Health Promotion Model Theory

Nola J. Pender

NOLA J. PENDER
√ 16 August 1941
√ She has many publications in a variety of texts and
journals, including six editions of Health Promotion in
Nursing Practice (6th Edition)
√ She is an author and a professor emeritus of
nursing at University of Michigan.(USA)
√ She earned her Ph.D. from Northwestern University
in 1969.
√ She was awarded an honorary doctorate of science
degree in 1992 from Widener University.

√ She received a lifetime Achievement Award form the Midwest Nursing Reasearch Society in 2005
√ She has been a nurse educator for over forty years
√ She taught baccalaureate,Masters and PhD students
√ She mentored a postdoctoral follows.
√ She was awarded an honorary doctorate of science degree in 1992 from Widener University

HEALTH PROMOTION THEORY

√ Indicates health preventive measures and describes the critical function of nurses in helping prevents
illness by self-care.
√ Describe the multidimensional nature of persons as they interact within their environment to
pursue health..

THE MODEL FOCUSES ON FOLLOWING THREE AREAS

1) Individual Characteristics and Experiences
2) Behavior-specific Cognitions and Affect
3) Behavioral Outcomes

Features
This model is based on the idea that human beings are rational, and will seek their advantage in
health. But the nature of this rationality is bounded by things like

 Self- esteem
 Perceived advantages of healthy behaviors
 Psychological states
  Previous Behavior

As for the medical profession in general, the main purpose here is not merely to cure disease, but to
promote healthy lifestyles and choices that affect the health of individuals.

Function
The central function of this theory is to show the individual as self- determining, but as also
determined by personal history and general personal characteristics. Health is a dynamic process, not a
static state. Health, to put it differently, is a lifestyle conditioned by a number of choices made by the
individual to actually live a healthy lifestyle. The medical profession itself is only a small part of this
world. The individual is posited in the model as “being” healthy, “living” it, rather than considering
health a static state. Health is a lifestyle.

Effects
The main effect of Pender’s model is that it puts the onus of healthcare reform on the person,
not on the profession. Healthcare is a series of intelligent, rational choices that promote health
concerning things like diet, exercise and positive thinking. All of these are choices and ingredients in
living healthy. Because of this, the health professions, Doctors and Nurses included, struggle in
eliminating the self destructive nature of a person. If these thoughts are reformed, then it can lead into
a healthy lifestyle.
Subconcepts of the Health Promotion Model

Personal Factors
 Personal factors are categorized as biological, psychological and socio-cultural. These factors are
predictive of a given behavior and shaped by the nature of the target behavior being considered.

 Personal biological factors. Include variables such as age gender body mass index pubertal status,
aerobic capacity, strength, agility, or balance.
 Personal psychological factors. Include variables such as self-esteem, self-motivation, personal
competence, perceived health status, and definition of health.
 Personal socio-cultural factors. Include variables such as race, ethnicity, acculturation, education,
and socioeconomic status.

Perceived Benefits of Action

Anticipated positive outcomes that will occur from health behavior.

Perceived Barriers to Action

Anticipated, imagined or real blocks and personal costs of understanding a given behavior.

Perceived Self-Efficacy
Judgment of personal capability to organize and execute a health-promoting behavior. Perceived self-
efficacy influences perceived barriers to action so higher efficacy results in lowered perceptions of
barriers to the performance of the behavior.

Activity-Related Affect
Subjective positive or negative feeling that occurs before, during and following behavior based on the
stimulus properties of the behavior itself.

Activity-related affect influences perceived self-efficacy, which means the more positive the subjective
feeling, the greater the feeling of efficacy. In turn, increased feelings of efficacy can generate a further
positive affect.

Interpersonal Influences
Cognition concerning behaviors, beliefs, or attitudes of the others. Interpersonal influences include
norms (expectations of significant others), social support (instrumental and emotional encouragement)
and modeling (vicarious learning through observing others engaged in a particular behavior). Primary
sources of interpersonal influences are families, peers, and healthcare providers.

Situational Influences
Personal perceptions and cognitions of any given situation or context that 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. Situational influences may
have direct or indirect influences on health behavior.

Immediate Competing Demands and Preferences

Competing demands are those alternative behaviors over which individuals have low control because
there are environmental contingencies such as work or family care responsibilities. Competing
preferences are alternative behaviors over which individuals exert relatively high control, such as
choice of ice cream or apple for a snack

Commitment to Plan of Action

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

Health-Promoting Behavior
A health-promoting behavior is an endpoint or action outcome that is directed toward attaining
positive health outcomes such as optimal wellbeing, personal fulfillment, and productive living.

Major Assumptions in Health Promotion Model

 Individuals seek to actively regulate their own behavior.
 Individuals in all their biopsychosocial complexity interact with the environment, progressively
transforming the environment and being transformed over time.
 Health professionals constitute a part of the interpersonal environment, which exerts influence on
persons throughout their life span.
 Self-initiated reconfiguration of person-environment interactive patterns is essential to behavior
change.

Strengths and Weaknesses

Strengths
 The Health Promotion Model is simple to understand yet it is complex in structure.
 Nola Pender’s nursing theory gave much focus on health promotion and disease prevention making
it stand out from other nursing theories.
 It is highly applicable in the community health setting.
 It promotes the independent practice of the nursing profession being the primary source of health
promoting interventions and education.
Weaknesses
 The Health Promotion Model of Pender was not able to define the nursing metapradigm or the
concepts that a nursing theory should have, man, nursing, environment, and health.
 The conceptual framework contains multiple concepts which may invite confusion to the reader.
 Its applicability to an individual currently experiencing a disease state was not given emphasis.
Significance
The Health Promotion Model provides a counterpart to models based on illness-prevention. By defining
health as a positive state of wellness, nurses can assist patients with attaining healthy lifestyles. Health
promoting behavior enhances individuals’ functional ability and improves their quality of life. These
benefits profit individuals and they profit society as a whole. As society benefits, results include
“economic prosperity, interpersonal harmony, decreased social problems such as violence, suicide, and
sexually transmitted disease, and reduced health care costs” (Peterson & Bredow, 2009, p. 225).

Conclusion
Due to its focus on health promotion and disease prevention per se, its relevance to nursing actions
given to individuals who are ill is obscure. But then again, this characteristic of her model also gives the
concepts its uniqueness.

Pender’s principles paved a new way of viewing nursing care but then one should also be reminded
that the curative aspect of nursing cannot be detached from our practice.

Although not stated in the model, for example, in the Intensive Care Unit, health promotion model may
still be applied in one way or another. This is projected towards improving health condition and
prevention of further debilitating conditions. Diet modifications and performing passive and active
range of motion exercises are examples of its application.
VIRGINIA HENDERSON

EARLY LIFE

 Virginia Avenel Henderson was an influential

nurse, theorist, researcher and author.
 known as “The First lady of NursingVirginia
Henderson was born in Kansas City, Missouri in
1897.
 At age of 4, she returned to Virginia and began
her schooling at a boys’ school, Bellevue, run by
her grandfather.
 By the time, she was propelled by patriotic
fervor to enroll in the Army Nursing School at
the Walter Reed Hospital in Washington,
training programs spurred by Nightingale’s
preaching's had helped.
 In 1929, she entered Teachers College at
Columbia University for her Bachelor’s Degree in
1932, and took Master’s Degree in 1934.

History and Background

 Virginia Henderson, who took a temporary job caring for World War I.
 Her own experiences in taking care of patients for the Army in Washington, and later as a public
health nurse there and in New York in the 1920’s, informed and inspired her work. But it was as an
educator and researcher, first at Teachers College of Columbia University in 1934 to 1948. And
after 1953, at the Yale School of Nursing, that Miss Henderson made her greatest contribution to a
long- scorned profession.
 It was an era not far removed from when nurses were regarded as the best glorified domestics
filling in for female relative caring for home-bound patients (and paid somewhere between cooks
and seamstresses). At worst, they were regarded as dregs of a society that expected prostitutes
and other female outcasts recovering from illness to care for sicker patients in the almshouses that
were the fore runners of modern hospitals.
 Miss Henderson, who had initially planned to switch professions after two years, helped remedy
that view of nurses in part through exhaustive research that helped established the scholarly
underpinnings of her profession.
 Beginning in 1939, she was the author of three editions of “Principles and Practices of Nursing,” a
widely used text, and her “Basic Principles of Nursing,” published in 1966 and revised in 1972, has
been published in 27 languages by the International Council of Nurses.
  Her most formidable achievement was a research project in which she gathered, reviewed,
catalogued, classified and cross-referenced every known piece of research on nursing published in
English, resulting in the five-volume “Nursing Research: Survey and Assessment,” written with Leo
Simmons and published in 1964, and her four volume “Nursing Studies Index,” completed in 1972.
 It was a tribute to her work that in creating the first nursing library, the nursing society Sigma Theta
Tau International named it the Virginia Henderson International Nursing Library. The Library, in
Indianapolis, has been available in electronic form through the Internet since 1994.
 Curiously, while Miss Henderson consistently stressed nursing’s duty to the patient rather than to
the doctor, her efforts to provide a scientific basis for nursing, including creating the universally
used systems of recording observations of the patient, have helped make nurses far more valuable
to doctors.
 Miss Henderson died in March 19, 1996 at the age of 98.

Overview of Henderson’s “The Nature of Nursing Model”

 The Henderson Theory of Nursing encompasses a definition of nursing, a description of the

function of a nurse, and the enumeration of the 14 components that make up basic nursing care.
 Henderson defined nursing as “doing things for patients that they would do for themselves if they
could, that is if they were physically able or had the required knowledge. Nursing helps the patient
become healthy or die peacefully, and also helps people work toward independence, so that they
can begin to perform the relevant activities for themselves as quickly as possible.”

14 components that make up the basic nursing care

- The 14 components of Virginia Henderson's theory shows holistic approach to nursing that covers
the physiological, psychological, spiritual and social needs.

 Physiological Components
1. Breathe normally
2. Eat and drink adequately
3. Eliminate body wastes
4. Move and maintain desirable postures
5. Sleep and Rest
6. Select Suitable clothes- dress or undress
7. Maintain body temperature within normal range by adjusting clothing and modifying
environment
8. Keep the body clean and well groomed and protect the integument
9. Avoid dangers in the environment and avoid injuring others
 Psychological Aspects of communicating and Learning
10. Communicate with others in expressing emotions, needs, fears, or opinions
14. Learn, discover, or satisfy the curiosity that leads to normal development and health and
use the available health facilities
 Spiritual and Moral
11. Worship according to one’s faith.
 Sociologically Oriented to Occupation and Recreation
12. Work in such a way that there is a sense of accomplishment
13. Play or participate in various forms of recreation

Major Assumptions of the theory

 Nurses care for patient until patients can care for themselves once again. Patients desire to return
to health.
 Nurses are willing to serve and that nurses will devote themselves to the patient day and night.
 Nurses should be educated at the university level in both arts and sciences.

