CHAPTER I Context- environment to which nursing act takes place
INTRODUCTION Content- subject of theory
Nursing
- geared on realizing & restoring patient’s biophysical wellbeing & NURSING
assisting them to live a dignified & normal life
- Nursing Theory explains Science & Art of Nursing (melting pot of
knowledge, creeds, backgrounds of care collected & preserved)
THEORY
- organized system of accepted knowledge composed of concepts,
propositions, definitions, & assumptions to explain a fact, event,
or phenomena.
Concept- idea formulated by mind/experience perceived &
observed (justice, love, war, disease)
Proposition- explain relationships of diff. concepts
Definition – descriptions conveying general meaning &
reduces vagueness in understanding concepts
Assumption- statement specifying relationship of factual
concept/phenomena
- “creative & rigorous structuring of ideas that projects tentative,
purposeful, & systematic view of phenomena” (Chinn & Kramer,
1991)
NURSING THEORY
- group of interrelated concepts developed from related studies
- aims to view essence of nursing care
- articulated & communicated conceptualization of
invented/discovered reality (central phenomena & relationships)
in pertaining to nursing for purpose of describing, explaining,
predicting, of prescribing nursing care” (Meleis, 1991)
 express nursing theory to provide direction to nursing care
- acc. to Barnum (1994), complete nursing theory has:
Process- method by which nurse acts in nursing theory
 American Nursing Association (ANA)
“Diagnosis & treatment of human responses to
actual/potential health problems”
 International Council of Nurses (ICN)
“autonomous & collaborative care of individuals of all ages,
families, groups, & communities, sick or well in all settings.
Nursing includes promotion of health, illness prevention,
and care of ill, disabled, & dying. Advocacy, promotion of
safe environment, research, participation in shaping health
policy & inpatient & health systems management, and
education are also key nursing roles”
 Virginia Henderson
“to assist clients in performance of activities contributing to
health, its recovery/peaceful death clients will perform
unaided, if they had necessary will, strength, knowledge”
 Association of Deans of Philippine Colleges of Nursing (ADPCN)
“dynamic discipline. It’s an art & science of caring for
individuals, families, communities toward promotion &
restoration of health, illness prevention, alleviation of
suffering, & assisting clients to face death w/ dignity &
peace. It’s focused on assisting client as they respond to
health-illness situations, utilizing nursing process & guided
by ethico-legal moral principles”
 Focused in supporting communities, families, individuals in
maintaining, restoring, achieving state of optimum health &
functioning. It’s both science & art concerned with quality
of life defined by clients.
NURSING PARADIGMS
-patterns/models showing clear relationship
among existing theoretical works in nursing
- metaparadigms  “meta” (with) & “paradeigma” (pattern)
-focused on relationships among 4 major concepts
(metaparadigms) that establish better direction & understanding
of nursing:
Person- recipient of nursing care (individuals) (client, patient)
Ex: Nightingale proposed that physical, intellectual, &
spiritual being of person isn’t capable of manipulating
environment to promote health
Environment- external/internal life aspects influencing a person
Ex: Nightingale focused on ventilation, warmth, noise, light, cleanly
Health- holistic degree of wellness/illness a person experiences
Ex: Nightingale defined nursing as “profession for women within goal
“to discover & use laws governing health in service of humanity”,
believing all nursing activity’s goal should promote client’s health
Nursing- interventions of nurse rendering care in support
of/cooperation with client
independent, dependent, interdependent
Ex: Nurse is responsible in promoting clients’ wellbeing by
manipulating environment (Nightingale)
 - Nursing Metaparadigm embodies knowledge base, theory,
philosophy, research, practice, & educational experience &
literature identified w/ nursing.
THEORISTS
FLORENCE NIGHTINGALE

JEAN WATSON
Philosophy & Theory of Transpersonal Caring CARITAS PROCESSES
- based on 10 carative factors (has dynamic phenomenological “Practice of loving-kindness & equanimity within context
component relative to individuals involved in relationship as of caring consciousness”
encompassed by nursing)
- later expanded/translated into caritas processes (decidedly “Being authentically present & enabling & sustaining deep
spiritual dimension & overt evocation of love & caring) belief system & subjective life-world of self & one being
cared for”
CARATIVE FACTORS
1. Formation of Humanistic Altruistic System of Values
- learned early in life but can be influenced by nurse educators
- satisfaction through giving & extension of sense of self
2. Instillation of Faith-Hope “Cultivation of one’s own spiritual practices & transpersonal
- incorporating humanistic & altruistic values, facilitates self going beyond ego self”
promotion of holistic nursing care & positive health within
patient population
- describes nurse’s role in developing effective nurse-patient
interrelationships & in promoting wellness by helping patient “Developing and sustaining a helping trusting authentic
adopt health-seeking behaviors caring relationship”
3. Cultivation of Sensitivity to Self & Others
- recognizing feelings leads to self-actualization through self-
acceptance for nurse & patient
- as nurses acknowledge their sensitivity & feelings, they become
more genuine, authentic, & sensitive to others
4. Development of Helping-Trust Relationship
- crucial for transpersonal caring
- trusting relationship promotes & accepts expression of positive
& negative feelings
- involves: “Being present to & supportive of expression of positive &
congruence (honest, genuine, authentic) negative feelings as a connection w/ deeper spirit & self &
empathy (experience & understand other’s perceptions & one-being-cared for”
feelings and communicate it)
nonpossessive warmth (moderate speaking volume, relaxed “Creative use of self & all ways of knowing as part of caring
open posture, facial expressions congruent process; to engage in artistry of caring-healing practices”
w/other communications)
effective communication (cognitive, affective, behavior response)
5. Promotion & Acceptance of Positive/Negative Feelings Expression
- sharing of feelings is risk-taking experience for nurse & patient
- nurse must recognize that intellectual & emotional understandings
of a situation differ’ “Engaging in genuine teaching-learning experience that
6. Systematic Use of Scientific Problem-Solving Method for attends to unity of being & meaning, attempting to stay
Decision Making within others’ frame of reference”
- nursing process brings a scientific problem-solving approach to
nursing care, dispelling traditional image of a nurse as doctor’s
handmaiden
- nursing process is similar to research process (systematic &
organized
7. Promotion of Interpersonal Teaching-Learning
- separates caring from curing
- allows patient to be informed & shifts responsibility
for wellness & health to patient
- nurse facilitates this w/ teaching-learning techniques designed
to enable patients to provide self-care, determine personal 8. Provision for Supportive, Protective, & Corrective Mental,
needs, & provide opportunities for their personal growth Physical, Sociocultural, & Spiritual Environment
 - nurses must recognize internal/external environments’ influence
on persons’ health & illness
- internal environment (mental & spiritual well-being,
sociocultural beliefs)
- external variables (comfort, privacy, safety, clean, aesthetic
surroundings
9. Assistance with Gratification of Human Needs
- nurse recognizes biophysical, psychophysical, psychosocial, “Creating healing environment at all levels (physical &
intrapersonal needs of self & patient nonphysical, subtle environment of energy & consciousness,
- Patients must satisfy lower-order needs before attempting to whereby wholeness, beauty, comfort, dignity, & peace are
attain higher-order needs potentiated)”
LO biophysical needs (Food, elimination, ventilation)
LO psychophysical “ (activity, inactivity, sexuality)
HO psychosocial “ (achievement, affiliation)
HO intrapersonal-intrapersonal “ (Self-actualization)
10. Allowance for Existential-Phenomenological Forces “Assisting with basic needs, with an intentional caring con-
- Phenomenology describes data of immediate situation that sciousness, administering ‘human care essentials,’ which
help people understand phenomena in question potentiate alignment of mind body spirit, wholeness, &
- Existential psychology is science of human existence that unity of being in all aspects of care”
uses phenomenological analysis, which Watson considers
difficult to understand (includes to provide a thought-
provoking experience, leading to better understanding of
self & others)
- nurses have responsibility to go beyond carative factors &
facilitate patients’ development in health promotion through “Opening & attending to spiritual-mysterious & existential
preventive health actions, accomplished by teaching patients dimensions of one’s own life-death; soul care for self &
personal changes to promote health, provide situational one-being-cared for”
support, teach problem-solving methods, & recognize coping
skills & adaptation to loss
 INTRODUCTION
Nursing Theory
- geared on realizing & restoring patient’s biophysical wellbeing &
- explains Science & Art of Nursing (melting pot of knowledge, creeds,
backgrounds of care collected & preserved)
- nursing actions focus on restoring clients’ whole being
- core: grounded w/ scientific truth to provide safe & quality
Theory
- explains person’s manifestation
- acceptable general principle to explain phenomena procedure followed
Phenomena- actions that can be seen
Theory of Nightingale
- envisioned nurses as educated women; nursing would be open
- strong emphasis on practice; worked throughout century toward
development of nursing as profession
Nurse- holistic approach of care to patients
- signs (seen by nurse); symptoms (by patient)
Doctor- diagnose & order medication actions; treat
HISTORY
- began w/ Florence Nightingale
- (1950’s) nursing profession leaders began discussing need to develop
nursing knowledge to guide nursing practice
- Nursing as science nursing practice; based on principles & traditions
handed down through apprenticeship model of education & individual
hospital procedure manual
- Nursing Practice is reflected:
Vocation- calling & passion; service by heart
Profession- monetary; academic knowledge; degree
CURRICULUM ERA
- address question of what content nurse should study to be a nurse
- course selection & content for nursing programs; gave way to Research E. Environment- external/internal life aspects influencing a person
- (1930s) standardized curriculum (scope of nursing practice)
CHED  Technical Committee on Nursing Edu. (regulate nursing crclm)
Past: Hospital-based diploma Present: College & University
GN (Graduate Nurse)  BSN  Masters’  Doctorate
RESEARCH ERA
- focused on research process & acquire substantive knowledge to guide
nursing practice; must be aligned w/ profession/practice
- research courses were included in nursing curricula
- (mid-1970s,) nursing studies lacked conceptual connections &
theoretical frameworks, accentuating need for the development for
specialized nursing knowledge
- awareness for need of concept & theory devt coincided w/ 2 milestones:
1. Standardization of curricula for nursing master’s education by
National League for Nursing accreditation criteria for baccalaureate
& high-degree programs
2. Decision that doctoral education for nurses should be in nursing
Nurse Leaders- embraced higher education
Research- from assumptions in past; answer questions from practice
3 areas: Nursing Education (academe); Nursing Practice, Research
GRADUATE EDUCATION ERA
- developed w/ research era; transition from vocation to profession
- nursing Master’s programs emerged to meet public need for specialized
clinical nursing practice
Concepts: 1. Concept development 3. Early nursing theorist
2. Nursing models 4. Knowledge development process
- Baccalaureate degree gained wider acceptance as:
a. Educational level for professional nursing
b. Academic discipline in higher education
- Nurse researchers develop & clarify specialized body of nursing knowledge
w/ following goals:
a. Improving quality of patient care
- core of practice; restore towards near maximal function of patient
b. Providing professional style of practice
c. Achieving recognition as a profession
- nursing practice to be based on nursing science based on debates
- (Meleis, 2007) “ theory is not a luxury in nursing discipline of but an
integral part of nursing lexicon in education, administration & practice”
- important precursor was acceptance of nursing as profession & academic
discipline in its own right
THEORY ERA
- natural outgrowth of research & graduation education eras
- emphasis on theory development & testing
- accelerated due to recognition of early works developed as curricula
framework & advanced practice guides
- Fawcett’s 4 global nursing concepts as nursing metaparadigm 
organizing structure for nursing frameworks & introduced way of organizing
individual theoretical works in meaningful structure
Metaparadigm Concepts:
Person- recipient of nursing care (client, patient)
Ex: Nightingale proposed that physical, intellectual, & spiritual being
of person isn’t capable of manipulating environment to promote health
- internal (emotions); external (noise, surroundings)
Ex: Nightingale focused on ventilation, warmth, noise, light, cleanly
Health- holistic degree of wellness/illness a person experience
Ex: Nightingale believed nursing’s goal should promote client’s health
Nursing- interventions/actions of nurse on providing care
Actions: Dependent – no medical order; sound judgment from nurse
Independent- require direction
Interdependent/Collaborative- nurse + medical practitioners
- clarified & improved knowledge comprehension development by positioning
theorists’ works in larger context, helping growth of nursing science
- (20th century) emphasis shifted from learning about theorist to use of
theoretical works to generate:
a. Research questions c. Organize curricula
b. Guide practice
- (Kuhn’s, 1970)-observation of nursing theory dev’t progress bring description
of normal science to life
a. His philosophy of science clarifies understanding of evolution of nursing
theory through paradigm science.
b. Need to understand that what we view collectively today as nursing
models & theories is work of who originally published their ideas &
conceptualization of nursing
- Theory development emerged as process & product of professional
scholarship & growth & sought higher education among:
a. Nurse leaders c. Educators (academic)
b. Administrators (head) d. Practitioners
 Leaders recognized theory limitations from other disciplines to
describe, explain, predict nursing outcomes
 labored to establish scientific basis for nursing curricula, practice,
research & management

