Group 6 Local Theories and Models of Nursing Interventions

Carmencita M. Abaquin

 Master’s Degree in Nursing obtained from the University of the Philippines College of
Nursing.
 Medical Surgical Nursing with subspecialty in Oncologic Nursing, which made her
known both here and abroad.
 Served the University of the Philippines College of Nursing, as faculty and held the
position as Secretary of the College of Nursing.
 Her latest appointment as Chairman of the Board of Nursing speaks of her competence
and integrity in the field she has chosen.

“PREPARE ME” Interventions & the Quality of Life of Advance Progressive 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 external life”

The Meaning of the Theory

1. Terminally-ill patients especially cancer patients require holistic approach of nursing in different
aspects of man namely the emotional, psychological, social and spiritual. In this premise, patients
with incurable disease require multidimensional nursing care to improve quality of life.
2. PREPARE ME nursing interventions are effective in improving quality of life in terminally-ill
patients.
3. Utilization of intervention as a basic part of care given to cancer patients, likewise, incorporation
in the basic nursing curriculum in the care of these patients. PREPARE ME must be introduced
and focus during training of nurse both in academe and practice.
4. Development of training programs for care provider as well as health care profession where
intervention is a part of treatment modalities.
5. The nurse must be honest about the feedback on his/her condition. Nurses must do this so that
they would know what the expectations of the patient and the family so that they may render a
holistic caring style for the patient together with his family in his dying days. This would help the
patient and family address the needs of the patient in any manner possible. (Physical, emotional
and spiritual)
6. The nurse must help make a supportive environment for the patient and his family in his dying
days. An environment like this would promote dignity in his days left thus helping the patient
accept his fate and help him/her be ready for the afterlife. The family is also guided in this rough
time addressing their grieving process by instilling in them that death is part of life.

Metaparadigm in Nursing
Person
Her theory is specific to patients in advanced stages of cancer. They are holistic being with physical,
psychological, social, religious, level of independence, and environmental aspects. Patients who are
terminally-ill or those with incurable diseases as with cancer must be approached in multifaceted care to
improve their quality of life.
Environment
Just like all the other paradigms, environment was not defined accurately. Nevertheless we can assume
that environment is an aspect or dimension integrated to the cancer patient. Her quality of life can also be
assessed in this aspect thus it must be given consideration in the provision of care.
Health
The concept of her theory revolves around illness, particularly cancer and the provision of holistic care to
improve quality of life despite their terminal cases. Quality of life is defined as a multifaceted construct
that encompasses the individual’s capabilities and abilities of enriching life when it can no longer be
prolonged. This includes proper care and maintaining integrity of the body, mind and spirit despite the
limitations brought about by the present condition. The quality of life is seen through the patient's many
dimensions.

Nursing
The goal of nursing care is the improvement of quality of life for advance stage cancer patients despite
their current situation. Her concept of providing holistic nursing care in addressing the multidimensional
problems that cancer patients face is summarized in the acronym PREPARE ME.

Logical Adequacy

 The conceptual framework is logical because it is parallel with her definition of nursing and it
works for the goal which is QUALITY OF LIFE
 She didn’t give emphasis on the extraneous variables affecting the variables involved.

Strength

 It provides us standardized and holistic approached in addressing the needs of terminally ill
cancer patients.
 It can also be used for other terminal cases.

Weakness/Limitations

 Caring Ideals of nurse

 Severe depression of the patient.
 more time is needed to make the patient interested in PREPARE ME interventions because they
are already experiencing loss of interest in things
 "Understaffing in Philippine hospitals is prevalent. (Inamarga, 2009)
 In the Philippine setting, due to understaffing and financial constrain, time for bed side care is
limited.
Usefulness (practicability)

 This theory is useful in addressing the needs of terminally-ill cancer patients. This encompassed
different aspects including family relationship and self-actualization.
 Appreciating the impact of a relative's cancer and offering guidance and support via patient-
centered counseling can enhance quality of care.(Zapka et al, 2006)

Generalizability & parsimony (thriftiness)

 It can only be applicable to terminally ill patients and hospice facilities
 Abaquin’s theory has a wide scope of application. She generated it primarily as a result of her
experience with oncology patients. But it is not limited to use in the setting.
 It is applicable whenever a nurse encounters terminally-ill patients.
 It seems to be most useful when working with those patients with imminent death.

Simplicity
 Abaquin’s theory does not possess simplicity because there are many variables. The theory is
designed to facilitate nursing care holistically.

Testability of the theory (empirical properties)

 Due to high mortality/morbidity rate of cancer patients, it can be applied in practice, education
and research for enrichment of oncology care.
 According to DOH (2007), cancer is the top 3 highest mortality rate in the Philippines.
 Can also be utilized in hospice care.

Freslyn Lim-Saco, RN, MN

Asst. Freslyn Lim-Saco is one of the many nurses who are devoting themselves in helping create
a better world. In a brood of four, she’s the only girl in the family which contributed to the fact that
during childhood, Freslyn never lost her enthusiasm and fighting spirit through every task and challenges.
Freslyn made a name for herself being active in the many extra- and co-curricular activities in at the
College of Nursing in Silliman University. Her dynamism also led her to be accepted as a member of the
faculty a few years after graduation. In 2011, she took up and completed a MS in Nursing Major in
Nursing Administration. She now plans on pursuing doctorate studies, while proceeding to serve God
through the profession the combines teaching and healing.
Cliford Masayon Kilat, RN, MA
Kilat, Cliford Masayon is a member of the College of Nursing Faculty and a Research Associate
of St. Paul University Dumaguete, Dumaguete City. He co-authored the Synchronicity in Human-Space-
Time: A Theory of Nursing Engagement in a Global Community published at the International Journal of
Human Caring. He is currently the President of the Philippine Nurses Association Siquijor Chapter in
which he is an active member helping the members with their concern and indulging the chapter with
activities for personal and professional growth.
Rozzano Locsion, RN, PhD, FAAN
Rozzano Locsin is a Professor of Nursing at Tokushima University in Japan, a Professor Emeritus
of Florida Atlantic University in the United States of America, and a Visiting Professor at universities in
Thailand, Uganda, and the Philippines. He took his Doctor of Philosophy in Nursing from the University
of the Philippines in 1988 and his Master of Arts in Nursing and Bachelor of Science in Nursing from
Silliman University in 1978 and 1976 respectively in the Philippines. He is renowned for his book
entitled Technological Competency as Caring in Nursing: A Model for Practice, edited and co-authored
three more books, including one entitled A Contemporary Nursing Practice: The (Un)Bearable Weight of
Knowing in Nursing. His scholarly works regarding technology and caring in nursing converge on the
theme “life transitions in human health.” His book deeply explained the conception of being
technologically competent as caring in nursing. It is practical illumination of excellent nursing in a
technological world.
Synchronicity in Human-Space-Time: A Theory of Nursing Engagement in a Global Community
Abstract
Synchronicity in the Human–Space–Time Theory of Nursing undergirds the innovative process
of nursing engagement expressed as interpersonal relating, technological knowing, rhythmical
connecting, and transformational engaging. The philosophical and theoretical perspectives
declare the evolutionary design in affirming the meaningful human caring experiences within
nursing practice. Moreover, theory-based practice sustains the human science view of wholeness
of persons while focusing on the inclusion of the coexistence between technology and caring in
nursing. The practice of nursing approaches human caring beyond the customary, fragmented,
and routinary healthcare commitment.

Assumptions of the Theory

1. Human-Space-Time is theoretical sphere of caring experiences among persons with patterns of
occurrence viewed as meaningful for both the nurse and the nursed. The HST consciousness of
caring experiences is similar to Watson’s caring moment that transcends space and time (Watson,
2007) as well as Parse’s human universe viewpoint that is invisible, unpredictable and ever-
changing in co-creating reality of becoming (Parse, 2013). The theory claims that synchronicity
and nursing engagement occurs through the appreciation of the integrality of human—
 environment and the time being. This is illustrated, for example, as synchronistic nursing
engagement in various settings (e.g., emergency department, community setting, hospital ward)
perceiving the patient not as a disease or a product of some stereotypical clients, rather as
individuals whose internal and external wholeness are connected.

2. Nursing unfolds in a unitarily pattern of wholeness integrated within the HTS processes. Humans
are assimilating their lives with technology, instigating the nursing profession toward
transformations. The conceptualization of caring, nursing, and technology by Locsin (2015)
elucidates the nursing profession as continually evolving here, now, and beyond. Therefore, in
enhancing caring praxis through SynHSTTNE, the humanistic caring patterns are beyond bedside
procedures and routines or technological expertise. According to Reed (1997), nursing is
developing, fostering, healing, helping, nourishing, progressing, and sustaining the well-being
of humans, and to Smith (2015), “nursing is the voice that represents the wholeness of the
person; no other discipline does this”

3. The nurse–nursed HST consciousness is irreducibly evolving thus co-creating human

transcendence. The individual experiences and perspectives of the nurse and the one being nursed
are not deductively viewed apart from the whole nurse–nursed relationship. This is summarily
illustrated, for instance, in the practice of nursing in disaster occasions. Nurses in their practice
share the struggle with the people with resilient attitude. In this situation, both the nurse and the
people’s experience influence the hoped-for understanding of the nursing engagement. The
theoretical assertion is that human transcendence mediates the relationship between resilience and
well-being and that the HST consciousness of persons is the driving force that pervades the sense
of faith, hope, and love in all processes of nursing engagements. In nursing engagement, the lived
experience of self and other is honored, human dignity is sustained, humanity is preserved, and
wholeness of persons is held within human caring transcending the limits of space, time, illness,
diagnosis (Watson, 2007), sociopolitical conditions, and technological advancements.

