4 | Theoretical Foundation in Nursing 1

UNIT 4: NURSING THEORIES

 

1.0 Intended Learning Outcomes

a. Present the Different nursing theories
b. Apply nursing theories in the nursing practice
c. Discuss the salient point for each theory

 
1.1. Introduction

As defined by Morse (2017) a conceptual model is a representation of a system

that uses concepts and ideas to form said representation. It is used as a way to
describe physical or social aspects of the world in an abstract way. Moreover, A
conceptual model or theoretical framework provides a coherent, unified and orderly
way of envisioning related events or processes relevant to a discipline (Fawcett
2005).
The terms ‘conceptual model’ and ‘theoretical framework’ are often used
interchangeably, but a theoretical framework generally incorporates at least part of a
specific theory as the basis for a study. In addition, a theoretical framework often
includes propositional statements describing the relationships among variables and
has received more testing than the more tentative conceptual model (Polit & Beck
2004).

1.2 Topics/Discussion (with Assessment/Activities) -Rosales-

A. Hildegard Peplau: Interpersonal Relations Theory

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Biography of Hildegard E. Peplau (Gonzalo,

2019)
Hildegard Elizabeth Peplau (September 1, 1909 – March 17, 1999) was an American
nurse who is the only one to serve the American Nurses Association (ANA) as Executive
Director and later as President. She became the first published nursing
theorist since Florence Nightingale.

Peplau was well-known for her Theory of Interpersonal Relations, which helped to

revolutionize the scholarly work of nurses. Her achievements are valued by nurses all
over the world and became known to many as the “Mother of Psychiatric Nursing” and
the “Nurse of the Century.” 

Hildegard Peplau’s Interpersonal Relations

Theory
Hildegard Peplau’s Interperosonal Relations Theory emphasized the nurse-client
relationship as the foundation of nursing practice. It gave emphasis on the give-and-
take of nurse-client relationships that was seen by many as revolutionary. Peplau went
on to form an interpersonal model emphasizing the need for a partnership between
nurse and client as opposed to the client passively receiving treatment and the nurse
passively acting out doctor’s orders.

The four components of the theory are: person, which is a developing organism that
tries to reduce anxiety caused by needs; environment, which consists of existing
forces outside of the person, and put in the context of culture; health, which is a word
symbol that implies forward movement of personality and nursing, which is a
significant therapeutic interpersonal process that functions cooperatively with other
human process that make health possible for individuals in communities.

The nursing model identifies four sequential phases in the interpersonal

relationship: orientation, identification, exploitation, and resolution.

It also includes seven nursing roles: Stranger role, Resource role, Teaching role,
Counseling role, Surrogate role, Active leadership and Technical expert role.

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Description
Hildegard E. Peplau’s theory defined Nursing as “An interpersonal process of therapeutic
interactions between an individual who is sick or in need of health services and a nurse
especially educated to recognize, respond to the need for help.” It is a “maturing force and
an educative instrument” involving an interaction between two or more individuals with
a common goal.

In nursing, this common goal provides the incentive for the therapeutic process in
which the nurse and patient respect each other as individuals, both of them learning
and growing as a result of the interaction. An individual learns when she or he selects
stimuli in the environment and then reacts to these stimuli.

Assumptions
The assumptions of Hildegard Peplau’s Interpersonal Relations Theory are: (1) Nurse
and the patient can interact. (2) Peplau emphasized that both the patient and nurse
mature as the result of the therapeutic interaction. (3) Communication and
interviewing skills remain fundamental nursing tools. And lastly, (4) Peplau believed
that nurses must clearly understand themselves to promote their client’s growth and
to avoid limiting the client’s choices to those that nurses value.

Major Concepts of the Interpersonal Relations

Theory
The theory explains the purpose of nursing is to help others identify their felt
difficulties and that nurses should apply principles of human relations to the problems
that arise at all levels of experience.

Man
Peplau defines man as an organism that “strives in its own way to reduce tension
generated by needs.” The client is an individual with a felt need.

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Health
Health is defined as “a word symbol that implies forward movement of personality and
other ongoing human processes in the direction of creative, constructive, productive,
personal, and community living.”

Society or Environment
Although Peplau does not directly address society/environment, she does encourage
the nurse to consider the patient’s culture and mores when the patient adjusts to
hospital routine.

