FAYE GLENN ABDELLAH Classification of the 21 nursing problems

(Faye, Abdellah, et al, 1960,1965)

‘’Twenty- One Nursing Problems Theory of Nursing’’ BASIC TO ALL PATIENTS

10 Steps to identify the client’s problem: • To maintain good hygiene and physical comfort.
• To promote optimal activity: exercise
• Learn to know the patient
• To promote safety through the prevention of
• Sort out relevant and significant data
accidents, injury or other trauma and through
• Make generalizations about available data in
the prevention of the spread of infection.
relation to similar nursing problems presented
• To maintain good body mechanism and prevent
by other patients
and correct deformity
• Identify the therapeutic plan
• Test generalizations with the patient and make SUSTENAL CARE NEEDS
additional generalizations
• To facilitate the maintenance of a supply of
• Validate the patient’s conclusions about his
oxygen to all body cells
nursing problems
• To facilitate the maintenance of nutrition of
• Continue to observe and evaluate the patient
all body cells
over a period of time to identify any attitudes
• To facilitate the maintenance of elimination
and cues affecting his behavior
• To facilitate the maintenance of fluid and
• Explore the patients and family’s reaction to
electrolytes balance
the therapeutic plan and involve them in the
• To recognize the physiological responses of
plan
the body to disease conditions
• Identify how the nurse feels about the
• To facilitate the maintenance of regulatory
patients nursing problems
mechanism and functions
• Discuss and develop a comprehensive nursing
• To facilitate the maintenance of sensory
care plan
functions

11 Nursing Skills
REMEDIAL CARE NEEDS
• Observation of health status • To identify and accept positive and negative
• Skills of communication expressions, feelings, and reactions
• Application of knowledge • To identify and accept the interrelatedness
• Teaching of patients and families of emotions and organic illness
• Planning and recognizing of work • To facilitate the maintenance of effective
• Use of resource materials verbal and nonverbal communication
• Use of personal resources
• To promote the development of productive
• Problem solving interpersonal relationships
• Direction of works of others • To facilitate progress toward achievement of
• Therapeutic use of the self personal spiritual goals
• Nursing procedures • To facilitate awareness of self as an
Three major categories individual with varying physical, emotional and
developmental needs.
• Physical, sociological, and emotional needs of
clients
• Types of interpersonal relationships between
the nurse and patient
• Common elements of client care
 Nursing Problems • Broadly grouped into the 21 problem areas
guide care and promote use of nursing
➢ Nursing problem presented by a patient is a
judgment
condition faced by the patient or patient’s
• A helping profession
family that the nurse through the
performance of professional functions can TWENTY- ONE NURSING PROBLEMS
assist them to meet.
• ‘’patient – centered approaches to nursing
The problem can be either can overt or convert model’’
nursing problem • Abdellah and colleagues developed a list of 21
nursing problems .it has 3 chief concepts
Overt nursing problem
• Utilizing these 3 concepts, her theory
➢ An apparent condition faced by the patient or proposes that: the utilization of the problem-
family, which the nurse can assist him or them solving technique with chief nursing problems
to meet through the performance of her related to the health requirements of clients.
professional functions. • it is a model describing the ‘’arenas’’ or
➢ Obvious or can be seen condition concerns of nursing, rather than a theory
describing relationships among phenomena
Covert nursing problems • in this way the theory distinguished the
➢ Is concealed or hidden condition faced, practice of nursing with focus on the 21
➢ Unseen or masked one nursing problems from the practice of
medicine with focus on disease and cure

METAPARADIGMS: PERSON
IMOGENE KING (1971-1981)
• Defined as beneficiary of care
• Viewed as a holistic being composed of ‘’ Conceptual system and middle range theory of goal
attainment’’
physical, psychological, sociological and
spiritual concepts.

