PSYCHOSOCIAL THEORY
Erik Erikson
Erik Homberger Erikson was a German-born
American developmental psychologist and
psychoanalyst known for his theory on psychosocial
development of human beings. He may be most famous
for coining the phrase identity crisis
Born: June 15, 1902, Frankfurt, Germany.
Died: May 12, 1994, Harwich, Massachusetts, United
States
Education: University of Vienna
Influenced by: Sigmund Freud, Anna Freud
Published several books: Childhood and Society, Young
man Luther, Youth: Change and Challenge, Insight and
Responsibility,
Identity: Youth and Crisis
Became Boston's first child analyst and obtained a
position at the Harvard Medical School
He also held positions at institutions including Yale,
Berkeley, and the Menninger Foundation.
Erikson then returned to California to the Center for
Advanced Study in the Behavioral Sciences at Palo Alto
and later the Mount Zion Hospital in San Francisco,
where he was a clinician and psychiatric consultant
Erik Erikson
Stresses importance of culture and society in
personality development
Described child development in terms of developmental
tasks that must be achieved
What are the 8 stages of psychosocial development
1. Trust versus Mistrust
2. Autonomy versus Shame and Doubt
3. Initiative versus Guilt
4. Industry versus Inferiority
5. Identity versus Role Confusion
6. Intimacy versus Isolation
7. Generativity versus Stagnation
8. Integrity versus Despair
Developmental Tasks
Trust versus Mistrust
Infancy - Learns to love and be loved
Provide security such as soft sounds and touch.
Positive: Children develop a sense of trust when
caregiver provide reliability, care and affection
Negative: withdrawal, apprehensive suspicious around
people.
Autonomy versus Shame and Doubt
Toddlerhood
Provide opportunities for decision making
Praise for abilities to make decision
Self confidence
Positive: Self-control without loss of self-esteem
Ability to cooperate and express oneself
Negative: willfulness, defiance
Initiative versus Guilt
Pre-school (3 - 5 yrs. Old)
Opportunities for exploring new places or activities
Beginning ability to evaluate one’s own behavior
Success leads to sense of purpose
Negative: lack of confidence, fear of wrongdoing
Industry versus Inferiority
School age (6-12 yrs).
Beginning to create , develop and manipulate
Outcome: Children need to cope with new social and
academic demands.
Success leads to a sense of competence, while failure
results in feelings of inferiority, loss of hope,
withdrawal from school
Identity versus Role Confusion
Adolescence (12 – 20 years old)
Coherent sense of self.
Outcome: Success leads to ability to stay true to
yourself, while failure leads to role confusion and weak
sense of self, possible anti-social behavior
Intimacy versus Isolation
Young Adulthood (21 – 25 years old)
Commitment to work and relationship
Outcome: Young adults need to form intimate
relationships with other people.
Success leads to strong relationships while failure
results in loneliness and isolation
Generativity versus Stagnation
Adulthood (26 – 65 years old)
Creativity , productivity, concern for others.
Outcome: Success leads to feelings of usefulness and
accomplishments, while failure results in shallow
involvement in the world, lack of interests and
commitments.
Integrity versus Despair
Maturity (65 years old to death)
Reflection on life
Acceptance of worth and uniqueness of one’s own life
Acceptance of death
Success at this stage leads to feelings of wisdom while
failure results in regret, bitterness and despair.
CASAGRA TRANSFORMATIVE LEADERSHIP MODEL
Sister Carolina S. Agravante
- Has Bachelor’s Degree in Nursing in St. Paul Collge
Manila in 1964
- Has Master’s Degree in Nursing Education in Catholic
University of America in 1970
- Has Doctoral degree in nursing in university of the
Philippines manila on April 2002
CASAGRA transformative leadership model
-derived CASAGRA theory from her name
“Focus on the type of leadership in nursing that can
challenge the values of the changing world…”
Main Propositions          nurses, migration made easy, attractive salaries and
- CASAGRA transformative leadership is a psycho-
spiritual model, was an effective means for faculty to
become better teachers and servant-leaders.
- Care complex is a structure in the personality of the
caregiver that is significantly related to the leadership
behavior.
- The CASAGRA servant-leadership formula is an
effective modality in enhancing the nursing faculty’s
servant-leadership behavior.
-Vitality of Care Complex of the nursing faculty is
directly related to leadership behavior
Key Concepts
>CASAGRA transformative leadership model have
concepts of leadership from a psycho-spiritual point of
view, designed to lead to radical change from apathy or
indifference to a spiritual person.
>Servant-leader formula is the enrichment package
prepared as intervention for the study which has three
parts that parallel the three concepts of the CASAGRA
transformative leadership model, namely: the care
complex primer, a retreat-workshop on Servant-
leadership, and a seminar-workshop on Transformative
Teaching for nursing faculty.
> Special expertise is the level of competence in the
particular nursing area that the professional nurse is
engaged in.
>Retreat-workshop is the spiritual exercise organized in
an ambience of prayer where the main theme is the
contemplation of Jesus Christ as a Servant-leader.
>Servant-leadership behavior refers to the perceived
behavior of nursing faculty manifested through the
ability to model the servant leadership qualities to
students, ability to bring out the best in students,
competence in nursing skills, commitment to the
nursing profession, and sense of collegiality with the
school, other health professionals, and local
community.
>Nursing leadership is the force within the nursing
profession that sets the vision for its practitioners, lays
down the roles and functions, and influences the
direction toward which the profession should go.
>Transformative teaching may also be termed
Reflective teaching, an umbrella term covering ideas,
such as thoughtful instruction, teacher research,
teacher narrative, and teacher empowerment.
>Care complex is the nucleus of care experiences in the
personality of a nurse formed by a combination of
maternal care experiences, culture based-care practices
indigenous to a race and people, and the professional
training on care acquired in a formal course of nursing.
WHAT PROMPTED SISTER CAROLINA AGRAVANTE TO
DO THE THEORY?
-The present day demands in the nursing profession
challenge nursing educators to revisit their basic
responsibility of educating professional nurses who are
responsive to technological, educational and social
changes happening in the Philippines society today. The
reopening of the doors of foreign market to Filipino
benefits way beyond what hospitals can afford to give. 
Nursing education is faced with a new concern that is
globalization of nursing services for the international
market. Therefore a need to develop globalization of
care with focus on developing caring nurses. 
The formation of new nursing leaders is urgently
needed; leaders with new vision who will venture new
traits and who have gone through new formation in
order to serve the society as professional nurse.
Nurses needs competent leaders with a dream what
nursing can be, whose basic stand is caring and service
who are competent in nursing, assertive of their own
rights with the help profession. 
MEANING OF THE THEORY
Based on the study, the effect of the CASAGRA
Leadership model using the servant leader model on
the leadership behavior of the nursing faculty, the care
complex in the personality of the nursing faculty is
highly correlated to their leadership behavior. The care
complex is necessary given as a stimulant in the
performance of the leadership activities. The leadership
behavior of the faculty after going to the servant
leadership formula was significantly higher in the two-
post test periods than during the pre-test. It improved
the leadership behavior of the nursing faculty in both
groups.
LOGICAL ADEQUACY
- The conceptual framework is logical because the
variables are very well explained on how
transformative-leadership model be applicable through
care complex, transformative teaching servant-leader
spirituality, and servant-leader behavior.
- A person with dynamic care complex is the
cornerstone of nursing leadership. According to care
complex of Agravante, caring personality rests on the
possession of a care complex with in a person as an
energy source of caring.
- The framework explains and predicts the continuous
formation of nursing leadership behavior in nursing
faculty that will eventually affect their teaching
function.
- Servant-leadership formula runs parallel to the generic
elements of the transformative-leadership model.
- Transformative teaching is the guide that desired for
the modern educative process designed to form the
millennium professional nurse.
- Expertise is the practice of caring and proactive in face
of challenges for the profession go hand-in-hand.
Education and practice bring this about.
Locsin’s Technological Competency as Caring
"The practice of knowing persons as whole, frequently
with the use of varying technologies” (Locsin, 2001) .
Rozzano Locsin, RN, PhD, FAAN
Rozzano C. Locsin was born in 1954 in the Philippines.
Is a Professor of Nursing at Tokushima
University (Japan),
A Professor Emeritus of Florida Atlantic University
(United States), and a Visiting Professor at universities
in Thailand, Uganda, and the Philippines.
Dr. Rozzano Locsin earned his Doctor of Philosophy in
Nursing degree from the University of the Philippines in
1988
Master of Arts in Nursing and Bachelor of Science in
Nursing from Silliman University in 1978 and 1976
respectively in the Philippines.
Assumptions
1. Persons are caring by virtue of their humanness
(Boykin & Schoenhofer, 2001
2. Persons are whole or complete in the moment
(Boykin & Schoenhofer, 2001)