4. SynHSTTNE is a pandimensionally transforming process of interconnectedness among humanity

and beyond infinity. Based on the tenets of the Rogerian Science of Unitary Human Beings,
pandimensionality is viewed as “a nonlinear domain without spatial or temporal attributes”
(Watson & Smith, 2002), and transformation is the outcome of the ever-evolving human
transcendence. Synchronicity in the HST exists within the dynamic transcendence of human
beings, space, time, and the emerging variables around the universe. Within this theory, nurses
appreciate the progressions in the healthcare system, including the individual’s participation in
human caring within technological advancements (i.e., nursing informatics, telehealth, big data
analytics, robotics) thereby espousing that caring praxis in the SynHSTTNE takes full advantage
of resources, optimizing the potentials of humanistic nursing care regardless of future social and
environmental demands. Under any circumstances, such as nursing shortage, ethical dilemmas,
administrative, and political biases, expression of nursing actions and intentions of caring are
inseparable, optimizing human health and well-being.
Principles of the Theory
SynHSTTNE is structured around four life principles, namely,
1. Interconnectivity, the 2. Equitability, the system of
connectedness of beings and fairness and justice within and
systems. across healthcare systems.
 3. Emancipation, the liberation of HST boundaries or the
from oppressive situations or transformation of persons
human health conditions. beyond their biologic nature,
4. Human transcendence, the social norms, and universal
ability to go beyond the limits perspectives.
These principles guide nurses in living caring within the HST, in health and well-being of their
patients. Synchronicity as “meaningful connectedness” strengthens a more human-to-human interaction
co-creating patterns, new interpretations or meanings, new understanding, and realities. By ensuring
equity, patients receive human care regardless of their background, affiliations, and conditions and
without the influence of administrative prejudices.
Application of the Theory
The following processes elucidate caring within the milieu of synchronicity:
1. Interpersonal Relating (IR) is the 3. Rhythmical Connecting (RC) means
nurturance of a relationship that dancing to the cadence of treatments and
appreciates the self and others as whole nursing activities where each
and transcendental beings in the dance meaningful, caring experience is not
of caring persons (Boykin and merely an encounter, but a fit into a
Schoenhofer, 2013) in which rhythmical pattern through which the
synchronicity is founded. Synchronicity interconnectivity of persons within the
is enhanced through optimism, HST is nurtured. This process enables
perseverance, and keen intuition, while open communication between the nurse
excessive levels of anxiety, depression, and the nursed to interconnect.
anger, and resentment preclude it 4. Transformational Engaging (TE)
(Davidson, 2016). refers to the process of intimately
2. Technological Knowing (TK) is concurring with the recognized
adapted from Locsin (2015) Theory of improvement of the caring moment and
Technological Competency as Caring in human health experiences, a continous
Nursing, it is focused on providing evaluation and infinite reflection of
authentic and humane caring. Guided by wholeness by both the nurse and the
technology, TK is the process that leads nursed. There is a constant process of
the nurse in sensing relevant data and transformation and is flourished by the
pattern information about the nursed in engagement of caring attributes,
interaction as persons and as objects of knowledge, and skills
care (Locsin & Purnell, 2017).

Cecilia Laurente

Theory of Nursing Practice and Career

Assumptions of the Theory

1. Caring Behavior are actions concerned with the patient’s well-being. It is also a trademark of a
genuine nurse that demonstrates excellence in nursing practice.
 a. Presence – refers to the person mutual trust between the nurse
to person contact between the and the patient.
client and the nurse/s. c. Stimulation – nurse stimulation
b. Concern – refers to the through words encourage
development in time through powerful resources of energy of
a person to heal.
2. Caring behaviors cited by patients are:
a. Respectful d. Gentleness
b. Patience e. Guidance
c. Various helping acts
Enhancing Factors

 Caring experience, beliefs, and attitude  Patients opinion on nurse coping

 Feeling good about work mechanism to problems encountered
 Learning caring at school  Communication

Predisposing Factors

 Age
 Sex
 Civil Status
 Educational Background
 Length of Work
 Experience
 Group 7

Maslow’s Human Needs Theory

Introduction

Maslow's hierarchy of needs is a motivational theory in psychology comprising a five-tier model of human needs,
often depicted as hierarchical levels within a pyramid. Abraham Maslow was an American psychologist perhaps best
known as one of the founders of humanistic psychology and for his famous hierarchy of needs. Maslow felt that Freud's
psychoanalytic theory and Skinner's behavioral theory were too focused on the negative or pathological aspects of
existence and neglected all of the potential and creativity that human beings possess. Maslow's hierarchy of needs
suggested that people have a number of needs, and as these needs are met they are able to go on to pursue other needs.
The needs at the base of his hierarchy are more basic in nature, gradually moving up into more social, emotional and self-
actualizing needs as one moves up the hierarchy.

"The story of the human race is the story of men and women selling themselves short." — Abraham Maslow

Maslow's Early Life

Abraham Maslow was born on April 1, 1908, in Brooklyn, New York, where he grew up the first of seven children
born to his Jewish parents who emigrated from Russia. Maslow later described his early childhood as unhappy and lonely,
and he spent much of his time in the library immersed in books.

Origin of Theory

While earning his PhD at the University of Wisconsin, Maslow studied rhesus monkeys. By observing the monkeys,
he noticed that some of their needs took precedence over others. He had felt that prior theories did not capture the complexity
of human behavior adequately. This experience heavily influenced and inspired his Hierarchy of Human Needs. As nurses,
we use Maslow’s Hierarchy of Needs theory to guide the prioritization of patient care needs.

Maslow’s Hierarchy of Needs

Maslow (1943, 1954) stated that people are motivated to achieve certain needs and that some needs take precedence
over others.

Our most basic need is for physical survival, and this will be the first thing that motivates our behavior. Once that
level is fulfilled the next level up is what motivates us, and so on.

The original hierarchy of needs five-stage model includes:

1
Basic Needs

1. Physiological needs - these are biological requirements for Human survival, e.g. air, food, drink, shelter, clothing,
warmth, sex, sleep.

If these needs are not satisfied the human body cannot function optimally. Maslow considered physiological needs
the most important as all the other needs become secondary until these needs are met.

2. Safety needs - protection from elements, security, order, law, stability, freedom from fear.

Psychological Needs

3. Love and belongingness needs - after physiological and safety needs have been fulfilled, the third level of human needs
is social and involves feelings of belongingness. The need for interpersonal relationships motivates behavior

Examples include friendship, intimacy, trust, and acceptance, receiving and giving affection and love. Affiliating,
being part of a group (family, friends, work).

4. Esteem needs - which Maslow classified into two categories: (i) esteem for oneself (dignity, achievement, mastery,
independence) and (ii) the desire for reputation or respect from others (e.g., status, prestige).

Maslow indicated that the need for respect or reputation is most important for children and adolescents and precedes
real self-esteem or dignity.

Self-fulfillment needs

5. Self-actualization needs - realizing personal potential, self-fulfillment, seeking personal growth and peak experiences.
A desire “to become everything one is capable of becoming”.

Metaparadigm of Maslow’s Hierarchy of Needs

Nursing Caring based on assessment of client’s needs and

encouraging strengths
Person Identifying with humankind is necessary for
growth to reach self-actualization
Health Needs must be met physiologically first
Environment Includes all social interactions with other
individuals (family and peers)

Importance of Maslow’s Hierarchy of Needs

With the perspective of the nursing profession nurses and clinical care that is extended to patients, Maslow’s
theory holds great importance. It helps nurses to prioritize client’s needs. Whenever they will face a situation that
2
demands them to prioritize they will easily be able to decide that physiological needs hold the most importance and need
to be fulfilled first, then the others may be taken care of.

Von Bertalanffy’s General Systems Theory

Introduction

A theory is a group of related concepts that propose action that guide practice. General system theory describes
“how to break whole things into parts and then to learn how the parts work together in systems”. General system theory is
known by different names - systems theory, theory of open systems, systems model, and family systems theory. The author
of General system theory was Ludwig Von Bertalanffy in 1950’s, A system is a complex of elements in interaction, which
on first appearance does not seem interconnected or inter related.

General System Theory Definition

As Von Bertalanffy theory emerged in the early 1930s, scholars from many disciplines discovered that the concepts
of General system theory could be applied equally to their own fields, such as chemistry, physics, and social sciences. The
application of General system theory to psychiatry was helpful in conceptualizing the development of personality. Von
Bertalanffy (1969) introduced General systems theory as a universal theory applicable to many field of study which provides
a way of examining interrelationship and deriving principles. General system theory describes how to break the whole apart
and then learn how the parts work together.

-Emphasizes the relationships between parts.

-Describes how parts function and behave.

Basic Concepts Of General System Theory

Concept of system : A system is a set consisting of integrated, interesting parts or components that function as a
whole. Each part is necessary to make a complete and meaningful whole.

Components:

-Share a common purpose or goal.

-Form a whole which is more than the sum of its parts.

Terms: Systems are usually complex and consist of several parts called subsystems.