NURSING THEORY ERA

- use of theory to convey organizing structure & meaning for processes to
convergence of ideas
- (Fitzpatrick & Whall, 1983) “Nursing is on a brink of exciting new era”

THEORY UTILIZATION ERA

- emphasized theory application in nursing practice, research, education &
administration; produce evidence for professional practice
- restored balance between research & knowledge development in nursing

Theoretical Work Types:

Nursing Philosophy
- sets forth meaning of nursing phenomena through analysis, reasoning,
logical presentation
- contributed to knowledge development by providing directions or a basis
for subsequent development
Nursing Conceptual Methods
- nursing works by theorist (pioneers in nursing)
Nursing Theory
- from nursing philosophies, conceptual models/abstract nursing theories SIGNIFICANCE OF NURSING THEORY
- developed from conceptual framework; more specific than framework Discipline- cognitive/knowledge domain; academia
- theories may be specific to particular aspect/setting of nursing practice - rule/system governing a conduct/activity
Middle Range Theory Profession- application of theory knowledge; action/practice-based
- more specific focus & concrete than nursing theory in abstraction level - found upon theoretical structure of science/knowledge of abilities
- more precise; focus on answering specific nursing practice questions - principal calling, vocation, employment
- address specifics of nursing situations within model/theory perspective Why is it important for nursing profession  basis for nursing knowledge
Factors:
age group of patient health condition action of the nurse Significance for Discipline
family situation patient location - “discipline is dependent on theory for its continued existence”
- functional focus (nurse action) to patient focus (nurse knowledge)
Forms of basis in recognizing nursing as discipline:
a. Knowledge of person b. Health c. Environment
- every discipline includes theoretical knowledge
- Nursing as academic discipline depends on existence of nursing knowledge
Batey (1977)
- called attention to importance of nursing conceptualization in research
process & role of conceptual framework for science production
- led into theory development era, moving nursing toward goal developing
nursing knowledge to guide nursing practice
Fawcett (1978)
- double helix metaphor on interdependent relationship of theory & research
Henderson, Nightingale, Orlando, Peplau & Wiedenbach
- relevant nature of their earlier theoretical writings developed by educators
as frameworks to structure curriculum content/guide course content
Orlando’s (1961, 1972)
- derived from early nationally funded research project to study nursing
Donaldson & Crowley (1978) Concept- idea, belief, notion, thought, perception, impression
- reopened discussion of nature of nursing science & nature of knowledge for - building blocks of theories
discipline & profession - enhances one’s capacity to understand phenomena as it
- classic reference in recognizing difference between discipline & profession helps define meaning
- discipline & profession are inextricably linked; failure to recognize & Types: Abstract- indirectly observed; independent on time & place
separate them anchors nursing in vocational than a professional view - love, care, freedom
- Nursing conceptual frameworks were used to organize curricula in nursing Concrete- directly observed; specific to time & place
programs; recognized as models that address nursing values & concepts
Proposition- explains relationships of different concepts
Ex: Children don’t want to stay in hospital due to fear of injections.
Significance for Profession Definition- convey general meaning
- Theory is essential for existence of nursing as academic discipline; vital to - reduces vagueness in understanding set of concepts
practice of professional nursing; Higher degree nursing = profession Assumption- specifies relationship/connection of factual concepts/ phenom
- emphasize relationship of nursing theoretical works & profession achievement Ex: All patients not able to take care of themselves need nurses.
- use of substantive knowledge for theory-based evidence for nursing  qualityPhenomenon- fact/occurrence that can be observed
- commitment to theory-based evidence for practice  guides systematic, - notable; excites people’s interest & curiosity
knowledgeable care Philosophy- beliefs/values about humans & their world
Criteria for development of professional nursing status: - concerned w/purpose of life, nature of being &reality, theory &
1. Utilizes in its practice a well-defined &organized body of specialized limits of knowledge
knowledge that’s on intellectual level of higher learning. Concept, Proposition,
Assumption Definitions
 Theory  Phenomena
2. Constantly enlarges body of knowledge & improves educ. Techniques
& service through scientific method.
3. Entrust practitioners’ education to institutions of higher education THEORY
4. Applies body of knowledge in practical services for human & social welfare. Characteristics
5. Functions autonomously in formulation of professional policy, in control 1. of Can correlate concepts to generate a way of looking at fact/phenomenon
professional activity.
2. Must be logical in nature
6. Attracts individuals w/ intellectual & personal qualities of exalting service - Interrelationships of concepts must be sequential & consistently used
above personal gain who recognize chosen occupation as life work. within theory
7. Strives to compensate its practitioners by providing freedom of action, 3. Should be simple but generally broad in nature
opportunity for continuous professional growth, economic security. - Parsimonious  simple terms that describe/explains/predicts phenomena
Styles (1982) 4. Can be source of hypotheses that can be tested for it to be elaborated
- Described distinction of collective nursing profession & individual 5. Contribute in enriching general body of knowledge through studies
professional nurse; called for internal developments for new endowment implemented to validate them
based nursing ideas & beliefs 6. Can be used by practitioners to direct/enhance their practice
- profession needed new, positive approach for future that was devoid of 7. Consistent w/ other validated theories, laws, principles but will leave
past problems, if progress in professional development was to continue open unanswered questions that need to be tested

Nursing theory is a tool for: Types

a. Reasoning b. Critical Thinking Descriptive/Factor Isolating Theories
c. Decision-making for quality nursing practice - to know properties & workings of a discipline
- don’t explain relationship of concepts
Explanatory/Factor Relating Theories
TERMINOLOGIES - examine how properties relate & thus affect discipline
Predictive/Situation Relating Theories
Science- latin scientia (“knowledge”) - calculate relationships between properties & how they occur
- systematically organized body of knowledge about a subject
Prescriptive/Situation Producing Theories
- performing process of observation, description, experimental, - identify under which conditions relationships occur
investigation, & theoretical explanation of natural phenomenon
Knowledge- general awareness, understanding; possession of information, Components
facts, ideas, truths, principles Context- environment to which nursing act occur
- info, skills, expertise acquired by person through experiences/ Content- subject of theory
formal/informal learning Process- method by which nurse acts in using nursing theory
Sources: Traditional- nursing practice passed down in generations Nursing Theory & Models
Authoritative- idea by person/authority perceived as true due to - provide info on: definitions of nursing & nursing practice
his/ her expertise : principles that form basis of practice
Scientific- from scientific method through research : goals & functions of nursing
Theory- organized system of accepted knowledge composed of concepts, - derived from concepts; based on nursing metaparadigm
propositions, definitions, assumptions to explain fact/event/phenomena.Nursing Metaparadigm- pattern/model used to show clear relationship among
- group of related concepts that propose actions that guide practice existing nursing theoretical works
Metaparadigm- (Greek) Meta (“with”); Paradeigma (“pattern”)
- main concepts encompassing subject matter & scope of discipline
Theory basis: interrelationship of healthful environment w/ nursing
- organizing conceptual/philosophical framework of discipline/profession
- defines & describes relationships among major ideas/values
Theory goal: nurse help patients retain their own vitality by meeting their
Nursing focus: environment control for individuals, families, communities
Importance of Nursing Theory
- helps to decide what nurses know & need to know
- better patient care, enhanced professional status, improved
communication between nurses
- guides nursing research & education
Purpose if Nursing Theory
Research:
a. Offers framework for generating knowledge & new ideas
b. Assist in knowledge discovery in specific field of study
c. Offer systematic approach to identify questions for scaling, variables Cleanliness- free from dust, dampness, dirt
selection, interpretation of findings
Clinical Practice:
a. Assist nurses to describe, explain, predict experiences
b. Guide nursing care assessment, implementation, evaluation
c. Provide rationale for collecting reliable/valid data about clients’ health
status for effective decision-making & implementation
d. Helps establish criteria to measure quality of nursing care.
e. Build common nursing terms in communicating w/other health programs
f. Assist in clarifying beliefs, values, goals
g. Define unique contributions of nursing care to clients
h. Enhance autonomy in nursing
Nursing Education:
a. Provide general focus for curriculum design
b. Guide curricular decision making
Research/Theory/Practice Cycle
Relationships
Theory & Research- Research validates & modifies theory
- Theory stimulates exploration
Theory & Practice- Theory guides practice & provide insights about nursing
practice situations
- Practice shapes theory
Research & Practice- Research develops practice
FLORENCE NIGHTINGALE (ENVIRONMENTAL THEORY)
- external conditions prevent, suppress, contribute to disease/death
basic needs through control of environment
Types of Environment:
Physical- affects all other environment aspects
- environment cleanliness related directly to disease prevention &
patient mortality
Psychological- provide positive stress-free surrounding
- affected by negative physical env., causing stress
- communication w/person, about person, about other people
Social- collecting data about illness & disease prevention
- person’s home/room, total community that affect’s patient’s env.
- stress-free surroundings
Major Components of Healthful Environment
1. Proper ventilation 3. Sufficient warmth 5. Effluvia control
2. Adequate Light 4. Noise Control
Nightingale’s 13 Canons
Ventilation & Warmth- body & room temp, foul odors, air must be pure
Light- create & implement adequate light (sunlight)
Health of Houses- pure air, pure water, efficient drainage, cleanliness, light
- remove garbage, stagnant water
Noise- avoid startling noise; keep noise to minimum; avoid whispering
Bed & Bedding- keep it dry, wrinkle-free, lowest height for comfort
Personal Cleanliness- keep patient dry/clean; assess patient’s skin integrity
Variety- diversional therapy (puzzles, flowers, books, cards)
- encourage relatives to engage in stimulating activity to avoid boredom
Chattering Hopes & Advices- fact-based; avoid personal talk
Food- preferences/restrictions; client always has food/drink to enjoy
Taking Food- check client’s diet; record food & fluids ingested in every meal
Petty Management- ensures care continuity
- record care plan & evaluate outcomes to ensure continuity
Observation of the Sick- observe client’s env.; make changes if needed
Metaparadigms acc. to Nightingale
Person- “patient”; human w/ reparative powers acted upon by nurse/
affected by environment
- recovery is in patient’s power
Environment- external conditions/forces affecting life & development
- nurse’s appropriate aura; proper nurse-patient interaction
- nurse must uplift patient’s social status by improving living conditions
- person’s food to nurse’s verbal/nonverbal interactions w/ person
Health- maintain well-being using patient’s powers to fullest extent
- disease: reparative process instituted by nature when patient didn’t
attend to health concerns
- nurse must help client through healing process
Nursing- provide basic essentials (air, light, warmth, diet, cleanliness)
- facilitate reparative by ensuring best possible environment
- nurse influences env. To affect health
Nightingale’s Assumptions
1. Nursing is separate from medicine.
2. Nurses should be trained.
3. Environment is important to nursing.
4. Disease process isn’t important to nursing.
5. Nursing should support environment to assist patient in healing.
6. Research is utilized by observation & empirics to define nursing discipline.
7. Nursing is empirical science & art
8. Nursing’s concern is w/ person & environment.
9. Person is interacting w/ environment.
10. Sick & well are governed by same health laws.
11. Nurse should be observant & confidential
PATRICIA BENNER (FROM NOVICE TO EXPERT THEORY)
Metaparadigms acc. to Benner:
Person- “self-interpreting being, person doesn’t come into world predefined but
gets defined through living a life”
Major aspects of understanding person deals with:
1. Role of Situation 3. “ of Personal Concerns
2. “ of Body 4. “ of Temporality
Health- what can be assessed
- well-being (human experience of health/wholeness)
- illness (human experience of loss/dysfunction)
- disease (what can be assessed at physical level)
Environment- situation (suggests social environment w/social meaning
 person’s engagement, interaction, interpretation, understanding about
situation (person enters situation w/their own meaning)
Nursing- caring relationship; enabling condition of connection & concern”
- care & study of lived experience of health, illness, disease as well as 4. Administer & monitor therapeutic interventions & regimens
their relationship
- clinical practice; nurse give care based on skill & experience
Benner’s Stages of Clinical Competence
Proficient
- perceive situation as whole than in terms of aspects
- guided by maxims (cryptic instructions that make sense only if there’s
already deep understanding of situation; fundamental truth)
- recognize salient aspects; intuitive grasp of situation based on understanding
- increased confidence in knowledge & abilities
- recognition & implementation of skilled responses to situations
- key word: perception (3-5 years experience in same area)
Expert
- no longer relies on analytic principle (rule, guideline, maxim) to connect [
understanding of situation to appropriate action
- operates from deep understanding of total situation
- intuitive grasp of problem w/o losing time
- immediately continue management based on diagnostics
- qualitative change: nurse knows patient as a whole (patterns/responses)
- focus on patient’s actual concerns & needs (5+ years experience)
Key aspects: Demonstrate clinical grasp & resource-based practice
Possess embodied knowledge
Seeing big picture
Seeing the unexpected
7 Domains of Nursing Practice
1. Helping role
2. Diagnostic client-monitoring function
3. Effective management of rapidly changing situations
5. Monitor & ensure quality health care practices
6. Organizational & work-role performance
7. Teaching/coaching function