Major Concepts of the theory

A. Person. Individual requiring assistance to achieve health and independence or a peaceful death.
B. Environment. All external conditions and influences that affect life and development.
C. Health. Equated with independence, viewed in terms of the client’s ability to perform 14
components of nursing care unaided.
- Nurses need to stress promotion of health and prevention and cure of disease.
- Good health is a challenge. Affected by age, cultural background, physical and
intellectual capacities, and emotional balance.
D. Nursing. Assists and supports the individual in life activities and the attainment of independence.
- Purpose: To assist the client in gaining independence as rapidly as possible.

 Nurses serves to make patient “complete” “whole” or “independent”

 Henderson’s classic definition of nursing:
“ I say that the nurse does for others what they would do for themselves if they had the
strength, the will, and the knowledge. But I go on to say that the nurse makes the patient
independent of him or her as soon as possible.”
 The nurse is expected to carry out physician’s therapeutic plan. Individualized care is the
result of the nurse’s creativity in planning for care.
 Using nursing research
- Categorized Nursing: nursing care
- Non nursing: ordering supplies, cleanliness and serving food.
 In the nature of Nursing “ that the nurse is and should be legally, an independent
practitioner and able to make independent judgments as long as she is not diagnosing,
prescribing treatment for disease, or making a prognosis, for these are the physician’s
function.”
 “Nurse should have knowledge to practice individualized and humane care and should be a
scientific problem solver”
  In the Nature of Nursing, nurse role is, “to get inside the patient’s skin and supplement his
strength, will, or knowledge according to his needs”
 And nurse has responsibility to assess the needs of the individual patient, help individual
meet their health need, and/or provide an environment in which the individual can
perform activity unaided.

Henderson’s Model and Nursing Process

Henderson views the nursing process as “really the application of the logical approach to the
solution of a problem. The steps are those of the scientific method.“ Nursing process stresses the
science of nursing rather than the mixture of science and art on which it seems effective health care
service of any kind of based.

Summarization of the stages of the nursing process as applied to Henderson’s definition of nursing
and to the 14 components of basic nursing care.”

Nursing Process Henderson’s 14 components and definition of nursing

Nursing Assessment Henderson’s 14 components and definition of nursing
Nursing Diagnosis Analysis: Compare the data to knowledge base of health and disease.
Nursing Plan Identify individual’s ability to meet own needs with or without
assistance, taking into consideration strength, will or knowledge.
Nursing Implementation Document how the nurse can assist the individual, sick or well
Assist the sick or well individual in the performance of activities in
meeting human needs to maintain health, recover from illness, or to
aid in peaceful death.
Implementation based on the physiological principles, age, cultural
background, emotional balance, and physical and intellectual
capacities.
Carry out treatment prescribed by the physician.
Nursing 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 which or
degree to which the patient performs independently the activities of
daily living.
Maslow’s Henderson’s
Psychological needs Breathe normally
Eat and drink adequately. Eliminate by all avenues
of elimination. Move and maintain desirable
posture. Sleep and rest. Select Suitable clothing.
Maintain body temperature . Keep body well clean
and well groomed and protect the integument.
Safety Needs Avoid dangers in the environment and avoid
injuring others.
Belongings and love needs Communicate with other. Worship according to
one’s faith.
Esteem Needs Work in such a way that there is a sense of
accomplishment.
Play or participate in various forms of recreation.
Learn, discover, or satisfy the curiosity.

Comparison with Maslow’s Hierarchy of needs

IMOGENE KING
JANUARY 30, 1923 – DECEMBER 24, 1997

HISTORY AND BACKGROUND

 Imogene King was a pioneer of Nursing theory

development. Her interacting systems theory of
Nursing and her Theory of goal attainment have
been included in every major nursing theory
text. These theories are taught to thousands of
nursing students.
 Born in 1923
 Earned a diploma in nursing from St. Louis
- Worked as office nurse, staff nurse, school
nurse, and private duty nurse
 Bachelor of Science in Nursing from St. Louis
University
 Masters of Science in Nursing from St. Louis University
 Doctorate from Teacher’s college, Columbia University, New York
 Med-Surg Nursing Instructor and Asst. Director of St. John’s Hospital School of Nursing
 Director of School of Nursing at Ohio University
- Associate Professor at Loyola University, Chicago
 Professor at Loyola University, Chicago
 Died on 1997

During her career, King was an active member of the District IV Florida Association, the American
Nurses Association, and Sigma Theta Tau International. Dr. King’s contribution to NANDA International
span 40 years. She was a participant at the first National Conference on the Classification of Nursing
Diagnoses in St. Louis in 1973

Overview of Imogene King’s “Conceptual System and Theory of Goal Attainment”

Dr. King’s conceptual system is based on the assumptions that human beings are the focus of
Nursing. Imogene King stated that “Nursing’s domain involves human beings, families, and communities
as a framework within which nurse make transactions in multiple environments with health as a goal.”
The link between interactions and health is behavior, or human acts.

Human Being’s have three fundamental health needs:

1. The need for health information that is usable at the time when it is needed and can be used,
2. The need for care that seeks to prevent illness, and
3. The need for care when human beings are unable to help themselves.
Propositions of King’s Theory
 If perceptual interaction accuracy is present in nurse-client interactions, transaction will occur
 If nurse and client make transaction, goal will be attained
 If goals are attained, satisfaction will occur
 If transactions are made in nurse-client interactions, growth and development will be enhanced
 If role expectations and role performance as perceived by nurse and client are congruent,
transaction will occur.
 If role conflict is experienced by nurse or client of both, stress in nurse-client interaction will occur
 If nurse with social knowledge and skill communicate appropriate information to client, mutual
goal setting and attainment will occur.

Theory of Goal Attainment

CONCEPTUAL SYSTEM

Three Interacting Systems:

 Personal System
 Interpersonal System
 Social System

1. Personal Systems
These are individuals. Each individual is an open, total, unique system in constant interaction with
the environment.
The following concepts to understand individuals as personal system:
 Perception
 Self
 Growth and development
 Body Image
 Space
 Time
2. Interpersonal Systems
Two or more individuals in interaction process. King’s process of nursing occurs primarily within the
interpersonal systems.
The following concepts to understand interpersonal systems:
 Communication
 Interaction
 Role
 Stress
 Stressors
 Transaction
3. Social System
Large groups with common interests or goals. It includes health care settings, workplaces,
educational institutions, religious organizations, and families.
The following concepts to understand social systems:
 Organization
 Authority
 Power
 Status
 Decision making

CONCEPTUAL SYSTEM

 Perception, goals, needs and values of the nurses and clients influence the interaction process.
 Individuals have the right to knowledge about themselves and to participate in decisions that
influence their lives, health and community services, and right to accept or reject health care.
 Health professionals have the responsibility that helps individuals to make informed decisions
about their health care.

Basic assumption of goal attainment theory is that nurse and clients communicate information, set
goal mutually and then act to attain those goals. This is also the basic assumption of nursing process.

 Nursing processes:
 Assessment
 Nursing Diagnosis
 Planning
 Implementation
 Evaluation

ASSESSMENT
King indicates that assessment occur during interaction, where the nurse brings special
knowledge and skills by collecting data regarding the client while the client brings knowledge of self
and perception of problems of concern, to this interaction. Perception and Communication plays a
major part in this process.

NURSING DIAGNOSIS
The data collected by assessment are used to make nursing diagnosis in nursing process.
According to King, in process of attaining goal, the nurse identifies the problems, concerns and
disturbances about which person seeks help.
PLANNING
After nursing diagnosis, planning for interventions to solve those problems is done. In goal
attainment, planning is represented by setting goals and making decisions about and being agreed on
the means to achieve goals. Transaction and client’s participation is encouraged in making decision on
the means to achieve goals.

IMPLEMENTATION
In nursing process implementation involves the actual activities to achieve goals. In goal
attainment, it is the continuation of transaction.

EVALUATION
It involves the finding out whether goals are achieved or not. According to King, he described
this process as speaking about the attainment of goal and effectiveness of nursing care.
Concepts/Metaparadigm

PERSON/HUMAN BEING
A social being who is rational and sentient that has the ability to perceive, think, feel, choose, set goals,
select means to achieve goals, and to make decision.

Three fundamental needs:

 Need for health information

 Need for care to prevent illness
 Need for care from the nurses

ENVIRONMENT
The background for human interactions. It involves internal environment and external environment.

Internal environment – transforms energy to enable person to adjust to continuous external

environmental changes.
External Environment – involves formal and informal organizations. The nurse is a part of the patient’s
environment.

HEALTH
It involves dynamic life experiences of a human being, which implies continuous adjustment to stressors
in the internal and external environment through optimum use of one’s resources to achieve maximum
potential for daily living.

NURSING
Nursing is defined as a process of action, reaction and interaction by which nurse and client share
information about their perception in nursing situation. It is also a process of human interactions
between nurse and client whereby each perceives the other and the situation. Through communication,
they set goals, explore means, and agree on means to achieve goals. King also discussed the goal,
domain and function of professional nurse.
Nursing Theorist

Dorothea Elizabeth Orem (1914 -2007)

“Nursing is perhaps best described as the giving of

direct assistance to a person, as required, because of
the person’s specific abilities in self-care resulting
from a situation of personal health”

-Dorothea Orem

BACKGROUND
Life of Dorothea Orem

 Born on July 15, 1914 in Baltimore, Maryland.