3. Knowing persons is a process of nursing that allows
for continuous appreciation of persons moment to
moment
Assumptions
4. Technology is used to know wholeness of persons
moment to moment (Locsin, 2004).
5. Nursing is a discipline and a professional practice
(Boykin & Schoenhofer, 2001).
Dimensions of Technological Value in the Theory
Technology as completing human beings to re-
formulate the ideal human being such as in
replacement parts, both mechanical (prostheses) or
organic (transplantation of organs.)
Technology as machine technologies, e.g. computers
and gadgets enhancing nursing activities to provide
quality patient care such as Penelope or Da Vinci in the
Operating Theatres;
Technologies that mimic human beings and human
activities to meet the demands of nursing care
practices, e.g. cyborgs (cybernetic organisms) or
anthropomorphic machines and robots such as
‘nursebots’ (Locsin & Barnard, 2007)
Technological Competency as Caring in Nursing
Technological competency as caring in nursing is the
harmonious coexistence between technologies and
caring in nursing.
The harmonization of these concepts places the
practice of nursing within the context of modern
healthcare and acknowledges that these concepts can
co-exist.
Technological Competency as Caring in Nursing
• Technology brings the patient closer to the nurse.
Conversely, technology can also increase the gap
between the nurse and nursed.
• When technology is used to know persons
continuously in the moment, the process of nursing is
lived.
Metaparadigm
Nursing
“Nurses value technological competency as an
expression of caring innursing” (Locsin, 2013)
Health
Humanity is preserved by technology
“An experience that is often expressed in terms of wellness
and illness, and may occur in the presence or absence of
disease” (Nursing Scope and Standards of Practice, 2010, p.
65)
Environment
Environment as the technological world in which we live
Person
Patients seen as “participants in their care rather than
object of nurse care” (Locsin, 2013).
Describes persons as human beings who are whole and
complete in any moment (Locsin, 2005)
Transcultural theory in Nursing
MADELEINE M. LEININGER
 Creator of Transcultural Subfield of Nursing
 Obtained her basic nursing education at St
Anthony’s School of Nursing,Denver Colorado
(1948)
 BS degree from Benedictine College Atchison ,
Kansas
 MS in Anthropology from University of
Washington Seattle
Transcultural Nursing Theory
 Goal is to provide culture specific and universal
nursing care practices for the health and well
being of people or to help them face
unfavorable human conditions, illness or death
in culturally meaningful ways
Culture
 Broadly define set of values, beliefs and
traditions that are held by a specific group of
people and handed down from generation to
generation
 Beliefs, habits, likes, dislikes ,customs and
rituals learned from one’s family
 Guide thinking, decisions and actions in
patterned ways
Religion
 Set of belief in a divine or super human power
Ethnic
 Refers to a group of people who share a
common and distinctive cultures and who are
members of a specific group.
Cultural Diversity
 Refers to differences or variations that can be
found both between and among different
cultures
Cultural Universality
 Commonalities or similarities that exist in
different cultures.
Diversity
 Refers to the fact or state of being different
 Can occur between cultures and within a
cultural group
Culturally congruent care
 Care that fits the people’s valued life practices
and set of meanings generated from the people
themselves
Culturally competent care
 Ability of the practitioner to bridge cultural gaps
in caring, work with cultural differences and
enable clients and families to achieve
meaningful and supportive caring
Cultural sensitivity
 Professional awareness of the significance of
cultural factors in the delivery of health
Cultural competence
  The ability to understand and plan care for
culturally diverse groups of clients .
Protective practices
 Amulets
 Charms
 Food substances may be ingested to prevent
illness
Traditional remedies
 Folk medicines
 Plants
 Roots
 Stems
 Flowers
 Seeds
Gender roles
 Male is usually the dominant figure
 Female is passive
Illness cause and preventon r/t food
 Hot-cold imbalance
 Cold-honey,avocado, banana
 Hot-chocolate, coffee, corn meal, garlic .onions
and peas
Metaparadigm in Nursing
Person
 Believed to be caring and capable of being
concerned about the desires, welfare and
continued existence of others
 Humans have endured within cultures and
through place and time
Humans
 Universally caring beings who survive in a
diversity of cultures through their ability to
provide the universality of care in a variety of
ways accdg to differing cultures, needs and
settings
ENVIRONMENT
 Totality of an event, situation or experience
 Centers on society and the patterning of
actions, thoughts and decisions that occurs as
the result of learned, shared and transmitted
values, beliefs, norms and lifeways
Health
 Universal across cultures but distinct with each
culture in a way that represents the beliefs,
values and practices of the particular culture
 Both universal and diverse
Nursing
3 types of nursing actions that are culturally –based
 Cultural care preservation/maintenance
 Retain and or preserve relevant care
values so that clients can maintain their
well being, recover from illness or face
handicaps and/or death
 Cultural care accommodation/negotiation
 Adapt or negotiate with the others for a
beneficial satisfying health outcome
with professional care providers.
 Cultural care repatterning/restructuring
 Change or greatly modify client’s life
ways for a new, different and beneficial
health care pattern
Transcultural Theory in Nursing
 Different cultures perceive, know and practice
care in different ways, yet there are some
commonalities about care among all cultures of
the world
 diversity-difference
 Universality-commonality
Core, care and cure model
Lydia Hall
Lydia Hall was born in New York City on September
21, 1906.
She promoted involvement of the community in
health-care issues.
She derived from her knowledge of psychiatry and
nursing experiences in the Loeb Center the
framework she used in formulating her theory of
nursing.
Achievements
1975: Evaluation of Loeb center revealed that those
admitted in the unit were “readmitted less often,
more independent, had higher post- discharge
quality of life more satisfied with hospital
experience”
Theory Overview
Theory developed in late 1960’s
Nursing care can be delivered on three interlocking
levels
Patient care only from trained nurses
Defines nursing as care performed by a professional
Care focused on individuals, families and
communities
Care focused on maintaining optimal health and
quality life from birth to end of life
Three interlocking circles to represent aspects of
the patient
the core,
the care and
the cure
The core
 Social sciences
 Therapeutic use of self-aspects of nursing
 The care
 Natural and biological sciences
 Intimate bodily care-aspects of nursing
The cure
 Pathological and therapeutic sciences
 Seeing the patient and family through the
medical care-aspects of nursing
Lydia hall-core, care and cure model
 Believed that professional nursing care
hastened recovery
 As less medical care was needed, more
professional nursing care and teaching were
necessary
Major Concept
 Health can be inferred to be a state of self-
awareness with conscious selection of
behaviours that are optimal for that individual
 The concept of society/ environment is dealt
with in relation to the individual
 Nursing is identified as consisting of
participation in the aspect of patient care.
Hall’s Metaparadigm
 Person
• Client is composed of body, pathology, and
person. People set their own goals and are capable
of learning and growing.
 Environment
• Should facilitate achievement of the client’s
personal goals.
 Health
• Development of a mature self-identity that assists
in the conscious selection of actions that facilitate
growth.
Hall viewed becoming ill is behavior. Illness is
directed by one’s feelings-out-of-awareness, which
are the roots of adjustment difficulties
 Nursing
• Caring is the nurse’s primary function.
Professional nursing is most important during the
recuperative period, a period of physical or mental
recovery
• The major purpose of care is to achieve an
interpersonal relationship with the individual that
will facilitate the development of core, i.e. the
development of self-identity and self-direction by
the patient.
Assumptions
 The motivation and energy necessary for
healing exist within the patient, rather than in
the health care team
 The three aspects of nursing should not be
viewed as functioning Independently but as
interrelated
 The Three aspects interact, and the circles
representing them change size, depending on
the patient’s total course of progress.
 During the ACUTE PHASE OF ILLNESS, the CURE
will be the largest
 During the evaluation & follow-up visits, CARE
CIRCLE is the biggest.
During LONG TERM CARE, core circle should be
the largest
LIMITATIONS
 ACUTE STAGE ILLNESS PATIENTS ARE NOT INCLUDED.
ONLY REFERS ADULT PATIENTS
 ONLY TOOL OF THERAPEUTIC COMMUNICATION IS
REFLECTION. FAMILY MENTIONED ONLY IN CURE CIRCLE.
RELATES ONLY TO THOSE WHO ARE ILL. WAS NOT
PLEASED WITH CONCEPT OF “TEAM NURSING”
Parse’s Theory of Human Becoming
 The human becoming theory posits quality of
life from each person's own perspective as the
goal of nursing practice.
 Human Becoming Theory values the most
idealistic way of holism…. of what nursing ought
to be.
 The theory could have a huge impact on the
way our society views the role of nursing.
Rosemarie Rizzo Parse  from the sum of the parts. The goal is to show
 Published the theory in 1981 as the "Man-living-
health" theory (ICPS) The name was officially
changed to "the human becoming theory" in
1992 to remove the term "man," after the
change in the dictionary definition of the word
from its former meaning of "humankind."
 