Each system is a part of a larger system known as a super system, a collection of two or more systems into a larger
system. A separation that differentiates one system from another is called boundary.

3
Basic attributes of system

1. Wholeness system : system.

Consisting of elements. each element has own 4. Dynamic

particular structures and functions. When each element
A system is changing along with the change of
comes together in certain ways to form a whole , it then
time, one one hand, to function a system must arrive at
has a new function that a single element has not. Here, the
optimum state via the interaction among elements inside,
function of the whole is different from and greater than
the exchange of energy, information and matter, and the
the sum of its elements . In other words , a system is
constant adjustment of internal structure on the other
different from the system than the sum of its sub system.
hand, a system always exists in certain environment and
2. Interrelation : exchanges matter, energy and information with its
environment in order to adopt the environment and to
There are interrelations and interactions existed
maintain itself is survival and development.
among elements of a system . changes in one part of a
system will create changes in other parts 5. Finality:

3. Levels : The finality of system means the movement of a

system eventually tends to be in order and to be a stable
To certain system , it is composed of some
state.
elements, and also is an element that build up larger
Classification of Systems

1. Classifying according to the influence of human 3. Classifying according to the relationship between a
being and system system and its environment

a. Nature system - is one that consists of natural Matter
and objectively exists.
b. Man-made system - is one that is build up by human
beings to achieve some purposes.
2. Classifying according to the content and elements
a. A matter system - means the one that is made up of
matter entity, for ex:- the animal and mechanical systems
b. Conceptual system - is one that is made up of non-
matter entity. eg : - computer program, software.
a. A open system – is that one that constantly exchanges
matter, energy, & information with its environment. The
function between an open system and its environment is
achieved by input, output & feedback
4. Classifying according to the attribute of system
movement
a. A dynamic system is the one that the state of a system
is changing along with the change of time.
b. A static system is the one that the state of a system does
not change along the change of time and it has relative
stability.

2
 Principles Of General System Theory And Its Application In Nursing
1. The Principle Of Wholeness:
It is the core of General system theory , This
principle provides the guidance or methodology to us in
order that we can study all kinds of objects effectively.
2. The Principle Of Optimization :
The principle of optimization of a system is to
achieve an optimal state in certain condition and to
perform its best function by organization and
coordination.
a. Local effect must obey whole effect :
To achieve the optimization on a base of a whole
is a key purpose in principle of optimization local effect
must obey whole effect when they are not consistent .
(b) Insisting multipolar optimization :
Optimization should be seen through the whole
course of movement of a system. When providing
Nursing care to the patients we should decide the choice
of optimization on the processes of identifying health
problems determining objectives , establishing nursing
care plan, implementing and evaluation to pursue the
optimal effect to nursing activities in possible conditions
(c) To combine the Absoluteness and relatively of
optimization .
When we face some patients with various
complicated conditions . we feel difficulty in finding
solution to them. In this kind of situation , it is necessary
for us to choose a relative optimization project from
inconsistent requirements, in which all aspects are
satisfied .
2
3. The Principle Of Modeling :
Modeling is to design a model similar to a real
system first , then to describe and understand the
characterization and level of real system by studying the
model.
a. Concrete model : is to reproduce a prototype by using
a similar model in some degree and forms eg. CPR model
b. Abstract model : is the reflect the similar relation of a
prototype of a system by non objective forms of language,
symbol and diagram, such as Nursing diagnosis.
c. Structural model : is to describe the structural relation
among elements in real system in the form similar to the
structure of a prototype , such as the model
ofhierarchyofneedstheory.
d. A Functional model : is to describe the movement
process similar to a prototype in certain members and to
find out manners of systems in movement operations eg.
Nursing process.
The principle of modeling is composed of 3
aspects. (1) Principle of similarity : A model should be
an imitation and abstract of an actual system. (2) The
Principle of simplicity : A model with lose its function if
there is no reality we should be good at grasping key
contradiction, neglecting the secondary factors to achieve
simplicity under the precondition of ensuring necessary
precision.
4. The Principle Of Objectivity:
The relations of similarity and simplicity between a model
and a prototype may result in completely consistency in
data and production provided by model and the situation
of a real system.
II-C. The Revolution of General system theory to Nursing.

To look at a person with systematic view point. The human being is the object of Nursing. The human being is a system
that is composed of many elements, such as physiological, psychological, social , spiritual and cultural elements .

The human being is a natural system c. Nursing system is dynamic system

a. A basic condition of life activities and heath of human
being is hormony and equilibrium of internal and external
environment in the human body.
b. A human being is an open and dynamic system A
human being exchanges the energy, matter, and
information with its environment constantly, as well as
within its body to maintain life and health.
c. A Human being is an system with a subjective activity
d. Nursing system is with the function of decision making
and feedback.
Characteristic of systems.
1. Systems refer specifically to self regulating systems
2. Systems are self correcting through feedback
3. System have structure that is defined by its process and
parts.
4. Systems are generalization of reality.

A human being is conscious and able to supervise and 5. The various parts of a system have functional as well
control his / her state of functions. as structural relations between each others.

1. To understand nursing with a systematic viewpoint. 6. System tends to function in the same way

a. Nursing system is system with complicated structure b. 7. Every living organism is essentially an open system
Nursing system is an open system System theory and nursing .

Nursing Theory Has Drawn From The Work Of Von Bertalanffy On Systems Theory.

1. Newman’s system theory, Roger’s theory, Roy’s adaptation model, Imogene King’s theory, Orem’s Self-care deficit
theory, Johnsons behavioral system theory.

Improving Health Care By Embracing Systems Theory

The underlying principles of Systems Theory should seem largely intuitive to health care professionals. Although
many of us spend considerable time siloed, focusing on the functionings of individual organs, our jobs necessitate that we
think about how each intricate organ system influences, and is influenced by, its environment.

Metaparadigm of General Systems Theory

• Health is seen narrowly as a state of thermodynamic balance. Illness lurks in the presence of undesirable - that is,
unpredictable - sights, sounds and events.

1
 • The nurse's job is to assess the extent to which all parts of the patient's system are in working order, and to identify
and correct actual or potential threats to the patient's stability.
• The role of the recipient of nursing care is to comply with the professional's expert maneuvers.
• The Environment must be completely sanitized, well-ventilated and complete with equipment to make nursing
practice most efficient.
• The nurse "must decide whether to support, to contract or to stabilize the forces at work" and is responsible
for "safety and instruction and coordination of care.
• The nurse who applies general systems theory to nursing will be concerned with all aspects of the life of
the individual. For instance, he or she may urge a person to eat a varied diet, strive to be punctual, watch programs
other than soap operas on television, improve interpersonal relations or acquire further training or education.

Lewin’s Change Theory

Introduction

Change is an essential component of nursing practice. Leading change is a challenge for nurse leaders amid the
complexities and challenges of evolving health care environments in providing quality patient care. This chapter is designed
to provide nurse leaders with guidance through various theories and frameworks to effectively support the change process
in shaping healthy work environments. Additionally, you will learn about resistance to change and how to respond
constructively to change.

Lewin acknowledged that change can often be short lived in the face of setbacks, leading to the design of a three-
step model to guide practitioners in this process: Heward et al. (Heward et al., 2007) described how the work of Lewin has
been applied in the Victorian public service (Australia) to analyze the forces resisting change to health promotion capacity
building. Lewin's organizational change theory was used in two of the case studies of research undertaken in health
promotion: in one case study, it was used to assist with conceptual analysis of capacity building implementation strategies.
The second case study was about the implementation of health promotion technology in which Lewin's work was used as
the basis for a selective coding framework for content analysis of qualitative data that were gathered (Heward et al.,
2007). Analysis of each case study indicated that efficiency, effectiveness and sustainability can be maximized by
incorporating organizational change as a central component of health promotion practice and research.

Lewin’s definition of behavior in this model is “a dynamic balance of forces working in opposing directions.” The
Change Theory has three major concepts: driving forces, restraining forces, and equilibrium. Driving forces are those that
push in a direction that causes change to occur. They facilitate change because they push the patient in a desired direction.
They cause a shift in the equilibrium towards change. Restraining forces are those forces that counter the driving forces.
They hinder change because they push the patient in the opposite direction. They cause a shift in the equilibrium that
opposes change. Equilibrium is a state of being where driving forces equal restraining forces, and no change occurs. It can
be raised or lowered by changes that occur between the driving and restraining forces.

2
Unfreeze

This first stage of change involves preparing the organization to accept that change is necessary, which involves
breaking down the existing status quo before you can build up a new way of operating. Key to this is developing a
compelling message showing why the existing way of doing things cannot continue. This is easiest to frame when you can
point to declining sales figures, poor financial results, worrying customer satisfaction surveys, or suchlike. These show
that things have to change in a way that everyone can understand. To prepare the organization successfully, you need to
start at its core – you need to challenge the beliefs, values, attitudes, and behaviors that currently define it. Using the
analogy of a building, you must examine and be prepared to change the existing foundations as they might not support
add-on storeys. Unless this is done, the whole building may risk collapse. This first part of the change process is usually
the most difficult and stressful. When you start cutting down the "way things are done," you put everyone and everything
off balance. You may evoke strong reactions in people, and that's exactly what needs to be done. By forcing the
organization to re-examine its core, you effectively create a (controlled) crisis, which in turn can build a strong motivation
to seek out a new equilibrium. Without this motivation, you won't get the buy-in and participation necessary to effect any
meaningful change.