 Father was a construction worker.
 Mother was a home maker
 Youngest of two (2) daughters
 Died on June 22, 2007 in savannah, Georgia at
age 92.
 1931 – Graduated from Seton high school in Baltimore, Maryland.
 1934 – Earned Nursing Diploma from Providence Hospital School of Nursing in Washington, D.C.
 Received a BSN Ed. in 1939 and MSN Ed. in 1945 from Catholic University of America.
 1959 – Guidelines For Developing Curricula For the Education of Practical Nurses
 1971 – First published her formal articulation of ideas in Nursing: Concepts of Practice
 1976 – Honorary Doctorate Degree of Science From Georgetown University
 1980- Honorary Doctorate Degree From Incamate World College
 Subsequent works of her theory were published in 1980, 1985, 1991,1995 and 2001
 O.R. Nurse
 Private Duty Nursing (Home and Hospital)
 Pediatric and Adult Med/Surg Staff Nurse
 E.R. Evening Supervisor
 Biological Science Teacher
 Director of the Providence Hospital School of Nursing in Detroit, Michigan
 People should be self-reliant and responsible for their own care
 People are distinct individuals
 Nursing is a form of action
 A person’s knowledge of potential in necessary for promoting self-care behaviors.
Theory
Orem’s Self-care model

Theory of self-care

 Developed between 1959 – 2001

 Grand nursing theory
 Patient focus
 Promotes recovery and healing
 Overall theme is SELF-CARE
 Composed of three (3) interwoven theories:
 Theory of self-care
 Theory of self-care deficit
 Theory of nursing system
 Self – care
 Self – care agency
 Self-care requisites:
 Universal
 Developmental
 Health deviation
 Therapeutic self-care demand

Theory of Self-care Deficit

 Identifies need
 5 method of helping:
 Acting and doing for others
 Guiding
 Physical and psychological support
 Promotion of personal development to meet future demands

Theory of Nursing System

 Role of the nurse

 Nursing system classification
 Wholly compensatory system
 Partly Compensatory system
 Supportive - educative
METAPARADIGM
Person

Composed of (4) aspects:

1. Physical
2. Psychological
3. Interpersonal
4. Social

Nursing

 Consist of those actions to overcome or prevent self-care deficits

 Providing care for someone who is unable to perform self-care

Environment

 Anything outside of or external to the person

 Can positively or negatively affect a person’s ability to function

Health
-The internal and external conditions that permit self-care needs to be met.
Helps nurses identify the self-care requisites of their patients so that comprehensive care can be
provided.

How is Orem’s theory Useful in current Nursing Practice?

FAYE GLENN ABDELLAH

BACKGROUND

 Born on March 13, 1919 in New York City

 Nursing diploma at Fitkin Memorial Hospital School
of Nursing in Neptune, New Jersey in 1942.
 Obtained her Undergraduate, Masters, and Doctor
of Education from Teacher’s College, Columbia
University.
 Appointed Chief Nurse Officer of the U.S. Public
Health Service (USPHS) in 1970 and served that
position for 17 years.
 First woman to serve as Deputy Surgeon General of
the United of States.
 Inducted into the US National Women’s Hall of
Fame in 2000 due to her contributions in the field
of education and nursing research.
 Staff Nurse, Head Nurse, Faculty Member at Yale
University and Columbia University.
 Public Health Nurse and an author of more than 150 articles and books.
 Research Consultant to the World Health Organization
 Recipient of more than 79 academic honors and professional awards in her excellence in nursing.
 Developed a list of 21 unique nursing problems related to human needs.

FAYE GLENN ABDELLAH

 Transformed Nursing Profession

 Established Standards
 Served in Military
 International Contributions

“We cannot wait for the world to change…. Those of us with intelligence, purpose, and vision must
take the lead and change the world. Let us move forward together! I promise never to rest until my
work has been completed.”

Faye glenn abdellah

ABDELLAH’s theory
Abdellah’s “patient-centered approaches to nursing model”

10 Steps to Identify the Client’s Problem

h
Learn to know the patient Explore the patient’s and
family’s reaction to the
Test generalization with the patient therapeutic plan and involve
and make additional generalizations them in the plan

Sort out relevant and

significant data
Identify how the nurse
Validate the patient’s conclusions feels about the patient’s
about this nursing problems nursing problems
Make generalization about
available data in relation to
similar nursing problems
presented by other patients. Continue to observe and evaluate
the patient over a period of time Discuss and develop a
to identify any attitudes and clues
Identify therapeutic plan comprehensive nursing
affecting his behavior
care plan

Observation of Health Status Use of personnel resources

Skills and communication Problem-solving
Application of knowledge Direction of work of others

11 Nursing
Skills

Teaching of patients and families

Therapeutic use of the self
Planning and organization of work
Use of resource materials
Nursing procedures
ABDELLAH’S 21 NURSING PROBLEMS
BASIC TO ALL PATIENTS

 To maintain good hygiene and physical comfort

 To promote optimal activity: exercise, rest, and sleep
 To promote safety through prevention of accidents, injury or other trauma and through the
prevention of the spread of information
 To maintain good body mechanics and prevent and correct deformity

SUSTENAL CARE NEEDS

 To facilitate the maintenance of a supply of oxygen to all body cells

 To facilitate the maintenance of nutrition of all body cells
 To facilitate the maintenance of elimination
 To facilitate the maintenance of fluid and electrolyte
 To recognize the physiological responses of the body to disease conditions
 To facilitate the maintenance of regulatory mechanisms and functions
 To facilitate the maintenance of sensory function

REMEDIAL CARE NEEDS

 To identify and accept positive and negative expressions, feelings, and reactions
 To identify and accept interrelatedness of emotions and organic illness
 To facilitate the maintenance of effective verbal and nonverbal communication
 To promote the development of productive interpersonal relationships
 To facilitate progress toward achievement of personal spiritual goals
 To create and/or maintain a therapeuticenvironment
 To facilitate awareness of self as an individual with varying physical, emotional, and developmental
needs

RESTORATIVE CARE NEEDS

 To accept the optimum possible goals in the light of limitations, physical and emotional
 To use community resources as an aid in resolving problems arising from
 To understand the role of social problems as an influencing factors in the case of illness

CONCEPTS/METAPARADIGM OF ABDELLAH’S 21 NURSING PROBLEMS

 Person
 Society and Environment
 Health
 Nursing
PERSON

 Abdellah describes people as

having physical, emotional, and
sociological needs. These needs
may overt, consisting of largely
physical needs, or covert, such as emotional, sociological and
interpersonal needs- which are
often missed and perceived incorrectly.
 The individuals (and families) are the recipients of nursing, and
health, or achieving of it, is the
purpose of nursing services.

SOCIETY AND ENVIRONMENT

 Society is included in “planning for optimum health on local, state, and

international levels.” However, as Abdellah further delineates her
ideas, the focus of nursing service is clearly the individual.
 The environment is the home or community from which patient
comes.

Health

 Health may be defined as the dynamic pattern of functioning whereby

there is a continued interaction with internal and external forces that
results in the optimal use of necessary resources to minimize
vulnerabilities.
 The individuals (and families) are the recipients of nursing, and
health, or achieving of it, is the purpose of nursing services.

NURSING

 Nursing is a helping profession. Nursing care is doing something to or

for the person or providing information to the person with the goals of
meeting needs, increasing or restoring self-help ability, or alleviating
impairment.
 Considers nursing to be comprehensive service that is based on art
and science and aims to help people, sick or well, cope with their
health needs.
USE OF 21 NURSING PROBLEMS IN THE NURSING PROCESS

 Assessment
 Nursing Diagnosis
 Planning Phase
 Implementation
 Evaluation
Hildegard Peplau

Who was Hildegard Peplau?

 Name: Hildegrad Elizabeth Peplau

 Nickname: Hilda
 Regarded as: Mother of psychiatric nursing
 Birthday: September 9, 1909
 Birthplace: Reading, Pennsylvania
 Died: march 17. 1999 in Sherman Oaks, California
 Father: Gustave Peplau
 Mother: Otyllie Peplau
 Number of siblings: 6 (Hilda being the second one)

Characteristics of Peplau

 Strong willed
 Motivated
 Doesn’t want to be like traditional Women
 Wanted more out of life

Achievements

 Worked as executive director of ANA

 President of ANA 1970-1972
 Worked with W.H.O., NIMH, ang Nurse Corps.
 First nurse to publish a theory since Florence Nighthingale
 Published the theory of Interpersonal theory, which revolutionized the scholarly works of nursing
 She is also the primary contributor to mental health law leading to humane or specialized
treatment to patients with mental disorders

The Interpersonal Theory

 Emphasizes the importance of the nurses’ understanding of their own behavior in order to identify
other’s difficulties.
 Emphasizes the focus on the Interpersonal process and therapeutic relationship that develops
between the nurse and the client
 Has four phases
 It gave emphasis on give-and-take of nurse-client relationship

Major Concepts
 Nursing is an interpersonal personal process because it involves interaction between two or more
individual with a common goal
 The attainment of goal is achieved through the use of series of steps following a series of pattern
 The nurse and the patient work together so both become mature and knowledgeable in the
process
 The theory explains the purpose of nursing is to help other identify their felt difficulties
 Nursing is therapeutic in that it is a healing art, assisting and individual who is sick or in need of
healthcare

Components of the Theory

(Metaparadigm)

 Person- is a developing organism that tries to reduce anxiety caused by needs.

 Environment- consists of existing forces outside of the person and put in the context of culture.
 Health- which is a word symbol that implies forward movement of personality and other on-going
human process in the direction of creative, constructive, personal and community living
 Nurse- The medium of the art of nursing, a mature force. The unique blend of ideas, values,
integrity, and commitment to the well-being of others

Phases of the Interpersonal theory

 A. Orientation Phase

Get acquainted phase of the nurse-patient relationship

Preconceptions are worked through

Parameter are set

Roles begin to understood

 B. Identification Phase

The client begins to identify problems to be worked on within relationship

The goal of the nurse: Help recognize the patient his/her own participation role and

promote responsibility for self.

 C. Exploitation Phase

Client trust of nurse reached full potential

Client making full use of nursing services

Solving immediate problems

Identifying and orienting self to goals

 D. Resolution Phase

Client met needs

Mutual termination of relationship

Sense of security is formed

Patient is less reliant to the nurse

Increased self-reliance to deal with own problems

Interpersonal Therapeutic Process

 Interpersonal therapeutic process- This type of process is based on the theory proposed by Peplau
and particularly useful in helping psychiatric patients become receptive for therapy. It is often
termed as “Psychological Mothering”.
 The patient is accepted unconditionally as a participant in a relationship that satisfies his needs;
 There is a recognition of and response to the patient’s readiness for growth, his initiative; and
 Power in the relationships shifts to the patient, as the patient is able to delay gratification and
invest in goal achievement

Nursing Roles

 Stranger: offering the client same acceptance and courtesy that the nurse would do to any stranger
 Resource Person: Providing specific answers to questions within larger context
 Teacher: Helping the client learn formally or informally
 Leader: Offering direction to the client or group
 Surrogate: Serving as a substitute for another such as a parent or a sibling
 Counselor: Promoting experiences leading to health for the client such as expression of feelings
 Technical expert: Provides physical care for the patient and operates equipment

Additional Roles

 Consultant
 Health teacher
 Tutor
 Socializing agent
 Safety agent
 Manager of environment
 Mediator
 Administrator
 Recorder observer
 Researcher

Analysis

 Peplau conceptualized clear sets of nurse’s roles that can be used by each and every nurse with
their practice. It implies that a nurse’s duty is not just to care but the profession encompasses
every activity that may affect the care of the patient.