 Educated at Duquesne University, Pittsburgh
•MSN and Ph.D. from University of Pittsburgh
 •Published her theory of nursing,  Man Living-
Health in 1981
 •Editor and Founder, Nursing Science Quarterly
•Has published eight books and hundreds of
articles about Human Becoming Theory
•Professor and Niehoff Chair at Loyola
University, Chicago
Theoretical Sources
 The human becoming school of thought is
“consistent with Martha E. Rogers’ principles
and postulates about unitary human beings,
and it is consistent with major tenets and
concepts from existential phenomenological
thought, but it is a new product, a different
conceptual system”
 Heidegger, Sartre, and Merleau- Ponty.
Purpose: - posit an idea of nursing rooted in the
human sciences as an alternative to ideas
grounded in the natural sciences. Natural
Sciences - nursing as having to do with the
quantification of man and illness rather than
the qualification of man’s total experience with
health.
 The theory is structured around three abiding
themes: meaning, rhythmicity, and
transcendence.
Meaning
 Human Becoming is freely choosing personal
meaning in situations in the intersubjective
process of living value priorities.
 Client will co-participate in creating reality
 Man’s reality is given meaning through lived
experiences
 Man and environment co create
Rhythmicity
 Human Becoming is co creating rhythmical
patterns of relating in mutual process with the
universe.
 Man and environment co create ( imaging,
valuing, languaging) in rhythmical patterns.
 Synchronizing rhythm means – dwelling with
the pitch, roll of the universe , living moment to
moment.
Transcendence
 Human Becoming is co transcending multi
dimensionally with emerging possible.
 Refers to reaching out and beyond the limits
that a person sets.
 One constantly transforms and moving beyond
the meaning.
NURSING PARADIGMS AND PARSE'S THEORY
 Person
 Open being who is more than and different
qualities of life through client’s perspective.
Note: Quality of life emerges through nurse-
person process
 The nurse bears witness through the clients
own living of values priority
 Environment
Everything in the person and his experiences.
Inseparable, complimentary to and evolving
with
 Health and environment are mutually and
simultaneously interrelating as a unit
 Human universe health process is more than
and different from the sum of its parts
 Human co- create health in relationship with
the environment.as an alternative
 Health
 Open process of being and becoming. Involves
synthesis of values
  Health is flowing progression of human
becoming
 Hope is a living experience of health inextricably
connected to quality of life
 Health is living experience of ongoing human –
universe change.
Nursing
 A human science and art that uses an abstract
body of knowledge to serve people
 Presents as an alternative to biomedical model
and bio-psycho social spiritual approach.
 Enhances the quality of life from each client’s
own perspectives
 Nurses responsibilities to society is in the
guiding of individuals and their families.
 The client is the authority figure and primary
decision maker.
 Framework for practice
 Personal connection between nurse and client
 Care plan must address emotional and
psychological needs od client
 Using human connection: Joy, Sorrow, laughter,
Compassion, Empathy
 What Nurses Ought To Be
 Monitor client’s experiences moment to
moment
 Prevent further injury or injustice by attending
to physical, psychological and spiritual needs
 Teach the client to be the leader of their own
health needs
Science of Unitary Human Being
Martha E. Rogers
• Born on May 12, 1914 in Dallas, Texas, USA
• Died March 13, 1994 (80 years old)
• Earned her Diploma at Knoxville General Hospital
School of Nursing (1936
• Completed BSN in Public Health Nursing from George
Peabody College, TN (1937)
• Obtained Master’s degree from Teacher’s College,
Columbia University, NY (1945)
• Earned MPH (1952) and eventually Doctor of Science
(1954) from Johns Hopkins University, Baltimore, MD
(1952)
• Worked as a public health nurse, director, professor,
author, lecturer and division head • Was a professor
emeritus
Science of Unitary Human Beings
Martha Rogers’ theory is known as the Science of
Unitary Human Beings (SUHB). The theory views nursing
as both a science and an art as it provides a way to view
the unitary human being, who is integral with the
universe. The unitary human being and his or her
environment are one. Nursing focuses on people and
the manifestations that emerge from the mutual
human-environmental field process.
SUHB contains two dimensions:
● the science of nursing, which is the knowledge
specific to the field of nursing that comes from
scientific research;
● and the art of nursing, which involves using the
science of nursing creatively to help better the
life of the patient.
Her model addresses the importance of the
environment as an integral part of the patient, and uses
that knowledge to help nurses blend the science and art
of nursing to ensure patients have a smooth recovery
and can get back to the best health possible.
There are eight concepts in Rogers’ nursing theory:
energy field, openness, pattern, pan-dimensionality,
homeodynamic principles, resonance, helicy, and
integrality.
Concepts in Rogers’ Nursing Theory
Energy Field
• Known as the bases of both living and non-living and
provides view for the people and environment as a
whole that may vary in intensity, density, and extent
• Refer to the influence changes of nursing profession
in the human energy system such as physical,
emotional, mental, and spiritual health.
Openness
• The human being are exposed in environment
considering that there is no boundaries for the flow of
energy because human beings and their environment
are open system.
Pattern
• Rogers’ identify that energy field as single wave
because it is continuous to address the needs of the
patient in order to yield outputs to the identify field.
Pan-dimesionality
• A non- linear domain without spatial or temporal
attributes, as the parameter or way of describing the
patients status.
PRINCIPLE OF HOMEODYNAMICS
Homeodynamics should be understood as a dynamic
version of homeostasis (a relatively steady state of
internal operation in the living system).
Homeodynamic principles postulate a way of viewing
unitary human beings. The three principles of
homeodynamics are resonance, helicy, and integrality.
PRINCIPLE OF RECIPROCY
Postulates the inseparability of man and environment
and predicts that sequential changes in life process are
continuous, probabilistic revisions occurring out of the
interactions between man and environment.
PRINCIPLE OF SYNCHRONY
This principle predicts that change in human behavior
will be determined by the simultaneous interaction of
the actual state of the human field and the actual state
of the environmental field at any given point in space-
time.
PRINCIPLE OF INTEGRALITY
(Synchrony + Reciprocy)
Because of the inseparability of human beings and their
environment, sequential changes in the life processes
are continuous revisions occurring from the interactions
between human beings and their environment.
Science of Unitary Human Beings and Nursing Process
The nursing process has three steps in Rogers’ Theory of
Unitary Human Beings: assessment, voluntary mutual
patterning, and evaluation.
The areas of assessment are: the total pattern of events
at any given point in space-time, simultaneous states of
the patient and his or her environment, rhythms of the
life process, supplementary data, categorical disease
entities, subsystem pathology, and pattern appraisal.
The assessment should be a comprehensive assessment
of the human and environmental fields.
Mutual patterning of the human and environmental
fields includes:
· sharing knowledge
· offering choices
· empowering the patient
· fostering patterning
· evaluation
· repeat pattern appraisal, which includes nutrition,
work/leisure activities, wake/sleep cycles, relationships,
pain, and fear/hopes
· identify dissonance and harmony
· validate appraisal with the patient
· self-reflection for the patient
NURSING PARADIGMS
Person
• A unitary human being is one that is open systems
which continuously interact with the environment. A
person cannot be viewed in parts and should be
considered as a whole.
Environment
• It includes the entire energy field other than a