METAPARADIGMS: PERSON

METAPARADIGMS: HEALTH • Exist in an open system as a spiritual being and

rational thinker
• Center and purpose of nursing services
• They make choices selects alternative course
• Is affected by age, culture, intellectual
of action.
capacities and emotional balance
• Has the ability to record their history through
their own language and symbols, unique, holistic
and have different needs wants and goals
METAPARADIGM: ENVIRONMENT

• Affects / involves in achieving optimal health

levels METAPARADIGMS: HEALTH
• The home or community from which patient
• The ability of a person to adjust to the
comes
stressor that the internal and external
METAPARADIGMS: NURSING environment exposes to the client.
• It is the maximal use of the potentials that a
• An all-inclusive service based on the
person can perform to achieve balance in one’s
disciplines of art and science that serves
health.
individuals to make their functions as whole
of independent
 METAPARADIGM: ENVIRONMENT 3 HEALTH NEEDS OF HUMAN BEING

• The process of balance involving internal and 1. Need for information

external interactions inside the social system 2. Need for care for illness prevention
• It has a direct exchange in information 3. Need for total care when a person doesn’t
between the internal and external have the capacity to help themselves
environment

METAPARADIGMS: NURSING
GOAL ATTAINMENT THEORY
• An act wherein the nurse interacts and
• A Middle- Range Theory that is a product of
communicates with the clients
development from the interacting system
• Nurse help client identify existing health
theory
condition, exploring and agreeing on activities
• Mutual goal- setting between a nurse & clients
to promote health
is based on:
• Goal – help client maintain health through
a) Assessment of client’s concern, problem,
health promotion and maintenance,
and disturbance in health
restoration & caring for the sick & dying.
b) Perception of interference of both nurse
and client
c) Sharing of information of both nurse and
INTERACTING SYSTEM FRAMEWORK & GOAL
client -goals attained
ATTAINMENT THEORY
• Nurses interact with family members when
Theoretical Framework clients cannot verbally participate in the goal
setting
King Dynamic Interacting system
• It is focused on the interpersonal system and
• Society = Social System interactions that take place between
• Groups = Interpersonal System individuals most specially in the nurse client
• Individuals = Personal System relationship.

INTERACTING SYSTEM FRAMEWORK INTERPERSONAL PROCESS

• PERSONAL – how the nurse view & integrates • ACTION

self-based from personal goals and beliefs. It • INTERACTION
is composed of body image, growth and • REACTION
development, perception, self-space and time. • OPEN SYSTEM

• INTERPERSONAL – how the nurse

interrelates with a co-worker or patient, INTERPRSONAL PROCESS
particularly in a nurse patient relationship .it is
• ACTION
composed of the concepts of communication,
• A means of behavior or activities that
interaction, role, stress, & transaction
are towards the accomplishment of
• SOCIAL – how the nurse interacts with the
certain act. It is both MENTAL &
coworkers, superiors, subordinates, and the
PHYSICAL
client environment in general. it is composed
concepts of authority decision making,
organization, power, and status.
REACTION MADELEINE LEININGERS

• Form of reacting or a response to a ‘’transcultural nursing theory ‘’

certain stimulus.
Who is Madeleine Leininger?
INTERACTION
• Madeleine Leininger is considered as the
• Any situation wherein the nurse release founder of the theory of transcultural
& deals with a clientele or patient nursing.
• Her theory has now developed as a discipline
OPEN SYSTEM
in nursing. • Evolution of her theory can be
• The absence of boundary existence, understood from her books:
wherein exchange of information • Culture Care Diversity and Universality (1991)
transpires without barriers of • Transcultural Nursing (1995)
hindrances. • Transcultural Nursing (2002)
• Transcultural nursing theory is also known as
Culture Care theory.
• Theoretical framework is depicted in her
model called the Sunrise Model (1997).
• One of the first nursing theorist and
PROPOSITION OF THE GOAL ATTAINMENT transcultural global nursing consultant. • MSN
THEORY - Catholic University in Washington DC. • PhD
in anthropology - University of Washington. •
1. If the perceptual accuracy is present in the She developed the concept of transcultural
nurse client interactions, then transaction will nursing and the ethno-nursing research model
occur.
2. If nurse & clients make transaction, then
goals will be attained TRANSCULTURAL THEORY OF NURSING
3. If goals are attained, then satisfaction will
occur • The most current title is CULTURAL
4. If goals are attained, then effective nursing CARE OR CULTURE CARE
care will occur DIVERSITY AND UNIVERSALITY
5. If transaction is made in nurse client
• Leininger developed her theory on the fact that
interactions
the people of each culture can not only know &
6. If role expectation & role performance
define the ways in which they see their nursing
perceived by nurse and client are congruent,
world, but also can compare these to their general
then transaction will occur
health beliefs & practices.
7. If role conflict is experienced by nurse and
client or both, then stress in nurse client TRANSCULTURAL THEORY OF NURSING CULTURE
interactions will occur CARE /CULTURE CARE DIVERSITY & UNIVERSALITY