Nursing
Hildegard Peplau considers nursing to be a “significant, therapeutic, interpersonal
process.” She defines it as a “human relationship between an individual who is sick, or
in need of health services, and a nurse specially educated to recognize and to respond
to the need for help.”

Therapeutic nurse-client relationship

A professional and planned relationship between client and nurse that focuses on the
client’s needs, feelings, problems, and ideas. It involves interaction between two or
more individuals with a common goal. The attainment of this goal, or any goal, is
achieved through a series of steps following a sequential pattern.

Four Phases of the therapeutic nurse-patient relationship:

1. Orientation Phase
The orientation phase is directed by the nurse and involves engaging the client in
treatment, providing explanations and information, and answering questions.

 Problem defining phase

 Starts when the client meets nurse as a stranger

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 Defining problem and deciding the type of service needed

 Client seeks assistance, conveys needs, asks questions, shares
preconceptions and expectations of past experiences
 Nurse responds, explains roles to the client, helps to identify problems and to
use available resources and services

2. Identification Phase
The identification phase begins when the client works interdependently with the nurse,
expresses feelings, and begins to feel stronger.

 Selection of appropriate professional assistance

 Patient begins to have a feeling of belonging and a capability of dealing with
the problem which decreases the feeling of helplessness and hopelessness

3. Exploitation Phase

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In the exploitation phase, the client makes full use of the services offered.

 In the exploitation phase, the client makes full use of the services offered.
 Use of professional assistance for problem-solving alternatives
 Advantages of services are used is based on the needs and interests of the
patients
 The individual feels like an integral part of the helping environment
 They may make minor requests or attention-getting techniques
 The principles of interview techniques must be used in order to explore,
understand and adequately deal with the underlying problem
 Patient may fluctuate on independence
 Nurse must be aware of the various phases of communication
 Nurse aids the patient in exploiting all avenues of help and progress is made
towards the final step

4. Resolution Phase
In the resolution phase, the client no longer needs professional services and gives up
dependent behavior. The relationship ends.

 In the resolution phase, the client no longer needs professional services and
gives up dependent behavior. The relationship ends.
 Termination of professional relationship
 The patients needs have already been met by the collaborative effect of
patient and nurse
 Now they need to terminate their therapeutic relationship and dissolve the
links between them.
 Sometimes may be difficult for both as psychological dependence persists
 Patient drifts away and breaks the bond with the nurse and healthier
emotional balance is demonstrated and both becomes mature individuals

Interpersonal Theory and Nursing Process

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Both Peplau’s Interpersonal Relations Theory and the Nursing Process are sequential
and focus on the therapeutic relationship by using problem-solving techniques for the
nurse and patient to collaborate on, with the end purpose of meeting the patient’s
needs. Both use observation communication and recording as basic tools utilized by
nursing.

Orientation
Assessment
 Non-continuous
 Continuous data collection and analysis data collection

 May not be a felt need  Felt need

 Definite needs
Identification
Nursing Diagnosis & Planning
 Interdependent
 Mutually set goals
goal setting
Implementation Exploitation

 Plans initiated towards achievement of  Patient actively

mutually set goals seeking and
drawing help
 May be accomplished by patient, nurse,
or significant other.  Patient-initiated
Resolution

Evaluation  Occurs after other

phases are
 Based on mutually expected behaviors
completed
 May led to termination and initiation of successfully
new plans
 Leads to
termination

ASSESSMENT NO. 3:
1. PROVIDE A SUMMARY OF PEPLAU’S INTERPERSONAL
RELATIONS THEORY. OBSERVE PROPER CITATION USING
APA7.(200-300 WORDS ONLY).
2. HOW CAN YOU APPLY THIS NURSING THEORY TO THE
NURSING PRACTICE AND WHAT IS ITS SIGNIFICANCE?

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B. Faye Glenn Abdellah's Twenty-One Nursing Problems

Biography and Career of Faye Glenn Abdellah

Faye Glenn Abdellah was born on March 13, 1919. Abdellah was the first nurse
officer to earn the ranking of a two-star rear admiral. She was the first nurse and the
first woman to serve as a Deputy Surgeon General. Her work changed the focus of
nursing from disease-centered to patient-centered, and began to include the care of
families and the elderly in nursing care. The Patient Assessment of Care Evaluation
developed by Abdellah is now the standard used in the United States.

