utilized by practitioners to guide and
improve their practice.

3 LEVELS COMPRISING THE NURSE-PATIENT

RELATIONSHIP
 LIMITATIONS CONCLUSION

➢ Lack of conceptual linkage between

● Henderson provides the essence of what she
physiological and other human characteristics.
believes is a definition of nursing.
➢ No concept of the holistic nature of human
● Her emphasis on basic human needs as the
beings.
central focus of nursing practice has led to
➢ If the assumption is made that the 14
further theory development regarding the needs
components prioritized, the relationship among
of the person and how nursing can assist in
the components is unclear.
meeting those needs.
➢ Lacks interrelate of factors and the influence of
● Her definition of nursing and the 14
nursing care.
components of basic nursing care are
➢ Assisting the individual in the dying process she
uncomplicated and self-explanatory.
contends that the nurse helps, but there is little
explanation of what the nurse does.
➢ “Peaceful death” is a curious and significant
nursing role.

STRENGTHS

➢ Virginia Henderson’s concept of nursing is

widely accepted in nursing practice today.
➢ Her theory and 14 components are relatively
simple, logical, and can be applied to
individuals of all ages.

WEAKNESSES

➢ There is an absence of a conceptual diagram

that interconnects the 14 concepts and
subconcepts of Henderson’s theory.
➢ On assisting the individual in the dying process,
there is a little explanation of what the nurse
does to provide “peaceful death”.

APPLICATION OF THE THEORY

➢ Henderson’s Needs Theory can be applied to

nursing practice as a way for nurses to set
goals based on Henderson’s 14 components.
➢ Meeting the goal of achieving the 14 needs of
the client can be a great basis to further
improve one’s performance towards nursing
care.
➢ In nursing research, each of her 14
fundamental concepts can serve as a basis for
research although the statements were not
written in testable terms.
 NUR 016: THEORETICAL FOUNDATION OF NURSING
MODULE 13:
FIRST SEMESTER l S.Y. 2023-2024 TRANSCRIBED BY: NATHALIE KIM E. ALMEDORA
LECTURER: MS. MICHELLE TIANGSON DIZON

OUTLINE OF THE TOPIC/S

○ behavioral outcomes
➢ The theory notes that each person has unique
➢ Nola J. Pender’s Health Promotion Model personal characteristics and experiences that
affect subsequent actions. The set of variables
for behavior specific knowledge and affect have
NOLA J. PENDER’S HEALTH PROMOTION
MODEL
important motivational significance. The
variables can be modified through nursing
LIFE STORY actions.
➢ Health promoting behavior is the desired
➢ Nola J. Pender, PhD, RN, FAAN – former behavioral outcome, which makes it the end
professor of nursing at the University of point in the Health Promotion Model. These
Michigan behaviors should result in improved health,
➢ She was born on August 16, 1941, in Lansing, enhanced functional ability and better quality of
Michigan to parents who advocated education life at all stages of development.
for women. ➢ The final behavioral demand is also influenced
by the immediate competing demand and
preferences, which can derail intended actions
for promoting health.

THEORY ASSUMPTIONS

➢ The HPM is based on the following

assumptions, which reflect both nursing and
behavioral science perspectives:
○ Individuals seek to actively regulate their
own behavior.
THEORY DESCRIPTION ○ Individuals in all their biopsychosocial
complexity interact with the
➢ Designed to be a “complementary counterpart environment, progressively transforming
to models of health protection”. the environment and being transformed
➢ It defines health as a positive dynamic state over time.
rather than simply the absence of disease. ○ Health professionals constitute a part of
Health promotion is directed at increasing a the interpersonal environment, which
patient’s level of well-being. exerts influence on persons throughout
➢ This model describes the multidimensional their life span.
nature of persons as they interact within their ○ Self-initiated reconfiguration of
environment to pursue health. person-environment interactive patterns
➢ Pender’s model focuses on three areas: is essential to behavior change.
○ individual characteristics and
MAJOR CONCEPTS AND DEFINITIONS
experiences
○ behavior-specific cognitions and affect
● Health promotion
 ➔ defined as behavior motivated by the ethnicity, acculturation,
desire to increase well-being and education, and socioeconomic
actualize human health potential. status.
➔ It is an approach to wellness.
➢ Perceived Benefits of Action
● Health protection or illness prevention ○ Anticipated positive outcomes that will
➔ described as behavior motivated desire occur from health behavior.
to actively avoid illness, detect it early,
or maintain functioning within illness ➢ Perceived Barriers to Action
constraints. ○ Anticipated, imagined, or real blocks
and personal costs of understanding a
● Individual characteristics and experiences given behavior.
➔ prior related behavior and personal
factors. ➢ Perceived Self-Efficacy
○ The judgment of personal capability to
● Behavior-specific cognitions and affect organize and execute a
➔ perceived benefits of action, perceived health-promoting behavior. This
barriers to action, perceived influences perceived barriers to action,
self-efficacy, activity-related affect, so higher efficacy results in lowered
interpersonal influences, and situational perceptions of barriers to the behavior’s
influences. performance.

● Behavioral outcomes ➢ Activity-Related Affect

➔ commitment to a plan of action, ○ Subjective positive or negative feeling
immediate competing demands and occurs before, during, and following
preferences, and health-promoting behavior based on the stimulus
behavior. properties of the behavior itself. This
influences perceived self-efficacy, which
SUBCONCEPTS means the more positive the subjective
feeling, the greater its efficacy. In turn,
➢ Personal Factors increased feelings of efficacy can
○ These factors are predictive of a given generate a further positive affect.
behavior and shaped by the target
behavior’s nature being considered ➢ Interpersonal Influences
○ 3 Categories: ○ Cognition concerning behaviors, beliefs,
■ Personal biological factors – or attitudes of others. Interpersonal
include variables such as age, influences include norms (expectations
gender, body mass index, of significant others), social support
pubertal status, aerobic capacity, (instrumental and emotional
strength, agility, or balance. encouragement), and modeling
■ Personal psychological (vicarious learning through observing
factors – include variables such others engaged in a particular behavior).
as self-esteem, self- motivation, Primary sources of interpersonal
personal competence, perceived influences are families, peers, and
health status, and definition of healthcare providers.
health.
■ Personal socio-cultural factors ➢ Situational Influences
– include variables such as race,
 ○ Personal perceptions and cognitions of
any given situation or context can
facilitate or impede behavior. Include
perceptions of options available,
demand characteristics, and aesthetic
features of the environment in which
given health-promoting is proposed to
take place. These may have direct or
indirect influences on health behavior.

➢ Commitment to Plan of Action

○ The concept of intention and
identification of a planned strategy leads
to the implementation of health
behavior.

➢ Competing Demands
○ These are alternative behaviors over
which individuals have low control
because of environmental contingencies
such as work or family care
responsibilities.

➢ Competing Preferences PROPOSITIONS OF THE THEORY

○ These are alternative behaviors over
which individuals exert relatively high ➢ Prior behavior and inherited and acquired
control, such as choice of ice cream or characteristics influence beliefs, affect, and
apple for a snack. enactment of health-promoting behavior.
➢ Persons commit to engaging in behaviors from
➢ Health-Promoting Behavior which they anticipate deriving personally valued
○ This is an endpoint or action-outcome benefits.
directed toward attaining positive health ➢ Perceived barriers can constrain commitment to
outcomes such as optimal wellbeing, action, a mediator of behavior as well as actual
personal fulfillment, and productive behavior.
living. ➢ Perceived competence or self-efficacy to
execute a given behavior increases the
likelihood of commitment to action and the
behavior’s actual performance.
➢ Greater perceived self-efficacy results in fewer
perceived barriers to specific health behavior.
➢ Positive affect toward a behavior results in
greater perceived self-efficacy, which can, in
turn, result in increased positive affect.
➢ When positive emotions or affect are associated
with a behavior, the probability of commitment
and action is increased.
➢ Persons are more likely to commit to and
engage in health-promoting behaviors when
 significant others model the behavior, expect ➢ The conceptual framework contains multiple
the behavior to occur, and provide assistance concepts, which may invite confusion to the
and support to enable the behavior. reader.
➢ Families, peers, and health care providers are ➢ Its applicability to an individual currently
important sources of interpersonal influence experiencing a disease state was not given
that can increase or decrease commitment to emphasis.
and engagement in health-promoting behavior.
➢ Situational influences in the external CHECK FOR UNDERSTANDING
environment can increase or decrease
commitment to or participation in 1. The Health Promotion Model was designed to
health-promoting behavior. be a “complementary counterpart to models of
➢ The greater the commitments to a specific plan health protection. How does Pender's Health
of action, the more likely health-promoting Promotion Model describe nurses?
behaviors will be maintained over time. a. As part of a client’s interpersonal
➢ Commitment to a plan of action is less likely to environment
result in the desired behavior when competing b. As agents of change
demands over which persons have little control c. As partners
require immediate attention. d. All of the above
➢ Commitment to a plan of action is less likely to Answer: As part of a client’s interpersonal
result in the desired behavior when other environment
actions are more attractive and preferred over
the target behavior. 2. Pender's Health Promotion Model examines the
➢ Persons can modify cognitions, affect, and the multi-dimensional nature of persons as they interact
interpersonal and physical environment to within their environment to pursue health. Which of
create incentives for healthy actions. the following is/are NOT a behavior-specific
cognition and affect variable?
STRENGTHS
a. Perceived self-efficacy
b. Perceived benefits of action
➢ The Health Promotion Model is simple to
c. Situational influences
understand, yet diving deeper shows its
d. Prior related behavior
complexity in its structure.
Answer: Prior related behavior
➢ Nola Pender’s nursing theory focused on health
promotion and disease prevention, making it
3. Individual's likelihood of taking action- results
stand out from other nursing theories.
from a person's perception of benefits and barriers
➢ It is highly applicable in the community health
to taking action. Which of the following major
setting.
concepts of Pender’s health model pertains to the
➢ It promotes the nursing profession’s
frequency of the same or similar behavior in the
independent practice, being the primary source
past?
of health-promoting interventions and
a. Prior related behavior
education.
b. Personal factors
c. Perceived benefits of action
WEAKNESSES
d. Health promoting behavior
Answer: Prior related behavior
➢ The Health Promotion Model of Pender could
not define the nursing metaparadigm or the
4. The end result directed toward accomplishing
concepts that a nursing theory should have,
beneficial health outcome such as optimal
man, nursing, environment, and health.
well-being, personal fulfillment, and personal living
a. personal psychological factors
b. health promoting behaviors a. Personal factors
c. activity-related affect b. Psychological factors
d. perceived self-efficacy c. Biological factors
Answer: health promoting behaviors d. Socio cultural factors
Answer: Psychological factors
5. Pender’s health promotion model defines health
as “a positive dynamic state not merely the 10. The Health Promotion Model is similar in
absence of disease.” Which of the following include construction to the health belief model, which
variables such as self-esteem, self-motivation, explains disease prevention behavior. Which of the
personal competence, perceived health status, and following involves anticipated, imagined or real
definition of health: barriers preventing the change?
a. Personal socio-cultural factors a. Perceived self-efficacy
b. Perceived self-efficacy b. Health promoting behavior.
c. Perceived barriers to action c. Perceived barriers to action
d. Personal factors d. Perceived benefit of action
Answer: Personal factors Answer: Perceived barriers to action

6. Describes subjective positive or negative feelings

that occur before, during and after behavior.
a. Interpersonal influences
b. Situational influences
c. Commitment to a plan of action
d. Activity related affect
Answer: Activity related affect

7. Health promotion is directed at increasing a

client’s level of well-being. Which of the following
variables pertains to age, gender, race, basal
metabolic rate?
a. Personal factors
b. Psychological factors
c. Biological factors
d. Socio cultural factors
Answer: Biological factors

8. The health promotion model (HPM) proposed by

Nola J Pender (1982; revised, 1996) was designed
to be a “complementary counterpart to models of
health protection.” Which of the following personal
factors include race, ethnicity, and acculturation?
a. Personal factors
b. Psychological factors
c. Biological factors
d. Socio cultural factors
Answer: Socio cultural factors

9. Which of the following personal factors include

self-esteem and self-motivation?
 NUR 016: THEORETICAL FOUNDATION OF NURSING
MODULE 14:
FIRST SEMESTER l S.Y. 2023-2024 TRANSCRIBED BY: NATHALIE KIM E. ALMEDORA
LECTURER: MS. MICHELLE TIANGSON DIZON

OUTLINE OF THE TOPIC/S

➢ She developed the concept of transcultural
nursing and the ethno-nursing research model.
➢ Madeleine Leininger’s Culture Care Theory in
Nursing THEORY DESCRIPTION

MADELEINE LEININGER’S CULTURE CARE ➢ Transcultural nursing is a comparative study

THEORY IN NURSING of cultures to understand similarities (culture
universal) and difference (culture-specific)
➢ “Transcultural nursing is a substantive area of across human groups (Leininger, 1991).
study and practice focused on comparative ➢ Through her observations while working as a
cultural care (caring) values, beliefs, and nurse, Madeleine Leininger identified a lack of
practices of individuals or groups of similar or cultural and care knowledge as the missing
different cultures with the goal of providing component to a nurse’s understanding of the
culture-specific and universal nursing care many variations required in patient care to
practices in promoting health or well-being or to support compliance, healing, and wellness
help people to face unfavorable human which led her to develop the theory of
conditions, illness, or death in culturally Transcultural Nursing also known as Culture
meaningful ways.” Care Theory.
➢ The main focus of Leininger’s theory is for
nursing care to fit with or have beneficial
meaning and health outcomes for people of
different or similar cultural backgrounds. With
these, she has developed the Sunrise Model in
a logical order to demonstrate the
interrelationships of the concepts in her theory
of Culture Care Diversity and Universality.
➢ Culture is also beliefs, habits, likes, dislikes,
customs and rituals learned from one’s family.
○ Culture is the learned, shared and
transmitted values, beliefs, norms and
LIFE STORY life way practices of a particular group
that guide thinking, decisions, and
➢ She is considered as the founder of the actions in patterned ways.
theory of transcultural nursing. ○ Culture is learned by each generation
➢ Her theory has now developed as a discipline in through both formal and informal life
nursing. experiences.
➢ Theoretical framework is depicted in her model ○ Language is primarily through means of
called the Sunrise Model (1997). transmitting culture.
➢ One of the first nursing theorists and ○ The practices of particular cultures often
transcultural global nursing consultants. arise because of the group's social and
➢ MSN - Catholic University in Washington DC. physical environment.
➢ PhD in anthropology - University of Washington.
 ○ Culture practice & beliefs are adapted
➔ Refers to the fact or state of being
over time but mainly remain constant as different. Diversity can occur between
long as they satisfy needs. cultures and within a cultural group.
○ Set of values, beliefs and traditions, that
are held by a specific group of people ACCULTURATION
and handed down from generation to ➔ People of a minority group tend to
assume the attitudes, values, beliefs, and
generation.
practices of the dominant society resulting
in a blended cultural pattern.
RELIGION
➔ Is a set of belief in a divine or super CULTURAL SHOCK
human power (or powers) to be obeyed ➔ The state of being disoriented or unable
and worshiped as the creator and ruler of to respond to a different cultural
the universe. environment because of its sudden
strangeness, unfamiliarity, and
ETHNIC incompatibility to the stranger's
➔ Refers to a group of people who share a perceptions and expectations is
common and distinctive culture and who differentiated from others by symbolic
are members of a specific group. markers (cultures, biology, territory,
religion).
ETHNICITY
➔ A consciousness of belonging to a group. ETHNIC GROUPS
➔ Share a common social and cultural
CULTURAL IDENTITY heritage that is passed on to successive
➔ The sense of being part of an ethnic generations.
group or culture
ETHNIC IDENTITY
CULTURE-UNIVERSALS ➔ Refers to a subjective perspective of the
➔ Commonalities of values, norms of person's heritage and to a sense of
behavior, and life patterns that are similar belonging to a group that is
among different cultures. distinguishable from other groups.

