TFN Transes M1 M7

LESSON / FIRST SEMESTER 2nd BLOCK
M1 LESSON 1: Course
Introduction
• Identify the non-nursing theories on the development
of a nursing theory.
• Identifies the health needs of the clients (individuals,
families, group, and community) in given situations or
settings. • This course deals with the meta concepts of a person,
• Identify and discuss the significance of nursing health, environment and nursing as viewed by the
theories to nursing education, research and clinical different theorists.
practice. • Likewise, it includes non-nursing theories such as
• Discuss the current BSN Curriculum systems, developmental and change theories.
• Differentiate philosophies, theories and conceptual • It presents how these concepts and theories serve as
models for Nursing according to the metaparadigm of guide to nursing practice.
nursing. • It further deals with health as a multifactorial
• Trace the historical development of Nursing theory phenomenon and the necessary core competencies
• Discuss the overview of patient safety including that the nurse needs to develop.
common terms, history and the model of patient • Lesson 1 focuses on the Course Introduction and the
safety. relevant information which is essential in your nursing
• Apply “patient-safety thinking” in their day to day education journey. This includes exploring key
activity. concepts about the course, its learning outcomes as
well as some relevant reminders.
• Make use of effective interviewing skills, use of on-
line literature and studies in identifying the emerging
local models of nursing interventions and their
relevance to the nursing practice.
• Determine own learning needs, personal and
professional goals and aspirations.
• Demonstrates consistently the core values of nursing
which includes the Love of GOD, Caring, Love of
• Has successfully completed a recognized and
People, and Love of Country.
approved nursing education program in the country
where the qualification was achieved;
• Has acquired the necessary requirements to be
registered to practice nursing in this jurisdiction and
use the title ‘registered nurse’;
• Demonstrates and maintains competency in the
practice of nursing.
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An individual nurse’s scope of practice is dynamic – that is,

it will change and grow as they progress in their career.
o The scope of nursing practice is the range of roles,
The scope of practice of the individual nurse is influenced by a
functions, responsibilities, and activities which a
number of factors, including:
registered nurse is educated, competent, and has
authority to perform.
o The nurse's educational preparation, professional
o Nursing practice is underpinned by values that guide
practice, and competence.
the way in which nursing care is provided.
o Local, national, and international guidelines, policies,
and evidence.
o The practice setting.
o Collaborative practice.
o Other factors, such as patient safety, patient needs,
1. In making decisions about their individual scope of and care outcomes.
practice; nurses should keep to the fore the rights,
needs, and overall benefit to the patient and the
importance of promoting and maintaining the
highest standards of quality in the health services. M1 LESSON 2: Nursing Core
2. Nurses respect all people equally without
discriminating on the grounds of age, gender, race, Values and Outcomes
ethnicity, religion, civil status, family status, sexual
orientation, disability (physical, mental or
Based Education
intellectual), or membership of the Traveller
community.
3. Fundamental to nursing practice is the therapeutic • This module explores the relevant values held by the
relationship between the nurse and the patient that nurses and the nursing profession as well as the
is based on open communication, trust, framework for Nursing Education.
understanding, compassion, and kindness, and
serves to empower the patient to make life
choices.
4. The nursing practice involves advocacy for the
rights of the individual patient and for their family. It
also involves advocacy on behalf of nursing 1. Love of God and Country
practice in organizational and management 2. Caring
structures within nursing. 3. Quality and Excellence
5. Nurses recognize their role in delegating care 4. Integrity
appropriately and providing supervision to junior 5. Collaboration
colleagues and other health care workers, where
required.
6. Nursing care combines art and science. Nursing
care is holistic in nature, grounded in an
understanding of the social, emotional, cultural,
spiritual, psychological, and physical experiences
of patients, and is based upon the best available 1. Cognitive
research and experiential evidence. 2. Pscyhomotor
7. Nursing practice must always be based on the 3. Affective
principles of professional conduct stated in the
latest edition of the Code of Professional Conduct
and Ethics for Registered Nurses.
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Analysis Synthesis
– Def: Def:
• Considered as a strategy or direction in Nursing to O Understands O Formulates new

meet the Philippine Education Quality Assurance both the content structures from
Standards set by the government. and structure of existing knowledge
material. and skills.
• It entails that classroom learning into lifelong learning.
Sample Verbs: Sample Verbs:

COGNITIVE DOMAIN -analyze -combine
-categorize Evaluation -develop
Thinking | knowledge
-evaluate Def: -generate
Application -interpret -plan
Knowledge
Def: -justify O Judges the value -construct
Def:
-select of material for a -design
O Remembers O Uses learning in -support given purpose. -propose
previously learned new and concrete
material. situations (higher Sample Verbs:
level of -assess
Sample Verbs: understanding.) -conclude
-define -interpret
-identify Sample Verbs: -justify
Comprehension
-label -apply -select
Def:
-list -carry out -support
-name -demonstrate
O grasps the
-recall -prepare
meaning of
-state -solve
material. (lowest
-use
level of
understanding.)
Sample Verbs:
-describe
-discuss
-explain
-locate
-paraphrase
-translate
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Organization
AFFECTIVE DOMAIN
Def:
FEELING | ATTITUDE O Conceptualize the value and resolves conflict
between it and other values. Internalizing
Receiving Valuing Def:
Def: Sample Verbs:
Def: O Integrates the value into a value
-adapt
system that controls behaviour.
O Attaches value or -adjust
O Selectively attends
worth something. -arrange
to stimuli. Responding Sample Verbs:
-balance
Def: -classify -act upon -support
-conceptualize -advocate
-accept -adopt
O Responds to -formulate -defend
-acknowledge -assume
stimuli. -group -exemplify
-be aware responsibility
-behave according -organize -influence
-listen Sample Verbs:
to -rank -justify behaviour
-notice -agree to
-choose -theorize -maintain
-pay attention -answer freely
-tolerate -commit -serve
-assist
-desire
-care for
-exhibit loyalty
-communicate
-express
-comply
-initiate
-conform PSYCHOMOTOR DOMAIN
-prefer
-contribute
-seek DOING | SKILLS
-cooperate
-use resources to
-follow Adaption Organization
-obey Def: Def:
-participate willingly o Adapts skill sets to o Creates new patterns
-read voluntarily meet a problem situation. for specific situations.
-respond
-adapt -reorganize -design -originate
-after -revise -combine -compose
-change -construct
Guided Response
Def:
o Imitates and practices skills, often in discrete steps.
Sample Verbs:
-copy -duplicate -imitate -manipulate with
-guidance -practice -try -operate with
-repeat -supervision
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Complete Overt Response Set BASIS OF PROGRAM GOALS:

Def: Def: NNCCS
5 responsibilities:
o Performs automatically. o Is mentally, - For each responsibility there are specific indicators
emotionally, and
Sample Verbs: physically ready to act. 6 responsibilities
-act habitually -control - With specific indicators
-advance with -direct Sample Verbs:
3 responsibilities
-assurance -excel -achieve a posture
- With specific indicators
-guide -manage --assume a body
-master -organize -establish a body
-perfect -proceed position
-maintain efficiently -sit, stand, station
-position the body
Mechanism Perception
Def: Def: COMPETENCY OUTCOME
o Performs acts with o Senses cues that A general statement A very specific statement
increasing confidence and guide motor activity. detailing the desired that describes exactly what
knowledge and skills of a student will be able to do
proficiency.
student graduating from our in some measurable way.
Sample Verbs: course or program.
Sample verbs: -detect -view
-complete with -hear -watch
-confidence -pace -listen
-conduct -make -see
-demonstrate -produce -observe
-execute -perceive
-improve efficiency -sense
-increase speed -smell
-show dexterity -taste
’ ’
’
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INTRODUCTION:
DIFFERENT VIEWS ON
NON-NURSING THEORIES Environmentalism: -The human being is an
empty organism at birth.
British Empiricism -The human being is
• While caring for patient nurses often learns and uses
Behaviourism passive, and development is
nursing theory as a great resource. However, there Cultural Anthropology totally achieved by
are other theories that is considered not specific for experiencing the
nurses but is able to provide valuable and useable environment.
information to contribute for the betterment of the -The adults role is to shape
Nursing profession. the child according to
• The different Non- Nursing Theories can serve as the socially accepted standards
of behaviour.
backbone of the Nursing Theories. They serve the
purpose of providing information on how Nursing
theories develop. The understanding of the non- Organismic: -The Human being is active
nursing theories will aid in better understanding of the in determining its own
different nursing theories that will be discussed in this Naturalism course of development.
course. Maturationism
Cognitive Developmental -Interaction occurs between
Theory organism and environment
Humanism so that both are involved in
Ethology varying degrees in process
Moral Developmental of development.
Theory
▪ Identify the non-nursing theories on the development
of a nursing theory practice
▪ Describe the non-nursing theories. -The human being is not
▪ Identify the importance of the non-nursing theories in Psychaanalytic rational but is governed by
the Nursing profession. Psychoanalysis emotion or appetite.
-Development is being
M2 LESSON 1: process of continuous
DEVELOPMENTAL THEORY compromise between the
individuals needs and
society’s expectations.
3 theoretical perspectives:
1. Environmentalism
2. Organismic Perspective
3. Psychoanalytic Perspective
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ENVIRONMENTALISM
Howard and Tracey Lendler (1950’s-1960s) discovered
developmental differences in the ways children and adults
The view emphasizes that people grow to what they are made learn and solve problems in laboratory settings. They repeat
to be by their environments. rewarded behaviors and delete behaviors that are not
rewarded.
• British Empiricism
• Behaviorism
• Cultural Anthropology
Margaret Mead (1901-1978) and Ruth Benedict (1887-1948)

emphasized the experiential factors in development and
claimed that different patterns of child rearing that reflect
The origin of modern environmentalist perspectives can be diverse cultural values would result in a considerable variety of
traced to the ideas of John Locke (1632-1704) who believed adult characteristics.
that the human mind is a “Blank Slate” at birth, and that all
knowledge of the world comes to us through our senses.
Children are uncivilized creatures who need adults to shape ORGANISMIC PERSPECTIVE
them into everything they will eventually become.
Stress the importance of factors within the organism itself.

People grow to what they make of themselves to be rather
than what the environment makes them.
John B. Watson (1878-1958) believed that the only way to

• Naturalism
understand the human organism is through objective
• Maturationism
observation of behaviors. For him, environmental experiences
• Cognitive Development Theory
imposes itself on the person through principles of conditioning
• Humanism
and reinforcement. The only behavior worth studying is
learned behavior. • Ethology
• Moral Development Theory
B.F. Skinner defined operant conditioning as a learning
process that depends on reward and punishment. He also
talked about the principle of reinforcement. According to
Skinner, reinforcement or the perceived consequences of
behavior, influences the frequency with which the behavior
Jean Jacques Rousseau’s (1712-1778) philosophy stresses
occurs.
that children are innately good unless corrupted by society’s
evils. There are five stages that corresponds to the evolution of
Albert Bandura (1960s) developed the perspective known as
human nature.
social learning and the key concept is that development is
guided by the initiation or avoidance of behavior that is • Animal feelings of pleasure & pain
modeled by other people. By observing the consequences of (0-5 yrs)
someone else’s action, people could learn how to brush their • Savage sensory awareness
teeth or how to ride a bicycle. (5-12 yrs)
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Thinking is more socialize

and logical; with increased
CONCRETE OPERATION intellectual and conceptual
• Rational functioning and exploration
(7-11 years) development; begins
(12-15 yrs) problem solving by use of
• Emotional and Social interests inductive reasoning and
(15-20 yrs) logical thought.
• Spiritual maturity during adulthood
LOGICALLY SOLVES all

types of problems; thinks
FORMAL OPERATION SCIENTIFICALLY; solves
(11 years – above) COMPLEX problems;
COGNITIVE structures
Hall believed that the individual development of a child repeats mature.
the phases of human evolution and describes adolescence as
a period of “storm & stress” corresponding to a turbulent state
of western civilization.
Gesell emphasized internal biological factors in development

virtually ignoring the role of the environment. He advocated the
“Normative Tradition” of developmental analysis Focus on the dignity and freedom of all individuals. Humanists
like Abraham Maslow (1890-1970), Charlotte Buhler (1893-
1974) and Carl Rogers (1902-1988) rejected the view of
human nature that emphasizes environmental control and
observable actions. Instead, they stressed internal factors and
self-perception.
Emphasizes internal mental processes and their interactions
with the environment.
Cognitive developmentalists like Jean Piaget (1896-1980)

attempt to explain how the individual thinks and how human
processes vary.
Infant develops physically

with a gradually increase in
the ability to think and use
SENSORIMOTOR language; progresses from
(0-2 years) simple reflex responses to
repetitive behaviors to
deliberate and imaginative
activity. Fulfillment of unique potential
Self-esteem and respect; prestige
Child begins to understand Giving and receiving affection; companionship; group
PRE-OPERATIONAL relationships and develops identification
(2-7 years) basic conceptual thought Avoiding harm; security; and physical safety
stage. Biological needs for oxygen, water, food, sleep, sex
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DESCRIPTION OF MASLOW’S • The theory provides the blueprint for prioritizing client
HERARCHY OF NEEDS care according to a hierarchy of needs (McEwen &
Wills, 2007)
Maslow’s theory is based on the idea that some

needs, physical as well as psychological take
precedence over others
The needs are placed in a pyramid with the most Lawrence Kohlberg suggested that some people reach a
important making the base post-conventional level of moral thinking where they think in
terms of universal ethical principles which take priority over
If the basic needs are not met, the base of the society’s laws and values.
pyramid is not formed and the rest of the needs are
not achieved.
The first levels of needs are the deficiency needs,

’
those that if not met cause a deficiency, or lack that LEVEL 1 PRECONVENTIONAL LEVEL
motivates a person to strive to achieve the need. Stage 1 Punishment and Obedience
Orientation
“I must follow the rules otherwise I
The fifth level, the actualization level, is a growth will be punished.”
level. Stage 2 Instrumental Relativist Orientation
“I must follow the rules for the
Few people ever reach the growth level and spend reward and favor it gives.”
their lives going up and down the pyramid meeting LEVEL 2 CONVENTIONAL LEVEL
the lower level needs. Stage 3 Good-Boy-Nice-Girl Orientation
“I must follow rules so I will be
accepted.”
Stage 4 Society-Maintaining Orientation
“I must follow rules so there is
order in the society.”
Maslow’s hierarchy of needs is easily applied to nursing practice
LEVEL 3 POST CONVENTIONAL LEVEL
Stage 5 Social Contract reorientation
• The theory focuses on human potential, “gives hope a “I must follow rules as there are
chance. reasonable laws for it.”
• The theory allows the nurse to highlight the person’s Stage 6 Universal Ethical Principle
strengths instead of focusing on one’s deficits Orientation
“I must follow rules because my
(McEwen & Wills, 2007).
conscience tells me.”
• Basic needs such as air, food, drink and warmth, are
the basic needs of human survival and health.
• Safety, be it with ambulation or in taking medication,
is very important to nursing.
• Social needs are met with visiting hours and through
the nurse-patient (care giver) relationship.
• Esteem and self-actualization may or may not be met
in the hospital setting
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PHASES AGE RANGES DEVELOPMENTAL

FOCUS
Mouth is the major site of

• Describe human behavior / development in real life tension and gratification
settings. Oral Birth-18months including biting and sucking
• Recognize the importance of Human being’s living in activities. ID is present at
harmony with their environment. birth.
Anus and surrounding area
• Primary concern is the role of human behavior in the
are major source of
survival of human species. Anal 1 1/2years- interest. Voluntary
3yrs sphincter control is the
The contribution of ethology to the study of human goal. Ego develops
development centers on the suggestion that human as well as gradually.
lower animal behavior may have biological origins. Phallic 3 – 5 years Genital is the focus.
Penis envy & Elektra
Complex (girls).
Castration fear & Oedipus
Complex (boys).
Latency 5-11 extended Complexes are resolved.
to 13 years Genital focus is turned to
Focus on the underlying forces that motivate behavior. social activities.
Sigmund Freud described a series of psychosexual stages in Genital 11-13 over Development of biologic
which gratification shifts from one body zone to another and lapping with capacity for orgasm. Starts
the child’s maturational level determines when the shifts will previous to appreciate capacity for
occur. True Intimacy.
Erik Erickson described eight stages of psychosocial

development between infancy and old age. Each stage
-Sexual and Aggressive drive involves the resolution of a particular crisis, achieving balance
-Inborn between extremes and crisis emerges according to
ID -Operates on pleasure principle maturationally based time table.
-Primary thinking process: Imagery
-Irrational and not based on reality
-Chief executive officer Virtue DEVELOPMENTAL DEVELOPMENTAL

-Operates on reality principle STAGE TASK
-Secondary thinking process: logical and
Viewing the world as
reality-oriented
safe and reliable;
EGO -Major functions: adaption to reality,
Drive and Trust vs. Mistrust relationships as
modulation of anxiety, problem solving,
hope nurturing, stable, and
control and regulates instinctual dives. Use
dependable.
Reality Testing and Defense Mechanism.
CONSCIENC, punishes one for something

Self-control Automony vs. Achieving a sense of
SUPEREGO wrong that was done. EGO-Ideal, rewards
& will power Shame/ Doubt control and free will.
one for something good that was done.
Residue of internalized values and moral
training of early childhood.
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Beginning
development of a • General Systems Theory: There are parallels found
Direction & Initiative vs. Guilt conscience; learning in different scientific disciplines; certain principles
Purpose to manage conflict
which are common to all systems and by identifying
and anxiety.
these common elements hopefully knowledge
Emerging confidence generated in different disciplines to be combined. A
Methods & Industry vs. in own abilities; systems approach facilitates understanding of
Competence Inferiority taking pleasures in complex phenomenon by encouraging clustering of
accomplishments. information and clarification of relationships between
different elements
Devotion & Identity vs. Role Formulating a sense
Fidelity Confusion of self and belonging.
Formulating adult,
loving relationships
Affiliation & Intimacy vs. and meaningful
Love Isolation attachments to • We all work within and between a variety of systems:
others. structural systems (a road network), functional
systems (academic department), social system (work
Productivity Generativity vs. Being creative and
& Care Stagnation productive; group), information system (a class or course).
establishing the next
generation.
Wisdom Ego Integrity vs. Accepting
Despair responsibility for • A System is a set of components or units interacting
one’s self and life. with a boundary that filters both the kind and rate of
flows of inputs and outputs to and from the system
(Hall and Weaver, 1985).
M2 LESSON 2: GENERAL
SYSTEMS THEORY and
THEORIES OF CHANGE
1. Includes purpose, content and process, breaking
down the “whole” and analyzing the parts.
2. The relationships between the parts of the whole are
examined to learn how they work together.
• Systems theory is concerned with elements and
3. A system is made up separate components. The
interactions among all the factors/variables in a
parts rely on one another, are interrelated, share a
situation.
common purpose, and together form a whole.
• Interactions between the person and the environment 4. Input is the information that enters the system.
occur continuously, thereby creating complex, 5. Output is the end product of a system.
constantly changing situations. 6. Feedback is the process through which the output is
returned to the system.
7. Von Bertalanffy (1969, 1976) developed general
systems theory, which has the following assumptions.
• Systems theory provides a way to understand the o All systems must be goal directed.
many influences on the whole person and the o A system is more than the sum of its parts.
possible impact of change of any part of the whole.
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o A system is everchanging and any change in one

part affects the whole.
o Boundaries are implicit and human systems are
open and dynamic.
Systems differ from each other related to degree of

self-sufficiency, complexity, and adaptability.
• Closed systems have fixed relationships among

system components and no interaction with the
environment. Not really of concern to IT.
• Open systems interact with their environment, have
dynamic interaction of components, and can be self-
Systems have two important aspects—structure and function
regulating.
or process. A system should be able to perform three
essential processes.
Examples of systems:
• Human organisations are open systems; boundaries • Adaptation to the environment
are permeable, continually engage in importing, • Integration of system parts
transforming, and exporting matter, energy, • Decision-making about allocation of resources
information, and people; Human organisations are at
the high end of the complexity scale due to these In order to carry out the systems processes the system must
characteristics decide whether or not to exchange matter, energy or
information depending on specific premises. This is referred to
as Transactional Modes.
GOAL
ENVIRONMENT
1. GEMEINSCHAFT - is based on the premise that the
CONTROL system and the environment are committed to each
other.
INPUT 2. LEGAL-BUREAUCRATIC - is when the system and
its environment respond to each other because “It is
PROCESS their duty” or “It is the policy”.
3. TEAM-COOPERATIVE - is when the system,
OUTPUT subsystem and the environment recognizes that each
subsystem has something to contribute in order to
FEEDBACK achieve a common goal.
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4. BARGAINING - is when a system has needs and 3. STEADY STATE - there are certain processes that
goals different from those of its subsystem or its allow a system to achieve some constancy in the
environment, it can negotiate to meet these needs input—output exchange.
and goals.
5. COERCION - in a system makes use of favors, threat Generally, nursing is an open system characterized by
or deception to obtain what is necessary for the continuous exchange of energy, matter and information within
system’s survival. its boundary.
o The GST is a universal theory. Ex. Multidisciplinary

Boundaries are important because they mark the interface approach in health care.
between systems and allows for the exchange process of o The GST views human beings as holistic and goal-
input-thoroughput-output to occur. Bredemeier describes the directed. Ex. Roy Adaptation Model.
following as functions of boundary maintenance. o The GST views persons as open systems who strive
to maintain harmony and balance between their
internal and external environment. Ex. Neuman’s
Health care systems model and Johnson’s Behavioral
systems model.
According to Thompson and McEven there are 4 modes of o The GST also holds that individuals at the subsystem
maintaining boundaries. The nurse within the system utilizes carry out networking activities with their environment
each mode depending on the situation: in hierarchically arranged systems of increasing
complexity. Ex. Imogene King’s interpersonal system.
o The GST emphasizes relationships as well as
1. COMPETITION - is when two functional components
share a common relationship with a third party. components of the system. Ex. Hildegard Peplau’s
Model.
2. CO-OPTATION - is when leadership elements in one
system attempt to take over another.
3. BARGAINING - is when an agreement exists
between two systems concerning the exchange of
goods and services.
4. COALITION FORMATION - is when two systems
become committed to joint decisions.
People grow and change throughout their lives. This growth

and change are evident in the dynamic nature of basic human
needs and how they are met.
Hall and Weaver (1985) described the 3 system states.
Change happens daily. It is subtle, continuous and manifested
1. NEGENTROPY - is achieved by a process called in both everyday occurrences and more disruptive life events.
feedback mechanism.
2. EQUIFINALITY - the tendency to reach a
characteristic final state from the different initial states
in various ways based on the dynamic interaction.
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KURT LEWIN (1962) • The goal of the movement phase is to achieve the
desired change. This is when change is implemented.
-Developed the change theory.
• The goal of the refreezing phase is stabilization of the
change. Change must continuously be practiced until
it becomes familiar.
1. Recognition of the area where change is needed. RONALD LIPPIT

2. Analysis of a situation to determine what forces exist -Change theories identifies.
to maintain the situation and what forces are working
to change it.
3. Identification of methods by which change can occur.
4. Recognition of the influence of group mores or 1. Development of a need for change.
customs on change. 2. Establishment of a change relationship.
5. Identification of the methods that the reference group 3. Working towards change.
uses to bring about change. 4. Clarifications or diagnosis of the client system’s
6. The actual process of change. problem.
5. Examination of alternative routes and goals;
establishing goals, and intentions of action.
6. Transformations of intentions into actual change
Lewin identified 3 stages of change: efforts.
7. Generalization and stabilization of change.
1. UNFREEZING 8. Achieving a terminal relationship.
o Involves finding a method of making it possible
for people to let go of an old pattern that was
counterproductive in some way.
CHIN AND BENNE’S (1976)
2. MOVEMENT -Developed 3 general strategies:
o “Moving to a new level”. Involves a process of
change in thoughts, feeling, behavior, or all three,
that is in some way more liberating or more
1. EMPIRICAL
productive.
o Rational strategies
3. REFREEZING
➢ People are rational beings and people will
o Is establishing the change as a new habit, so that
follow reason once it is revealed to them.
it now becomes the “standard operating
2. NORMATIVE
procedure.” Without this stage of refreezing, it is
o Re-educative Strategies
easy to backslide into the old ways.
➢ People have human motivation. Change will
occur when the person are brought to
change their normative orientations to old
patterns and develop commitments to new
• Freezing theory states that change occurs whenever
ones.
the forces in a given field are unequal.
3. Power
• During unfreezing, conditions are viewed as stable or
o Coercive strategies
“frozen”. Change begins with a felt need, a plan that
➢ Based on the application of power in some
maximizes driving forces and minimizes restraining
form.
forces.
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RICHARD WALTON (1969)