person. These energy fields are irreducible are not
limited by space or time, identified by its pattern and
organization.
Health
• It is determined by the interaction between fields
i.e human and environment.
• Bad interaction or misplacing of energy leads to
illness.
Nursing
• Said to be both science and art.
• Constantly maintains energy field which is conducive
for the patient • Nursing action directs the interaction
between person and environment to maximize health
potential.
STRENGTHS
Martha Rogers’ concepts provide a worldview from
which nurses may derive theories and hypotheses and
propose relationships specific to different situations.
Rogers’ theory is not directly testable due to lack of
concrete hypotheses, but it is testable in principle.
WEAKNESSES
● Rogers’ model does not define particular
hypotheses or theories for it is an abstract,
unified and highly derived framework.
● Testing the concepts’ validity is questionable
because its concepts are not directly
measurable.
● The theory was believed to be profound and
was too ambitious because the concepts are
extremely abstract.
● Rogers claimed that nursing exists to serve
people, however, nurses’ roles were not clearly
defined.
● The purpose of nurses is to promote health and
well-being for all persons wherever they are.
However, Rogers’ model has no concrete
definition of health state.
THE ASSUMPTION OF ROGERS' Theory of SCIENCE
UNITARY HUMAN BEING ARE AS FOLLOW:
1. Man is a unified whole possessing his own integrity
and manifesting characteristics that are more than and
different from the sum of his parts. 2. Man and
environment are continuously exchanging matter and
energy with one another.
3. The life process evolves irreversibly and
unidirectionally along the space-time continuum.
4. Pattern and organization identify the man and reflect
his innovative wholeness. And lastly,
5. Man is characterized by the capacity for abstraction
and imagery, language and thought, sensation and
emotion.
CONCLUSION
● The Science of Unitary Human Beings is highly
generalizable as the concepts and ideas are not
confined to a specific nursing approach unlike
the usual way of other nurse theorists in
defining the major concepts of a theory.
● Rogers gave much emphasis on how a nurse
should view the patient. She developed
principles which emphasize that a nurse should
view the client as a whole.
● Her statements, in general, made us believe
that a person and his or her environment are
integral to each other. That is, a patient can’t be
separated from his or her environment when
addressing health and treatment. Her
conceptual framework has greatly influenced all
aspects of nursing by offering an alternative to
traditional approaches of nursing.
Dorothy Johnson Behavioral System Model
Dorothy E. Johnson was born on August 21, 1919 in
Georgia.
She attended Armstrong Junior College, from which she
received her A.A. in 1938, and Vanderbilt University
from which she received her B.S.N. in 1942. She also
attended Harvard University from which she received
her M.P.H. in 1948. She taught pediatric nursing at
Vanderbilt University and later at the University of
California, Los Angeles
Behavioral System Model of Nursing
“each individual has patterned, purposeful, repetitive
ways of acting that comprises a behavioral system
specific to that individual.”
She defined nursing as “an external regulatory force
which acts to preserve the organization and integration
of the patients behaviors at an optimum level under
those conditions in which the behaviors constitutes a
threat to the physical or social health, or in which illness
is found”
Four goals of nursing are to assist the patient:
● Whose behavior commensurate with social
demands.
● Who is able to modify his behavior in ways that
it supports biological imperatives
● Who is able to benefit to the fullest extent
during illness from the physicians knowledge
and skill.
● Whose behavior does not give evidence of
unnecessary trauma as a consequence of illness
ASSUMPTIONS
There are several layers of assumptions that Johnson
makes in the development of conceptualization of the
behavioral system model viz.
1. Assumptions about system
2. Assumptions about structure
3. Assumptions about functions
4. Assumptions about system
There are 4 assumptions of system:
First, there is “organization, interaction,
interdependency and integration of the parts and
elements of behaviors that go to make up the system ”
A system “tends to achieve a balance among the
various forces operating within and upon it', and that
man strive continually to maintain a behavioral system
balance and steady state by more or less automatic
adjustments and adaptations to the natural forces
impinging upon him.”
A behavioral system, which both requires and results in
some degree of regularity and constancy in behavior, is
essential to man, that is to say, it is functionally
significant in that it serves a useful purpose, both in
social life and for the individual.
Last, “system balance reflects adjustments and
adaptations that are successful in some way and to
some degree.”.
Assumptions about the structure and function of each
subsystem
“from the form the behavior takes and the
consequences it achieves can be inferred what “drive”
has been stimulated or what “goal” is being sought”
Each individual has a “predisposition to act with
reference to the goal, in certain ways rather than in
other ways”. This predisposition is called as “set”.
Each subsystem has a repertoire of choices or “scope of
action”
The fourth assumption is that it produces “observable
outcome” that is the individual’s behavior.
Each subsystem has three functional requirements
System must be “protected" from noxious influences
with which system cannot cope”.
Each subsystem must be “nurtured” through the input
of appropriate supplies from the environment.
Each subsystem must be “stimulated” for use to
enhance growth and prevent stagnation.
These behaviors are “orderly, purposeful and
predictable and sufficiently stable and recurrent to be
amenable to description and explanation”
METAPARADIGM IN NURSING
Person Two major systems:
1. Biological System–medicine’s focus
2. Behavioral System–nursing’s focus
Health
• Supports the idea that the individual is attempting to
maintain some balance or equilibrium. Environment
• Relates to the environment in which the individual
exists.
• Influenced by all events in the environment.
Nursing • Primary goal is to foster equilibrium within
the individual, which allows for the practice with
individuals at any point in the health-illness continuum.
SYSTEM MODEL
Johnson's theory of nursing believes that humans are
behavioral systems made up of seven subsystems.
Three (3) Subsystem Functional Requirements
1. System must be “protected” from noxious influences
with which system cannot cope”.
2. Each subsystem must be “nurtured” through the
input of appropriate supplies from the environment.
3. Each subsystem must be “stimulated” for use to
enhance growth and prevent stagnation.
JOHNSON’S SEVEN BEHAVIORAL SUBSYSTEM:
1. ATTATCHEMENT OR AFFILIATIVE SUBSYSTEM:
"social inclusion intimacy and the formation and
attachement of a strong social bond"
2. DEPENDENCY SUBSYSTEM: "approval, attention
or recognition and physical assistance"
3. INGESTIVE SUBSYSTEM: "the emphasis is on
the meaning and structures of the social event
surrounding the occasion when the food is
eaten"
4. ELIMINATIVE SUBSYSTEM: "human cultures
have defined different socially acceptable
behaviors for excretion of waste but the
existence of such a pattern remains different
from culture to culture"
5. AGGRESSIVE SUBSYSTEM: "it relates to the
behaviors concerned with protection and self
preservation johnson view aggreesive
subsystem as one that generates defensive
response from the individual when life or
territory is being threatened"
6. ACHIEVEMENT SUBSYSTEM: "provokes
behavior that attempt to control the
environment intellectual, physical, creative,
mechanical and social skills achievement are
some of the areas that johnson recognizes"
7. Sexual subsystem:” both biological and social
factor affect the behavior in the sexual
subsystem”
Diagnosis
Diagnosis tends to be general to the system than
specific to the problem. Grubb has proposed 4
categories of nursing diagnosis derived from Johnson's
behavioral system model:
1. Insufficiency
2. Discrepancy
3. Incompatibility
4. Dominance