8. If nurses with special knowledge and skills • “Different cultures perceive, know
communicate appropriate information to and practice care in different ways,
clients then mutual goal setting and goal yet there are some commonalities
attainment will occur. about care among cultures of the
world.”- 1985
• It focuses on diverse cultures & subcultures
in relation to their caring values, expressions
& beliefs & patterns of behavior about health
& illness.
 • Focuses on serving individuals, groups, CULTURAL DIMENSIONS
communities, societies & institutions by
1. Worldview of caring
carefully considering cultural dimensions.
2. Language of caring
3. Philosophical and religions factors
METAPARADIGMS: PERSON
4. Kinship & social factors
5. Cultural beliefs, value & lifeways
• Humans are caring & capable of being
6. Political & legal factors
concerned about the desires, welfare &
7. Economic factors
continued existence of others.
8. Educational factors
• Human care is collective, seen in all cultures.
9. Technological factors
• Humans are universally caring beings who
survive in a diversity culture through their
ability to provide the universality of care in a SR. CALLISTA ROY
variety of ways – culture, needs, settings.
(1979, 1984, 1989, 1991)
‘’adaptation model’’
METAPARADIGMS: HEALTH
DEVELOPMENTAL THEORIES
Both universal and diverse in terms of
✓ Based their assumptions and prepositions on
beliefs, values and practices.
the essence of growth and maturation as a
• It is composed of:
process of transformation going to a state of
1. health systems
a particulate functional competence.
2. health care practices
✓ Appreciate and comprehend man’s uniqueness
3. changing health patterns
for safe and effective nursing practice
4. health promotions
✓ Each level of development stage must be met
5. health maintenance
to fulfill the holistic health of the individual,
METAPARADIGMS: ENVIRONMENT failure to achieve a positive resolution or
achievement in a particular phase would result
• Worldview, social structure & environmental
to delay of succeeding stage and thus alter
context.
the level of wellness of a person
• Culture are learned, shared & transmitted
values, beliefs, norms & lifeways Born on October 14, 1939 in Los Angeles, California.
• It is centered on a particular group (society)
1963, earned her BSN degree from Mount Saint Mary
and the patterning of actions, thoughts &
College, LA.
decisions.
1966, Master’s Degree in Pediatric Nursing.

1977, Doctorate in Sociology from University of

METAPARADIGMS: NURSING
California. Her postdoctoral studies in Neuroscience
These are nursing actions which are culturally based Nursing were at the University of California at San
Francisco.
• The nursing care being delivered best fits the
She is a theorist and a professor at the William F.
client’s culture as a result reduces cultural stress
Connell School of Nursing at Boston College,
& conflict between client & caregiver. Massachusetts.

1. Cultural care Preservation/Maintenance

2. Cultural care Accommodation/Negotiation Fellow, American Academy of Nursing and an active

3. Cultural care Repatterning/Restructuring

member of nursing organizations which includes
Sigma
ENVIRONMENTAL STIMULI:
Theta Tau and North American Nursing Diagnosis
1. FOCAL – those most immediately confronting
Association (NANDA). the person, it attracts more attention.