CULTURE-SPECIFIES RACE
➔ Values, beliefs, and patterns of behavior ➔ The classification of people according to
that tend to be unique to a designated shared biologic characteristics, genetic
culture. markers, or features. Not all people of the
same race have the same culture.
MATERIAL CULTURE
➔ Refers to objects (dress, art, religious CULTURAL AWARENESS
artifacts) ➔ It is an in-depth self-examination of one's
own background, recognizing biases and
NON-MATERIAL CULTURE prejudices and assumptions about other
➔ Refers to beliefs customs, languages, people.
social institutions.
CULTURALLY CONGRUENT CARE
SUBCULTURE ➔ Care that fits the people's valued life
➔ Composed of people who have a distinct patterns and set of meanings -which is
identity but are related to a larger cultural generated from the people themselves,
group. rather than based on predetermined
criteria.
BICULTURAL
➔ A person who crosses two cultures, CULTURALLY COMPETENT CARE
lifestyles, and sets of values. ➔ Is the ability of the practitioner to bridge
cultural gaps in caring, work with cultural
DIVERSITY differences and enable clients and
 ● The cultural care worldview flows into
families to achieve meaningful and
supportive caring. knowledge about individuals, families, groups,
communities, and institutions in diverse health
care systems. This knowledge provides
THE SUNRISE MODEL OF LEININGER’S THEORY
culturally specific meanings and expressions in
relation to care and health.
➢ This is relevant because it enables nurses to
● The next focus is on the generic or folk system,
develop critical and complex thoughts towards
professional care systems, and nursing care.
nursing practice. These thoughts should
Information about these systems includes the
consider, and integrate, cultural and social
characteristics and the specific care features of
structure dimensions in each specific context,
each. This information allows for the
besides the biological and psychological
identification of similarities and differences or
aspects involved in nursing care.
cultural care universality and cultural care
diversity.
● Next are nursing care decisions and actions
which involve cultural care preservation or
maintenance, cultural care accommodation or
negotiation and cultural care repatterning or
restructuring. It is here that nursing care is
delivered.

Cultural care preservation or Maintenance

● Cultural care preservation is also known as
maintenance and includes those assistive,
supporting, facilitative, or enabling
professional actions and decisions that help
people of a particular culture to retain and/or
preserve relevant care values so that they
can maintain their well-being, recover from
illness, or face handicaps and/or death.

Cultural care accommodation or Negotiation

● Cultural care accommodation also known as
negotiation, includes those assistive,
supportive, facilitative, or enabling creative
professional actions and decisions that help
people of a designated culture to adapt to or
negotiate with others for a beneficial or
satisfying health outcome with professional
care providers.

Culture care repatterning or Restructuring

● Culture care repatterning or restructuring
includes those assistive, supporting,
facilitative, or enabling professional actions
and decisions that help a clients reorder,
change, or greatly modify their lifeways for
new, different, and beneficial health care
pattern while respecting the clients cultural values ● Worldview
and beliefs and still providing a beneficial or ➔ This is the way in which people look at
healthier lifeway than before the changes were the world, or at the universe, and form a
coestablished with the clients. (Leininger, 1991) “picture or value stance” about the world
and their lives.
MAJOR CONCEPTS AND DEFINITIONS
● Cultural and Social Structure Dimensions
● Transcultural Nursing ➔ These are defined as involving the
➔ This is defined as a learned subfield or dynamic patterns and features of
branch of nursing which focuses upon interrelated structural and organizational
the comparative study and analysis of factors of a particular culture (subculture
cultures with respect to nursing and or society) which includes religious,
health-illness caring practices, beliefs, kinship (social), political (and legal),
and values with the goal to provide economic, educational, technological
meaningful and efficacious nursing care and cultural values, ethno-historical
services to people according to their factors, and how these factors may be
cultural values and health-illness interrelated and function to influence
context. human behavior in different
➔ This is the study of nursing care beliefs, environmental contexts.
values, and practices as cognitively
perceived and known by a designated ● Culture Care
culture through their direct experience, ➔ This is defined as the subjectively and
beliefs, and value system (Leininger, objectively learned and transmitted
1979). values, beliefs, and patterned lifeways
that assist, support, facilitate, or enable
● Professional Nursing Care (Caring) another individual or group to maintain
➔ This is defined as formal and cognitively their well-being, health, improve their
learned professional care knowledge human condition and lifeway, or to deal
and practice skills obtained through with illness, handicaps or death.
educational institutions that are used to
provide assistive, supportive, enabling, ● Culture Care Diversity
or facilitative acts to or for another ➔ This indicates the variabilities and/or
individual or group in order to improve a differences in meanings, patterns,
human health condition (or well-being), values, lifeways, or symbols of care
disability, lifeway, or to work with dying within or between collectives that are
clients. related to assistive, supportive, or
enabling human care expressions.
● Cultural Congruent (Nursing) Care
➔ This is defined as those cognitively ● Culture Care Universality
based assistive, supportive, facilitative, ➔ This indicates the common, similar, or
or enabling acts or decisions that are dominant uniform care meanings,
tailor-made to fit with individual, group, pattern, values, lifeways or symbols that
or institutional cultural values, beliefs, are manifest among many cultures and
and lifeways in order to provide or reflect assistive, supportive, facilitative,
support meaningful, beneficial, and or enabling ways to help people.
satisfying health care, or well-being (Leininger, 1991)
services.
 ADDITIONAL CONCEPTS TO BE TAKEN NOTED therapies such as Ayurveda and Panchakarma.

➢ Illness and wellness are shaped by various

HEALTH PRACTICES IN DIFFERENT CULTURES
factors including perception and coping skills,
as well as the social level of the patient. ● Use of Protective Objects
➢ Cultural competence is an important component ○ Protective objects can be worn or
of nursing. carried or hung in the home (charms
➢ Culture influences all spheres of human life. It worn on a string or chain around the
neck, wrist, or waist to protect the
defines health, illness, and the search for relief
wearer from evil eye/evil spirits).
from disease or distress.
➢ Religious and cultural knowledge is an ● Use of Substance
important ingredient in health care. ○ It is believed that certain food
➢ The health concepts held by many cultural substances can be ingested to prevent
groups may result in people choosing not to illness. Examples of these are eating
raw garlic or onion to prevent illness or
seek modern medical treatment procedures.
wear them on the body or hang them in
➢ Health care providers need to be flexible in the the home.
design of programs, policies, and services to
meet the needs and concerns of the culturally ● Religious Practices
diverse population, groups that are likely to be ○ Burning of candles, rituals of
encountered. redemption etc.
➢ Most cases of lay illness have multiple ● Traditional Remedies
casualties and may require several different ○ The use of folk or traditional medicine
approaches to diagnosis, treatment, and cure is seen among people from all walks of
including folk and Western medical life and cultural ethnic background.
interventions.
● Healers
➢ The use of traditional or alternate models of
○ Within a given community, specific
health care delivery is widely varied and may people are known to have the power to
come into conflict with Western models of heal.
health care practice.
➢ Culture guides behavior into acceptable ways ● Immigration
for the people in a specific group as such ○ Immigrant groups have their own
cultural attitudes ranging beliefs and
culture originates and develops within the social
practices regarding these areas.
structure through interpersonal interactions.
➢ For a nurse to successfully provide care for a ● Gender Roles
client of a different cultural or ethnic to ○ In many cultures, the male is the
background, effective intercultural dominant figure and often they make
communication must take place. decisions related to health practices
and treatment. In some other cultures
females are dominant. In some
APPLICATION TO NURSING cultures, women are discriminated
against in providing proper treatment
➢ To develop understanding, respect and for illness.
appreciation for the individuality and diversity of
a patient's beliefs, values, spirituality and ● Beliefs about Mental Health
○ Mental illnesses are caused by a lack
culture regarding illness, its meaning, cause,
of harmony of emotions or by evil
treatment, and outcome. spirits. Problems in this life are most
➢ To encourage in developing and maintaining a likely related to transgressions
program of physical, emotional and spiritual committed in a past life.
self-care introduce
● Economic Factors and social interactions in particular
○ Factors such as unemployment, physical, ecological, sociopolitical
underemployment, homelessness, lack and/or cultural settings. These terms
of health insurance and poverty are not defined by Leininger; she
prevent people from entering the health speaks instead of worldview, social
care system. structure, and environmental context.

● Time Orientation
○ It varies for different cultures and THE NURSING PROCESS AND THE ROLE OF
groups. THE NURSE

● Personal Space ● Assessment

○ Respect the client's personal space ○ Determine the client's cultural heritage
when performing nursing procedures. and language skills, & if any of health
The nurse should also welcome visiting beliefs relate to the cause of the illness
members of the family and extended or to the problem.
family. ○ Collect information that any home
remedies the person is taking to treat
the symptoms.
THEORY IN VIEW OF METAPARADIGMS ○ Nurses should evaluate their attitudes
toward ethnic nursing care.
● Nursing ○ Self-evaluation helps the nurse to
○ This is defined as a learned humanistic become more comfortable when
and scientific profession and discipline providing care to clients from diverse
which is focused on human care backgrounds.
phenomena and activities in order to ○ Understand the influence of culture,
assist, support, facilitate, or enable race & ethnicity on the development of
individuals or groups to maintain or social emotional relationship, child
regain their well-being (or health) in rearing practices & attitude toward
culturally meaningful and beneficial health.
ways, or to help people face handicaps ○ Collect information about the
or death. socioeconomic status of the family and
● Person its influence on their health promotion
○ Such are believed to be caring and to and wellness.
be capable of being concerned about ○ Identify the religious practices of the
the needs, well-being, and survival of family and their influence on health
others. Leininger also indicates that promotion belief in families.
nursing as a caring science should ○ Understanding of general
focus beyond traditional nurse-patient characteristics of the major ethnic
interactions and dyads to include groups, but always individualizing care.
families, groups, communities, total
cultures, and institutions. ● Diagnosis
● Health ○ The nursing diagnosis for clients
○ It is a state of well-being that is should include potential problems in
culturally defined, valued, and their interaction with the health care
practiced, and which reflects the ability system and problems involving the
of individuals (or groups) to perform effects of culture.
their daily role activities in culturally
expressed, beneficial, and patterned ● Planning
life ways. ● Interventions
● Environment ○ The planning and implementation of
○ Environmental context is the totality of nursing interventions should be
an event, situation, or particular adapted as much as possible to the
experience that gives meaning to client's cultural background.
human expressions, interpretations,
 and healthy it contributes to the well-being of
● Evaluation
○ Evaluation should include the nurse's the client(s) – whether individuals, groups,
self-evaluation of attitudes and families, communities, or institutions – as they
emotions toward providing nursing care function within the context of their environments
to clients from diverse sociocultural ➢ Nursing care will be culturally congruent or
backgrounds. beneficial only when the clients are known by
○ Self-evaluation by the nurse is crucial the nurse and the clients’ patterns, expressions,
as he or she increases skills for
interaction. and cultural values are used in appropriate and
meaningful ways by the nurse with the clients.
➢ If clients receive nursing care that is not at least
ASSUMPTIONS OF THE THEORY
reasonably culturally congruent (that is,
compatible with and respectful of the clients’
➢ Different cultures perceive, know, and practice
lifeways, belief, and values), the client will
care in different ways, yet there are some
demonstrate signs of stress, noncompliance,
commonalities about care among all cultures of
cultural conflicts, and/or ethical or moral
the world.
concerns.
➢ Values, beliefs, and practices for culturally
related care are shaped by, and often STRENGTHS
embedded in, the worldview, language,
religious (or spiritual), kinship (social), political ➢ Leininger has developed the Sunrise Model in a
(or legal), educational, economic, technological, logical order to demonstrate the
ethno-historical, and environmental context of interrelationships of the concepts in her theory
the culture. of Culture Care Diversity and Universality.
➢ While human care is universal across cultures, ➢ Leininger’s theory is essentially parsimonious in
caring may be demonstrated through diverse that the necessary concepts are incorporated in
expressions, actions, patterns, lifestyles, and such a manner that the theory and its model
meanings. can be applied in many different settings.
➢ Cultural care is the broadest holistic means to ➢ It is highly generalizable. The concepts and
know, explain, interpret, and predict nursing relationships that are presented are at a level of
care phenomena to guide nursing care abstraction which allows them to be applied in
practices. many different situations.
➢ All cultures have generic or folk health care ➢ It can be easily understood upon the first
practices, that professional practices vary contact.
across cultures, and that in any culture there
will be cultural similarities and differences WEAKNESSES
between the care-receivers (generic) and the
professional caregivers. ➢ The theory and models are not simple in terms.
➢ Care is a distinct, dominant, unifying and
central focus of nursing, and, while curing and CONCLUSION
healing cannot occur effectively without care,
care may occur without cure. ● According to transcultural nursing, the goal of
➢ Care and caring are essential for the survival of nursing care is to provide care congruent with
humans, as well as for their growth, health, cultural values, beliefs, and practices.
well-being, healing, and ability to deal with ● Cultural knowledge plays a very important role
handicaps and death. for nurses on how to deal with the patients. To
➢ Nursing, as a transcultural care discipline and start off, it helps nurses to be aware of the ways
profession, has a central purpose to serve in which the patient’s culture and faith system
human beings in all areas of the world; that provide resources for their experiences with
when culturally based nursing care is beneficial
 illness, suffering, and even death. It helps c. Diversity
nurses to be understanding and respectful of d. Caring
the diversity that is often very present in a Answer: Caring
nurse’s patient load. It also helps strengthen a
nurse’s commitment to nursing based on 3. Which of the following is/ are NOT true about
nurse-patient relationships and emphasizing the culture?
whole person rather than viewing the patient as a. Refers to learned, shared, and transmitted
simply a set of symptoms or illness. Finally, values, beliefs, norms and life ways of a particular
using cultural knowledge to treat a patient also place.
helps a nurse to be open-minded to treatments b. Provides the basis for cultural values, which
that can be considered non-traditional, such as identify ways thinking or acting.
spiritually based therapies like meditation and c. Both exhibit diversity and universality
anointing. d. Refers to the outlook of a person or group on the
● Nowadays, nurses are required to be sensitive world or their universe to form a picture or a value
to their patients’ cultural backgrounds when perception about their life or world around them
creating a nursing plan. This is especially Answer: Refers to the outlook of a person or
important since so many people’s culture is so group on the world or their universe to form a
integral in who they are as individuals, and it is picture or a value perception about their life or
that culture that can greatly affect their health, world around them
as well as their reactions to treatments and
care. With these, awareness of the differences 4. What are the three types of nursing actions
allows the nurse to design culture-specific according to Madeleine Leininger, except?
nursing interventions. a. Cultural Care Preservation or Maintenance
● Through the help of Leininger’s theory, nurses b. Cultural Care Accommodation or Negotiation
can actually observe how a patient’s cultural c. Cultural Care Repatterning or Restructuring
background is related to his or her health, and d. Culture Care Assimilation
use that knowledge to create a nursing plan Answer: Culture Care Assimilation
that will help the patient get healthy quickly
while still being sensitive to his or her cultural 5. Pepper, a 79-year old diabetic patient is
background. conscious about what she eats by eating foods rich
in fiber. She also makes it
CHECK FOR UNDERSTANDING a point to take her insulin shots on time. Which of
the following types of nursing actions demonstrates
1. According to Leininger, the true essence of Martha’s behavior?
nursing is caring. Which of the following pertains to a. Cultural Care Preservation or Maintenance
commonalities of care? b. Cultural Care Accommodation or Negotiation
a. Universality c. Cultural Care Repatterning or Restructuring
b. Culture care d. Culture Care Assimilation
c. Diversity Answer: Cultural Care Preservation or
d. Goal of Transcultural Nursing Maintenance
Answer: Universality
6. Encouraging direct care such as bathing,
2. What are the dominant, distinctive, and unifying feeding, and other activities of daily living by family
features of nursing that are essential for a person’s members who may be interested in actively
survival, development, and ability to deal with life contributing in the care of a loved one is referring to
events? ________________.
a. Spiritual aspect of care a. Cultural Care Preservation or Maintenance
b. Goal of Transcultural Nursing b. Cultural Care Accommodation or Negotiation
c. Cultural Care Repatterning or Restructuring and that explains, and interprets human lifeways
d. Culture Care Assimilation within particular cultural trends refers to:
Answer: Cultural Care Preservation or a. Acculturation
Maintenance b. Bicultural
c. Ethnohistory
7. Nurse Pepper teaches Arnold, a 67-year-old d. Ethnicity
Filipino-American patient that although garlic may Answer: Ethnohistory
lower his blood pressure; he still needs to take the
prescribed antihypertensive medications. Which of
the following explains Nurse Pepper’s nursing
action?
a. Cultural Care Preservation or Maintenance
b. Cultural Care Accommodation or Negotiation
c. Cultural Care Repatterning or Restructuring
d. None of these
Answer: Cultural Care Accommodation or
Negotiation

8. Orah is an 89-year-old patient who does not

believe that she needs an advance directive
because “death is up to God.” Nurse Pepper, who
is taking care of her, can educate her about having
her wishes followed when she can no longer make
decisions or speak for herself. Explaining that by
creating advance directives, her wishes will be
followed. Which of the following explains Nurse
Pepper’s nursing action?
a. Cultural Care Preservation or Maintenance
b. Cultural Care Accommodation or Negotiation
c. Cultural Care Repatterning or Restructuring
d. None of these
Answer: Cultural Care Repatterning or
Restructuring

9. Refers to cultural variability or differences in care

beliefs, meanings, patterns, values, symbols, and
lifeways within and between cultures and human
beings.
a. Globalization
b. Culture Care Universality
c. Culture Care Diversity
d. World view
Answer: Culture Care Diversity

10. Past facts, events and experiences of

individuals, groups, and various cultures and
institutions that are mainly people-centered (ethnic)
 NUR 016: THEORETICAL FOUNDATION OF NURSING
MODULE 15:
FIRST SEMESTER l S.Y. 2023-2024 TRANSCRIBED BY: NATHALIE KIM E. ALMEDORA
LECTURER: MS. MICHELLE TIANGSON DIZON

OUTLINE OF THE TOPIC/S

absence of disease (Newman, 2010). The
theory asserts that every person in every
➢ Margaret A. Newman’s Theory of Health as situation, no matter how disordered and
Expanding Consciousness hopeless it may seem, is part of the universal
process of expanding consciousness – a
MARGARET A. NEWMAN’S THEORY OF HEALTH process of becoming more of oneself, of finding
AS EXPANDING CONSCIOUSNESS greater meaning in life, and of reaching new
dimensions of connectedness with other people
LIFE STORY and the world (Newman, 2010).
➢ Humans are open to the whole energy system
➢ Born on October 10, 1933. of the universe and constantly interact with the
➢ Bachelor’s degree - University of Tennessee in energy. With this process of interaction, humans
1962 are evolving their individual's pattern of whole.
➢ Master’s degree - University of California in ➢ According to Newman, understanding the
1964 pattern is essential. The expanding
➢ Doctorate - New York University in 1971 consciousness is pattern recognition.
➢ She has worked in - University of Tennessee, ➢ Pattern of individual so the pathology of the
New York University, Pennsylvania State diseases exists before the symptoms appear so
University, University of Minnesota, University removal of disease symptoms does not change
of Minnesota the individual structure.
➢ Newman also redefines nursing. According to
her, nursing is the process of recognizing the
individual in relation to the environment and it is
the process of understanding consciousness.
➢ The nurse helps to understand people to use
the power within to develop the higher level of
consciousness. Thus, it helps to realize the
disease process, its recovery and prevention.