 The idea of a nurse-client interaction is limited with those individuals incapable of conversing,
specifically those who are unconscious.

 The concepts are highly applicable to the care of psychiatric patients considering Peplau’s
background. But it is not limited in those set of individuals. It can be applied to any person capable
and has the will to communicate.
 The phases of the therapeutic nurse-client are highly comparable to the nursing process making it
vastly applicable. Assessment coincides with the orientation phase; nursing diagnosis and planning
with the identification phase; implementation as to the exploitation phase; and lastly, evaluation
with the resolution phase.

Strength

 Peplau’s theory helped later nursing theorists and clinicians develop more therapeutic
interventions regarding the roles that show the dynamic character typical in clinical nursing.
 Its phases provide simplicity regarding the natural progression of the nurse- patient relationship,
which leads to adaptability in any nurse-patient interaction, thus providing generalizability.

Weakness

 Though Peplau stressed the nurse-client relationship as the foundation of nursing practice, health
promotion, and maintenance were less emphasized.
 Also, the theory cannot be used in a patient who doesn’t have a felt need such as with withdrawn
patients.

Conclusion

 Peplau’s theory has been used by nurse theorists and clinicians. Her theory helped create more
sophisticated theories which are now used by many clinicians. Peplau’s theory says entails that the
duty of a clinical nurse is not just about care but also nursing profession incorporates every activity
that might affect the patients health.\
 Studying Peplau’s Interpersonal Relations Theory of Nursing can be very substantial especially to
those who are aspiring to be part of the profession. Having the knowledge of the seven roles of
nursing, future nurses can apply for different roles in different situations, which will guarantee
their patients to acquire the best care possible, and will ultimately speed along treatment and
recovery.
ROSEMARIE RIZZO PARSE: THE THEORY OF HUMAN BECOMING

ROSEMARIE RIZZO PARSE

• BORN ON JULY 18, 1938

• GRADUATE OF DOQUESNE UNIVERSITY
• MASTER & DOCTORATE AT UNIVERSITY OF PITSBURGH
• DEAN OF NURSING SCHOOL AT DUQUESNE UNIVERSITY
• EDITOR OF NURSING SCIENCE QUARTERLY
• FELLOW IN AMERICAN ACADEMY OF NURSING
• PUBLISHED 9 BOOKS & 100 ARTICLES
• TWO LIFETIME AHIEVEMENT AWARDS: MIDWEST NURSING
RESEARCH SOCIETY & THE ASIAN AMERICAN PACIFIC ISLANDER
NURSES ASSOCIATION
• MARTHA E. ROGERS SLINKY AWARD
• NEW YORK TIMES NURSE EDUCATOR OF THE YEAR AWARD
ROSEMARIE RIZZO PARSE’S WORKS
• NURSING FUNDAMENTALS (1974)
• MAN-LIVING-HEALTH: A THEORY OF NURSING (1981)
• NURSING SCIENCE, MAJOR PARADIGMS, THEORIES & CRITIQUES (1981)
• ILLUMINATIONS: THE HUMAN BECOMING THEORY IN PRACTICE & RESEARCH (1995)
• THE HUMAN BECOMING SCHOOL OF THOUGHT (1998)
• AN INTERNATIONAL HUMAN BECOMING PERSPECTIVE (1999)

Definition of the Four Nursing Metaparadigms

PERSON. Open being is more than and different from the sum of its parts.

ENVIRONMENT. Everything in the person and his experience.

HEALTH. Open process of being and becoming. Involves synthesis of values.

NURSING. Human science and art that uses an abstract body of knowledge to serve.
THE THEORY OF HUMAN BECOMING

Is a nursing perspective that focuses on life quality and

human dignity from the perspective of patients, families, and
communities.

Nine assumptions

(About Humans)

The human is coexisting while co-constituting rhythmical patterns with the universe.

The human is open, freely choosing meaning in situation, bearing responsibility for decisions.

The human is unitary, continuously co-constituting patterns of relating.

The human is transcending multidimensionally with the possible.

(About Becoming)

Becoming is unitary human-living-health.

Becoming is rhythmically co-constituting human-universe process.

Becoming is the human’s patterns of relating value priorities.

Becoming is an intersubjective process of transcending with the possible.

Becoming is unitary human’s emerging.

3 Principles
Principle 1, MEANING

“ STRUCTURING MULTI-DIMENSIONALLY IS CO-CREATING REALITY

THROUGH THE VALUING AND MEANING”

INCLUDES:
 IMAGING
 VALUING
 LANGUAGING

Principle 2, RHYTHM

“ CO-CREATING RHYTHMICAL PATTERNS OF RELATING IS LIVING WITH

PARADOXICAL UNITY OF REVEALING-CONCEALING WHILE CONNECTING AND
SEPARATING.”
INCLUDES:
 REVEALING-CONCEALING
 ENABLING-LIMITING
 CONNECTING-SEPARATING

Principle 3, TRANSCEDENCY

“CO-TRANSCENDING WITH POSSIBLE IS POWERING UNIQUE WAYS OF

ORIGINATING IN THE PROCESS OF TRANSFORMING”

INCLUDES:
 POWERING
 ORIGINATING
 TRANSFORMING

Dimensions and Processes

 ILLUMINATING AND EXPLICATING
 SYNCHRONIZING RHYTHMS AND DWELLING
 MOBILIZING TRANSCENDENCE AND MOVING BEYOND

Application to Nursing Profession

 PARSE’S THEORY EMPHASIZE ON HOW INDIVIDUAL CHOOSE AND
BEAR RESPONSIBILITY PATTERNS OF PERSONAL HEALTH.
 THIS THEORY FORMULATES THE ABILITY TO SEE PATIENT’S
PERSPECTIVE.
MADELEINE LEININGER
TRANSCULTURAL NURSING THEORY
(Cultural Care Diversity and Universality Theory)

BACKGROUND
Biography
 born on July 13, 1925 in Sutton, Nebraska U.S.
 she graduated at Sutton high school in 1942.
 in 1948, graduated from St. Anthony’s School of Nursing in
Denver, Colorado.
 in 1950, earned a B.S. from Mount St. Scholastica (Benedictine
College) in Atchison Kansas.
 earned equivalent of BSN through studies in biological
sciences, nursing administration, teaching and curriculum at
Creighton University in Omaha, Nebraska, 1951-1954
 in 1954, M.S.N. in Psychiatric and Mental health Nursing from
the Catholic University of America in Washington, D.C.
 from 1955-58, she pursued further graduate studies and
directed the Child Psychiatric Nursing Program as Associate
Professor of Nursing.
 in 1960, she pursued doctoral studies, during which she
received a National League of Nursing Fellowship for fieldwork
in the Eastern highlands in New Guinea
 she studied convergence and divergence of human behavior in
two Gadsup villages
 in 1966, was awarded a Ph.D. in cultural and social anthropology from the University of
Washington, Seattle
 died on August 10, 2012 at the age of 87 years old

Career
 in 1954, Associate Professor of Nursing at the University of Cincinnati
 1966-69, Held a joint appointment in the College of Nursing and Anthropology and directed the
nurse scientist program at the University of Colorado
 1969-74, Dean and Professor of Nursing at University of Washington, and lecturer in dept of
Anthropology
 1974-81, Dean and Professor of Nursing, Adjunct Professor of Anthropology University of Utah
 1981-85, Professor of Nursing, Adjunct Professor of Anthropology, and Transcultural Nursing at
Wayne State University
 in 1955, Adjunct Clinical Professor of Nursing at the University of Nebraska

Honors
 fellow of the American Academy of Nursing
 Distinguished Fellow of the Royal College of Nursing, Australia
 Living Legend by the American Academy of Nursing 1998
 honorary degrees from Benedictine College, University of Indianapolis, and University of
Kuopio, Finland
THEORY
TRANSCULTURAL NURSING

Transcultural Nursing is a substantive area of study and practice focused on comparative human
care (caring) differences and similarities of the beliefs, values, and practices of individuals or groups of
similar or different cultures. transcultural nursing’s goal is to provide culture-specific and universal
nursing care practices for the health and well-being of people or to help them face unfavorable human
conditions, illness, or death in culturally meaningful ways.

Definitions in Transcultural Nursing

 Culture
 Religion
 Ethnic
 Ethnicity
 Cultural identify
 Culture-universals
 Culture-specifies
 Material culture
 Subculture
 Bicultural
 Diversity
 Acculturation
 Culture shock
 Ethnic groups
 Ethnic identity
 Race
 Culture care diversity

METAPARADIGM

 Person
 Environment
 Health
 Nursing
Lydia Hall

• Lydia Hall was born in September 21, 1906 in New York City.

• Nursing as a graduate of the York Hospital School of Nursing in York, Pennsylvania

• Nursing diploma in 1927.

• Bachelor’s in public health nursing in 1937

• Master’s in teaching Natural sciences in 1942.

• Lydia Hall worked as the first director of the Loeb Center for Nursing

• She had variety of nursing experience in clinical nursing, nursing education, research, and in a
supervisory role.

Care, Cure, Core Theory of Nursing

• Lydia E. Hall developed the Care, Cure, Core

Theory of Nursing in the late 1960s as a result of
her work in psychiatry, as well as her
experiences at the Loeb Center.

• Also known as “the Three Cs of Lydia Hall,”

• Hall’s theory contains three independent but

interconnected circles. The three circles are: the
core, the care, and the cure

CARE (The body)

The primary purpose of the care is therefore to achieve the interpersonal relationship with a person to
assist the development of the care. This involves the improvement of the nurses to meet the patients’s
need, managing the nursing care, establishing a nurse-patient relationship and collaborating with other
healthcare professionals in the care delivery to the patients (Jacobs et al. 2016).