Novice
- no experience of situations they’re involved
- learn context-free rules to guide action (stimulus-response thinking)
- difficulty in discerning what’s relevant, priority, etc.
- rule-governed behavior; inflexible
Advanced Beginner
- demonstrate marginally acceptable performance
- can identify recurring meaningful situations & apply these in new situation
- goal: task completion; unable to see entirety of new situation
- feel more responsible in patient care but still rely on mentors
- clinical situations are viewed as test of abilities & its demands be placed on
them rather than in terms of patient needs & responses
Competent
- consistency, predictability, time mngmnt is important in competent
performance
- sense of mastery is acquired through planning & predictability
- increased efficiency; focus on time management & task organization than
timing in terms of patient needs (2-3 years experience)
- critical stage (nurse recognize patterns; identify prioritization)
 MARTHA ROGER (SCIENCE OF UNITARY HUMAN BEING)
- focus on concepts & principles of homeodynamics:
Homeodynamics- balance between dynamic life process & env
Roger’s Assumptions
1. Human is a whole which can’t be viewed as subjects
2. Human’s life process is irreparable & one way (birth to death)
3. Health & illness are life process’ continuous expression
4. Energy flows freely between individual & environment
5. Human possesses ability to think, imagine, sense, feel, & use language for
expression
6. Humans have ability to adapt acc to new changes in env
7. All humans are viewed as integral part of universe
8. Humans & environment have energy field; nursing action is directed
towards patterning & maintaining energy fields
4 Concepts of Homeodynamics
Energy Fields- inevitable; energy can freely flow between human & env
Openness- no boundary that inhibits energy flow between human & env,
leading to continuous energy movement/matter
Pattern- energy field’s distinguishing character
Pandimensional- undeviating field not constricted by space/time
- infinite domain w/o boundary
Nursing Education
- emphasize on understanding of patient & self, energy f., environment
- training focuses on teaching non-invasive modalities (therapeutic touch,
meditation, humor, regular in-service edu. program)
Nursing Research
- Rogerian theory is testable & applicable in research
Nursing Process acc to Theory
1. Pattern Appraisal
- inclusive assessment of human & env energy fields, energy f. organization,
& identification of areas of dissonance
- nurse validates entire appraisal along w/ client
2. Mutual Patterning
- proper patterning of energy f. between human & env
- mutual interaction between client & nurse
- done by suggesting alternatives, educating, empowering, encouraging
(depend on client’s condition & needs)
- nutrition appraisal, rest & sleep, exercise, discomfort, relation w/others
- patterning activities (therapeutic touch, meditation, humor, imaginery)
3. Evaluation
- done by repeating pattern appraisal after mutual patterning to determine
extents of dissonance & harmony

Principle of Homeodynamics  help view human as unitary being Martha Elizabeth Rogers
- born May 12, 1914 (Dallas, Texas); died March 13, 1994
Integrality
- (1936) nursing diploma in Knoxville General Hospital School of Nursing
- energy fields are dynamic & constantly interact w/ human & env, affecting
our env (vice-versa) - (1937) BS from George Peabody College
- (1945) MA public health nursing supervision in Teachers College, Columbia Uni
- where meditation & humor works to produce positive env
- (1952) MPH & (1954) ScD from Johns Hopkins University
Resonancy - formed Society of Rogerian Scholars & published Rogerian Nurs. Science News
- ordered arrangement of rhythm characterizing human & env fields - American Nurses Association Hall of Fame (posthumous) (1996)
- constant change in e. field’s way/pattern from lower to higher frequency
- energy movement is made by human touch, guided imagery activities,
drawing, storytelling (imagination)
Heliecy
- any minute change in env leading to ripple effect, results to larger changes
in other field
- change is constant & unpredictable; many factors interact & cause change

Metaparadigms acc to Roger

Person- unitary human b. is open system that continuously interact w/ env
Environment- entire energy field other than a person
- energy f. are irreducible, not limited by space/time, identified by its
pattern & organization
Health- not clearly defined by Roger
- determined by interaction between energy fields (human & env)
- bad interaction/misplacing of energy leads to illness
Nursing- science & art; maintains energy f. which is conducive for patient
- directs interaction of person & env to maximize health potential