THEORY DEVELOPMENT
THEORY DESCRIPTION (ORDER: THEORIST, THEORY, DESCRIPTION)

➢ The theory of health as expanding ● Martha Rogers

consciousness stems from Rogers' theory of ○ Unitary Human Beings Theory
unitary human beings. ■ The main basis of the
development of her theory,
➢ The theory of health as expanding
Health as Expanding
consciousness (HEC) was stimulated by Consciousness. Rogers’
concern for those for whom health as the assumptions regarding
absence of disease or disability is not possible wholeness, pattern, and
(Newman, 2010). unidirectionality are
➢ The theory has progressed to include the health foundational to Newman’s
of all persons regardless of the presence or theory.
 ● Illness reflected the life patterns of the person
● Itzhak Bentov
○ Concept of Evolution of Consciousness and that what was needed was the recognition
■ Explication of life as the of that pattern and acceptance of it for what it
process of expanding meant to that person.
consciousness prompted ● Health and illness are simply manifestations of
Newman to assert her new the rhythmic fluctuations of the life process is
concept of health as the the foundation for viewing health and illness as
process of expanding
consciousness. a unitary process moving through variations in
order-disorder. that is, health as absence of
● Arthur Young disease or health as a continuum from wellness
○ Theory of Process to illness. Health and the evolving pattern of
■ Theory of human evolution consciousness are the same.
pinpointed the role of pattern
● The pattern is evolving through various
recognition for Newman. She
explained that Young’s ideas permutations of order and disorder, including
provided impetus for her to what in everyday language is called health and
integrate the basic concepts disease. Pattern recognition emerges from a
of her new theory, movement, process of uncovering meaning in a person’s
space, time, and life. Meaning is inherent in pattern, and vice
consciousness, into a versa.
dynamic portrayal of life and
● Consciousness is defined as the informational
health.
capacity of the system (the human being); that
● David Bohm is, the ability of the system to interact with the
○ Theory of Implicate environment.
■ Theory of implicate order ○ Consciousness includes not only the
supports Newman’s postulate cognitive and affective awareness
that disease is a
normally associated with
manifestation of the pattern of
health. consciousness, but also the
interconnectedness of the entire living
system, which includes physiochemical
ASSUMPTIONS OF THE THEORY
maintenance and growth processes as
well as the immune system. This pattern
➢ Health encompasses conditions heretofore
of information, which is the
described as illness, or, in medical terms,
consciousness of the system, is part of
pathology.
a larger, undivided pattern of an
➢ These pathological conditions can be
expanding universe.
considered a manifestation of the total pattern
○ Three Correlates of Consciousness:
of the individual
1. Movement
➢ The pattern of the individual that eventually
2. Time
manifests itself as pathology is primary and
3. Space
exists prior to structural or functional changes.
○ The relevance of movement, time and
➢ Removal of the pathology in itself will not
space was part of the original
change the pattern of the individual.
explication and has re-emerged in the
➢ If becoming ill is the only way an individual's
evolving patterning of unfolding
pattern can manifest itself, then that is health
consciousness.
for that person.
○ To see health as the pattern of the
whole, one needs to see disease not as
USE OF EMPIRICAL EVIDENCE
a separate entity but as a manifestation
 of the evolving pattern of
of consciousness...” Persons are
person-environment interaction “centers of consciousness” within an
overall pattern of expanding
consciousness.
● Health
○ Health and illness are synthesized as
health - the fusion of one state of being
(disease) with its opposite
(non-disease) results in what can be
regarded as health.
● Environment
○ Environment is described as a
“universe of open systems”.

APPLICATION TO NURSING

● Nursing Practice (Administration & Leadership):

Useful in the practice of nursing because it
contained concepts used by the nursing
profession. Movement and time are an intrinsic
part of nursing intervention, that is, range-of-
motion, ambulation, turning, coughing, and
deep- breathing. These parameters are used
each day by the nurse in practice.
● Nursing Education: Students should have the
opportunity to study various approaches to
health and nursing and to choose what is
relevant to them in their practice and research.
● Nursing Research: Research should center
around “participatory investigations in which
subjects (clients) are our partners, our
core-searchers, in our search for health
patterns”.

STRENGTHS

THEORY IN VIEW OF METAPARADIGMS ➢ Generates caring interventions

● Nursing WEAKNESSES
○ Nursing is “caring in the human health
experience”. Nursing is seen as a ➢ Being abstract
partnership between the nurse and
➢ Multi-dimensional and qualitative.
client, which both grow in the “sense of
higher levels of consciousness”. ➢ Little discussion on environment
● Person
○ The human is unitary, that cannot be CRITIQUE OF THE THEORY
divided into parts, and is inseparable
from the larger unitary field. “Persons ● Clarity
as individuals, and human beings as a ○ Semantic clarity is evident in the
species are identified by their patterns definitions, descriptions, and
 c. Nursing is seen as a partnership between the
dimensions of the concepts of the
theory. nurse and the other members of the healthcare
team
● Simplicity d. Nursing is seen as the sole responsibility of the
○ The deeper meaning of the theory of nurse in caring for the patient
health as expanding consciousness is Answer: Nursing is seen as a partnership
complex. The theory as a whole must
between the nurse and patient
be understood, not just the isolated
concepts.
2. Newman’s Health as Expanding Consciousness
● Generality Theory is beneficial because it can be applied in
○ The theory has been applied in several any setting and “generates caring interventions.”
different cultures. It is applicable Which of the following is the reason why it is
across the spectrum of nursing care
considered as a grand nursing theory?
situations.
a. It addresses more narrowly defined phenomena
● Empirical Precision and can be used to suggest an intervention.
○ Quantitative methods are inadequate in b. It addresses more narrowly defined phenomena
capturing the dynamic, changing and can be used to suggest a nursing diagnosis.
nature of this theory. c. It is broader and provides an overall framework
● Derivable Consequences for structuring ideas.
○ Newman's theory provides an evolving d. It is broader and provides a specific framework
guide for all health-related disciplines. for structuring ideas.
Answer: It is broader and provides an overall
framework for structuring ideas.
CONCLUSION

3. The theory asserts that every person in every

➢ Newman's theory can be conceptualized as: situation, no matter how disordered and hopeless it
○ A grand theory of nursing may seem, is part of the universal process of
○ Humans cannot be divided into parts expanding consciousness. Which among the
○ Health is central to the theory and is following is NOT among the three correlates of
seen as a process of developing consciousness?
awareness of self and the environment a. Space
○ Consciousness is a manifestation of an b. Movement
evolving pattern of person-environment c. Time
interaction d. Motion
Answer: Motion
CHECK FOR UNDERSTANDING
4. A concept of Newman's theory which refers to
1. The theory explains that health and illness are the depicts the whole and is characterized by
synthesized as health. In this model, nursing is movement, diversity, and rhythm.
regarded as “caring in the human health a. Pattern
experience.” Which of the following choices is true b. Consciousness
regarding this statement? c. Time and Timing
a. Nursing is seen as a partnership between the d. Pattern Recognition
nurse and the patient’s immediate family members Answer: Pattern
b. Nursing is seen as a partnership between the
nurse and patient 5. Newman emphasizes the importance of
examining ___________ together as dimensions of
emerging patterns of consciousness rather than as c. Choosing
separate concepts of the theory. d. Feeling
a. Pattern recognition Answer: Assumption
b. Movement-Space-Time
c. Consciousness 10. This pertains to the manifestations of the
d. Health rhythmic fluctuations of the life process. (Select all
Answer: Movement-Space-Time that apply)
a. Illness
6. The theory, Health as Expanding b. Consciousness
Consciousness, stems from Rogers’ (1970) science c. Pattern
of unitary human beings and other theories. Which d. Health
among the following theorists implicates order and e. Disease
supports Newman’s postulate that disease is a Answer: Illness and Disease
manifestation of the pattern of health?
a. David Bohm
b. Martha Rogers;
c. Itzak Bentov
d. Arthur Young
Answer: David Bohm

7. Persons are centers of consciousness. Which

among the following theory and theorists provided
impetus for Newman to integrate the basic
concepts of her new theory, movement, space,
time, and consciousness, into a dynamic portrayal
of life and health?
a. David Bohm’s; The Theory of Implicate
b. Martha Rogers; Theory of Unitary Human Beings
c. Itzak Bentov; The concept of evolution of
consciousness
d. Arthur Young; Theory of Process
Answer: Arthur Young; Theory of Process

8. Which among the following nursing paradigms

under Newman’s theory is the key process that
creates unique configurations for each individual?
a. Person
b. Health
c. Environment
d. Nursing
Answer: Environment

9. Newman suggested the use of nine patterns of

interaction in the health assessment framework of
NANDA. Which of the following is/are NOT one of
them?
a. Communicating
b. Assumption
 NUR 016: THEORETICAL FOUNDATION OF NURSING
MODULE 16:
FIRST SEMESTER l S.Y. 2023-2024 TRANSCRIBED BY: NATHALIE KIM E. ALMEDORA
LECTURER: MS. MICHELLE TIANGSON DIZON

OUTLINE OF THE TOPIC/S

➢ This theory posits quality of life from each
person's own perspective as the goal of nursing
➢ Rosemarie Rizzo Parse’s Theory of Human practice.
Becoming ➢ Parse first published the theory in 1981 as the
"Man-living-health" theory.
ROSEMARIE RIZZO PARSE’S THEORY OF ➢ The name was officially changed to "the human
HUMAN BECOMING becoming theory" in 1992 to remove the term
"man" after the change in the dictionary
LIFE STORY definition of the word from its former meaning of
"humankind".
➢ Educated at Duquesne University, Pittsburgh
➢ MSN and Ph.D. from University of Pittsburgh THEORY DEVELOPMENT
➢ Published her theory of nursing,
Man-Living-Health in 1981 ➢ The human becoming theory was developed as
➢ Name changed to Theory of Human Becoming a human science nursing theory in the tradition
in 1992 of Dilthey, Heidegger, Sartre, Merleau-Ponty,
➢ Editor and Founder, Nursing Science Quarterly and Gadamer and Science of Unitary Human
➢ Has published eight books and hundreds of Beings by Martha Rogers.
articles about Human Becoming Theory ➢ The assumptions underpinning the theory were
➢ Professor and Niehoff Chair at Loyola synthesized from works by the European
University, Chicago philosophers, Heidegger, Sartre, and
Merleau-Ponty, along with works by the pioneer
American nurse theorist, Martha Rogers.
➢ The theory is structured around three abiding
themes: meaning, rhythmicity, and
transcendence.

ASSUMPTIONS OF THE THEORY

➔ About Man
◆ The human is coexisting while
THEORY DESCRIPTION co-constituting rhythmical patterns with
the universe.
➢ The Parse theory of human becoming guides ◆ The human is open, freely choosing
nurses In their practice to focus on quality of life meaning in the situation, bearing
as it is described and lived (Karen & responsibility for decisions.
Melnechenko, 1995). ◆ The human is unitary, continuously
➢ The human becoming theory of nursing co-constituting patterns of relating.
presents an alternative to both the conventional ◆ The human is transcending
biomedical approach and the multi-dimensionally with the possible
bio-psycho-social-spiritual (but still normative)
approach of most other theories of nursing. ➔ About Becoming
 ◆ Becoming is unitary
experiences
human-living-health. ○ Inseparable, complimentary to and
◆ Becoming is a rhythmically evolving with
co-constituting human-universe process.
◆ Becoming is the human’s pattern of
SYMBOL OF HUMAN BECOMING THEORY
relating value priorities.
◆ Becoming is an intersubjective process
● Black and white = opposite paradox significant
of transcending with the possible.
to ontology of human becoming and green is
◆ Becoming is unitary human’s emerging
hope
● Center joined = co-created mutual human
THREE ABIDING THEMES universe process at the ontological level &
nurse-person process
● Meaning ● Green and black swirls intertwining =
○ Human Becoming is freely choosing
personal meaning in situations in the human-universe co creation as an ongoing
intersubjective process of living value process of becoming
priorities.
○ Man’s reality is given meaning through
lived experiences
○ Man and environment co-create

● Rhythmicity
○ Human Becoming is co-creating
rhythmic patterns of relating in mutual
process with the universe.
○ Man and environment co-create RELATIONSHIPS OF THE DIFFERENT SHAPES IN
(imaging, valuing, languaging) in THE MODEL
rhythmical patterns
● Powering = a way of revealing and concealing
● Transcendence imaging
○ Human Becoming is co transcending ● Originating = a manifestation of enabling and
multidimensional with emerging limiting valuing
possible ● Transforming = results from languaging of
○ Refers to reaching out and beyond the connecting and separating
limits that a person sets
○ One constantly transforms
SUMMARY OF THE THEORY

THEORY IN VIEW OF METAPARADIGMS ➢ Human Becoming Theory includes Totality

Paradigm
● Nursing ○ Man is a combination of biological,
○ A human science and art that uses an
psychological, sociological and spiritual
abstract body of knowledge to serve
people factors
● Person ➢ Simultaneity Paradigm
○ Open being who is more than and ○ Man is a unitary being in continuous,
different from the sum of the part mutual interaction with environment
● Health ➢ Originally Man-Living-Health Theory
○ Open process of being and becoming.
Involves synthesis of values
● Environment
○ Everything in the person and his
 MAJOR CONCEPTS AND DEFINITIONS the event of restrictions and obstacles of
everyday living.
● Structuring ➔ Ex: Imagine a family whose house was
➔ It is the way individuals see the world. razed by fire. They will think that the fire
How they visualize (imaging) it is their has virtually taken everything from them.
reality. They create this reality with Yet they are thankful that no one got
others and they show (languaging) their hurt in the fire.
reality in the ways they speak and
remain silent and in the ways they move ● Connecting
and stay still. ➔ Separating is the way a person creates
➔ Imaging is the person’s view of reality. It patterns of connecting and separating
is the personal interpretation of with people.
meaning, possibility, and consequence ➔ These patterns show the person’s value
of the phenomenon. Valuing is how priorities. This is exemplified by the
persons confirm or deny beliefs with behavior of people to separate from a
respect to his own view of reality in the group of people and join another group.
world. It reflects what is important to the
person. ● Co-transcending
➔ Describes persons as always engaging
● Languaging with and choosing from an infinite
➔ It is how persons symbolize and express number of possibilities about “how to be
their imagined reality and their value a person, what attitude or approach to
characteristics. Their behavior have, who to relate with, and what
communicates their inner thoughts and interests or concerns to be bothered
their perception of their reality through with”
either speaking it out or remaining silent.
● Powering
● Co-creating ➔ Reflects “struggle and life and the will to
➔ It is the person’s creation of patterns in go on despite hardship and threat”.
daily life activities the describe the ➔ It is the capacity to act and live with
person’s personal meanings and values. purpose among possibilities for affirming
and holding what is cherished and at the
● Revealing-concealing same time, living with loss and the risk
➔ It is the way individuals disclose and of death and rejection.
keep hidden the persons they are
becoming. This is done simultaneously ● Originating
and is evident in the popular notion that ➔ Describes people’s tendency to be
we have more to tell and more to know someone else while maintaining their
about ourselves. This is evident in own uniqueness. It is becoming like
instances where we are able to say someone else but wanting to be
something that we never thought we different.
could say or do something we never
thought we could. ● Transforming
➔ Reflects the purposive, deliberate
● Enabling-limiting change and the shifting views of
➔ These are the freedoms and persons about their lives.
opportunities that become observable in
 ➔ Allows people to change and move in ● Nursing Research
the direction of their cherished hopes ○ Enhances understanding of human lived
and dreams. experience, health, quality of life and
quality of nursing practice
○ Expands the theory of human becoming
○ Builds new nursing knowledge about
universal lived experiences which may
ultimately contribute to health and
quality of life

STRENGTHS

➢ Differentiates nursing from other disciplines

➢ Practice - provides guidelines of care and
useful administration
➢ Useful in education
➢ Provides research methodologies
➢ Provides a framework to guide inquiry of other
theories (grief, hope, laughter, etc.)