Faye Glenn Abdellah's Contribution to Nursing Theory: Twenty-One Nursing

Problems
According to Abdellah’s Twenty-One Nursing Problems theory of nursing,
“Nursing is based on an art and science that moulds the attitudes, intellectual
competencies, and technical skills of the individual nurse into the desire and ability
to help people, sick or well, cope with their health needs.”
The patient-centered approach to nursing was developed from Abdellah’s practice,
and the theory is considered a human needs theory. It was created to help with
nursing education, so it most applicable in that area. The nursing model is intended

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to guide care in hospitals, but can be applied to community nursing, as well.

The model has interrelated concepts of health and nursing problems, as well as
problem-solving, which is an activity inherently logical in nature.

Abdellah’s theory identifies ten steps to identify the patient’s problem and 11
nursing skills used to develop a treatment typology. The ten steps are:

1. Learn to know the patient.

2. Sort out relevant and significant data.
3. Make generalizations about available data in relation to similar nursing
problems presented by other patients.
4. Identify the therapeutic plan.
5. Test generalizations with the patient and make additional generalizations.
6. Validate the patient’s conclusions about his nursing problems.
7. Continue to observe and evaluate the patient over a period of time to identify
any attitudes and clues affecting his or her behavior.
8. Explore the patient and his or her family’s reactions to the therapeutic plan
and involve them in the plan.
9. Identify how the nurses feel about the patient’s nursing problems.
10. Discuss and develop a comprehensive nursing care plan.

The 11 nursing skills are:

1. observation of health status
2. skills of communication
3. application of knowledge
4. teaching of patients and families
5. planning and organization of work
6. use of resource materials
7. use of personnel resources
8. problem-solving
9. direction of work of others
10. therapeutic uses of the self
11. nursing procedure

The model identifies nursing as a helping profession. Nursing care is doing something
to or for a patient, or providing information to the patient with the intention of meeting
needs, increasing self-ability, or alleviating impairment. In other words,helping patients
become more healthy.

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Abdellah describes health as a state mutually exclusive of illness. There is no definition of

health given by her in the theory, but she speaks to “total health needs” and “a healthy
state of mind and body” in her description of nursing as a comprehensive service.

The nursing process in Abdellah’s Twenty-One Nursing Problems theory is: assessment,
nursing diagnosis, planning, implementation, and evaluation.

In the assessment phase, nursing problems provide guidelines for the collection of data. A
principle underlying the problem-solving approach is that for each identified problem,
pertinent data is collected. The overt or covert nature of problems necessitates a direct or
indirect approach, respectively.

The results of the collection of data in the assessment phase determine the patient’s
specific problems, which can be grouped under one or more of the broader nursing
problems. This creates the nursing diagnosis.

The statement of nursing problems most closely resembles goal statements. Using the
goals in the framework, a nursing care plan is developed and appropriate nursing
interventions are determined. Putting those interventions in action is the implementation
phase of the nursing process.

After the interventions have been carried out, the evaluation takes place. The most
appropriate evaluation would be the nurses’ progress or lack of progress toward the
achievement of the goals established in the planning phase.

ASSESSMENT NO. 2:
1. PROVIDE A SUMMARY OF ABDELLAH'S TWENTY-
ONE NURSING PROBLEMS. OBSERVE PROPER
CITATION USING APA7.(200-300 WORDS ONLY).
2. HOW CAN YOU APPLY THIS NURSING THEORY TO
THE NURSING PRACTICE AND WHAT IS ITS
SIGNIFICANCE?
C. Virginia Henderson: Nursing Need Theory (Gonzalo, 2019)

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Biography of Virginia Henderson

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

Need Theory

Among her other works, Henderson’s widely known contributions to nursing is the
Need Theory. The Need Theory emphasizes on the importance of increasing the
patient’s independence and focus The Nursing Need Theory was developed by
Virginia Henderson to define the unique focus of nursing practice. The theory focuses
on the importance of increasing the patient’s independence to hasten their progress in
the hospital. Henderson’s theory emphasizes on the basic human needs and how
nurses can assist in meeting those needs.