Theory Applications
Clinical Practice
- nursing action is focused on unitary human b. & change energy field
between human & env
- nursing interventions include noninvasive actions (guided imaginary,
humor, therapeutic touch, music) to increase human’s potential
- prioritize on pain mgmt, supportive psychotherapy, human rehabilitation
 - brings scientific, problem-solving approach to nursing care
MARGARET JEAN WATSON (PHILOSOPHY & SCIENCE OF CARING) 7. Promotion of interpersonal teaching-learning
- gives client maximum health control to provide info & alternatives
Caring- immeasurable; promote self-actualization; caring > curing
- distinguish caring from curing by assigning health responsibility to client
- focus: Promotion of health (holistic approach) - enables client to provide self-care by deciding for themselves
“Caring is central in nursing practice, therefore better than curing”
8. Provision for supportive, protective & corrective mental, physical,
Metapradigms acc to Watson sociocultural & spiritual environment
Person- valued, respected, nurtured, understood, assisted - assess & facilitate client’s coping abilities to support & protect mental &
- viewed acc to client’s development physical wellbeing
5 Conditions of Caring: Awareness & knowledge of one’s needs for care - must understand person’s background/diversity by providing best env
Intention to act 9. Assisting w/ gratification of human needs
Positive change as a result of caring - address nurse’s & client’s needs
Underlying value & moral commitment - must meet lower-order needs before higher-order needs
Will to care Lev 1: Physiological Needs (food, warmth, water, rest
Environment- society w/influences; norm (values of how one behaves & 2: Safety N. (security, safety)
what goals one should strive) 3: Belongingness & Love N. (intimate relationship, friends)
- sensitive to client’s social, cultural, spiritual aspect 4. Esteem N. (prestige; accomplishment feeling)
Health- unity & harmony in mind, body & soul 5. Self-actualization (achieve full potential)
3 elements: higher level of overall physical, mental, social functioning 10. Allowance for Existential-Phenomenological forces
general adaptive- maintenance level of daily functioning - experiences shape one’s individual perceptions
absence of illness/presence of efforts that lead to its absence - leads to better understanding of oneself & others through performing
nursing process
Nursing- holistic health care
- human science of people & health-illness experiences by
professional, personal, scientific, aesthetic, ethical care transactions
MARGARET JEAN HARMAN WATSON, PhD, RN, AHN-BC, FAAN
Watson’s Major Assumptions - June 10, 1940 (West Virginia, USA)
1. Caring is demonstrated & practiced only Interpersonally - Lewis Gale School of Nursing, Roanoke, Virgina (graduated 1961)
2. Caring has carative factors resulting in human needs satisfaction - nursing educ & graduate studies at Univ. of Colorado
3. Effective caring promotes health & individual/family growth - baccalaureate degree in nursing (1964) at Boulder campus
- master’s in psychiatric–mental health nursing (1966) at Health Sciences campus
4. Caring env accepts person as he is & looks to what he may become
- doctorate in educational psychology & counseling (1973) at Graduate School,
5. Caring env offers development of potential while allowing person to
Boulder campus.
choose best action for himself/herself at a given time
- established Center for Human Caring at Univ of Colorado (nation’s 1st
6. Caring is more “healthogenic” than is curing. Caring integrates interdisciplinary center committed to using human caring knowledge for clinical
biophysical knowledge w/ human behavior knowledge to generate practice, scholarship, administration, & leadership)
/promote health & provide ministrations of sick
- found Board of Boulder County Hospice
7. Science of caring is complementary to science of curing.
8. Caring is central to nursing
10 Carative Factors
1. Forming Humanistic-Altruistic value system
- occurs early in life but can be influenced by nursing educators
- accomplished by examining one’s views, beliefs, interactions w/cultures
& personal growth experiences
- provides satisfaction through giving & extending oneself
2. Instillation of faith-hope
- nurse’s role in effective nurse-patient interrelationships & wellness
- accomplished by helping client adopt health seeking behaviors
(instinct/volunteer to seek care by himself) by positively using powers
of suggestion & supporting them
3. Cultivating sensitivity to self & others
- recognition of feelings leads to self-actualization through self-
acceptance for nurse & patient
- nurse become more genuine, authentic & sensitive to others
4. Development of helping-trust relationship
- establishes rapport & caring; expression of positive & negative feelings
- accomplished through congruence, empathy, nonpossesive warmth, &
effective communication
5. Promotion & Acceptance of Positive/Negative feelings expression
- sharing of feelings; being prepared for positive & negative feelings
- nurse = good listener
6. Systematic use of scientific problem-solving method for decision-making
- research, defining discipline & developing scientific knowledge base
 8. Promotion of human functioning & development.
DOROTHA E. OREM (SELF-CARE DEFICIT THEORY)
B. Developmental Self-care requisites
- address client’s self-care needs
- result from maturation; conditions (adjusting to change in body
- make clients perform self-care activities to live independently image/loss of a spouse)
- patients recover better when they maintain INDEPENDENCE to provide - promote maturation; prevent conditions deleterious to maturation
own self-care
C. Health Deviation Self-care requisites
Self-care need- goal-oriented activities set towards generating interest in
- result from illness or its treatment; seeking medical assistance, carrying out
client’s part to maintain life & health development
prescribed treatment; learning to live w/ effects of illness or treatment
Metaparadigms acc to Orem: - set standards to which degree of self-care demand is needed.
Person
- patient: functions biologically, symbolically & socially; has potential 2. THEORY OF SELF-CARE DEFICIT
for learning & development - why people can be helped through nursing
- subject to nature forces; capacity for self-knowledge; engage in deliberate Self-care deficit: arises when self-care agency can’t meet self-care requisites
action, interpret experiences & perform beneficial actions Helping Methods: Acting / doing for another
- can learn to meet self-care requisites Guiding & directing
Providing physical / psychological support
Health
Teaching
- Orem supports WHO’s definition: “state of physical, mental, social Provide & maintain env that supports personal development
wellbeing & not merely absence of disease or infirmity”.
- physical, psychological, interpersonal & social aspects (inseparable) 3. THEORY OF NURSING SYSTEMS
- health promotion & maintenance, illness treatment, complication - relationships must be brought about & maintained for nursing to be produced
prevention - series of actions nurse takes to meet patient’s self-care requisites
Environment Nursing Agency: established capabilities of nurse who can legitimately perform
- environmental factors, elements, conditions (external physical & activities of care for client.
psychosocial surroundings) & developmental environment (personal : helps person achieve their health care demand.
dev’t promotion through motivation to establish goals & adjust behavior Nursing Design: prof. functions performed by nurse in to meet client’s needs
to meet goals: formation/change in attitudes & values, creativity, self
: guideline of needed & foreseen results in nursing production
concept & physical development)
toward achievement of nursing goals
Nursing
3 Types of Nursing Systems:
- help clients establish/identify ways to perform self-care activities.
- actions geared towards client independence; - based on values - each system describes nursing responsibilities, nurse & patient roles,
rationales for nurse-patient relationship; types of actions to meet patient’s
- human service focusing on persons w/ inabilities to maintain continuous
self-care agency & therapeutic self-care demand
provision of healthcare
1. A wholly compensatory nursing system
3 related theories: - used when patient’s self-care agency is so limited that they depend on
1. THEORY OF SELF-CARE others for well-being
- why & how people care for themselves 2. A partly compensatory NS
Self- Care: activities one performs independently to promote & maintain - used when patient can meet some requisites but needs nurse meet others
personal well-being - nurse & patient have roles in performing self-care
Self- Care Agency: complex acquired ability of mature & maturing persons 3. Supportive – Educative NS
to know & meet their continuing requirements for - used when patient can meet requisites but needs assistance w/ decision
action to regulate their functioning & development Making, behavior control, knowledge acquisition skills
agent- engage in meeting person’s need; facilitate what’s been done
&needs to be done (nurse)
self-care agent- provides self-care (patient)
dependent care agent- person other than self-care agents (family)
Therapeutic SC Demand: activities to meet existing self-care requisites
: use of actions to maintain health & well-being,
: each patient’s demands varies in life
Self-care requisites/Needs: requirements one must meet & perform to
achieve well-being.
Categories
A. Universal Self-care requisites
- universally set goals done for person to function in healthy living
1. Maintenance of sufficient air intake
2. “ “ “ food intake
3. “ “ “ water intake
4. Provision of care associated w/ elimination
5. Maintenance of balance between activity & rest.
6. “ “ “ “ solitude & social interaction.
7. Prevention of hazards to human life, functioning, & wellbeing
 f. Reaction- outcomes of stressors; actions of line of resistance
BETTY NEUMAN (SYSTEMS THEORY) - depends on degree of reaction produced to adjust & adapt w/
situation
“Health is a condition in which al parts & subparts are in harmony w/ whole
Negentropy- towards stability/wellness (positive)
life of client”
Egentropy- “ disorganization of system, producing illness (negative)
FOCUS: Person as a complete system, subparts of which are interrelated
factors: g. Degree of Reaction- energy amount required to adjust to stressor
Physiological (basic needs) 3 Levels of Prevention
Psychological cognitive process towards env) 1. Primary- intervention before reaction occurs; performed when stressor is
Sociocultural (interaction/sensitive to people’s preference) suspected/identified
Spiritual- beliefs - strengthen capacity to maintain optimum level of functioning while
Developmental- age-related interacting w/env (health promotion/disease prevention))
- deals w/ stress & stress reduction; effects of stress on health 2. Secondary- after reaction occurs
Metaparadigms acc to Neuman - alleviate actual existing effects that altered health balance
Person- multidimensional (complex), dynamic (continuous) system - reduce env influences that leads to decline of functioning level &
strengthen/restore resistance after illness exposure
- individual, group, community
3. Tertiary- after system has been treated through secondary
- open system (interaction & reaction; exchange of info) working
together w/other parts as it interacts w/env - actual treatment/adjustment to strengthen person after being
exposed to illness
- basic core (genetic features; strength & weakness of system
parts), physiological, sociocultural, developmental, &
i. Reconstitution- adjustment state from degree of reaction
spiritual variables
- state of going back to actual health state before illness
Health- equated w/wellness; “condition in which all parts & subparts/
variables are in harmony w/ client’s whole
- continuum of wellness to illness that’s dynamic & changing
Environment- internal (within client) & external (outside) factors
that surround/interact w/person & client
Nursing- whole person (holistic approach), approach that considers all
factors affecting client’s health status
- unique profession concerned w/ all variables affecting person’s
response to stress

Systems Model in Nursing Practice

a. Client Variables- physio, psycho, sociocultural, spiritual, developmental
b. Lines of Resistance- internal resources/factors that help defend against
stressor (immune system)
- facilitate coping to overcome stressors in person 1. Person exposed to stress flexible LOD is alarmed to protect normal LOD to
c. Normal Line of Defense- state of stability/wellness/health keep system free from stressor reactors
- maintained overtime by lifestyle; standard to assess deviations 2. If person is continuously exposed to stress & flexible LOD can’t cope up
in usual wellness  normal LOD is altered; there will be threat to wall protecting person’s
- if stressor did enter, perform prompt diagnosis to prevent basic structure, causing instability of systems  ILLNESS
further complications
d. Flexible Line of Def.- protective barrier to prevent stressors from
breaking through normal line of defense
- dynamic; change rapidly over short time

BETTY NEUMAN
- born 1924; Lowell, Ohio
` - (1947) RN Diploma: Peoples Hospital School of Nursing, Akron, Ohio
- moved to Cali as hospital/staff/head/school/industrial nurse, CI in
medical-surgical, critical care, communicable disease
- (1972) model published in Nursing Research as “Model for teaching
total person approach to patient problems”
- developed model to teach introductory nursing course
- model based on philosophical views, Gestalt Theory, Hans Selye’s
e. Stressors- produce tension/alteration, causing instability in client Stress Theory, & General System’s Theory
Intrapersonal- within person (emotions, feelings)
Interpersonal – between persons (pressure on role expectation)
Extrapersonal- outside person (job/financial pressure)
 5. If transaction’s made in N-C int, growth & dev’t will be enhanced
IMOGENE KING (GOAL ATTAINMENT THEORY)
“Dynamic interpersonal relationship as person grows & develops to
attain goals”
- nurse & patient mutual communication to establish goals & take action
to obtain goals
- nurse & patient are strangers coming together in health care org to
help/be helped to mutual state of health
Goals: Nurse’s goal to patient ; Patient’s goal to oneself
Central focus: MAN (dynamic; perceptions of object, person, events
influence his behavior, social interaction, health)
3 basic premises: Reactive- aware; responsive to stimuli
Time-oriented- influenced by past actions
Social- continuous exchange w/persons in env
- language is social link & facilitate interpersonal comm
3 Interacting Systems
PERSONAL- individual
- how nurse view & integrate self-based from personal goal & beliefs
Concepts: Individual’s Perception- representation of reality; unique
Self- subjective env, value, idea, attitude, commitment
Growth & Dev’t- cellular, molecular, behavioral changes
- predictable; dev’t milestones
Body Image- body perception; reaction of others on their body
Space- immediate physical territory lived by person & behavior
Time- order of events & relationship to each other
INTERPERSONAL- group; how nurse interrelates to coworker/patient
- nurse-patient relationship
Concepts: Interaction- nurse relates & deals w/patient
Communication- indire/directly transmit info between persons
Transaction- person & env interaction to attain goal; communicati
Role- person’s expected behaviors in specific position & to
rules governing position & affect interaction between persons
Stress- positive/nega energy exchange between person & env
SOCIAL- society/organization (family, school, workplace, religious group)
- nurse interact w/ coworkers, superiors, subordinates, client env
- comprises: Social Roles, Behavior (prof. ethics), Practices (culture)
Concepts: Organization- group w/similar interest who prescribed role &
position; use resources to achieve personal/organiz. goal
Authority- observable behavior; provide guidance & order
- being responsible for actions
Power- ability to use resources to achieve goal
- means of influencing others
Status- person/group position; accomplished by duty/privilege
Decision-Making- from developing & acting on perceived
choices for goal attainment
6. If role expectation & role performance perceived by N & C are
congruent, transactions will occur
7. If role conflict is experienced by N&C, stress in N-C interaction will occur
8. If nurses w/ special knowledge & skills communicate appropriate info to
clients, mutual goal setting & goal attainment will occur
Metaparadigms acc to King:
Person- spiritual being (morality; ethics); capacity to think, know, make choices,
select alternative courses
- ability through language & symbols to record their history & preserve
culture; open system in transaction w/environment
- unique & holistic; intrinsic worth & capable of rational thinking &
decision making in most situations
3 fundamental health needs
1. Need for information (medical info)
2. “ “ care for illness prevention
3. “ “ total care when one have no capacity to help themselves
Health- dynamic state in life cycle; illness (interference in life cycle)
- continuous adjustment to stress in int/ext. env using personal
resources to achieve optimal daily living
Environment- process of balance in int/ext interaction in social system
- from General Systems Theory as open system w/permeable
boundaries allowing exchange of matter, energy, info
- promote chance to understand, learn, etc
Nursing- help client identify existing health condition; exploring & agreeing on
activities promoting health
- promote health/prevent illness by health educ; maintain client’s self-worth
- palliative care (supportive care depends on client’s ability to reciprocate
- goal of nurse: Maintain health by health promotion & maintenance
Restoration & caring for sick & dying
IMOGENE KING
- born in 1923, youngest of 3 children; died 2007
- (1946) St. John's Hospital School of Nursing, St Louis, Missouri
- (1948) BS Nursing Education; (1957) MS in Nursing: St. Louis University
- (1961) EdD ; Postdoctoral in research design, statistics, computers:
Teachers College, Columbia University, New York
Expertise: adult medical-surgical nursing
Experience: administrator, educator, practitioner