WEAKNESSES

➢ Research considered to be in a “closed circle”

➢ Rarely quantifiable results - difficult to compare
to other research studies, no control group,
standardized questions
➢ Does not utilize the nursing process/diagnosis
➢ Negates the idea that each person engages in
a unique lived experience
➢ Not accessible to the novice nurse
➢ Not applicable to acute, emergent care

CRITIQUE OF THE THEORY

APPLICATION TO NURSING
● Congruence with personal values
● Nursing Practice (Administration & Leadership) ○ Nurse must subscribe to this world
○ A transformative approach to all levels view to truly
of nursing ● Congruence with other professional
○ Differs from the traditional nursing values
process, particularly in that it does not ○ Complements and competes with other
seek to “fix” problems health care professionals’ values
○ Ability to see patient’s perspective ○ Exoteric foundations
allows nurse to “be with” patient and ○ Esoteric utility
guide them toward desired health ● Congruence with social values
outcomes ○ Fulfills society’s expectations of
○ Nurse-person relationship co-creates nursing role
changing health patterns
● Social Significance
 3. Based on Parse’s Symbol of Human Becoming
○ Makes a substantial difference in the
lives of clients and nurses Theory, what does the intertwining of the green and
black swirls signify?
a. Human-Universe co- creation as an ongoing
CHECK FOR UNDERSTANDING process of becoming
b. Hope
1. Parse synthesized the original nine assumptions c. Opposite paradox significant to ontology of
about humans and into four assumptions about human becoming
human becoming. All of these are included d. Co-created mutual human universe process at
EXCEPT: the ontological level and nurse person process.
a. Human becoming is structuring meaning, freely Answer: Human-Universe co- creation as an
choosing with situation. ongoing process of becoming
b. Human becoming is configuring rhythmical
human universe patterns. 4. A concept of Newman's theory which depicts the
c. Human becoming is contradicting illimitably with whole and is characterized by movement, diversity,
emerging possibilities. and rhythm.
d. Human becoming is the human universe a. Pattern
co-creating a seamless symphony. b. Consciousness
Answer: Human becoming is contradicting c. Time and Timing
illimitably with emerging possibilities d. Pattern Recognition
Answer: Pattern
2. Which of the following statements is NOT TRUE
about the Human Becoming Theory? 5. Parse's model rates quality of life from each
a. The theory guides the practice of nurses to focus person's own perspective as the goal of the
on quality as it is described and lived practice of nursing. Which of the following is an
b. The theory presents an alternative to both the example of a paradox?
conventional biomedical approach as well as the a. Marga is very shy and loves public speaking
bio-psycho-social - spiritual approach of nursing b. Nurse Renee takes good care of his patient by
c. The theory rates quality of life from each making sure that their needs are met
person's own perspective as the goal of the c. Everyone is born with unique characteristics
practice of nursing. d. Health is wealth
d. The theory presents a broad, holistic and Answer: Marga is very shy and loves public
system-based method to nursing that maintains a speaking
factor of flexibility. It focuses on the response of the
patient system to actual or potential environmental 6. One of the purposes of the theory is to assist
stressors and the maintenance of the client with critical thinking and problem solving. What are
system’s stability through primary, secondary, and the three major themes of the Human Becoming
tertiary nursing prevention intervention to reduce Theory?
stressors. a. Imaging, valuing, languaging
Answer: The theory presents a broad, holistic b. Rhythmicity, imaging, languaging
and system-based method to nursing that c. Meaning, rhythmicity, transcendence
maintains a factor of flexibility. It focuses on the D. Revealing-concealing, enabling-limiting,
response of the patient system to actual or connecting-separating
potential environmental stressors and the Answer: Meaning, rhythmicity, transcendence
maintenance of the client system’s stability
through primary, secondary, and tertiary 7. The Neuman Systems Model views the client as
nursing prevention intervention to reduce an open system that responds to stressors in the
stressors. environment. The client variables are physiological,
psychological, sociocultural, developmental, and
spiritual. Three principles constitute the human
becoming theory. Each principle contains three
concepts that require thoughtful exploration. People
are always engaging with and choosing from infinite
possibilities about how to be, what attitudes and
approach to have, who to relate to. What principle
is exemplified in the given statement?
a. Con-transcending with impossibilities
b. Configuring rhythmical patterns
c. Structuring meaning
d. Con-transcending with possibilities
Answer: Con-transcending with possibilities

8. This principle means that human beings create

patterns in day-to-day life and these patterns tell
about personal meanings and values.
a. Structuring of meaning multidimensionally
b. Co-creating rhythmical patterns of relating
c. Co-transcending with the possibilities
d. Revealing-concealing
Answer: Co-creating rhythmical patterns of
relating

9. It is the indivisible unbounded knowing extended

to infinity, the all at once remembering and
prospecting with the moment.
a. Paradox
b. Illimitability
c. Freedom
d. Mystery
Answer: Illimitability

10. It is being with and apart from others, ideas,

objects and situations all at once.
a. Originating
b. Revealing- concealing
c. Powering
d. Connecting- separating
Answer: Connecting- separating
 NUR 016: THEORETICAL FOUNDATION OF NURSING
MODULE 17:
FIRST SEMESTER l S.Y. 2023-2024 TRANSCRIBED BY: NATHALIE KIM E. ALMEDORA
LECTURER: MS. MICHELLE TIANGSON DIZON

OUTLINE OF THE TOPIC/S

➢ Technology brings the patient closer to the
nurse. Conversely, technology can also
➢ Rozzano Locsin’s Technological Competency as increase the gap between the nurse and
Caring nursed.
➢ Carolina S. Agravante’s Casagra Transformative
Leadership Model ➢ When technology is used to know persons
continuously in the moment, the process of
nursing is lived.
ROZANNO LOCSIN’S TECHNOLOGICAL
COMPETENCY AS CARING AND THE PRACTICE
ASSUMPTIONS OF THE THEORY
OF KNOWING PERSONS IN NURSING

➢ Technological Competency as Caring in

➢ “The practice of knowing persons as whole,
Nursing is a middle range theory grounded in
frequently with the use of varying technologies.”
Nursing as Caring (Boykin & Schoenhofer,
2001). It is illustrated in the practice of nursing
grounded in the harmonious coexistence
between technology and caring in nursing.
○ Persons are caring by virtue of their
humanness.
○ Persons are whole or complete in the
moment.
○ Knowing persons is a process of nursing
that allows for continuous appreciation
LIFE STORY
of persons, moment to moment.
○ Technology is used to know the
➢ 1976 – BSN & 1978 – MAN, Silliman University
wholeness of persons, moment to
of the Philippines
moment.
➢ 1988 – PhD; University of the Philippines
○ Nursing is a discipline and a
➢ 1991 – professor; Christine E. Lynn College of
professional practice.
Nursing, Florida Atlantic University
➢ Program of Research: “Life transitions n the
health- illness experience” DIMENSIONS OF TECHNOLOGICAL VALUE IN
THE THEORY
THEORY DESCRIPTION
● Technology as completing human beings
○ To re-formulate the ideal human being
➢ Technological competency as caring in nursing such as in replacement parts, both
is the harmonious coexistence between mechanical (prostheses) or organic
technologies and caring in nursing. (transplantation of organs)
➢ The harmonization of these concepts places the
● Technology as machine technologies
practice of nursing within the context of modern
○ Examples are computers and gadgets
healthcare and acknowledges that these enhancing nursing activities to provide
concepts can co-exist. quality patient care such as Penelope
or Da Vinci in the Operating Theatres
 ● Wholeness paradox
● Technologies that mimic human beings
and human activities ➔ Because persons are unique and
○ To meet the demands of nursing care unpredictable
practices, examples are cyborgs ➔ Persons can only be fully known: in the
(cybernetic organisms) or moment, if the nurse chooses to enter
anthropomorphic machines and robots the world of the other, and if the person
such as ‘nursebots’ allows the nurse to know him/her

MAJOR CONCEPTS AND DEFINITIONS ● Nursing situation

➔ Shared lived experience between the
● Focus of nursing nurse and nursed
➔ A human being whose hopes, dreams, ➔ Condition in which the nurse and the
and aspirations are to live fully as a other allow each other to know one
caring person another
➔ Nurse’s responsibility to know the
● Intention of nursing person’s hopes, dreams, and aspirations
➔ To know human beings fully as a whole
person: ● Vulnerability
◆ By affirming, appreciating, and ➔ The nurse and nursed become
celebrating personhood vulnerable as they enter each other’s
◆ Through expert and competent world and move toward continuous
use of nursing technologies knowing of one another

● Technology of competence ● Vulnerability in caring situations

➔ conceptualized as an expression of ➔ Allows participation
caring (co-existence of technology and ➔ Embodiment of vulnerability enables
caring in nursing) and providing a recognition of it in others
framework for practice ➔ Allows engagement of “power with”
➔ Purposes: rather than “power over”
◆ Acknowledge wholeness of ➔ Nurses’ work is to ameliorate
persons as a focus of nursing vulnerability (Daniels, 1998)
◆ Technological means are used to
know wholeness more fully ● The entirety of nursing
◆ Technology used to know “who is ➔ This is to direct, focus, sustain, and
person” rather than “what is maintain the person
person” ➔ Through calls and responses for nursing

● What is a Person? PERSON ARE COMPLETE AND WHOLE IN THE

➔ Empirical facts about the compositions MOMENT
of the person; persons as objects
➢ Persons are complete, unique and
● Who is Person? unpredictable ◦ Expressions of completeness
➔ Understanding the unpredictable, vary from moment to moment
irreducible person who is more and ➢ Nursing interventions are not focused on “fixing”
different than the sum of his or her or making persons “whole again.”
empirical self; persons as unique ➢ Nurses come to know persons as whole.
individual ➢ Nursing responses are based on the persons’
uniqueness.
 FOCUSING ON RECEIVED TECHNOLOGICAL
which the a nurse can organize a
DATA ALONE TO KNOW PERSON
rewarding nursing practice that is
responsive to the patient’s desire for care.
➢ Provides the nurse with an understanding of
persons as objects who need to be fixed or PARTICIPATION IN APPRECIATION
made whole again ➔ The simultaneous practice of conjoined
activities which are crucial to knowing
persons. In this stage of the process is
PROCESS OF KNOWING PERSON AS A WHOLE
the alternating rhythm of implementation
AND COMPLETE IN THE MOMENT and evaluation. The evidence of
continuous knowing, implementation and
➢ Persons choose whether or not to allow nurses participation is reflective of the cyclical
to know them fully. process of knowing persons.
➢ In holding the idealization of persons as
VERIFYING KNOWLEDGE
“complete in the moment”, nurses must:
➔ The continuous, circular process
○ Choose to enter the world of the other demonstrates the ever-changing, dynamic
○ Establish rapport, trust, confidence, nature of knowing in nursing. Knowledge
commitment, and compassion about the person that is derived from
knowing, designing, and implementing
KNOWING IS THE PRIMARY PROCESS OF further informs the nurse and the one
NURSING nursed.

➢ Knowing Nursing CALLS FOR NURSING

○ “All at once” knowing of personal,
ethical, empirical, and aesthetic realms ➢ Nurses rely on the person for calls
➢ Continuous knowing of person ➢ Knowing persons allows the nurse to use
○ Occurs moment to moment technologies in articulating calls
○ Deters objectification ➢ Illustrations of the person’s unique hopes,
○ Overpowers the motivation to prescribe dreams, and aspirations
and direct the person’s life ➢ Individual expressions such as desire to go
home & wishing to die peacefully
THE PROCESS OF NURSING
NURSING RESPONSES
➢ This is a dynamic unfolding of situations
encompassing knowledgeable practices. ➢ Nurses respond to calls from persons.
➢ Nurses respond with authentic intentions to fully
KNOWING
➔ The process of knowing person is guided know persons continually in the moment.
by technological knowing in which
persons are appreciated as participants in SISTER CAROLINA S. AGRAVANTE’S CASAGRA
their care rather than as objects of care. TRANSFORMATIVE LEADERSHIP MODEL
The nurse enters the world of the other. In
this process, technology is used to ➢ “Focus on the type of leadership in nursing that
magnify the aspect of the person that can challenge the values of the changing
requires revealing – a representation of
the real person. The person’s state world...”
change moment to moment - person is
dynamic, living, and cannot be predicted.

DESIGNING
➔ Both the nurse and the one nursed
(patient) plan a mutual care process from
 LIFE STORY attractive salaries and benefits way beyond
what hospitals can afford to give.
➢ Bachelor’s Degree in Nursing in St. Paul ● Nursing education is faced with a new concern
College Manila in 1964 that is globalization of nursing services for the
➢ Master’s Degree in Nursing Education in international market. Therefore, a need to
Catholic University of America in 1970 develop globalization of care with focus on
➢ Doctoral degree in nursing in university of the developing caring nurses.
Philippines manila on April 2002 ● The formation of new nursing leaders is
➢ derived CASAGRA theory from her name urgently needed; leaders with new vision who
will venture new traits and who have gone
THEORY DESCRIPTION through new formations in order to serve the
society as professional nurses.
➢ The complete title of her model is “The ● Nurses need competent leaders with a dream
CASAGRA Transformative Leadership Model: of what nursing can be, whose basic stand is
Servant – Leader Formula & the Nursing caring and service who are competent in
Faculty’s Transformative Leadership Behavior”. nursing, assertive of their own rights with the
➢ The theory “CASAGRA Transformative help profession.
Leadership” is a psycho spiritual model.
➢ This is classified as a Practice Theory basing MAIN PROPOSITIONS OF THEORY
on the characteristics of a Practice Theory
stated by McEwen (2007): ➢ CASAGRA transformative leadership is a
○ Complexity / Abstractness, Scope - psycho-spiritual model, and was an effective
Focuses on a narrow view of reality, means for faculty to become better teachers
simple and straightforward and servant-leaders.
○ Generalizability / Specificity - Linked ➢ Care complex is a structure in the personality of
to a special populations or an identified the caregiver that is significantly related to the
field of practice leadership behavior.
○ Characteristic of Scope – Single, ➢ The CASAGRA servant-leadership formula is
concrete concept that is operationalized an effective modality in enhancing the nursing
○ Characteristic of Proposition – faculty’s servant-leadership behavior.
Propositions defined ➢ Vitality of Care Complex of the nursing faculty is
○ Testability – Goals or outcomes defined directly related to leadership behavior
and testable
○ Source of Development – Derived from MAJOR CONCEPTS AND DEFINITIONS
practice or deduced from middle range
theory or grand theory ➢ The CASAGRA Transformative Leadership
Model has concepts of leadership from a
psycho-spiritual point of view, designed to lead
THEORY DEVELOPMENT to radical change from apathy or indifference to
a spiritual person.
● The present day demands in the nursing
profession challenge nursing educators to ● Servant-leader formula
revisit their basic responsibility of educating ➔ This is the enrichment package
professional nurses who are responsive to prepared as intervention for the study
technological, educational and social changes which has three parts that parallel the
happening in the Philippines society today. three concepts of the CASAGRA
● The reopening of the doors of foreign markets transformative leadership model,
to Filipino nurses, migration made easy, namely: the care complex primer, a
 retreat-workshop on Servant-leadership, care acquired in a formal course of
and a seminar-workshop on nursing.
Transformative Teaching for nursing
faculty. THREE-FOLD TRANSFORMATIVE LEADER
CONCEPT
● Special expertise
➔ It is the level of competence in the ● Servant-Leadership Spirituality
particular nursing area that the ○ This is prescribed to run parallel to the
generic elements of the transformative
professional nurse is engaged in the
leadership model.
workshop is the spiritual exercise ○ This formula consists of a spiritual
organized in an ambience of prayer exercise, the determination of the
where the main theme is the vitality of the care complex in the
contemplation of Jesus Christ as a personality of an individual and finally a
Servant-leader. seminar workshop on transformative
teaching.
○ The servant-leader formula prescription
● Servant-leadership behavior
includes a spiritual retreat that goes
➔ This refers to the perceived behavior of through the process of awareness,
nursing faculty manifested through the contemplation, storytelling, reflection,
ability to model the servant leadership and finally commitment to become
qualities to students, ability to bring out servant-leaders in the footsteps of
the best in students, competence in Jesus.
nursing skills, commitment to the
● Self-Mastery
nursing profession, and sense of ○ This consists of a vibrant care complex
collegiality with the school, other health possessed to a certain degree by all
professionals, and local community. who have been through formal studies
in a caregiving profession such as
● Nursing leadership nursing.
➔ This is the force within the nursing
● Special-Expertise Level
profession that sets the vision for its ○ This is shown in a creative, caring,
practitioners, lays down the roles and critical, contemplative and collegial
functions, and influences the direction teaching of the nurse faculty who is
toward which the profession should go. directly involved with the formation of
the nursing.
● Transformative teaching
➔ This may also be termed Reflective
teaching, an umbrella term covering
ideas, such as thoughtful instruction,
teacher research, teacher narrative, and
teacher empowerment.