1964, her work Roy Adaptation Model (RAM) was 2. CONTEXTUAL – all other stimuli that
known. strengthens the effect of the focal stimulus.

She had publications on nursing theory and other 3. RESIDUAL – those stimuli that can affect the
focal stimulus but the effects are unclear.
professional topics to include:

a) Introduction to Nursing: An Adaptation Model

NURSING
b) Essentials of Roy Adaptation Model
• Science and practice that expands
c) Theory of Construction in Nursing: An Adaptation
adaptive abilities and enhance person and
Model environment transformation. 
• It is about the decrease, enhancement,
d) Roy Adaptation Model: The Definitive Statement
modification and alteration of the
stimulus to achieve adaptation

METAPARADIGM IN NURSING ROY’S ADAPTATION MODEL (RAM)

PERSON KEY CONCEPTS:

• A biopsychosocial being in constant 1. The person is adapting in a stable interaction

interaction with a changing environment. with the environment, either internal or
• An open, adaptive system who uses coping external.
skills to deal with stressors.
2. The environment serves as the source of a
• It includes people as individuals or in groups
range of stimuli that will either threaten or
(families, organization, communities, nation
promote the person’s unique wholeness.
and society).
3. The person’s major task is to maintain integrity
HEALTH
and face these environmental stimuli. 
• It’s the process of being and becoming an
INTEGRITY – degree of wholeness achieved by
integrated and whole person.
adapting to change in needs.
• ADAPTATION – the process and outcome
whereby thinking and feeling, as individuals
and in groups, use conscious awareness and
ADAPTATION LEVEL
choice to create human and environmental
integration. •  Ability to respond positively in a
situation.
• It is described as integrated,
ENVIRONMENT compensatory or compromised.
• It is modulated by a person’s coping
• Conditions, circumstances and influences that
mechanism and control processes.
surround and affect the development and
behavior of a person.
• Describes stressors as “stimuli”.
CATEGORIES OF COPING MECHANISM :
 1. Regulator subsystem – transpires through ✓ GOAL: Psychological Integrity
neural, chemical and endocrine processes.
These are automatic responses to stimuli.
(Increase in vital signs – sympathetic ROLE FUNCTION
response to stress)
✓ A set of expectation about how a person
occupying one’s position behaves towards a
person occupying another position.
2. Cognator subsystem – occurs through
✓ GOAL: Social Integrity
cognitive emotive processes (effects of
prolonged hospitalization to a child).

INTERDEPENDENCE

CONTROL PROCESSES: ✓ Occurs between the person & the most

significant others or between the person and
1. Stabilizer subsystem - the established
support system which result in giving and
structures, values, & daily activities whereby
receiving of love, respect & value.
participants accomplish the primary purpose
✓ GOAL: Affectional Adequacy
of the group & contribute to common purpose
of society.
2. Innovator subsystem – allows the person to
NURSING PROCESS
change to higher levels of potential through
cognitive & emotional strategies. • A problem-solving approach for gathering
data, identifying the capacities & needs of
the human adaptive system, selecting &
FOUR ADAPTIVE MODES implementing approaches for nursing care &
evaluation the outcome of care provided. 
1. Physiological adaptive mode
• It is goal-oriented.
2. Self-Concept adaptive mode

3. Role Function adaptive mode

4. Interdependence adaptive mode

STEPS of the NURSING PROCESS:
1. Assessment of Behavior

PHYSIOLOGICAL 2. Assessment of Stimuli

✓ Way a person responds as a physical being 3. Nursing Diagnosis

to stimuli from the environment.
4. Goal Setting
✓ GOAL: Physiological Integrity
5. Intervention

6. Evaluation
SELF-CONCEPT / GROUP INDENTITY

✓ Psychological & spiritual characteristic of the

person consist of all beliefs & feelings that DOROTHEA ELIZABETH OREM
one has formed about oneself. Components
(1970,1985)
includes: physical (body sensation & image)
and personal self (ideals, morals & spiritual ‘’self – care deficit nursing theory’’
self) 
 ‘’ Individuals, family’s groups and communities • The model is a constellation of three (3)
need to be taught self-care ‘’ interrelated theories:
1. Theory of self -care
2. Theory of self-care deficit
PERSON 3. Theory of nursing system