-Developed 2 strategies of social change.
Learning as the product of the stimulus conditions and the
responses that follow.
1. POWER STRATEGY - To command attention and
Respondent conditioning by Ivan Pavlov (Classical or
establish a basis for a quid pro quo, people must
pavlovian conditioning) emphasizes the importance of stimulus
threaten the other with harm, loss, inconvenience or
conditions and the associations formed in the learning process.
embarrassment.
2. ATTITUDE CHANGE STRATEGY - This involves
overtures of love and trust, and gestures of good will.
These are all intended to result in attitude change and
concomitant behavior change.
1. CLASSICAL CONDITIONING - is learned based on
pairing of conditioned and unconditioned stimuli
M2 LESSON 3 : LEARNING resulting in a conditioned response.
THEORIES AND OTHER 2. OPERANT CONDITIONING - is learning based on
RELATED THEORIES consequences meaning, behavior that is rewarded is
most likely to be repeated.
▪ Operant Conditioning by B.F. Skinner focuses on

the behavior of the organism and the reinforcement
Learning theories and models explain how people learn.
that occurs after the response.
▪ Positive reinforcement or reward greatly enhances
When nurses use these to guide client education process, they
the likelihood that a response may be repeated in
can use principles to structure meaningful client educational
similar circumstances.
experiences, prevent overloading clients with information, and
▪ Negative reinforcement or punishment- happens
understand reasons for unsuccessful client education
after a response is made. This involves the removal
encounters.
of an unpleasant stimulus through either escape
conditioning or avoidance conditioning. The difference
a. Bandura’s Social Learning Theory
between the two is timing.
b. Hochbaum, Rosenstock and Becker’s Health Belief
▪ The gestalt perspective of cognitive learning
Model
emphasizes the importance of perception in learning.
c. Green’s PRECEDE Framework for Health Education
▪ Perception is selective. Individuals orient themselves
Planning and Evaluation
to the experience while screening out or habituating
d. Knowles’ Adult Learning Theory
to other features.
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o OUTCOME EXPECTATION - About the

consequences of one’s actions or opinions about
Cognitive learning theorists stress the importance of what how individual behavior is likely to influence
goes on inside the learner. The key to learning and changing is outcomes.
the individuals cognition (perception, thought, memory, and o EFFICACY EXPECTATION OR SELF
ways of processing and structuring information). EFFICACY - About one’s own competence to
perform the behavior needed to influence
E.C. Tolman (1930) conducted a classic experiment and found outcomes.
out that we can make mental or cognitive maps to reach a d. Incentive (or reinforcement) is defined as the value of
goal. He found out that learning can be faster in the presence a particular object or outcome.
of a reward. e. When reinforcements or consequences of behavior
are believed to operate by influencing expectations
Cognitive and information processing perspectives regarding the situation, such formulations are
emphasizes thinking processes: thought, reasoning, the way generally termed as “value-expectancy” theories.
information is encountered and stored, and memory
functioning.
The model was originally proposed by Godfrey M. Hochbaum

in 1958 as a theoretical model of preventive health behavior,
Albert Bandura developed SLT. later developed by Rosenstock in 1966 who coined the term
“Health Belief Model” and further modified by Becker in 1974.
The SLT states that there is a continuous and reciprocal
relationship between these factors: (1) a person’s behavior; (2) It suggests that the decision whether or not to change behavior
the environmental consequences of that behavior; and (3) the will be influenced by an evaluation of its feasibility and its
cognitive processes going on inside the person. benefits weighed against its costs.
a. SLT is the offshoots of Cognitive Learning. HBM hypothesizes that health related action depends upon the
b. Cognitive learning theories assume the individual simultaneous occurrence of three classes of factors.
must have direct Experiences in order to learn.
c. Contends that much learning occurs by observation- ▪ perceived susceptibility or perceived threat.
watching other people and seeing what happens to ▪ perceived severity
them. ▪ perceived benefits or effectiveness of treatment
d. Role modeling is a central concept. ▪ perceived cost or barriers
▪ cue to action
a. SLT was later called Social Cognitive Theory.

b. According to Bandura, behavior is determined by The theory is developed by Fishbein and Ajzen in 1975 argues
expectancies and incentives that perceived social norms also play a role in determining
c. Expectancies may include: motivation.
o ENVIRONMENTAL CUES - Environmental cues Motivation to act is seen as a product of perceived group
beliefs about how events are connected. norms and one’s private beliefs about the action.
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4 – 5. EDUCATIONAL DIAGNOSIS
identified 3 classes of factors that affect health behaviors:
a. PREDISPOSING FACTOR - includes a person’s
• This was developed by Lawrence W. Green in 1980 attitudes, beliefs, values and perceptions.
as a comprehensive model for planning and b. ENABLING FACTOR - are barriers created mainly by
evaluating health education and health promotion societal forces or systems such as limited facilities &
programs. inadequate resources.
• The framework recognized the integration of health c. REINFORCING FACTOR - are those related to the
promotion as an extension of health education. feedback the learner receives from others.
• Green (1980) defined Health Education as “any
combination of learning experiences designed to 6. ADMINITRATIVE DIAGNOSIS
facilitate voluntary adaptations of behavior conducive actual development and implementation of a health education
to health”. program.
• Green (1991) defined health promotion as “the
combination of educational and environmental 7. EVALUATION
supports for actions and conditions of living conducive is an integral and continuous part of working with the entire
to health”. framework.
Evaluation proceeds from process evaluation of the program,

to impact evaluation in terms of changing the predisposing,
enabling, reinforcing factors as well as the behavior itself; lastly
a. PRECEDE is an acronym for Predisposing, to outcome evaluation dealing with changes in health status
Reinforcing, and Enabling causes in Educational and quality of life.
Diagnosis and Evaluation
b. It is a model intended for the planning and evaluation
of health education and addresses the acknowledged
problem of disjointed planning (Green, 1980).
c. The PRECEDE component of the model begins
ideally with an appraisal of the quality-of-life in the
population of interest and the education factors ▪ PRECEDE – PROCEED Model for health promotion,
affecting the behavior of interest. planning and evaluation in 1991 with a more
comprehensive field of health promotion.
▪ PROCEED is an acronym for Policy, Regulatory and
Organization Constructs in Educational and
Environmental Developments.
1. SOCIAL DIAGNOSIS ▪ This phase reviews and reconciles existing and
quality of life in a community required resources such as personnel, time and
finances.
2. EPIDEMIOLOGICAL DIAGNOSIS ▪ Green (1991) “Behavior is seen increasingly not as
identify specific health problems isolated acts under the autonomous control of the
individual, but rather as socially conditioned, culturally
3. BEHAVIORAL DIAGNOSIS embedded, economically constrained patterns of
identify specific health related behaviors living”.
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▪ Heath promotion emerged out of health education M2 LESSON 4 :

and is aimed at encouraging complementary social
THEORIES/MODELS OF
and political actions that will facilitate the necessary
organizational, economic and environmental supports COMMUNICATION
for the conversion of individual actions into health
enhancements and quality of life gains.
INTRODUCTION
Communication is described as the exchange of meanings

between and among individuals through a shared system of
Malcolm Knowles (1967) recognized the need for a unifying symbols that have the same meaning for both the sender and
theory for adult education. Andragogical theory is based on 4 the receiver of the message.
main assumptions:
THEORIES OF COMMUNICATION
1. Changes in Self-Concept
2. The Role of Experience An (interpersonal) source:
3. Readiness to Learn • some person with ideas, needs, intentions,
4. Orientation to Learning information and a reason for communicating.
Adults learn best when learning is problem-centered, A message:

meaningful and experiential. • coded, systematic set of symbols representing ideas,
purpose, intentions and feelings.
An encoder:
• the mechanism for expressing or translating the
purpose of the communication into the message.
A theory of motivation stressing emotions rather than cognition
and responses, the psychodynamic perspective emphasizes A channel:
the importance of conscious and unconscious forces in guiding • the medium for carrying the message.
behavior, personality conflicts, and the enduring impact of
childhood experiences. A decoder:
• the mechanism for translating the message into a
form that the recipient can use.
A receiver:
• the target or recipient of the message.
Underlying the humanistic perspective on learning is the
assumption that each individual is unique and that all
individuals have a desire to grow in a positive way.
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addition, this theory is linear and essentially a theory

of signal transmission.
• The process begins with a source selecting a
Communication is diverse, ranging from mass media, popular message out of all messages which would be
culture and language to indvidual and social behavior. possible to communicate. The transmitter is the voice
mechanism producing the signal (spoken words or
“Communicare” meaning to “make common” the varying pressure passing from the vocal system of
one person to the ear of another) transmitted through
There are two main schools of thought explaining air (the channel). The receiver (the ear) decodes the
communication: message and reconstructs the message from the
signals transmitted. This is passed on to a
1. PROCESS SCHOOL destination.
sees communication as the transmission of messages.
Includes theories of Shannon and Weavers (1949) and
Newcombs (1953).
2. SEMIOTIC SCHOOL
uses semiotics or the science of signs and meanings as its There are other components of communication process that
main methods of study. It is concerned with text and culture. cannot be help and can be present at times.
o A radically different approach that puts emphasis on ➢ NOISE

communication as the generation of meaning. is anything which is added to the signal which is not intended
o Semiotics or semiology is the study of signs and the by the information source.
way they work. The American logician and
philosopher C.S. Pierce and swiss linguist Ferdinand ➢ ENTROPY
de Saussure were the founders of semiotics (Fiske, is the uncertainty or disorganization of communication,
1990). associated with the amount of freedom of choice one has in
o In semiotics, the receiver, also called the reader, is constructing a message.
seen as playing a more active role.
o Meanings are determined by the cultural experience ➢ ENTROPY REDUNDACY
of the reader, who in turn helps create the meaning of is that portion of the message which is not determined by the
the text by bringing to it his or her experience, free choice of the sender.
attributes and emotions.
It functions to convey information about the speaker and his

or her identity, emotions, attitudes, intentions or social position.
• Communication includes all of the procedures by
which one mind may affect the other.
The second function of non-verbal communication is to
• Shannon & Weavers Mathematical Theory of
manage the kind of relationship that one person wants with
Communication is general enough that it can be
another. By using a certain tone of voice, posture, facial
applied to written language, musical notes, spoken
words, pictures and other communication signals. In
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expression, gesture, the nurse can attempt to dominate a hostility, superiority, inferiority) and emotional state
patient, reassure, or intimidate. (tension and relaxation).
This is carried out through codes such as gestures, eye

movements, physical appearance, posture, qualities of voice
and others. They are limited to face to face communication or
PHYSICAL APPEARANCE when the communicator is present (Buerkel-Rothfuss, 1985).
• Refers to body characteristics that are under The examples of Non-Verbal Mode of Communication are:
voluntary control---hair, clothes, body paint and Physical Appearance, Body Movement, Paralanguage,
adornment---and those less controllable—height and touching, time, space and territory.
weight.
• This can indicate physical health, personal grooming
habits or eating habits. It can send messages about
personality, social status and emotional state.
BODY MOVEMENT
• Kinesics is the study of body movement in o Includes voice qualities such as speaking rate, pitch
communication. range, pitch variety, rhythm and tempo of speaking,
• It has 3 categories: Facial expression, Gestures and raspness and tone.
Body Stance. o Also includes giggling and whimpering and vocalized
pauses (um, er, eh or throat clearing), which are used
to fill in spaces between words and phrases.
o Involves the use of SILENCE. This can convey
interest in what the other is saying, sympathy or
FACIAL EXPRESSION respect.
• This can convey emotional messages such as o Silence accompanied by head nods or interrupted by
happiness, sadness, fear, concern and others. ‘uh-hum’ encourages the speaker to go on and
EYE CONTACT convey the message “I am listening”.
• is a special type of facial expression.
• Maintaining eye contact coupled with a smile usually
effects rapport with a patient
GESTURES
• This involves the hands, arms, feet and head.
o HAPICS - is the study of touch in communication.
• Gestures may indicate either general emotional
o Nurses need to be aware that they send powerful
arousal or specific emotional states. messages through the use of touch.
• Intermittent, emphatic and forceful up-and-down o The amount and quality of touch people receive can
gestures often indicate strong emotional states, significantly affect their emotional and physical health.
whereas more fluid, continuous, circular gestures o Thoughts somehow project through touch.
indicate a desire to explain or to persuade.
BODY STANCE
• Includes posture, configuration of arms or legs,
distribution of body weight and over-all quality of
movement.
• Our ways of standing, sitting and lying can
communicate interpersonal attitudes (friendliness,
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(12-25 feet) This distance is

acceptable between a
PUBLIC ZONES speaker and an audience,
small groups, and other
informal functions.
o CHRONEMICS - is the study of how people use time
FUNCTIONAL- Used in examinations or
in communication. PROFESSIONAL TOUCH procedures such as when
the nurse touches a client to
o The way a nurse goes about her activities in a assess skin turgor or a
patient’s room (as if she can’t wait to leave, how early masseur performs a
or late we arrive for a meeting, how long we keep a massage.
patient waiting before answering inquiries, and the SOCIAL-POLITE TOUCH Used in greeting, such as a
length of time we spend before responding to a call) handshake and the “air kiss”
some women use to greet
all convey non-verbal messages. acquaintances, or when a
gentle hand guides
someone in the correct
Direction.
FRIENDSHIP-WARMTH Involves a hug in greeting,
TOUCH ZONES an arm thrown around the
o Proxemics is the study of the distances people shoulder of a good friend, or
the back slapping some men
maintain between themselves and others and how
use to greet friends and
they defend their territories to maintain preferred relatives.
distances. LOVE-INTIMACY TOUCH Involves tight hugs and
o People need space to feel comfortable. Space kisses between lovers or
expands and contracts based on the situation close relatives.
SEXUAL-AOURSAL
PRIVACY AND TOUCH Used by lovers
An interpersonal interaction
RESPECTING
between the nurse and client
BOUNDARIES
during which the nurse
PROXEMICS
focuses on the client’s
= Distance Zone
specific needs to promote an ▪ Personal preference
TOUCH
effective exchange of ▪ The relationship between the communicators
information. ▪ The nature of the topic discussed
▪ Cultural heritage of the participants
▪ The nature of the communication context
(0-18 inches) Space
The kind of territory will generally influence how much
between people who
INTIMATE ZONES mutually desire personal personal space a person can expect to have.
contact, or people wanting
to have some private
moments.
(18-36 inches) This distance PUBLIC TERRITORY - is a setting that is open to anyone. Ex.
PERSONAL ZONES is comfortable between and parks, bars, hospitals
among family members and INTERACTIONAL TERRITORY - is a space reserved for
friends who are talking.
particular people during a specific period of time. Ex.
(4-12 feet) This distance is
SOCIAL ZONES acceptable for classrooms, patient’s room
communication in social, HOMES TERRITORY - is a space in which individuals live and
work, and business setting. work.
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M2 LESSON 5 : CRISIS
INTERVENTION THEORY
1. BASIC CRISIS THEORY

• Asserted that impediments to life goals that cannot be
overcome through customary behaviors. He believed
Crisis is defined as Perception or experience of an event or that the most important aspects of mental health are
situation as an intolerable difficulty that exceeds the person’s the state of ego, state of maturity and quality of its
current resources and coping mechanisms. This can lead to structure
severe affective, behavioral and cognitive malfunctioning. • Crisis ensues when a person faces an obstacle to
Aside from that, it is an inevitable aspect of human important life goals that cannot be resolved by using
existence. It also threatens a person’s coping and functioning. the usual coping strategies
CAPLAN : Assessment is based on 3 additional areas.

o Capacity of the person to withstand stress and
anxiety and maintain equilibrium
o Degree of reality recognized and faced in problem
Offers immediate help to establish equilibrium. solving
The immediate goal is to reinforce the individuals strengths o Stock of coping mechanisms used to maintain
and minimize weaknesses, to move from a state of being balance.
passive and dependent to an adult, independent state in a
short period of time
HISTORY : Crisis Intervention Baldwin (1978) developed a classification system that

describes six general types of crises:
Lindemann in 1944 formally developed Crisis Intervention in
handling bereaved fire victims. Later, Caplan elaborated on 1. DISPOSITIONAL CRISES
this, becoming the father of modern crisis treatment measures ➢ caused by distress that arises from a problematic
intervention. situation in which intervention is not directed at the
Parad, Rapoport, Jacobson and Aguilera refined crisis emotional level.
theory and developed treatment models for crisis in marital, 2. ANTICIPATED LIFE TRANSITION CRISES
family conflicts and suicide prevention. ➢ relate to normal life transitions over which the person
may or may not have control.
3. CRISES RESULTING FROM TRAUMATIC STRESS
➢ precipitated by externally imposed stressors that are
▪ Presence of danger and opportunity unexpected and uncontrolled.
▪ Complicated symptomatology 4. MATURATIONAL OR DEVELOPMENTAL
▪ Seeds of growth and change ➢ relate to an attempt to achieve emotional maturity by
▪ No panaceas or quick fixes completing developmental tasks; involves struggle
▪ The necessity of choice with a deep-seated unresolved issue.
▪ Universality or idiosyncrasy 5. PSYCHOPATHOLOGICAL CRISES
➢ Pre-existing psychopathological condition precipitates
the crises or complicates resolution of crises.
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6. PSYCHIATRIC EMERGENCY CRISES

➢ severe psychiatric disorder with severe impairment;
o Crisis is seen as being sustained through maladaptive
incompetent; danger to self or others.
behaviors, negative thoughts and destructive defense
mechanisms.
o Crisis is resolved when maladaptive coping behaviors
are changed to adaptive behaviors.
FIRST PHASE - is a rise in anxiety as a response to trauma.
The individual tries to use his usual coping mechanisms to
resolve the feeling of increased anxiety.
SECOND PHASE - characterized by increased anxiety due to
o Rado saw human behavior as being based on the
failure in coping.
dynamic principle of motivation and adaptation
THIRD PHASE - the person’s anxiety continues to escalate
o Behavior is viewed in terms of its effect on the welfare
and he usually feels forced to reach out for help.
of the individual
FOURTH PHASE - is the active state of crises wherein the
o His adaptational psychotherapy emphasizes the
individual’s inner resources and support system are
immediate present without neglecting the influence of
inadequate.
the developmental past.
2. EXPANDED CRISIS THEORY
o People cannot sustain a personal state of crisis if they

believe in themselves and in others and have
o Disequilibrium that accompanies a person’s crisis can
confidence that they can become self-actualized and
be understood through gaining access to the
overcome the crisis.
individual’s unconscious thoughts and past emotional
o Return the power of self-evaluation to the person.
experiences.
o An early childhood fixation can explain why an event
becomes a crisis.
o Developed ego psychology by focusing on the

epigenesis of the ego.
o Adopts an interpersonal systems way of thinking as
o Epigenetic development is characterized by an
opposed to what is going on only within the client.
orderly sequence of development at particular stages,
o There is a focus on the interrelationships and
depending on the previous stages for successful
interdependence among people and between people
completion.
and events.
o Considered reality functions important in the Chaos is the result of overwhelming anxiety
adaptation of the individual to the environment. CRISIS - Chaos becomes self-organizing and client is unable
o Emphasized that an individuals adaptation in early to identify patterns or preplan options to solve dilemmas at
childhood affects his ability to continue adapting to hand.
the environment in later life. EXPERIMENTATION - Trial and error, False starts, dead ends
o The fitting of the individual and the society is to make sense of and cope with crisis.
important.
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• COGNITIVE MODEL
o This is based on the premise that crises are
rooted in faulty thinking about the events or
situations that surround the crisis. The goal
Aguilera and Messick (1942) made the factors that influence
of this model is to help people become
the crisis intervener in analyzing and resolving a crisis
aware of and to change their views and
situation. The factors are:
beliefs about the crisis events.
1. PERCEPTION OF THE EVENT - is determined by

• ECLECTIC CRISIS INTERVENTION MODEL
the extent to which the event is a threat to the
- Gelliland
individual’s values and life goals. A crisis event may
be perceived as a threat or a challenge where one is - James
- Bowman
able to mobilize energies and engage in purposeful
problem solving. - Thorne
o Identify valid elements in all systems and integrate
2. SITUATIONAL SUPPORT- This refers to the persons
them into an internally consistent whole.
in the environment who can be depended on to help
o Consider all pertinent theories, methods and
the individual solve problems. Lack of support system
standards.
makes the individual vulnerable and increases
disequilibrium. o keep an open mind.
3. COPING MECHANISM - Lifestyles are developed
around patterns of response which in turn are • PSYCHOSOCIAL TRANSISTION MODEL
established to cope with stressful situations. - Adler
- Erikson
- Minuchin
3. APPLIED CRISIS THEORY o This model states that people are products of their
hereditary endowment ad the learning they have
absorbed from their social environment
o The experiences which the individual has gone
through will help him adjust to situations.
• EQUILIBRIUM MODEL
o Significant others assist the individual welcoming
- LINDEMANN, 1944;
challenges.
- CAPLAN, 1961;
- LEITNER, 1974
o The model underscores that the emotional state
during equilibrium leads to a persons stability, being
in control and psychologically mobile.
o The focus is to remain in pre-crisis state.
o The person must have the ability to use coping
mechanisms and a problem-solving approach.
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M2 LESSON 6 : GENDER
CONCEPTS AND ISSUES IN
HEALTH
The importance of gender in understanding health practices
and illness experiences is increasingly recognized, and key to
this work is a better understanding of the application of gender
relations. The influence of masculinities and femininities, and
the interplay within and between them manifests within
relations and interactions among couples, family members and
Gender concepts are studied because attitudes and behavior
peers to influence health behaviours and outcomes.
regarding gender are taken for granted. Even though gender
exerts a powerful influence on our health. Gender refers to
those social, cultural, and psychological traits linked to males
and females through particular social contexts. o INSTRUMENTAL - Socialization is for men and this is
characterized by the ability to compete,
aggressiveness, the ability to lead, wield power and
accomplish tasks.
o EXPRESSIVE - Socialization includes learning to
nurture, to be affiliate and to be sensitive to the needs
of others.
SEX - is the biological attribute that differentiates men and

women.
GENDER SOCIALIZATION - is the process by which men and
women learn and acquire their roles and responsibilities,
qualities and behaviors.
GENDER NORMS - are powerful mechanisms that control 1. FUNCTIONALISM
human behavior (Strassen, 1992). -Suggests that separate gender roles for women and men are
beneficial.
-Society maintain order by assigning different tasks to men and
women.
-Offers a reasonable explanation for the origin of gender roles
and demonstrates functional utility of assigning tasks on the
A child learns self-concept by interacting with the environment, basis of gender.
family and peer group.
PLAY - is considered a significant part of gender socialization 2. CONFLICT THEORY
that teaches children how to relate to their environment. The -Reflects Marxian (Karl Marx) ideas about class conflict and
most crucial period in the formation of gender identity is from the relationship between the exploiter and the expolited.
the age 3 to 6 years old, during this period, boys tend to -Women are subordinate to men in the autocracy of the
receive more negative reinforcement for gender inappropriate household. Men’s economic advantage provides the basis for
behavior from parents. gender inequality
RAI | 25
3. SYMBOLIC INTERACTIONISM those which lead to female mortality. Compounding