CURE (The Disease)

In cure, the nurse will employ the therapeutic understanding regarding healing of the patient while in
the core stage, the nurse focuses on the social and emotional requirements of the person for a
comfortable environment and effective communication [Smith & Parker, 2015]

CORE (The Person)

The core is the patient to whom nursing care is directed. The core has set goals by him or herself rather
than by a healthcare provider or family and friends. The core makes decisions and behaves according to
his or her feeling and values (Wayne, 2014)
Hall’s Three Aspects of Nursing

Metaparadigm of Lydia Hall Theory

PERSON

She viewed a patient as composed of three aspects: body, pathology and person. She
emphasized the importance of the individual as unique, capable of growth and learning and requiring a
total person approach. Patients achieve their maximal potential through learning process, therefore, the
chief therapy they need is teaching. (Sidon, 2014)

ENVIRONMENT

The concept of environment is dealt with in relation to the individual. She was credited with
developing the concept of Loeb Center for Nursing because she assumed that the hospital environment
during the treatment of acute illness creates a difficult psychological experience for the ill individual.
Loeb Center focuses on providing an environment conducive to self development in which the action of
nurses is for assisting the individual in attaining a personal goal. (Sidon, 2014)

HEALTH

Hall viewed becoming ill is behavior. Illness is directed by feelings-out-of-awareness, which are
the root of adjustment difficulties. Healing may be hastened by helping people move in the direction of
self-awareness. Once people are brought to terms with their true feelings and motivations, they
become free to release their own powers of healing. Through the process of reflection, the patient has
the chance to move from the unlabeled threat of phobia or disease to a properly labelled threat (fear)
with which he can deal constructively. (Sidon, 2014)

NURSING

- Nursing is identified as consisting of participation in the care core and cure aspects of nursing
care. Nursing can and should be professional. Hall stipulated that patients should be cared for only by
professional nurses who can take total responsibility for the care and teaching of their patients. Care is
the sole function of the nurse, where as core and cure are shared with other member of the health
team. However the major purpose of care is to achieve an interpersonal relationship with the individual
that will facilitate the development of care. (Sidon, 2014)
Rozzano C. Locsin

Biography

▸ 1954

▸ earned his Doctor of Philosophy in Nursing degree from the

University of the Philippines in 1988, and his Master of Arts
in Nursing and Bachelor of Science in Nursing from Silliman
University in 1978 and 1976 in the Philippines. He joined
Florida Atlantic University, Christine E. Lynn College of
Nursing in 1991 where he is a tenured Professor of Nursing.

▸ Dr. Locsin's research and scholarly works concerning

technology and caring in nursing converge on the theme
"life transitions in human health."

▸ first recipient of the Lillian O. Slemp Endowed Chair in Nursing at the University of Texas-Pan
American in Edinburg, Texas in 2007

▸ August 2009, he was the first recipient of the John F. Wymer, Jr. Distinguished Professor in
Nursing at Florida Atlantic University.

▸ In 2006, Dr. Locsin was inducted as Fellow of the American Academy of Nursing (FAAN).

▸ Edith Moore Copeland Excellence in Creativity Award from Sigma Theta Tau International Honor
Society of Nursing in 2003.

▸ Currently, as Fulbright Senior Specialist in Global and Public Health, he continues to lead
collaborative research studies advancing the development of models of nursing practice in
Uganda, Thailand, and the Philippines.

▸ first Masters program in Nursing in Uganda while researching the phenomenon "waiting-to-
know" and the lived experiences of persons exposed to patients who died of Ebola Hemorrhagic
Fever. With Mbarara University and the Fulbright Alumni Initiative Award, he established the
first Community-based University Nursing Education Program.

The Process of Nursing

A. Knowing

The process of knowing person is guided by technological knowing in which persons are appreciated as
participants in their care rather than as objects of care.

In this process, technology is used to magnify the aspect of the person that requires revealing - a
representation of the real person.
B. Designing

Both the nurse and the one nursed (patient) plan a mutual care process from which the nurse can
organize a rewarding nursing practice that is responsive to the patient’s desire for care.

C. Participation in appreciation

In this stage of the process is the alternating rhythm of implementation and evaluation. The evidence of
continuous knowing, implementation and participation is reflective of the cyclical process of knowing
persons.

D. Verifying knowledge

The continuous, circular process demonstrates the ever-changing, dynamic nature of knowing in
nursing. Knowledge about the person that is derived from knowing, designing, and implementing
further informs the nurse and the one nursed.

Technological Competency as Caring in Nursing

by Rozanno C. Locsin

1. Overview of Theory

Technological competency as caring is the skilled demonstration of intentional, deliberate, and

authentic activities by experienced nurses who practice in environments requiring technological
expertise.

2. Metaparadigm of the Theory

 Person
 Nursing
 Health
 Environment
 Model
Knowing Persons: Framework for Nursing

Calls for Nursing

(Supporting,
Affirming,
Multiple Patterns Celebrating) Nursing as
of Knowing in Caring
Nursing (Boykin and Schoenhofer,
Empirics, Aesthetics, Ethics, 2001)
Personal (Carper, 1978) Responses to Calls
for Nursing

Knowing
Persons
Who is Person?
What is Person?

3. Dimensions of Technological Value in the Theory

Technology as completing human beings

To re-formulate the ideal human being such as in replacement parts, both mechanical or organic.

Technology as machine technologies

Computers and gadgets enhancing nursing activities to provide quality patient care.

Technologies that mimic human beings and human activities

To meet the demands of nursing care practices.

Risks with technology in nursing

Doctor Google

Patients diagnosing or misdiagnosing themselves based on information from the Internet.

Confidentiality

The widespread availability of private information.

EMR

Permanent, nationally accessible health record.

4. Key Points from the Theory

 Technology as caring in nursing is the harmonious coexistence between technologies and caring
in nursing.
 Technology as brings the patient closer to the nurse.
 When technology is used to know persons continuously in the moment, the process of nursing
is lived.

Summary

“Nurses have always used techniques and tools in meaningful ways to achieve valued ends.”

- Locsin (2001)
MARGARET JEAN WATSON

MARGARET JEAN WATSON

• an American nurse theorist and nursing professor who is

well known for her “Philosophy and Theory of
Transpersonal Caring.”

• Born as Margaret Jean Harmon

• Born on June 10, 1940

• In the Appalachian Mountains of West Virginia

• Youngest of eight children

• Got married to Douglas

• Has authored 11 books, shared in authorship of six books

and has written countless articles in nursing journal

• World renowned for her Philosophy and Science of Caring

• Founder of Center for Human Caring in Colorado

first interdisciplinary center committed to using human caring knowledge for clinical practice,

scholarship, etc.

• Founder and Director of the Watson Caring Science Institute

a non-profit foundation that was created to further the work of Caring Science in the world

EDUCATIONAL BACKGROUND:

 1961- Nursing Diploma from Lewis Gale School of Nursing

 1964- BS in Nursing from University of Colorado

 1966- MS in Psychiatric and Mental Health Nursing from University of Colorado

 1973- PhD in Educational Psychology & Counseling

 Currently has 10 Honorary Doctoral Degrees

AWARDS AND HONORS RECEIVED:

• International Kellogg Fellowship in Australia (1982)

• Distinguished Nurse Scholar by New York University (1998)

 • Fetzer Institute National Normal Cousins Award (1999)

• Honorary Doctor of Sciences in Nursing from the University of Victoria in Columbia (2010)

• Lifetime Leadership Award from American Academy Nursing (2013)

JEAN WATSON’S THEORY OF TRANSPERSONAL CARING

PHILOSOPHY AND THEORY OF TRANSPERSONAL CARING

 Nursing model states that “Nursing is concerned with promoting health, preventing illness, caring
for the sick, and restoring health.”

 The nursing model also states that caring can be demonstrated and practiced by nurses. Caring for
patients promotes growth; a caring environment accepts a person as he or she is, and looks to
what he or she may become.

MAJOR ELEMENTS:

a. The (10) carative factors

b. The transpersonal caring relationship

c. The caring occasion/caring moment

10 ARATIVE FACTORS:
1. Formation of a Humanistic-Altruistic System of Values

 Begins developmentally at an early age with values shared with the parents

 Mediate through ones own life experiences, the learning one gains and exposure to the
humanities

 Is perceived as necessary to the nurse’s own maturation which then promote altruistic
behavior towards others

2. Instillation of Faith-Hope

 Essential to both the carative and curative

 Nurse can use this to provide a sense of well being

3. Cultivation of Sensitivity to Self and to Others

 Striving to become sensitive, makes the nurse more authentic, which encourages self-
growth and self-actualization in both the nurse and the person whom the nurse
interacts.
  Nurses promote health and higher level functioning when they form person to person
relationship.

4. Establishing a Helping-Trust Relationship

 strongest tool is mode of communication which includes verbal, nonverbal and

listening which connotes empathetic understanding

 congruence, empathy and warmth are needed in the helping

5. Promotion and Acceptance of the Expression of Positive and Negative Feelings

 Awareness of the feelings helps to understand the behavior it endangers

6. Systematic use of the scientific problem-solving method for decision making

 Watson values the relative nature of nursing and supports the need to examine and
develop the other methods of knowing to provide a holistic perspective

7. Promotion of interpersonal teaching-learning

 caring nurse must focus on the learning process as much as the teaching process

 Understanding the person’s perception of the situation assist the nurse to prepared a
cognitive plan

8. Promoting a supportive, protective, and corrective mental, physical, socio-cultural and spiritual
environment

 Watson divides these into external and internal variables, which the nurse manipulates
in order to provide support and protection for the person’s well being

9. Assisting with gratification and human-needs

 She has created a hierarchy which she believes is relevant to the science of caring in
nursing.

 Each need is equally important for quality nursing care and promotion of optimal health

1o. Allowing for existential-phenomenological forces

 Phenomenology is a way of understanding people from the way things appear to them,
for their frame of reference

 Existential psychology is the study of human existence using phenomenological analysis

 This factor helps the nurse to reconcile and mediate the incongruity of viewing the
person holistically while at the same time attending to the hierarchical needs.
HIERARCHY OF NEEDS

Transpersonal Caring Relationship characterizes a human care relationship that depends on:

• The nurse’s moral commitment in protecting and enhancing human dignity as well as the deeper/
higher self.

• The nurse’s caring consciousness communicated to preserve and honor the embodied spirit,
therefore, not reducing the person to the moral status of an object.

• The nurse’s caring consciousness and connection having the potential to heal since experience,
perception and intentional connection are taking place.

CARING OCCASION/CARING MOMENT

• The moment (focal point in space and time) when the nurse and another person come together in
such a way that an occasion for human caring is created.

• Not simply a goal for the cared-for, Watson insist that the nurse i.e., the caregiver also needs to be
aware of her own consciousness and authentic presence of being in a caring moment with her
patient.