Characteristics of Man
a. Ability to Perceive d. “ Choose between alternative course of action
b. “ “ Think e. “ “ Set goals
c. “ “ Feel f. “ “ Select means of accomplishing goals

Propositions of Theory
1. If perceptual accuracy is present in nurse-client interaction,
transactions will occur.
2. If nurse & client make transactions, goals will be attained
3. If goals are attained, satisfactions will occur
4. If goals are attained, effective nursing care will occur
 DOROTHY E. JOHNSON (BEHAVIORAL SYSTEM MODEL)
“Person experiencing a disease is more important than disease itself”
- person is a behavioral system made of set of organized, interactive,
interdependent, & integrated subsystems
- Constancy is maintained by actions & behaviors regulated & controlled by
biological (physio), psychological (mental/cognitive state), sociological
(interaction) factors
Focus: Monitor patient’s effective/effiicient behavioral functioning
(patterns, outcomes) before, during, after illness
Metaparadigms acc to Johnson
Person- have 2 major systems: biological (physiological; survival needs) &
behavioral (patterned, repetitive, purposeful ways of behaving,
linking person to env)
- strives to maintain steady state by adapting & adjusting to env forces Person/Individual- 16 y/o + older past acute stage of long-term illness (focus)
that cause imbalance
- when imbalance/health problem occurs, physical, social, or
psychological integrity is threatened
- lower resistance = disturb behavioral system = threaten integrity
Health- affected by social, biological, psychological, physiological factors
- persons strives to maintain stability in factors
Environment- consists of all factors not part of behavioral system, but
influence this system
- behavior is influenced by all events in env & varies in culture
- can be manipulated by nurse to attain health goal
Nursing- external force acting to preserve organization of patient’s
behavior by imposing regulatory mechanisms/providing
resources while patient is under stress
- steady state is maintained by adjust & adapt to int & external forces
7 Subsystems
1. Attachment/ Affiliative – most critical, basis for all social organization - circle represents nurse’s role; focused on task of nurturing patients
- promotes survival & provides sense of security
- results in social inclusion, intimacy, form strong bond
2. Dependency- promotes helping/nurturing behavior from others
- results in approval, attention, recognition, physical assistance
3. Ingestive- food intake
- relates to biological need for food & psychological meanings &
structures of social events around food consumption
- results in appetite satisfaction
4. Eliminative- behavior around waste excretion from body
- psychological meanings & structures of socially acceptable
behaviors for waste elimination
5. Sexual- behavior in procreation & sexual gratification
- psychologically & socially acceptable behaviors (courtship & mating) - through expression, patient can gain self-identity & develop maturity
- results in dev’t of sex role identity & sex role behavior
6. Aggressive- behavior in self- protection & preservation self & society
- belief that aggression is learned & harmful; people & property
must be respected & protected
7. Achievement- behavior in env manipulation to gain mastery & control
over aspect of oneself/env
- control is measured against standard of excellence
3 Functional Requirements of Humans
a. to be protected from noxious influences where person can’t cope
b. “ “ nurtured through input of supplies from env (factors)
c. “ “ stimulated to enhance growth & prevent stagnation
LYDIA ELOISE HALL (CARE, CURE, CORE THEORY)
- aka Three Cs of Lydia Hall
- size of each circle varies & depends on patient’s state
- emphasizes total patient than 1 part; depends
on all 3 components working together.
“To look at & listen to self is often too difficult
w/o help of significant figure (nurturer) who
has learned how to hold up a mirror & sounding
board to invite behaver to look & listen to himself. If he accepts it, he will explore
concerns in his acts & as he listens to his exploration through nurse’s reflection, he may
uncover in sequence his difficulties, problem area, problem, & threat which is dictating
his out-of-control behavior.”
Metaparadigms acc to Hall
- individual/person care recipient is energy source & motivation
rather than health care provider
- emphasize importance of person as unique, capable of growth
& learning, requiring total person approach
Health- state of self-awareness w/conscious selection of optimal behaviors
- emphasize need to help person explore their behavior meaning to
identify & overcome problems by dev’t of self-identity & maturity
Environment- dealt related w/ person; conducive to self-development
- nurse’s focus of action is individual, so any actions taken in relation to
society/environment are for assisting individual attain personal goal
Nursing- “participation in patient care’s care, core, & cure aspects CARE is
nurse’s sole function, CORE & CURE are shared w/other health team.”
- care’s major is to achieve interpersonal relationship w/ person that
facilitate core’s dev’t
Subconcepts: The Circle
CARE (Body) (“Intimate bodily care”)
- Nurturing: concept of mothering (care & comfort) & provide teaching-learning activities
- defines prof nurse’s primary role to provide patient bodily care, helping them complete
basic daily biological functions, educating them
- nurse & patient has opportunity for closeness. As closeness develops, patient can share
& explore feelings w/nurse.
- when providing care, nurse’s goal is patient’s comfort
CORE (Person) (“Therapeutic use of self”)
- patient receiving nurse care
- has goals set by oneself than by others & behaves acc to one’s feelings & values;
involves therapeutic use of self, shared w/health team
- emphasizes patient’s social, emotional, spiritual, intellectual needs related to family,
institution, community, world
- helps patient verbally express feelings about disease process & its effects using
reflective technique.
Reflective technique- used by nurse where they act as mirror to patient to help explore
their feelings about current health status & lifestyle changes
Motivations- discovered by process of being aware of feelings experienced
- w/ awareness, patient can make conscious decisions based on
understood & accepted feelings & motivation
CURE (Disease) (“Seeing patient & family through medical care”)
- administer medication/treatment; shared by nurse w/ health professionals
- interventions/actions toward treating patient for illness he’s suffering
- nurse is an active advocate of patient

