ANGELES UNIVERSITY FOUNDATION

Angeles City
COLLEGE OF NURSING

NCM 0100
THEORETICAL FOUNDATION IN NURSING
1st Semester, A.Y. 2020-2021

MODULE 4
Different Views of Person, Health, Environment, and Nursing
Nursing Theories

Module Overview
The metaparadigm for nursing is a framework for the discipline that sets forth the
phenomena of interest and the propositions, principles, and methods of discipline. The
metaparadigm is very general and is intended to reflect agreement among the different
concepts in nursing practice. It is considered as the most abstract level of nursing
knowledge and closely mirrors beliefs held about nursing. The metaparadigm offers a
context for developing conceptual models and theories. Much of the theoretical work in
nursing focused on articulating relationships among the four major concepts: person,
environment, health, and nursing.
Different nursing theorists from different times and ages have specifically
contributed to Nursing Theories. Nursing theory was primarily used to develop and guide
nursing education in universities. Today, nursing theories are known to give direction and
purpose to nurse practitioners; it guides critical thinking and decision-making in clinical
nursing practice. Nursing theories ensure adequate and quality nursing delivery, and to
clarify and improve the status of Nursing as a profession.

Learning Outcomes
Upon completion of this module, the student should be able to:
1. Provide appropriate evidence-based nursing care based on variety of theories and
standards relevant to health and healing
2. Ensure a working relationship with the client and/or support system based on patient
care competencies through safe and quality nursing care, communication,
collaboration and teamwork, and health education
3. Customize nursing interventions based on Philippine culture and values

Learning Objectives
At the end of the discussion, the students will be able to answers the following questions:
1. What is a nursing theory?
2. Who is Faye Glenn Abdellah? What are the 21 Nursing Problems? What are the five
steps to the problem-solving process? How do we use it in nursing practice today?
How did she define the metaparadigm in nursing?
3. Who is Virginia Henderson? What are the 14 Human Needs? What made her definition
of nursing become the universally accepted definition of what nursing is? How is it
different from Abdellah’s 21 Nursing Problems? How did she define the metaparadigm
in nursing?
4. Who is Lydia Hall? What is the Care, Core, Cure Model? Which of the three concepts
(care, core, cure) is the nurse’s primary responsibility? How did she define the
metaparadigm in nursing?
5. Who is Ernestine Wiedenbach? What is the Helping Art of Clinical Nursing? How

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 important is the central purpose? What are the three parameters to say that an action
is voluntary? What are the five realities in the situation? How did she define the
metaparadigm in nursing?
6. Who is Ida Jean Orlando? What is the Theory of Deliberative Nursing Process? When
does a need for help arise? What is the nursing process? Which is more important -
automatic or deliberative nursing actions? How did she define the metaparadigm in
nursing?
7. Who is Myra Estrin Levine? What are the Conservation Principles? How is
wholeness/holism attained? How did she define the metaparadigm in nursing?
8. Who is Madeleine Leininger? What is the Theory of Culture Care Diversity and
Universality? How does culture care diversity differ from culture care universality? How
can nurses provide a trans-culturally sensitive nursing care? How did she define the
metaparadigm in nursing?
9. Who is Margaret Newman? What is the Theory of Health as Expanding
Consciousness? How did she define the metaparadigm in nursing?
10. Who is Hildegard Peplau? What is the Theory of Interpersonal Relationship? What
are three phases in a nurse-patient relationship? What are the different nursing roles
during the nurse-patient relationship? How did she define the metaparadigm in
nursing?
11. Who is Joyce Travelbee? What Human to Human Relationship Model? How can
nurses ease the suffering and provide hope for their patients? How did she define the
metaparadigm in nursing?

Definition of Key Terms

Before going through this module, the student is advised to read the following terms:
Caring - the essence of nursing and the dominant, unifying, and distinctive feature of
nursing".

Communication - the process of sharing information or the process of generating and

transmitting meanings

Environment - the external and internal surroundings that influence or affect the person

Grand theory -broad in scope and composed of concepts representing global and
extremely complex phenomena.