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

Assumptions of the Need Theory

The assumptions of Virginia Henderson’s Need Theory are: (1) Nurses care for patients
until they can care for themselves once again. Although not precisely explained, (2)
patients desire to return to health. (3) Nurses are willing to serve and that “nurses will

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devote themselves to the patient day and night.” (4) Henderson also believes that the
“mind and body are inseparable and are interrelated.”

Major Concepts of the Nursing Need Theory

The following are the major concepts (nursing metaparadigm) and definitions of the
Need Theory of Virginia Henderson.

Individual

Henderson states that individuals have basic needs that are component of health and
require assistance to achieve health and independence or a peaceful death. According
to her, an individual achieves wholeness by maintaining physiological and emotional
balance on the basic human needs so that progress after hospitalization would not be
delayed.

She defined the patient as someone who needs nursing care but did not limit nursing
to illness care. Her theory presented the patient as a sum of parts with biopsychosocial
needs and the mind and body are inseparable and interrelated.

Environment

Although the Need Theory did not explicitly define the environment, Henderson stated
that maintaining a supportive environment conducive for health is one of the elements
of her 14 activities for client assistance.

Henderson’s theory supports the tasks of the private and the public health sector or
agencies in keeping the people healthy. She believes that society wants and expects
the nurse’s service of acting for individuals who are unable to function independently.

Health

Although not explicitly defined in Henderson’s theory, health was taken to mean
balance in all realms of human life. It is equated with the independence or ability to
perform activities without any aid in the 14 components or basic human needs.

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Nurses, on the other hand, are key persons in promoting health, prevention of illness
and being able to cure. According to Henderson, good health is a challenge because it
is affected by numerous factors such as age, cultural background, emotional balance,
and others.

Nursing

Virginia Henderson wrote her definition of nursing before the development of

theoretical nursing. She defined nursing as “the unique function of the nurse is to
assist the individual, sick or well, in the performance of those activities contributing to
health or its recovery that he would perform unaided if he had the necessary strength,
will or knowledge. And to do this in such a way as to help him gain independence as
rapidly as possible.” The nurse’s goal is to make the patient complete, whole, or
independent. In turn, the nurse collaborates with the physician’s therapeutic plan.

Nurses temporarily assist an individual who lacks the necessary strength, will, and
knowledge to satisfy one or more of the 14 basic needs. She states: “The nurse is
temporarily the consciousness of the unconscious, the love life for the suicidal, the leg
of the amputee, the eyes of the newly blind, a means of locomotion for the infant,
knowledge, and confidence of the young mother, the mouthpiece for those too weak
or withdrawn to speak”

Additionally, she stated that “…the nurse does for others what they would do for
themselves if they had the strength, the will, and the knowledge. But I go on to say that
the nurse makes the patient independent of him or her as soon as possible.”

Her definition of nursing distinguished the role of a nurse in health care: The nurse is
expected to carry out a physician’s therapeutic plan, but individualized care is the
result of the nurse’s creativity in planning for care.

The nurse should be an independent practitioner able to make an independent

judgment. In her work Nature of Nursing, she states the nurse’s role is “to get inside the
patient’s skin and supplement his strength, will or knowledge according to his needs.”
The nurse has the responsibility to assess the needs of the patient, help him or her
meet health needs, and provide an environment in which the patient can perform
activity unaided.

14 Components of the Need Theory

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The 14 components of Virginia Hendersons Need Theory show a holistic approach to

nursing that covers the physiological, psychological, spiritual and social needs.

Physiological Components

 1. Breathe normally
 2. Eat and drink adequately
 3. Eliminate body wastes
 4. Move and maintain desirable postures
 5. Sleep and rest
 6. Select suitable clothes – dress and undress
 7. Maintain body temperature within normal range by adjusting clothing and
modifying environment
 8. Keep the body clean and well groomed and protect the integument
 9. Avoid dangers in the environment and avoid injuring others

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Psychological Aspects of Communicating and Learning

 10. Communicate with others in expressing emotions, needs, fears, or

opinions.
 14. Learn, discover, or satisfy the curiosity that leads to normal development
and health and use the available health facilities.