Symbolic interactionism aims to understand human behavior health problems is the lack of access to health care
by analyzing the critical role of symbols in human interaction. including lack of access to information and health
This is certainly relevant to the discussion of masculinity and facilities.
femininity. • It has also been recognized that women are treated in
an inferior way by health professionals and therefore
4. FEMINIST SOCIOLOGICAL THEORY are hesitant to seek treatment.
Feminism is an inclusive world-wide movement to end sexism
and sexist oppression by empowering women.
There is a move to erase the race-class-gender disparity and
provide a link.
Given women’s disadvantaged position in society, reducing

gender inequalities require measures and/or policies to reduce
discrimination against women which are even into the political,
• Historically, nursing is a profession for women. Its
cultural, economic and religious fabric of the society (Okojie,
founders were women with an exceptional gift for
1994).
social reform. Many of their efforts were directed
specifically at the welfare of women and children
Robinson (1994) suggested steps in providing the best
(Shea, 1990)
possible care to female patients.
• According to Flanelly (1984) the conflict for the nurse
1. Be aware of your own socialization and possible sex-
(male of female) is how to strike a balance between
role biases that may affect your attitude toward
caring traits often considered to be intrinsically female
female patients
and the skills and leadership abilities usually thought
2. Avoid using patronizing, demeaning, or sexist
of as characteristically male. Thus the nurse must be
language.
able to acquire and exhibit both masculine and
3. Be aware of socio-cultural stresses on women. The
feminine characteristics.
fact that they perform multiple roles in the home.
Community and society renders women vulnerable to
heath hazards, physically and psychologically.
4. See women’s help-seeking behaviors as an
• The ideological foundation for gender inequality in opportunity for preventive healthcare: encourage
many 3rd world countries is Patriarchy-defined as a them to give priority to their health.
“set of social relations with a material base that 5. Take women’s problems and symptoms seriously.
enables men to dominate women”. This is reinforced Make a thorough assessment rather than prematurely
by various institutions—economic, political, social, deciding on physical or psychologic diagnosis, or
legal and religious—all of which emphasize women’s judge her as a hypochondriac.
inferior position in society. These have implications 6. Routinely ask women about current or past abuse.
for women’s health status and health behaviors in the Abuse can be physical, emotional or sexual.
event of illness (Okojie, 1994). 7. Learn about incidences, causes, physical and
emotional consequences of violence against women
to improve diagnosis, treatment and care.
’
• Women’s health problems include those which affect
their physical, social and mental well-being as well as
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EMOTIONAL DIMENSION - HOW the mind and body interact

to affect body function and to respond to body conditions also
influences health. Long term stress affects the body systems
This is being aware of, and being open and responsive to and anxiety affects health habits; conversely, calm acceptance
issue which have something to do with the social relations and relaxation can actually change body responses to illness.
between women and men within specific societies and Examples:
cultures. Health providers must develop themselves to have o Prior to a test, a student always has diarrhea.
gender sensitivity and gender awareness. o Extremely nervous about a surgery, a man
experiences severe pain following his operation.
M2 LESSON 7 : INTERLINKING o Using relaxation techniques, a young woman reduces
her pain during the delivery of her baby.
RELATIONSHIPS OF FACTOR
AFFECTING HEALTH INTELLECTUAL DIMENSION - The intellectual dimension
encompasses cognitive abilities, educational background and
past experiences. These influence a client’s responses to
INTRODUCTION teaching about health and reactions to health care during
illness. They also play a major role in health behaviors.
According to the World Health Organization, Health is a Examples:
state of complete physical, mental, social and spiritual well- o An elderly woman who has only a third-grade
being and not merely the absence of disease or infirmity. That education who needs teaching about a complicated
is why in order to improve population health status and reduce diagnostic test.
health inequalities, it is important to identify and understand o A young college student with diabetes who follows a
the main factors affecting Health. diabetic diet but continues to drink beer and eat pizza
with friends several times a week.
ENVIRONMENTAL DIMENSION - The environment has many

influences on health and illness. Housing, sanitation, climate
and pollution of air, food and water are aspects of
environmental dimension.
Examples:
PHYSICAL DIMENSION - Genetic make-up, age,
o Increased incidence of asthma and respiratory
developmental level, race and sex are all part of an individual’s
problems in large cities with smog.
physical dimension and strongly influence health status and
health practices.
SOCIO-CULTURAL DIMENSION - Health practices and
Examples:
beliefs are strongly influenced by a person’s economic level,
o The toddler just learning to walk is prone to fail and
lifestyle, family and culture. Low- income groups are less likely
injure himself.
to seek health care to prevent or treat illness; high-income
o The young woman who has a family history of breast
groups are more prone to stress-related habits and illness. The
cancer and diabetes and therefore is at a higher risk
family and the culture to which the person belongs determine
to develop these conditions.
patterns of livings and values, about health and illness that are
often unalterable.
Examples:
o The adolescent who sees nothing wrong with
smoking or drinking because his parents smoke and
drink.
RAI | 27
o The person of Asian descent who uses herbal

remedies and acupuncture to treat an illness.
SPIRITUAL DIMENSION - Spiritual and religious beliefs are o The doctrine or the principles underlying an art as
important components of the way the person behaves in health distinguished from the practice of that particular art.
and illness. o A formulated hypothesis or opinion not based upon
Examples: actual knowledge.
o Roman Catholics require baptism for both live births o A provisional statement or set of explanatory
and stillborn babies. propositions that purports to account for or
o Jehovah Witnesses’ are opposed to blood characterize some phenomenon.
transfusions.
M3 LESSON 3.1 Describes the relationship between two or more concepts.

INTRODUCTION TO NURSING
THEORY
1. Systematic, logical and coherent

(orderly reasoning, no contradictions)
2. Creative structuring of ideas
There was once an author who said and I quote, “The Mental images of one’s experiences and create different ways
systematic accumulation of knowledge is essential to progress of looking at a particular event or object.
in any profession. However, theory and practice must be 3. Tentative in nature
constantly interactive. Theory without practice is empty and (change over time or evolving but some remain valid despite
practice without theory is blind.” passage of time)
Where did our nursing profession all started? The history of

professional nursing began with Florence Nightingale. It was
Nightingale who envisioned nurses as a body of educated
women at a time when women were neither educated nor
employed in public service. Following her service of organizing
and caring for the wounded in Scutari, during the Crimean
War, her vision and establishment of a School of Nursing at St.
Thomas’ Hospital in London marked the birth of modern
nursing. Nightingale’s pioneering activities in nursing practice
and subsequent writings describing nursing education became
a guide for establishing nursing schools in the United States at
the beginning of the twentieth century (Kalisch & Kalisch,
2003; Nightingale, 1859/1969). Nursing began with a strong
emphasis on practice, but throughout the century, nurses
worked toward the development of nursing as a profession
through successive periods recognized as historical eras
(Alligood, 2006a).
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1. Purpose “Why is the theory formulated” 1. Theory guides and improve nursing practice
2. Concepts are building blocks of theory – ideas, ▪ Theory provides goal for nursing care and with
mental images of a phenomenon, an event or object goals, nursing practice is rendered more effective
that is derived from an individual’s experience and and efficient.
perception ▪ Theories help to focus the goals, making nurses
3. Has a major concept like nursing, person, health or more confident about the practice.
environment. 2. Theory guides research
4. Definitions give meaning to concepts which can ▪ According to Meleis, primary use of theory is to
either be descriptive or procedural guide research. It validates and modifies the
5. (stipulate-use of term within the theory) theory.
3. Theory contributes to the development of the
Propositions - are expressions of relational statements disciplines body of knowledge.
between and among the concepts. It can be expressed as 4. Theory enhances communication.
statements, paradigms or figures, AKA as theoretical
assertions
Assumptions - accepted “truths” that are basic and
fundamental to the theory. Or value assumptions where what
is good or right or ought to be.
• Discipline is specific and refers to a branch of

education a department of learning or a domain of
knowledge.
Goal: To develop knowledge as a basis for nursing
practice.
o Nursing discipline is dependent to theory.
1. Conceptualization for nursing research projects and

the development of conceptual frameworks for
nursing curricula.
2. To structure curriculum content
3. To guide the teaching of nursing practice in nursing
programs
o Emphasis on knowledge about how nurses
functions
o Concentrated on the nursing process
o Focus on what nurses know and how they use
knowledge to guide their thinking and decision
making while concentrating on the patient
4. To provide the nurse with a perspective of the patient
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METAPARADIGM - (meta- more comprehensive or

transcending; paradigm- philosophical or theoretical
1. Served as a driving force for the development of the framework):
nursing profession. • Person- the recipient of nursing care
2. Theory based practice is beneficial to the patient it • Environment- physical and social
provides a systematic, knowledgeable approach to • Health- a process or state
nursing practice. • Nursing- goals, roles and functions
3. Useful tool for reasoning, critical thinking and decision
making in nursing practice.
• Organize patient data
• Understand patient data It refers to the way of It refers to the knowing that
• Analyze patient data perceiving and is expressed in a form that
• Make decisions about nursing interventions’ understanding self and can be shared and
• Plan patient care the world. communicated to others.
• Predict outcomes of care
• Evaluate patient outcomes
M3 LESSON 3.2 : ’
METAPARADIGM AND FOUR
WAYS OF KNOWING
• Considered to be epistemology of nursing.
• Written in 1975, and has been foundational to nursing
knowledge since then
• Other ways of knowing have been proposed.
Professionals define themselves in terms of what knowledge

they possess and seek to acquire. Have you ever considered
how bachelor's degree of registered nurses add to their The aim of Carper’s theory was to:
knowledge base? Barbara Carper (1978) identified four • Formally express nursing knowledge
fundamental patterns of knowing that form the conceptual and • Provide a professional and discipline
syntactical structure of nursing knowledge. These four patterns • identity
include: personal, empirical, ethical, and aesthetic knowing. • Convey to others what nursing contributes
Let’s look at how these ways of knowing can assist you in your • to healthcare
pursuit of knowledge as a nursing student. • Create expert and effective nursing
• practice
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ETHICAL knowing helps one develop our own moral code; our
sense of knowing what is right and wrong. For nurses, our
personal ethics is based on our obligation to protect and
We gain EMPIRICAL knowledge from research and objective respect human life. Our deliberate personal actions are guided
facts. This knowledge is systematically organized into general by ethical knowing. The “Code of Ethics for Nurses” (American
laws and theories. One of the ways we employ this knowledge Nurses Association, 2015) can guide us as we develop and
is through the use of evidenced-based practice (EBP). This refine our moral code.
way of knowing is often referred to as the “science” of nursing
(Chinn & Kramer, 2015). • The component of moral knowledge in nursing
• Based on values of profession
▪ THE SCIENCE OF NURSING • Choosing, justifying and judging actions based on
▪ Objective, abstract, quantifiable duty, rights and obligations
▪ Can be verified with testing • Universal values to profession, as well as personal
▪ Arranged into theories values of the nurse
▪ Case knowledge (biomedical model) • Guides and directs how nurses conduct their practice
▪ Concerned with “monitoring of disease and • Requires
therapeutic responses” o Experiential knowledge of social values
▪ Quantitative research uncovers this type of knowing o Ethical reasoning
• Focus is on:
➢ Based on the assumption that what is known is o Matters of obligation, what ought to be done
accessible through the physical senses: seeing, o Right, wrong and responsibility
touching and hearing. o Ethical codes of nursing
o Reality exists and truths about it can be o Confronting and resolving conflicting values,
understood norms, interests or principles
➢ Draws on traditional ideas of science. Sources
➢ Expressed in practice as scientific competence • Nursing’s ethical codes and professional standards
o Competent action grounded in scientific • An understanding of different philosophical positions
knowledge including theories and formal o Consequentialism
description o Deontology
o Involves conscious problem solving and logical o Duty
reasoning o Social justice
o Nursing theory
Positivist Science
• Knowledge is systematically organised into general
laws and theories
Source of this knowledge ETHICAL knowing helps one develop our own moral code; our
• Research sense of knowing what is right and wrong. For nurses, our
• Theory personal ethics is based on our obligation to protect and
respect human life. Our deliberate personal actions are guided
by ethical knowing. The “Code of Ethics for Nurses” (American
RAI | 31
Nurses Association, 2015) can guide us as we develop and • Acceptance of self that is grounded in self-knowledge
refine our moral code. and confidence
• Awareness of self in relationship
• THE ART OF NURSING • Does not require mediation through language
• Intangible essence of what nursing is • Engagement, active, empathetic participation of nurse
• Attends to uniqueness of “contextual wholeness” as “knower”
rather than particular moment. • Means being authentic – incorporating that theory of
• Anticipation of outcome rather than just evaluation of interpersonal relationships until it is second nature
select intervention • The “A-HA” experience
• Concerned with becoming self-aware
• Expressive, intuitive and creative aspect of nursing, a o Self–awareness that grows over time through
difficult to verbalize (Expert nurse actions done before interactions with others
actual event “How did they know that???) • Used when nurses engage in the therapeutic use of
Expressed through: self in practice
o Actions, bearing, conduct, attitudes, narrative and o Scientific competence, moral/ethical practice, insight
interaction and experience of personal knowing
o Knowing what to do without conscious deliberation • Personal reflection
o Informed by the response of others
Involves: • Openness to experience
o Deep appreciation of the meaning of a situation
o Moves beyond the surface of a situation
o Often shared without conscious exchange of words
o Transformative art/acts
o Brings together all the elements of a nursing care
situation to create a meaningful whole
Experience (Experiential)
• Perceives the nature of a clinical situation and • Benner Novice to Expert
interprets this information • Knowing how or „knowledge-as-ability” vs knowing
• Is to respond with skilled action that (Carper’s view, according to Benner). Skill based.
It uses the nurses intuition and empathy Intuition
• Is based on the skill of the nurse in a given situation • Non-rational thought processes of feeling or sensing
• Not logically explained results with vast amounts of
experience
Unknowing
• Position of openness to understand the world view of
PERSONAL knowing refers to the knowledge we have of the patient (client-centered). Leads to empathy and
ourselves and what we have seen and experienced. This type pt’s perspective.
of knowledge comes to us through the process of observation, Sociopolitical
reflection, and self-actualization. It is through knowledge of
• Seeks to understand the „wherein „ of nursing as a
ourselves that we are able to establish authentic, therapeutic
practice profession.
relationships as it propels us towards wholeness and integrity
• Understanding of what nursing is by public, and what
(Chinn & Kramer, 2015).
society and its politics are by nurses.
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M3 LESSON 3.3 :
Development Process of
Nursing Theory
“Nursing’s potential for meaningful human service rests on the

union of theory and practice for its fulfillment” (Rogers, 1970, p.
viii).
Theory development in nursing is an essential component of

nursing scholarship undertaken to advance the knowledge of
the discipline. Nursing theories that clearly set forth an
understanding of nursing phenomena guide scholarly
development of the science of nursing practice through
research. Once a nursing theory addressing a phenomenon of
interest has been proposed, several considerations follow,
such as its completeness and logic, internal consistency, and Source of knowledge:
correspondence with empirical findings, and whether it has • Blind obedience to medical authority.
been defined operationally for testing. Analyses of this nature Impact of theory and research:
lead logically to further development of the theory. Scientific • Little attempt to develop theory.
evidence accumulates through repeated rigorous research that • Research was limited to collection of epidemiologic
supports or refutes theoretical assertions and guides data.
modifications or extensions of the theory. Nursing theory
development is not a mysterious activity, but a scholarly
endeavor that is pursued systematically. Rigorous
development of nursing theories, then, is a high priority for the
future of the discipline and the practice of the profession of
’
nursing.
Source of knowledge:
It is important to understand the concept of systematic • Learning through listening to others.
development because approaches to construction of theory Impact of theory and research:
differ. One aspect that they have in common is that they • Theories were borrowed from other disciplines.
approach theory development in a precise, systematic manner,
making the stages of development explicit. The nurse who
systematically devises a theory of nursing and publishes it for
the nursing community to review and debate engages in a
process that is essential to advancement of theory
development. As scholarly work is published in the literature,
nurse theoreticians and researchers review and critique the
adequacy of the logical processes used in the development of
the theory with fresh eyes in relation to practice and available
research findings.
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Impact of theory and research: Includes both separate and connected knowledge.
• As nurses acquired non-nursing doctoral degrees,
they relied on the authority of educators, sociologists,
psychologists, physiologists and anthropologists to
provide answers to nursing problems. ’
• Research was primarily educational research or
sociologic research.
• Integration of different types of knowledge (intuition,
reason, and self-knowledge)
Impact of theory and research:
’ • Nursing theory should be based on prior empirical
studies, theoretical literature, client reports of clinical
Source of knowledge: experiences and feelings and the nurse scholar’s
intuition or related knowledge about the phenomenon
• Authority was internalized and a new sense of self
of concern.
emerged.
➢ The development of nursing science has evolved
• A negative attitude toward borrowed theories and
since the 1960s as a pursuit to be understood as a
science emerged.
scientific discipline.
➢ The unique contribution of nursing to the care of
patients, families, and communities is acknowledged.

• Nurse scholars focused on defining nursing and on
developing theories about and for nursing.
ACCORDING TO RANGE:
• Nursing research focused on the nurse rather than on
clients and clinical situations.
• Consist of broad conceptual frameworks that reflect

wide and expansive perspectives for practice and
ways of describing, explaining, predicting and looking
• Proliferation of approaches to theory development. at nursing phenomena. They are the most complex
• Application of theory in practice was frequently and broadest in scope.
underemphasized. Emphasis was placed on the • Henderson’s The Nature of Nursing ; Levine’s The
procedures used to acquire knowledge, with over- Four Conservation Principles of Nursing, Roy’s
attention to the appropriateness of methodology, the Adaptation Model, and Orem’s Self-Care
criteria for evolution and statistical procedures for • (Marriner-Tomey)
data analysis.
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• Less complex and narrower in scope than grand

theory and micro theory. THIS CATEGORY INCLUDES THE THEORIES DEVELOPED
• A more workable level is the middle range.more BY THE FOLLOWING:
limited in scope and less variables, and testable.
NIGHTINGALE
EXAMPLES: ABDELLAH
Grand theory on stress and adaptation might not yield any HENDERSON
interpretable guidelines on practice but if the theory is focused OREM
on chronic lingering illness as the stressor on family, the stress ROY
theory becomes operational for both research and practice LEVINE
purposes. HALL
Ex. Peplau’s Psychodynamic Nursing PENDER
and Orlando’s Nursing Process Theory
• Theories on NURSE-CLIENT DYNAMICS focus on

• Are the least complex. interaction between the nurse and client.
• Contain the least complex concepts and are • Some of these nursing theories highlighted one – to-
narrowest in scope. one client-nurse relationships which depicted persons
• Deal with a small aspect of reality, generally a set of as interactive beings.
theoretical statements • This category includes theories developed by the
• Deals with specific and narrow defined phenomena following:
o Peplau
o Watson
o King
o Orlando
• Nursing is a structured and deliberate process. It is an
ACCORDING TO THE ORIENTATION OR FOCUS OF THE THEORY: interpersonal process occurring between a person
(Client) need for help, and a person (nurse) capable
of giving help and assistance.
• The term “patient” will be used to refer to clients who
are confined in a hospital. Otherwise, the term “client”
• Are those focused on the needs and problems that
will refer to any person in need of help for a health
clients have which are met, resolved or alleviated by
problem. There are multiple factors in the
nursing interventions.
environment that influence nurse-client dynamics.
• Some of these nursing theories focused on man as a
biological system, a behavioral composite and an
organism with stages of development.
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• Focus on the interaction between nurse and client in

an environment that includes broader dimensions of
time and space as well as culture and cultural
diversity and universality.
Neuman asserted that man is in constant interaction with the

environment and that any change occurring in one affects the
other.
• Theories of Neuman and Leininger are discussed
under this category. They considered all the
dimensions of man and the interactions of the nurse-
client simultaneously and comprehensively within a
cultural and systems environmental perspective.
• They viewed the environment as encompassing
family, society, culture, health care professionals,
significant others, as well as the socio-economic and
“ENVIRONMENTAL THEORY”
social additions surrounding the client.
NURSING “the act of utilizing the environment of the patient to

M4 LESSON 1: F. assist him in his recovery”.
Nightingale, F. Abdellah & 5 environmental factors:
▪ Fresh air
V. Henderson by Dr. Sofia ▪ Pure water
Magdalena Robles ▪ Efficient drainage
▪ Sanitation/cleanliness
▪ Light and direct sunlight
Florence Nightingale is the founder of the Modern Nursing and

once Nurses get their license as a Registered Nurse or RN,
they are invited to attend an oath taking ceremony where the
Nightingale Pledge is being recited.
RAI | 36
’ ’
• The first published nursing theory (1860)

• Persons are in relation with the environment
▪ Referred to by Nightingale as “the patient”
• Stresses the healing properties of the physical
▪ A human being acted upon by a nurse, or affected by
environment (fresh air, light, warmth, and cleanliness)
the environment
• Nursing puts patients in the “best conditions” for
▪ Has reparative powers to deal with disease
nature to act upon them
▪ Recovery is in the patient’s power as long as a safe
• Health is “the positive of which the pathology is the environment exists
negative”
• “Nature alone cures”
Theory basis:
• The inter-relationship of a healthful environment with
nursing External influences and conditions can
prevent, suppress, or contribute to disease or death ▪ The foundational component of Nightingale’s theory.
Theory goal: ▪ The external conditions & forces that affect one’s life
• Nurses help patients retain their own vitality by and development.
meeting their basic needs through control of the ▪ Includes everything from a person’s food to a nurse’s
environment verbal & nonverbal interactions with the patient.
Nursing’s Focus:
Control of the environment for individuals, families & the
community
▪ Maintained by using a person’s healing powers to
’ their fullest extent
▪ Maintained by controlling the environmental factors so
as to prevent disease
▪ Disease is viewed as a reparative process instituted
by nature
o Health of Houses
▪ Health & disease are the focus of the nurse
o Ventilation and Warming ▪ Nurses help patients through their healing process
o Light
o Noise
o Variety
o Bed and Bedding
o Cleanliness of Rooms and Walls ▪ Nursing education belongs in the hands of nurses!
o Personal Cleanliness ▪ Nursing is a discipline distinct from medicine focusing
o Nutrition and Taking Food on the patient’s reparative process rather than on
o Chattering Hopes and Advices their disease!!
o Observation of the Sick
o Social Considerations
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“PATIENTS CENTERED APPROACHES”
According to Faye Glenn Abdellah's theory, “Nursing is based

on an art and science that moulds the attitudes, intellectual
competencies, and technical skills of the individual nurse into 1. Recognizing the ng problems of the patient
the desire and ability to help people, sick or well, cope with 2. Deciding the appropriate course of action to
their health needs.” take in terms of relevant nursing principles
3. Providing continuous care of the individuals
total needs
4. Providing continuous care to relieve pain
and discomfort and provide immediate
security for the individual
5. Adjusting the total nursing care plan to meet
the patient’s individual needs
6. Helping the individual to become more self-
directing in attaining or maintaining a healthy
state of mind &.
7. Instructing nursing personnel and family to
help the individual do for himself that which
he can within his Limitations
8. Helping the individual to adjust to his
limitations and emotional problems
• In 1960, influenced by the desire to promote client- 9. Working with allied health professions in
centered comprehensive nursing care, planning for optimum health on local, state,
• Abdellah described nursing as a service to national and international levels
individuals, to families, and, therefore to, to society. 10. Carrying out continuous evaluation and
• Pioneer nursing researcher, helped transform nursing research to improve nursing techniques and
theory, nursing care and nursing education. to develop new techniques to meet the
health needs of people.
According to her, nursing is based on an art and science that
mold the attitudes, intellectual competencies, and technical
skills of the individual nurse into the desire and ability to help
▪ Abdellah’s patient-centered approach to nursing was
people, sick or well, cope with their health needs.
developed inductively from her practice and is
considered a human needs theory.
▪ The theory was created to assist with nursing
education and is most applicable to the education of
nurses.
▪ The theory was created to assist with nursing
education and is most applicable to the education of
nurses.
RAI | 38
BASIC TO ALL PATIENTS:

’ 1. To maintain good hygiene and physical comfort
2. To promote optimal activity: exercise, rest and sleep
3. To promote safety through the prevention of
accidents, injury, or other trauma and through the
1. Learn to know the patient prevention of the spread of infection
2. Sort out relevant data 4. To maintain good body mechanics and prevent and
3. Make generalizations data in relation to correct deformities
similar nursing problems presented by other 5. To facilitate the maintenance of a supply of oxygen to
patients all body cells
4. Identify the therapeutic plan 6. To facilitate the maintenance of nutrition for all body
5. Test generalizations with the patient and cells
make additional generalizations 7. To facilitate the maintenance of elimination
6. Validate patient’s conclusions about his 8. To facilitate the maintenance of fluid and electrolyte
nursing problems balance
7. Continue to observe and evaluate the patient 9. To recognize the physiologic responses of the body to
over a period of time to identify any attitudes disease conditions—pathologic, physiologic, and
and clues affecting his behavior compensatory
8. Explore the patient’s and family’s reaction to 10. To facilitate the maintenance of regulatory
the therapeutic plan and involve them in the mechanisms and functions
plan 11. To facilitate the maintenance of sensory function
9. Identify how the nurses feels about the REMEDIAL CARE NEEDS:
patient’s nursing problems 12. To identify and accept positive and negative
10. Discuss and develop a comprehensive expressions, feelings, and reactions
nursing care plan 13. To identify and accept the interrelatedness of
emotions and organic illness
14. To facilitate the maintenance of effective verbal and
non-verbal communication
15. To promote the development of productive
interpersonal relationships
1. Observation of health status 16. To facilitate progress toward achievement of personal
2. Skills of communication spiritual goals
3. Application of knowledge 17. To create and / or maintain a therapeutic environment
4. Teaching of patients and families 18. To facilitate awareness of self as an individual with
5. Planning and organization of work varying physical, emotional, and developmental
6. Use of resource materials needs
7. Use of personnel resources RESTORATIVE CARE NEEDS:
8. Problem-solving 19. To accept the optimum possible goals in the light of
9. Direction of work of others limitations, physical and emotional
10. Therapeutic use of the self 20. To use community resources as an aid in resolving
11. Nursing procedures problems arising from illness
21. To understand the role of social problems as
influencing factors in the case of illness
’
RAI | 39
➢ In Patient –Centered Approaches to Nursing,