Health - a state of complete physical, mental, and social well-being, not merely the
absence of disease or infirmity that is influenced by political, economic, socio-cultural,
and environmental factors

Middle-range theories -address more concrete and more narrowly defined phenomena or
have more concrete and narrower focus than a grand theory.

Nursing - the art and science of caring for individuals, families, groups, or community

Person - the recipients of care; can be an individual, family, or community

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C. Nursing Theories

Faye Glenn Abdellah

About the Author
Faye Glenn Abdellah was born in New York City on May 13, 1919. She graduated
magna cum laude from Fitkin Memorial Hospital School of Nursing in Neptune, New
Jersey in 1942. She received her B.S. degree in 1945, M.A. in 1947, and EdD in 1955
from Teachers College, Columbia University. She has more than 140 publications and
received 11 honorary doctorates from various institutions. These honors recognized her
work in nursing research, development of the first nurse scientist training program,
expertise in health policy, as well as her outstanding contributions to health. In 1960,
influenced by the desire to promote patient-centered comprehensive nursing care,
Abdellah came up with her theory of the Twenty-One Nursing Problems.

Concepts of "Twenty-One Nursing Problems"

In her theory, Abdellah stated that nursing is the use of the problem-solving
approach with key nursing problems related to the health needs of people. The problem-
solving process involves (1) identifying the problem (2) selecting the relevant data (3)
formulating the hypothesis (4) testing the hypothesis through collection of data (5) revising
hypothesis when necessary on the basis of conclusions obtained from the data. The
process emphasizes that the correct identification of nursing problems influences the
nurse’s judgment in selecting the next steps in solving the patient’s nursing problems.

Abdellah's Twenty-One Nursing Problems:

Basic to All Patients:
1. To maintain good hygiene and physical comfort.
2. To promote optimal activity: exercise, rest and sleep.
3. To promote safety through prevention of accidents, injury or other trauma and through
the prevention of the spread of infection.
4. To maintain good body mechanics and prevent and correct deformity.

Sustental Care Needs:

5. To facilitate the maintenance of a supply of oxygen to all body cells.
6. To facilitate the maintenance of nutrition of all body cells.
7. To facilitate the maintenance of elimination.
8. To facilitate the maintenance of fluid and electrolyte balance.
9. To recognize the physiological responses of the body to disease conditions -
pathological, physiological and compensatory.
10. To facilitate the maintenance of the regulatory mechanism and functions.
11. To facilitate the maintenance of sensory functions.

Remedial Care Needs:

12. To identify and accept positive and negative expressions, feelings and reactions
13. To identify and accept interrelatedness of emotions and organic illness.
14. To facilitate maintenance of effective verbal and non verbal communications.
15. To promote the development of productive interpersonal relationships.
16. To facilitate progress toward achievement and personal spiritual goals.
17. To create or maintain a therapeutic environment
18. To facilitate awareness of self as an individual with varying physical, emotional, and
developmental needs.

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 Restorative Care Needs:
19. To accept the optimum possible goals in the light of limitations, physical and
emotional.
20. To use community resources as an aid in resolving problems arising from illness.
21. To understand the role of social problems as influencing factors in the cause of illness.

Abdellah's 4 Major Concepts

Person Health Environment Nursing
She describes the In her Patient- The environment is The concept of nursing in
recipients of nursing Centered the least discussed this theory is generally
care as individuals, Approaches to concept. grouped into 21 problem
families and society. Nursing, health is a Society is included in areas for nurses to work
state that is mutually "planning for out their judgment and
Her 21 nursing exclusive of illness. optimum health on appropriate care.
problems deal with She implicitly defined local, state, national Adbellah considers
biological, health as a state and international nursing to be a
psychological and when the individual levels. comprehensive service
social areas of has no unmet needs As she further that is based on the
individuals - and no anticipated or delineates her ideas, disciplines of art and
describing people as actual impairments. the focus of nursing science and aims to help
having physical, service is the people, sick or well, cope
emotional and individual. with their health needs.
sociological needs. Nursing care is doing
something to or for the
The needs of the person or providing
individual may be information to the person
overt - physical needs with the goals of meeting
or covert - emotional needs, increasing or
and social needs. restoring self-help ability,
or alleviating impairment.