Planning and implementation
Implementation of the nursing care related to the
diagnosis may be difficult because of lack of clients
input in to the plan. the plan will focus on nurses
actions to modify clients behavior, these plan than have
a goal ,to bring about homeostasis in a subsystem,
based on nursing assessment of the individuals drive,
set behavior, repertoire, and observable behavior. The
plan may include protection, nurturance or stimulation
of the identified subsystem.
JOHNSON’S AND CHARACTERISTICS OF A THEORY
Interrelate concepts to create a different way of viewing
a phenomenon - Concepts in Johnson's theory are
interrelated.
Theories must be logical in nature- Johnson's theory is
logical in nature.
Theories must be simple yet generalizable - The theory
is simple.
Theories can be bases of hypothesis that can be tested -
Research studies are conducted applying Jonhson's
theory.
Theories contribute to and assist in increasing the body
of knowledge within the discipline through the research
implemented to validate them.
Theories can be utilized by practitioners to guide and
improve their practice.
Theories must be consistent with other validated
theories, laws and principles but will leave unanswered
questions that need to be investigated.
CHANGE THEORY
Kurt Lewin
Kurt Lewin (1890-1947) is considered as the father
of social psychology
He was born in Germany, later emigrated to the US.
He is well known for his writings on group dynamics,
group therapy and social psychology.
Kurt Lewin introduced his field theory concepts,
emphasizing that the group differs from the simple
sum of its parts.
Lewin coined the term  group dynamics in 1939.
States that one’s behaviour is related both to one’s
personal characteristics and to the social situations
in which one finds oneself.
To begin the change management process, you
must begin by creating awareness and
understanding why the change must take place.
Kurt Lewin’s Stages of Change Theory
1. Unfreezing
2. Changing or Movement or Transition
3. Refreezing
1. Unfreezing
Process which involves finding a method of
making it possible for people to let go of an old
pattern that was counter productive in some
ways.
Reducing the forces that are striving to maintain
the status quo and dismantling the current
mind set.
By presenting a provocative problem or event
to get people to recognize the need for change
and to search for new solutions.
2. Changing or Movement or Transition
Involves a process of change in thoughts,
feelings, behavior or all three that is in some
way more productive through organizational
structure and development techniques.
3. Refreezing
Establishing the change as the new habit so
that it now becomes the “standard operating
procedure”
Without this stage of refreezing it is easy to go
back to the old ways
RETIREMENT AND ROLE DISCONTINUITIES
SISTER LETTY G. KUAN
A nurse
Master’s degree in Nursing and Guidance and
Counselling, MS in Education
Clinical fellowship and specialization in
Neuropsychologu
With Bioethics formal training
Expert in the fields of Gerontology, Care of Older
Persons and Bioethics
Former Board of Nursing
Her legacy is undisputable
BASIC ASSUMPTIONS
PHYSIOLOGICAL AGE-is the endurance of cells and
tissues to withstand the wear and tear phenomenon of
the human body
Role- set of shared expectations focused upon a
particular position
Change of life- period between near retirement and
post retirement years
Retiree- is an individual who has left the position
occupied for the past years of productive life because
he/she has reached the prescribed retirement age or
has completed the required years of service
Role discontinuity-is the interruption in the line of
status enoyed or role performed
Coping approaches- refers to the interventions or
measures applied to solve a problematic situation or
state in order to restore or maintain equilibrium and
normal functioning
Determinants of positive perceptions in retirement
and positive reactions toward role discontinuities
Health status- physiological and mental state of the
respondents, classified as either sickly or healthy
Income- refers to the financial affluence of the
respondent which can be classified as poor,moderate or
rich
Work status
Family constellation- type of family composition
described either close knit or extended family
Self preparation
Findings and recommendations
Health status dictates the capacities and type of role
one takes both for the present and the future
Family constellation is a positive index regarding
retirement positively and also in reacting to role
discontinuities
Income has a high correlation with both the perception
of retirement and reactions towards role discontinuities
Work status goes hand in hand with economic security
that generates decent compensation
Self preparation which are said to be both therapeutic
and recreational in essence pays its worth in old age
To cope with the changes brought by retirement, one
must cultivate interest in recreational activities
To perceive retirement positively, it requires early
socialization of the various role we take in life
Government agency to construct holistic pre retirement
preparation program which will take care of the retirees
finances, psychological, emotional and social needs
Retirement should be recognized as the fulfillment of
every individual birthright and must be lived
meaningfully
“Prepare me” Interventions and the quality of life
of advance progressive cancer patients
Carmencita M. Abaquin
Biographic sketch
Nurse
With Masters and Doctoral Degree in Nursing (UP
College of Nursing)
Expert of Medical Surgical Nursing
Chairman of the Board of Nursing
Conceptual Model
Quality of Life
When can you say you are living a quality life?
Encompasses the individual’s capacities and abilities
with an aim of enriching life when it cannot longer be
prolonged
BASIC ASSUMPTIONS AND CONCEPTS
PRESENCE- being with another person during the times
of need
Includes therapeutic communication, active listening
and touch
Reminisce therapy- Recall of past experiences feelings
and thoughts to facilitate adaptation to present
circumstances
Relaxation-breathing
Techniques to encourage and elicit relaxation for the
purpose of decreasing undesirable signs and symptoms
such as pain ,muscle tension and anxiety
Prayer
Meditation - Encourages an elicit form of relaxation for
the purpose of altering patient’s level of awareness by
focusing on an image or thought to facilitate inner sight
which helps establish connection and relationship with
God
Values clarification
Assisting another individual to clarify his own values
about health and illness in order to facilitate effective
decision making skills
Develop an open mind for the acceptance of disease or
deepen/enhance values
Findings and recommendations:
Terminally ill patients require holistic approach of
nursing
PREPARE ME interventions are said to be effective in
improving the quality of life of cancer patients
Must be introduced during the training of nurses both
in the academe and practice
Development of training for care providers is also
recommended
For patients, an honest view and feedback regarding
their illness and management can lead to improvement
of services and communication
Supportive environment that patients can attain dignity
of dying with peace
Health Promotion Model
Dr. Nola Pender
•Dr. Pender developed the Health Promotion Model
that is used internationally for research, education, and
practice.
•During her active research career, she conducted
research testing on the Health Promotion Model with
adults and adolescents.
•Developed the program “Girls on the Move” with her
research team and began intervention research into the
usefulness of the model in helping adolescents adopt
physically active lifestyles, developing a number of
instruments that measure components of the model. In
retirement, she
•Consults on health promotion research nationally and
internationally.
Teaching
•Dr. Pender has been a nurse educator for over forty
years. Throughout her career, she taught baccalaureate,
masters, and PhD students; she also mentored a
number of postdoctoral fellows.
•In 1998, she received the Mae Edna Doyle Teacher of
the Year Award from the University of Michigan School
of Nursing.
•Currently serves as a Distinguished Professor at Loyola
University Chicago, School of Nursing.
Publications Related to Nola Pender
 Health Promotion in Nursing Practice (6th
Edition)
 Pender, Nola J. Study Guide for Health
Promotion in Nursing Practice
 Philosophies and Theories for Advanced Nursing
Practice
 Robbins, L.B., Gretebeck, K.A., Kazanis, A.S. and
Pender, Nola.J. Girls on the Move
 Program to Increase Physical Activity
Participation, Nursing Research, 2006
 Pender, Nola.J., Bar-Or, O., Wilk, B. and
Mitchell, S. Self-Efficacy and Perceived Exertion
of Girls During Exercise, Nursing Research, 2002
 Eden, K.B., Orleans, C.T., Mulrow, C.D., Pender,
Nola.J. and Teutsch, S.M. Does Counseling by
Clinicians Improve Physical Activity? A Summary
 of the Evidence for the U.S. Preventive Services
Task Force, Annals of Internal Medicine, 2002
 Robbins, L.B., Pender, Nola.J., Conn, V.S., Frenn,
M.D., Neuberger, G.B., Nies, M.A., Topp, R.V.
and Wilbur, J.E. Physical Activity Research in
Nursing, Nursing School Journal, 2001
Nursing Metaparadigms of the Health Promotion
Model
Person
A biopsychosocial organism with unique
experiences and attributes that determine actions.
Environment
Factors, including social, cultural and physical,
that surround the individuals life. The individual has the
ability to manipulate the environment to facilitate
positive health behaviors.
Health
“A positive dynamic state not merely the absence of
disease”.
Nursing
Works in collaboration with the client to create the
condition for optimal health.
Health promotion is directed at increasing a patient’s
level of well-being. The health promotion model
describes the multidimensional nature of persons as
they interact within their environment to pursue health.
Major Concepts of the Health Promotion Model
 Individual characteristics and experiences -
affect subsequent actions.
 Behavior-specific cognitions and affect-
important motivational significance.
 Behavioral outcomes- end point in the Health
Promotion Model.
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.
 Personal biological factors. Include variables
such as age gender body mass index pubertal
status, aerobic capacity, strength, agility, or
balance.
 Personal psychological factors. Include variables
such as self-esteem, self-motivation, personal
competence, perceived health status, and
definition of health.
 Personal socio-cultural factors. Include variables
such as race, ethnicity, acculturation, education,
and socioeconomic status.
Perceived Benefits of Action
Anticipated positive outcomes that will occur
from health behavior.
Perceived Barriers to Action
Anticipated, imagined or real blocks and
personal costs of understanding a given behavior.
Perceived Self-Efficacy
Judgment of personal capability to organize and
execute a health-promoting behavior. Perceived self-
efficacy influences perceived barriers to action so higher
efficacy results in lowered perceptions of barriers to the
performance of the behavior.
Activity-Related Affect
Subjective positive or negative feeling that
occurs before, during and following behavior based on
the stimulus properties of the behavior itself.
Activity-related affect influences perceived self-
efficacy, which means the more positive the subjective
feeling, the greater the feeling of efficacy. In turn,
increased feelings of efficacy can generate a further
positive affect.
Interpersonal Influences
Cognition concerning behaviors, beliefs, or
attitudes of the others. Interpersonal influences include
norms (expectations of significant others), social
support (instrumental and emotional encouragement)
and modeling (vicarious learning through observing
others engaged in a particular behavior). Primary
sources of interpersonal influences are families, peers,
and healthcare providers.
Situational Influences
Personal perceptions and cognitions of any
given situation or context that can facilitate or impede
behavior. Include perceptions of options available,
demand characteristics and aesthetic features of the
environment in which given health promoting is
proposed to take place. Situational influences may have
direct or indirect influences on health behavior
Commitment to Plan of Action
The concept of intention and identification of a
planned strategy leads to the implementation of health
behavior
Immediate Competing Demands and Preferences
Competing demands are those alternative
behaviors over which individuals have low control
because there are environmental contingencies such as
work or family care responsibilities. Competing
preferences are alternative behaviors over which
individuals exert relatively high control, such as choice
of ice cream or apple for a snack.
Health-Promoting Behavior
A health-promoting behavior is an endpoint or
action outcome that is directed toward attaining
positive health outcomes such as optimal wellbeing,
personal fulfillment, and productive living.
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.
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. Persons can modify cognitions, affect, and the
interpersonal and physical environment to create
incentives for health actions.
GENERAL SYSTEM’S THEORY
Ludwig Von Bertalanffy
Born 19 September 1901, Atzgersdorf near Vienna,
Austria-Hungary
Died 12 June 1972 (aged 70), Buffalo, New York, USA
Alma Mater University of Vienna
Known for General systems theory
Von Bertalanffy function
Fields Biology and systems theory
Karl Ludwig von Bertalanffy (19 September 1901 – 12
June 1972) was an Austrian biologist known as one of
the founders of general systems theory (GST), the
"conceptual part" of which was first introduced by
Alexander Bogdanov.
This is an interdisciplinary practice that describes
systems with interacting components, applicable to
biology, cybernetics and other fields. Bertalanffy
proposed that the classical laws of thermodynamics
might be applied to closed systems, but not necessarily
to "open systems" such as living things. His
mathematical model of an organism's growth over time,
published in 1934, is still in use today.
He defined a general system as any theoretical system
of interest to more than one discipline. This new vision
of reality is based on awareness of the essential
interrelatedness and inter-dependence of all
phenomena - physical, biological, psychological, social
and cultural. It transcends orthodox disciplinary and
conceptual boundaries.
GENERAL SYSTEM’S THEORY
Systems theory may be considered as a specialization of
systems thinking and a generalization of systems
science.
First proposed by Ludwig von Bertalanffy (1901-1972) as
General Systems theory.
General systems theory is a general science of
'wholeness'.
Systems theory has been applied in developing nursing
theories and conducting nursing research.
Characteristics of systems
 "Systems" refer specifically to self-regulating
systems.
 Systems are self-correcting through feedback.
 Systems have a structure that is defined by its
parts and processes.
 Systems are generalizations of reality.
 The various parts of a system have functional as
well as structural relationships between each
other.
 Systems tend to function in the same way.
 Every living organism is essentially an open
system
General System Theory, therefore, is a general science
of 'wholeness'.
(1) There is a general tendency towards integration in
the various sciences, natural and social.
(2) Such integration seems to be centred in a general
theory of systems.
(3) Such theory may be an important means of aiming
at exact theory in the nonphysical fields of science.
(4) Developing unifying principles running 'vertically'
through the universe of the individual sciences, this
theory brings us nearer to the goal of the unity of
science.
(5) This can lead to a much-needed integration in
scientific education.
The System Concept
In dealing with complexes of 'elements', three different
kinds of distinction may be made - i.e.,
(1) according to their number;
(2) according to their species;
(3) according to the relations of elements.
A system may be defined as a set of elements standing
in interrelation among themselves and with
environment.
Progress is possible only by passing from a state of variously and rather loosely is called adaptiveness,
undifferentiated wholeness to a differentiation of parts. purposiveness, goal-seeking and the like.