• Caring can be demonstrated and practiced by nurses

• Caring for patients promotes growth

• A caring environment accepts a person as he or she is, and looks to

what he or she may become

WATSON’S THEORY AND THE NURSING PROCESS:

1. Assessment

involves observation, identification and review of the problem, use of applicable knowledge in
literature

2. Care plan

helps the nurse determine how variables would examined or measured; includes design for
problem solving and what data would be collected

3. Intervention

is the implementation of the care plan and data collection

4. Evaluation

analyzes the data, interprets the results, and may lead to an additional hypothesis

METAPARADIGM

1. HUMAN BEING OR PERSON

2. HEALTH

3. NURSING

4. ENVIRONMENT

HUMAN BEING

 She referred this as valued person in and of him or herself to be cared for, respected, nurtured,
understood and assisted.

 Human is viewed as greater than and different from the sum of his or her parts.

HEALTH

 defined as a high level of overall physical, mental, and social function

 a general adaptive-maintenance level of daily functioning

  And presence of efforts leading to the absence of illness.

NURSING

 Science of persons and health-illness experience that are mediated by professional, personal,
scientific, and ethical care interactions.

10 CARATIVE FACTORS:

1. Formation of a Humanistic-Altruistic System of Values

2. Instillation of Faith-Hope

3. Cultivation of Sensitivity to Self and to Others

4. Development of a Helping-Trust Relationship

5. Promotion and Acceptance of the Expression of Positive and Negative Feelings

6. Systematic use of the scientific problem-solving method for decision making

7. Promotion of interpersonal teaching-learning

8. Promoting a supportive, protective, and corrective mental, physical, and spiritual environment

9. Assisting with gratification and human-needs

10. Allowing for existential-phenomenological forces

JOYCE TRAVELBEE’S HUMAN TO HUMAN RELATIONSHIP MODEL

Joyce Travelbee
(1926-1973)

• A psychiatric nurse, educator and writer born in 1926.

• 1956, she completed her BSN degree at Louisiana State

University

• 1959, she completed her Master of Science Degree in Nursing

at Yale University.

• 1952, Psychiatric Nursing Instructor at Depaul Hospital

Affilliate School, New Orleans.

• A psychiatric nurse, educator and writer born in 1926.

• Worked later in the Charity Hospital School of Nursing in Louisiana State University, New York
University, and the University of Mississippi
• Travelbee died in 1973 at the age of 47.
• Some of Joyce Travelbee’s works include:
1. Travelbee’s Intervention in Psychiatric Nursing:
A One-To One Relationship
2. Interpersonal Aspects of Nursing
3. Intervention in Psychiatric Nursing:
Process in the One-To One Relationship

HUMAN TO HUMAN RELATIONSHIP MODEL

PATRICIA BENNER

“Nursing is concerned with social sensient body that dwells infinite human worlds; that gets sick and
recovers; that is altered during illness, pain, and suffering; and that engage with the world differently
upon recovery”

—BENNER, 1999, FROM NOVICE TO EXPERT MODEL

THEORIST BACKGROUND

BACKGROUND: PATRICIA BENNER

 She earned her bachelor of arts degree in nursing from

Pasadena College in 1964.

 She obtained her master of science degree in medical-

surgical nursing from the University of California at San
Francisco in 1970

 Ph.D. from the University of California at Berkeley in 1982.

 She became an Associate professor at University of

California, San Francisco.

 She has published 9 books including From Novice to Expert,

Nursing Pathways for Patient Safety and The Primacy of
Caring.

 Book of The Year Award from AJN (American Journal of Nursing) 4 times awardee.

 Linda Richards Award for Leadership and Excellence in Nursing Research/Education Award.

NOVICE TO EXPERT MODEL

What is NOVICE TO EXPERT MODEL?

Patricia Benner developed a concept known as “From

Novice to Expert.” This concept explains that nurses
develop skills and an understanding of patient care over
time from a combination of a strong educational foundation
and personal experiences.

It is also known as Benner’s Stages of Clinical Competence

and was adapted from the Dreyfus Model of Skill
Acquisition.
1. NOVICE

The person has no background experience of the situation in which he or she is

involved.

A novice is a beginner with no experience. They are taught general rules to

help perform tasks, and their rule-governed behavior is limited and inflexible.

Novices have a very limited ability to predict what might happen in a particular
patient situation.

This would be a nursing student in his or her first year of clinical education; behavior in the clinical
setting is very limited and inflexible.

2. ADVANCE BEGINNER

This is when the person can demonstrate marginally acceptable

performance, coped with enough real situations to note, or to
have to have pointed out by a mentor, the recurring meaningful
components of the situation.

Nurses functioning at this level still requires mentor of

experienced nurse to assist with defining situations, to set
priorities, and to integrate practical knowledge. (English, 1993)

Those are the new grads in their first jobs; nurses have had more experiences that enable them to
recognize recurrent, meaningful components of a situation. They have the knowledge and the know-
how but not enough in-depth experience.

3. COMPETENT

These nurses lack the speed and flexibility of proficient nurses, but they
have some mastery and can rely on advance planning and organizational
skills.

Competent nurses recognize patterns and nature of clinical situations

more quickly and accurately than advanced beginners.

Anxiety. They feel exhilarated when they perform well and feel remorse when
they recognize they could have been more effective. These emotional
responses are the formative stages of aesthetic appreciation of good practice.
4. PROFICIENT

The nurse possesses a deep understanding of situations as they occur,

less conscious planning is necessary, critical thinking and decision-
making skills have developed. (Frisch, 2009)

At this level, nurses are capable to see situations as “wholes” rather than
parts. Proficient nurses learn from experience what events typically
occur and are able to modify plans in response to different events.

Nurses at this level, no longer rely on preset goals for organization, and
they demonstrate increased confidence in their knowledge and abilities.

5. EXPERT

This stage is achieved after five years of greater in the same area of
nursing. The expert performer no longer rely on analytical principle (i.e.
rule, guideline, maxim) to connect an understanding of the situation to
an appropriate action.

The expert nurse, with an enormous background of experience, now has

an intuitive grasp of each situation. They are able to identify the
problem without losing time because of the range of alternative
diagnoses and solutions.

KEY ASPECTS OF EXPERT PRACTICE:

• Demonstrating a clinical grasp and resource-based practice

• Possessing the embodied know-how

• Seeing the big picture

• Seeing the unexpected

Expert nurses’ performances are fluid, flexible, and highly-proficient. Benner’s writings explain that
nursing skills through experience are a prerequisite for becoming an expert nurse.

The different levels of skills acquisition show changes in the three aspects of skilled performance:
movement from relying on abstract principles to using past experiences to guide actions; change in the
learner’s perception of situations as whole parts rather than separate pieces; and passage from a
detached observer to an involved performer, engaged in the situation rather than simply outside of it.
METAPARADIGM

1. NURSING

“Nursing as enabling condition of connection and concern”-(Marriner-Tomey, p192)

She viewed nursing practice as the care and study of the lived experience of health, illness and disease
and the relationship among these three elements.

2. PERSON

“Self-interpreting being, that is, the person does not come into the world predefined but gets defined in
the course of living a life. A person also has an effortless and non-reflective understanding for the self in
the world. The person is viewed as the participant in common meanings”

– (Tomey,2002 p173)

Major Aspects of understanding that

the person must deal:

The role of the situation

The role of the body

The role of personal concerns

The role of temporarility

3. HEALTH

Brenner focused

“on the lived experience of being healthy and ill.”

She defined health as what can be assessed, while well-being is the human experience of health
or wholeness.

4. ENVIRONMENT

Instead of using the term “environment”, Benner used the term “situation”, because it suggests a social
environment with social meaning and definition.

She used the phenomenological terms of being situated and situated meaning, which are
defined by the person’s engaged interaction, interpretation and understanding of the situation.
DOROTHY JOHNSON

Background of Dorothy Johnson

 born on August 21, 1919 in Savannah, Georgia

 well-known for her "Behavioral System Model," which

was first proposed in 1968 -1938, received her associate
degree from Armstrong Junior College in Savannah,
Georgia

 1942, she received her Bachelor of Science degree in

nursing from Vanderbilt University

 1943 - 1944, She was a staff nurse at the Chatham

Savannah Health Council

 1955 and 1956, Johnson was a pediatric nurse assigned to

the Christian Medical College School of Nursing in Vellore,
South India.

 1965-1967, she served as chairperson on the committee of the California Nurses Association

 She was an instructor and assistant professor in pediatric nursing at Vanderbilt University
School of Nursing.

 Johnson was an assistant professor of pediatric nursing, an associate professor of nursing, and a
professor of Nursing at the University of California in Los Angeles.

 In 1981,Vanderbilt University School of Nursing presented her with the Award for Excellence in
Nursing.

 She was also given the Lulu Hassenplug Nurses Distinguished Achievement Award (1977) from
the California Nurses Association.

 Johnson passed away in February 1999 at the age of 80.

MAJOR CONCEPTS AND IMPORTANT PRINCIPLES

 Behavior — the output of intraorganismic structures and processes as they are coordinated and
articulated by and responsive to changes in sensory stimulation.

 System - using Rapport's 1968 definition of system, Johnson defined system as a whole that
functions as a whole by virtue of the interdependence of its parts.

 Behavioral system - encompasses the pattered, repetitive, and purposeful ways of behaving.
  Subsystems - a mini system maintained in relationship to the entire system when it or the
environment is not disturbed.

CONTENT OF THE THEORY

 Johnson's model was greatly influenced by Florence Nightingale's book, Notes on Nursing.

 She used work of behavioral scientists in psychology sociology, and ethnology to develop her
theory.

 Began with the premise that nursing was a profession that made a distinctive of society.

 Its strength is the consistent integration of concepts defining behavioral systems drawn from
general systems theory.

 She wrote that nursing contributes by facilitating effective behavioral functioning in the patient
before, during and after the illness

BEHAVIORAL SYSTEM

 The model advocates the fostering of efficient and effective behavioral functioning in the
patient to prevent illness.

 The patient is defined as a behavioral system composed of seven behavioral subsystems.

 The nurse's role is to help the patient maintain his or her equilibrium.

 Johnson's theory defines health as a purposeful adaptive response to internal and external
stimuli in order to maintain stability and comfort. The main goal of nursing is to foster
equilibrium within the individual patient. The practice of nursing is concerned with the
organized and integrated whole, but maintaining a balance in the behavior system when illness
occurs is the major focus of the career.

 The nursing process of the Behavior System Model of Nursing begins with an assessment and
diagnosis of the patient. Once a diagnosis is made, the nurse and other healthcare professionals
develop a nursing care plan of interventions and setting them in motion. The process ends with
an evaluation, which is based on the balance of the subsystems.
JOHNSON’S BEHAVIORAL SYSTEM MODEL:

 Attachment-Affiliative Subsystem — most critical because it forms the basis for all social
organization and provides survival and security.