● Care complex
➔ It is the nucleus of care experiences in
the personality of a nurse formed by a
combination of maternal care
experiences, culture based-care
practices indigenous to a race and
people, and the professional training on
● The conceptual framework is logical because ● Nursing Education
the variables are very well explained on how ○ For nurse educators, they can apply
transformative-leadership models are this concept by being passionate
applicable through complex, transformative about their craft. They can also show
teaching servant-leader spirituality, and willingness to impart their acquired
servant-leader behavior. knowledge to their students and
colleagues in a selfless way.
○ These educators contemplate first
by attending a variety of workshops
regarding new trends in nursing,
applying evidenced- based practices
through patient simulation, and
cascading it to the target learning
group.

● Nursing Administration
○ The model is a powerful tool in
achieving the organization’s vision
and mission as it is designed and
aimed in developing a network of
APPLICATION TO NURSING innovative, competent and
empowered educators towards
● Nursing Practice excellence and nation building.
○ In our shifts, it is important that one of Since it is spiritual and religious, a
the nurses will take on the lead, in our paradigm of peace is embedded to
institution, it is the charge nurse who engage and prepare nursing
takes on this role. administrators and educators to
○ The charge nurse will serve as the modern world-challenges today.
captain of the ship, so it is vital that he ○ The theory is based on Biblical
or she take on the job with utmost care teachings of Jesus Christ, which
and compassion. While the charge would impact on the ethical practice
nurse mainly serves leadership that must be followed in the nursing
functions, there are times that they also field. In contrast, the theory might
become educators, especially to young not be accepted in Muslim countries
nurses who are just starting their as it is Bible-Based and does not
careers. conform to diversities in culture,
○ The servant-leader formula can be a which might face hesitation among
useful tool to charge nurses as this will other theorists, and scholars in the
enable them to become leaders and field of Nursing.
educators while following the footsteps
of our Lord, Jesus Christ. Shifts are ● Nursing Research
unpredictable; it can be easy in the early ○ There were no citations about its use
hours but they can become toxic as the in research but her approach to the
hours progress. It is important for the development of the theory can be
charge nurse to keep his vibrant care modified to include nurses with
complex in check, aspiring other nurses different religion and employ nursing
to lead and serving the others to lead educators from a wider variety of
selflessly just like the way Jesus did. schools to attain practicability.
 ○ With the increasing demands for
similar leadership formation that will be
nurses that need to surpass the provided to them by the nursing
ordinary practices of the current educators who advocated the
norms, not only in the Philippines but CASAGRA Transformative Leadership
all over the world, it is just in time model. It will give them the confidence
that we develop our new leaders that they need to face the challenges in the
will protect and nurture the quality of profession.
○ Transformative teachers are basically
the nursing care. who looks into herself, sees her
assumptions and feelings in the light of
STRENGTH the nursing profession in the modern
days, how her own philosophy of life
➢ It provided the task of the formation of the nurse affects professional life with her
leaders at the baccalaureate level so that the students
profession assured the graduates possess the
● Simplicity
mind and heart of a nursing leader who is of the ○ Agravante’s theory does not possess
nursing profession. simplicity because the study group has
➢ It can also be used in other educational to undergo seminars and retreats
settings, not just in the nursing profession. which somehow give hassles to them.
○ The theory is designed to transform a
WEAKNESSES servant leader which Agravante
possesses Jesus as a sample.
➢ CASAGRA transformative leadership limits only ● Empirical Precision
on Roman Catholic and Christians nursing ○ Agravante’s theory does not possess
educators; it did not consider other religions to simpThe study was conducted to
this study. In the Philippines we have a variety determine the effects of the CASAGRA
of religions present. Every religion has its own transformative leadership model for
nursing faculty on the servant
traditions and practices to be considered.
leadership behavior of the nursing
➢ According to the study, the control and study faculty. The quasi-experimental
groups were selected from the same faculty in two-group pretest posttest design was
the two schools, it is highly possible that utilized in the study. The study
experience could have been discussed casually population consisted of 30 nursing
in the faculty room and in some way must have faculty , divided into control and study
groups randomly selected to participate
contaminated the intervention.
in the Servant-leader formula for
nursing faculty.
CRITIQUE OF THE THEORY

● Usefulness / Practicability CONCLUSION

○ It will help them to achieve the
vision-mission as a network of ● Indeed, Sr. Carolina’s CASAGRA
innovative, competent empowered Transformative Leadership Theory is timely in
educators towards excellence in
national and global development. The this ever fast-paced world.
theory could be the answer in the ● Nursing as a profession is inevitably changing
modern-world challenges in nursing and the demand to be at par with technology
education that is centered on the made it more competitive. Nursing students
teaching of Jesus, a paradigm of need nursing teachers to look up to.
peace. ● Embodied with the three-fold transformative
● Generalizability & Parsimony leadership concepts, it is timely to put this
○ Nursing students will be assured of theory into practice.
 CHECK FOR UNDERSTANDING b. Through competent use of nursing technologies
c. By affirming personhood
1. Which of the following is considered as the focus d. By appreciating personhood
of nursing in the theory of Locsin? e. By ignoring personhood
a. Knowing persons is a process of nursing that Answers: Through competent use of nursing
allows for continuous appreciation of persons, technologies, By affirming personhood, & By
moment to moment. appreciating personhood
b. Technology is used to know persons as whole
moment to moment. 5. This refers to the nurse and nursed becoming
c. Nursing is a discipline and a professional susceptible as they enter each other’s world and
practice. move toward continuous knowing of one another.
d. A human being whose hopes, dreams, and a. Nursing situation
aspirations are to live fully as a caring person. b. Process of nursing
Answer: A human being whose hopes, dreams, c. Vulnerability
and aspirations are to live fully as a caring d. Wholeness paradox
person. Answer: Vulnerability

2. All of the following are purposes in creation of 6. In CASAGRA transformative leadership theory,
Technological Competency as Caring and the this is referred to as the level of competence in the
Practice of Knowing Persons in Nursing by particular nursing area that the professional nurse
Rozanno Locsin: (Select all that apply) is engaged in?
a. Acknowledge wholeness of persons as a focus a. Novice
of nursing b. Competent
b. Technological means are used to know c. Expert
wholeness more fully d. Special expertise
c. Technology used to know “what is person” rather Answer: Special expertise
than “who is
d. Technology used to know person as unique 7. This is known to be the force within the nursing
individual profession that sets the vision for its practitioners,
Answers: Acknowledge wholeness of persons lays down the roles and functions, and influences
as a focus of nursing, Technological means are the direction toward which the profession should
used to know wholeness more fully, & go.
Technology used to know person as unique a. Nursing leadership
individual b. Servant leadership
c. Transformative leadership
3. In Locsin’s theory, this provides a framework for d. None of the above
the practice of its application. Answer: Nursing leadership
a. Nursing as an art
b. An expression of caring 8. Which of the following is not included in the
c. Persons as unique individual three-fold transformation leadership concepts of
d. Intentions of nursing CASAGRA model?
Answer: An expression of caring a. Special expertise
b. Care complex
4. All are considered to be intentions of nursing in c. Self-mastery
the theory Technological Competency as Caring d. Servant-leader spirituality
and the Practice of Knowing Persons in Nursing: Answer: Care complex
(Select all that apply)
a. Through novice use of nursing technologies
9. CASAGRA transformative leadership models
have concepts of leadership from a psycho-spiritual
point of view, designed to lead to radical change
from apathy or indifference to a spiritual person. Its
main propositions are as follow: (Select all that
apply)
a. Care complex is a structure in the personality of
the caregiver that is significantly related to the
leadership behavior.
b. Vitality of care complex of the nursing faculty is
indirectly related to leadership behavior.
c. CASAGRA Transformative Leadership is a
physio-spiritual model, and was an effective means
for faculty to become better teachers and
servant-leaders.
d. The CASAGRA servant-leadership formula is an
effective modality in enhancing the nursing faculty’s
servant-leadership behavior.
Answers: Care complex is a structure in the
personality of the caregiver that is significantly
related to the leadership behavior & The
CASAGRA servant-leadership formula is an
effective modality in enhancing the nursing
faculty’s servant-leadership behavior

10. Which of the following is true about the

CASAGRA paradigm of care complex theory?
a. The framework explains and predicts the
continuous formation of nursing leadership
behavior in nursing faculty that will eventually affect
their teaching function.
b. Transformative teaching runs parallel to the
generic elements of the transformative-leadership
model.
c. Servant-leadership formula is the guide that is
desired for the modern educational process
designed to form the millennium professional nurse.
d. The care complex is necessary given as a
depressant in the performance of the leadership
activities.
Answer: The framework explains and predicts
the continuous formation of nursing leadership
behavior in nursing faculty that will eventually
affect their teaching function
 NUR 016: THEORETICAL FOUNDATION OF NURSING
MODULE 18:
FIRST SEMESTER l S.Y. 2023-2024 TRANSCRIBED BY: NATHALIE KIM E. ALMEDORA
LECTURER: MS. MICHELLE TIANGSON DIZON

OUTLINE OF THE TOPIC/S

➢ Determine the effects of the “COMPOSURE”
behavior of the Advance Nurse Practitioner
➢ Carmelita C. Divinagracia’s Composure Model on the wellness outcome of the selected
➢ Sister Letty G. Kuan’s Retirement and Role cardiac patients
Discontinuities Model

SIGNIFICANCE OF THE STUDY

CARMELITA C. DIVINAGRACIA’S COMPOSURE
MODEL ➢ Nursing as a healthcare profession would prove
its worth of being at par in quality performance
LIFE STORY with other health care professionals.

➢ Former President: The Association of the STUDY POPULATION

Philippine Colleges of Nursing (ADPCN); Dean
of University of the East Ramon Magsaysay ➢ Adult Cardiac Patients – admitted and confined
Memorial Medical Center, Inc. (UERMMMC) at the Philippine Heart Center, Coronary Care
College of Nursing Unit
➢ Member of CHED’s technical Committee on
Nursing Education MAJOR CONCEPTS AND DEFINITIONS
➢ Education: BSN UERMMMC, 1962; master UP,
1975; PhD UP, 2001 ● Advance Nurse Practitioner
➢ She has been a clinic staff and head nurse, ➔ must be a BSN graduate, licensed &
instructor, asst. Dean and Dean has a clinical experience of at least 2
➢ She lectured and wrote about her work as a years in the clinical area
nurse and she used her hand-on experience to ➔ must undergone special training in
develop better ways to teach nursing. critical area & has set of behaviors or
nursing measures that the nurse
demonstrates to selected cardiac
patients

● COMPOSURE
➔ it is an acronym which stands for:
◆ COMpetence
◆ Presence and Prayer
◆ Open-mindedness
◆ Stimulation
ADVANCE NURSE PRACTITIONER’S ◆ Understanding
COMPOSURE BEHAVIOR AND PATIENT’S ◆ Respect and Relaxation
WELLNESS OUTCOME ◆ Empathy

● Composure Behaviors
OBJECTIVE OF THE STUDY
➔ this is a condition of being in a state of
well-being, a coordinated and integrated
 living pattern that involves the ➢ “I have grown and sown and now I can reap the
dimension of wellness reward and blessing of a life lived in joy and
➔ sets of behaviors or nursing measures love, for I too have made others grow.”
that the nurse demonstrates to selected
patients

THREE MAIN THEMES AND SUBTHEMES

● Coordination
○ Intra-organizational Coordination
○ Inter-organizational Coordination
○ Reciprocal Interdependence

● Communication LIFE STORY

○ Environmental Factors
○ Personal Factors ➢ Born on November 19, 1936 in
Katipunan-Dipolog, Zamboanga del Norte
● Interpersonal Relationship ➢ She had a vast contribution to the University of
○ Engagement
the Philippines College of Nursing Faculty &
○ Esprit (morale)
○ Concern Academic achievements
○ Support ➢ She is now a Professor Emeritus, a title
awarded only to a few who met the strict
criteria.
CONCLUSIONS
➢ She has two Masters Degrees, M.A in Nursing
and M.S in Education, Major in Guidance and
● Coordination, communication and interpersonal
Counseling, culminating in Doctor of Education
relationships have been identified as major
(Guidance and Counseling)
components of collaboration based on the lived
➢ Has a Clinical Fellowship and Specialization in
experiences of the respondents.
Neuropsychology in University of Paris, France
● Quality patient care and training of students can
(Salpetriere hospital), Neurogerontology in
be at best only if nursing service and education
Watertown, New York (Good Samaritan
can truly operationalize the meaning of
Hospital) & Syracuse University, New York
collaboration and put into real action.
➢ She also had Bioethics formal training at
● The connectedness of nursing service and
Institute of Religion, Ethics and Law at Baylor
education calls for a new wave of visionary
College of Medicine in Houston, Texas
leadership, empowerment and an environment
➢ She is a recipient of the Metrobank Foundation
of trust and openness.
“Outstanding Teachers Award” in 1995 and an
● Nursing as a profession can really draw a
“Award of Continuing Integrity and Excellence in
power base if only a unification model can be
Service” in 2004 (ACIES)
crafted which is culture-based, practical,
➢ Her religious community is the Notre Dame de
relevant and acceptable to the concerned
Vie founded in France in 193
nursing professionals.
➢ She authored several books giving her insights
● Recommend “unification model for
in the areas of Gerontology, Care of Older
collaboration”.
Persons and Bioethics and Essence of Caring:
○ Concepts of illness and health care
SISTER LETTY G. KUAN’S RETIREMENT AND
intervention in an urban community
ROLE DISCONTINUITIES MODEL ○ Understanding the Filipino elderly: a
textbook for nurses and related health
professional
 ○ Essence of Caring
an accident, emergency, and change of
○ Pag-aaruga Sa Mga Taong May Edad position or retirement.
Na
○ Bioethics in Nursing ● Coping Approaches
○ Refer to the interventions or measures
applied to solve a problematic situation
BASIC ASSUMPTIONS AND CONCEPTS OF THE or state in order to restore or maintain
MODEL equilibrium and normal functioning.
● Physiological Age
○ It is the endurance of cells and tissues DETERMINANTS OF POSITIVE PERCEPTIONS IN
to withstand the wear-and-tear RETIREMENT AND POSITIVE REACTIONS
phenomenon of the human body. TOWARD ROLE DISCONTINUITIES
Individuals are gifted with strong
genetic affinity to stay young for a long ● Health Status – refers to physiological and
time.
mental state of the respondents, classified as
● Role either sick or healthy
○ Refers to the set of shared ● Income (economic level) – the financial
expectations focused upon a particular affluence of respondent which can be classified
position. These may include beliefs as poor, moderate or rich
about what goals or values the position ● Work Status
incumbent is to pursue and the norms
that will govern his behavior. ○ Family Constellation – the type of
○ It is also the set of shared expectations family composition described either
from the retiree’s socialization close knit or extended family where
experiences and the values three or more generations of family
internalized while preparing for the members live under one roof; or
position as well as the adaptations to distanced family, whose members live in
the expectations socially defined for
separate dwelling units; or nuclear type
the position itself. For every social role,
there is a complementary set of roles in of family where only husband, wife and
the social structure among which children live together.
interaction constantly occurs. ● Self-Preparation – it is preparing of self to the
possible outcomes in life
● Change of Life
○ This is the period between near
CONCEPTUAL MODEL OF THE THEORY
retirement and post retirement years.
In medico-physiologic terms, this
equates with the climacteric period of
adjustment and readjustment to
another tempo of life.