Change

After the uncertainty created in the unfreeze stage, the change stage is where people begin to resolve their
uncertainty and look for new ways to do things. People start to believe and act in ways that support the new direction. The
transition from unfreeze to change does not happen overnight: people take time to embrace the new direction and
participate proactively in the change. A related change model, the Change Curve , focuses on the specific issue of
personal transitions in a changing environment and is useful for understanding this aspect in more detail. In order to
accept the change and contribute to making it successful, people need to understand how it will benefit them. Not
everyone will fall in line just because the change is necessary and will benefit the company. This is a common assumption
and a pitfall that should be avoided. Time and communication are the two keys to the changes occurring successfully.
People need time to understand the changes, and they also need to feel highly connected to the organization throughout
the transition period. When you are managing change , this can require a great deal of time and effort, and hands-on
management is usually the best approach.

Refreeze

When the changes are taking shape and people have embraced the new ways of working, the organization is ready
to refreeze. The outward signs of the refreeze are a stable organization chart, consistent job descriptions, and so on. The
refreeze stage also needs to help people and the organization internalize or institutionalize the changes. This means
making sure that the changes are used all the time, and that they are incorporated into everyday business. With a new
sense of stability, employees feel confident and comfortable with the new ways of working. The rationale for creating a
new sense of stability in our ever-changing world is often questioned. Even though change is a constant in many
2
organizations, this refreezing stage is still important. Without it, employees get caught in a transition trap where they
aren't sure how things should be done, so nothing ever gets done to full capacity. In the absence of a new frozen state, it is
very difficult to tackle the next change initiative effectively. How do you go about convincing people that something
needs changing if you haven't allowed the most recent changes to sink in? Change will be perceived as change for
change's sake, and the motivation required to implement new changes simply won't be there.

Metaparadigm of Lewin’s Change Theory

Nursing The process of unfreezing, change, and refreezing.

Lewin’s theory can be used by nurses to assist
patients to bring about change and by
understanding the process patients go through.
Person “One’s behavior is related both to one’s personal
characteristics and to the social situation in which
one finds oneself.” -Lewin is most renowned for
his development of the field theory. The field
theory is the "proposition that human behavior is
the function of both the person and the
environment: expressed in symbolic terms, B = f
(P, E)."(Deaux 9) This means that one’s behavior
is related both to one’s personal characteristics
and to the social situation in which one finds
oneself.
Health Letting go of an old pattern that was
counterproductive. Learning new patterns that
involves a process of change in thoughts, feeling,
behavior, or all three, that is on some way more
liberating or more productive. Establishing the
change as the new habit, so that it now becomes
the “standard operating procedure”.
Environment Driving forces are forces that push in a direction
that causes change to occur, facilitate change by
pushing in the desired location and causing a shift
towards change. Restraining forces are forces that
counter driving forces, hinder change by pushing
in the opposite direction and cause a shift that
opposes change.

Importance of Lewin’s Change Theory

Change processes often fail because an organization does not succeed in communicating the need for change to
their Nurses. Nurses/ employees will only be able to make concessions and let go of the old situation when they are aware
of the need for change. The only way in which management will succeed in convincing staff of this need, is openness,
transparency and honesty. When the nurses are involved in the process, they will understand the need for change and they
can work on their awareness of the change.

2
GROUP 8
I. CARING: THE CORE OF NURSING PRACTICE

Florence Nightingale (1860) defined nursing as having “charge of the personal health of somebody…and what nursing has
to do…is to put the patient in the best condition for nature to act upon him.” In one way or another, this definition of nursing
has remained the same. And at the very core of nursing practice is the act of caring. Caring and nursing are so intertwined
that nursing would not be nursing without the act of caring. Caring is “a feeling and exhibiting concern and empathy for
others; showing or having compassion” (The Free Dictionary, 2015). Caring is a feeling that also requires an action. The
American Association of Colleges of Nursing (2008) and the National League for Nursing (2007) have identified caring as
a foundational value for nursing.
No one can disagree with the advanced achievements of medical technology and growing specialization. However, care is
more than cure. Caring is more than being patient-centered. Care needs to recognize every person as human beings whose
experiences affect health and wellbeing directly. Nurses need to develop the “head, hand and heart” approach, which
incorporates practical know-how with empathic understanding and technical knowledge to provide humane and sensitive
care. Nurses need to be taught about caring and what attitudes they need to achieve it safely and with dignity for everyone
involved (Hemingway, 2013).

Attitudes, Beliefs, and Values

What is the most important element in what nurses do? Perhaps it is based on the concept of treating others as valued human
beings. When we provide nursing in a respectful manner, with dignity and care, then everything we do for and with those
human beings will reflect that. All the issues faced by the patient will be handled to the best of our ability with a caring
attitude. The nurse’s thoughts and actions will be controlled by a desire to do things in a way that would be acceptable for
ourselves, our partners, our families, and our friends. Nurses need to consider how best to develop their ability to “walk a
mile in another’s shoes.” We need to ensure that everyone who works with vulnerable ill people has an attitude that enables
them to empathize, listen to, and learn from another’s experiences (Hemingway, 2013).

Applying the 5 Cs of Caring in Your Daily life as a Nurse

The 5 Cs of caring, developed by Sister Simone Roach (2002), includes commitment, conscience, competence, compassion,
and confidence. Benefits of consistently applying the five Cs by nurses in the workplace can lead to improved work
relationships, improved patient relationships, and increased the likelihood of career advancement.

The Five Cs Nursing Behavior

-Dedicated to going above and beyond normally expected behaviors.
-Pledging to uphold strong values.
Commitment
-Career commitment to life-long learning that will enhance the level of care delivered to
patients.
-Sense of moral responsibility resulting from a strong conscience.
Conscience -Working consistently on another’s behalf and “representing the concerns of the patient.”
-Continued focus on empathy and putting yourself in the patient’s shoes.
-Consistently arriving to work on time.
-Presenting a professional manner.
Competence -Hold self to a high standard of excellence when fulfilling daily tasks.
-Ask for help or clarification when there is uncertainty about a specific duty or method.
-Continually improve skills to develop competence.
-Empathize with patients.
Compassion
-Provide kind and considerate treatment at all times. In return, nurses may receive an
inspirational sense of human connection and confirmation of the meaning of their work.
Confidence
-Confidence ties the other 4 of the 5 Cs together.

3
 -It takes confidence in skills and knowledge to act with commitment, follow conscience,
constantly act in a competent manner, and express compassion, even in the most
challenging circumstances.
-A confident nurse can assist others who are dealing with difficult news. A strong sense
of self will summon positive change in patient care.

II. THE 7Cs OF HUMAN CARING

CARING is the vehicle through which nurses interact with patients and and assist them to cope with suffering, to find
meaning in their experiences, to promote health and wellness and to die with dignity. CARING is action that nurtures; action
that fosters growth, recovery, health and protection of those who are vulnerable. CARING is the empowering of those for
whom care is given (Roach, 1997).

CARING is the framework through which we as nurses implement the art and science of professional practice.

1. COMPASSION:
Compassion means to be with another in their suffering. It is empathy and sensitivity to human pain and joy that allows one
to enter into the experience of another. It is the understanding of whom that person truly is for whom one is caring. According
to Simone Roach, “With compassion, one becomes a colleague of humanity” (Roach, 1992, p. 18). Compassion is an
essential component of the nurse patient relationship.

2. COMPETENCE:
Competence is acquiring and using evidence-based scientific and humanistic knowledge and skill in the application of
therapeutic interventions in the current practice of nursing. Competence is reflected in the cognitive, affective and
psychomotor domains of learning. It is the knowledge of the role of the nurse in the health care delivery systems of the
hospital and the community.

3. CONSCIENCE:
Conscience directs moral, ethical and legal decision-making. It motivates us to increase the knowledge and skills needed to
respond appropriately to moral, ethical and legal issues faced by oneself and others. It directs us to adhere to the standards
of professional nursing practice. It directs us to respond to social injustices. It is the increased awareness of local, national
and global health concerns and current trends in health care that affect all ages and populations. It is the sense of
accountability, responsibility and leadership for patient CARE.

4. CONFIDENCE:
Confidence is trust in one’s ability to CARE for others. It is the belief that our skilled, professional presence can make a
difference. Confidence is necessary to effectively implement the roles of the nurse as caregiver, teacher, counselor, advocate,
leader, manager, and researcher. Confidence in our own ability to create CARING environments serves as a catalyst for
change. Confidence empowers both ourselves and others to define and accomplish goals. Confidence is developed through
the successful utilization of knowledge and experience.

5. COMMITMENT: Commitment is maintaining and elevating the standards and obligations of the nursing profession and
assuring the delivery of excellence in nursing CARE. Commitment is the loyal endeavor to devote ourselves to the welfare
of patients. It assures that CARING will be part of every nurse patient interaction. It is a conscious effort to grow within the
nursing profession through dedication to continuing education, life-long learning, and becoming more skilled, socially
conscious, ethical, politically competent and CARING.

6. COMPORTMENT:
Comportment is the professional presentation of us as nurses to others in behaviour, attitude, appearance, dress and language
that communicate a CARING presence. It includes the need for self-awareness, awareness of impact of self on others, and
accepting responsibility for our actions. This extends to responsibility for the healthcare environment and the behaviour of
others who contribute to it.