 Dependency Subsystem - promotes helping behavior that call for a nurturing response.

 Ingestive Subsystem — has to do with when, how, what, how much, and under what conditions
we eat.

 Eliminative Subsystem — addresses when, how, and under what conditions we eliminate.

 Sexual Subsystem — has the dual functions of procreation and gratification.

 Achievement Subsystem — attempts to manipulate the environment. Areas of achievement

include intellectual, physical, creative, mechanical, and social skills.

 Aggressive-Protective Subsystem — function is protection and preservation.

  Equilibrium — a stabilized but transitory, resting state in which the individual is in harmony
with himself and with his environment (Johnson, 1961)

 Functional Requirements and Sustainable Imperatives — is needed for the subsystems to

develop and maintain stability

 Requlation/ControI - implies that deviations will be detected and corrected

 Tension - the state of being strained and can be viewed as the end-product of a disturbance in
equilibrium

 Stressor— internal or external stimuli that produce tension and result in a degree of instability

METAPARADIGM OF THE THEORY

 Nursing - an external regulatory force which acts to preserve the organization and integration of
the patient's behavior at an optimal level under those conditions in which behavior constitutes
a threat to physical or social health, or in which illness is found

 Person - a behavioral system with patterned, repetitive, and purposeful ways of behaving link
person with the environment

 Health elusive - dynamic state influenced by biological. psychological, and social factors

 Environment — consists of all the factors that are not part of the individual's behavioral system,
but that influence the system

APPLICABILITY

 Johnson's theory could help guide the future of nursing theories, models, research, and
education. By focusing on behavioral rather than biology, the theory clearly differentiates
nursing from medicine. Focusing on behavioral (instead of just biological) works. It can be an
asset and that has been proven by Johnson and some of her followers. In order to focus on the
holistic idea of nursing, it is important to think of the behavioral and biological together as
health. We cannot look at one without looking at the other.
Sister Callista L. Roy
Adaptation Model

Background of Sister Callista L. Roy

 Born in Los Angeles, California on October 14, 1939 as the 2nd child of Mr. and Mrs. Fabien Roy.

 She entered the Sisters of Saint Joseph Carondelet.

 She earned a Bachelor of Arts with Major in Nursing from Mount St. Mary’s College, Los Angeles
in 1963 and joined the faculty in 1966.

 She is also a nurse theorist and a professor at the William F. Connell School of Nursing at Boston
College, Massachusetts.

 She worked with Dorothy E. Johnson, an another Nursing theorist who focused in the discipline
of nursing.

 She is best known for her work on the Roy Adaptation Model of Nursing.

Overiview on Roy’s Adaptation Model

(RAM)

 The Ram provides a useful framework for providing nursing care for persons in health and in
acute, chronic and terminal illness.

 The environment is the source of a variety of stimuli that either threaten or promote the
person’s unique wholeness.

 Roy categorizes environmental stimuli as Focal, Contextual or Residual.

Categories of Stimuli Adaptation Model

1. Focal Stimuli
 Those most immediate confronting the person, it attracts the most attention.
 It is the internal or external stimulus most immediately challenging the person’s
adaptation.
 The focal stimulus is the phenomenon that attracts the most of one’s attention
2. Contextual Stimuli
 All other stimuli that strengthens the effect of the focal stimulus.
 Are all other stimuli existing in a situation that strengthens the effect of the focal
stimulus.
 Environmental Stressors (Stimuli)

Focal Contextual
Physiologic Demographic &
stress other data
Health
promotion
activities
3. Residual Stimuli

 Those stimuli that can affect the focal stimulus but the effects are unclear.

 Are any other phenomena arising from a person’s internal or external environment that may
affect the focal stimulus but whose effects are unclear.

Control Processes
Adaptation Model

 These coincide with the regulator and cognator subsystem when a person responds to a
stimulus

Types of Control Process

1. Stabilizer subsystem

Refers to the established structures, values, and daily activities whereby participants accomplish
the primary purpose of the group and contribute to common purpose of society (Roy and
Andrew, 1999).

2. Innovator Subsystem

Refers to the cognitive and emotional strategies that allow a person to change to higher levels
of potential(Roy and Andrew, 1999).
Roy’s Adaptation model

Coping Process

 Not possible to directly observe the functioning of theses systems

 Behaviours can be observed in 4 adaptive modes

effector

 Physiological-physical
 Self-concept-group identity
 Role function
 interdependence
3.1 physiological-physical mode

Physi ol ogi cal mode Physi cal mode

Indi v i dual Gr oup

Physiologic Group manifest at ion

act ivit ies of adapt at ion

PHYSIOLOGICAL-PHYSICAL MODE

• Five basis needs – oxygenation, nutrition, elimination, activity and rest, protection.

• Four complex processes – senses; fluid, electrolyte, and acid-base balance; neurologic
function; endocrine function.

• Manifestation of physiologic activities of cells, tissues, organs and systems making up the
body.

• Underlying need is physiological integrity.

3.2 Self concept - group identity mode

Individual
Group

Self-concept Group identity

 Self-concept mode

• Composite of beliefs and feelings that a person holds about him or

herself at a given time.

• 2 aspects - physical self and personal self

Physical self

Body sensation Body image

Self-consistency

Personal - self Self-ideal

Moral-ethical-spiritual self
Self concept - group identity mode

• Need is psychic and spiritual integrity

group identity mode

• Inter-personal relationships, group self-image, social milieu, culture, shared responsibility of the
group.

Identity integrity – underlying need

3.3 role function mode

• Need is social integrity - knowing who one is in relation to others so one can act

• Role set is the complex of positions individual holds.

• Role classification: Primary, Secondary, Tertiary

ROLE FUNCTION - GROUP

• Involves role development, instrumental and expressive behaviours, and role taking process

• Role transition

• Role of person in a society and role within a group.

3.4 interdependence mode

• Need is to achieve relational integrity

• Using process of affectional adequacy, i.e., the giving and receiving of love, respect, and value
through effective relations and communication.

• Individual - significant other, support system

• Group - infrastructure and member capability

• Feeling of security in nurturing relationships

 Output

 Four Adaptive Modes

• Physiological
• Self-concept
• Role function
• Interdependence

 Stimuli
• Focal
• Contextual
• Residual

ROY ADAPTATION MODEL

• Roy defines the person as an Adaptive Open System.

• The systems’ Input is:

a. Three classes of stimuli: focal, contextual and residual, within and without the system

b. The systems’ adaptation level or range of stimuli in which responses will be adaptive.

• Inputs are mediated by the systems’ Regulator and Cognator subsystems.

• The system runs into difficulty when coping activity is inadequate as a result of need deficits or
excesses.

• System effectors (body organs that become active with stimulation) are the four modes
(physiological, self-concept, role function and interdependence.

• Output of the person as systems may be adaptive or ineffective.

• Adaptive responses contribute to the goals of the system i.e.; survival, growth promotion,
reproduction and self-mastery.

• Ineffective responses do not contribute to the systems’ goals.

M E T A P A R A D I G M

PERSON HEALTH

ENVIRONMENT NURSING

• Bio-psycho-social being in constant interaction with a change in environment.

• Use innate and acquired mechanism to adapt

• An adaptive system described as a whole comprised of parts

• Includes people as individuals or in groups – families, organizations, communities, and society as

a whole.

• An adaptive system with regulator and cognator subsytems acting

to maintain adaptation in four adaptive modes.

• All condition, circumstances, and influences surrounding and affecting the development and
behaviour of persons and groups with particular consideration of mutuality of person and earth
resources, including focal, contextual and residual stimuli.

• World within and around humans.

• Changing environment stimulates erson to make adaptive responses.

• A state and a process of being and becoming integrated and whole that reflects person and
environment mutuality.

• Inevitable dimension of person’s life

• Viewed as reflection of adaptation

• Represented by a health-illness continuum (earlier)

• A process in which health and illness can co-exist

• To promote adaptation for individuals and groups in the four adaptive modes, thus contributing
to health, quality of life, and dying with dignity by assessing behaviours and factors that
influence adaptive abilities and to enhance environmental factors.

• To promote full-life potential for individuals, families, group AND THE GLOBAL SOCIETY
 PREPARE ME
HOLISTIC NURSING INTERVENTIONS
&
COMPOSURE MODEL

To Nursing... May be able to provide the care that our clients need in maintaining their quality of life
and being instrumental in "birthing" them to external life.
- Dr. Carmencita Abaguin

Background

• Prominent nursing leader in the Philippines

• Studied Masters and Doctoral Degrees in Nursing at the University

of the Philippines

• An expert Medical-surgical Nursing with specialty in Oncologic

Nursing

• Was a Secretary of the College of Nursing in her alma mater

• Was also appointed as Chairman of the Board of Nursing

PREPARE ME

Interventions and the Quality of Life of Advance Progressive Cancer Patients

During the past decade, the incident of cancer has significantly increased not only in the
Philippines but also nationwide. Cancer has been associated with multifaceted issues and concerns
regardless of stages of development. For patients with advanced progressive cancer, these problems are
compounded, thus the need to develop interventions that can address the needs especially those
concerning the ability to be in control and maintaining their integrity.

Basic Assumption and Concepts

PREPARE ME (Holistic Nursing Interventions) are the nursing interventions provided to address
the multi-dimensional problems of cancer patients that can be given in any setting where patient
choose to be confined. This program emphasizes a holistic approach to nursing care. PREPARE ME has
the following components, as follows:

 Presence- Being with another person during the times of need. This includes therapeutic
communication, active listening, and touch.
 Reminisce Therapy- Recall of past experiences, feelings, and thoughts to facilitate adaptation to
present circumstances. - It may be done through the use of music and other relaxation
techniques.
  Values Clarification- Assisting another individual to clarify his own values about health and
illness in order to facilitate effective decision making skills.
- The process of values clarification helps one become what we do and what we feel.
 Prayer
 Relaxation-breathing- Techniques to encourage and elicit 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 patient’s level of
awareness by focusing on an image or thought to facilitate inner sight which helps establish
connection and relationship with God.

Quality of life is a multifaceted construct that encompasses the individual’s capacities and abilities
with an aim of enriching life when it cannot longer be prolonged. This includes proper care of the
body, mind and spirit to maintain integrity of the whole person despite limitations brought by the
present situation. This can be seen with the following dimensions of man such as physical,
psychological, social, religious, level of independence, environmental and spiritual.

Findings & Recommendations

PREPARE ME Interventions are said to be effective in improving the quality of life of cancer
patients. It can also be promisingly introduced to the patients with acute or chronic diseases and those
with prolonged hospital stays.