● Retiree
○ Is an individual who has left the
position occupied for the past years of
productive life because he/she has
reached the prescribed retirement age
of has completed the required years of
service.

● Role Discontinuity
○ This is the interruption in the line of
status enjoyed or role performed. The
interruption may be brought about by
 FINDINGS AND RECOMMENDATIONS ● Work enhances the aspects of
self-esteem and contributes to the feeling
1. Health status – dictates the capacities and the of wellness even and old age.
type of role one takes both for the present and 5. Self-preparation – said to be both therapeutic
for the future. and recreational in essence pays its worth in
● It fits for everyone to maintain and old age.
promote health at all ages because only ● This does not only account for
proper care of the mind and body is professionalism or expertise but also
needed to maintain health in old age. benevolent work as in charitable actions
2. Family constellation – a positive index with the colleagues.
regarding retirement positively and also in ● Self-preparation is investing not in
reacting to role discontinuities. monetary benefits but in something that
● In the Philippines, the family undoubtedly gives them dignity; enhances their
stands as the security or trusting bank feelings of self-worth and happiness.
where all members, young and old can 6. To cope with the changes brought by
always run and get help. retirement, one must cultivate interest in
● When one retires, the shock of the role recreational activities to channel feelings of
discontinuities is softened because the depression or isolation and facing realities
family not only cushions the impact, but through confrontation with some issues.
also offers gainful substitutes, as in 7. To perceive retirement positively, it requires
providing monetary support, absorbing early socialization of the various roles we take
emotional strains that often times with in life. The best place to start is at home
discontinuities and other forms of extending to schools, neighborhoods, The
surrogating. community and society in general. In
3. Income – has a high correlation with both the retirement, their fellow retirees are their own
perception of retirement and reactions towards best advocates. To facilitate this, barriers to full
role discontinuities. participation in the areas where important
● Since income is one of the factors that decisions are rich should be eliminated in order
secure the outlook of an individual, efforts to give recognition and appreciation of the
must be exerted to save and spend knowledge, wisdom, experience and values
money wisely while still actively earning in which are the social assets that make the
order to have some reserve when one retired age and the custodians’ folk wisdom.
grows old. 8. Government agency – to construct a holistic
● It also implies that retirement pensions pre retirement preparation program which will
should be adjusted to meet the demands take care of the retiree’s finances,
of the elderly. psychological, emotional, and social needs.
● This should be done in order to have a 9. Retirement – should be recognized as the
more relevant and realistic pension and fulfillment of every individual’ s birthright and
benefits adjustment. must be lived meaningfully.
4. Work status – goes hand and hand with
economic security that generates decent CHECK FOR UNDERSTANDING
compensation.
● For the retired, it implies that retirement
1. Who were the subjects of Divinagracia’s theory?
should not be conceptualized as a period
a. 31 adult cardiac patients at the Philippine Heart
of no work because capabilities to function
Center, Coronary Care Unit
get sharpened and refined as they
b. 31 pediatric cardiac patients at the Philippine
practice it on a regular basis.
Heart Center, Coronary Care Unit
c. 31 adult cardiac patients at the Philippine Lung a. Conveying interest and acceptance of patient's
Center, Coronary Care Unit condition and his or her entire being
d. 31 pediatric cardiac patients at the Philippine b. Discouraging patients to do self-care
Children’s Hospital, Coronary Care Unit c. Perceiving the current positive thought or feeling
Answer: 31 adult cardiac patients at the and communicates by putting themselves in the
Philippine Heart Center, Coronary Care Unit patient's place
d. The use of “po” and “opo” when talking to them
2. Which of the following is the definition of Nursing Answer: The use of “po” and “opo” when
in the Advance Nurse Practitioners' Composure talking to them
Behavior and Patients' Wellness Outcome by
Carmelita Divinagracia? 6. This “Retirement and role discontinuities theory”
a. Profession that surpasses time and aspects of states that __________ is another phase in a
the individual as one of its clients person's life that would require some adjustments?
b. Dynamic discipline, art, and science of caring a. Retirement
c. It is the study of unitary, irreducible, indivisible b. Physiological age
human and environmental fields: people and their c. Role
world. d. Change of life
d. Both A and B Answer: Retirement
e. All except A
Answer: Both A and B 7. These are sets of shared expectations focused
upon a particular position?
3. What organization was Divinagracia a former a. Retirement
president of? b. Physiological age
a. The Association of Deans of Philippine Colleges c. Role
of Nursing (ADPCN) d. Change of life
b. Philippine Nurses Association (PNA). Answer: Role
c. Operating Room Nurses Association of the
Philippines (ORNAP) 8. These are interruptions that may be an accident,
d. Mother and Child Nurses Association of the emergency and change of position:
Philippines (MCNAP) a. Role discontinuity
Answer: The Association of Deans of Philippine b. Coping approaches
Colleges of Nursing (ADPCN) c. Retirement
d. Change of life
4. Being receptive/open to new ideas or reason is a Answer: Role discontinuity
way of considering the patient's preferences and
opinions related to his or her current health 9. ________________ recognized as fulfillment of
condition. The following are ways in which a nurse every individual birth right and must be lived
may be able to show therapeutic use of self meaningfully.
EXCEPT: a. Role discontinuity
a. Therapeutic communication b. Coping approaches
b. Active listening c. Retirement
c. Turning a blind eye to the patient’s concerns d. Change of life
d. Use of touch Answer: Retirement
Answer: Turning a blind eye to the patient’s
concerns 10. This refers to the interventions or measures
applied to solve a problematic situation or state in
5. Which of the following is an example of showing order to restore or maintain equilibrium and normal
positive regard to elderly patients? functioning.
a. Role discontinuity
b. Coping approaches
c. Retirement
d. Change of life
Answer: Coping approaches
 NUR 016: THEORETICAL FOUNDATION OF NURSING
MODULE 19:
FIRST SEMESTER l S.Y. 2023-2024 TRANSCRIBED BY: NATHALIE KIM E. ALMEDORA
LECTURER: MS. MICHELLE TIANGSON DIZON

OUTLINE OF THE TOPIC/S

that can be given in any setting where patients
choose to be confined.
➢ Carmencita M. Abaquin’s Prepare Me Holistic ● PREPARE ME (Holistic Nursing
Nursing Interventions Interventions) are the nursing interventions
➢ Cecilia Laurente’s Theory of Nursing Practice and
Career Synchronicity in Human-Space-Time: A provided to address the multi-dimensional
Theory of Nursing Engagement in Global problems of cancer patients that can be given in
Community any setting where patients choose to be
confined.
CARMENCITA M. ABAQUIN’S PREPARE ME ● This program emphasizes a holistic approach to
HOLISTIC NURSING INTERVENTIONS nursing care. PREPARE ME has the following
components:
LIFE STORY
PRESENCE
➔ Being with another person during the
➢ She is a nurse with a Master's Degree in times of need. This includes therapeutic
Nursing obtained from the University of the communication, active listening, and
Philippines, College of Nursing. touch.
➢ An expert in Medical Surgical Nursing with
PRAYER
subspecialty in Oncologic Nursing, which made
her known both here and abroad. REMINISCE THERAPY
➢ She had served the University of the Philippines ➔ Recall of past experiences, feelings and
College of Nursing, as faculty and held the thoughts to facilitate adaptation to present
position as Secretary of the College of Nursing. circumstances.
➢ Her latest appointment as Chairman of the
RELAXATION-BREATHING
Board of Nursing speaks of her competence ➔ Techniques to encourage and elicit
and integrity in the field she has chosen. relaxation for the purpose of decreasing
undesirable signs and symptoms such as
pain, muscle tension, and anxiety.

MEDITATION
➔ Encourages an elicit form of relaxation for
the purpose of altering a patient's level of
awareness by focusing on an image or
thought to facilitate inner sight which
helps establish connection and
relationship with God. It may be done
through the use of music and other
relaxation techniques.
BASIC ASSUMPTIONS AND CONCEPTS OF THE
MODEL VALUES CLARIFICATION
➔ Assisting another individual to clarify his
● Her theory is centered on the nursing own values about health and illness in
interventions provided to address the order to facilitate effective decision
multidimensional problems of cancer patients making skills. Through this, the patient
develops an open mind that will facilitate
 ➢ The nurse can help strengthen the family’s term
acceptance of disease state or may help
deepen or enhance values. The process of knowledge, skills, and attitude through
of values clarification helps one become effective communication, employed informative,
internally consistent by achieving closer psychotherapeutic, modeling, behavioral,
between what we do and what we feel. cognitive-behavioral, and/or hypnotic
techniques are summarized and evaluated.
CECILIA LAURENTE’S THEORY OF NURSING ➢ Anxiety is a mental state of fear or nervousness
PRACTICE AND CAREER SYNCHRONICITY IN about what might happen.
HUMAN–SPACE–TIME: A THEORY OF NURSING
ENGAGEMENT IN GLOBAL COMMUNITY NURSES CARING BEHAVIOR THAT AFFECT THE
PATIENT ANXIETY
LIFE STORY
● Presence – person to person contact between
➢ Graduated BSN at UP in 1967 & MAN in 1973. the client and the nurses
➢ She worked as a staff nurse (1968-1969), ● Concern – development in the time through
became a head nurse (1973-1976), and mutual trust, nurse and the patient.
Nursing Supervisor at Philippine General ● Stimulation – nurse stimulation through words
Hospital (1977-1979). tops the powerful resources of energy of a
➢ She focused her work on helping a patient person for healing.
through support systems specifically the family.
➢ She became a dean of the College of Nursing Enhancing ● One's caring experience,
in UP Manila from 1996-2002. Factors beliefs and attitude.
● Feeling good about
● Learning at school
● What patients tell about the
nurse coping mechanism to
problems encountered.
● Communication

Predisposing ● Age
Factors ● Sex
● Civil Status
THEORY DESCRIPTION ● Educational Background
● Length of work
● Experience
➢ She has a publication entitled "Categorization of
Nursing activities as Observed in Medical
Surgical Ward Unit in Selected Government and
Private Hospitals in Metro Manila”, which was CHECK FOR UNDERSTANDING
conducted from January to June year 1987.
➢ In the recent study, she states that the other 1. The goal of nursing care, according to
entry point of helping the patient is through the Carmencita Abaquin's theory is the improvement of
family, when nurses can be of great assistance quality of life for advanced stage cancer patients
to prevent at the very beginning serious despite their current situation. Which of the
complications. following are the prepare me components?
a. Presence
BASIC ASSUMPTION AND CONCEPT OF THE b. Reminisce Therapy
MODEL c. Meditation
d. Values Clarification
e. All of the above
Answer: All of the above 6. The following statements are TRUE about the
Prepare Me Holistic Nursing Interventions,
2. A therapeutic intervention which is being with EXCEPT:
another person during the times of need is a. "Prepare Me" Interventions and the Quality of
_______________. Life of Advance Progressive Cancer Patients
a. Presence b. Prepare Me are the nursing interventions
b. Reminisce Therapy provided to address the multi-dimensional problem
c. Meditation of cancerpatients
d. Values Clarification c. There are five components of the theory
e. All of the above d. None of the above
Answer: Presence Answer: None of the above

3. A therapeutic intervention which is the action of 7. Multifaceted construct that encompasses the
the recalling of past experiences, feelings and individual’s capacities and abilities with an aim of
thoughts to facilitate adaptation to present enriching life when it cannot longer be prolonged.
circumstances is ___________________. Which of the following is/are not manifestations of a
a. Presence good quality of life?
b. Reminisce Therapy a. Proper care of the body
c. Meditation b. Properly maintained body and mind integrity
d. Values Clarification c. Proper mind and spirit
e. All of the above d. Inability to cope up with changes
Answer: Reminisce Therapy Answer: Inability to cope up with changes

4. What is developed in the patient when the 8. ______________it is the state of being when
patient clarifies her/his values? there is no further medical treatment that can
a. An open mind that will facilitate acceptance of stabilize a patient.
the disease state or may help deepen or enhance a. Impaired self-esteem
values b. Boosted self-esteem
b. Proper care of the body, mind, spirit to maintain c. Acutely ill
integrity of the person d. Terminally ill
c. The ability to recall of past experience, feelings, Answer: Terminally ill
and thoughts to facilitate
d. A close mind that will facilitate acceptance of 9. Which of the following is the goal of Cecilia
disease Laurente's Theory?
Answer: An open mind that will facilitate a. For the patient to accept death and die
acceptance of the disease state or may help peacefully
deepen or enhance values b. Continuum that includes wellness and illness
c. Maintaining or restoring the client's
5. Which of the following can elicit a form of independence in the satisfaction of the 14
relaxation for the purpose of altering patients level fundamental needs.
of awareness by focusing on an image? d. Determine the effects of the "COMPOSURE"
a. Presence behavior of the Advanced Nurse Practitioner on the
b. Reminisce Therapy wellness outcome of the selected cardiac patients
c. Meditation Answer: For the patient to accept death and die
d. Values Clarification peacefully
e. All of the above
Answer: Meditation 10. The Theory of Nursing Practice and Career
proposes that the nurse is not afraid to give hope
and company to a patient until his or her final hour
if in terminal condition. Which of the following
mental states where an individual experiences fear
or nervousness about what might happen?
a. Depression
b. Anxiety
c. Compulsion
d. Obsession
Answer: Anxiety
 NUR 016: THEORETICAL FOUNDATION OF NURSING
MODULE 20:
FIRST SEMESTER l S.Y. 2023-2024 TRANSCRIBED BY: NATHALIE KIM E. ALMEDORA
LECTURER: MS. MICHELLE TIANGSON DIZON
Physiological Air, food, water, sex, sleep,
OUTLINE OF THE TOPIC/S other factors towards
homeostasis.
➢ Abraham Maslow’s Hierarchy of Needs Theory
➢ Harry Stack Sullivan’s Transactional Analysis

ABRAHAM MASLOW’S HIERARCHY OF NEEDS

THEORY

➢ Proposed theory in his 1943 paper A Theory of

Human Motivation
➢ This theory is a motivational theory that argues
that while people aim to meet basic needs, they
seek to meet successively higher needs in the
form of a hierarchy. BEING NEEDS AND DEPRIVATION NEEDS
➢ Maslow's theory has been applied in nursing to
● Deficiency (D-Needs / Deprivation Needs)
guide the prioritization of patient care needs.
○ The first four levels are considered
➢ It is often represented as a pyramid with five deficiency or deprivation needs in that
levels of needs. their lack of satisfaction causes a
➢ This is based on the theory that one level of deficiency that motivates people to
needs must be met before moving on to the meet these needs.
next step.
● Growth Needs (B-Needs / Being Needs)
○ The needs Maslow believed to be
Self-Actualization Morality, creativity, problem higher, healthier, and more likely to
solving. emerge in self-actualizing people were
being needs, or B-needs.
Esteem Confidence, self-esteem, ○ Growth needs are the highest level,
achievement, respect. which is self-actualization, or the self-
fulfillment.
Belongingness Love, friendship, intimacy, ○ Maslow suggested that only two
family. percent of the people in the world
achieve self-actualization. Ex:
Safety Security of environment, Abraham Lincoln, Thomas Jefferson,
employment, resources, Albert Einstein, Eleanor Roosevelt.
health, property. ○ Self-actualized people were reality and
problem-centered.
 ○ They enjoyed being by themselves, (18 months to 6
and having deeper relationships with a years)
few people instead of more shallow
relations with many people. Juvenile Era Formation of peer group
○ They tended to be spontaneous and (6 to 9 years)
simple.
Pre-adolescence Developing relationships
(9 to 12 years) within same gender
APPLICATION OF THE THEORY IN NURSING
Early Adolescence Identity
● Maslow's hierarchy of needs is a useful (12 to 14 years)
organizational framework that can be applied to
Late Adolescence Forming lasting, intimate
the various nursing models for assessment of a (14 to 21 years) relationships
patient’s strengths, limitations, & need for
nursing interventions (Smeltzer SC, Bare BG,
THREE TYPES OF SELF
2004)

● The ‘good me’ versus the ‘bad me’ based on

HARRY STACK SULLIVAN'S TRANSACTIONAL
ANALYSIS
social appraisal and the anxiety that results
from negative feedback.
● The ‘not me’ refers to the unknown, repressed
component of the self.