Virginia Henderson
About the Author
Virginia Henderson was born on March 19, 1897 in Kansas City, Missouri.
Henderson’s interest in nursing evolved during World War I from her desire to help the
sick and wounded military personnel. She enrolled in the Army School of Nursing in
Washington D.C., and graduated in 1921. In 1932, she completed her B.S. degree and in
1934, her M.A. degree in nursing education at Columbia University Teachers College.
Henderson was the recipient of numerous recognitions for her outstanding contributions
to nursing. Her writings are far-reaching and have made an impact on nursing throughout
the world. In 1955, she worked with a Canadian nurse named Bertha Harmer to revise a
book entitled Textbook of the Principles and Practice of Nursing, where she gave her first
definition of nursing. Later in 1966, Henderson published another book entitled The
Nature of Nursing, and it is in this book where Henderson’s ultimate definition of nursing
was written. Henderson died at the age of 98 on November 30, 1996.

Concepts of "Fourteen Fundamental Human Needs"

Virginia Henderson’s focus on individual care is evident when she stressed on the
idea of assisting individuals with essential activities to maintain health, to recover, or to

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achieve peaceful death. She proposed 14 components of basic nursing care to enhance
her definition of nursing. The definition of nursing and the 14 components together outline
the functions the nurse can initiate and control. She also considered the biological,
psychological, sociological, and spiritual components of the individual.

CONCEPTS:
1. Fourteen fundamental human needs
1. Breathe normally
2. Eat and drink adequately
3. Eliminate Body Waste
4. Move and maintain desirable posture
5. Sleep and rest
6. Select Suitable clothes
7. Maintain normal body temperature
8. Keep the body clean and well-groomed to protect the integument
9. Avoid dangers in the environment and avoid injuring others.
10. Communicate with others in expressing emotions, needs, fears, or opinions.
11. Worship according to one's faith.
12. Work in such a way that there is a sense of accomplishment
13. Play and participate in various forms of recreation.
14. Learn, discover, or satisfy the curiosity that leads to normal development and health
and use the available health facilities.
*1-9: physiological
10 & 14: psychological
11: spiritual and moral
12 & 13: occupation and recreation

2. Biophysiological concept
-biological knowledge is the basis to determine appropriate care needed to alleviate the
illness or injury.

3. Concept of culture
-learned from the family and other social groups.

4. Interaction-communication
-the ability to react and understand the patient's thoughts, feelings, and responses.

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 Henderson's 4 Major Concepts
Person Health Environment Nursing
Henderson referred to Henderson viewed All external conditions Henderson asserted
a person as a patient. health as a quality of and influences that that nurses function
life and is very basic affect life and independently from the
She stated that the for a person to development. The physician but in
person is an individual function fully. As a environment is coordination with the
who requires vital need, health composed of the therapeutic plan
assistance to achieve requires following components: developed by the
health and independence and 1. biological health team.
independence or in interdependence -all living things Another special role of
some cases, a (Alligood, 2018). 2. physical the nurse is to help
peaceful death -sphere in which all both sick and well
The level of health is living things operate individuals. Care must
For a person to directly related to the (ex: sunlight, water, include people from all
function to the utmost, patient’s ability to oxygen, nutrients) walks of life, from the
he must be able to independently satisfy 3. behavioral well to the sick, and
maintain physiological his or her basic needs -social interactions, from the newborn to
and emotional (Masters, 2012). customs, economic, the dying. The care
balance. political, and religious given by the nurse, as
Since health is a systems Henderson stressed,
multifactor (Masters, 2012) must empower the
phenomenon, it is patient to gain
influenced by both independence as
internal and external rapidly as possible.
factors which play
independent and Henderson's definition
interdependent roles of nursing was
in achieving health. considered as the
"signature " of the
She also gave profession.
emphasis in
prioritizing health
promotion as more
important than care of
the sick.