Abdellah describes health as a state mutually
exclusive of illness.
➢ Although Abdellah does not give a definition of health,
she speaks to “total health needs” and “a healthy
state of mind and body” in her description of nursing
as a comprehensive service.
➢ Nursing is a helping profession. In Abdellah’s model,
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. ➢ Society is included in “planning for optimum health on
➢ She considers nursing to be comprehensive service local, state, national, and international levels”.
that is based on art and science and aims to help However, as she further delineated her ideas, the
people, sick or well, cope with their health needs. focus of nursing service is clearly the individual.
➢ The environment is the home or community from
which patient comes.
➢ Nursing is a helping profession. In Abdellah’s model,

nursing care is doing something to or for the person The Nursing Need Theory was developed by Virginia
or providing information to the person with the goals Henderson to define the unique focus of nursing practice. The
of meeting needs, increasing or restoring self-help theory focuses on the importance of increasing the patient's
ability, or alleviating impairment. independence to hasten their progress in the hospital.
➢ She 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.
➢ Abdellah describes people as having physical,
emotional, and sociological needs. These needs may
overt, consisting of largely physical needs, or covert,
such as emotional and social needs.
➢ Patient is described as the only justification for the
existence of nursing.
➢ Individuals (and families) are the recipients of nursing
Health, or achieving of it, is the purpose of nursing
services.
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Defined Nursing: “Assisting the individual, sick or well, in the

performance of those activities contributing to the health or its
recovery (or to peaceful death) that an individual would
perform unaided if he had the necessary strength, will or ➢ Individual requiring assistance to achieve health and
knowledge. independence or a peaceful death. Mind and body
are inseparable.
In 1996, Virginia Henderson’s definition of the unique function
of nursing was a major stepping stone in the emergence of
nursing as a discipline separate from medicine.
Like Nightingale, Henderson describes nursing in relation to ➢ All external conditions and influences that affect life
the client and the client’s environment. Unlike Nightingale, and development
Henderson sees the nurse as concerned with both healthy and
ill individuals, acknowledges that nurses interact with clients
even when recovery may not be feasible, and mentions the
teaching and advocacy roles of the nurse.
➢ Assists and supports the individual in life activities
1. Breathing normally and the attainment of independence.
2. Eating and drinking adequately
3. Eliminating body wastes
4. Moving and maintaining a desirable position
5. Sleeping and resting
➢ Equated with the independence, viewed in terms of
6. Selecting suitable clothes
the client’s ability to perform 12 components of
7. Maintaining body temperature within normal range by
nursing care unaided:
adjusting clothing and modifying the environment
o breathing, eating, drinking, maintaining comfort,
8. Keeping the body clean and well-groomed to protect
sleeping, resting clothing, maintaining body
the integuments
temperature, ensuring safety, communicating,
9. Avoiding dangers in the environment and avoiding
worshiping, working, recreation, and continuing
injuring others
development.
10. Communicating with others in expressing emotions,
needs, fears, or opinions
11. Worshipping according to one’s faith
12. Working in such a way that one feels a sense of
accomplishment
13. Playing or participating in various forms of recreation
14. Learning, discovering, or satisfying the curiosity that
leads to normal development and health, and using
available health facilities
RAI | 41
’
M4 LESSON 2 : D. Orem, N.
Pender & Sr. C. Roy by Dr.
Sofia Magdalena N. Robles
Self-care – practice of activities that individual initiates and

perform on their own behalf in maintaining life, health and well-
being.
Self-care agency – is a human ability which is "the ability for
engaging in self-care”
Dorothea Orem's Self-Care Deficit Theory focuses on each • Conditioned by age developmental state, life
“individual's ability to perform self-care, defined as 'the practice experience sociocultural orientation health and
of activities that individuals initiate and perform on their own available resources
behalf in maintaining life, health, and well-being. Therapeutic self-care demand – "totality of self-care actions
to be performed for some duration in order to meet self-care
requisites by using valid methods and related sets of
operations and actions"
Universal self-care requisites
o Associated with life processes and the
maintenance of the integrity of human structure
and functioning
Common to al, ADL
Identifies these requisites as:
o Maintenance of sufficient intake of air, water,
food
o Provision of care associated with elimination
process
o Balance between activity and rest, between
solitude and social interaction
o Prevention of hazards to human life well-being
1949-1957 Orem worked for the Division of Hospital and
and Promotion of human functioning
Institutional Services of the Indiana State Board of Health. Her
Developmental self-care requisites
goal was to upgrade the quality of nursing in general hospitals
o Associated with developmental processes/ derived
throughout the state. During this time, she developed her
from a condition…. Or associated with an event
definition of nursing practice.
o E.g. adjusting to a new job adjusting to body changes
1959 Orem subsequently served as acting dean of the school
Health deviation self-care
of Nursing and as an assistant professor of nursing education
Required in conditions of illness, injury, or disease these
at CUA. She continued to develop her concept of nursing and
include:
self-care during this time.
o Seeking and securing appropriate medical assistance
Orem’s Nursing: Concept of Practice was first published in
o Being aware of and attending to the effects and
1971 and subsequently in 1980, 1985, 1995, and 2001.
results of pathologic conditions
Continues to develop her theory after her retirement in 1984.
RAI | 42
o Effectively carrying out medically prescribed

measures
o Modifying self-concepts in accepting oneself as being
in a particular state of health and in specific forms of
health care
o Learning to live with effects of pathologic conditions 1. The person’s health status
2. The physician’s perspective of the person’s health
status
3. The person’s perspective of his or her health
4. The health goals within the context of life history, life
Specifies when nursing is needed: style, and health status
Nursing is required when an adult (or in the case of a 5. The person’s requirements for self-care
dependent, the parent) is incapable or limited in the provision 6. The person’s capacity to perform self-care
of continuous effective self-care
Orem identifies 5 methods of helping:
1. Acting for and doing for others
Nurse designs a system that is wholly or
2. Guiding others
partly compensatory or supportive-educative.
3. Supporting Another
The 2 actions are:
4. Providing an environment promoting personal
1. Bringing out a good organization of the components
development in relation to meet future demands
of patients’ therapeutic self-care demands
5. Teacher another
2. Selection of combination of ways of helping that will
be effective and efficient in compensating for
overcoming patient’s self-care deficits
o Nurse assists the patient or family in self-care matters

{ ’ to achieve identified and described health and health
related results. collecting evidence in evaluating
o Diagnosis and results achieved against results specified in the
prescription; nursing system design
determine why o Actions are directed by etiology component of nursing
o Assessment nursing is needed. diagnosis
o Nursing Diagnosis o Analyze and
o Evaluation
o Plans with scientific interpret – make
rationale judgement
o Implementation regarding care
o Evaluation o Design of a nursing
system and plan for
delivery of care
o Production of
nursing systems
RAI | 43
➢ Human being – has the capacity to reflect, symbolize

and use symbols
➢ Is art, a helping service, and a technology ➢ Conceptualized as a total being with universal,
➢ Actions deliberately selected and performed by developmental needs and capable of continuous self-
nurses to help individuals or groups under their care care
to maintain or change conditions in themselves or ➢ A unity that can function biologically, symbolically and
their environments socially
➢ Encompasses the patient’s perspective of health
condition, the physician’s perspective and the nursing
perspective
➢ Goal of nursing – to render the patient or members
of his family capable of meeting the patient’s self-care HEALTH PROMOTION MODEL
needs
➢ To maintain a state of health Nola Pender is a nursing theorist, author and academic.
➢ To regain normal or near normal state of health in the She is a professor emerita of nursing at the University of
event of disease or injury Michigan. She created the Health Promotion Model. She has
➢ To stabilize, control, or minimize the effects of chronic been designated a Living Legend of the American Academy of
poor health or disability Nursing. August 16, 1941 (age 74), Lansing, Michigan, United
States Fields: Nursing Books: Health Promotion in Nursing
Practice Institution: Northern Illinois University, University of
Michigan
➢ Health and healthy are terms used to describe living

things. It is when they are structurally and functionally
whole or sound wholeness or integrity. Purpose: Assist nurses in understanding the major
➢ It includes that which makes a person human, determinants of health behaviors as a basis for behavioral
operating in conjunction with physiological and counseling to promote healthy lifestyles
psychophysiological mechanisms and a material Philosophical Roots: Reciprocal Interaction World View in
structure and in relation to and interacting with other which humans are viewed holistically, but parts can be studied
human beings in the context of the whole. Human beings interact with their
environment and shape it to meet their needs and goals.
Theoretical Roots: Expectancy value theory – Individuals
engage in actions to achieve goals that are perceived as
possible and that result in valued outcomes.
➢ Environment components are environmental factors, Social cognitive theory – Thoughts, behavior, and
environmental elements, conditions, and environment interact. For people to alter how they behave,
developmental environment they must alter how they think
Brief Description. The model identifies background factors
that influence health behavior. Using the model and working
collaboratively with the patient/client, the nurse can assist the
client in changing behaviors to achieve a healthy lifestyle.
RAI | 44
6. Positive affect toward a behaviour results in greater

HPM Assumptions is based on the following assumptions, perceived self-efficacy.
which reflect both nursing and behavioral science 7. When positive emotions or affect are associated with
perspectives: a behavior, the probability of commitment and action
is increased.
1. Persons seek to create conditions of living through 8. Persons are more likely to commit to and engage in
which they can express their unique human health health promoting behaviors when significant others
potential. model the behavior, expect the behavior to occur, and
2. Persons have the capacity for reflective self- provide assistance and support to enable the
awareness, including assessment of their own behavior.
competencies. 9. Families, peers, and health care providers are
3. Persons value growth in directions viewed as positive important sources of interpersonal influence that can
and attempt to achieve a personally acceptable increase or decrease commitment to and
balance between change and stability. engagement in health- promoting behavior.
4. Individuals seek to actively regulate their own 10. Situational influences in the external environment can
behavior. increase or decrease commitment to or participation
5. Individuals in all their biopsychosocial complexity in health-promoting behavior.
interact with the environment, progressively 11. The greater the commitment to a specific plan of
transforming the environment and being transformed action, the more likely health- promoting behaviors
over time. are to be maintained over time.
6. Health professionals constitute a part of the 12. Commitment to a plan of action is less likely to result
interpersonal environment, which exerts influence on in the desired behavior when competing demands
persons throughout their lifespan. over which persons have little control require
7. Self-initiated reconfiguration of person-environment immediate attention.
interactive patterns is essential to behavior change. 13. Commitment to a plan of action is less likely to result
in the desired behavior when other actions are more
HPM Theoretical Propositions derived from the model attractive and thus preferred over the target behavior.
provide a basis for investigative work on health 14. Persons can modify cognitions, affect, interpersonal
behaviors. The HPM is based on the following theoretical influences, and situational influences to create
propositions: incentives for health promoting behavior.
1. Prior behavior and inherited and acquired

characteristics influence beliefs, affect, and
enactment of health-promoting behavior.
2. Persons commit to engaging in behaviors from which
they anticipate deriving personally valued benefits.
3. Perceived barriers can constrain commitment t0
action, a mediator of behavior as well as actual Person is a biopsychosocial organism that is partially shaped
behavior. by the environment but also seeks to create an environment in
4. Perceived competence or self-efficacy to execute a which inherent and acquired human potential can be fully
given behavior increases the likelihood of expressed. Thus, the relationship between person and
commitment to action and actual performance of the environment is reciprocal. Individual characteristics as well as
behavior. life experiences shape behaviors including health behaviors.
5. Greater perceived self-efficacy results in fewer
perceived barriers to a specific health behavior.
RAI | 45
Environment is the social, cultural and physical context in

which the life course unfolds. The environment can be
manipulated by the individual to create a positive context of
cues and facilitators for health-enhancing behaviors.
➢ Sister Callista Roy was born in October 1939 in

California.
➢ She is a member of the Sisters of Saint Joseph of
Health in reference to the individual is defined as the Carondelet. She received undergraduate degrees in
actualization of inherent and acquired human potential through nursing, has both a masters and doctorate in
goal-directed behavior, competent self-care, and satisfying sociology.
relationships with others, while adjustments are made as ➢ She held professor status at Mount St Mary’s College
needed to maintain structural integrity and harmony with and was a postdoctoral fellow at University of
relevant environments. Health is an evolving life experience. California-Roy has authored many books and articles
There are definitions for family health and community health and has received numerous personal and
that have been proposed by other authors. professional achievement recognitions.
Illnesses are discrete events throughout the ➢ Roy was challenged by Johnson to create a model for
life span of either short (acute) or long nursing; Roy, a pediatric nurse at the time, had great
(chronic) duration that can hinder or facilitate interest in children and their ability to adapt especially
one’s continuing quest for health. in the face of great physical and psychological
changes.
➢ First operationalized at Mount St Mary’s college as
foundation of nursing school; 1977 model was
presented.
Nursing is collaboration with individuals, families, and
communities to create the most favorable conditions for the
expression of optimal health and high-level well-being.
Sr. Callista Roy's Adaptation Model of Nursing was developed

by Sister Callista Roy in 1976. The prominent nursing theory
aims to explain or define the provision of nursing. In her theory,
Roy's model sees the individual as a set of interrelated
systems who strives to maintain balance between these
various stimuli.
RAI | 46
• Adaptive responses are those that promote the

integrity of the person.
• The person’s integrity, or wholeness, is behaviorally
demonstrated when the person is able to meet the
goals in terms of survival, growth, reproduction and
mastery.
• Ineffective responses do not support these goals.
(Roy & Andrews, 1991)
• Coping mechanisms describe the control processes
of the person as an adaptive system. Some coping
mechanisms are inherited or genetic, such as white
blood cell defense mechanism against bacteria that
seek to invade the body.
• Other mechanisms are learned, such as the use of
antiseptics to cleanse a wound.
1. Physiologic-physical mode: physical and chemical

processes involved in the function and activities of
living organisms; the underlying need is physiologic
integrity as seen in the degree of wholeness achieved
through adaptation to changes in needs. In groups, A. Cognator subsystem “A major coping process
this is the manner in which human systems manifest involving four cognitive-emotive channels: perceptual
adaptation relative to basic operating resources. The and information processing, learning, judgment, and
basic need of this mode is composed of the needs emotion.”
associated with oxygenation, nutrition, elimination, B. Regulator subsystem “A basic type of adaptive
activity and rest, and protection. The complex process that responds automatically through neural,
processes of this mode are associated with the chemical, and endocrine\ coping channels.”
senses, fluid and electrolytes, neurologic function,
and endocrine function. Focal stimuli. Those stimuli that are the proximate causes of
2. Self-Concept-Group Identity Mode: focuses on the situation.
psychological and spiritual integrity and a sense of Contextual stimuli. All other stimuli in the internal or external
unity, meaning, purposefulness in the universe. environment, which may or may not affect the situation.
3. Role function mode: refers to the roles that Residual stimuli. Those immeasurable and unknowable
individuals occupy in society fulfilling the need for stimuli that also exist and may affect the situation.
social integrity; it is knowing who one is, in relation to
others.
4. Interdependence mode: the close relationships of
people and their purpose, structure and development
individually and in groups and the adaptation potential
of these relationships.
RAI | 47
“The human adaptive system” and defined as “a whole with

parts that function as a unity for some purpose. Human
systems include people… groups… organizations,
communities, and society as a whole.” (Roy & Andrews, 1999)
Myra Estrin Levine (1921–1996) is a nursing theorist known
for her esoteric model of nursing—the Conservation Model. In
this model, the goal of nursing is to promote adaptation and
maintain wholeness using the four principles of conservation.
Aside from being a major influence in the nursing profession,
Conditions, circumstances and influences that… affect the
Levine was also a family woman, friend, educator,
development and behavior of humans as adaptive systems.
administrator, student of humanities, scholar, enabler, and
confidante.
Myra Estrin Levine was born in Chicago in 1920, the first

A state and process of being and becoming integrated and child in a family of three siblings.
whole.
She received her diploma in nursing from the Cook County
School of Nursing, then continued on to finish her Bachelor of
Science in Nursing from the University of Chicago in 1949. Her
Master’s of Science in Nursing was granted to her from Wayne
Goal of nursing State University in Detroit in 1962.
The “promotion of adaptation in each of the four modes.”
Adaptation She was a private duty nurse in 1944, a civilian nurse in the
The “process and outcome whereby thinking and feeling U.S. Army in 1945, a preclinical instructor in the physical
persons as individuals or in groups use conscious awareness sciences at Cook County from 1947 to 1950, director of
and choice to create human and environmental integration.” nursing at Drexel Home in Chicago from 1950 to 1951, and
surgical supervisor at both the University of Chicago Clinics
from 1951 to 1952, and the Henry Ford Hospital in Detroit from
1956 to 1962.
M4 LESSON 3 : M. Levin,L. In 1951, Levine also became a clinical instructor at Bryan

Hall & M. Rogers by Mary Memorial Hospital in Lincoln, Nebraska and administrative
Grace Gutierrez supervisor at the University of Chicago.
Myra Estrine Levine died on March 20, 1996, at the age of 75.
RAI | 48
• “Conservation is about achieving a balance of energy

supply and demand that is within the unique biological
realities of the individual.”
• “Through conservation, individuals are able to
✓ Developed in early 1970s confront disability”
✓ Initially constructed as a teaching framework for • The primary focus of conservation is keeping together
medical-surgical nursing of the wholeness of the individual,
✓ Based on physical science principles, Gives rationale
behind nursing actions
✓ Integrated numerous authors and their work to help
develop the concepts of Conservation Model.
▪ A holistic being—not only in the physical needs, but

also the psychosocial, cultural and spiritual
aspects—who constantly strives to preserve
wholeness and integrity.
▪ A unique individual in unity and integrity, feeling,
believing, thinking and is a whole system.
▪ The environment completes the wholeness of the

individual.
• Levine stated that “the unceasing interaction of the
▪ Where the individual lives her life.
individual organism with its environment does
represent an ‘open and fluid’ system, and a condition
of health, wholeness, exists when the interaction or
constant adaptations to the environment, permit
ease—the assurance of integrity…in all the
dimensions of life.” ▪ Health and disease are patterns of adaptive change.
▪ Ability to function normally and able to return to daily
activities, self-hood, and ability to pursue one's
interest without constraints
▪ Not just an absence of disease and successful
adaptation and not merely healing of an affected part
• Adaptation is the process of change, and
conservation is the outcome of adaptation
• “A process of change whereby the individual retains
his integrity within the realities of his internal and
external environment” (Levine 1969, p.95)
RAI | 49
▪ Nursing involves engaging in “human interactions” • A change in behavior of an individual during an

▪ “The nurse enters into a partnership of human attempt to adapt to the environment is called
experience where sharing moments in time—some an organismic response.
trivial, some dramatic—leaves its mark forever on • It helps individual to protect and maintain their
each patient” (Levine, 1977, p. 845). integrity.
Quick response to threat or

▪ Levine’s Conservation Model discussed the way in perceived threat
which the person and the environment become
Restores physical
congruent over time.
wholeness (healing)
▪ The terms described are; adaptation and organismic
response. Integrated Response
developed over time
Focusing on specific
aspects of environment
• Process of interacting with environment

• Process of change or of life
• Can be equated with
o Homeostasis
o Stability
o Equilibrium
o Balance
--Protects functional integrity
--Pacing activities to restore
function
--Physical healing
--Physiologic activities
--Refers to --There is a --Ability to function in groups

person’s genetic system to deal --Person displays --Self is developed in family
makeup with each task multiple and society
--Happens at the --Unique responses to
cellular level stimulus- dysfunction --Recognition of self
--Based in response --Multiple systems --Protection of personal
personal and pathways, task deal with threat space
genetic past oriented
history --Interacting
sequences of
events
RAI | 50
• It refers to balance between energy expenditure and

conservation. Patient activity is dependent on energy
• Social beings interacts with in a family, a community,
balance.
a religious group, an ethnic group, a political system
• Energy is measured in everyday nursing practice via
and a nation.
body temperature, blood gases, pulse, and blood
• Nursing Intervention: Helping the individual to
pressure; fluctuations determine either energy
preserve his or her place in the family, community
expenditure or conservation
and society.
EXAMPLES:
EXAMPLES:
o Availability of adequate rest
• Position patient in bed to foster social interaction with
o Maintenance of adequate nutrition
other patients
• Avoid sensory deprivation
• Promote patient’s use of newspaper, magazines,
radio. TV
• Provide support and assistance to family
• Focused on preserving the anatomical structure of the

body and preserving healing.
• Nursing Intervention aims in helping the individual to
prevent skin breakdown and limiting the amount of
tissue involvement in infectious disease.
EXAMPLES:
o Maintenance of clean, dry, wrinkle free linen.
o Regular turning of patient side to side every 2 hours • Conservational model provides the basis for
to patients who are bedridden development of two theories
o Perform ROM exercises
o Maintenance of patient’s personal hygiene
• Untested, speculative theory that redefined aging and

everything else that has to do with human life
• Aging is diminished availability of redundant system
• A client is a person with dignity, sense of identity and
necessary for effective maintenance of physical and
self-worth.
social well being
• Individual strives for recognition, respect, self-
awareness, self-hood and self-determination.
• Individuals require privacy
EXAMPLES:
o Expression of patient’s feelings
o Involvement of patient in plan of care,
o Recognize and protect patient’s space needs
RAI | 51
• To seek a way of organizing nursing interventions out

of the biological realities which the nurse has to
confront
• Therapeutic regimens should support the following
goals:
- Facilitate healing through natural response to
Lydia Eloise Hall (September 21, 1906 – February 27, 1969)
disease
was a nursing theorist who developed the Care, Cure, Core
- Provide support for a failing auto regulatory
model of nursing. Her theory defined Nursing as “a
portion of the integrated system
participation in care, core and cure aspects of patient care,
- Restore individual integrity and well being
where CARE is the sole function of nurses, whereas the CORE
- Provide supportive measure to ensures comfort
and CURE are shared with other members of the health team.”
- Balance a toxic risk against the threat of disease
- Manipulate diet and activity to correct metabolic
Lydia Hall was born on September 21, 1906 in New York City.
imbalance and stimulate physiological process
- Reinforce usual response to create a therapeutic-
Lydia Hall graduated from York Hospital School of Nursing in
changes
1927 with a diploma in nursing. However, she felt as if she
needed more education. She entered Teacher’s College at
Columbia University in New York and earned a Bachelor of
Science degree in public health nursing in 1932. After a
number of years in clinical practice, she resumed her
education and received a master’s degree in the teaching of
• Provided nursing with a systematic way to view
natural life sciences from Columbia University in 1942. Later,
patient holistically and intervene accordingly
she pursued a doctorate and completed all of the requirements
• Advocated for use of scientific process in nursing
except for the dissertation.
• Now called, “Evidence Based Practice”
She spent her early years as a registered nurse working for the
Life Extension Institute of the Metropolitan Life Insurance
• Myra Levine’s Theory interrelates the concepts of
Company in Pennsylvania and New York where the main focus
conservation, adaptation, and integrity.
was on preventative health. She also had the opportunity to
• The purpose of conservation is health, or integrity- the work for the New York Heart Association from 1935 to 1940. In
wholeness of an individual 1941, she became a staff nurse with the Visiting Nurses
• Adaptation is the process by which conservation Association of New York and stayed there until 1947. In 1950,
occurs. she became a professor at Teacher’s College at Columbia,
where taught nursing students to function as medical
consultants. She was also a research analyst in the field of
Internal Environment adapts to external environmental cues
cardiovascular disease.
through conservation so that person maintains integrity.
Hall died on February 27, 1969, at Queens Hospital in New
York.
RAI | 52
INTERPERSONAL PROCESS
UNEDRSTANDING THEMSELVES
• Nurturing component of care
• Involves the concept of “Mothering”
• Provides bodily care for the patient and helps the PROBLEM FOCUSSING AND PROBLEM SOLVING
patient to complete such basic daily biologic activities
• Provides teaching and learning activities
• Nurses goal is to “comfort” the patient
• Patient may explore and share feelings with nurse
• Nurse is concerned with intimate bodily care • Care based on pathological and therapeutic sciences
• Nurse applies knowledge of natural and biological • Application of medical knowledge by nurses
sciences to provide a strong theoretical base for • Nurse assisting the doctor in performing tasks
nursing implementations. • Nurse is patient advocate in this area
• Nurse act as potential comforter • Nurses role changes from positive quality to negative
quality
INTERPERSONAL RELATIONSHIP • Medical surgical and rehabilitative care
• COPERATE WITH FAMILIES OR CARE GIVERS
EXPLORATION OF FEELINGS
• Emphasis placed on the importance of total person