CALLISTA ROY (ADAPTATION MODEL)
Key Concepts
- person is adapting in stable interaction w/ internal/external env
- person’s major task is to maintain integrity in facing stimuli.
INTEGRITY- degree of wholeness achieved by adapting to need changes
SYSTEM- set of parts connected to function as a whole by virtue of
interdependence of its parts
employs feedback cycle of:
Input- stimuli coming from environment/within person
Throughput- uses person’s:
processes (control mechanism used as adaptive system)
effectors (physiologic function (automatic), self-concept, role function COMPROMISED- result from inadequate integrated & compensatory life
in adaptation)
Output- system’s outcome, person’s behaviors (if system is a person)
adaptive response- promote integrity in human system’s goal
of adaptation
ineffective “ – don’t contribute to integrity “ “ “
Metaparadigms acc to Roy:
Person- recipient of nursing care; main focus of nursing
- biopsychosocial being in constant interaction w/changing env
- open adaptive system who use coping skills (cognator, regulator) to
deal w/ stressors
- people as individual/group (famiy, org, community, nation, society)
Environment- conditions, circumstances, influences that surround & affect
person’s dev’t & behavior
- internal & external, provide input in form of stimuli
Health- Roy: “health-illness continuum; health & illness as inevitable
dimension of person’s life”
- process of being & becoming integrated & whole person.
- reflection of adaptation (interaction of person & env)
Nursing- science & practice that expands adaptive abilities & enhances
person & env transformation
- Roy’s goal of nursing: promotion of adaptation in each of 4 modes,
contributing to health, quality of life, & dying w/dignity
Types of Stimuli (Helson, 1964)
FOCAL- int/external stimulus primarily/ immediately confronting person
- attracts most attention
ex: (smoker) addiction to smoking
CONTEXTUAL- all other stimuli in situation that strengthens/contribute
effect of focal stimulus
ex: gratification, relaxation
RESIDUAL - affect focal stimulus but effects are unclear
ex: perceived increase masculinity, body image, etc
 3 stimuli act together & influence adaptation level (ability to respond
positively in a situation)
Coping Mechanism & Control Process
COPING MECHANISM- processes person uses for self-control (conscious)
- innate/acquired ways of interacting w/changing environment
Innate CM- genetically determined/common to species
- genetically viewed as automatic process
Acquired CM- developed through strategies like learning
categories:
Regulatory Subsystem- automatic response, neural, chemical, & endocrine
ex: increase in vital signs- sympathetic response to stress
Cognator S. - 4 cognitive-emotive channels: perceptual & info processing;
learning; judgment & emotion
ex: effects of prolonged hospitalization for 4 y/o child
Control Process
stabilizer s. – similar to regulator; concerned w/ stability
innovator s. - similar to cognator; “ “ creativity, change, growth
DEFENSE MECHANISM- unconscious (projection- blaming others for one’s anxiety)
Adaptation Level
INTEGRATED- structures/functions are working as whole to meet human needs
ex: Stable process of ventilation, breathing (exchange air between lungs & atmosphere
COMPENSATORY- cognator & regulator are activated by challenge/stimulus
ex: grieving, role transition
processes; adaptation problem
ex: Hypoxia, ventilatory impairment, unresolved loss, abusive relationship
Adaptive Modes
- behavior categories to adapt to stimuli; determine person’s adaptation level
- identify adaptive/ineffective responses by observing person’s behavior in
relation to adaptive modes
1. PHYSIOLOGICAL- survival; response as physical being to stimuli from env
- goal: Physiological Integrity
5 Physiologic needs: oxygen, nutrition, activity & rest, elimination & protection
4 Complex Processes: senses; fluids, electrolytes & acid-base balance;
neurologic function; endocrine function
2. SELF-CONCEPT/GROUP IDENTITY MODE
- focus specifically on human system’s psychological & spiritual aspects
2 components: physical self (body sensation & body image)
personal “ (self-consistency, self-ideal, moral ethical spiritual self)
GROUP IDENTITY- how people in groups perceive themselves
- goal: Psychological Integrity
3. ROLE FUNCTION MODE- role is set of expectations about person’s behavior in a
position towards a person of another position
- roles are carried out w/instrumental & expressive behaviors
- goal: Social Integrity
person performs ff roles:
Primary- determines majority of behavior by person in particular period of life
Secondary- person assumes to complete task associated w/ developmental
stage & primary role
Tertiary- related to primarily to secondary roles; persons meet their role
associated obligations (civic/organizational roles)
3. INTERDEPENDENCE MODE- focus on close relationships between significant others
- result to sense of belongingness
- goal: Affectional Adequacy
Goal of Nursing in RAM: Promote adaptation in each of 4 adaptive modes
Person as Adaptive System: INPUT  Control Process  Effectors  OUTPUT
NURSING PROCESS- problem-solving approach for gathering data, identifying
capacities &needs of human adaptive system, selecting & implementing
approaches for nursing care, evaluation of outcome of care provided
6 Steps:
1. Assessment of Behavior- data gathering about person’s behavior as adaptive
system in each of adaptive modes
observable behavior- vital signs; objective; signs
 non-observable b.- feelings; subjective; symptoms
Health-
2. “ “ Stimuli- stimulus: change in int/ext env that induces response in
- focal, contextual, residual
3. Nursing Diagnosis- statement formulation that interpret data about
adaptation on person status (behavior & most relevant stimuli)
4. Goal Setting- clear statements/design of behavioral outcomes
for nursing care which is realistic & attainable
- done together w/ client
5. Intervention- determination of how best to assist person in attaining
established goals
6. Evaluation- assess effectiveness of nursing intervention related to behavior
after it was performed in comparison w/ goal established
CALLISTA ROY
- born 10/14/1939, LA, California
- (1963) BSN: St. Mary College, LA
- (1966) MA in Pediatric Nursing; (1977) Doctorate in Sociology: UCLA
- 4 honorary doctorate from 4 institutions; nurse theorist & professor
- fellow in American Academy of Nursing (honorary nursing society that
elects nursing leaders annually)
Introduction to Nursing: An Adaptation Model
Essentials of the Roy Adaptation Model
Theory Construction in Nursing: An Adaptation Model
Essentials of the Roy Adaptation Model
Roy Adaptation Model: The Definitive Statemen
HILDEGARD PEPLAU (THEORY OF INTERPERSONAL RELATIONS)
- based on psychodynamic nursing (understanding one’s behavior to help others
identify their difficulties)
Focus: PATIENT
Phases of Nurse-Patient Relationship
a. ORIENTATION- defining phase; person felt need & seeks professional assistance Metaparadigms acc to Abdellah
- nurse helps patient recognize & understand problem & know help
- patient exhibit trust & cooperation
- collaborative clarifying & defining of problem
affecting factors:
b. IDENTIFICATION- patient relates w/ who can help them (self-belongingness)
- nurse help patient recognize his role
- strengthen positive forces in personality & provide satisfaction
c. EXPLOITATION- explore new avenues of health (patient must have full trust)
- patient moves on from dependent to independent role
- nurse project new goals to be achieved by personal effort (interview)
- power shifts from nurse to patient
d. RESOLUTION- after patient’s needs are met, therapeutic relations ends
- patient earns independence over his care as he gradually puts
aside old goals & formulates new goal
- difficult phase
Metaparadigms acc to Peplau:
Person- man as organism living in unstable balance of a given system
symbolizes
adaptive s. movement of personality & human processes directing
person towards creative, constructive, productive, community living
- for one’s health to be achieved & maintained, his needs must be met
Environment- forces outside organism & in context of socially approved way
of living (norms, customs, beliefs)
Nursing- significant, therapeutic interpersonal process (sequential nursing process)
- relationship of person who’s sick & a nurse educated to respond to need
- achieve its goal by promoting patient’s skill development to deal w/ problems
& achieve health
Nursing Roles
a. Role of Stranger- nurse treat patient w/ utmost courtesy
- acceptance of patient as person & respect over his individuality
b. Role of Resource Person- nurse provides specific answers to questions (health info,
advices) & simple explanation of healthcare
c. Teaching Role- combination of all roles
- give instructions & provide training; analysis & synthesis of experience
d. Leadership R.- nurse as advocate for patient’s best interest & enable him to
make decisions over his care through cooperation & participation
e. Surrogate R.- nurse as substitute due to patient’s dependency for care (pediatrics)
- helps patient see differences between nurse’s role & actual relative
f. Counseling R.- greatest importance & emphasis in nursing
- strengthens nurse-patient relationship as nurse becomes a listening
friend, understanding family member, & gives sound & emphatic advises
FAYE ABDELLAH (21 NURSING PROBLEMS)
- theoretical statement can be created by utilizing her 3 chief concepts of Health,
Nursing Problems, & Problem Solving
- proposed that nursing is “utilization of problem-solving techniques w/ chief nursing
problems related to health requirements of clients.
- importance on problem-solving as medium for nursing problems as client is geared
in direction of health (outcome)
Person- nursing care recipient; family/individiuals
- has physical, emotional, sociological needs, helping these needs is nursing’s
only justification
- Abdellah: typology of nursing problems evolve from recognition of need for
patient-centered approaches to nursing
- capable of learning & of self-help to varying degrees
Health- center & purpose of nursing services; state excluding illness
- “total health needs” & “healthy state of mind & body”
- state where person has no unmet needs & no actual impairments
Environment- least discussed concept in Abdellah’s model
- atmosphere of a client’s room, home & community
Nursing- helping profession
- all-inclusive service based on art & science disciplines that serves individuals
sick or well, cope w/ their health needs
- uses nursing process, a problem-solving approach
- use 21 nursing problems as guide from nursing care
NURSING PROBLEM
- condition presented/faced by client/family where nurse can offer assistance
- health needs seen as problems: overt (obvious/seen) covert (unseen/masked)
- Abdellah: practice of competent nursing care in future is for nursing student to realize
that identifying & answering overt & covert problems is core of Nursing
Typology of 21 Nursing Problems- identification & classification of problems
 Division: a. physical, sociological & emotional needs of patient Nursing- intentional assessment of comfort needs; comfort design interventions
b. types of interpersonal relationship between nurse & patient address needs;
c. common elements of patient care - reassessment of comfort levels after implementation compared w/baseline
- use nursing process; subj/objective

1. To maintain good hygiene & physical comfort Types

2. To promote optimal activity: exercise, rest, sleep
RELIEF- patient’s state who has its specific need met
3. “ “ safety through preventing accident, injury, trauma & spread of infection
EASE- state of calmness/contentment
4. To maintain good body mechanics & prevent & correct deformity
TRANSCENDENCE- where one rises above one’s problem/pain
5. To facilitate maintenance of oxygen supply to all body cells
6. “ “ “ of nutrition of all body cells Context
7. “ “ “ of elimination. PHYSICAL- bodily sensations (verbalization, expression)
8. “ “ “ of fluid & electrolyte balance PSYCHOSPIRITUAL- internal self-awareness (self-esteem, beliefs)
9. To recognize body’s physiological responses to disease conditions ENVIRONMENTAL- external surroundings, condition, influence
(pathological, physiological & compensatory) SOCIAL- interpersonal, family, societal relationship (communication/interaction)
10. To facilitate maintenance of regulatory mechanisms & functions
11. “ “ “ of sensory function. Taxonomic Structure of
12. To identify & accept positive & negative expression, feelings & reactions.
Comfort
13. “ “ “ interrelatedness of emotions & organic illness
14.To facilitate maintenance of effective verbal & nonverbal communication.
15. To promote development of productive interpersonal relationships
16. To facilitate progress toward achievement & personal spiritual goals
17.To create/maintain a therapeutic environment
18.To facilitate awareness of self as individual w/ diff physical, emotional &
developmental needs
19. To accept optimum possible goals in light of limitation, physical & emotional
20. To use community resources as aid in resolving problems from illness
21. To understand social problems’ role as influencing factors in illness’ cause

PROBLEM SOLVING Major Concepts

- process of identifying overt & covert nursing problems
HEALTH CARE NEEDS- arose from stressful health care situations that can’t be met by
- interpreting, analyzing, & selecting appropriate actions to solve problems recipient’s traditional support system
- steps resemble pace of Nursing process of Assessment, Diagnosis, Planning,
COMFORT INTERVENTION- nursing actions to address specific comfort needs (in/dependent)
Implementation, & Evaluation
INTERVENING VARIABLES- interacting forces influence patient’s perceptions of total comf
Process: 1. Identifying problem 5. Revising hypo on basis of - can’t be controlled; hinder/strengthen
2. Selecting relevant data conclusions from data
COMFORT- state experienced by comfort intervention
3. Devising hypotheses
4. Testing hypotheses through data assessment HEALTH-SEEKING BEHAVIOR- outcomes of pursuit of health defined in nurse consultation
- synthesized by Schlotfeldt (1975), proposed to be int, external, peaceful death
BEST PRACTICES-use evidence-based healthcare interv. to produce best outcome
FAYE ABDELLAH INSTITUTIONAL INTEGRITY- possess qualities of being complete, whole, sound, appealing,
- born 3/13/1919, NYC ethical, sincere (corporation, community, hospital)
- (1942) Diploma in Nursing: Fitkin Memorial Hospital School of Nursing, BEST POLICIES- institutional/regional policies; protocol for procedures & medical conditions
Neptune, New Jersey - access & delivery of healthcare
- (1945) BSN; (1947) MA; (1955) EdD: Teacher's College, Columbia University,
NYC 4 Major Theoretical Proposition
- 1st nurse & 1st woman as Deputy Surgeon General of United States 1. Comfort is generally state-specific
- (2000) inducted into US National Women’s Hall of Fame in 2000 for 2. Outcome of comfort is sensitive to changes over time
contributions in Education & Nursing 3. Any consistently applied holistic nursing interv w/established history for effectiveness
- motivated to develop her typology by desire to promote comprehensive, client- enhances comfort over time
centered nursing care; used problem solving approach as basis for typology 4. Total comfort is greater than sum of its parts
- (1960) published typology of Nursing problems in Patient Centered Approaches
Major Assumptions
in Nursing
1. Humans have holistic responses to complex stimuli
2. Comfort of desirable holistic outcome germane to nursing discipline
KATHARINE KOLKABA (THEORY OF COMFORT) 3. Comfort is basic need which person strive to meet (active endeavor)
COMFORT- antidote to stressors in health care situations; fundamental 4. Enhanced comfort strengthens patient to engage in health-seeking behavior
- when enhanced, patients/families are strengthened 5. Patients empowered to engage in HS behavior are satisfied w/their healthcare
- enhanced by health-seeking behavior; 1st & last consideration 6. Institutional integrity is based on value system oriented to patients. Of equal
- nurses are more satisfied w/their care importance is orientation to health-promoting, holistic setting for family/care provider
Metaparadigms acc to Kolkata
Conceptual Framework of Theory
Person- patient; recipient of care; individual, family, community in need of health care
Health- optimal functioning as defined by patient/group
Environment- aspect of patient, family, institutional setting manipulated by nurse,
relatives, institution to enhance comfort