Lydia Hall
About the Author
Lydia Hall received her basic nursing education at York Hospital School of Nursing
in York, Pennsylvania, and graduated in 1927. She received her B.S. in Public Health
Nursing in 1937 and M.A. in teaching Natural Sciences in 1942 at Teachers College,
Columbia University in New York. Hall was the first director of the Loeb Center for Nursing
and Rehabilitation and continued in that position until her death in 1969. Her experience
in nursing spans the clinical, educational, research, and supervisory components.

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Concepts of Care, Core, Cure
Hall's theory of nursing is presented as three interlocking circles, each circle
representing a particular aspect of nursing: care, core, and cure. Hall emphasizes the
importance of total person approach. Thus, these aspects of nursing should not be viewed
as functioning independently, but as interrelated.

CONCEPTS:
1. Care: The Body
-represents the nurturing component and is exclusive to nursing. It is concerned with
bodily care (e.g. biological functions such as eating, bathing, and dressing) and
opportunity for teaching-learning activities. When providing this care, the nurse’s goal is
the comfort of the patient. At this point, the nurse and patient create a therapeutic
relationship, and as it develops, the patient can share and explore feelings with the nurse.

2. Core: The Person

-based on social sciences, involves the therapeutic use of self, and is shared with other
members of the health team. By developing an interpersonal relationship with the patient,
the nurse is able to help the patient verbally express feelings regarding the disease and
its effects. Through the use of reflective technique (acting as a mirror for the patient) the
nurse can help the patient look at and explore feelings regarding his current health status
and related potential changes in lifestyle. Through this, the motivation and energy for
healing that exist within the patient is discovered. The patient becomes aware of his
abilities, and he is now able to make conscious decisions based on this motivation and
energy.

3. Cure: The Disease

-based in the pathological and therapeutic sciences, and is shared with other members
of the health team. The nurse assists the doctors by doing medical tasks or functions, and
helps the patient through his medical, surgical, and rehabilitative care.

Hall's 4 Major Concepts

Person Health Environment Nursing
> A person is > a state of self- >environment is >nursing consists of
someone who is 16 awareness with dealt with the patient participation in the
years or older and conscious selection care, core, and cure
past the acute stage of behaviors that are >any actions taken in aspects of patient
of a long-term optimal for that relation to society or care. Care is the
illness. individual environment are for only function of
the purpose of nurses, whereas
> the source of >the need to help assisting the core and cure are
energy and the person explore individual in attaining shared with other
motivation for the meaning of his a personal goal members of the
healing behavior resulting to (environment should health care team.
development of self- be conducive to self-
> unique, capable of identity and maturity development)
growth and learning,
and requires a total
person approach

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Ernestine Wiedenbach
About the Author
Ernestine Wiedenbach was born in Germany in 1900 and later migrated to the USA
during her early childhood. She graduated from Wellesley College in 1922 with a liberal
arts degree. Her interest in nursing had been stimulated by her ailing grandmother. She
enrolled in the Post Graduate Hospital School of Nursing, though she had been expelled
from this program after she served as the spokesperson for student grievances. She later
enrolled at the John Hopkins School of Nursing in Baltimore, Maryland and received her
nursing diploma in 1925. In 1934, she earned her Master’s Degree and certificate in public
health nursing from Teachers College, Columbia University in New York. In 1964, she
wrote Clinical Nursing – A Helping Art, in which she described her ideas about nursing as
a “concept and philosophy”. She died on April 1, 1999 in Florida.

Concepts of "The Prescriptive Theory/ Helping Art of Clinical Nursing"

Wiedenbach postulated that clinical nursing is directed toward meeting the
patient’s perceived need-for-help. Her theory is a situation-producing theory and may be
described as one that conceptualizes both a desired situation and the prescription by
which it is to be brought about. Thus, it directs action toward a specific goal.

CONCEPTS:
1. Central purpose
-It is also known as “commitment”. It is that which the nurse wants to accomplish; the
overall goal toward which she is striving; the mission she believes is hers to accomplish.
-The central purpose defines the quality of health she desires to affect or sustain in her
patient and specifies what she recognizes to be her special responsibility in caring for the
patient. This commitment is based on the individual nurse's philosophy. Philosophy of the
nurse motivates her to act, guides her thinking, and influences her decisions. It is unique
to each nurse and is expressed in her way of nursing.