4
7. CREATIVITY:
Creativity is having a vision of how nursing care can be, and making it better. Creativity in nursing requires thinking
reflectively, critically and imaginatively to create healing environments and enhance CARE-giving practices. It requires the
nurse to develop the qualities of envisioning, risk-taking, openness and resourcefulness. Creativity results in integrating
new insights into existing nursing knowledge and awareness. It creates the potential for the nurse to individualize CARE
and embrace change.

III. THE 1987 CONSTITUTION OF THE REPUBLIC OF THE PHILIPPINES – ARTICLE XIV

ARTICLE XIV
EDUCATION, SCIENCE AND TECHNOLOGY, ARTS, CULTURE AND SPORTS

Section 14. The State shall foster the preservation, enrichment, and dynamic evolution of a Filipino national culture based
on the principle of unity in diversity in a climate of free artistic and intellectual expression.
Section 15. Arts and letters shall enjoy the patronage of the State. The State shall conserve, promote, and popularize the
nation’s historical and cultural heritage and resources, as well as artistic creations.

Sister Simone Roach

- establishing the first code of ethics for nurses in Canada and inspiring generations of nurses.
- In 1980, Sister Simone, who died on July 2 in Antigonish, N.S., at the age of 93, was called upon to oversee
the development of a code of ethics for registered nurses in Canada.
- spent nine years building the nursing department at St. Francis Xavier University in Antigonish,
- " A need to care for others is what called you into the profession, and it's what will sustain you through
the joys, conflicts and challenges you will experience.

IV. PATRIOTISM AND NATIONALISM

PATRIOTISM
Patriotism or national pride is the feeling of
love, devotion and sense of attachment to a
homeland and alliance with other citizens who
share the same sentiment. This attachment can
be a combination of many different feelings
relating to one's own homeland, including
ethnic, cultural, political or historical aspects.

NATIONALISM
Nationalism is an ideology and movement that
promotes the interests of a particular nation
especially with the aim of gaining and
maintaining the nation's sovereignty over its
homeland.

5
WHAT’S THEIR DIFFERENCE?
The difference between patriotism and nationalism is simple - a patriot loves his country and is proud of it for what it does
whereas a nationalist loves his country and is proud of his country NO MATTER WHAT IT DOES.

V. INFORMATION TECHNOLOGY IN NURSING

The Nursing Information Technology is a specialty that integrates nursing science, computer science, and information
science to manage and communicate data, information, knowledge, and wisdom in nursing practice.” Informatics is
becoming increasingly present in our profession due to rapidly changing technologic advances. Healthcare systems are
assimilating technology into daily practice at a quick pace. Security and patient privacy must be upheld while achieving
the goal of transforming data into useful knowledge. Integrating informatics with evidence-based practice (EBP) can only
help improve the care we provide to our patients.

Applying technology to knowledge may help identify potential problems earlier. For example, with the use of electronic
documentation, identifying changes in patient status can occur quickly because the information is readily available.
Trending of patient vital signs is always accessible and the data are interpreted, systematized, and arranged. The nurse is
able to use this knowledge to formalize an appropriate plan of action.

1
GROUP 3

Hildegard Peplau
Hildegard Peplau, a nurse theorist who introduced the therapeutic nurse-patient relationship, started the second wave of
changes in the nursing profession, (nurse-patient relationship, also known as the therapeutic relationship, is the
professional interaction of the nurse to her client that is aimed towards the promotion of wellness and health of the latter),
the emphasis given to the dynamics of social interactions between the nurse and the patient was considered little and
lacking in answering the health needs of the client. However, in the emergence of the holistic approach, many new
nursing leaders saw the need to give importance on the positive results of an effective nurse-patient relationship.

Metaparadigm in Nursing

Person
Peplau defines person as a man who is an organism that lives in an unstable balance of a given system.

Health
Peplau considers “health” as a word that symbolizes movement of the personality and other ongoing human
processes that directs the person towards creative, constructive, productive and community living. Peplau also
gave importance on the belief that for one’s health to be achieved and maintained, his needs must be met. These
needs are physiological demands and interpersonal conditions.

Environment
Peplau defines environment as forces outside the organism and in the context of the socially-approved way of
living, from which vital human social processes are derived such as norms, customs and beliefs. However, these
given conditions that lead to health always include the interpersonal process.

Nursing
Peplau described nursing as a significant, therapeutic interpersonal process. It functions cooperatively with
human processes that present health as a possible goal for individuals. When nurses, together with the health care
team offer health services, they project health holistically taking while considering the socio-economic, spiritual,
emotional and physical aspect of every person. When interacting with patients or clients in every setting
available, the nurse uses the interpersonal model as a way to explore and to identify the needs of the person
seeking professional help.

Interpersonal Relations Theory

Hildegard Peplau, a psychiatric nurse, introduced her interpersonal concepts in 1952. Central to Peplau’s
theory is the use of a therapeutic relationship between the nurse and the client.
Nurses enter into a personal relationship with an individual when a need is present. The nurse-client
relationship evolves in four phases:

Orientation. During this phase, the client seeks help, and the nurse assists the client to understand the problem and the
extent of the need for help.

Identification. During this phase, the client assumes a posture of dependence, interdependence, or independence in
relation to the nurse (relatedness). The nurse’s focus is to assure the person that the nurse understands the
interpersonal meaning of the clients situation.

Exploitation. In this phase, the client derives full value from what the nurse offers through the relationship. The client
uses available services based on self-interest and needs. Power shifts from the nurse to the client.

Resolution. In this final phase, old needs and goals are put aside and new ones adopted. Once older needs are resolved,
newer and more mature ones emerged.
Phases of Nurse-Patient Relationship

’
2
Orientation
The initial interaction between the nurse and the patient wherein the latter has a felt need and expresses the desire
for professional assistance. The nurse assists the patient in recognizing and understanding the “patient”
experience.

Identification
The patient and the nurse explore the experience and the needs of the patient which leads to a feeling of
relatedness. It is very important in the relationship that the nurse assists the patient in reorienting his feelings and
sustaining a constant positive environment.

Exploitation
In this phase, the patient derives the full value of the relationship as he moves on from a dependent role to an
independent one. New goals are projected by the nurse, but the power is shifted to the patient as these goals
would be achieved through personal or self-effort.

Resolution
In its final stages, the patient earns independence over his care as he gradually puts aside old goals and
formulates new ones. Even though the patient and the nurse end the relationship, it is very apparent that the
experience leaves a lasting impression on the patient since illness and assuming a dependent role is a unique
human experience.

Nursing Roles
In the course of the nurse-patient relationship, the nurse assumes several roles which empower and equip
her in meeting the needs of the patient. These roles are appropriately being used by the nurse in different nursing
situations and phases of Interpersonal Relationship. These roles could overlap one over the other and could be
observed as soon as the situation comes up.

To help clients fulfill their needs, nurses assume many roles:

Role of the Stranger- receives the client in the same way one meets a stranger in other life situations provides
an accepting climate that builds trust.
In their initial contact, the nurse and the patient are strangers to one another. As the nurse
attempts to know the patients better, she must treat him with outmost courtesy, which includes acceptance of the
patient as a person and due respect over his individuality. This role coincides with the Identification Phase.
Teaching Role- who imparts knowledge in reference to a need or interest-
As the interaction progresses, the nurse assumes a teaching role as she gives much importance
for self-care an in helping him understand the therapeutic plan. In assuming this role, the nurse must determine
how the patient understands the subject at hand. She must develop her discussion around the interest of the
patient and his ability of using the information provided.
Role of the Resource Person- one who provides a specific needed information that aids in the understanding of
a problem or new situation
As the patient assumes a dependent role, the nurse provides specific answers to his queries
which include health information, advices, and simple explanation of the healthcare team’s course of care. It is
the responsibility of the nurse to appropriately change her responses to the patient’s level of understanding.
Surrogate Role- helps to clarify domains of dependence interdependence and independence and acts on clients
behalf as an advocate.
The patient’s dependency for his care give the nurse a surrogate (temporary care giver) role. This creates an
atmosphere wherein feelings previously felt, such as feeling towards her mother. Some other relationships are
reactivated and nurtured. Although the patient recognizes that the nurse has similarities with the person whom he
recalls in previous relationships, the nurse must assist the patient to make sure that her surrogate role is different
and only temporary.
Leadership Role- helps client assume maximum responsibility for meeting treatment goals in a mutually
satisfying way
Although dependent to the healthcare team over his care, the patient is still considered vital in
deciding as to what course his plan of care would take. The nurse as a leader must act in behalf of the patient’s
best interest and the same time enable him to make decisions over his own care. This is achieved through
cooperation and active participation.
Counseling Role- helps to understand and integrate the meaning of current life circumstances ,provides guidance

3
 and encouragement to make changes
Peplau believes that the counseling role has the greatest important and emphasis in nursing. This
role strengthens the nurse-patient relationship as the nurse becomes a listening friend, an understanding family
member, and someone who gives sound and emphatic advises. The very core of the interpersonal technique is
from the patient to remember and to understand the experience and how could it be integrated into his daily life.
Peplau’s model continues to be used by clinicians when working with individuals who have psychologic
problems.

Faye Glenn Abdellah

Faye Glenn Abdellah is recognized as a leader in the development of nursing research and nursing as a
profession within the Public Health Service and an international expert on health problems.