Acceptance of Theory
PRACTICE
- theory as guiding framework for studies (perioperative nursing, hospice, etc)
- when nurses ask patient/family to rate comfort 0-10 before & after intervention/at
regular intervals, they produce documented evidence that comfort work is done
- used by Perianesthesia nurses into Clinical Practice Guidelines for comfort mngmt:
1. Assess comfort needs related to current surgery/pain issues
2. Create comfort contract w/patient prior to surgery
3. Facilitate comfortable positioning, temp, comfort factors during surgery
4. Continue comfort management & measurement post-surgery
EDUCATION
- applied to role-model a supportive learning partnership w/students
- assist students to transform to professionals for comfort roles/lifelong learning
- used in any clinical setting facilitated by using Kolakaba’s Comfort Care Plans
- theory’s taxonomic structure & conceptual framework guided ways of being
comforting faculty member
- help students by:
1. Obtain relief from heavy coursework by helping questions to clinical problems
2. Maintain ease w/curriculum by trusting faculty
3. Achieve transcendence from stressors through self-comforting techniques
RESEARCH
- nurse provide evidence to influence decision-making at institutional, community,
legislative levels through studies demonstrating effectiveness of comforting care
- use taxonomic structure of comfort as guide; Kolkaba made General Comfort
Questionnaire to measure holistic comfort in hospital/community participants
- researchers make comfort questionnaires; verbal rating scales from Kolkaba’s
website where she responds to inquiries
IDA JEAN ORLANDO (NURSING PROCESS THEORY)
- interrelated; allows nurse to formulate effective nursing care plan easily adapted
when there’s complexity comes up w/patient
- emphasizes reciprocal relationship between patient & nurse
- emphasize critical importance of patient’s participation in nursing process
- nursing as distinct profession & separated it from medicine where nurse as
determining nursing action than being prompted by physician’s orders, organizational
needs, & past personal experience
- physician’s orders are for patients, not for nurses
Metaparadigms acc to Orlando
Person- human; emphasize individuality & dynamic nature of nurse-patient relationship
- focus of nursing practice: humans in need
Health- sense of helplessness as initiator of necessity for nursing
- nursing deals w/persons who need help
Environment- completely disregarded; focused on patient’s immediate need
- relationship & actions between nurse & patient
Nursing- unique & independent in its concerns for person’s need for help
- efforts to meet need for help are done in interactive situation & disciplined
manner that required proper training
Major Dimensions
a. Nurse’s role is to find out & meet patient’s immediate need for help
b. Patient’s presenting behavior may be plea for help; help needed may not be what it
appears to be
c. Nurses need to use perception, thoughts on perception, feeling endangered from
thoughts to explore patient’s behavior meaning
d. This process help nurse find out nature of distress & what help patient needs
Goals
1. Develop theory of effective nursing practice
Theory explains that nurse’s role is to find out & meet patient’s need of help
All patient behavior can be cry of help
Nurse’s job is to find out nature of patient’s distress & provide help they need
Assumptions
1. When patients are can’t cope w/needs on own, they are distressed by helplessness
2. In its professional character, nursing adds to patient’s distress
3. Patients are unique & individual in how they respond
4. Nursing offer mothering & nursing analogous to adult who nurtures child
5. Nursing practice deals w/people, env, & health
6. Patients need help communicating their needs; they’re uncomfy & ambivalent about
dependency needs
7. People can be secretive/explicit about needs, perceptions, feelings
8. Nurse-patient situation is dynamic; actions & reaction influenced by nurse & patient
9.People attach meanings to situations & actions that aren’t apparent to others
10. Patients enter nursing care through medicine
11. Patient can’t state nature & meaning of distress w/o nurse or w/o them first having
established helpful relationship w/patient
12. Any observation shared/observed w/patient is helpful in ascertaining & meeting
needs/finding out that they’re not in need at that time
13. Nurse is concerned w/patient’s needs unable to meet on their own
Terms
DISTRESS- patient experience whose need hasn’t been met
NURSING ROLE- discover & meet patient’s immediate need for help
- patient’s behavior may not represent true need
- nurse validates their understanding of patient’s need
NURSING ACTION- directly/indirectly provide for patient’s immediate need
OUTCOME- patient’s behavior change indicating relief from distress/unmet need
- observable verbally/nonverbally
Concepts
PROF. NURSING FUNCTION (Organizing Principle)
- finding out & meeting patients’ immediate need for help
- “nursing is responsive to persons who suffer helplessness; focused on process of care
in immediate experience”
- concerned w/providing direct assistance to persons for purpose of avoiding, relieving,
diminishing, curing their helplessness (Orlando)
PRESENTING BEHAVIOR (Problematic Situation)
- nurse must 1st recognize situation as problematic to find out immediate need for help
- patient’s presenting behavior may represent plea for help
- stimulus (patient’s present behavior) cause autonomic internal response in nurse &
nurse’s behavior causes response in patient
IMMEDIATE REACTION (Internal Response)
3 processes: person perceives using any of 5 sense organs as object
perceptions stimulate automatic thought
each thought stimulate automatic feeling
NURSING PROCESS DISCIPLINE (Investigation)
- any observation shared & explored w/patient is useful in ascertaining & meeting his
need/finding out that he’s not in need at that time
- nurse doesn’t assume that any of her reaction’s aspect to patient is correct, helpful/
appropriate until she checks its validity in exploration w/patient
IMPROVEMENT (Resolution)
- it’s not nurse’s activity that’s evaluated but its result: whether activity serves to help
patient communicate their need for help & how it’s met
- in each contact, nurse repeats process of learning how to help patient
Nursing Process
1. ASSESSMENT- nurse completes holistic assessment of patient’s needs
- done w/o considering reason for encounter
2. DIAGNOSIS- use nurse’s clinical judgment about health problems
- confirmed using links to defining characteristics, related factors, & risk
factors found in patient’s assessment
3. PLANNING- address each problem identified in diagnosis
 - each problem is given specific goal/outcome confidence for young mother, mouthpiece for those too weak/withdrawn to speak, &
- each outcome is given nursing interventions to help achievesogoal
on.”
4. IMPLEMENTATION- nurse begins to use nursing care plan
5. EVALUATION- nurse looks at patient’s progress toward goals set in nursing care plan
- changes can be made to plan based on patient’s progression to goals
VIRGINIA AVENEL HENDERSON (BASIC HUMAN NEED THEORY)
A. PHYSIOLOGICAL NOLA J. PENDER (HEALTH PROMOTION THEORY)
1. Breathe normally 6. Select suitable clothes (dress/undress) - each person has unique personal characteristics/experience affecting subsequent acts
2. Eat and drink adequately 7. Maintain body temp within by adjusting - health promoting behavior: desired behavioral outcome; endpoint in HP model
3. Eliminate body wastes clothing & modifying env : result in improved health, enhanced functional ability, better quality
4. Move & maintain desirable posture 8. Keep body clean, well groomed, protect skin of life at all dev’t stages
5. Sleep & rest 9. Avoid dangers in env; avoid injuring others - final behavioral demand influenced by immediate competing demand & preference,
B. PSYCHOLOGICAL which can derail intended health-promoting actions
10. Communicate in expressing emotions, needs, fears, opinions - health: positive dynamic state than simply disease absence
- health promotion: directed at increasing patient’s level of wellbeing
C. SPIRITUAL - person’s multidimensional nature as they interact within env to pursue health
11. Worship according to one’s faith - designed to be complementary counterpart to models of health protection
D. SOCIOLOGICAL - incorporate behaviors for improving health & applies across lifespan
12. Work in a way that there’s a sense of accomplishment Goal: Nurse assist in knowing & understanding major determinants of health behavior
13. Play/participate in recreation
Subconcepts
E. PSYCHOLOGICAL
PERSONAL FACTORS- biological, psychological, sociocultural
14. Learn, discover, satisfy curiosity that leads to normal dev’t & health; use available - predictive of given behavior; shaped by target behavior’s nature
health facilities
PERCEIVED BENEFITS OF ACTION- anticipated positive outcomes from health behavior
 Henderson emphasized need to view patient & his family as a single unit
“ BARRIERS TO ACTION- anticipated/imagined/real blocks & personal costs of
 For patient to achieve health, he must meet need for support system (by family)
understanding given behavior
Metaparadigms acc to Henderson: “ SELF-EFFICACY- judgment of personal capability to organize & execute HP behavior
Person- patient; require assistance to achieve health & independence/peaceful death ACTIVITY-RELATED AFFECT- subjective pos/neg feeling before, during, following behavior
- person & family viewed as a unit; mind & body are inseparable based on behavior’s stimulus properties
- must maintain physiological & emotional balance - influence perceived self-efficacy
- more positive subjective feeling = greater feeling of efficacy
Health- quality of life basic to human functioning
- requires independence & interdependence INTERPERSONAL INFLUENCE- cognition on others’ behavior, belief, attitudes
- its promotion is more important than care - norms, social support, modelling
- primary source: family, peers, healthcare providers
- maintained if they have necessary strength, will, knowledge
SITUATIONAL “ - situation’s personal perception/cognition that facilitate/impede behavior
Environment- not specifically defined; relationship w/family, community & its
responsibility for providing health care. COMMITMENT TO PLAN OF ACTION- intention & identification of planned strategy leads to
- Henderson: society wants & expects nurses to provide service for persons health behavior implementation
incapable of functioning independently IMMEDIATE COMPETING DEMANDS & PREFERENCES
Nursing- “unique nurse’s function is to assist individual, sick or well in performance of Competing Demands- alternative behaviors where persons have low control due to env
activities contributing to health/recovery/peaceful death; that they can contingencies (work/family responsibilities)
perform unaided if they had necessary strength, will, knowledge. To do this Competing Preference- exert relatively high control (choice of snack)
in a way that help him gain independence as rapidly as possible.” HEALTH-PROMOTING BEHAVIOR- endpoint/act outcome toward positive health outcome
- requires working interdependently w/ health care team - optimal wellbeing, personal fulfillment, productive living
- nurse functions independently of physician but uses latter’s plan of care to
provide holistic care Major Assumptions
 Nurse functions in relation w/patient, physician, & members of health team 1. Persons seek to actively regulate own behavior
2. Persons, in all their biopsychosocial complexity, interact w/env, progressively transforming
Nurse-Patient Relationship env & being transformed over time
a. Nurse as substitute for patient 3. Health professionals is part of interpersonal env, exerting influence on people
- making up for what patient lacks to be whole & independent again 4. Self-initiated reconfiguration of personal env interactive patters is for changing behavior
b. Nurse as helper to patient
14 Theoretical Assertions
- institute medical interventions to assist patient meet basic needs
1. Prior behavior & inherited/acquired characteristics influence belief, affect, & enactment of
c. Nurse as partner w/patient
HP behavior
- foster therapeutic relationship w/ patient; function as member of health care team
2. Persons engage in behaviors where they anticipate deriving personally valued benefit
Nurse-Physician Relationship 3. Perceived barriers can constrain commitment to action, mediator & actual behaviors
- nurses function independently from physicians 4. “ competence/self-efficacy to execute behavior increase likelihood of action
- plan of care must be implemented in a way that promotes physician’s prescribed commitment & actual behavior performance
therapeutic plan 5. Family, peers, healthcare providers are important sources of interpersonal influence that
increase/decrease commitment & engagement in HP behavior
Nurse as Member of Healthcare Team
6. Situational influence in ext env inc/decrease commitment/participation to HP behavior
- every member work interdependently
7. Greater commitment to plan of action=more likely HP behaviors maintained over time
- nurse works & contributes in carrying out total program of care
8. Plan of action commitment is less likely to result in desired behavior when competing
demands where persons have little control require immediate attention
“She is temporarily consciousness of unconscious, love of life for suicidal, leg of
amputee, eyes of newly blind, means of locomotion for infant, knowledge & 9. “ “ “ “ “ when other actions are more attractive & preferred over target behavior
 10. Persons can modify cognition, affect, interpersonal, physical env to create
WORLD
incentives
VIEW-foroutlook to form value perception about life/world around person
health actions Social Structure- culture’s organizational factors (religion, educ, economics) & how
these give meaning & order to culture
Environmental Context- totality of event, situation, experience that give meaning
to expression, interpretation & social interaction in physical,
ecological, sociopolitical, cultural settings