approach
• Patient care is based on social sciences
• Importance placed on all three aspects functioning
• Involves the Therapeutic use of self
together
• The nurse is able to help the patient verbally express
• All three aspects interact and change in size,
feelings regarding the disease process and its effects,
depending on the patient’s total course of progress.
as well as discuss the patient’s role in recovery or
healing process.
• Patient is able to maintain who they are (self-identity)
• Patient able to develop a maturity level when nurse
listens to them and acts as sounding board
• Patient able to make informed or conscious decisions
based on understood and accepted feelings and
motivations.
• Helps the patient look at and explore feelings
regarding his or her current health status • The individual human who is 16 years of age or older
▪ Emphasis on social, emotional, spiritual and and past the acute stage of a long-term illness is the
intellectual needs focus of nursing care in Hall’s work.
▪ Patient makes more rapid progress towards • The source of energy and motivation for healing is the
recovery and rehabilitation individual care recipient, not the health care provider.
RAI | 53
emphasizing the aspects that are most appropriate for

a particular situation.
Health can be inferred to be a state of self-awareness with

conscious selection of behaviors that are optimal for that
individual.
Born in Dallas, Texas, on May 12, 1914.After attending the
University of Tennessee at Knoxville from 1931 to 1933,
Rogers entered the Knoxville General Hospital School of
Nursing, receiving her diploma in 1936, and earned a bachelor
• The concept of society/environment is dealt with in
of science degree from George Peabody College, Nashville, in
relation to the individual.
1937. She was employed as a public health nurse in Michigan
• Hall is credited with developing the concept of Loeb
from 1937 to 1939, and as a member of the staff of the
Center because she assumed that the hospital
Hartford, Connecticut Visiting Nurses Association from 1940 to
environment during treatment of acute illness creates
1945. In 1952, she received a master's degree in public health
a difficult psychological experience for the ill
and in 1954, a doctor of science degree, both from Johns
individual.
Hopkins University. In 1954, Rogers was appointed professor
of nursing and head of the Division of Nursing at New York
University.
Nursing is identified as consisting of participation in the care,

core, and cure aspects of patient care. The fundamental unit of both the living and nonliving; infinite,
pandimensional, unpredictable – Roger’s definition of Unitary
Human Being.
• Lydia Hall’s Theory involves three interlocking circles,
each representing on aspect of nursing.
o The care aspect represents intimate bodily care
Energy fields that represents the person’s whole existence –
o The core aspect deals with the innermost
they are intangible, non-visible manifestations but perceptually
feelings and motivations of the patient
present in all interactions.
o The cure aspect tells how the nurse helps the
patient and the family through the medical aspect
of care.
• Of the major concepts of nursing’s metaparadigm, ’
only nursing is defined as the function necessary to
carry out care, core, and cure. Hall presents a • The way which a person’s life process evolve
philosophical view of humans as having the energy
• Physiological equilibrium (homeostasis) of person
and motivation of self-awareness and growth.
Consists of:
Definitions of health, person, and environment are
Resonancy: continuous movement from lower to higher
inferred.
frequency wave patterns between person and environment;
• Lydia Hall’s theory may be applied in the nursing
postulated to be associated with a heightened sense of well-
process. The limitations of Hall’s theory-illness
being.
orientation, age, restrictions on family contact, and
use of reflection only-can be overcome by taking a
broader view of care, core, and cure and by
RAI | 54
Helicy: the unpredictable changes between person and

environment which foster creativity, innovation, and problem
solving.
Integrality: continuous interactive rhythms between person Irreducible pandimensional sharing of energy and patterns with
and environment. humans through synchronous interactions.
o Synchrony: continuous change that happens
simultaneously between person and environment. M4 LESSON 4 : D. Johnson &
o Reciprocy: continuous interaction between person
and environment.
R. Parse by Mary Grace
Gutierrez
Behavioral Systems Model - 1968

• Requires specific learning
• Considered a profession Dorothy E. Johnson was born on
• Both an Empirical science and art August 21, 1919 in Savannah,
• Purpose is to promote health and well-being for all Georgia. She earned her Bachelor
persons of Science in Nursing in 1942 from
• Exits for the people and life process of humans Vanderbilt University in Nashville, Tennessee. In 1948, she
received her Master’s degree from Harvard University. During
her career, 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. She
• An open system continuously connected to the retired in 1978.
environment
• Whole in the truest sense and non-reducible Johnson is known for her Behavior System Model of
comprised of patterns and pandimensional energy Nursing, which was first proposed in 1968. The model
fields. 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. Each subsystem is comprised of four structural
characteristics. An imbalance in each system results in
• Passive means without illness (wellness) disequilibrium. The nurse’s role is to help the patient maintain
• Relates to a person’s value systems and personal his or her equilibrium.
cultural interpretation, consisting of both high and low
values.
• “life process” is filled with dynamic and creative unity
with one’s environment.
RAI | 55
By 1980, Johnson defined nursing as:

• “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 the behavior constitutes a threat to physical or
social health, or in which illness is found”
Based on the definition, four goals of nursing are to assist the

patient to become a person:
1. Whose behavior is commensurate with social

demands
2. Who is able to modify his behavior in ways that
support biologic imperatives
“social inclusion, intimacy,
3. Who is able to benefit to the fullest extent during
Attachment or Affiliative and the formation and
illness from the physician’s knowledge and skill attachment of a strong
subsystem
4. Whose behavior does not give evidence of social bond.”
unnecessary trauma as a consequence of illness.
“approval, attention or
Overview of johnson’s “behavioral system model” recognition, and physical
DEPENDENCY SUBSYTEM assistance (helping or
nurturing)
• Johnson’s Behavioral System Model is a model of
nursing care that advocates the fostering of efficient “the emphasis is on the
and effective behavioral functioning in the patient to meaning and structures of
prevent illness. INGESTIVE SUBSYSTEM the social events
• The three functional requirements for each subsystem surrounding the occasion
include protection from noxious influences, provision when the food is eaten.”
for a nurturing environment, and stimulation for
Relates to behavior
growth. surrounding the excretion of
ELIMINATIVE SUBSYSTEM waste products from the
body.
“both biological and social

SEXUAL SUBSYSTEM factor affect the behavior in
the sexual subsystem.”
“related to the behavior

AGGRESSIVE SUBSYSTEM concerned with protection
and self-preservation.”
ACHIEVEMENT SUBSYSTEM “provokes behaviors that

attempt to control the
environment.”
RAI | 56
AN 8 SUBSYTEM, RESTORATIVE IS ADDED

• Concerned with rest, sleep, comfort/freedom from
pain
Seen as “an external regulatory force which acts to preserve
Each subsystem has three functional requirements: the organization and integration of the patient’s behavior at an
optimal level under those conditions in which the behavior
1. System must be “protected” from noxious influences constitutes a threat to physical or social health, or in which
with which system cannot cope illness is found.”
2. Each subsystem must be “nurtured” through the
input of appropriate supplies from the environment.
3. Each subsystem must be “stimulated” for use to
enhance growth and prevent stagnation • Johnson’s behavioral model is clearly an Individual-
oriented framework. Its extent to consider families,
groups and communities was not considered.
• Categorizing different behaviors in seven subsystems
divided the focus of nursing interventions. In turn
quality of care given by the nurse may be lessened
because of fractionalized care which does not support
seeing the individual as a whole adaptive system.
A lack of an authenticated schematic diagram by
• Views human beings as having two major systems: Johnson which is seen necessary was not presented.
the biological system and the behavioral system. Johnson has developed multiple concepts thus a
• It is the role of medicine to focus on the biological diagram showing each and every concepts
system, whereas nursing’s focus is the behavioral relationship might be helpful.
system.
• Johnson’s Behavioral System Model of nursing care

that advocates the fostering of efficient and effective
Is not directly defined, but it is implied to include all elements of behavioral functioning in the patient to prevent illness.
the surroundings of the human system and includes interior The patient is identified as a behavioral system
stressors. composed of seven behavioral subsystems: affiliative,
dependency, ingestive, eliminative, sexual,
aggressive, and achievement.
• Each subsystem is composed of four structural
characteristics: drive, set, choices, and observable
Seen as the opposite of illness, and Johnson defines it as behaviors. The three functional requirements for each
“some degree of regularity and constancy in behavior, the subsystem include protection from noxious
behavioral system reflects adjustments and adaptations that influences, provision for a nurturing environment, and
are successful in some way and to some degree..adaptation is stimulation for growth. An imbalance in any of the
functionally efficient and effective.” behavioral subsystems results in disequilibrium.
• It is nursing’s role to assist the client to return to a
state of equilibrium.
RAI | 57
• She developed the Theory of Human Becoming

through a combination of concepts from Martha
Rogers and from existential-phenomenological
THEORY OF HUMAN BECOMING thought.
• Her nine assumptions are based on the three main
Rosemarie Rizzo themes of meaning, rhythmicity, and transcendence.
Parse was born in • Each theme leads to a principle: meaning relates to
Pennsylvania in imagining, valuing, and languaging; rhythmicity
1938. She went on to relates to revealing-concealing, enabling-limiting, and
graduate from St. connecting-separating; transcendence relates to
Francis Academy in powering, originating, and transforming.
1956, before enrolling at Duquesne University. ... She began
her teaching career at the University of Pittsburgh while
finishing her Ph.D. before accepting a position at Duquesne in
1966.
I. The human is coexisting while reconstituting
rhythmical patterns with the universe. – Individuals
take an active party in creating their own patterns and
reality.
II. The human is open, freely choosing meaning in
situation, bearing responsibility for decisions. –
• She began her work on the Human Becoming theory
Human beings make choices on how to act and react.
in the 1970s and was first published in 1981. The
They are responsible for the outcome of these
human becoming theory was developed as a human
choices.
science nursing theory
III. The human is unitary, continuously reconstituting
• The assumptions underlining the theory were
patterns of relating. – People are more than a sum of
synthesized from works by the
their parts. One can be distinguished from another by
• European philosophers, Heidegger, Sartre, and
patterns of appearance, mannerisms, voice and other
Merleau-Ponty, along with works by the pioneer
characteristics
American nurse theorist, Martha Rogers.
IV. The human is transcending multidimensionally with
the possibles – The human is capable of changing
and growing beyond their limitations.
V. Becoming is an open process, experienced by the
human. – Becoming is continous growth towards
• Theory was based on Dr. Parse’s lived experience in more diversity & complexity. Growing includes
nursing & its poor fit with the existing paradigms choosing who one will be in a given situation.
• The theory focuses on the human-universe-health VI. Becoming is a rhythmically reconstituting human
process and is based on the premise that the human universe process – Health & becoming are
being pursues and creates his own process of being intertwined. The elements of our environment in
with the world which we connect and separate from, change us.
• The uniqueness of the theory is its perspective on With these elements we reconstitute our health.
paradoxes of human becoming. VII. Becoming is the human’s patterns of relating value
• The theory emphasizes the relationship between priorities. – Health is living the ideals chosen by the
human & environment with paradoxical rhythmical individual.
patterns
RAI | 58
VIII. Becoming is an inter subjective process of

transcending with the possible– Health is reaching
beyond the actual to the possible through subject-to-
subject interchange. This interchange can occur
through two persons or with another element of the Health – a process of changing life’s meanings a personal
environment power emerging from the individual’s collective relationships
IX. Becoming is a rhythmically reconstituting human with others and the universe
universe process – Health & becoming are
intertwined. The elements of our environment in
which we connect and separate from, change us.
With these elements we reconstitute our health.
X. Becoming is the human’s patterns of relating value Nursing – a basic science the practice of which is a
priorities. –Health is living the ideals chosen by the performing art.
individual.
XI. Becoming is an inter subjective process of
transcending with the possible– Health is reaching
:
beyond the actual to the possible through subject to-
subject interchange. This interchange can occur
through two persons or with another element of the ’ <
environment
’ ’
XII. Becoming is human unfolding – We are continuously
changing, never to return to our previous state
Human Beings/Person – an open being in mutual process

with the universe cocreating patterns of relating with others
Environment/Society – assumed under the larger view of

human beings – universe; inseparable, complementary and
evolving together.
RAI | 59
M5 Lesson I: H. Peplau / J.
Watson / I. King
• Problem defining phase
• Starts when client meets nurse as stranger
• Defining problem and deciding type of service needed
• Client seeks assistance, conveys needs, asks
questions, shares preconceptions and expectations of
past experiences
When nurses enter the healthcare
field, they need to work with people. Nurse responds, explains roles to client, helps to identify
The nurse-patient relationship problems and to use available resources and services
should be well understood by the
nurses for them to be better quipped
to work with their patients and,
ultimately, provide better care for
them. Hildegard Peplau’s model of
nursing focuses on that nurse-patient relationship and identifies
the different roles nurses take on when working with patients.
’
• Nursing is therapeutic because it is a healing art and
assists the individual who is either sick or in need of
health care.
• An INTERPERSONAL PROCESS because of the
interaction between the two or more individuals who
have a common goal
• The Nurse and Patient work together so both become
mature and knowledgeable in the care process.
• Selection of appropriate professional assistance.
• Patient begins to have a feeling of belonging and a
capability of dealing with the problem which decreases
the feeling of helplessness and hopelessness.
1. Orientation • This phase is the DEVELOPMENT OF A NURSING
2. Identification CARE PLAN based on patient’s situation and goals.
3. Exploitation
4. Resolution
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• Termination of professional relationship

• The patient needs have already been met by the
collaborative effect of patient and nurse
o Difficult phase for both if psychological
dependence exists
• The EVALUATION phase of the nursing process
• The nurse and patient evaluate the situation based on
the goals set and whether or not they were met
Use of professional assistance for problem solving alternatives

based on the NEEDS AND INTERESTS OF THE PATIENTS.
1. The patient feels like an integral part of the helping

environment
2. Patient may make minor requests or use attention- Stranger – where the nurse receives the patient in the same
getting techniques way the patient meets a stranger in other life situations
3. Implementation phase where the goals for the patients Teacher: who imparts knowledge in reference to a need or
to be met are being considered while taking interest
appropriate actions Resource Person: one who provides a specific needed
information that aids in the understanding of a problem or new
situation
Counselor: helps recognize, face, accept and resolve problems
1. Nurse should use interview techniques when

communicating with the patient to explore, understand
and adequately deal with the underlying problem.
2. The nurse must also be aware of the various phases
Leader: initiates and maintains group goals through interaction
of communication since the patient’s independence is
Surrogate: take the place of another
likely to fluctuate
Technical Expert: provides physical care using clinical skills
3. The nurse should help patient exploit all avenues of
help as progress is made toward the final phase.
4. The nurse implements the nursing plan, or taking
actions toward meeting the goals set in the
identification phase.
RAI | 61
patients. These "Caritas processes" will guide nurses on how

to instill hope in patients, develop a trusting relationship and
provide a supportive mental, social and spiritual environment.
Jean Watson's theory is on "Mind-Body-Spirit Approach" to
healing.
A developing organism that tries to reduce anxiety caused by • The foundation of Jean Watson’s theory of nursing was
needs. published in 1979 in nursing: “The philosophy and
science of caring”
• Watson believes that the main focus in nursing is on
carative factors. She believes that for nurses to
develop humanistic philosophies and value system, a
Existing forces outside the organism and in the context of strong liberal arts background is necessary.
culture. • A higher degree of harmony within the mind-body-spirit
generates self-knowledge, self-reverence, self-healing
and self-care processes.
• This in turn can potentiate HEALING and HEALTH
• This goal is attainable through transpersonal caring
A word symbol that implies forward movement of guided by the CARATIVE FACTORS and
personality and other ongoing human processes in the direction corresponding CARITAS PROCESSES
of creative, constructive, productive, personal and community
living.
1. The formation of a humanistic- altruistic system of

values.
A significant therapeutic interpersonal process. It functions
2. The installation of faith-hope.
cooperatively with other human process that make health
3. The cultivation of sensitivity to one’s self and to others.
possible for individuals in communities.
4. The development of a helping-trust relationship
5. The promotion and acceptance of the expression of
positive and negative feelings.
6. The systematic use of the scientific problem-solving
method for decision making
7. The promotion of interpersonal teaching-learning.
Nurses are guided by the concept of 8. The provision for a supportive, protective and /or
Holistic Nursing Care that they corrective mental, physical, socio-cultural and spiritual
respond not only for the physiologic environment.
needs but also consider the mental, 9. Assistance with the gratification of human needs.
social and spiritual well-being of the 10. The allowance for existential-phenomenological
patient. The next nursing theory forces.
incorporates the numerous
humanistic processes that the nurse
may consider while giving care to
RAI | 62
The first three carative factors form the “philosophical 6. The systematic Use all ways of knowing as part of
foundation” for the science of caring. The remaining seven use of the scientific the caring process and
carative factors spring from the foundation laid by these first problem-solving engagement in the artistry of
method for decision caring-healing process
three. making
7. ENGAGING IN STAYING WITHIN OTHER’S

TRANSPERSONAL FRAME OF REFERENCE OR A
TEACHING AND SHIFT TOWARD COACHING
1. The formation of a Begins at an early age with values LEARNING WITH MODEL FOR EXPANDED
humanistic- altruistic shared with the parents. CONTEXT OF HEALTH / WELLNESS
system of values BY: • Mediated through ones CARING
own life experiences. RELATIONSHIP
PRACTICE OF • Is perceived as
LOVING- KINDNESS, necessary to the nurse’s
COMPASSION AND own maturation which 8. Provision for a CREATE A HEALING
EQUANIMITY FOR then promotes altruistic supportive, ENVIRONMENT AT ALL
ONESELF AND behavior towards others. protective and /or LEVELS, WHERE WHOLENESS,
OTHER corrective mental, BEAUTY, COMFORT, DIGNITY
physical, socio- AND PEACE ARE
cultural and spiritual POTENTIATED
BEING TOTALLY PRESENT AND environment
2. The installation of ENABLING, SUSTAINING, AND
Faith-hope HONORING THE DEEP BELIEF
SYSTEM AND SUBJECTIVE RESPECTFULLY ASSIST WITH
LIFE WORLD OF ONESELF AND 9. Assistance with BASIC NEEDS OR ATTENDING
THE ONE BEING CARED FOR the gratification of TO BOTH THE EMBODIED
human needs SPIRIT AND EVOLVING
EMERGENCE
DEEPENING OF SELF-
AWARENESS AND SENSITIVE
3. Cultivation of TO OTHERS BY CULTIVATING OPENING AND ATTENDING TO
sensitivity to one’s OWN SPIRITUAL PRACTICES 10. Allowance for SPIRITUAL, UNKNOWN
self and to others AND GOING BEYOND THE EGO existential- EXISTENTIAL DIMENSIONS OF
SELF TO TRANSPERSONAL phenomenological LIFE, DEATH AND SUFFERING
SELF forces OR “ALLOWING FOR A
MIRACLE”
4. Establishing a DEVELOPING AND

helping-trust SUSTAINING AUTHENTIC
relationship CARING RELATIONSHIP
BEING PRESENT TO,

5. The expression of AND SUPPORTIVE
feelings, both OF THE EXPRESION
positive and negative OF FELINGS OR
LISTENING TO OTHER
PERSON’S STORY
RAI | 63
TRANSPERSONAL CARING relationships are the foundation

of the work
• A valued person in and of him or herself to be cared

TRANSPERSONAL conveys a concern for the inner life world
for, respected, nurtured, understood and assisted; in
general a philosophical view of a person as a fully
TRANSPERSONAL CARING relationship moves beyond ego-
functional integrated self.
self and radiates to spiritual, even cosmic concerns and
• He, human is viewed as greater than and different
connections that tap into healing possibilities and potentials.
from, the sum of his or her parts”.
A CARING MOMENT occurs whenever the nurse and another
came together, beyond ego, with their unique life histories and
phenomenal fields in a human-to-human connection.
Watson believes that there are other factors that are needed to
be included in the WHO definition of health. She adds the
following three elements:
• A heart-centered loving energetic field; a turning point o A high level of overall physical, mental and social
• A call to higher / deeper consciousness, intentionality functioning
• An authentic choice of caring / living o A general adaptive-maintenance level of daily
• Requires presence-centering-search for meaning; new functioning
level of authenticity – potentiating healing and o The absence of illness (or the presence of efforts that
wholeness leads its absence)
• Within the MODEL OF TRANSPERSONAL CARING,

clinical caritas consciousness is engaged at a According to Watson caring (and nursing) has existed in every
foundational ethical level for entry into this framework society. A caring attitude is not transmitted from generation to
• Together nurse and the other join in a mutual search generation. It is transmitted by the culture of the profession as a
for meaning and wholeness of being and becoming to unique way of coping with its environment.
potentiate comfort measures, pain control, sense of
well-being, wholeness or even spiritual transcendence
of suffering
She defines nursing as…..

“A human science of persons and human health-illness
experiences that are mediated by professional, personal,
scientific, esthetic and ethical human transactions”.
RAI | 64
• THAT PROVIDES “one approach to studying systems

Conceptual System and Middle Range Theory of as a whole rather than as isolated parts of the system
Goal Attainment • the reason King’s theory has sustained time and basic
alteration is that it is based upon the central tenet of
Many of the nurses decided to pursue a communication and interaction
career in Nursing to be of help to patients • Each system defines HUMAN BEINGS as the basic
maintain their health. This is possible if elements in the system thus the unit of analysis in
the nurse and patient work hand in hand frameworks was human behavior in a variety of social
to set the health goal for the patient and environments
together design the plan in order to
achieve the goal. The theory of Imogene
King focuses on this process. King also
postulated that human beings are open systems continuously
interacting with the environment.
• Born in 1923
• Completed her Bachelor in science of nursing from St.
Louis University in 1948
• Master of science in nursing in 1957
• Completed her Doctorate from Teacher’s college,
Columbia University
• A SYSTEMATIC representation of nursing is needed
to develop a science to accompany a century or more
of art in the everyday world of nursing”
• She continued providing community service and
helped plan care through her conceptual system and
the theory of various health care organization
QUESTIONS she asked were:

What is the GOAL of nursing?
What are the functions of nursing?
• Nursing focus is the care of human being
• Nursing goal is the health care of individuals & groups An awareness of the complex dynamics of human behavior in
A SYSTEMS APPROACH is used nursing situations prompted King the formulation of this
• Her framework is concerned with: conceptual framework that represented the personal,
o HUMAN TRANSACTIONS IN DIFFERENT interpersonal and social systems as the domain of nursing.
KINDS OF ENVIRONMENTS
o NOT with fragmenting human beings and the
environment
RAI | 65
PERSONAL SYSTEM as a PATIENT or a NURSE A more comprehensive interacting system consist of groups that
To understand human being as persons King specified the make up society
concept of: • Organization
• Perception • Authority
• Self • Power
• Growth & development • Status
• Body image • Decision making
• Space The influential behavior of an extended family on an individuals
• Time growth and development is nother social system
Derived this theory from conceptual system where….