• An individual with physical and emotional

requirements for development of self-care and
THEORY OF SELF -CARE ……
maintenance of their well-being.
• Human can reflect upon events, themselves • Self – care. Practice of activities initiate and
and their environment. perform independently on their behalf in
• They can symbolize experiences that they maintaining life, health and well-being
have been through by using words and ideas • Self – care Agency. Is a human abiliy which
• Human functioning is an integrated system – is the ability for engaging in self-care
physical, psychological, interpersonal and social activities’’ conditioned by age developmental
aspects. state, life experience, sociocultural
orientation, health and available resources
• Therapeutic self – care Demand. ‘’Totality of
self-care actions to be performed for some
HEALTH
duration in order to meet self-care requisites
• A state of physical, mental and social well- by using valid methods and related sets of
being and not merely the absence of disease operation and actions.
or infirmity (WHO) • Self -care Requisites. Actions directed
• Structural and functional soundness and towards provision of self-care. There are
wholeness of the individual three (3) categories: (a) universal, (b)
• It is based on preventive healthcare which developmental and (c) health deviation.
includes:
1. Promotion and maintenance of health
2. Treatment of disease or injury
3. Prevention of complication

SEFL-CARE REQUISITES
ENVIRONMENT
1. Universal self-care requisites – needs all
• Clients surroundings which may affect their people have which are essential to health and
ability to perform their self-care activities. vitality.it includes: air, water, food,
elimination, activity and rest, solitude and
social interactions, prevention of harm and
SELF-CARE DEFICIT NURSING THEORY (SCDNT) promotion or normality.
2. Developmental self-care requisites – needs
• It addresses client’s self-care needs. It is a
that relate to development of the individual.
goal-oriented activity that are set towards
These include the interventions and teachings
generating interest in the part of the client
designed to return a person to or sustain a
to maintain life and health development. It
level of optimal health and well-being.
aims towards making client perform self-care
Examples: toilet training a child or learning
activities in order to live independently
healthy eating
3. Health Deviation Requisites – needs that
arise as a result of a patient’s condition. It
THEORETICAL FRAMEWORK
 encompasses the variations in self-care which • Three (3) support or system modalities are
may occur as a result of disability, illness or identified:
injury. 1. Wholly compensatory system – client
unable to do for themselves. Total nurse
care.
THEORY OF SELF-CARE DEFICIT 2. Partially compensatory system –
involves both the nurse and the client
• The individual is unable to meet his own self-
sharing in the self-care requirements.
care requisites.
3. Supportive – educative system – clients
• Professional nurse has the duty and obligation
have primary responsibility for personal
to recognize and identify such deficits in
health, with nurse acting as consultant.
order to define a support modality or
intervention.
• Nurses are to rate their patients’
MARGARET JEAN WATSON
dependencies or each of the self-care deficits
on the following scale: ‘’Caring in nursing conveys physical acts, nut embraces
1. Total compensation, (b) partial the mind body spirit as it reclaims the embodied
compensation (c) educative / supportive spirit as its focus of attention.’’

‘’Philosophy and theory of transpersonal caring’’

• Orem identified five (5) methods of helping
1. Acting for and doing for others Metaparadigm – PERSON
2. Guiding others
• Human being is a valued person-cared for,
3. Supporting another
respected, nurtured, understood & assisted.
4. Providing an environment to promote patient’s
• A fully functional integrated delf (philosophical
ability
view)
5. Teaching another
• A being in the world who hold 3 spheres -mind,
body and spirit -that are influenced by the
concept of self &who is unique & free to make
choice.