ETHNOHISTORY- past events/experience of cultures; people-centered

MADEILINE LEININGER (CULTURAL CARE DIVERSITY & UNIVERSALITY)
- defines theory differently from other theorists
- theory must consider cultural belief, caring, behavior, & values to provide effective,
satisfying, & culturally congruent nursing care
Metaparadigms acc to Leininger:
Person- human being; caring & can be concerned about desires, welfare, others’
continued existence
- although care is universal; ways of caring varies across cultures
Health- state of wellbeing culturally defined, valued, practiced
- reflects persons’ ability to perform daily roles; health system, practice, pattern
Environment
Environmental Framework: totality of event, situation, experience giving meaning
to human expression, interpretation, social interaction on
physical, ecological, sociopolitical, cultural settings
Culture: groups & patterning of actions, thoughts, decisions occurring as result of
“learned, shared, & transmitted belief, norm, lifeways”
Nursing- learning humanistic art & science focusing on personalized behavior,
function, process to promote & maintain health/recovery
- explain, interpret human lifeways within cultural trends
GENERIC (FOLK/LAY) CARE SYSTEM
- culturally learned/transmitted; indigenous (traditional), folk (community/home-based)
knowledge & skills to provide assistive, supportive, enabling acts towards others
w/evident needs to improve lifeway/health condition (wellbeing) or deal w/handicaps &
death situations
PROFESSIONAL CARE SYSTEM
- formally taught/transmitted prof care, health, illness, wellness & related knowledge &
practice skills prevailing in professional institutions w/multidisciplinary personnel to give
service to others
CARMENCITA M. ABAQUIN (PREPARE ME THEORY)
- “PREPARE ME” interventions & Quality of Life of Advance Progressive Cancer Patients
- framework on nonpharmacologic, non-surgical care approach to advanced cancer cases
- nurse not seen as mere caregivers but facilitators of peaceful acceptance of condition

3 modes of nursing action Focus:assist patient explore humanity & internal serenity facing life & death than cure
- culturally-based, consistent w/client’s needs/values PRESENCE- during times of need; therapeutic communication, active listening, touch
- assistive, supporting, facilitative, enabling professional acts & decisions REMINISCE THERAPY- recall of past experiences, feelings, thoughts to facilitate adaptation
a. Cultural care Preservation / Maintenance to present circumstances
- help people w/culture to retain/preserve relevant care values to they can PRAYER- praying to God
maintain wellbeing, recover from illness, face handicaps/death
RELAXATION-BREATHING- encourage relaxation to decrease undesirable signs & symptoms
b. “ “ Accommodation / Negotiation
MEDITATION- relaxation to alter patient’s level of awareness by focusing on image/thought
- help those to adapt/negotiate w/others for beneficial/satisfying health outcome
to help inner sight which establish connection & relationship w/ God
w/prof care providers
VALUES CLARIFICATION- clarify values on health & illness to help effective decision making
c. “ “ Repatterning / Restructuring - patient develops open mind for disease state acceptance/enhance values
- help client change/modify lifeways for new, diff, beneficial healthcare pattern - helps one become internally consistent by achieving closer between what we
while respecting their cultural value & belief & providing beneficial/healthier do & what we feed
lifeway before changes were laid out
Metaparadigms acc to Abaquin:
About Theory
Person- patient in advanced stages of cancer; holistic being w/ physical, psycho, social,
- assumptions supporting her claim that “diff cultures perceive, know, & practice care religious, level of independence, & environmental aspects.
in diff ways, yet there’s commonalities among cultures in world”
- terminally-ill/incurable diseases must be approached in multifaceted care
Transcultural Nursing Model to improve quality of life
Transcultural Nursing- learned branch of nursing about comparative study & analysis Health- focus on illness (cancer) & provision of holistic care to improve life quality
of cultures as they apply to nursing & health-illness practice, belief, values despite terminal cases
- knowing & understanding culture w/respect to nursing & health-illness practice Quality of Life- multifaceted construct encompassing persons capabilities of
Goal: provide care congruent w/cultural values, beliefs, practices enriching life when it can no longer be prolonged.
- includes proper care & maintaining body integrity, mind, spirit
CARE- assist, support, enable behaviors that ease/improve condition
- diff meanings in diff cultures determined by examining person’s world view, Environment- not defined accurately; aspect/ dimension integrated to cancer patient
social structure, language Nursing- goal of care: quality of life improvement for advance stage cancer patients
CARING- actions/activities toward assisting, supporting, enabling person w/
evident/anticipated needs to improve condition to recover/face death
CULTURE- learned, shared, transmitted values, belief, norms, lifeways
- guides thinking, decisions, actions
- basis for cultural values which identify ways of thinking/acting
- values are held for long time & guide decision-making in culture
- exhibit diversity (perceive, know, practice care in diff ways) &
universality (care commonalities)
CULTURAL CARE- subjectively & objectively obtained value, belief, outline of lifeway
- assist, support, facilitate, empower others to maintain wellbeing,
health, & deal w/illness, handicaps, death
CC Diversity- diff belief, value, symbols of care within concepts related in
supporting, assisting human care (role of sick person)
CC Universality- similarities in cultures & reflect assistive ways to help
 Health- expressed in wellness/illness Nursing- expression of caring

Assumptions
Persons are caring by virtue of humanness; whole/complete in the moment.
knowing persons is process of nursing allowing for continuous appreciation of person
moment to moment.
echnology is used to know wholeness of persons moment to moment.
Nursing is a discipline & professional practice
SR. LETTY KUAN (RETIREMENT & ROLE DISCONTINUITIES THEORY) Technological Competency as Caring in Nursing
Retirement- require adjustments; a. Harmonious coexistence between technologies & caring in nursing.
- there are some roles that person has already learned to play for many years. b. Harmonization of concepts places practice of nursing within context of modern
- now that role has to be discontinued, there’s period of adjustment so person can healthcare & acknowledges that concepts can co-exist
adjust to another new role in life c. Technology brings patient closer to nurse. Technology increase gap of nurse & nursed
d. When technology is used to know persons continuously, process of nursing is lived
Basic Assumptions & Concepts:
PHYSIOLOGICAL AGE- endurance of cells/tissues to withstand wear-&-tear Dimensions of Technological Value in Theory
ROLE- shared expectations focused on a position - Technology as completing human beings to reformulate ideal human (organic/ mechanical
- beliefs on goals/ values to pursue; norms that govern behavior. replacement parts)
- shared expectations from retiree’s socialization experiences & values - “ as machine technologies (computers, gadgets)
internalized while preparing for position; adaptations to expectations socially - “ that mimic humans & human activities to meet demands of nursing care practices
defined for position itself
Nursing Process
- for every social role, there’s complementary roles in social structure
1. KNOWING- guided by tech knowing which persons are appreciated as participants in
CHANGE OF LIFE- between near retirement & post retirement years their care than as objects of care; nurse enters world of other:
- (medico-physiologic terms) climacteric period of adjustment & readjustment
- technology is used to magnify person’s aspect that requires revealing
to another tempo of life
(representation of real person)
RETIREE- left productive years & completed required years of service
2. DESIGNING- nurse & nursed plan a mutual care process where nurse organize a
ROLE DISCONTINUITY- interruption in status/role enjoyed rewarding nursing practice responsive to patient’s desire for care
- brought about by accident, emergency, change of position/retirement
3. PARTICIPATION IN APPRECIATION- simultaneous practice of conjoined activities for
COPING APPROACH- restore/maintain equilibrium & normal functioning knowing persons.
- alternating rhythm of implementation & evaluation.
Determinants (Positive Perceptions in Retirement & Reactions to Role Discontinuity
- evidence of continuous knowing, implementation, & participation is reflective
HEALTH STATUS- physiological & mental state; classified as sickly/healthy of cyclical process of knowing persons.
INCOME/ECONOMIC LEVEL- financial affluence; “ “ poor/moderate/ 4. VERIFYING KNOWLEDGE- continuous, circular process demonstrates ever-changing,
WORK STATUS- acc to one’s work dynamic nature of knowing in nursing
FAMILY CONSTELLATION- family composition - Knowledge about person derived from knowing, designing,
- close knit/extended (3 or more generations under 1 roof) implementing further informs nurse and nursed
- distanced (member in separate house; nuclear (parents & children)
SELF-PREPARATION- prepare self to possible outcome in life Nursing Informatics
- info systems in healthcare include people, structures, process, & manual as well as
Findings & Recommendations automated tools that collect, store, interpret, transform, report practice & mngmt info
1. HEALTH STATUS- dictates capacity & role type for present & future
- fits for everyone to maintain & promote health at all ages
2. FAMILY CONSTELLATION- positive index on retirement & role discontinuity
- Philippines: family as security/trusting bank
- when one retires, shock of role discontinuity is softened due to family & bc it
offers gainful substitutes (provide monetary support, absorb emotional strains)
3. INCOME- high correlation w/retirement perception & reaction to role discontinuity
- retirement pensions must be adjusted; to have more relevant & realistic pension
4. WORK STATUS- works w/economic security that generates decent compensation
- retirement shouldn’t be a period of no work since function get sharpened
- work enhances self-esteem & contributes to wellness even at old age
5. SELF-PREPARATION- therapeutic/recreational; professionalism/expertise, benevolent work
- investing in what gives dignity, self-worth, happiness than in money
7. To perceive retirement positively, it requires early socialization, full participation. Fellow
retirees must recognize & appreciate knowledge, wisdom, experience, values (social
assets that make retired age & custodians’folk wisdom)
8. Gov’t agency to construct holistic pre-retirement preparation program
9. Retirement must be recognized as fulfilment of one’s birthright & meaningful life
“I have grown & sown, now I can reap reward & blessing of life lived in joy & love, for I too
have made others grow” (Letty Gurdiel Kuan)

ROZZANO LOCSIN (TECHNOLOGICAL COMPETENCY AS CARING IN NURSING)

- is a middle range theory grounded in Nursing as Caring
- nursing practice grounded in harmonious coexistence of technology & nurse caring

Metaparadigm acc to Locsin

Person- participants Environment- technological world