Spiritual and Moral

 11. Worship according to one’s faith

ASSESSMENT NO. 2:

3. PROVIDE A SUMMARY OF VIRGINIA

HENDERSON’S THEORY. OBSERVE PROPER
CITATION USING APA7.(200-300 WORDS ONLY).
4. HOW CAN YOU APPLY THIS NURSING THEORY TO
THE NURSING PRACTICE AND WHAT IS ITS
SIGNIFICANCE?

Nursing Theoretical Works

Non- Nursing Theories

Human needs theories propose that all humans have certain basic universal
needs and that when these are not met conflict is likely to occur (Danesh,
2011).
 Maslow's Hierarchy of Needs Theory- According to Abraham Maslow as cited
by Akrani(2010), human behavior is related to his needs. It is adjusted as per the
nature of needs to be satisfied. In hierarchy of needs theory, Maslow identified five
types / sets of human need arranged in a hierarchy of their importance and priority.
He concluded that when one set of needs is satisfied, it ceases to be a motivating
factor. Thereafter, the next set of needs in the hierarchy order takes its place. These
needs in hierarchy can be compared to a pyramid. At the lowest level, there will be
first set of needs which can be described as basic needs and are universal in

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character. This will be followed by other sets of needs.

Source: Akrani, 2010

The Maslow's Pyramid of Human Needs is explained below (Akrani, 2010) :

Physiological Needs: Physiological needs are the basic needs for sustaining human life.
These needs include food, shelter, clothing, rest, air, water, sleep and sexual satisfaction.
These basic human needs (also called biological needs) lie at the lowest level in the
hierarchy of needs as they have priority over all other needs.

Security / Safety Needs: These are the needs connected with the psychological fear of loss
of job, property, natural calamities or hazards, etc. An employee wants protection from
such types of fear. The safety needs come after meeting the physiological needs. Such
physiological needs lose their motivational potential when they are satisfied. As a result,
safety needs replace them. They begin to manifest themselves and dominate human
behavior. Safety needs act as motivational forces only if they are unsatisfied.

Love and belonging Needs: Every person desires to be affiliated to such groups. This is
treated as basic social need of an individual. He also feels that he should be loved by the
other members. He needs friends and interaction with his friends Social needs occupy third

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position in the hierarchy of needs.

Esteem Needs : This category of needs include the need to be respected by others, need to
be appreciated by others, need to have power and finally prestigious position. Once the
previous needs are satisfied, a person feels to be held in esteem both by himself and also by
others. Thus, esteem needs are two fold in nature. Self -esteem needs include those for self
confidence, self-respect, competence, etc. The second groups of esteem needs are those
related to one's status, reputation, recognition and appreciation by others. This is a type of
personal ego which needs to be satisfied.

Self-actualisation Needs : This is the highest among the needs in the hierarchy of needs
advocated by Maslow. Self- actualisation is the desire to become what one is capable of
becoming. It is a 'growth' need. Here, a person feels that he should accomplish something
in his fife. He want to utilise his potentials to the maximum extent and desires to become
what one is capable of becoming. A person desires to have challenges and achieves
something special in his life or in the area of his specialization. This need is fully satisfied
rarely.

ASSESSMENT # 4:
Explain how Maslow’s Hierarchy of Needs can be useful in
achieving your goals.
 System Theory

Systems Theory is developed by Karl Ludwig von Bertalanffy. In 1969, von

Bertalanffy described what has since become known as General Systems Theory, the
concept that systems cannot be reduced to a series of parts functioning in isolation,
but that, in order to understand a system as a whole, one must understand the
interrelations between its parts (Bertalanffy, 1969).

According to Anderson (2016), application of this theory rests on the assumption

that most individuals strive to do good work, but that they are acted upon by
diverse influences. It further relies on the premise that functional and efficient
systems not only account for, but also embrace, these influences. Causal analysis
based on Systems Theory asserts that, when errors occur, one ought not focus solely
on individual failings, but on the surroundings that allowed such events to
transpire. It further asserts that outcomes can be influenced by smart interventions
developed after studying common patterns and behaviors across time.

She added that he underlying principles of Systems Theory should seem largely

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intuitive to health care professionals. Although many of us spend considerable time

siloed, focusing on the functioning of individual organs, our jobs necessitate that we
think about how each intricate organ system influences,
and is influenced by, its environment.