We term a system 'closed' if no material enters or leave

it; it is called 'open' if there is import and export of
material.

Living systems are not closed systems in true CARMELITA DIVINA GRACIA
equilibrium but open systems in a steady state. NURSING THEORY: ADVANCE NURSE
PRACTITIONERS’ COMPOSURE BEHAVIOR AND
An open system is defined as a system in exchange of PATIENT’S WELLNESS OUTCOME
matter with its environment, presenting import and Former President:
export, building-up and breaking-down of its material -The Association of the Philippine Colleges of Nursing
components. (ADPCN)
and
Closed and Open Systems
-Dean of University of the East Ramon Magsaysay
We find systems which by their very nature and Memorial Medical Center, Inc. (UERMMMC) College of
definition are not closed systems. Every living organism Nursing
is essentially an open system. It maintains itself in a Also a member of CHED’s technical Committee on
continuous inflow and outflow, a building up and Nursing Education
breaking down of components, never being, so long as EDUCATION
it is alive, in a state of chemical and thermodynamic BSN UERMMMC 1962
MASTER UP 1975
equilibrium but maintained in a so-called steady state
Ph.D UP 2001
which is distinct from the latter.
She has been a clinic staff and head nurse, instructor,
Information and Feedback Asst. Dean and Dean
She lectured and written about her work as a nurse and
Another development which is closely connected with she used her hand-on experience to develop better
system theory is that of the modern theory of ways to teach nursing.
communication OBJECTIVE and SIGNIFICANCE OF THE STUDY
- Determine the effects of the “COMPOSURE” behavior
The general notion in communication theory is that of of the Advance Nurse Practitioner on the wellness
information. In many cases, the flow of information outcome of the selected cardiac patients
corresponds to a flow of energy, e.g. if light waves - Nursing as a healthcare profession would prove its
emitted by some objects reach the eye or a worth of being at PAR in quality performance with other
photoelectric cell, elicit some reaction of the organism health care professionals.
or some machinery, and thus convey information. STUDY POPULATION
Adult Cardiac Patients - admitted and confined at the
A second central concept of the theory of
Philippine Heart Center, Coronary Care Unit
communication and control is that of feedback. DEFINITION OF TERMS
Feedback arrangements are widely used in modern ADVANCE NURSE PRACTITIONERS
technology for the stabilization of a certain action, as in - BSN graduate
thermostats or in radio receivers; or for the direction of - Licensed and has a clinical experience of at least 2
years in the clinical area
actions towards a goal where the aberration from that
goal is fed back, as information, till the goal or target is
- Has undergone special training in critical area
COMPOSURE BEHAVIORS
reached.
- Set of behaviors or nursing measures that the nurse
There is indeed a large number of biological demonstrates to selected cardiac patients
phenomena which correspond to the feedback model. COMPOSURE is an acronym which stands for:
First, there is the phenomenon of so-called COM - petence
homeostasis, or maintenance of balance in the living P-resence & Prayer
organism, the prototype of which is thermoregulation in O-penmindedness
S-timulation
warm-blooded animals.
U-nderstanding
Causality and Teleology R-espect and Relaxation
E-mpathy
We may state as characteristic of modern science that WELLNESS STATUS
this scheme of isolable units acting in one-way causality A condition of being in a state of well-being, a
has proved to be insufficient. Hence the appearance, in coordinated and integrated living pattern that involves
all fields of science, of notions like wholeness, holistic, the dimension of wellness
organismic, gestalt, etc., which all signify that, in the last THEORETICAL PARADIGM
resort, we must think in terms of systems of elements in “COMPOSURE BEHAVIOR”
mutual interaction. Composure - a calmness or repose especially of mind,
bearing, or appearance: self - possession.
Similarly, notions of teleology and directiveness Behavior - the way in which one acts or conducts
appeared to be outside the scope of science. oneself, especially toward others.
“WELLNESS OUTCOME”
Nevertheless, these aspects exist, and you cannot
Wellness - is an active process of becoming aware of
conceive of a living organism, not to speak of behaviour
and making choices toward a healthy and fulfilling life.
and human society, without taking into account what
Wellness is more than being free from illness, it is a
dynamic process of change and growth.
Outcome - the way a thing turns out; a consequence.
“PHYSIOLOGIC OUTCOME”
- This includes vital signs, chest pains, and
hemoglobin.
“BIOBEHAVIORAL OUTCOME”
- This includes physical, emotional, intellectual,
and spiritual.
Based on several analysis, the following
conclusions are made:
1. The socio - demographic characteristics
specifically gender, and age are related to
wellness outcome of adult cardiac patients.
2. A significant difference exists in the pre-test and
post-test scores of the wellness outcome aftere
the composure behavior intervention in the
three groups.
1. Nursing profession can actively deliver quality
care through biobehavioral caring interventions
like the composure behavior because
regardless of creed, social class, gender, age
and nationality, each one needs humane,
caring, spirituality - oriented intervention that
can facilitate wellness.
Transactional Analysis
Harry Stack Sullivan
BACKGROUND
 Born on February 21, 1892
 Died of Cerebral Hemorrhage on January 14,
1949
 Poor relationship with father with lonely
childhood experience.
 Close friendship with Clarence Bellinger.
 Suffered a schizophrenic breakdown, while
having a poor academic performance in
freshman year at Cornell.
 Enrolled for Medicine, received degree 2 yrs.
After graduation
 Work with William Alanson White.
 Private practice in New York
 Zodiac group
 His therapy was neither psychoanalysis nor neo-
freudian
TRANSACTIONAL ANALYSIS
 Transactional analysis one of the idea by
Sullivan’s and later on formulated by Eric Berne.
 Transaction means the fundamental unit of
intercourse.
 TA or Transactional Analysis is all about the
method in studying the interaction between
individual with relation to personality.
 This theory is different from Freud’s theory of
personality believing that there 3 components
of personality Id, Ego, and Superego. In order,
to produce reasonable mental stability.
 But the greatest contribution of Freud to Berne
in relation with TA is human personality is
multifaceted.
 TA involves the identification of ego states
behind each transaction.
 Ego state means “a consistent pattern of feeling
and experience directly related to a
corresponding consistent pattern of behavior.”
 Berne ultimately defined the three ego states
as: Parent, Adult, and Child.
 It is important to note that these are
fundamentally different than Freud’s Ego, Id,
and Superego. Berne describes this best when
he writes in Transactional Analysis in
Psychotherapy:
“It will be demonstrated that Parent, Adult, and
Child are not concepts, like Superego, Ego, and
Id, or the Jungian constructs, but
phenomenological realities.“5 Stated another
way, Freud’s ego states are unobservable,
theoretical states; but Berne’s three ego states
can be confirmed with observable behaviors.
 The three (3) Ego states:
 Parent- The parent represents a
massive collection of recordings in the
brain of external events experienced or
perceived in approximately the first five
years of life. because from the start the
action perceive by a child is from
parents.
2 types of Parent Ego Stae:
1. Nurturing Parent Ego- nurturing behavior,
very caring, very compromising, and etc.
2. Critical Parent Ego- A punishing personality,
criticize, prejudice, finds fault, and
disapproves.
Examples of recordings in the Parent include:
“Never talk to strangers” “Always chew with your
mouth closed” “Look both ways before you cross the
street”
 Adult- Close to one year of age, a child
begins to exhibit gross motor activity.
Example: “Wow. It really is true that pot handles should
always be turned into the stove” said Sally as she saw
her brother burn himself when he grabbed a pot handle
sticking out from the stove.
 Child- In contrast to the Parent, the
Child represents the recordings in the
brain of internal events associated with
external events the child perceives.
Stated another way, stored in the Child
are the emotions or feelings which
accompanied external events. 
2 types of Child Ego:
1. Natural Child- is spontaneous, energetic,
curious, loving and uninhibited, the part of you
that feels free and loves pleasure.
2. Adapted Child- developed when you learned to
change (adapt) your feelings and behaviour in
response to the world around you. 
Example:
- “When I saw the monster’s face, I felt really
scared”
- “The clown at the birthday party was really
funny!
ANALYZING TRANSACTIONS
 Structural analysis- the process of analyzing
personality
 Straight transactions (or complementary
transactions)- response must go back from the
receiver to the sender

 Simple transactions are between Adult- Adult
ego states and Parent- Child transactions.
- For example, a surgeon will survey the patient,
and based upon the data before him/her,
his/her Adult decides that the scalpel is the next     
instrument required. The surgeon’s Adult holds
out his/her hand, providing the transactional
stimulus to the nurse. The nurse’s Adult looks at
the hand, and based upon previous
experiences, concludes that the scalpel is
needed. The nurse then places the scalpel in the
surgeon’s hand.
 Crossed transaction- an ego state different than
the ego state which received the stimuli is the
one that responds.
Agent’s Adult: “Do you know where my cuff
links are?”
Respondent’s Child: “You always blame me for
everything!”
According to Dr. Mehrabian, when an individual
is speaking, the listener focuses on the
following three types of communication:
Actual Words – 7%
The Way words are delivered (tone, accents on
certain words, etc.) – 38%
Facial expressions – 55%
 Ulterior Transactions- communicating in two
(2) ways:
- Social message- what we say
- Psychological message- what we mean
 Stroke
- means the fundamental unit of social action
- Recognition hunger as the requirement of
adults to received strokes.
- Positive or Negative effect, is better than no
stroke at all.
 Life scripts and Early decisions
- Life scripts- is an unconscious life plan
- Early decisions- is the most important part of
our life scripts
- Games- is an ongoing series of complementary
ulterior transactions progressing to a well-
defined, predictable outcome.
- First degree games- are played in social circles
generally lead to mild upsers not major
traumas.
- Second degree games- occur when the stakes
may be higher.
- Third degree games- involves tissue damage
and may end up in the jail, hospital or morgue.
 Games people play
- Game players usually assume one of three basic
roles: victim, persecutor, rescuer.
 persecutors are people who:
- make unrealistic rules
- enforce rules in cruel ways
- pick on 'little people' rather than people their own
size
 