21 Nursing Problem

“I never wanted to be a medical doctor because I could do all I wanted to in nursing, which is a caring profession”

According to Abdellah, as a complete humanitarian service, nursing includes the following:

 Be acquainted with the nursing problems of the patient

 Choose the definite courses of actions to make in the scope of relevant nursing principles
Make available continuous care of the individuals entire health care needs
 Give continuous care to relieve pain and discomfort and provide immediate security for the individual.
 Regulate the total nursing care plan to meet the patient’s tailored needs.
 Serving the individual to become more self-determining in achieving maintaining a healthy state of mind and
body.
 Informing nursing personnel, family and support-system to provide the individual act for oneself within
perceived limitations.
 Facilitate the individual to adapt to limits and emotional problems
 Team up with different allied health professions in working with the diagram for optimum health in local, state,
national and international levels
 Engaging in non-stop evaluation and research to develop nursing techniques and to create nursing techniques to
serve the health needs of different people.

Metaparadigm in Nursing
Person
Abdellah classifies the beneficiary of care as individuals. However, she does not set standard limits on
the nature and essence of human beings. The twenty-one nursing problems relate with biological, psychological,
and social aspects of individuals and can be set to correspond to concepts of importance.
Health
In this theory, the concept of health is defined as the center and purpose of nursing services. 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.
Environment
The idea of environment is addressed by Abdellah and is included in “planning gor optimum health in
local, state, national and international levels.” However, as Abdellah
elaborates her ideas, the apex (core) od nursing service is the individual.
Nursing
the concept of nursing in this theory is generally grouped into twenty-one problem areas for nurses to
work out their judgment and appropriate care. Abdellah considers the nursing to be an all-inclusive service that is
based on the disciplines of art and science that serves individual, sick or well, cope with their health needs.

Typology of twenty one-nursing problems

4
To maintain good hygiene and physical comfort
To promote optimal activity: exercise, rest, sleep
To promote safety through prevention of accident,
injury, or other trauma and through prevention of
accident, injury, or other trauma and through
prevention of the spread of infection
To maintain good body mechanics and prevent and
correct deformity
To facilitate the maintenance of a supply of oxygen to all body cells
To facilitate the maintenance of nutrition for all body cells
To facilitate the maintenance of elimination
To facilitate the maintenance of fluid and electrolyte balance
To recognize the physiologic responses of the body to disease conditions—pathologic, physiologic, and compensatory
To facilitate the maintenance of regulatory mechanisms and functions
To facilitate the maintenance of sensory function
To identify and accept positive and negative expressions, feelings, and reactions
To identify and accept interrelatedness of emotions
and organic illness
To facilitate the maintenance of effective verbal and nonverbal communication
To promote the development of productive interpersonal relationships
To facilitate progress toward achievement and personal spiritual goals
To create or maintain a therapeutic environment
To facilitate awareness of self as an individual with varying physical, emotional, and developmental needs
To accept the optimum possible goals in the light of limitations, physical and emotional
To use community resources as an aid in resolving problems that arise from illness
To understand the role of social problems as influencing factors in the cause of illness

Moreover, the needs of patients are further divided into four categories: basic to all patients, sustenal care needs, remedial
care needs, and restorative care needs.
Basic Needs
The basic needs of an individual patient are to maintain good hygiene and physical comfort; promote
optimal health through healthy activities, such as exercise, rest and sleep; promote safety through the prevention
of health hazards like accidents, injury or other trauma and through the prevention of the spread of infection; and
maintain good body mechanics and prevent or correct
deformity.

Sustenal Care Needs

Sustenal care needs facilitate the maintenance of a supply of oxygen to all body cells; facilitate the maintenance
of nutrition of all body cells; facilitate the maintenance of elimination; facilitate the maintenance of fluid and
electrolyte balance; recognize the physiological responses of the body to disease conditions; facilitate the
maintenance of regulatory mechanisms and functions; and facilitate the maintenance of sensory function.

Remedial Care Needs

Remedial care needs to identify and accept positive and negative expressions, feelings, and reactions; identify
and accept the interrelatedness of emotions and organic illness; facilitate the maintenance of effective verbal and
non-verbal communication; promote the development of productive interpersonal relationships; facilitate
progress toward achievement of personal spiritual goals; create and maintain a therapeutic environment; and
facilitate awareness of the self as an individual with varying physical, emotional, and developmental needs.

Restorative Care Needs

Restorative care needs include the acceptance of the optimum possible goals in light of limitations, both physical
and emotional; the use of community resources as an aid to resolving problems that arise from illness; and the
understanding of the role of social problems as influential factors in the case of illness.
Abdellah’s work, which is based on the problem-solving method, serves as a vehicle for delineating nursing
(patient) problems as the patient moves toward a healthy outcome. The theory identifies ten steps to identify the
patient’s problem and 11 nursing skills used to develop a treatment typology.

5
 Joyce Travelbee
Human-to Human Relationship Model
“A nurse does not only seek to alleviate physical pain or render physical care – she ministers to the whole person. The
existence of suffering, whether physical, or mental or spiritual is the proper concern of the nurse.”
 Travelbee proposed that the goal of nursing was to assist an individual, family or community to prevent or cope
up with the experiences of illness and suffering and if necessary, to the meaning in these experiences with the
ultimate goal being the presence of hope.
 Her work was conceptual and she wrote about illness, pain, hope, communication, interaction, empathy,
sympathy, rapport and therapeutic use of self.
 She believed that it was as important to sympathize as it was to empathize if the nurse and the patient were to
develop a human-to-human relationship.
Metaparadigm in Nursing
Person
Travelbee defined peson as a human being, the patient as well as the nurse. A human being is a unique,
irreplaceable individual who is in the continuous process of becoming, evolving and changing.
Health
Travelbee stated that health is measured by subjective and objective health. A person’s subjective health status is
an individually defined state of well-being in accord to self-appraisal of physical, emotional and spiritual status.
Objective health is an absence of discernible diseases, disability, defect as measured by physical examination,
laboratory tests, assessment by a spiritual director or psychological counsellor.

Environment
Environment was not clearly defined in Travelbee’s theory. She defined human conditions and life experiences
encountered by all men as sufferings, hope pain and illness, These conditions are associated to to environment.

Nursing
As defined by Travelbee, nursing is an interpersonal process whereby the professional nurse practitioner assists
an individual, family or community to prevent or cope up with the experience of illness and suffering and if
necessary, to find meaning in these experiences. She explained that nursing is an interpersonal process because it is
an experience that occurs between nurse and an individual or group of individuals.

Human-to-Human Relationship Model

Travelbee’s formulation of her theory was greatly influenced by her experiences in nursing education. She
concluded that the nursing care rendered to patients in these institutions lacked compassion. She thought that nursing
care needed a “humanistic revolution” – a return to focus on the caring function towards the ill person.
In her theory, the nurse and the patient undergoes the following series of interactional phase:
Original Encounter
This is described as the first impression by the nurse of the sick person and vice-versa. The nurse and patient
see each other in stereotyped or traditional roles.

Emerging Identities
This phase is described by the nurse and patient perceiving each other as unique individuals. At this time, the
link of relationships begins to form.

Empathy
Travelbee proposed that two qualities that enhance the empathy process are similarities of experience and
the desire to understand another person. This phase is described as the ability to share in the person’s experience, The
result of the emphatic process is the ability to expect the behavior of the individual with whom he or she is
empathized.

Sympathy
Sympathy happens when the nurse wants to lessen the cause of the patient’s suffering. It goes beyond
empathy. The nurse should use a disciplined intellectual approach together with therapeutic use of self to make
helpful nursing actions.
Rapport
Rapport is described as nursing interventions that lessens the patient’s suffering. The nurse and the sick
person are relating as human being to human being. The sick person shows trust and confidence in the nurse and the
6
 nurse is able to establish rapport because she possesses the necessary knowledge and skills required to assist ill
persons and because she is able to perceive, respond to and appreciate the uniqueness of the ill human being.

Acceptance by the Nursing Community

Practice
The hospice is one good example in which Travelbee’s theory is applied. The hospice nurse attempts to build rapport
or a working relationship with the patient, as well as his significant others. She stated that understanding illness and
suffering enables the patient not only to accept the sickness but also to use it as a self-actualizing life experience.

Education
Travelbee’s concepts served as a better assistance for nurses who help individuals understand the meaning of illness
and suffering.

Research
Numerous sources in research studies have cited some aspects of the one-to-one relationship projected by Travelbee.
One study by O’Connor, Wicker and Germino which is nearly related to some of Travelbee’s ideas, discovers how
individuals who were recently diagnosed with cancer described their personal search for meaning. The results if this
study make known that the search for meaning seems to be both a spiritual and psychosocial process.

Lydia Hall
Care, Cure, Core Theory
“Participation in care, core and cure aspects of patient care, where CARE is the sole function of nurses, whereas
the CORE and CURE are shared with other members of the health team.”

Metaparadigm in Nursing

Person
The individual human who is 16 years of age or older and past the acute stage of long-term illness is the focus of
nursing care in Hall’s work. The source of energy and motivation for healing is the individual care recipient, not the
health care provider. Hall emphasizes the importance of the individual as unique, capable of growth and learning, and
requiring a total person approach.
Health
Health can be inferred to be a state of self-awareness with a conscious selection of behaviors that are optimal for
that individual. Hall stresses the need to help the person explore the meaning of his or her behavior to identify and
overcome problems through developing self-identity and maturity.
Society and Environment
The concept of society or environment is dealt with in relation to the individual. Hall is credited with developing
the concept of Loeb Center because she assumed that the hospital environment during treatment of acute illness creates a
difficult psychological experience for the ill individual. Loeb Center focuses on providing an environment that is
conducive to self-development. In such a setting, the focus of the action of the nurses is the individual, so that any actions
taken in relation to society or environment are for the purpose of assisting the individual in attaining a personal goal.
Nursing
Nursing is identified as consisting of participation in the care, core, and cure aspects of patient care.