• Agent. The individual who is engaged in

Metaparadigm – HEALTH
meeting the needs of a person. They are like
bridges that facilitates what has been done
• Unity & harmony within the mind, body & soul.
and what needs to be done
Also associated with the degree of congruence
• Dependent care agent. Individuals who takes
between self as perceived & as experienced.
full responsibility of taking care of a person
• Aside from WHO’s definition, she includes 3
who is incapable of providing care for
elements:
themselves or those who are living
1. A high level of over-all physical, mental &
dependently with others aid.
social functioning.
2. A general adaptive – maintenance level of
daily functioning.
THEORY OF NURSING SYSTEMS
3. The absence of illness (or the presence of
• The ability of the nurse to aid the person in
efforts that lead to its absence.)
meeting current and potential self-care
demands.

Metaparadigm – NURSING
• A human science of people and human health- 10. Existential-phenomenological – spiritual
illness experiences that are mediated by forces
professional, personal, scientific, aesthetic, and
ethical human care transactions.

Metaparadigm – ENVIRONMENT

• Provides the value that determine how one should

behave and what goals one should strive toward.
• Thus, ‘’Caring (and nursing) has existed in every
society. Every society has some people who have
cared for others. A caring attitude is not
transmitted from generation by genes. It is
transmitted by the culture of the profession as a
unique way of coping with its environment.’’

THE PHILOSOPHY & SIENCE OF CARING PATIENTS

Major elements of Watson’s Theory: • Creative problem solving

a) The carative factors • Supportive and protective all around
b) The transpersonal caring relationship environment
c) The caring occasion/ caring moment • Formation of humanistic – altruistic system of
values
• Instillation of faith hope
Major Elements of the Watson’s Theory
• Sensitivity to self and others
1. The Carative Factors • Assisting with basic human needs
• Guides for the core of nursing • Teaching-learning
• Derived from humanistic perspective • Allowance for existential phenomenological
combined with scientific knowledge base. spiritual forces
• It honors the human dimensions of nursing • Expression of negative and positive feelings
work & the inner life would & subjective • Helping, trusting, caring relationship
experiences of the people we serve. Concept of Clinical Caritas Processes
• Comprised of 10 elements ( Carative • This was introduced replacing the carative
Factors) factors
• ‘’caritas’’ – Greek vocabulary meaning to
10 CARATIVE FACTORS
cherish and to give special loving attention
1. Humanistic – altruistic system of value • Translation of the carative factors into
2. Faith-hope clinical caritas processes (refer to handout)
3. Sensitivity of self and others
4. Helping-trusting, human care relationship
5. Expressing positive & negative feelings CARATIVE FACTORS AND CARITAS PROCESSES
6. Creative problem – solving caring process
7. Transpersonal teaching -learning
8. Supportive, protective, and/or corrective 1.’’The formation of a Practice of loving -
mental, physical societal and spiritual humanistic system of kindness and equanimity
environment values within the context of
9. Human needs assistance caring consciousness.
2.’’the instillation of Being authentically potentiate alignment of
faith-hope’’ present an enabling and mind body spirit
sustaining the deep 10.the allowance for Opening an attending to
belief system existential spiritual mysterious and
3.’’the cultivation of Cultivation of ones own phenomenological forces existential dimension of
sensitivity to one’s self spiritual practices and ‘’became’’ allowance for one’s own life death soul
and others transpersonal self-going existential - care for self and the
beyond the ego-self. phenomenological one-being cared for
4.’’development of a Developing and
helping -trust sustaining a helping
relationship’ ’became trusting, authentic
‘’development of a caring relationship
helping -trusting human
caring relation ‘(in 2004 MAJOR ELEMENTS OF THE WATSON’s THEORY
Watson website)
B. Transpersonal Caring Relationship
5.the promotion and Being present to
acceptance of he supportive of the • Characterizes a special kind of human care
expression of positive expression of positive relationship which depends on the Nurses:
and negative feelings. and negative feelings a
1. Moral commitment in protecting & enhancing
connection with deeper
human dignity as well as the deeper/higher
spirit
self.
2. Caring consciousness communicated to
preserve & honor the embodied spirit, TF not
6.the systematic use of Creative use of self and reducing the person to the moral status of an
the scientific problem- all ways of knowing as object.
solving method for part of the caring 3. Caring consciousness & connection having the
decision making became process to engage in the potential to heal since experience, perception
systematic use of a artistry of caring -
& intentional connection are taking place.
creative problem-solving healing practices
caring process (in 2004
Watson website)
7.the promotion of Engaging in genuine
transpersonal teaching - teaching-learning • Transpersonal – to go beyond one’s own ego and
learning experience that attends
the here and now as it allows one to reach
to the unity of being
deeper spiritual connections in promoting the
and meaning, attempting
patients comfort & healing
to stay within others
• Goal is to protect, enhance & preserve the
frame of reference
8.the provision of the Creating healing persons dignity, humanity, wholeness & inner
supportive, protective, environment at all levels harmony.
and corrective mental, (physicals as well as the
C. Caring Occasion
physical, societal and nonphysical, subtle
spiritual environment environment of energy • The moment when the nurse and another person
9.the assistance with Assisting with basic come together in such a way that an occasion
the gratification of needs, with an for human caring is created.
human needs intentional caring
consciousness, 7 ASSUMPTIONS IN THE SCIENCE OF CARING
administering human
1. Caring can be effectively demonstrated &
care essentials, which
practiced only interpersonally.
 2. Effective caring promotes health & individual or • A person may have a disease & not experience
family growth illness because illness is the human experience
3. Caring responses accept a person not only as he of loss or dysfunction, while disease is what
or she is now but as what he or she may become can be assessed at the physical level.
4. A caring environment is one that offers the • It focuses on the ‘’lived experience of being
development of potential while allowing the healthy & ill’’
person to choose the best action for himself or • Health – is what can be assessed: Well-being –
herself at a given point in time. is the human experience of health or
5. Caring is more ‘’healthogenic’’ than is curing. The wholeness.
practice of caring integrates biophysical
knowledge with knowledge of human behavior to
generate or promote health and to provide care Metaparadigm – ENVIRONMENT
to those who are ill. A science of caring is
• The term ‘’situation’’ is used which suggest a
therefore complimentary to the science of curing
social environment with social definition &
6. The practice of caring is central to nursing
meaning.
7. Focus of nursing is on the carative factors
• Used the phenomenological terms of ‘’ being
situated’’ and ‘’situated meaning’’ -defined by
the persons engaged interaction,
PATRICIA BENNER
interpretation & understanding of the
‘’ Stages of Nursing Expertise Nursing situation.
Philosophies’’