 victims are people who:
- provoke others to put them down, use them,
or hurt them
- send helpless messages
- forget conveniently
- act confused
  rescuers are people who:
- offer an unreal helpfulness to keep others
dependant on them
- don't really help others and may actually
dislike helping
- work to maintain the victim role so they can
continue to play rescuer
   Interpersonal Theory
 Theory by Harry Stack Sullivan in relation with
transactional analysis.
 Explained the role of interpersonal relationships
and social experiences in shaping personality.
 Importance of current life events to
psychopathology.
 States the purpose of all behavior is to get
needs met through interpersonal interactions
and decrease or avoid anxiety.
 Personality- is an energy system.
- Tension is potentiality for action.
o 2 types :
 Needs- tensions brought about by a
biological imbalance between the
person and environment. 3 kinds of
needs these are:
1. Zonal needs- arises from a specific body
part.
2. General needs- over all well- being of a
person
3. Tenderness is a basic interpersonal
needs.
 Anxiety- disjunctive, diffuse and vague,
call forth no consistent action for relief
and no positive value.
- Energy Transformations- actions themselves.
Evolves into Dynamisms, a traits or habit
patterns.
o Major classes:
 Relted to specific zones of the body:
Mouth, Anus, and Genitals.
 Related to Tensions:
1. Disjunctive or Malevolence-
disjunctive dynamism between
evil and hatred.
2. Isolating or Lust- assumes an
isolating tendency. It hinders an
intimated relationship.
3. Conjunctive or Intimacy and
Self- system
 Self- system- most complex and inclusive of all
dynamisms. A consistent patterns of behavior
that maintains people’s interpersonal security
by protecting them from anxiety.
 Security Operations- reduces feelings of anxiety
or insecurity.
o 2 kinds:
 Dissociation- includes impulses,
desires, and needs that a person
refuses to allow into awareness. Or
dreams.
 Selective Inattention- refusal to
see things that one does not wish
to see. Or conscious.
 Stages of development

 3 types of self: Good me, Bad me, and Not me
Virginia Henderson's Need Theory
This page was last updated on February 4, 2012
“Nursing theories mirror different realities, throughout
their development; they reflected the interests of
nurses of that time.”
Introduction
 “The Nightingale of Modern Nursing”
 “Modern-Day Mother of Nursing.”
 "The 20th century Florence Nightingale."
 Born in Kansas City, Missouri, in 1897.
 Diploma in Nursing from the Army School of
Nursing at Walter Reed Hospital, Washington,
D.C. in 1921.
 In 1929, entered Teachers College at Columbia
University for Bachelor’s Degree in 1932,
Master’s Degree in 1934.
 Joined Columbia as a member of the faculty,
remained until 1948.
 Recipient of numerous recognitions.
 Honorary doctoral degrees from the Catholic
University of America, Pace University,
University of Rochester, University of Western
Ontario, Yale University
 Died: March 19, 1996.
 In 1939, she revised: Harmer’s classic textbook
of nursing for its 4th edition, and later wrote
the 5th; edition, incorporating her personal
definition of nursing (Henderson,1991)
Theory Background
 She called her definition of nursing her
“concept” (Henderson1991)
 She emphasized the importance of increasing
the patient’s independence so that progress
after hospitalization would not be delayed
(Henderson,1991)
 "assisting individuals to gain independence in
relation to the performance of activities
contributing to health or its recovery"
(Henderson, 1966).
 She categorized nursing activities into 14
components, based on human needs.
 She described the nurse's role as substitutive
(doing for the person), supplementary (helping
the person), complementary (working with the
person), with the goal of helping the person
become as independent as possible.
 Her definition of nursing was:
 "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. And to do this in
such a way as to help him gain independence as
rapidly as possible" (Henderson, 1966).
The 14 components
1. Breathe normally. Eat and drink adequately.
2. Eliminate body wastes.
3. Move and maintain desirable postures.
4. Sleep and rest.
5. Select suitable clothes-dress and undress.
6. Maintain body temperature within normal
range by adjusting clothing and modifying
environment
7. Keep the body clean and well groomed and
protect the integument
8. Avoid dangers in the environment and avoid
injuring others.
9. Communicate with others in expressing
emotions, needs, fears, or opinions.
10. Worship according to one’s faith.
11. Work in such a way that there is a sense of
accomplishment.
12. Play or participate in various forms of
recreation.
13. Learn, discover, or satisfy the curiosity that
leads to normal development and health and
use the available health facilities.
14. The first 9 components are physiological. The
tenth and fourteenth are psychological aspects
of communicating and learning The eleventh
component is spiritual and moral The twelfth
and thirteenth components are sociologically
oriented to occupation and recreation
Assumption
The major assumptions of the theory are:
 "Nurses care for patients until patient can care
for themselves once again. Patients desire to
return to health, but this assumption is not
explicitly stated.
 Nurses are willing to serve and that “nurses will
devote themselves to the patient day and
night” A final assumption is that nurses should
be educated at the university level in both arts
and sciences.
Henderson’s theory and the four major concepts
1. Individual
Have basic needs that are component of health.
Requiring assistance to achieve health and
independence or a peaceful death.
Mind and body are inseparable and interrelated.
Considers the biological, psychological, sociological, and
spiritual components.
The theory presents the patient as a sum of parts with
biopsychosocial needs.
2. Environment
Settings in which an individual learns unique pattern for
living.
All external conditions and influences that affect life and
development.
Individuals in relation to families
Minimally discusses the impact of the community on
the individual and family.
Basic nursing care involves providing conditions under
which the patient can perform the 14 activities unaided
3. Health
Definition based on individual’s ability to function
independently as outlined in the 14 components.
Nurses need to stress promotion of health and
prevention and cure of disease.
Good health is a challenge -affected by age, cultural
background, physical, and intellectual capacities, and
emotional balance Is the individual’s ability to meet
these needs independently.
4. Nursing
Temporarily assisting an individual who lacks the
necessary strength, will and knowledge to satisfy 1 or
more of 14 basic needs.
Assists and supports the individual in life activities and
the attainment of independence.
Nurse serves to make patient “complete” “whole", or
"independent."
The nurse is expected to carry out physician’s
therapeutic plan Individualized care is the result of the
nurse’s creativity in planning for care.
“Nurse should have knowledge to practice
individualized and human care and should be a scientific
problem solver.”
In the Nature of Nursing Nurse role is,” to get inside the
patient’s skin and supplement his strength will or
knowledge according to his needs.”
Henderson’s and Nursing Process
”Summarization of the stages of the nursing process as
applied to Henderson’s definition of nursing and to the
14 components of basic nursing care.
Nursing Process Henderson’s 14 components and
definition of nursing
Henderson’s 14 components
Nursing
Assessment
Nursing Diagnosis Analysis: Compare data to knowledge
base of health and disease.
Nursing plan Identify individual’s ability to meet own
needs with or without assistance, taking
into consideration strength, will or
knowledge.
Document how the nurse can assist the
Nursing
individual, sick or well.
implementation
Nursing Assist the sick or well individual in to
performance of activities in meeting
implementation
human needs to maintain health, recover
from illness, or to aid in peaceful death.
Nursing process Implementation based on the
physiological principles, age, cultural
background, emotional balance, and
physical and intellectual capacities.
Carry out treatment prescribed by the
physician.
Henderson’s 14 components and
Nursing
definition of nursing
evaluation
Use the acceptable definition of ;nursing
and appropriate laws related to the
practice of nursing.
The quality of care is drastically affected
by the preparation and native ability of
the nursing personnel rather that the
amount of hours of care.
Successful outcomes of nursing care are
based on the speed with which or degree
to which the patient performs
independently the activities of daily living
Comparison with Maslow's Hierarchy of Need
Maslow's Henderson
Breathe normally
Eat and drink adequately Eliminate by all
avenues of elimination Move and maintain
Physiological
desirable posture Sleep and rest Select
needs
suitable clothing Maintain body
temperature Keep body clean and well
groomed and protect the integument
Avoid environmental dangers and avoid
Safety Needs
injuring other
Belongingness Communicate with others
and love needs worship according to one's faith
Work at something providing a sense
of accomplishment
Esteem needs Play or participate in various forms of
recreation
Learn, discover, or satisfy curiosity
Characteristic of Henderson’s theory
 There is interrelation of concepts.
 Concepts of fundamental human needs,
biophysiology, culture, and interaction,
communication are borrowed from other
discipline.Eg.. Maslow’s theory.
 Her definition and components are logical and
the 14 components are a guide for the
individual and nurse in reaching the chosen
goal.
 Relatively simple yet generalizable.
 Applicable to the health of individuals of all
ages.
 can be the bases for hypotheses that can be
tested.
 assist in increasing the general body of
knowledge within the discipline.
 Her ideas of nursing practice are well accepted.
 can be utilized by practitioners to guide and
improve their practice.
Limitations
 Lack of conceptual linkage between
physiological and other human characteristics.
 No concept of the holistic nature of human
being.
 If the assumption is made that the 14
components prioritized, the relationship among
the components is unclear.
 Lacks inter-relate of factors and the influence of
nursing care.
 Assisting the individual in the dying process she
contends that the nurse helps, but there is little
explanation of what the nurse does.
 “Peaceful death” is curious and significant
nursing role.
Conclusion
 Henderson provides the essence of what she
believes is a definition of nursing.
 Her emphasis on basic human needs as the
central focus of nursing practice has led to
further theory development regarding the
needs of the person and how nursing can assist
in meeting those needs.
 Her definition of nursing and the 14
components of basic nursing care are
uncomplicated and self-explanatory.
THEORY OF MORAL DEVELOPMENT
Lawrence Kohlberg
American psychologist and educator known for his
theory of moral development.
Born on October 25, 1927, Bronxville, New York
He graduated from University of Chicago.
Kohlberg's work reflected and extended not only
Piaget's findings but also the theories of
philosophers George Herbert Mead and James Mark
Baldwin
Died January 17, 1987, Boston, Massachusetts)
Described child’s development in terms of their
concept of right and wrong
Moral development progresses through three (3) levels
and six (6) stages.
Lawrence Kohlberg ‘s stages of Moral Development
Many adults do not reach this level of moral
development
Review
Level I – Pre conventional
Stage 1 - Punishment & Obedient Orientation
Stage 2 – Instrumental Relativist/ Mutual Benefit
Level II - Conventional
Stage 3 – Interpersonal Concordance/ Social Approval
Stage 4 – Law and Order Orientation