• Theory describes a dynamic, interpersonal relationship
in which a person grows and develops to attain certain
life goals
• Theory of goal attainment was first introduced by
Imogene King in the early 1960’s.
• What is the question that motivated King to develop
UNDERSTANDING the interpersonal requirest the concepts
this theory???
of:
• What is the nature of NURSING?
• Interaction
THE WAY IN WHICH NURSES, IN THEIR ROLE, DO WITH
• Communication AND FOR INDIVIEUALS THAT DIFFERENTIATES NURSING
• Transaction FROM OTHER HEALHT PROFESIONALS.
• Role • Factors which affects the attainment of goal are:
• Stress roles, stress, space & time
This is formed when 2 or more
individuals interact forming dyads or
two people and triads or three people
Ex: dyads of a nurse and patient
If perceptual congruence is present in nurse-client interactions,
family acting as small group
transaction will occur
PC (I) T
If nurse and client make transaction, goal will be attained
T GA
If goal are attained, satisfaction will occur
GA S
RAI | 66
• If transactions are made in nurse-client

interactions, growth & development will be
enhanced
• If role expectations and role performance as The background for human interactions. It involves:
perceived by nurse & client are congruent, • Internal environment: transforms energy to enable
transaction will occur person to adjust to continuous external environmental
• If role conflict is experienced by nurse or client or changes.
both, stress in nurse-client interaction will occur • External environment: involves formal and informal
• If nurse with special knowledge skill communicate organizations. Nurse is a part of the patient’s
appropriate information to client, mutual goal environment.
setting and goal attainment will occur.
M5 Lesson 2: I. J. Orlando /
E. Weidenbach / J.
Travelbee / P. Benner
• Spiritual beings
• have the ability through their language and other
symbols to record their history and preserve culture
• unique and holistic of intrinsic worth and capable of One of the nurses' role is to know the needs of patients and how
rational thinking and decision making to intervene to achieve positive health outcomes. Ida Jean
• differ in their needs, wants and goals Orlando's theory guides nurses on how to create an effective
nursing care plan in order to achieve the health goals.
• She received her nursing diploma from New York

Medical College, her BS in public health nursing from
• An observable behavior found in the health care St. John's University, NY, and her MA in mental health
systems in society nursing from Columbia University, New York.
• helps individuals maintain their health to function in • Orlando's theory was developed in the late 1950s from
their roles observations she recorded between a nurse and
• an interpersonal process of action, reaction, interaction patient.
and transaction • She categorized the records as "good" or "bad"
nursing.
• From these observations she formulated the
deliberative nursing process.
• A dynamic state in the life cycle whereas illness

interferes with that process
• implies continues adjustment to stress in the internal
and external environment through the optimum use of
one’s resources
RAI | 67
form in which it appears, represents a plea for help in

meeting unmet needs.
o Verbal behavior encompasses all the
• The role of the nurse is to find out and meet the patient’s use of language. It may take the
patient's immediate need for help. form of complaints, requests, questions,
• The patient's presenting behavior may be a plea for refusals, demands, and comments or
help, however, the help needed may not be what it statements.
appears to be. o Nonverbal behavior includes physiological
• Therefore, nurses need to use their perception, manifestations, motor activity or vocal
thoughts about the perception, or the feeling actions.
engendered from their thoughts to explore with
patients the meaning of their behavior.
• This process helps nurse find out the nature of the
distress and what help the patient needs.
• Patient behavior stimulates nurse reaction which
marks the beginning of the nursing process discipline
• This reaction is comprised of three sequential parts
’ 1. The nurse perceives behavior through senses
2. The perception leads to automatic thought
• Based on the “process by which any individual acts” 3. The thought produces an automatic feeling
• The purpose is to meet the patient’s immediate need
for help (1) The nurse perceives behavior through senses
• Improvement in in the patient’s behavior that indicates (perceptions of the patient’s behavior)
resolution of the need is the desired result (2) The perception leads to automatic thought
(the thoughts stimulated by the perceptions)
(3) The thought produces an automatic feeling
(feelings in response to these perceptions and
thoughts).
In essence, the nurse, based on her/his perceptions, attaches a

meaning or interpretation to the patient’s behavior
1. the behavior of the patient;

2. the reaction of the nurse; and
3. the nursing actions that are designed for the patient’s • What the nurse says or does with or for the benefit of
benefit. the patient as professional nursing action
• The nurse can act in two ways: automatic or
deliberative
1) DELIBERATIVE ACTIONS, which consist of
those actions that ascertain or meet the patient’s
• The nursing process discipline is set in motion by immediate need for help and
patient behavior 2) AUTOMATIC ACTIONS or those activities
• Patient behavior may be verbal or nonverbal (The decided on for reasons other than the patient’s
presenting behavior of the patient, regardless of the immediate need.
RAI | 68
• Although both types of nursing activities have purpose: • Nursing is nurturing and caring for someone in
Orlando concludes that: motherly fashion
“only activities carried out deliberatively by the nurse are “Nursing is a helping service that is rendered with compassion,
effective since only these nursing activities meet the patient’s skill, and understanding to those in need of care, counsel, and
immediate need and accomplish the goal of nursing” confidence in the area of health”
(Wiedenbach, 1977)
• a philosophy
• a purpose
Nursing is the focus of Orlando’s work. Unique and independent • a practice
in its concerns for an individual’s need for help in an immediate • the art.
situation. Clinical nursing is directed toward meeting the patient’s
perceived needs for help in vision of nursing that reflects
considerable emphasis on the nursing art
Developmental beings with needs, individuals have their own

subjective perceptions and feelings that may not be observable
directly. - The nurses philosophy was their attitude and belief
about life and how that effected reality for them
- Philosophy is what motivates the nurse to act in a
certain way
Not defined directly but implicitly in the immediate context for a

patient.
- Nurses purpose is that which the nurse wants to

accomplish through what she does.
- It is all of the activities directed towards the overall
Sense of adequacy or well-being . Fulfilled needs. Sense of good of the patient
comfort.
- Observable nursing actions that are affected by beliefs

and feelings about meeting the patient’s need for help.
Based on identifying the patient's need-of-help through nursing

interaction and nursing action. The prescriptive theory directs
nursing actions toward achievement of a goal.
RAI | 69
- understanding patients needs and concerns 1. The CENTRAL PURPOSE

- developing goals and actions intended to enhance • Defines the quality of health the nurse desires to
patients ability effect on her patient.
- directing the activities related to the medical plan • It is a concept what the nurse puts into words,
- prevention of complications related to reoccurrence or believes in and accepts as a standard against the
development of new concerns value of her actions.
• This reflects the “NURSE’S PHILOSOPHY OF
CARE”
2. The PRESCRIPTION for the fulfillment of the central

purpose
Wiedenbach proposes that nurses perform IDENTIFICATION • The appropriate nursing actions selected to create
OF A PATIENT’S NEED FOR HELP in the following ways: and implement a care plan in accordance with the
central purpose.
1. Observation of presenting behaviors and symptoms • These actions may be “voluntary” or an intended
2. Exploration of the meaning of those symptoms with the response or “involuntary” or unintended response
patient • Voluntary Actions may be:
3. Determining the cause(s) of discomfort ▪ Mutually identified actions – agreed
4. Determining the patient’s ability to resolve the upon by the practitioner or nurse an the
discomfort or if the patient has a need for help patient
▪ Recipient-directed actions – in which
the recipient directs the way the action is
carried out
▪ Practitioner-directed actions – in
which the practitioner carries out the
• Reverence for life
action
• Respect for the dignity, worth, autonomy and
3. The REALITIES – the aspects of the situation that
individuality of each human being
influence the central purpose.
• Resolution to act on personally and professionally held
After the nurse determines the central purpose and has
beliefs.
developed the prescription, she considers the following realities:
▪ The AGENT or nurse practitioner who performs the
nursing action
▪ The RECIPIENT or the patient who is vulnerable and
is dependent on others for help
▪ The GOAL or directed outcomes the nurse wishes to
Wiedenbach’s theory
achieve
directs nursing actions
▪ The MEANS or actions, skills, experiences that
toward an explicit goal and
empower the nurse to achieve the desired goals
is based on three (3) factors
▪ The FRAMEWORK consists of human, environmental,
professional and organizational facilitities
RAI | 70
Joyce Travelbee defines Nursing as "An interpersonal process

▪ Any individual who is receiving help from a member of whereby the professional nurse practitioner assists an
the health profession or from a worker in the field of individual, family or community to prevent or cope with
health. experience or illness and suffering, and if necessary, to find
▪ Possess unique potential, strives toward self-direction meaning in these experiences”. She believes that in order to
and needs stimulation achieve a nursing goal, there should be a genuine "human-to-
human relationship which can be possible through an
"interaction process" which is divided into five phases.
• A psychiatric nurse practitioner, educator and writer

▪ Incorporates the environment within the realities • Born in 1926, she completed her basic nursing
▪ One element of the realities is the framework – preparation in 1946 at Charity Hospital School of
framework may include objects such as policies, Nursing in New Orleans
setting, atmosphere, time of day, humans and
happenings
• Primarily an experience or series of experiences

between a nurse and the recipient of her care.
▪ Concepts of nursing, client, and need for help and their ▪ Characteristic of these experiences is that the
relationships imply health-related concerns in the nursing needs of the individual are met
nurse—client relationship. • The human to human relationship in nursing situations
▪ Supports the WHO’s definition of health as a state of is the means through which the purpose of nursing is
complete physical, mental, and social well-being and accomplished
not merely the absence of disease and infirmity
ASSIST AN INDIVIDUAL, FAMILY or COMMUNITY

TO PREVENT OR COPE WITH EXPERIENCES OF ILLNESS
AND SUFFERING and FIND MEANING IN THESE
▪ Nursing is a helping process that will extend or restore EXPERIENCES.
the patient’s ability to cope with demands implicit in the
situation
▪ Nursing primarily consists of identifying a patient’s
need for help, facilitates the medical plan of care and
creates/implements a nursing plan of care based
on needs and desires of the patient 1. Original encounter - characterized by first
impressions by the nurse and patient perceiving each
other
RAI | 71
2. Emerging identities - characterized by the nurse and

patient perceiving each other as unique individual.
3. Empathy is characterized by the ability to share in the
person’s experience. The result of the empathic
process is the ability to predict the behavior of the Not explicitly defined. Travelbee defined human condition and
individual with whom he or she has empathized. life experiences encountered by all human beings as suffering,
4. Sympathy goes beyond empathy and occurs when the hope, pain, and illness. These conditions can be equated to the
nurse desires to alleviate the cause of patient’s illness environment.
or suffering
5. Rapport is characterized by nursing actions that
alleviate a patient’s distress
Defined by the criteria of subjective and objective health

• Subjective health status is an individually defined state
of well-being in accord with self-appraisal of physical
emotional spiritual status
• Objective health is an “absence of discernible disease,
disability or defect as measured by physical
examination, laboratory tests, assessment by a
spiritual director or psychological counselor
In order to become an expert nurse, a person should pass

through several stages in learning from Novice to Expert
through thorough education and a multitude of experiences.
Patricia Benner's Model is a very useful guide to understand the
different stages of professional growth and that a nurse should
go through a very long and progressive process of learning.
• Finished MS in Med/Surg Nursing, PhD in 1982

An interpersonal process whereby the professional nurse • Taught and done research since 1979
practitioner assist an individual, family or community to prevent • Published 9 books and numerous articles
or cope with the experience of illness and suffering and if • Published “Novice to Expert Theory” in 1982
necessary to find meaning in these experiences. • Associate Professor in Dept of Physiological Nursing
in University of California
A unique, irreplaceable individual who is in the continuous

process of becoming, evolving and changing.
RAI | 72
STAGE 2 ADVANCED BEGINNER
▪ These are the newly graduates in their first jobs

She introduced the concept that: ▪ They are more experienced than the novice that they
are able to recognize recurrent and meaningful
“EXPERT NURSES develop skills and understanding of components of a situation.
patient care over time through a sound educational base as ▪ They have the knowledge and know-how but lack in
well as of experiences.” depth experience
▪ Nurses focus on tasks and follow a “to do” list
“Understanding the five stages in learning from Novice to
Expert” STAGE 3 COMPETENT
▪ These nurses lack the speed and flexibility of proficient

nurses
▪ They have some mastery and can rely on advance
planning and organizational skills
▪ They work better than the advanced beginner that they
can recognize patterns and nature of clinical situations
more quickly and accurately
▪ Generally, has 2-3 years of experience on the job in
the same field.
STAGE 4 PROFICIENT
▪ At this level, nurse are already capable to see

situations as a whole rather than its parts.
▪ They learn from experience what events typically occur
’ ▪ They are able to modify plans in response to different
events
▪ Nurse has a more holistic understanding of nursing
which improves her decision-making skills
STAGE 1 NOVICE
STAGE 5 EXPERT
▪ A nurse beginner with no experience.
▪ Nurses are taught general rules to help perform tasks, ▪ Nurses are able to recognize demands and resources
and their behavior is governed by rules, limited and in situations and attain their goals.
inflexible. ▪ They no longer rely solely on rules to guide their
▪ Very limited ability to predict what might happen in a actions under certain situations.
particular patient situation ▪ They have an intuitive grasp of the situation based on
▪ Significant changes in the patient’s condition can only the deep knowledge and experience.
be recognized by a novice nurse after he has had ▪ Nurses focus on the whole picture event when
experience with patients with similar symptoms performing tasks and able to notice subtle signs of a
situation.
RAI | 73
Patricia Benner 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. Well-being and being ill are
Patricia Benner described nursing as an recognized as different ways of being in the world. Health is
“enabling condition of connection and concern” which shows a described as not just the absence of disease and illness. Also,
high level of emotional involvement in the nurse-client a person may have a disease and not experience illness
relationship. She viewed nursing practice as the care and study because illness is the human experience of loss or dysfunction,
of the lived experience of health, illness, and disease and the whereas disease is what can be assessed at the physical level.
relationships among these three elements.
M6: MAJOR CONCEPTS AD

DEFINITIONS
Benner stated that a “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 of the self in the world. The HOLISTIC APPROACH – Clients are viewed as wholes whose
person is viewed as a participant in common parts are in dynamic interaction; (physiological, psychological,
meanings.” Benner believed that there are significant aspects socio-cultural, developmental, and spiritual.)
that make up a person. She had conceptualized the major OPEN SYSTEM- A system in which there is continuous flow of
aspects of understanding that the person must deal as: input and process, output and feedback. It is a system of
1. The role of the situation organized complexity where all elements are in interaction.
2. The role of the body. FUNCTION OR PROCESS – The client as a system exchanges
3. The role of personal concerns. energy, information, and matter with the environment as it uses
4. The role of temporarility available energy resources to move toward stability and
wholeness.
INPUT AND OUTPUT – For the client as a system, input and
output are the matter, energy and information that are
exchanged between the client and the environment
Instead of using the term “environment”, Benner used the term FEEDBACK – System output in the form of matter, energy, and
“situation”, because it suggests a social environment with social information serves as feedback for future input for corrective
definition and meaning. She used the phenomenological terms action to change, enhance, or stabilize the system
of Being situated and situated meaning, which are defined by NEGENTROPY - A process of energy conservation that
the person’s engaged interaction, interpretation an increase organization and complexity, moving the system
understanding of the situation. toward stability or a higher degree of wellness.
ENTROPY -a process of energy depletion and disorganization
moving the system toward illness or possible death.
STABILITY - A state of balance of harmony requiring energy
exchanges as the client adequately copes with stressors to
retain, attain, or maintain an optimal level of health thus
preserving system integrity.
RAI | 74
CULTURALLY CONGRUENT CARE – it is the culturally based

care knowledge, acts, and decisions used in sensitive, creative,
and meaningful ways to appropriately fit the cultural values,
values, beliefs, and lifeways of clients for their health and well-
GOAL OF THE PROFESSION: The end the member of the
being, or to prevent or face illness, disabilities, or death.
profession strives to achieve
CULTURE CARE DIVERSITY – it refers to the variabilities or
BENEFICIARY: A person or a group of people who the
differences in culture care beliefs, meanings, patterns, values,
professional directs their activities like the client
symbols, lifeways, and other features among human beings
ROLE: This is the part that the professional plays. It is the
related to providing beneficial care for clients from a designated
societal function of the professional
culture.
SOURCE OF DIFFICULTY: The probable origin of the clients’
CULTURE CARE UNIVERSALITY – it refers to commonly
difficulty to which the professional is prepared to cope
shared or similar cultural care phenomena features of human
INTERVENTIONS: The focus of the professional’s attention, the
beings or groups with recurrent meanings, patterns, values,
moment they intervene with the clients
symbols, or lifeways, that serve as a guide for caregivers to
CONSEQUENCES: The results of the professional’s effort to
provide assistive, supportive facilitative or enabling people care
attain the ideal and limited goal
for healthy outcomes.
WORLDVIEW – it refers to the way people look out on their
world or universe to form a picture or value stance about life or
the world around them. Worldview provides a broad perspective
about one’s orientation to life, people, or groups that influence
care or caring responses and guide one’s decisions or actions,
CARE – it refers to abstract and manifest phenomena with
especially related to matters to health or well-being.
expressions of assistive, supportive, enabling, and facilitating
CULTURAL AND SOCIAL STRUCTURAL DIMENSIONS- it
ways toward or about self or others.
refers to the dynamic, holistic, and interrelated patterns of
CARING – it refers to actions, attitudes, or practices to assist
structured features of a culture (or subculture) that include but
others toward healing and well-being.
are not limited to technology factors; religious and philosophical
GENERIC CARE – it refers to the learned and transmitted lay,
factors; kinship and social factors; cultural values, beliefs, and
indigenous, traditional or local folk (emic) knowledge and
lifeways; political and legal factors; economic factors; and
practices to provide assistance, supportive, enabling and
educational factors as well as environmental context, language,
facilitative facts for or toward others with evident or anticipated
and ethno history.
health needs in order to improve wellbeing or to help with dying
ENVIRONMENTAL CONTEXT – it refers to the totality of an
or other human conditions.
event, situation, or particular experience that gives meaning to
PROFESSIONAL CARE – it refers to the formal and explicit
people’s expressions, interpretations, and social interactions
cognitively learned professional care knowledge and practices
within particular geophysical ecological, spiritual, sociopolitical,
obtained generally through educational institutions that are
and technological factors in specific cultural settings.
taught to nurses and others to provide assistive, supporting,
ETHNOHISTORY – it refers to the sequence of past facts,
enabling, or facilitative acts for or to another individual or group
events, instances, or experiences of human beings, groups,
in order to improve their health, prevent illnesses, or to help with
cultures, or institutions over time in particular contexts that help
dying or other human conditions.
explain past and current lifeways about culture care influencers
CULTURE – it refers to learned, shared and transmitted values,
affecting the health and well-being, disability, or death of people.
beliefs, norms, and lifeways of a particular culture that guide
EMIC – it refers to local, indigenous, or the insider cultural
thinking, decisions, and actions in patterned ways.
knowledge and views about specific phenomena.
CULTURE CARE – it refers to the synthesis of the two major
ETIC – it refers to the outsider or stranger (often health
constructs (care and culture) that guide the researcher to
professionals) views or institutional or system knowledge and
discover, explain, and account for health, well-being, care
interpreted values about cultural phenomena.
expressions, and other human conditions.
RAI | 75
M6 - Lesson 1.1. Betty • Pioneer of nursing involvement in mental health;

Neuman - System Model developed the nurse counselor role within community
crisis centers in Los Angeles
• Neuman has continuously developed and made
“I believe that theory is vital to the famous the Neuman Systems Model through her work
development of an autonomous and as an educator, author, health consultant.
accountable nursing profession...I believe • She has been involved in a wide variety of professional
that the model is relevant for the future activities including numerous publications, paper
because of its dynamic and systemic presentations, consultations, lectures and conferences
nature; its concepts and propositions are on application and use of the model.
timeless” • She is a fellow of the American Association of Marriage
and Family Therapy; continues practice as a licensed
clinical marriage and family therapist.
• Maintains a leadership role in the Neuman Systems
• 1924 - Born in Ohio. Model Trustees Group.
• 1947 - Completed initial nursing education with double
honors at People Hospital School of Nursing (now
General Hospital), Akron, Ohio
• 1957 - Earned a baccalaureate degree in public health
and psychology with honors • Reflects nursing’s interest in well and ill people as
• 1966 - Earned a master’s degree in mental health, holistic systems and in environmental influences on
public health consultation from the University of health.
California, Los Angeles (UCLA). • Client’s and nurse’s perceptions of stressors and
• Late 1960’s -Developed first explicit Teaching and resources are emphasized, and clients act in
Practice Model for mental health consultation which is partnership with nurses to set goals and identify
cited in her first book publication, Consultation and relevant information preventions and interventions.
Community Organization in Community Mental Health • The individual, family or other group, community, or a
Nursing. social issue all are client systems, which are viewed as
• 1970 - Designed a nursing conceptual model for UCLA composites of interacting physiological, psychological,
nursing students; the purpose of which is to expand psychological, sociocultural, developmental, and
understanding of client variables beyond the medical spiritual variables.
model. The Neuman model included behavioral
science concepts such as problem identification and Neuman synthesizes knowledge from several disciplines and
prevention. incorporates her own philosophical beliefs and clinical nursing
• Early 1970’s – first publication of the Neuman Model. expertise, particularly in mental health nursing. The model
She spent the following decade further defining and draws from:
refining various aspects of the model in preparation for
the first edition of The Neuman Systems Model: GESTALT THEORY, describes homeostasis as the process by
Application to Nursing Education and Practice. which an organism maintains its equilibrium, and consequently
(Neuman,1982) its health, under varying conditions.
• 1985 - Completed a doctoral degree in psychology DeCHARDIN PHILOSOPHY – wholeness of life.
from Pacific Western University MARX PHILOSOPHY – the properties of parts are determined
partly by the larger wholes within dynamically organized system.
RAI | 76
HANS SELYE’S DEFINITION OF STRESS