‘’nursing is concerned with the social sentient body

Metaparadigm – NURSING
that dwells in finite human world that gets sick and
recovers that is altered during illness pain and • The care & study of the lived experience of
suffering and that engages with the world differently health, illness & disease & the relationships
upon recovery.’’ among these three elements.
• An enabling condition of connection & concern,
which shows a high level of emotional
involvement in the nurse – client relationship.

Metaparadigm – PERSON The Nursing Expertise Model / Skill Acquisition in

Nursing: From Novice to Expert
• A self-interpreting being, that is the person
does not come into the world predefined but • Benner applied the Dreyfus model of skill
gets defined in the course of living a life. acquisition in nursing. Her area of concern was
• It has an effortless and non-reflective not how to do nursing but rather “how do
understanding of the self in the world .it was nurses learn nursing?”
viewed as a participant in common meanings • Dreyfus model is situation & describes the
• Made up of significant aspects: role of the – five levels of skill acquisition & development.
situation, body, personal concerns & It proposes that, as a person improves in skill
temporality. level, there is a corresponding change in the
performance of a given skill.
• Experience–based skill acquisition is safer and
Metaparadigm – HEALTH quicker when it is founded on a sound
educational base.
• Skill – refers to nursing interventions & situations, as well as how to modify plans as
clinical judgement skills in actual situations. needed.
• Expertise – is developed when the clinician 5. Expert nurses no longer rely on principles,
tests and modifies principle-based rules, or guidelines to connect situations and
expectations in the actual setting. determine actions. They have a deeper
background of experience and an intuitive
grasp of clinical situations. Their
performances are fluid, flexible, and highly-
proficient. Benner’s writings explain that
nursing skills through experience are a
prerequisite for becoming an expert nurse.