Level I – Preconventional – Moral reasoning is based on Level III – Post Conventional

the consequence/result of the act, not on whether the Stage 5 – Social Contract/ Legalistic Orientation
itself is good or bad. Stage 6 – Universal Ethical Principle
Egocentric focus
Person is responsive to cultural rules of labels of good
and bad, right or wrong

 Stage 1 – Punishment and Obedient

Orientation Maslow’s  Hierarchy of Needs
(one is motivated by fear of punishment)He will act to What motivates humans?
avoid punishment Abraham Maslow believed humans are motivated by
Toddler to 7 years old unsatisfied needs.
Does the right things to avoid punishment When lower needs are satisfied, higher needs can be
addressed.
 Stage 2 Instrumental Relativist People are basically
Orientation/Mutual Benefit Trustworthy
Preschooler through school age Self-protecting
Carries out actions to satisfy own needs Self-governing
Does something for another if that person does Five levels of needs
something in return Physiological needs
There’s no feeling of justice, loyalty or gratitude Safety needs
Love needs
Level II – Conventional – Moral reasoning is based on Esteem needs
conventions or “norms” of society. Self-actualization needs
Societal focus Physiological needs
Person is concerned with maintaining expectations and These are basic needs: air, water, food, sleep, sex.
rules of the family, group, nation or society When these are missing, we feel sick, irritated, pain.
We are motivated to address them quickly.
 Stage 3 Interpersonal Concordance Orientation Safety needs
(Social approval). The person act because These needs address our security … 
she/he values how he/she will appear to others.     in a home, in a family, in employment.
“good boy , good girl”     When people are stuck at this level, 
    they often turn to religion -- looking 
Lawrence Kohlberg ‘s stages of Moral Development     for guidance and support.
 Stage 4 Law and Order Orientation – Safety needs
Adolescence and adulthood Personal Security
One is motivated to act to uphold the law and order. Financial security
Follows rules of authority figures as well as parents to Health and well- being
keep the system working Love needs
Everyone has a desire to be loved, to belong to a group,
Level III – Post-conventional to be accepted.
– Moral reasoning is based on enduring or consistent We NEED to be NEEDED, or wanted by someone else.
principle Love needs
Inclusion: part of a group, colleagues, peers, family
Universal focus ,clubs.
 Stage 5 – Social Contract Legalistic Orientation Affections : loved and be loved.
Middle age or older adult Control: Influence over other and self.
Follows the standards of society for the good of all Esteem needs
people (mother Theresa, MLK These needs include a feeling of competence and
(Associated with development of one’s conscience recognition.
Stage 5 Social Contract Legalistic Orientation – Laws We feel powerful when someone else admires or
that are wrong can be changed. One will act based on respects our accomplishments.
social justice and the common good Esteem needs
Confidence
 Stage 6 Universal Ethical Principle Orientation Respect
Middle age or older adult Status
Respect and dignity of humanity Self-actualization needs
When you live up to your full potential, you will have
fulfilled the self-actualization level.
You have arrived!
Self-actualization needs
Some Self Actualizing People from history:
Abraham Lincoln
Mahatma Gandhi
Albert Einstein
Remember that human needs are not constant; they
are fluid and changing with first one, then another,
taking priority. What may start as a basic need for food
can take on social and personal significance. Your care
plan as well as your patience are aimed toward the
satisfaction of the patient's needs. He has common
needs because he is a person; he has individual needs
because he is unique; he has special needs because he
is sick. The Practical Nurse supplies the help that is
required to meet the patient's needs during the
stressful periods of hospitalization and recuperation.
Physiological--food, shelter, water, sleep, oxygen.
Safety--security, stability, order, physical safety.
Love and belonging--affection, identification,
companionship.
Esteem and recognition--self-esteem, self-respect,
prestige, success, esteem of others.
Self-actualization--self-fulfillment, achieving one's own
capabilities.
Aesthetic--beauty, harmony, spiritual.
Relationship Between Levels of Needs.
Joyce Travelbee (1926-1973)
This page was last updated on January 25, 2012
“The nurse is responsible for helping the patient avoid
and alleviate the distress of unmet needs.” - Travelbee
Introduction
 Joyce Travelbee (1926-1973) developed the
Human-to-Human Relationship Model
presented in her bookInterpersonal Aspects of
Nursing (1966, 1971).
 She dealt with the interpersonal aspects of
nursing.
 She explains “human-to-human relationship is
the means through which the purpose of
nursing if fulfilled”
About the Theorist
 A psychiatric nurse, educator and writer born in
1926.
 1956, she completed her BSN degree at
Louisiana State University
 1959, she completed her Master of Science
Degree in Nursing at Yale University.
 1952, Psychiatric Nursing Instructor at Depaul
Hospital Affilliate School, New Orleans.
 Later in Charity Hospital School of Nursing in
Louisiana State University, New York University
and University of Mississippi.
 Travelbee died at age 47.
Development of the Theory
 Travelbee based the assumptions of her theory
on the concepts of existentialism by Soren
Kierkegaard and logotherapy by Viktor Frankl.
 Existential theory believes that that humans are
constantly faced choices and conflicts and is
accountable to the choices we make in life
 Logotherapy theory was first proposed by
Viktor Frankel, a survivor of Auschwitz, in his
book Man's Search for Meaning (1963).
 Logotherapy
Basic Concepts
1. Suffering
"An experience that varies in intensity, duration and
depth ... a feeling of unease, ranging from mild,
transient mental, physical or mental discomfort to
extreme pain and extreme tortured ..."
2. Meaning
Meaning is the reason as oneself attributes
3. Nursing
Is to help man to find meaning in the experience of
illness and suffering. Has a responsibility to help
individuals and their families to find meaning.
The nurses' spiritual and ethical choices, and
perceptions of illness and suffering, is crucial to helping
to find meaning.
4. Hope
Nurse's job is to help the patient to maintain hope and
avoid hopelessness.
Hope is a faith that can and will be change that would
bring something better with it.
Hope's core lies in a fundamental trust the outside
world, and a belief that others will help someone when
you need it.
Six important factors characteristics of hope are:
 It is strongly associated with dependence on
other people.
 It is future oriented.
 It is linked to elections from several alternatives
or escape routes out of its situation.
 The desire to possess any object or condition, to
complete a task or have an experience.
 Confidence that others will be there for one
when you need them.
 The hoping person is in possession of courage
to be able to acknowledge its shortcomings and
fears and go forward towards its goal
5. Communications
"a strict necessity for good nursing care"
6. Using himself therapeutic
" one is able to use itself therapeutic."
Self-awareness and self-understanding, understanding
of human behavior, the ability to predict one's own and
others' behavior are imporatnt in this process.
7. Targeted intellectual approach
Nurse must have a systematic intellectual approach to
the patient's situation.
Nursing Metaparadigms
Person
Person is defined as a human being.
Both the nurse and the patient are human beings.
Health
Health is subjective and objective.
Subjective health is an individually defined state of well
being in accord with self-appraisal of physical-
emotional-spiritual status.
Objective health is an absence of discernible disease,
disability of defect as measured by physical
examination, laboratory tests and assessment by
spiritual director or psychological counselor.

Environment
Environment is not clearly defined.

Nursing
"an interpersonal process whereby the professional
nurse practitioner assists an individual, family or
community to prevent or cope with experience or
illness and suffering, and if necessary to find meaning in
these experiences.”

Description of the theory

 Travelbee believed nursing is accomplished

through human-to-human relationships that
begin with the original encounter and then
progress through stages of emerging identities,
developing feelings of empathy, and later
feelings of sympathy.
 The nurse and patient attain a rapport in the
final stage. For meeting the goals of nursing it is
a prerequisite to achieving a genuine human-to-
human relationships.
 This relationship can only be established by an
interaction process.
It has five phases.
 The inaugural meeting or original encounter
 Visibility of personal identities/ emerging
identities.
 Empathy
 Sympathy
 Establishing mutual understanding and contact/
rapport
 Travelbee's ideas have greatly influenced the
hospice movement in the west.
Conclusion
 Travelbee's theory has significantly influenced
nursing and health care.
 Travelbee's ideas have greatly influenced the
hospice movement in the west