The utilization of the invention as a basic part of care given to cancer patients is recommended,
as well as the incorporation of the intervention in the basic nursing curriculum in the care of these
patients.

CARMELITA C. DIVINAGRACIA

• Filipino Theorist

• Graduated BSN degree from University of East Ramon

Magsaysay Memorial Medical Center (UERMMMC) in 1962

• Took her Masters and Doctoral degrees in Nursing from the

University of the Philippines Manila College of Nursing (1975
& 2001 respectively)

• Former Dean of UERMMMC and a former President of the

Association of Deans of Philippine Colleges of Nursing
Incorporated (ADPCN, Inc.)

• Has been a clinic nurse, staff nurse, instructor, assistant dean

and dean

• Has been lauded for developing the art and competency of teaching nursing
 • Recipient of the prestigious Anastacia Giron Tupas Award by Philippine Nurses Association (PNA)

• Her love for nursing and her dedication to carve out leading tools for nursing students has been
a commendable and rare field of discipline

COMPOSURE MODEL

Advanced Nurse Practitioners’ Composure Behavior and Patient’s Wellness Outcome

This study aims to determine the effects of composure behavior of the advanced nurse
practitioners on the wellness outcome of the selected cardiac patients. Behavior include; COMpetence,
Presence and prayer, Open-mindedness, Stimulation, Understanding, Relaxation, and Empathy.

• Competence- Refers to an in-depth knowledge and clinical expertise demonstrated in caring

for patients.

• Presence and prayer - Refers to a form of nursing measure which means being with another
person during times of need.

• Open-mindedness - Refers to a form of nursing measure which means being receptive to

new ideas or reason.

• Stimulation - Form of nursing measure demonstrated by means of providing

encouragement that conveys hope and strength, guidance in the form of giving explanation and
supervision.

• Understanding - According to Dr. Divinagracia, it conveys interest and acceptance not

only of patient’s condition but also his entire being.

• Respect - Acknowledging the 31 patient’s presence.

• Relaxation - Entails a from of exercise that involves alternate tension and relaxation of
selected group of muscles.

• Empathy - Senses accurately other person’s inner experience.

Patient Wellness Outcome

- This refers to the perceived wellness of selected orthopedic patients after receiving nursing
care in terms of physiologic and bio behavioral.

Psychological Wellness Outcome

- This refers to the perceived wellness of selected orthopedic patients after receiving nursing
care in terms of vital signs, bone pain sensation, and complete blood count.

Biobehavioral Wellness Outcome

- This refers to the perceived wellness of selected orthopedic patients after receiving nursing
care in terms of physical, intellectual, emotional, and spiritual.
Nursing Process Theory:
Ida Jean Orlando

Objectives

By the end of this topic, you’ll be able to:

 Discuss the Nursing Process Theory

 Describe the major concepts of nursing according to Orlando

 Define the assumptions of Orlando’s theory

 Discuss the proportions of Orlando’s theory

 Explain Orlando’s theory as a framework for nursing practice

 Explain the nursing process and Orlando’s theory

Early life and Education

• IDA JEAN ORLANDO (1926-2007)

• 1947- Received a diploma in nursing from Flower Fifth Avenue Hospital
School of Nursing in New York .
• 1951- Bachelor of Science in Public Health from St. John’s University in
Brooklyn, NY.
• 1954- Master of Arts in Mental Health consultation from Teachers
College, Columbia University.
Nursing Career and Education

During her study:

• Worked as staff nurse in various clinical

nursing positions; OB, MS and ER.
• Became supervisor in general hospital.

• Assistant director of nursing and a teacher of

several courses in the hospital-based school
ofnursing.

After her master:

• 1958-1961: Associate professor
and the director of the graduate
program in mental health and
psychiatric nursing at Yale
University foe eight years.
Nursing Career and Education
• 1961- Her first book,
“The Dynamic Nurse-Patient Relationship: Function, Process and Principles of Professional Nursing
Practice”
- The ideas in this book provided the foundation for Orlando’s theory of deliberative process.
• 1962- Clinical Nursing Consultant at McLean Hospital in Belmont, Massachusetts.
• 1972- her second book; “The Discipline and Teaching of Nursing Process: An Evaluation Study”
• 1987- Assistant director of Nursing for Education and Research at Metropolitan State Hospital.
• 1992- Retired from Nursing and received the “Nursing Living Legend” awarded by the
Massachusetts Registered Nurse Association.

Overview of Orlando’s Nursing Process

• This theory stresses the reciprocal relationship between patient and nurse.
• What the nurse and patient say and do affects them both.
• The function of the professional nurse is to discover and meet the patient’s immediate need for
help.
• The theory focuses on how to produce improvement in the patient’s behavior.

Major concepts of Nursing/Metaparadigm

Assumptions
Propositions
 Patient’s presenting behavior and the presence of patient distress.
 Using of Orlando’s distinct nursing function and the nurse’s ability to identify the problem.
 The more competent in immediate reaction, the more apt to find out the nature of distress.
 Nurse’s immediate reaction lessen the patient distress.
 Using deliberative nursing process is less costly than personal responses.
Critique of Orlando’s Theory
 Developed inductively and is logical and applicable to nursing practice.
 Simple because it contains few concepts and relationships.
 Internally consistent and meet the criteria for testability for a middle range theory.
 One of the most effective practice theories and especially helpful to new nurses as they begin
practice.

Orlando’s theory as a Framework for nursing practice

5 Interrelated concepts:
 The organizing principle or professional nursing function.
 The problematic situation or the patient’s presenting behavior.
 The internal response or immediate reaction.
 Reflective inquiry or deliberative nursing process.
 Resolution or improvement.
Case Study

Mrs. Laila is a 45 years old patient in surgical ward in Saqer Hospital. She is asking the nurse for
analgesic. The nurse ask her about pain score and Mrs. Laila states it 7 out of 10.
The nurse asked her if there is anything annoying her beside her pain. The patient cried and said that
she is thinking about her kids in home. The nurse suggested to call them which the Patient consider it a
good idea. She called them and thanked the nurse and said that she is not in need for analgesics
anymore.

Analysis of the previous case

 Nurse will focus on the patient. Her mind should be free of distracting thoughts.
 The nurse recognizes cues that the patient problem may exist before the next step of the
process. She identifies immediate perception thoughts, and feelings.
 the nurse share with the patient and confirm the problem.
 together with patient, they make the plan.
 The nurse helped the patient in implementation.
 The evaluation is if the need for help met.

Summary
 Background of Orlando
 Overview of the nursing process theory
 The major concepts nursing according to Orlando
 Assumptions of Orlando’s theory
 Propositions of Orlando’s theory
 Orlando’s theory as a framework for nursing practice
 The nursing process and Orlando’s theory

Conclusion
 Orlando’s Theory remains on of the most effective practice theories available which stresses the
reciprocal relationship between the patient and the nurse
References
 Kathleen Masters. 2nd edition(2015). Nursing Theories A Framework For Professional Practice.
Jones & Bartlett Learning.
Sister Letty Kuan
Retirement and Role Discontinuity Theory

Theorist Background
• Born on November 19, 1936 in Katipunan Dipolog, Zamboanga
del Norte
• Kuan is a holder of Doctoral Degree in Education and Master's
Degree in Nursing and Guidance Counseling.
• SPECIALIZATION:
⚬ NEUROPSYCHOLOGY - Salpetriere Hospital (France)
⚬ NEUROGERONTOLOGY - Good Samaritan Hospital (New
York)
• For her vast contributions to the University of the Philippines -
College of Nursing faculty and academic achievements, she was
awarded the distinctive post of Professor Emeritus, a title
awarded only to a few who met the strict criteria set by the
University of the Philippines in September 2004.
• She authored several books giving her insight in the areas of Gerontology, Care of Older Persons
and Bioethics.
• She is a recipient of the Metrobank Foundation Outstanding Teachers Award in 1995 and an Award
for Continuing Integrity and Excellence in Service (ACIES) in 2004.
• Her religious community is the Notre Dame de Vie founded in France in 1932.
• As a former member of the Board of Nursing, her legacy to the Nursing Community is without a
doubt, indisputable.
• She authored several books that dwells around Gerontology, Care of Older Persons and Bioethics
• AUTHOR:
⚬ CONCEPTS OF ILLNESS AND HEALTH CARE INTERVENTION IN AN URBAN COMMUNITY
• QUEZON CITY, 1975
⚬ UNDERSTANDING THE FILIPINO ELDERLY: A TEXTBOOK FOR NURSES AND RELATED HEALTH
PROFESSIONAL
• Dipolog City, Jesus D. Kuan Foundation, 1993
• AUTHOR:
⚬ ESSENCE OF CARING
• National Teacher Training Center for the Health Professions, University of the Philippines Manila,
Learning Resources Unit, 1993
⚬ PAG-AARUGA SA MGA TAONG MAY EDAD NA
• Quezon City: UP-KAT, 1998
⚬ BIOETHICS IN NURSING
• Manila: Educational Publication House, 2006
Retirement and Role Discontinuity Model

Kuan's Retirement and Role Discontinuity Model is for the purpose of knowing the reasons and
variables on how to make people happy at retirement by conceptualizing a framework and it
emphasizes that without positive acquisitions during childhood, the person (patient) will be "in a
pathological state" to delinquency

Basic Assumptions and Concepts

Physiological Age
refers to the endurance of cells and tissues to withstand wear-and-tear phenomenon of the human
body.
Role
refers to the set of shared expectations focused upon a particular position. These may include beliefs
about what goals or values the position incumbent is to pursue and the norms that will govern his
behavior.

Change of Life
is the period between near retirement and post retirement years.

Retiree
An individual who has left the position occupied for the past years of productive life because he/she has
reached prescribed retirement age.

Role Discontinuity
The interruption in the line of status enjoyed or role performed.

Coping Approaches
The interventions or measures applied to solve a problematic situation or state in order to restore or
maintain equilibrium and normal functioning

Determinants of positive perceptions in retirement and positive reactions toward role discontinuities:

Health Status
refer to physiological and mental state of the respondents, classified as either sickly or healthy.

Income
refers to the financial affluence of the respondent which can be classified as poor, moderate or rich.

Work Status
refers to individual's work status.
Family Constellation
means the type of family composition described either close knit or extended family where three more
generations of family members live under one roof; or distanced family, whose member live in separate
dwelling units; or nuclear type of family where only husband, wife and children live together.

Self Preparation
refers to the preparation of oneself for a possible outcome of a certain situation or event.