SULLIVAN’S THEORY EXPLAINS ABOUT

ANXIETY, SELF-SYSTEM AND SELF-ESTEEM

● Security operations – those measures that the

individual employs to reduce anxiety and
enhance security
➢ Interpersonal Psychoanalysis
● Self-system – all of the security operations an
➢ He proposed interpersonal theory of personality.
individual use to defend against anxiety and
➢ He explained the role of interpersonal
ensure self esteem
relationships and social experiences in shaping
personality.
APPLICATION OF THE THEORY IN NURSING
➢ He also explained about the importance of
current life events to psychopathology.
● Sullivan's interpersonal theory provides the
➢ The theory further states that the purpose of all
theoretical basis for interpersonal
behavior is to get needs met through
psychotherapy (IPT) for depression and
interpersonal interactions and decrease or
schizophrenia.
avoid anxiety.
● Interpersonal theory proposes that depression
➢ Sullivan explained six developmental stages
develops most often in the context of adverse
called "epochs" or heuristic Stages in
events, particularly interpersonal loss (Tasman
Development.
2008).
● He also wrote on techniques and approaches to
STAGES CHARACTERISTICS psychiatric interviews.
Infancy Gratification of needs
(birth to 18 months)

Childhood Delayed gratification

 CHECK FOR UNDERSTANDING d. Communicating concerns more concisely
Answer: Establishing priorities of care
1. Maslow's hierarchy of needs is a motivational
theory in psychology comprising a five-tier model of 5. Maslow's pyramid of human needs, beginning at
human needs, often depicted as hierarchical levels the base with physiological needs that must first be
within a pyramid. A clinical instructor is seen asking satisfied before higher-level safety needs and then
her student in the care of her acutely ill patient. psychological needs become active. You are asked
Which of the following physiologic needs is to use the Abraham Maslow's theory to prioritize
essential? the following health needs from most important
a. Healthy diet priority to the least important priority:
b. Hydration a. Disturbed Body Image
c. Elimination b. Altered Breathing Pattern
d. Oxygen c. Spiritual Distress
Answer: Oxygen d. Nutrition: Less Than Body Requirements
Answer: Altered Breathing Pattern
2. Pepper is a 90-year-old widow from Vancouver.
She just lost her husband Cay a week ago after 6. It is the condition of being honored, to regard
being admitted at the ICU due to heart failure. highly such as a highly favorable opinion or
Which of the following is the developmental tasks of judgment.
an older adult in the family? a. Security
a. Cope with loss of energy and privacy b. Physiological
b. Maintain a supportive home base c. Esteem
c. Prepare for retirement d. Self-Actualization
d. Adjust to loss of spouse Answer: Esteem
Answer: Adjust to loss of spouse
7. This includes the need to grow, to feel fulfilled, to
3. Surgical hand washing should reduce the realize one's potential.
release of skin bacteria from the hands of the a. Security
surgical team for the duration of the procedure in b. Physiological
case of a puncture of the surgical glove releasing c. Esteem
bacteria to the surgical wound. Careful d. Self-Actualization Needs
hand-washing and using sterile techniques are Answer: Self-Actualization Needs
ways in which nurses meet which basic human
need? 8. It grows from experiences of punishment.
a. Love & belonging a. Bad me
b. Physiologic b. Good me
c. Self-esteem c. Anxious me
d. Safety & Security d. Not me
Answer: Safety & Security Answer: Bad me

4. Nurse Pepper is assigned to care for patients at 9. Anxiety provoking experiences may create
the COVID ward. Maslow's Hierarchy of basic dissociation from self to form the __________,
human needs is essential when formulating a plan experiences that are denied.
and management of nursing care as it provides a a. Bad me
basis for? b. Good me
a. Establishing priorities of care c. Anxious me
b. Making accurate nursing diagnoses d. Not me
c. Integrating science into nursing care Answer: Not me
10. Any behavior that is rewarded, suppress parts
that you don't like, display good parts?
a. Bad me
b. Good me
c. Anxious me
d. Not me
Answer: Good me
 NUR 016: THEORETICAL FOUNDATION OF NURSING
MODULE 21:
FIRST SEMESTER l S.Y. 2023-2024 TRANSCRIBED BY: NATHALIE KIM E. ALMEDORA
LECTURER: MS. MICHELLE TIANGSON DIZON

OUTLINE OF THE TOPIC/S

➢ Ludwig Von Bertalanffy’s General Systems

Theory
➢ Kurt Lewin’s Change Theory

LUDWIG VON BERTALANFFY’S GENERAL

SYSTEMS THEORY

➢ This theory may be considered as a

specialization of systems thinking and a
generalization of systems science.
➢ First proposed by Ludwig von Bertalanffy
(1901-1972).
➢ General systems theory is a general science of
“wholeness”.
➢ This theory has been applied in developing
nursing theories and conducting nursing
research.

CHARACTERISTICS OF SYSTEM

● "Systems" refer specifically to self-regulating

systems
● Systems are self-correcting through feedback
● Systems have a structure that is defined by its GENERAL SYSTEMS THEORY AND NURSING
parts and processes
● Systems are generalizations of reality ➢ Many nursing theorists have drawn from his
● The various parts of a system have functional works on systems theory.
as well as structural relationships between each ○ Neuman's Systems Theory
other ○ Rogers 's Theory of Unitary Human
● Systems tend to function in the same way Beings
● Every living organism is essentially an open ○ Roy's Adaptation Model
system
 ○ Imogene King's Theory of Goal ➢ Lewin's theory states behavior as "a dynamic
Attainment balance of forces working in opposing
○ Orem Self-care Deficit Theory directions”.
○ Johnson's Behavior Systems Model
MAJOR CONCEPTS AND DEFINITIONS
KURT LEWIN’S CHANGE THEORY
● Driving Forces
➔ Driving forces are forces that push in a
direction that causes change to occur.
➔ Driving forces facilitate change because
they push the person in the desired
direction.
➔ They cause a shift in the equilibrium
towards change.

➢ Kurt Lewin (1890-1947) is considered as the ● Restraining Forces

Father of Social Psychology ➔ Restraining forces are forces that
➢ He was born in Germany, later emigrated to the counter driving forces.
US ➔ Restraining forces hinder change
➢ He is well known for his writings on group because they push the person in the
dynamics, group therapy and social psychology opposite direction.
➢ He introduced his field theory concepts, ➔ Restraining forces cause a shift in the
emphasizing that the group differs from the equilibrium which opposes change.
simple sum of its parts
➢ He coined the term group dynamics in 1939 ● Equilibrium
➢ His field theory states that "one’s behavior is ➔ Equilibrium is a state of being where
related both to one’s personal characteristics driving forces equal restraining forces
and to the social situation in which one finds and no change occurs.
oneself". ➔ Equilibrium can be raised or lowered by
changes that occur between the driving
THEORY DESCRIPTION and restraining forces.

➢ His most influential theory was his model of the 6 COMPONENTS OF THE THEORY
change process in human systems.
➢ He theorized a three-stage model of change 1. Recognition of the area where change is
that is known as the needed.
Unfreezing-Change-Refreeze Model that 2. Analysis of the situation to determine what
requires prior learning to be rejected and forces exist to maintain the situation and what
replaced. forces are working to change it.
➢ People grow and change throughout their lives. 3. Identification of methods by which change can
This growth and changes are evident in the occur.
dynamic nature of basic human needs and how 4. Recognition of the influence of group mores or
they are met. customs on change.
➢ Change happens daily It is subtle, continuous 5. Identification of the methods that the reference
and manifested in both everyday occurrences group uses to bring about change.
and more disruptive life events. Change 6. The actual process of change
involves modification or alteration. It may be
planned or unplanned.
 MOVING TO A NEW LEVEL / CHANGING OR
MOVEMENT
➢ This stage involves a process of change
in thoughts, feeling, behavior, or all three,
that is in some way more liberating or
more productive.

REFREEZING
➢ Refreezing is establishing the change as
a new habit, so that it now becomes the
“standard operating procedure”.
➢ Without this stage of refreezing, it is easy
to go back to the old ways.

APPLICATION OF THE THEORY IN NURSING

● It is pertinent that the driving and restraining

forces must be analyzed before implementing a
planned change.

CHECK FOR UNDERSTANDING

1. The system is independent of specific elements

and variables. Systems Theory is ____________.
a. Partial
b. Impartial
c. Specific
d. Holistic
Answer: Holistic

2. This theory provides recognition of interplay

UNFREEZING between ____________ factors in determining
➢ Unfreezing is the process which involves individual behavior.
finding a method of making it possible for a. Spherical and genetic
people to let go of an old pattern that was b. Spiritual and physical
counterproductive in some way.
c. Physiological and biological
➢ Unfreezing is necessary to overcome the
strains of individual resistance and group d. Biological and psychological
conformity. Answer: Biological and psychological
➢ Unfreezing can be achieved by the use of
three methods: 3. Systems theory is useful as a perspective for
1. Increase the driving forces that understanding small groups because this theory:
direct behavior away from the
a. reminds us that small groups are simpler than
existing situation or status quo
2. Decrease the restraining forces they appear.
that negatively affect the b. provides a framework for thinking about the
movement from the existing complex processes of groups of human beings.
equilibrium c. helps us describe how individual elements of a
3. Find a combination of the two whole can operate autonomously.
methods listed above d. can help a student identify the single most
important reason why something occurs in a group.
e. provides a group comparison to the "fight or c. Refreezing
flight" response of an individual. d. Unfreezing
Answer: provides a framework for thinking Answer: Refreezing
about the complex processes of groups of
human beings. 9. Which of the following may contribute to
unfreezing resistance?
4. Ludwig von Bertalanffy theory is a systems a. Adequate amount of information
theory. Which of the following is referred to as a b. Trust
structural limitation that separates a system from c. Rewards
other systems? d. Lack of information
a. Boundary Answer: Lack of information
b. Closed system
c. Open system 10. He is the founder of social psychology.
d. Entropy a. Abraham Lincoln
Answer: Boundary b. Kurt Lewin
c. Charles Sullivan
5. It is the state of disorganization. d. Ludwig von Bertalanffy
a. Boundary Answer: Kurt Lewin
b. Closed system
c. Open system
d. Entropy
Answer: Entropy

6. Kurt Lewin is considered as the father of social

psychology. His theory has three components.
Which component causes a nurse to recognize the
problem and need to change to address the
problem?
a. Freezing
b. Movement
c. Refreezing
d. Unfreezing
Answer: Unfreezing

7. This stage involves a process of change in

thoughts, feeling, behavior, or all three, that is in
some way more liberating or more productive.
a. Freezing
b. Moving to a new change
c. Refreezing
d. Unfreezing
Answer: Moving to a new change

8. It involves establishing the change as a new

habit so that it now becomes the "standard
operating procedure”.
a. Freezing
b. Moving to a new change
 NUR 016: THEORETICAL FOUNDATION OF NURSING
MODULE 22:
FIRST SEMESTER l S.Y. 2023-2024 TRANSCRIBED BY: NATHALIE KIM E. ALMEDORA
LECTURER: MS. MICHELLE TIANGSON DIZON
● EGO
OUTLINE OF THE TOPIC/S ○ Second structure to develop
○ Operates on reality principle
➢ Sigmund Freud’s Psychosexual Theory of ○ Mediates conflict among id, ego, &
Development superego
➢ Erik Erikson’s Stages of Psychosocial ○ Provides reality testing
Development ○ Monitors quality of interpersonal
relations
SIGMUND FREUD’S PSYCHOSEXUAL THEORY OF ○ Provides synthesis and coordination
DEVELOPMENT ○ Carries out primary autonomous
functions
○ Defends against anxiety

● SUPEREGO
○ Third structure to develop
○ Self-criticism based on moral values
○ Self-punishment
○ Self-praise based on ego ideal
○ Most functions are unconscious
○ Conflict is the main concept of
➢ This theory was developed by Sigmund Freud structural theory
(1856-1939)
➢ This revolutionized the understanding of mental
LIBIDO THEORY
life and human behavior
➢ Freud's theories helped in understanding early
➢ Libido theory assumes that biological needs
development of sexuality and mental
(drives) fuel behavior
functioning in the infant and adult psychological
➢ The aim of behavior is to gratify the drive
illnesses
➢ Drives are either sexual or aggressive in nature
➢ The libido theory explains that the sexual
PSCYHOANALYTIC THEORY
instinct plays an etiological role in the neuroses
and that sexual stimulation exerts a
1. Structural Theory
predominant force (which is called libido) on
2. Libido (Drive) Theory
mental activity throughout life
3. Topographical Theory of mind
➢ The discharge of libido is experienced as
4. Theory of Narcissism
pleasure

FREUD’S STRUCTURAL THEORY POSTULATED

ORDER: STAGE, AGES, FOCUS OF LIBIDO,
THE EXISTENCE OF THE ID, EGO, AND
MAJOR DEVELOPMENT, ADULT FIXATION
SUPEREGO
EXAMPLE
● ID
ORAL
○ First to develop
➢ 0 to 1
○ Completely unconscious
○ Mouth, Tongue, Lips
○ Contains all drives
■ Weaning off of breastfeeding
○ Ruled by pleasure principle
or formula
○ No awareness of reality
 identify and begin to think about the
● Smoking, Overeating
root causes of patient suffering.
ANAL ● Freud emphasized the importance of
➢ 1 to 3 individual talk sessions
○ Anus characterized by attentive listening,
■ Toilet Training with a focus on underlying themes
● Orderliness, Messiness
as an important tool of healing in
PHALLIC psychiatric care.
➢ 3 to 6
○ Genitals ERIK ERIKSON'S STAGES OF PSYCHOSOCIAL
■ Resolving Oedipus/Electra DEVELOPMENT
Complex
● Deviancy, Sexual
Dysfunction