Lydia Hall’s: Care, Core, Cure

Lydia Hall’s theory define Nursing as the “participation in care, core and cure aspects of patient care, where CARE is the
sole function of nurses, whereas the CORE and CURE are shared with other members of the health team.” The major
purpose of care is to achieve an interpersonal relationship with the individual that will facilitate the development of the
core. Lydia Hall used her knowledge of psychiatry and nursing experiences in the Loeb Center as a framework for
formulating her theory. Also known as “the Three Cs of Lydia Hall,” it contains three independent but interconnected
circles: the core, the care, and the cure.
 The core is the patient receiving nursing care. The core has goals set by him or herself rather than by any other
person, and behaves according to his or her feelings and values.
 The cure is the attention given to patients by medical professionals. Hall explains in the model that the cure circle
is shared by the nurse with other health professionals, such as physicians or physical therapists. These are the

7
 interventions or actions geared toward treating the patient for whatever illness or disease he or she is suffering
from.
 The care circle addresses the role of nurses, and is focused on performing the task of nurturing patients. This
means the “motherly” care provided by nurses, which may include comfort measures, patient instruction, and
helping the patient meet his or her needs when help is needed.
Hall’s theory emphasizes the total patient rather than looking at just one part and depends on all three
components of the theory working together.

Assumptions
The assumptions of Hall’s Care, Cure, Core Theory are as follows:
(1) The motivation and energy necessary for healing exist within the patient, rather than in the healthcare team.
(2) The three aspects of nursing should not be viewed as functioning independently but as interrelated. And lastly,
(3) The three aspects interact, and the circles representing them change size, depending on the patient’s total course of
progress.
Lydia Hall’s theory has three components which are represented by three independent but interconnected circles. The
three circles are: the core, the care, and the cure. The size of each circle constantly varies and depends on the state of the
patient.

 The Care Circle

The care circle defines the primary role of a professional nurse such as providing bodily care for the patient and
helping the patient complete such basic daily biological functions as eating, bathing, elimination, and dressing.
When providing this care, the nurse’s goal is the comfort of the patient.
Moreover, the role of the nurse also includes educating patients, and helping a patient meet any needs he or she is
unable to meet alone. This presents the nurse and patient with an opportunity for closeness. As closeness
develops, the patient can share and explore feelings with the nurse.

 The Core Circle

This area emphasizes the social, emotional, spiritual, and intellectual needs of the patient in relation to family,
institution, community and the world. This is able to help the patient verbally express feelings regarding the
disease process and its effects by the use of the reflective technique. Through such expression, the patient is able
to gain self-identity and further develop maturity.
Reflective technique is used by the professional nurse in a way the he or she acts as a mirror to the patient to help
the latter explore his or her own feelings regarding his or her current health status and related potential changes
in lifestyle.
Motivations are discovered through the process of bringing into awareness the feelings being experienced. With
this awareness, the patient is now able to make conscious decisions based on understood and accepted feelings
and motivation.

 The Cure Circle

Hall explains in the model that the cure circle is shared by the nurse with other health professionals, such as
physicians or physical therapists.
In short, these are the interventions or actions geared toward treating the patient for whatever illness or disease he
or she is suffering from. During this aspect of nursing care, the nurse is an active advocate of the patient.

Hall’s diagram showing interlocking circles that may change in size and overlap
As seen in the figure above, the three interlocking circles may change in size and overlap in relation to the patient’s phase
in the disease process. A nurse functions in all three circles but to different degrees.
For example, in the care phase, the nurse gives hands-on bodily care to the patient in relation in relation to the activities
of daily living such as toileting and bathing. In the cure phase, the nurse applies medical knowledge to treatment of the
person, and in the core phase, the nurse addresses the social and emotional needs of the patient for effective
communication and a comfortable environment.

8
GROUP 4
Virginia Henderson: Nursing Need Theory
• Virginia Avenel Henderson (November 30, 1897 – March 19, 1996)
• A nurse, theorist, and an author for Need Theory
defined nursing as:
“The unique function of the nurse is to assist the individual, sick or well, in the performance of those activities contributing to health
or its recovery (or to peaceful death) that he would perform unaided if he had the necessary strength, will or knowledge.”
 “The First Lady of Nursing”
 “The Nightingale of Modern Nursing”
 “Modern-Day Mother of Nursing”
 “The 20th Century Florence Nightingale.”

The need theory

“I believe that the function the nurse performs is primarily an independent one – that of acting for the patient when he lacks
knowledge, physical strength, or the will to act for himself as he would ordinarily act in health, or in carrying out prescribed therapy.
This function is seen as complex and creative, as offering unlimited opportunity for the application of the physical, biological, and
social sciences and the development of skills based on them.” (Henderson, 1960)

ASSUMPTIONS OF NEED THEORY

 The assumptions of Virginia Henderson’s Need Theory are:
(1) Nurses care for patients until they can care for themselves once again. Although not precisely explained,
(2) patients desire to return to health.
(3) Nurses are willing to serve and that “nurses will devote themselves to the patient day and night.”
(4) Henderson also believes that the “mind and body are inseparable and are interrelated.”

METAPARADIGM OF NEED THEORY

INDIVIDUAL
 Individuals have basic needs that are component of health and require assistance to achieve health and independence or a
peaceful death. According to her, an individual achieves wholeness by maintaining physiological and emotional balance.
 Someone who needs nursing care but did not limit nursing to illness care. Her theory presented the patient as a sum of parts
with biopsychosocial needs and the mind and body are inseparable and interrelated.
ENVIRONMENT
 Maintaining a supportive environment conducive for health is one of the elements of her 14 activities for client assistance.
 Henderson’s theory supports the tasks of the private and the public health sector or agencies in keeping the people healthy.
She believes that society wants and expects the nurse’s service of acting for individuals who are unable to function
independently.
HEALTH
 Health was taken to mean balance in all realms of human life. It is equated with the independence or ability to perform
activities without any aid in the 14 components or basic human needs.
 Nurses, on the other hand, are key persons in promoting health, prevention of illness and being able to cure. According to
Henderson, good health is a challenge because it is affected by numerous factors such as age, cultural background, emotional
balance, and others.
NURSING
 “the unique function of the nurse is to assist the individual, sick or well, in the performance of those activities contributing to
health or its recovery that he would perform unaided if he had the necessary strength, will or knowledge. And to do this in
such a way as to help him gain independence as rapidly as possible.”
 Nurses temporarily assist an individual who lacks the necessary strength, will, and knowledge to satisfy one or more of the 14
basic needs. She states: “The nurse is temporarily the consciousness of the unconscious, the love life for the suicidal, the leg
of the amputee, the eyes of the newly blind, a means of locomotion for the infant, knowledge, and confidence of the young
mother, the mouthpiece for those too weak or withdrawn to speak”

9
NOLA J. PENDER, PhD, RN, FAAN
HEALTH PROMOTION MODEL
HEALTH PROMOTION MODEL
 A nursing theory to aid nurse comprehension of the primary determinants of health behaviors as a foundation for healthy
lifestyle counseling
 Pender's health promotion model theory was first published in 1982 and later revised in 1996 and 2002.
 “complementary counterpart to models of health protection.”
 Pender’s health promotion model defines health as “a positive dynamic state not merely the absence of disease.”

The Health Promotion Model makes four assumptions:

1. Individuals seek to actively regulate their own behavior.
2. Individuals, in all their biopsychosocial complexity, interact with the environment, progressively transforming the
environment as well as being transformed over time.
3. Health professionals, such as nurses, constitute a part of the interpersonal environment, which exerts influence on people
through their life span.
4. Self-initiated reconfiguration of the person-environment interactive patterns is essential to changing behavior.

The model is based on the following theoretical propositions:

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 to action, a mediator of behavior as well as actual behavior.
4. Perceived competence or self-efficacy to execute a given behavior increases the likelihood of commitment to action and
actual performance of the behavior.
5. Greater perceived self-efficacy results in fewer perceived barriers to a specific health behavior.
6. Positive affect toward a behavior results in greater perceived self-efficacy, which can, in turn, result in increased positive
affect.
7. When positive emotions or affect are associated with a behavior, the probability of commitment and action is increased.
8. Persons are more likely to commit to and engage in health-promoting behaviors when significant others model the behavior,
expect the behavior to occur, and provide assistance and support to enable the behavior.
9. Families, peers, and health care providers are important sources of interpersonal influence that can increase or decrease
commitment to and engagement in health-promoting behavior.
10. Situational influences in the external environment can increase or decrease commitment to or participation in health-
promoting behavior.
11. The greater the commitments to a specific plan of action, the more likely health-promoting behaviors are to be maintained
over time.
12. Commitment to a plan of action is less likely to result in the desired behavior when competing demands over which persons
have little control require immediate attention.
13. Commitment to a plan of action is less likely to result in the desired behavior when other actions are more attractive and thus
preferred over the target behavior.
14. Persons can modify cognitions, affect, and the interpersonal and physical environment to create incentives for health actions.