 Change Theory by Kurt Lewin

•Kurt Lewin (1890-1947) is considered as the father of social psychology
•He is well known for his writings on group dynamics, group therapy and social
psychology.
•Kurt Lewin introduced his field theory concepts, emphasizing that the group
differs from the simple sum of its parts.
•His field theory states that "one’s behavior is related both to one’s personal
characteristics and to the social situation in which one finds oneself."
 LEWIN"S CHANGE THEORY
•His most influencial theory was his model of the change process in human systems.
•Kurt Lewin theorized a three-stage model of change that is known as the
unfreezing-change-refreeze model that requires prior learning to be rejected and
replaced.
•Lewin's theory states behavior as "a dynamic balance of forces working in opposing
directions. "

CONCEPTS
 Driving forces
•Driving forces are forces that push in a direction that causes change to occur.
•Driving forces facilitate change because they push the person in the desired
direction.
•They cause a shift in the equilibrium towards change.
 Restraining forces
•Restraining forces are forces that counter driving forces.
•Restraining forces hinder change because they push the person in the opposite
direction.
•Restraining forces cause a shift in the equilibrium which opposes change
 Equilibrium
 •Equilibrium is a state of being where driving forces equal restraining forces and no
change occurs
 •Equilibrium can be raised or lowered by changes that occur between the driving
and restraining forces.

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STAGES
Consists of three distinct and vital stages:
1. “Unfreezing” Realization
•Unfreezing is the process which involves finding a method of making it possible
for people to let go of an old pattern that was counterproductive in some way.
•Unfreezing is necessary to overcome the strains of individual resistance and group
conformity.
•Unfreezing can be achieved by the use of three methods.
oFirst, increase the driving forces that direct behavior away from the existing
situation or status quo.
oSecond, decrease the restraining forces that negatively affect the movement
from the existing equilibrium.
oThird, find a combination of the two methods listed above.
2. “Moving to a new level or Changing” or Movement-
•This stage involves a process of change in thoughts, feeling, behavior, or all three, that
is in some way more liberating or more productive.
3. “Refreezing”- new stablished change
•Refreezing is establishing the change as a new habit, so that it now becomes the
“standard operating procedure.”
•Without this stage of refreezing, it is easy to go back to the old ways (Current
nursing, 2011).

ASSESSMENT # 5:
1. Give one example of your attitude that you want to change.
2. Identify what are your driving forces and restraining forces
on the change that you wanted to have.
3. Using the stages of change theory, explain how will you
apply this to change your attitude/

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1.3 References

Akrani, G. (n.d.). Maslow's Hierarchy of Needs - Theory of Human Motivation. Retrieved August
13, 2020, from https://kalyan-city.blogspot.com/2010/06/maslow-hierarchy-of-needs-theory-
of.html

Anderson, B. (2016). The American Association for Thoracic Surgery Retrieved from August 13,
2020 from http://dx.doi.org/10.1016/j.jtcvs.2016.03.029

Danesh, H. (2011, November 13). Human Needs Theory, Conflict, and Peace. Retrieved August 13,
2020, from https://onlinelibrary.wiley.com/doi/abs/10.1002/9780470672532.wbepp127

Faye Abdellah. Nursing Theory. (2019, September 18). https://nursing-theory.org/nursing-

theorists/Faye-Abdellah.php.

Gonzalo, A., Gonzalo, A. (2019). Hildegard Peplau: Interpersonal Relations Theory Guide.
https://nurseslabs.com/hildegard-peplaus-interpersonal-relations-theory/.

Gonzalo, A., (2019, August 24). Virginia Henderson: Need Theory Study Guide. Nurseslabs.
https://nurseslabs.com/virginia-hendersons-need-theory/.

von Bertalanffy L. General system theory; foundations, development,

applications. New York: G. Braziller; 1969.

(n.d.). Retrieved August 13, 2020, from

http://currentnursing.com/nursing_theory/change_theory.html

1.4 Acknowledgment
 
The images, tables, figures and information contained in this module were
taken from the references cited above.

DISCLAIMER:
InformationA found in this learning material are based on the references
gathered by the teacher handling the subject. Information provided in this
learning packet is meant only for student’s learning reference and is not
suggested as replacement to standard references. Any inaccurate
information, if found, may be communicated to the email below.
rosalesrheajane@gmail.com

C. M. D. Hamo-ay