Stress - is the nonspecific response of the body to any demand
made on it. It increases the demand for readjustment. This
demand is nonspecific; it requires adaptation to a problem,
irrespective of the nature of the problem. Therefore, the essence Viewed on the continuum of wellness to illness
of stress is the nonspecific demand for activity (Selye, 1974). ▪ WELLNESS - is the condition in which all system parts
Stressors are the tension-producing stimuli that result in stress; and subparts are in harmony with the whole system of
they may be positive or negative the client.
▪ ILLNESS - is a state of insufficiency with disrupting
CAPLAN’S CONCEPTUAL MODEL – levels of prevention and needs unsatisfied.
relationship of prevention level to nursing.
Prevention as intervention; concerned with all potential

stressors
▪ STRESSORS - environmental factors, intrapersonal
(emotion, feeling), inter personal (role expectation),
and extra personal (job or finance pressure) in nature,
Five variables (physiological, psychological, sociocultural, that have potential for disrupting system stability.
developmental, and spiritual.) of the client in interaction with the ▪ A stressor is any phenomenon that might penetrate
environment comprise the client as a system. both the Flexible and Normal line of defense, resulting
▪ Physiological – body structure and function either a positive or negative outcome.
▪ Psychological – mental processes
▪ Sociocultural- effects and influences of social and The nurse uses three levels of prevention as interventions to
cultural conditions keep the client system stable to achieve an optimal level of
▪ Developmental – age related processes wellness.
▪ Spiritual – spiritual beliefs and influences
PREVENTION AS INTERVENTION
▪ Interventions are purposeful actions to help the client
retain, attain, or maintain system stability. They can
occur before or after protective lines of defense and
resistance are penetrated.
Being all the internal and external factors that surround or ▪ Neuman supports beginning intervention when a
interact with person and client. stressor is suspected or identified. Interventions are
based on possible or actual degree of reaction,
THREE RELEVANT ENVIRONMENTS resources, goals, and anticipated outcomes.
▪ INTERNAL – intrapersonal; with all interactions ▪ Neuman identifies three levels of intervention: (1)
contained within the client primary, (2) secondary, and (3) tertiary
▪ EXTERNAL - interpersonal or extrapersonal; with all
interactions occurring outside the client.
▪ CREATED – is developed unconsciously by the client
to express system wholeness symbolically. Its purpose
is to provide a safe arena for client system functioning,
and to insulate the client from stressors
RAI | 77
▪ PRIMARY PREVENTION- is used when a stressor is

suspected or identified. A reaction has not yet
occurred, but the degree of risk is known. The purpose
is to reduce the possibility of encounter with the
• Each client system is unique, a composite of factors
stressor or to decrease the possibility of a reaction.
and characteristics within a given range of responses
▪ SECONDARY PREVENTION- involves interventions
or treatment initiated after symptoms from stress have contained within a basic structure.
occurred. The client’s internal and external resources • Many known, unknown, and universal stressors exist.
are used to strengthen internal lines of resistance, Each differ in its potential for disturbing a client’s usual
reduce the reaction, and increase resistance factors. stability level or normal line of defense.
TERTIARY PREVENTION • The particular inter-relationships of client variables at
▪ Occurs after the active treatment or secondary any point in time can affect the degree to which a client
prevention stage. It focuses on readjustment toward is protected by the flexible line of defense against
optimal client system stability. possible reaction to stressors.
▪ The goal is to maintain optimal wellness by preventing • Each client/ client system has evolved a normal range
recurrence of reaction or regression. of responses to the environment that is referred to as
▪ Leads back in a circular fashion toward primary a normal line of defense. The normal line of defense
prevention. An example would be avoidance of can be used as a standard from which to measure
stressors known to be hazardous to the client health deviation.
• When the flexible line of defense is no longer capable
of protecting the client/ client system against an
environmental stressor, the stressor breaks through
the normal line of defense
• The client whether in a state of wellness or illness, is a

dynamic composite of the inter-relationships of the
variables. Wellness is on a continuum of available
energy to support the system in an optimal state of
system stability.
• Implicit within each client system are internal
resistance factors known as Lines of Resistance,
which function to stabilize and realign the client to the
usual wellness state.
RAI | 78
• Primary prevention relates to G.K. that is applied in RESEARCH

client assessment and intervention, in identification • A significant amount of research has been conducted
and reduction of possible or actual risk factors. over the past decade on the components of the model
• Secondary prevention relates to symptomatology to generate nursing theory and using the model as a
following a reaction to stressor, appropriate ranking of conceptual framework to advance nursing as a
intervention priorities and treatment to reduce their scientific discipline.
noxious effects.
• Tertiary prevention relates to adjustive processes M6 - Lesson 1.2. Evelyn
taking place as reconstitution begins and maintenance Adam -Conceptual Model for
factors move the back in circular manner toward
primary prevention.
Nursing
The client as a system is in dynamic, constant energy exchange
with the environment.
EDUCATION
• The model is well accepted in academe and is used
widely as a curriculum guide.
• Selected in other countries to facilitate student
learning.
• Guidelines have been published for use of the model
in education for the health professions.
• born April 9, 1929 in Lanark, Ontario, Canada.
PRACTICE • Daughter of Ewart Francis and Anna Irene (Dowdall).
• The model facilitates goal-directed, unified, holistic • 1950 - Registered Nurse, Hotel Dieu Hospital,
approaches to client care; also appropriate for Kingston, Ontario
multidisciplinary use to prevent fragmentation of client • 1951-1952: General duty nurse Deep River Hospital,
care. Ontario,
• The model delineates a client system and classification • 1952-1954: General duty nurse, Sunnybrook Hospital,
of stressors that can be understood and used by all Toronto, Ontario.
members of the healthcare team (Mirenda, 1986). • 1954-1961: General duty and head nurse Montreal
• Guidelines have been published for use of the model Neurological Institute
in clinical nursing practice (Freese, et al., 2002) and for • 1961: General duty nurse, Hopital Cantonal,
the administration of healthcare services (Shambaugh, Lausanne, Switzerland,
Neuman, & Fawcett, 2002). • 1962-1963: Hopital Ste-Justine, Montreal,
• Several instruments have been published to facilitate • 1963-1964: Clinical instructor Montreal Rehabilitation
use of the model. Institute
• These instruments include an assessment and • 1966: Bachelor in Nursing, U. Montreal,
intervention tool to assist nurses in collecting and • 1966-1969: Lecturer U. Montreal Faculty of Nursing
synthesizing client data, a format for prevention as • 1971: Master in Nursing, University of California at Los
intervention, and a format for application of the Angeles
nursing process (Neuman, 2002; Russell, 2002).
RAI | 79
• 1971-1977: Assistant professor

• 1977-1983: Associate professor
• 1983-1989: Professor
• 1989: Professor Emeritus
• 1982-1989: Faculty Secretary • In her book, Être Infirmière in 1979
• 1989: Lecturer, consultant in field (To Be a Nurse, 1980), she applies
• 1992: Honorary doctorate Laval University, Quebec Virginia Henderson’s definition of
City nursing to Johnson’s model and
• She started publishing in the mid-1970s. identifies the assumptions, beliefs and
values, and major units.
• Most of her work focuses on development models and
theories on the concepts of nursing. • In the latter category, she includes
the goal of the profession, the
beneficiary of the professional
service, the role of the professional,
the source of the beneficiary’s difficulty, the
intervention of the professional, and the
consequences.
• Broader than a theory, a conceptual model specifies
nursing's focus of inquiry and may thus lead to the
development of theories which will prove useful not
only to nurses but to other health professionals as well.
• Adam believes that a theory is useful to more than one
discipline, but that a conceptual model for a discipline • Goal of the profession: The end the member of the
is useful only to that discipline. profession strives to achieve
• A conceptual model consists of assumptions, beliefs • Beneficiary: A person or a group of people who the
and values, and major units. professional directs their activities like the client
• Adam developed Virginia Henderson’s concepts • Role: This is the part that the professional plays. It is
(Nursing Need Theory) within Dorothy E. Johnson’s the societal function of the professional
(Behavioural System’s Model) structure of a • Source of difficulty: The probable origin of the clients’
conceptual model. difficulty to which the professional is prepared to cope
• She describes the goal of nursing as maintaining or • Interventions: The focus of the professional’s
restoring the client’s independence in the satisfaction attention, the moment they intervene with the clients
of the 14 fundamental needs. Each need has a • Consequences: The results of the professional’s
biological, physiological, and psychological aspects. effort to attain the ideal and limited goal
• The nurse complements and supplements the client’s
strength, knowledge, and will.
• A classic paper which argues importance in shaping a

way of thinking and providing framework for practice
(Adam, 1999)
• Adam’s argument for an ideological framework in
nursing was described in an health telemetry education
conference. (Tallberg, 1997)
RAI | 80
• 1960’s – first to coin the concept “culturally congruent

M6 - Lesson 1. 3. Madeleine
care” which was the goal of the Theory of Culture Care.
Leininger -Culture Care Her appointment followed a trip to New Guinea opened
Theory of Diversity and her eyes to the need for nurses to understand their
Universality patients’ culture and background in order to provide
care
• 1966 - Taught the first course in transcultural nursing
at the University of Colorado where she was a
professor of nursing and anthropology. This marked
the first joint appointment in the U.S. of a professor of
nursing with another discipline.
• 1968 - Initiated the Committee on Nursing and
• July 13, 1925 - Born in Sutton, Nebraska Anthropology with the American Anthropological
Association.
• 1968-1969 - The Research Facilitation Office was
• 1945 - Entered the Cadet Nurse Corps; nurses are established under her leadership
being trained to meet anticipated needs during World • 1969-1974 - Appointed Dean of the University of
War II. Washington, School of Nursing
• 1948 - Received a diploma from St. Anthony’s School • 1973 - University of Washington was recognized as the
of Nursing in Denver, Colorado. outstanding public institutional school of nursing in the
• 1950 - Received a Bachelor’s Degree in Biological United States under her leadership
Science with a Minor in Philosophy and Humanistic • 1974 -Recognized worldwide as the founder of
Studies from Benedictine College in Atchison, Kansas. transcultural nursing, a program that she created at the
• 1954 - Earned an M.S. in psychiatric and mental health School. She is considered by some to be the “Margaret
nursing from the Catholic University of America in Mead of nursing”
Washington, D.C • 1974 to 1980 - served as Dean, Professor of Nursing,
• 1965- awarded a Ph.D. in cultural and social Adjunct Professor of Anthropology, and Director of the
anthropology from the University of Washington, Center for Nursing Research and of the Doctoral and
Seattle (Tomey and Alligood, 2001). Transcultural Nursing Programs at the University of
Utah College of Nursing.
• 1975- The first full-time President of the American
Association of Colleges of Nursing and one of the first
• 1950’s – worked in a child guidance home. She
members of the American Academy of Nursing
realized that recurrent behavioral patterns in children
appeared to have a cultural basis. She identified a lack • 1978 - Established the National Research Care
of cultural and care knowledge as the missing link to Conference to help nurses focus on the study of
nursing. human care phenomena.
• 1954 - served as an Associate Professor of Nursing • 1981- Was recruited to Wayne State University in
and Director of the Graduate Program in Psychiatric Detroit, where she was Professor of Nursing and
Nursing at the University of Cincinnati; Pursued further Adjunct Professor of Anthropology and Director of
graduate studies in curriculum, social sciences and Transcultural Nursing Offerings until her semi-
nursing in the same university retirement in 1995. She was also Director of the Center
for Health Research at this university for 5 years.
• 1956-1995 - educator and academic administrator
• 1961-1995 - writer
RAI | 81
• 1965-1995- lecturer • Won numerous awards, including the prestigious

• 1971-1992 - consultant President’s Award for Excellence in Teaching, the
• 1966-1995 - leader in the field of transcultural nursing Board of Governors Distinguished Faculty Award, and
• Professor Emeritus of Nursing at Wayne State the Gershenson’s Research Fellowship Award.
University and an adjunct faculty member at the • 1998- she was honored as a Living Legend by the
University of Nebraska Medical Center in Omaha and American Academy of Nursing and Distinguished
retired as the former in 1995 Fellow, Royal College of Nursing in Australia.
• Worked as an instructor, staff nurse, and head nurse • 1983- The Leininger Transcultural Nursing Award was
on a medical-surgical unit and opened a new established to recognize outstanding and creative
psychiatric unit as director of nursing services at St. leaders in transcultural nursing.
Joseph’s Hospital in Omaha, Nebraska.
• 1960- First basic psychiatric nursing texts she wrote • August 10th, 2012- passed away due to lung failure
with Hofling entitled Basic Psychiatric Concepts in at her home in Omaha, Nebraska. She was buried in
Nursing was published Sutton’s Calvary Cemetery.
• Written and edited 27 books and founded the Journal
of Transcultural Nursing to support the research of the
Transcultural Nursing Society, which she started in
1974.
• Published over 200 articles and book chapters,
produced numerous audio and video recordings, and
developed a software program. • Leininger developed the theory based on the belief that
• Given over 850 keynote and public lectures in US and people of different cultures are capable of guiding
around the world. professionals to receive the kind of care they desire or
• 1989 - Initiated the Journal of Transcultural Nursing need from others.
and served as its editor through 1995. • The purpose of the theory is to describe, account for,
• initiated and promoted worldwide certification of interpret, and predict cultural congruent care in order
transcultural nurses (CTN) for client safety and to attain the ultimate goal of the theory, namely to
knowledgeable care for people of diverse cultures. provide quality care to clients of diverse cultures that is
• Has provided downloads and answers to many congruent, satisfying, and beneficial to them
common questions in web pages to her discussion (Leininger, 1988).
board about transcultural nursing, her theory, and her • Leininger's model has developed into a movement in
research. nursing care called transcultural nursing.
• In 1995, Leininger defined transcultural nursing as "a
substantive area of study and practice focused on
comparative cultural care (caring) values, beliefs, and
• 1960 - awarded a National League of Nursing
practices of individuals or groups of similar or different
Fellowship for fieldwork in the Eastern Highlands of
cultures with the goal of providing culture-specific and
New Guinea, where she studied the convergence and
universal nursing care practices in promoting health or
divergence of human behavior in two Gadsup villages.
well-being or to help people to face unfavorable human
conditions, illness, or death in culturally meaningful
ways."
RAI | 82
• Three dominant modes as described by Leininger to

guide nursing decisions and actions in order to provide
cultural congruent care. (Leininger, 2001)
Human being, family, group, community, or institution.
Totality of an event, situation, or experience that gives meaning

to human expressions, interpretations, and social interactions in
physical, ecological, sociopolitical, and/or cultural settings
A state of well-being that is culturally defined, valued, and

• Leininger developed the “SUNRISE MODEL” and practiced
labeled as “an enabler”, to clarify that while it depicts
the essential components of the theory of culture care
diversity and universality, it is a visual guide for
exploration of cultures.
Activities directed toward assisting, supporting, or enabling with
needs in ways that are congruent with the cultural values,
beliefs, and lifeways of the recipient of care.
• Care is the essence and the central dominant, distinct,

and unifying focus of nursing.
• Humanistic and scientific care is essential for human
growth, well-being, health, survival, and to face death
and disabilities.
• Care (caring) is essential to curing or healing,
because there can be no curing without caring (this
assumption was held to have profound relevance
worldwide).
• Culture care is the synthesis of two major constructs
(culture and care) that guide the researcher to
discover, explain, and account for health, well-being,
care expressions and other human conditions.
RAI | 83
• Culture care expressions, meanings, patterns, • Clients were reluctant to press health providers to meet
processes, and structural forms are diverse, but some their cultural and social needs were not recognized or
commonalities (universalities) exist among and met;
between cultures. • Concept of culture care was limited interests to nurses
• Culture care values, beliefs, and practices are until late1970’s
influenced by and embedded in the worldview, social • Until 1990’s journal editors did not know, value or
structure factors (e.g. religion, philosophy of life, understand transcultural nursing articles submitted for
kinship, politics, economics, education, technology, publication
and cultural values) and the ethnohistorical and • Nursing remained too ethnocentric and far too
environmental contexts. adherent to following interests and directions of
• Every culture has generic (lay, folk, naturalistic; mainly organized western medicine
emic) and usually some professional (etic) care to be • Nursing progress in the development of a distinct body
discovered and used for culturally congruent care of knowledge was limited, because many nurse
practices. researches were dependent on using quantitative
• Culturally congruent and therapeutic care occurs when research methods
culture care values, beliefs, expressions, and patterns
are explicitly known and used appropriately,
sensitively, and meaningfully with people of diverse
• Acceptance and use of qualitative research methods in
similar cultures.
nursing continues to provide new insights and
• Leininger’s three theoretical modes of care offer new, knowledge related to nursing and transcultural nursing
creative, and different therapeutic ways to help people • The interest in using transcultural nursing knowledge,
of diverse cultures.
research, education and practices by nurses worldwide
• The ethno nursing research method and other has continued to grow and evolve as a the discipline of
qualitative research paradigmatic methods offer nursing has developed. (McFarland and Wehbe-
important mean to discover largely embedded, covert, Alamah,2015)
epistemic, and ontological culture care knowledge and
practices.
• Transcultural nursing is a discipline with a body of
• Inclusion of the theory in nursing curricula began in
knowledge and practices to attain and maintain the
1966; Few nurse educators were adequately prepared
goal of culturally congruent care for health and well-
being. to teach courses about transcultural nursing
• After the world’s first master’s and doctoral programs
in transcultural nursing were approved and
implemented in 1977, many nurses became
specifically prepared in transcultural nursing.
• Leininger received numerous requests to teach
courses, give lectures and conduct workshops on
Several factors identified associated with the reluctance by human care and transcultural care is US and other
nursing to recognize and value transcultural nursing countries until her death in 2012.
• During 1950’s few nurses were prepared in
anthropology or had cultural knowledge to help them
understand transcultural concepts, models or theories
and;
RAI | 84
complexity of health-care systems today, where the

• The theory is the only one in nursing focused successful treatment and outcome for each patient
specifically on culture care with a specific research depend on a range of factors, aside from the
method (ethno nursing) to study cultures and care competence of each individual health-care provider.
practices. • When so many types of health-care providers
• Nurses conducting transcultural studies are leaders in (physicians, midwives, dentists, surgeons, nurses,
sharing their research with students and colleagues at pharmacists, social workers, dieticians, and others) are
conferences and instructional programs related to involved in patient care, it can be very difficult to ensure
transcultural nursing worldwide and have been safe care, unless the system of care is designed to
instrumental in opening doors to transcultural nursing facilitate the timely and complete exchange of
in many organizations. information among all the health professionals involved
in caring for the patient.
M6 - Lesson 2. Patient Safety

M6 - Lesson 2. 1 Harms
caused by Health Care
Errors and System failures
• Patient safety is the absence of preventable harm to • In most hospitals and health care facilities, the extent
a patient during the process of health care and
of adverse events in the health system has long been
reduction of risk of unnecessary harm associated with recognized, the degree to which these events are
health care to an acceptable minimum.
acknowledged and managed varies greatly across
• An acceptable minimum refers to the collective notions health systems and health professions.
of given current knowledge, resources available and • Poor information and poor understanding of the
the context in which care was delivered weighed extent of the harm caused and the fact that most errors
against the risk of non-treatment or other treatment. do not cause any harm at all may explain why it has
• Every point in the process of care-giving contains a taken so long for patient safety to be seen as a priority.
certain degree of inherent unsafety. • In addition, mistakes affect one patient at a time, and
• Clear policies, organizational leadership capacity, data staff working in one area may only infrequently
to drive safety improvements, skilled health care experience or observe an adverse event.
professionals and effective involvement of patients in • Errors and system failures do not all happen at the
their care, are all needed to ensure sustainable and same time or place, which can mask the extent of
significant improvements in the safety of health care. errors in the system, or it seems to be unnoticeable.
• There has been and there is now an overwhelming- Harm caused by Health-care errors and System failures
evidences that significant numbers of patients are
harmed from health care, resulting in permanent injury, • Extent of adverse events
hospital admissions, increased lengths of stay in o many adverse events are preventable.
hospital and even death. o In a study by Leape et al., they found that more
• Over the last decade, there are reports of several than two-thirds of the adverse events in their
incidence that adverse events occur not because sample were preventable
people intentionally hurt patients, but rather due to the
RAI | 85
▪ 28% were due to the negligence of a health M6 - Lesson 2.2 Lessons

professional and
▪ 42% were caused by factors other than
about error and system
negligence. failure
• They concluded that many patients were injured as a
result of poor medical management and substandard
care. Large-scale technological disasters involving spacecraft,
ferries, offshore oil platforms, railway networks, nuclear power
plants and chemical installations in the 1980s led to the
development of organizational frameworks for safer workplaces
and safer work cultures.
• To assist the management of adverse events, many
health systems categorize adverse events by level of
The central principle underpinning efforts to improve the safety
seriousness. of these industries was that accidents are caused by multiple
• The most serious adverse events, which cause serious factors, not single, isolated factors. Individual situational factors,
injury or death, are called sentinel events, the workplace conditions and latent organizational factors and
“should never be allowed to happen” events. management decisions are commonly involved.
• The reason for categorizing adverse events is to
ensure that the most serious ones with the potential to
be repeated are analyzed using quality-improvement
• Analyses of these disasters also showed that the more
methods, and to make certain that the causes of the
complex the organization, the greater potential for a
problem are uncovered and steps taken to prevent
larger number of system errors
similar incidents.
• Tracing the “chain of events” is critical to

understanding the underlying causes of an accident.
There are significant human and economic costs associated
• Latent human errors are more significant than
with adverse events.
technical failure.
• Even when faulty equipment or components were
• The human costs in pain and suffering include loss of
present, it is observed that human action could have
independence and productivity for both patients
averted or mitigated the bad outcomes.
and their families and care providers.
• Organizational errors and violations of operating
o Many countries have accepted that the safety
procedures are evidence of a “poor safety culture”.
of the health-care system is a priority area for
• One of the lessons learned from the further
review and reform.
investigation is the critical importance of the extent to
• The economic costs of claims and premiums on
which a prevailing organizational culture tolerates
insurance for large medical negligence suits
violations of rules and procedures; that is how
o In 1999, the Institute of Medicine (IOM) in its
violations had become the rule rather than the
seminal report to err is human estimated that
exception.
between 44 000 and 98 000 people die each
• Violations were the product of continued negotiations
year from medical errors in hospitals alone,
between experts searching for solutions in an
thus making medical errors the eighth leading
imperfect environment with incomplete knowledge.
cause of death in the USA.
RAI | 86
A systems approach will create a safer health-care culture, For example, if a patient is found to have received the wrong
because it is easier to change the conditions people work under medication and suffered a subsequent allergic reaction, we look
than it is to change human behaviour. for the individual student, pharmacist, nurse or doctor
• To demonstrate a systems approach, industrial who ordered, dispensed or administered the wrong drug and
examples were used to show the benefits of built-in blame that person for the patient’s condition. Individuals who are
defences, safeguards and barriers. When a system identified as responsible are also shamed.
fails, the immediate question should be why it failed
rather than who caused it to fail. The person responsible may receive remedial training, a
disciplinary interview or be told never to do it again. We know
that simply insisting that healthcare workers try harder does not
work.
Policy and procedures may also be changed to help health-care

workers avoid allergic reactions in patient.
However, the focus is still on the individual staff member rather

than on how the system failed to protect the patient and prevent
the administration of the wrong medication.
• It is human nature to want to blame someone and it is

far more emotionally satisfying for everyone involved
in investigating an incident if there is someone to
M6 - Lesson 2.3 A Model of blame.
Patient Safety • Pivotal to our need to blame is the belief that punitive
action sends a strong message to others that errors
are unacceptable and that those who make them will
be punished.
The way we have traditionally managed failures and mistakes in • The problem with this assumption is that it is based on
health care has been based on the person approach–we single a belief that the offender somehow chose to make the
out the individuals directly involved in the patient care at the time error rather than adopt the correct procedure: that the
of the incident and hold them accountable. person intended to do the wrong thing.
This act of “blaming” in health care has been a common way

for resolving problems. We refer to this as the “blame culture.”
• Professionals accept responsibility for their actions as
This willingness to assign blame is thought to be one of the main part of their training and code of practice.
constraints on the health system’s ability to manage risk and • It is easier to attribute legal responsibility for an
improve care. accident to the mistakes or misconduct of those in
direct control of the treatment than to those at the
managerial level.
RAI | 87
responsibly and are accountable for their actions. Part of the

difficulty is that many health professionals break professional
rules daily, such as using incorrect hand hygiene techniques or
letting junior and inexperienced providers work without proper
Errors have multiple causes: personal, task-related, situational
supervision. Students may see health-care professionals on the
and organizational.
wards or in clinics who cut corners and think that this is the way
that things are done. Such behaviours are not acceptable.
Two-fold rationale for human error.
1. Human actions are almost always constrained and
governed by factors beyond the immediate control of
the individual.
o For example, nursing students must follow
policies and procedure developed by the
nursing staff. • Professionals who fail to practice hand hygiene
2. People cannot easily avoid actions that they did not between patients because they feel they are too busy
intend to perform. are an example of a routine violation.
o For example, a dental student who may have • these violations are common and often tolerated
intended to obtain consent from a patient for • Other examples: inadequate information exchange
an operation might have been unaware of the between staff at the change of a shift (hand-offs or
rules for informed consent. hand-overs or “endorsements”), not following a
protocol, and not attending on-call requests.
• A blame culture will not bring safety issues to the
surface. While many health-care systems are
beginning to recognize this, we have not yet moved • This category involves violations in which a person is
away from the person approach–in which finger-
motivated by personal goals, such as greed or thrills
pointing or cover-ups are common–toward an open
from risk-taking, the performance of experimental
culture in which processes are in place to identify
treatments, and the performance of unnecessary
failures or breaks in the “defences”.
procedures.
• Organizations that place a premium on safety routinely o E.g. senior professionals who let students perform
examine all aspects of their system in the event of an a procedure without proper supervision because
accident, including equipment design, procedures, they are busy with their private patients
training and other organizational features.
is defined as a deviation from safe operating

procedures, standards or rules. He linked the categories of • A person who deliberately does something they know
routine and optimizing violations to personal characteristics and to be dangerous or harmful does not necessarily intend
necessary violations to organizational failures. a bad outcome, but poor understanding of professional
obligations and a weak infrastructure for managing
unprofessional behaviour provide fertile ground for
aberrant behaviour to flourish. EXAMPLES:
The use of a systems approach for analyzing errors and
o Time-poor nurses and doctors who knowingly skip
failures does not imply a blame-free culture. In all cultures,
important steps in administering (or prescribing)
individual health professionals are required to be accountable
medication, or
for their actions, maintain competence and practice ethically. In
o A midwife who fails to record a woman’s progress
learning about systems thinking, students should appreciate
because of time constraints
that, as trusted health professionals, they are required to act
RAI | 88
Leaders in patient safety defined patient safety as follows:
“A discipline in the health-care sector that applies safety science

methods towards the goal of achieving a trustworthy system of
health-care delivery. Patient safety is also an attribute of health-
care systems; it minimizes the incidence and impact of, and
maximizes recovery from adverse events”
• Those who work in health care

• Those who receive health care or have a stake in its Understanding the multiple factors involved in failures
availability The infrastructure of systems for Students should:
therapeutic interventions (health-care delivery • Avoid blaming
processes) • Practise evidenced-based care
• The methods for feedback and continuous • Maintain continuity of care for patients
improvement • Be aware of the importance of self-care
• Act ethically every day
Recognize the role of patient safety in safe health-care

delivery
• Ask questions about other parts of the health system
• Ask for information about the hospital or clinic
This model shares
processes that are in place to identify adverse events
features with other
quality-design
models, including
understanding the
system of health
care, recognizing
that performance
varies across
services and
facilities, understanding methods for improvement, including
how to implement and measure change, and understanding the
people who work in the system and their relationships with one
another and with the organization.
RAI | 89
M7 - Local Models of Nursing