10
MAJOR CONCEPTS
 Individual characteristics and experiences (prior related behavior and personal factors).
 •Behavior-specific cognitions and affect (perceived benefits of action, perceived barriers to action, perceived self-efficacy,
activity-related affect, interpersonal influences, and situational influences).
 •Behavioral outcomes (commitment to a plan of action, immediate competing demands and preferences, and health-
promoting behavior).

Subconcepts of the Health Promotion Model

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

Biological personal factors

 age  pubertal status,
 gender  aerobic capacity,
 body mass index  strength, agility, or balance.
Psychological personal factors
 self esteem  Socio-cultural personal factors
 self motivation  race ethnicity,
 personal competence  education
 perceived health status  socioeconomic status.
 definition of health.

 Perceived Benefits of Action - Anticipated positive
outcomes that will occur from health behavior.
 Perceived Barriers to Action - Anticipated,
imagined or real blocks and personal costs of
understanding a given behavior.
 Perceived Self-Efficacy - Judgment of personal
capability to organize and execute a health-promoting
behavior.
 Activity-Related Affect - Subjective positive or
negative feeling that occurs before, during and
following behavior based on the stimulus properties
of the behavior itself.
 Interpersonal Influences - Cognition concerning
behaviors, beliefs, or attitudes of the others.
Interpersonal influences include norms, social
support and modeling. Primary sources of
interpersonal influences are families, peers, and
healthcare providers.
 Situational Influences - Personal perceptions and
cognitions of any given situation or context that can
facilitate or impede behavior
 Commitment to Plan of Action - The concept of
intention and identification of a planned strategy that
leads to the implementation of health behavior
 Immediate Competing Demands and Preferences -
 Competing demands are alternative
behaviors over which individuals have low
control because there are environmental
contingencies.
 Competing preferences are alternative
behaviors over which individuals exert
relatively high control
 Health-Promoting Behavior - an endpoint or action
outcome that is directed toward attaining positive
health outcomes

METAPARADIGM
PERSON
 is a biopsychosocial organism that is partially shaped by the environment but also seeks to create an environment in which
inherent and acquired human potential can be fully expressed. Thus, the relationship between person and environment is
reciprocal. Individual characteristics as well as life experiences shape behaviors including health behaviors.

11
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.
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.
HEALTH
 in reference to the individual is defined as the actualization of inherent and acquired human potential through goal-directed
behavior, competent self-care, and satisfying relationships with others, while adjustments are made as needed to maintain
structural integrity and harmony with relevant environments. Health is an evolving life experience. There are definitions for
family health and community health that have been proposed by other authors.
 Illnesses - are discrete events throughout the life span of either short (acute) or long (chronic) duration that can hinder or
facilitate one’s continuing quest for health.

MADELEINE M. LEININGER

“Care is the heart of nursing: Care is power, Care is essential to healing; Care is curing; and care is the central and dominant focus of
nursing and transcultural nursing decisions and actions”

THEORY OF CULTURE CARE DIVERSITY AND UNIVERSALITY

 It is also known as Transcultural theory
 Leininger first showed her presentation of theory in 1985.
 She presented her assumptions which support her claim that “Different Cultures perceive, know, and practice care in different
ways, yet there are some commonalities about care among all cultures of the world”(Leininger,1985).
 She refers to the general concepts as universality and the differences as diversity.
 The concept of culture in Leininger’s theory borrows its meaning from anthropology.
 . Culture is the “learned, shared, and transmitted values, beliefs, norms, and lifeways of a particular group that guides their
thinking, decisions, and actions in patterned ways”(Leininger,1985)
 The concept of culture in Leininger’s theory borrows its meaning from anthropology.
 . Culture is the “learned, shared, and transmitted values, beliefs, norms, and lifeways of a particular group that guides their
thinking, decisions, and actions in patterned ways”(Leininger,1985)
 A key component of Leininger’s theory is that of cultural diversity. This refers to the differences o variations that can be
found between between and among different cultures.
 . By recognizing the variations , the nurse can avoid the problem of stereotyping and assuming that all people will react to the
same nursing care.
 A similar concept is that of cultural universality, the opposite of diversity, which refers to the commonalities or similarities
that exist in different cultures.
 These ideas have led to an important achievement of the theory- that is, “to discover similarities and differences about care
and its impact on the health and well-being of groups”(Leininger,1995)

Major Concepts of the Transcultural Nursing Theory

Transcultural Defined as a learned subfield or branch of nursing which

focuses upon the comparative study and analysis of
Nursing
cultures with respect to nursing and health-illness caring
practices, beliefs, and values with the goal to provide
meaningful and efficacious nursing care services to people
according to their cultural values and health-illness
context.
Ethno nursing This is the study of nursing care beliefs, values, and
practices as cognitively perceived and known by a
designated culture through their direct experience, beliefs,
and value system (Leininger, 1979).

Nursing Defined as a learned humanistic and scientific profession

and discipline which is focused on human care phenomena
and activities in order to assist, support, facilitate, or
enable individuals or groups to maintain or regain their
well-being (or health) in culturally meaningful and
beneficial ways, or to help people face handicaps or death.
Professional Defined as formal and cognitively learned professional care
knowledge and practice skills obtained through educational
Nursing Care
institutions that are used to provide assistive, supportive,
(Caring) enabling, or facilitative acts to or for another individual or
group in order to improve a human health condition (or
well-being), disability, lifeway, or to work with dying
clients.

12
Cultural Defined as those cognitively based assistive, supportive,
facilitative, or enabling acts or decisions that are tailor-
Congruent
made to fit with individual, group, or institutional cultural
(Nursing) Care values, beliefs, and lifeway in order to provide or support
meaningful, beneficial, and satisfying health care, or well-
being services.
Health It is a state of well-being that is culturally defined, valued,
and practiced, and which reflects the ability of individuals
(or groups) to perform their daily role activities in
culturally expressed, beneficial, and patterned life ways.

Human Beings Such are believed to be caring and to be capable of being

concerned about the needs, well-being, and survival of
others. Leininger also indicates that nursing as a caring
science should focus beyond traditional nurse-patient
interactions and dyads to include families, groups,
communities, total cultures, and institutions.
Society and These terms are not defined by Leininger; she speaks
instead of worldview, social structure, and environmental
Environment context.

Culture Care Is defined as the subjectively and objectively learned and

transmitted values, beliefs, and patterned lifeways that
assist, support, facilitate, or enable another individual or
group to maintain their well-being, health, improve their
human condition and lifeway, or to deal with illness,
handicaps or death.
Culture Care Indicates the variabilities and/or differences in meanings,
patterns, values, lifeways, or symbols of care within or
Diversity between collectives that are related to assistive,
supportive, or enabling human care expressions.

Culture Care Culture care universality indicates the common, similar, or

dominant uniform care meanings, pattern, values, lifeways
Universality
or symbols that are manifest among many cultures and
reflect assistive, supportive, facilitative, or enabling ways
METAPARADIGM to help people. (Leininger, 1991)
PERSON

 Human beings are best explained in her assumptions. Humans are thus believed to be caring and capable of being concerned
bout the desires, welfare, and continued existence of others. Human care is collective, that is, seen in all cultures.

 Humans have endured within cultures and through place and time because they have been able to care for infants, children,
and the elderly in a variety of ways and in many different environments. Thus, humans are universally caring beings who
survive in a diversity of cultures through their ability to provide the universality of care in a variety of ways according to
differing cultures, needs, and settings. Leininger(1991)also indicates that nursing as a caring science should focus ahead of
traditional nurse-patient interactions to include “families, groups, communities, total cultures, institutions” as well as
worldwide health institutions and ways to expand international nursing care policies and practices.

HEALTH

She discussed about components of health, specifically:

 Health systems  Changing health patterns  Health maintenance

 Health care practices  Health promotions

-Health is a key concept in transcultural nursing. Because of the weight on the need for nurses to have knowledge that is specific to the
culture in which nursing is being practiced. It is acknowledged that health is seen as being universal across cultures but distinct within
each culture in a way that represents the beliefs, values, and practices of the particular culture. Thus, health is both universal and
diverse.

13
ENVIRONMENT

 In terms of environment, Leininger speaks about worldview, socal structure, and environmental context. However,
environment, if viewed as being signified in culture, is a major principle of Leininger’s theory. Environment framework is
defined as being the totality of an event, situation, or experience. Her description of culture centers on a particualr
group(society) and patterning of actions, thoughts, and decisions that occurs as the result of “learned, shared, and transmitted
values, beliefs, norms, and lifeways”. This learning, sharing, transmitting, and patterning take place within a group of people
who function in an identifiable setting or environment. Therefore, although Leininger does not use the specific terms of
society or environment, the concept of culture is closely related to society/environment, and is a central matter of her theory.

NURSING

She gave three types of nursing actions that are culturally-based and thus consistent with the needs and values of the clients. These
are:

 Cultural care preservation/maintenance  Cultural care re-patterning/restructuring

 Cultural care accommodation/negotiation

-These three modes of action can lead to the deliverance of nursing care that best fits with the client’s culture and thus reduce cultural
stress and chance for conflict between client and caregiver.

14
-These three modes of action can lead to the deliverance of nursing care that best fits with the client’s culture and thus reduce cultural
stress and chance for conflict between client and caregiver.