LATENCY
➢ 6 to 12
○ None
■ Developing Defense
Mechanism
● None

GENITAL
➢ 12+ ➢ He was a psychoanalyst who developed the
○ Genitals theory of psychosocial development.
■ Reaching Full Sexual Maturity ➢ He was born on June 15, 1902 in Karlsruhe
● If all stages were
Germany.
successfully completed
then the person should be ➢ His classic work "Childhood and Society" set
secually matured and forth his theory of the life cycle.
mentally healthy ➢ Young Man Luther, Identity: Youth & Crisis, &
Gandhi's Truth are his other influential works.
APPLICATIONS OF THE THEORY IN NURSING ➢ He believed that the achievements and failures
of earlier stages influence later stages, whereas
➢ Freud’s theory has relevance to psychiatric later stages modify and transform earlier ones.
mental health nursing practice at many ➢ Erikson's conceptualization of psychosocial
junctures. development based its model on the epigenetic
● First, the theory offers a principle of organismic growth in utero.
comprehensive explanation of ➢ Erikson views psychosocial growth occurs in
complex human processes and phases.
suggests that the formation of a
8 STAGES OF THE LIFE CYCLE
patient’s personality is strongly
influenced by childhood
experiences. ● Erikson explains developmental stages in which
● Freud’s theory of the unconscious physical, cognitive, instinctual, and sexual
mind is particularly valuable as a changes combine to trigger an internal crisis
baseline for considering the whose resolution results in either psychosocial
complexity of human behavior. regression or growth and the development of
● By considering conscious and specific virtues.
unconscious influences, a nurse can ● Erikson defined virtue as "inherent strength".
 ERIKSON’S STAGE THEORY IN ITS FINAL disintegration
VERSION
(ORDER: AGE, CONFLICT, RESOLUTION OR “VIRTUE”,
CULMINATION IN OLD AGE) TRUST VERSUS MISTRUST
(BIRTH TO ABOUT 1 YEAR)
INFANCY (0-1 year)
➢ Basic trust vs. Mistrust ➢ The infant is taking the world in through the
○ Hope
mouth, eyes, ears, and sense of touch.
■ Appreciation if interdependence
and relatedness ➢ A baby whose mother is able to anticipate and
respond to its needs in a consistent and timely
EARLY CHILDHOOD (1-3 years) manner despite its oral aggression will learn to
➢ Autonomy vs. Shame tolerate the inevitable moments of frustration
○ Will and deprivation
■ Acceptance of the cycle of life,
from integration to ➢ A person who, as a result of severe
disintegration disturbances in the earliest dyadic relationships,
fails to develop a basic sense of trust or the
PLAY AGE ( 3-6 years) virtue of hope may be predisposed as an adult
➢ Initiative vs. Guilt to the profound withdrawal and regression
○ Purpose characteristic of schizophrenia (Newton DS,
■ Humor; Empathy; Resilience
Newton PM, 1998).
SCHOOL AGE (6-12 years)
➢ Industry vs. Inferiority AUTONOMY VERSUS SHAME AND DOUBT
○ Competence (1 YEAR TO ABOUT 3 YEARS)
■ Humility; acceptance of the
course of one’s life and ➢ "This stage, therefore, becomes decisive for the
unfulfilled hopes ratio between loving good will and hateful
self-insistence, between cooperation and
ADOLESCENCE (12-19 years)
➢ Identity vs. Confusion willfulness, and between self-expression and
○ Fidelity compulsive self-restraint or meek compliance." -
■ Sense of complexity of life; Erikson
merging of sensory, logical and ➢ This oral-sensory stage of infancy, marked by
aesthetic perception the potential development of basic trust aiming
toward the achievement of a sense of hope.
EARLY ADULTHOOD (20-25 years)
➢ Intimacy vs. Isolation ➢ Child will develop an appropriate sense of
○ Love autonomy, otherwise doubt & shame will
■ Sense of complexity of undermine free will.
relationships; value of ➢ An individual who becomes fixated at the
tenderness and loving freely transition between the development of hope
ADULTHOOD (26-64 years) and autonomous will, with its residue of mistrust
➢ Generativity vs. Stagnation and doubt, may develop paranoiac fears of
○ Care persecution.
■ Caritas, caring for others, and ➢ Other disturbances of improper transition of this
agape, empathy and concern stage results in perfectionism, inflexibility,
stinginess and ruminative and ritualistic
OLD AGE (65-death)
➢ Integrity vs. Despair behavior of obsessive-compulsive personality
○ Wisdom disorder.
■ Existential Identity; a sense of
integrity strong enough to INITIATIVE VERSUS GUILT
withstand physical (ABOUT 3 YEARS TO ABOUT 6 YEARS)
➢ Here, the child’s task is to develop a sense of ➢ "The acceptance of one's one and only life
initiative as opposed to further shame or guilt. cycle and of the people who have become
➢ The lasting achievement of this stage is a significant to it as something that had to be and
sense of purpose. that, by necessity, permitted of no
➢ The child's increasing mastery of locomotor and substitutions."
language skills expands its participation in the ➢ The individual in possession of the virtue of
outside world and stimulates omnipotent wisdom and a sense of integrity has room to
fantasies of wider exploration and conquest. tolerate the proximity of death and to achieve.
➢ When the attempt to attain integrity has failed,
INDUSTRY VERSUS INFERIORITY the individual may become deeply disgusted
(ABOUT 6 YEARS TO ABOUT 12 YEARS) with the external world, and contemptuous of
persons as well as institutions.
➢ Here the child is in school-age, so called stage
of latency. APPLICATIONS OF THE THEORY IN NURSING
➢ He tries to master the crisis of industry versus
inferiority aiming toward the development of a ● Application of Erikson's stages of psychosocial
sense of competence. development helps in analyzing a patient's
symptomatic behavior in the context of
IDENTITY VERSUS ROLE CONFUSION traumatic past experiences and struggles with
(ABOUT 12 YEARS TO ABOUT 21 YEARS)
current developmental tasks.
● When patients' resolutions of previous
➢ At puberty, the fifth stage, the task of
psychosocial stages have been so faulty as to
adolescence is to navigate their “identity crisis”
seriously compromise their adult development,
as each individual struggles with a degree of
they have the opportunity to rework early
“identity confusion.”
development through the relationship with the
➢ The lasting outcome of this stage can be a
therapist. (Newton DS, Newton PM, 1998)
capacity for fidelity.
● "The object of psychotherapy is not to head off
future conflict but to assist the patient in
INTIMACY VERSUS ISOLATION
(ABOUT 20 YEARS TO ABOUT 25 YEARS)
emerging from each crisis with an increased
sense of inner unity, with an increase of good
➢ Young adulthood, at the stage of genitality or judgment, and an increase in the capacity `to
sixth stage, is marked by the crisis of intimacy do well' according to his own standards and to
versus isolation, out of which may come the the standards of those who are significant to
achievement of a capacity for love. him." (Erikson in Identity: Youth and Crisis)

GENERATIVITY VERSUS STAGNATION CHECK FOR UNDERSTANDING

(ABOUT 26 YEARS TO ABOUT 64 YEARS)

1. 1. The source of all instincts, drives, reflexes,

➢ "Generativity is primarily the concern for
needs, genetic inheritance, and capacity to respond
establishing and guiding the next generation."
and motivation.
➢ This failure of generativity can lead to profound
a. Id
personal stagnation, masked by a variety of
b. Ego
escapisms, such as alcohol and drug abuse,
c. Superego
and sexual and other infidelities. Mid-life crisis
d. Holistic
may occur.
Answer: Id

INTEGRITY VERSUS DESPAIR

(ABOUT 65 YEARS TO DEATH)
2. It differentiates subjective experiences, memory Answer: Tell the child’s girlfriend to visit the
images, and objective reality and attempts to child.
negotiate a solution.
a. Id 7. It involves learning basic skills and working with
b. Ego others.
c. Superego a. industry vs. inferiority
d. Holistic b. initiative vs. guilt
Answer: Ego c. autonomy vs. shame
d. intimacy vs. isolation
3. It is the second stage of Freud's theory. This is Answer: industry vs. inferiority
manifested by moving of the bowels and the fecal
retention. Symptoms of fixation include 8. This is where the self "ego" appears and is
anal-expulsive personality/anal-retentive striving for independence. Toddlers usually are fond
personality. of saying "No".
a. Oral stage a. industry vs. inferiority
b. Latency stage b. initiative vs. guilt
c. Genitalia stage c. autonomy vs. shame
d. Anal Stage d. intimacy vs. isolation
Answer: Anal Stage Answer: autonomy vs. shame

4. This is the last to develop and represents the 9. Which of the following is TRUE about the
moral component of personality. Helps to choose Industry vs. Inferiority stage?
right from wrong. a. The end of life, the period of old age
a. Id b. Intimacy can be sexual or platonic.
b. Ego c. The existence of a mutually caring and sharing
c. Superego relationship.
d. Holistic d. Peers foster inferiority, say exactly what they
Answer: Superego think.
Answer: Peers foster inferiority, say exactly
5. Freud's term for middle childhood, during which what they think.
children's emotional drives are quieter, the
psychosexual needs are repressed, and their 10. What stage happens in adolescence?
unconscious conflicts are submerged. a. industry vs. inferiority
a. Oral stage b. identity vs role confusion
b. Latency stage c. autonomy vs. shame
c. Genitalia stage d. intimacy vs. isolation
d. Anal Stage Answer: identity vs role confusion
Answer: Latency stage

6. Pepper is a 17-year-old child and is hospitalized

because of asthma, according to the psychosocial
theory, which of the following is an appropriate
intervention?
a. Tell the friends to visit the child
b. Encourage patient to help child learn lessons
missed
c. Call the priest to intervene
d. Tell the child’s girlfriend to visit the child.
 NUR 016: THEORETICAL FOUNDATION OF NURSING
MODULE 23:
FIRST SEMESTER l S.Y. 2023-2024 TRANSCRIBED BY: NATHALIE KIM E. ALMEDORA
LECTURER: MS. MICHELLE TIANGSON DIZON

OUTLINE OF THE TOPIC/S

● Assimilation
➔ The process of interpreting new
➢ Jean Piaget’s Cognitive Development experiences by incorporating them into
➢ Lawrence Kohlberg’s Theory of Moral existing schemes.
Development

● Accommodation
JEAN PIAGET’S COGNITIVE DEVELOPMENT ➔ The process of modifying existing
schemes in order to incorporate or
adapt to new experiences.

● Development
➔ Changes occurring throughout the
lifespan that are orderly and adaptive.

STAGES OF COGNITIVE DEVELOPMENT

➢ Jean Piaget (1952-1980) was a Swiss (ORDER: STAGE, AGE RANGE, WHAT HAPPENS AT THIS
developmental psychologist. STAGE))
➢ He developed one of the most comprehensive
SENSORIMOTOR
theories of cognitive development.
➢ 0-2 years old
➢ He explained genetic epistemology, a concept ○ Coordination of senses with motor
which refers to "study of developmental responses, sensory curiosity about
changes in the process of knowing and in the the world. Language used for
organization of knowledge". demands and cataloging. Object
permanence is developed.
MAJOR CONCEPTS AND DEFINITIONS
PREOPERATIONAL
➢ 2-7 years old
● Schema ○ Symbolic thinking, use of proper
➔ A term used by Piaget to describe the syntax and grammar to express
models, or mental structures, that we concepts. Imagination and intuition
create to represent, organize, and are strong, but complex abstract
interpret our experiences. thoughts are still difficult.
Conservation is developed.
● Organization CONCRETE OPERATIONAL
➔ The process by which children combine ➢ 7-11 years old
existing schemes into new and more ○ Concepts attached to concrete
complex intellectual structures. situations. Time, space, and quantity
are understood and can be applied,
but not as independent concepts.
● Adaptation
➔ An inborn tendency to adjust to the FORMAL OPERATIONAL
demands of the environment through ➢ 11 years old and older
assimilation and accommodation. ○ Theoretical, hypothetical, and
counterfactual thinking. Abstract logic
 and reasoning. Strategy and planning
become possible. Concepts learned
in one context can be applied to
another.

SENSORIMOTOR STAGE (0-2 years old)

➢ Learning through 5 senses
➢ Development of imitative behaviors
➢ Development of symbolic knowledge
➢ Develops object permanence ➢ Lawrence Kohlberg (1927-1987) devised a
➢ The beginning of goal-directed actions theory in which he explained the six stages of
moral development divided into three levels.
PREOPERATIONAL STAGE (2-7 years old) ➢ Morality is the system one uses to decide what
➢ Semiotic function – ability to use symbols
is right and wrong; how one’s conscience
➢ One-way logic
➢ Difficulty with the principle of conservation affects choices.
➢ Egocentrism ➢ Moral development refers to the capacity of the
individual to act in accord with conscience and
CONCRETE OPERATIONAL STAGE (7-11 moral imperatives rather than egocentric
years old) values.
➢ “Hands on” thinking
➢ Kohlberg defines moral judgments "as
➢ Identity
➢ Compensation judgments of value, as social judgments, and
➢ Reversibility as judgments that oblige an individual to take
➢ Classification action”.
➢ Seriation ➢ He was inspired by Swiss psychologist Jean
Piaget and the American philosopher John
FORMAL OPERATIONAL STAGE (11 years old
Dewey.
and older)
➢ Hypothetic deductive reasoning
➢ Abstract thinking MORAL DEVELOPMENT ACROSS LIFESPAN
➢ “Scientific” reasoning
➢ Adolescent egocentrism & imaginary ● By the second year of life, “moral emotions”
audience emerge.
➢ Not all individuals reach this stage ● By 36 months, most children demonstrate the
internalization of parental standards.
CONCLUSION ● During the school years, the importance of rules
and adhering to them become well-defined.
● Piaget made important contributions to our ● Moral development after adolescence is
understanding of normal intellectual complex and influenced by social factors.
development.
● Piaget theories provide a fundamental starting
point for understanding childhood cognitive Kohlberg’s Three Level of Reasoning and Six
development. Stages of Moral Development: Each level has two
stages that represent different degrees of
sophistication in moral reasoning.
LAWRENCE KOHLBERG’S THEORY OF MORAL
DEVELOPMENT
 3 LEVELS OF REASONING

1. Pre-conventional – reason according to the

self-perspective
2. Conventional – reasoning based on social
rules and norms
3. Post-conventional – use the principle behind
the social norm to direct their behavior

STAGES OF THIS THEORY

1. Obedience and Punishment Orientation

2. Individualism and Exchange
3. Good Interpersonal Relationships
4. Maintaining the Social Order
5. Social Contract and Individual Rights
6. Universal Principles

➢ The first two stages have a pre-conventional

level of morality.
➢ During stage 3 and 4, the child shows a
conventional level of morality.
➢ Post-conventional level of reasoning is
observed during stage 5 and 6.

CONCLUSION

● Parents influence the moral development of

their children.
● Kohlberg’s theory explained moral development
in a philosophical and psychological context.

CHECK FOR UNDERSTANDING

1. Jean Piaget's theory of cognitive development

suggests that children move through four different
stages of mental development. Child learns that he
is separate from his environment and that aspects
of his environment continue to exist even though
they may be outside the reach of his senses. Which
of Piaget's stages is this?
a. Sensorimotor stage
b. Preoperational stage
c. Concrete operational stage
d. Formal operational stage
Answer: Sensorimotor stage
2. Observing children, Jean Piaget proposed a objects can change and then return to their original
sequence consisting of normal development that all state.
normal children follow. Which of the following is one d. Prominent until the formal operational stage,
of the most important accomplishments at the reversibility is an ability to think about your own
sensorimotor stage? thought processes.
a. Children propose the questions of why and how Answer: Prominent until the concrete
come operational stage, reversibility is the
b. Intelligence is demonstrated through the logical understanding that numbers and objects can
use of symbols related to abstract concepts. change and then return to their original state.
c. Object permanence
d. They start solving problems in a more logical 6. Pepper, a pediatric nurse, is planning to teach
fashion the concepts of moral development theory with Mrs.
Answer: Object permanence Orah. What motivates the good boy and good girl
concepts for the child at the preconventional level?
3. _________ is the third of four stages from a. The behavior of the parents
Piaget's theory of cognitive development. It follows b. Punishment and reward
the preoperational stage, occurs between the ages c. Peer pressure
of 7 and 11 years and is characterized by the d. Social pressure
appropriate use of logic. Answer: The behavior of the parents
a. Sensorimotor stage
b. Preoperational stage 7. Pepper, a nurse educator, plans to conduct a
c. Concrete operational stage webinar for the staff nurses regarding Kohlberg's
d. Formal operational stage theory of moral development. What information
Answer: Concrete operational stage should the nurse include in the session? Which of
the following are included? (Select all that apply)
4. ___________ is the final stage of cognitive a. A person can move through all six stages in a
development. Intelligence is demonstrated through sequential fashion
the logical use of symbols related to abstract b. Moral development can move through in
concepts. relationship to cognitive development
a. Sensorimotor stage c. A person's capability to make moral judgments
b. Preoperational stage progresses over a period of time
c. Concrete operational stage d. The theory provides a framework for
d. Formal operational stage understanding how individuals determine a moral
Answer: Formal operational stage code to guide their behavior
e. In stage 1 (punishment-obedience orientation),
5. Jean Piaget is a Cognitive psychologist; He children are expected to reason as mature
created a 4-stage theory of cognitive development, members of society
and said that two basic processes work in tandem f. In stage 2 (instrumental-relativist orientation), the
to achieve cognitive growth. What is reversibility child conforms to rules to obtain rewards or have
and stage being it prominent in? favors returned.
a. Prominent until the preoperational stage, Answer: B, C, D, F
reversibility is a child's belief that others see the
world in precisely the same way they do. 8. Morality rests upon the individual conscience.
b. Prominent until the sensorimotor stage, What was Kohlberg's Stages of Moral Development
reversibility is an ability to think about your own for?
thought processes. a. That caring regenerates life energies and
c. Prominent until the concrete operational stage, potentiates our capabilities
reversibility is the understanding that numbers and b. Emphasis on hospital cleanliness and sanitation.
c. To determine how children would solve a series
of moral dilemmas based on their responses
d. Adaptive methods not only help the family
through the healing process, but teaches the nurse
methods to help the family emotionally and
physically.
Answer: To determine how children would solve
a series of moral dilemmas based on their
responses

9. A stage of moral development in which the

individuals consider universal moral principles,
which supersede the authority of the group.
a. Conventional Level
b. Pre-conventional Level
c. Post Conventional Level
d. Conventional Level, Stage 4
Answer: Post Conventional Level

10. Comprising stages 1 and 2; a stage or moral

development in which moral reasoning is based on
reward and punishment from those in authority?
a. Conventional Level
b. Pre-conventional Level
c. Post Conventional Level
d. Conventional Level, Stage
Answer: Pre-conventional Level