Intervention by Prof. Pearl
Ed G. Cuevas, Ph.D, RN PRESENCE
REMINISCE THERAPHY
PRAYER
RELAXATION
MEDITATION
VALUES CLARIFICATION
• Our theorist is a nurse with Master’s Degree in Nursing

and Doctor of Philosophy in Degree obtained from the
University of the Philippines – College of Nursing
• She is an expert in Medical Surgical Nursing with
subspecialty in Oncology Nursing, which made her
known here in the Philippines and Abroad.
• She had served the University of the Philippines
College of Nursing, as a faculty and held the position
as Secretary of the College Nursing.
• Her appointment as the Chairman of the Professional • Quality of Life is a multifaceted construct that
Regulatory Board of Nursing speaks of her encompasses the individual’s capacity and abilities
competence and integrity in the field she has chosen. with an aim of enriching life when it cannot longer be
• She developed the “PREPARE ME” theory that defines prolonged.
the holistic approach to the nursing care for cancer
patients.
“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 Eternal Life.”
• Lecturer
• Faculty of Management and development studies
• UP Open University
-are nursing interventions provided to address the EDUCATION:
multidimensional problems of cancer patients that can be given • B.S. Nursing (FEU-Manila, 1967)
in any setting and emphasizes a holistic approach to nursing
• Master in Nursing (UPCN, 1977)
care.
• PhD in Nursing (Adult Health Nursing) (UPCN,2000)
RAI | 90
Functional health performance was defined in terms of weighted

scores of quality exertion to walking and treadmill exercise test
scores.
• Associate Professor (UPCN, 1995-Present)

• Affiliate Faculty for M.A. Nursing Program, UP Open GOAL
University (1996-present) TO DETERMINE THE FUNCTIONAL HEALTH
• Coordinator, Distance Education, M.A. Nursing PERFORMANCE OUTCOMES OF MYOCARDIAL
Program, UP Open University (1999-2001); INFARCTION CLIENTS ON COMPLIANCE
• Head, Research and Creative Writing Program, UPCN
(2002-2007) l;
• Coordinator, Adult Health Nursing Specialty, UPCN
1. To determine the relationship between and among the
(1992-94/2003 2009);
following variables: age, marital status, years of
• Head, Continuing Education and community Service
education, occupation, family structure, ethnic
Program, UPCN (2007-present)
background, type of myocardial infarction, number of
cardiac drugs, and compliance to home instruction
program, and functional health performance.
2. To describe the dynamics accounting for successful
• 1995 Most Outstanding Teacher (UPM) adherence to home instruction program.
• Einthoven Plaque of Recognition for Extension 3. To describe the experiences of nurses providing home
Services to the PGH Central EKG Station (Sept. 2005); instructions programs to clients after myocardial
• Service Awards for 30 Years of Loyal Service to the infarction.
University, UP Manila (Oct. 2005);
• Outstanding Alumni Award, FEU Institute of Nursing
(Jan. 2006)
Functional health performance: It refers to observable
responses covering the function of physical, psychological,
occupational and spiritual activities that the participants do in the
During the transition from the Hospital to the home setting, normal course of their life as they recover to meet their basic
clients had expressed need for care because of the needs, fulfill usual roles and maintain health and well-being.
overwhelming experience brought about the physical, PEWS: It refers to current perceived exertion to walking as an
physiologic, psychosocial and emotional effects of myocardial activity and not during stress testing. It provides subjective
infarction. information about physical exertion and fatigue levels.
FHP Outcomes: It refers the overall score as measured by the
The home instruction program ad scheduled home visits were a.) cardiovascular-quality of life (CVS-QOL_ tool, b.) the
prescribed to address the clients needs. perceived exertion to walking scale (PEWS), and treadmill
exercises test (TET) scores measured in metabolic equivalent
The Intervention was based on the concepts of intervention, of a task (MET).
goal setting and information support. By increasing the quality TET score: In metabolic equivalent of a task (MET) refers to the
of interaction between the client, the nurse and significant workload and length of time spent (at each workload) in a
others, successful adjustment and recovery will be attained and treadmill machine that has variable speed and slope following a
functional health performance improve. prescribed exercise protocol. The measure correlate with a
known energy expenditure.
Compliance: It refers to the adherence to HIP and usual.
RAI | 91
Home Instructional Program (HIP): It refers to a structured • The findings of the study and control group of children
program package as a self-study module to be taken at home exposed to marital violence show that before the
for study. program, both have low scores on self-esteem and in
Client factors: t refers to the following client characteristics; the dimensions of pakikipagkapwa or interpersonal-
age, marital status, educational background, occupation, ethnic relatedness such as affiliation, respect, obedience,
background, family structure. humility, understanding, trust/confidence,
Medical Factors: It refers to the following; type of myocardial thoughtfulness and helpfulness.
infarction, number of medication prescriptions, cost of • Assertiveness related traits such as obedience and
medication. humility are lower in the study group after participation
in the BEST CHILD PROGRAM.
• The program had possibly facilitated assertiveness, a
mechanism that is resilience-enhancing.
• However, the study findings had not led to the
1. Impact on Nursing Practice
hypothesized increases in self-esteem and
2. Promoting research-theory development
interpersonal-
3. Addresses Current Concerns
• The findings indicate no significant effects of the BEST
4. Client Benefits
CHILD PROGRAM on the children’s present resiliency.
• However, the assertiveness enhancement shown in
the study may help in the children’s competence for the
future.
• The study aimed to find out the effects of the BEST

CHILD program on the personality traits of children
exposed to marital violence.
• Personality traits include self-esteem, traits of EDUCATIONAL BACKGROUND AND CREDENTIALS
interpersonal relatedness and resilience. • Finished her BSN and her Master in Arts in Nursing.
• The methodological triangulation, a non-equivalent Major in Maternal and Child Health, both in UST, with
quasi-experimental design and a sequential study the highest honors.
design • Obtained her Doctor of Philosophy in Nursing at the
• The qualitative data showed the treatment class had University of the Philippines.
significantly higher scores in self-esteem, in the • Educator, a counselor, a writer, a consultant and a
interpersonal –relatedness traits of respect, researcher both nationally and internationally.
obedience, humility and helpfulness, resilience scores • Faculty of the UST graduate school and College of
than the control class in the pretest. Nursing.
• Spoke in various international conference in the USA
Amsterdam, Malaysia, Bangkok, Hongkong, Beirut,
Bahrain, South Africa.
• Associate Professor at Aga Khan International Univ.
RAI | 92
Women abuse has been recognized as an increasing social

problem, affecting women of all ages, race, creed, and socio-
economic status.
• She was the former president of the Association of

Deans of Philippine Colleges of Nursing (ADPCN)
• The dean of UERMMMC College of Nursing
This study attempted to explore the women perception of
• She is also a member of CHED’s Technical Committee
womanhood and their self-esteem. It tested an intervention
on Nursing Education
measure, the Nursing Self-Esteem Enhancement (NURSE)
Program to enhance self-esteem so that in the end, women may
be assisted to take action and tend for them.
• BSN at UERMMMC in 1962
The study made use of the sequential methodological • A Master in Nursing at UP in 1975
triangulation • PhD in Nursing at UP in 2001
• She has been a clinic nurse, staff nurse, head nurse,
30 respondents in the National Home for Women called Instructor, asst. Dean, and Dean.
the Haven acted as study Participants. • She has lectured and written about her work as a
nurse.
There were 14 interviews conducted for the qualitative phase • She has used her hands-on experience to develop
while in the quantitative phase there were 15 participants for better ways to teach nursing.
both the study and control groups.
Instruments used were the Demographic data and Information • The study mainly attempted to determine the effects of
Sheet, Interview Guide, and the Self-Esteem Scale. Statistical the “COMPOSURE” behavior of the Advance Nurse
treatment of data includes descriptive statistics, multiple Practitioner on the wellness outcome of the selected
correlation, two-way repeated measures design, least cardiac patients.
significant difference (LSD) and step-wise multiple regression. • Nursing as a healthcare profession would prove its
worth of being at par in quality performance with other
It can be concluded that the intervention measure, the Nursing healthcare profession.
Self-Esteem Enhancement Program influenced the increased in
the level of self-esteem among the study group.
RAI | 93
The study population consisted of: Based on several statistical analysis, the following
Adult Cardiac Patients admitted and confined at the conclusions are made:
Philippines Heart Center, Coronary Care Unit
The socio-demographic characteristics, specifically gender and
age – are related to the wellness outcome of adult cardiac
patients.
ADVANCE NURSE PRACTITIONER A significant difference exists in the pretest posttest scores of
the wellness outcome – after the COMPOSURE BEHAVIOR
→ A BSN Graduate intervention in the 3-groups
→ Licensed and has a clinical experience of at least 2 years in
the clinical area The nursing profession can actively deliver quality care through
→ Has undergone special training in critical area biobehavioral caring interventions like the COMPOSURE
BEHAVIOR because regardless of creed, social class, gender,
COMPOSURE BEHAVIORS age, and nationality, each one need humane, caring, spirituality-
→are set of behaviors or nursing measures that the nurse oriented intervention that can facilitate wellness.
demonstrates to selected cardiac patients
→The word COMPOSURE is an acronym which stands for the
following:
COM → petence
PO → P – resence & Prayer / O – Openmindness
SURE → S – tinmulation / U -understanding /
R- espect and Relaxation / E - mpathy
WELLNESS STATUS
→Refers to a condition of being in a state of well-being, a
coordinated and integrated living pattern that involves the • Graduated BSN at University of the Philippines – 1967
dimensions of wellness. Master of Nursing 1973
• She worked as a staff nurse (1968-19690
• Head Nurse (1970-1972)
• Nursing Supervisor (1973-1976) at PHG
• She also worked at metropolitan hospital in Michigan
USA (1977-1979)
• She came and become an instructor at University of
the Philippines College of Nursing 1979
• She became a Dean of College of Nursing in UP
Manila from 1996-2002
RAI | 94
• In 2001, he edited the book Advancing Technology,

Caring, and Nursing.
1. Nurse’s caring behaviors that affect Pt. anxiety • In 2005, his middle range theory Technological
• PRESENCE – person to person contact between Competency as Caring in Nursing.
the client and the nurse. • In 2007, he co-edited book Technology and Nursing:
• CONCERN – development in the time through Practice, Concepts, and Issues
mutual trust the nurse and the patient. • In 2009, he co-edited, the book entitled, A
• STIMULATION – nurse stimulation through words Contemporary Nursing Process: The (Un)bearable
taps the powerful resources of energy of the Weight of Knowing in Nursing.
person for healing.
2. PREDISPOSING FACTORS • Technology competence was defined by Locsin as

o Age, Sex, Civil Status, Educational “proficiency in devices such as machines, instruments,
Background, Length of work experience and tools, and a manifestation of being caring in
nursing” (2001, p.89)
3. ENHANCING FACTORS • Nursing’s utilization of these technologies has an
o One’s caring experience, Beliefs and attitude, ultimate purpose of aiding the nurse in recognition of
Feeling good about work, Learning caring at knowing a person in their wholeness (Locsin, 2001).
school, What patients tell about the nurse • The ultimate purpose technological competency in
coping mechanism to problems encountered. nursing is to acknowledge the person as a focus of
nursing and that various technological means can and
should be used in the practice of knowing persons in
nursing.
• Technological competency therefore enhances the
nurse’s ability to fully know the person.
• However, the reverse also occurs, the technology can
increase the gap between the nurse/patient
relationship when the nurse does not consciously
regard the patient as a whole person consequently
• Dr. Rozzano Locsin earned his Doctor of Philosophy in causing alienation (Locsin, 2001).
Nursing degree from the University of the Philippines
in 1988, and his Master of Arts in Nursing and Bachelor
of Science in Nursing from Diliman University in 1978
• Locsin’s theory on technological competency as an
and 1976 in the Philippines.
expression of caring is grounded in the Nursing as
• He joined Florida Atlantic University, Christine E. Lynn
Caring theory of Boykin and Schoenhofer.
College of Nursing in 1991 where he is a tenured
• Locsin also found influence from Martin Heidegger; a
Professor of Nursing.
philosopher who spoke over fifty years ago expressing
concern over accepting technology without critical
evaluation (Locsin & Purnell, 2007).
• Dr. Locsin’s research and scholarly works concerning
technology and caring in nursing converge on the
theme “life transitions in human health.” Four books
attest to this thematic focus.
RAI | 95
• Persons are caring by virtue of their humanness

(Boykin & Schoenhofer, 2001)
THEORIST:
• Knowing person is a process of nursing that allows for
• BSN, Masters & PhD in Nursing at UP Manila
continuous appreciation of person moment to moment
• Worked as faculty of UP Manila
(Locsin, 2005)
• Authored books in Community Health Nursing
• Technology is used to know wholeness of persons
Practice.
moment to moment (Locsin, 2004)
• She is a mental health-psychiatric nurse, practitioner,
• Nursing is a discipline and professional practice
coordinator and leader for community-based nursing
(Boykin & Schoenhofer, 2001)
clinic projects.
• She was a nursing staff of a comprehensive rural
community health program and a volunteer nurse
practitioner of a social action for the urban poor.
• She has also done consultancy work and research on
the installation and monitoring of family & community
health empowerment interventions on safe
motherhood, well child care and communicable
disease control.
“Nurses value technological competency as an expression of
caring in nursing” (Locsin, 2013)
Humanity is reserved by technology.
• Empowerment is a concept of family based on the

product of the Department of Health with a vision of
putting health in the hands of the Filipino people.
Environment as the technological world in which we live. • The focus of empowerment experience of families and
the local government units is in the community.
• Families must recognize the existence of malaria as a
disease and a health risk or threat.
• Families must be empowered to take prompt and
Patients seen as “participants in their care rather than object of
appropriate health actions.
nurse care” (Locsin, 2013)
• Action must be done upon detection of cases with or
without laboratory tests or when life threatening signs
Describes persons as human beings who are whole and
& symptoms show.
complete in any moment (Locsin, 2005)
• Families must provide adequate care to the sick,
dependent, vulnerable or at-risk members.
“Technological competency as caring in nursing is a conceptual
• Families must provide a home environment
model that presents the link between technology and caring in
conducive to health maintenance.
nursing as co-existing harmoniously.”
• Nurses must maintain a mutual/reciprocal relationship
with the community and its resources to increase
RAI | 96
access to health services, sustain activities on

surveillance, case finding, follow up, referral and • The research used a quasi-experimental- partially-
environmental modification and other vector control treated control group design with pre-test and post-
measures. test.
• Two comparable areas in the province of Abra
comprise the research sites.
• Data collection procedures included in-depth
interviews, participant observation documentation and
records review.
• As part of a feasible and sustainable option to improve

malaria control in the community, the research part of
the theory determined the effects of motivation-
support-intervention on family competencies for
malaria prevention and control.
• There must be a deepening of the family’s insights into
its own vulnerability to Malaria.
• The art of nursing practice is caring towards human

becoming while its science is practice based evidence
• The motivation-support-intervention included four
and evidenced base methods and tool
home- based and community activities, viz., 1.
• Nurses can become models of how to deliver quality
visioning, goal-setting and purpose clarification; 2.
healthcare service to enhance the empowering planning session; 3. practice/ implementation session;
potential of clients in the community 4. feedback, monitoring and evaluation sessions.
• Nurses must have the will to lead towards • The theory suggests that the best predictors of the
empowerment. family competency scores are age of the respondents
(the younger the respondents, the higher the
competency score) and participation in the
practice/implementation session (as part of the
motivation-support-intervention). The two predictors
accounted for fifty one percent of the variability of the
competency scores.
• The family competencies on malaria prevention and
control can be developed and strengthened through
the motivation-support-intervention.
RAI | 97
• The health education activities at the grassroots can • The theory linking nurse-patient characteristics to
be enhanced through opportunities for families to patient satisfactions.
practice the skills learned or apply knowledge gained • The mediating role of the nurse-patient dyad bonding
from health workers. in bringing about patient satisfaction.
EMPOWERMENT
• The concept of family empowerment is a product of • The belief that nursing is an encounter. The nurse’s
DOH. goal of patient’s well-being is realized mainly through
• With a vision “putting health in the hands of Filipino the interaction between the nurse and patient. Such
People interaction creates relational links between the two.
• The nurse and patient are no longer separate entities
VISION during the interaction but a dyad.
• The nurse-patient dyad becomes not just the sum total
of the characteristics of the two persons, but an
EVALUATION PLANNING
integration of their characteristics working
synergistically, thereby bringing optimum outcomes of
care.
IMPLEMENTATION
• The characteristics of the nurse and the patient
synergize during the interaction, forming nurse-patient
dyad bonding that affects patient satisfaction.
• Deepening of the family’s insight vulnerability to
• Patient satisfaction is regarded as a critical part of the
malaria will lead to EMPOWERMENT
quality outcomes in healthcare.
• The nurse and the patient both have a role to play in
forming a therapeutic dyadic relationship that brings
about the desired outcome.
• NPBI Nurse Patient Bonding Instrument was used

to measure the degree of bonding between the nurse
THEORIST:
and patient based on their openness to each other and
• Graduated BSN, Cum Laude, UP Manila 1993
engagement in the care.
• Master of Arts in Nursing, Major in Nursing
• Openness of patient refers to their readiness to
Administration at University of Asia & the Pacific, 1999
manifest their condition and other things about
• PhD in Nursing at UP Manila, 2009
themselves to the nurse.
• Master of Translational Medicine in UC Berkeley & UC • Openness of nurse refers to their desire to gather as
San Francisco, 2018 much information pertinent to treatment and care about
• Post-Doctoral Fellowship at the University of the patient.
Technology in Sydney Australia, 2010 • Engagement refers to the effective provision of care
• Associate Professor at UP Manila by the nurse to the patient, and the involvement of the
• Dean, UPCN 2013-2017 patient into this care.
RAI | 98
• The different nurse-patient dyads were delineated • The dyadic interactions were categorized mostly as
and integrated in the synergy model developed by the therapeutic by both the patient and the nurse.
American Association of Critical Care Nurses. • Although some participants see the dyadic interactions
• The synergy model proposes that—patient to be task-oriented dyads.
characteristics drive nurses’ competencies. When • There were 3 dyads categorized as dysfunctional and
patient’s characteristics and nurses’ competencies 4 as conversational dyad.
match and synergize, outcomes for the patient are • The “bonding” factor of the dyadic interactions can be
optimal (Curley, 1998).
measured.
• The nurse-patient interaction as conceptualized in
• The intermediary role of the nurse-patient dyads in
this study is an interplay of two factors, openness and
bringing about the outcome of patient satisfaction was
engagement.
confirmed.
• Openness meant the willingness of the individual to
• The hypothesized descriptions of the different dyads
manifest his/her own self, her personal characteristics
were conformed and supplemented with more
to others.
circumstantial details.
• Engagement entails action, participation and
• The conversational dyad emerged as a kind of an
involvement in the interaction.
adjunct to the therapeutic dyad.
• The dyadic interactions is continually evolving. The
change in the type of dyad depends on the nurse or
• The main goal of the research is to test the proposed patient who steer the interactions towards a positive
theory asserting that the nurse-patient dyad mediates response to stimulus that could either be positive or
between nurse-patient characteristics and patient negative. The positive outcomes depend on the
satisfaction. conscientious effort of either person.
• The research also validated dyad categories as well as • The dyadic relationship is bonding between the nurse
the tool for categorizing nurse-patient dyads. and patient. The bonding evolves like in a dance,
• The dimensions and items in the nurse-patient bonding where one feels and senses how the other one would
instrument (NPBI) were generated from the results of react and therefore would act agreeably.
the preliminary qualitative studies done on nurse- • The nurse-patient dyad bonding mediated the relations
patient interactions at the PGH. between patient predictability and patient satisfaction,
• Questionnaires were also administered to gather data and nurse facilitation of learning and patient
on demographic profile, nurse competence, patient satisfaction.
clinical status and patient satisfaction. • With positive/negative behavior response coupled with
• The research utilized methods of triangulation. Both another positive/negative reaction, will determine the
qualitative and quantitative research approaches were fate of the emerging dyad.
employed to describe the phenomenon of the nurse- • The crucial aspect is in giving the response which may
patient dyad. result in bonding.
• Positive bonding results in mutual respect and trust,
treating each other as friends or family members.
• The nurse-patient dyad theory showed that bonding

may occur in every interaction.
• The nurse facilitates learning and patient satisfaction.
• Not all dyads are positive. Some dyads do not result to
bonding
RAI | 99
• Findings from previous studies have revealed that

interventions alone do not fully account for patient
outcomes, and that the effect of interventions on
outcomes is mediated by factors such as interpersonal
communication.
• The characteristic of the nurse and the patient
synergize during their interaction, forming nurse-
patient dyad bonding that affects patient satisfaction.
• Patient satisfaction is regarded as a critical part of
<
the quality outcomes in healthcare.
• The nurse and the patient both have a role to play in

forming a therapeutic dyadic relationship that brings
about the desired outcome. Further research on the
formation and development of nurse-patient dyads in
other settings and with other patient outcome is
recommended.
• Path analysis revealed that the patient characteristic of

predictability had both direct effect and indirect effects
on patient satisfaction, and that the nurse
characteristic of facilitation of learning had an indirect
effect on patient satisfaction.
• Nurse-Patient dyad bonding mediated the relations
between patient predictability and patient satisfaction,
and nurse facilitation of learning and patient
satisfaction.
RAI | 100

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LESSON / FIRST SEMESTER 2nd BLOCK

An individual nurse’s scope of practice is dynamic – that is,

• Considered as a strategy or direction in Nursing to O Understands O Formulates new

Sample Verbs: Sample Verbs:

Complete Overt Response Set BASIS OF PROGRAM GOALS:

Margaret Mead (1901-1978) and Ruth Benedict (1887-1948)

Stress the importance of factors within the organism itself.

John B. Watson (1878-1958) believed that the only way to

Thinking is more socialize

LOGICALLY SOLVES all

Gesell emphasized internal biological factors in development

Cognitive developmentalists like Jean Piaget (1896-1980)

Infant develops physically

Maslow’s theory is based on the idea that some

The first levels of needs are the deficiency needs,

PHASES AGE RANGES DEVELOPMENTAL

Mouth is the major site of

Erik Erickson described eight stages of psychosocial

-Chief executive officer Virtue DEVELOPMENTAL DEVELOPMENTAL

CONSCIENC, punishes one for something

o A system is everchanging and any change in one

Systems differ from each other related to degree of

• Closed systems have fixed relationships among

o The GST is a universal theory. Ex. Multidisciplinary

People grow and change throughout their lives. This growth

1. Recognition of the area where change is needed. RONALD LIPPIT

RICHARD WALTON (1969)

▪ Operant Conditioning by B.F. Skinner focuses on

o OUTCOME EXPECTATION - About the

The model was originally proposed by Godfrey M. Hochbaum

a. SLT was later called Social Cognitive Theory.

Evaluation proceeds from process evaluation of the program,

▪ Heath promotion emerged out of health education M2 LESSON 4 :

Communication is described as the exchange of meanings

Adults learn best when learning is problem-centered, A message:

addition, this theory is linear and essentially a theory

o A radically different approach that puts emphasis on ➢ NOISE

It functions to convey information about the speaker and his

This is carried out through codes such as gestures, eye

(12-25 feet) This distance is

1. BASIC CRISIS THEORY

CAPLAN : Assessment is based on 3 additional areas.

HISTORY : Crisis Intervention Baldwin (1978) developed a classification system that

6. PSYCHIATRIC EMERGENCY CRISES

o People cannot sustain a personal state of crisis if they

o Developed ego psychology by focusing on the

1. PERCEPTION OF THE EVENT - is determined by

SEX - is the biological attribute that differentiates men and

3. SYMBOLIC INTERACTIONISM those which lead to female mortality. Compounding

Given women’s disadvantaged position in society, reducing

EMOTIONAL DIMENSION - HOW the mind and body interact

ENVIRONMENTAL DIMENSION - The environment has many

o The person of Asian descent who uses herbal

M3 LESSON 3.1 Describes the relationship between two or more concepts.

1. Systematic, logical and coherent

Where did our nursing profession all started? The history of

• Discipline is specific and refers to a branch of

1. Conceptualization for nursing research projects and

METAPARADIGM - (meta- more comprehensive or