SAMPLE SITUATION

Nurse Jose, a student nurse on his senior year,

was assigned to take care of a patient who has fever.
He is instructed by his CI to assess the temperature
every 30 mins. and do tepid sponge bath to the patient.
He performs all his activities with close supervision
from the CI or the staff nurse.
LEVELS OF NURSING EXPERIENCE
After he graduated, he took & passed the board
1. A novice is a beginner with no experience. They exams & became a RN. He applied in a tertiary hospital
are taught general rules to help perform tasks, & was hired as a probationary nurse. On his 1st week,
and their rule-governed behavior is limited and he was told to accompany a staff nurse in doing the
inflexible. In other words, they are told what morning care. He was rotated in several special areas
to do and simply follow instruction. for training.
2. The advanced beginner shows acceptable
SAMPLE SITUATION
performance, and has gained prior experience
in actual nursing situations. This helps the 3 years later, he became an OR nurse. He has
nurse recognize recurring meaningful been working very hard & had always aspired to be
components so that principles, based on those promoted as a HN. Upon checking his qualifications
experiences, begin to formulate in order to required for the position, he found out that he still
guide actions. needs upgrading in several of his competencies. He
3. A competent nurse generally has two- or signed in to several seminars & trainings that will
three-years’ experience on the job in the same enhance his skills & knowledge in OR techniques &
field. For example, two or three years in patient care during operation. After a year of intense
intensive care. The experience may also be training & skills improvement, he was promoted as a
similar day-to-day situations. These nurses are HN.
more aware of long-term goals, and they gain
Because of his hard-earned credentials, Jose
perspective from planning their own actions,
was invited to teach in a prestigious University. But
which helps them achieve greater efficiency
because he lacks units in Master’s Degree in Nursing,
and organization.
he chose to enroll in a graduate school. He was so
4. A proficient nurse perceives and understands
competent in the clinical area that his colleagues seek
situations as whole parts. He or she has a more
his advice. It was as if it was so natural for him in doing
holistic understanding of nursing, which
nursing care. After finishing the doctoral degree, 7
improves decision-making. These nurses learn
yrs.
from experiences what to expect in certain
 After he finished his master’s degree, he is now the consultation with physicians, self-evaluation
Chief Nurse & teaches part time in a University. He and management of technology.
had written several books about nursing practices in 7. Organizational & work-role competencies. This
the OR. He is also holding positions in the association includes competencies in priority setting, team
of the OR nurses in the country. building, coordinating and providing for
continuity.

SEVEN DOMAINS OF NURSING PRACTICE

1. Helping role
2. Teaching & coaching function
3. Diagnostic client-monitoring function
4. Effective management of rapidly changing
situations
5. Administering & monitoring therapeutic
interventions & regimens
6. Monitoring & ensuring quality of health care
practices
7. Organizational & work role competencies

SEVEN DOMAINS OF NURSING PRACTICE

1. Helping role. This includes competencies

related to establishing a healing relationship,
providing comfort measures, and inviting active
patient participation and control in care.
2. Teaching & coaching function. This includes
timing, readying patients for learning,
motivating, change, assisting with lifestyle
alterations, and negotiating agreement on goals.
3. Diagnostic client-monitoring function. This
refers to competencies in ongoing assessment
and anticipation of outcomes.
4. Effective management of rapidly changing
situations. This includes the ability to
contingently match demands with resources and
to assess and manage care during crisis
situations.
5. Administering & monitoring therapeutic
interventions & regimens. This includes
competencies related to preventing
complications during drug therapy, wound
management, and hospitalization.
6. Monitoring & ensuring quality of health care
practices. This includes competencies with
regard to maintenance of safety, continuous
quality improvement, collaboration and