Three essential components for a Nursing Philosophy:

a. reverence for the gift of life
b. a respect for the dignity, worth, autonomy, and individuality of each human being
c. a resolution to act dynamically in relation to one's beliefs

2. Prescription
-It is a directive for activity that specifies both the nature of the action and the necessary
thought process. It indicates the action appropriate in implementing the basic concepts
and the kind of behavior needed to carry out those actions. These actions may be
voluntary or involuntary, where voluntary action is an intended response and involuntary
action is an unintended response.

Three Kinds of Voluntary Action

a. mutually understood and agreed upon action
b. recipient-directed action
c. practitioner-directed action

3. Realities of the situation

-Realities consist of all factors physical, physiological, psychological, emotional, and
spiritual - that are at play in a situation in which nursing actions occur at any given
moment.

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 The Five Realities are:
a. the agent
-it refers to the nurse or health care provider. She is considered as the propelling force
that moves the actions toward the accomplishment of the goal. The agent has the
following responsibilities: specify the objectives of her practice, practice nursing
according to her objectives, engage in activities that contribute to her self-realization &
to the improvement of nursing practice

b. the recipient
-it refers to the recipient of nursing actions. The recipient is vulnerable, dependent on
others, and risks losing individuality, dignity, worth, and autonomy.

c. the goal
-it refers to the desired outcome that the nurse wants to achieve. Identification of the
goal gives focus to the nurse’s action.

d. the means
-it refers to how the agent meets her goal. It includes skills, techniques, procedures,
and devices that may be used to meet the goal.

e. the framework
-it refers to the surroundings that influence reality. It consists of the human,
environmental, and organizational facilities that affect the nurse’s ability to obtain her
goal.

Wiedenbach's 4 Major Concepts

Person Health Environment Nursing
>any individual Wiedenbach does In Wiedenbach's >the practice of identification
who is receiving not define the work, she of a patient's need for help
help concept of health, incorporates the >if the need for help requires
however, she environment within intervention, the nurse
>possesses unique supports WHO's the realities - a major facilitates the medical plan of
potential, strives definition of health as component of her care and also creates and
toward self a state of complete theory. One element implements it based on needs
direction and needs physical, mental, and of the realities is the and desires of the patient
stimulation. social well-being, framework - a > a goal-directed activity
Whatever the and not merely the complex of requiring the application of
individual does absence of disease extraneous factors knowledge and skill toward
represents his or and infirmity. and circumstances meeting a need for help
her best judgment that are present in >the practice of nursing
at the moment. every nursing comprises:
Self awareness situation. The 1. identification of the
and self framework may patient's need for help
acceptance are include objects such -nurse observes the patient,
essential to the as "policies, setting, determines the cause of
individual's sense and atmosphere, problem, and confirms need
of integrity and self- time of day, humans for help
worth. and happenings." 2. ministration of the help
Wiedenback needed

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believes these -nurse gives advice and
characteristics carries out a therapeutic
require respect action
from the nurse. 3. validation
-the nurse verifies if the
actions were helpful

Ida Jean Orlando

About the Author
Ida Jean Orlando was born on August 12, 1926. She received a diploma in nursing
from New York Medical College in 1947. In 1951, she received a B.S. in public health
nursing from St. John’s University in Brooklyn in New York. Later, she earned an M.A.
degree in mental health consultation from Columbia University Teachers College. From
then on, she worked as a staff nurse in obstetrical, medical, surgical, and emergency
nursing services. In 1958, she worked as a research associate and principal investigator
of "Integration of Mental Health Concepts in Basic Curriculum". This project focused on
identifying factors that influence the integration of mental health principles in a basic
nursing curriculum. She reported her findings on her book entitled The Dynamic Nurse-
Patient Relationship: Function, Process, and Principles of Professional Nursing Practice,
which was published in 1961. Her theory has substantial merit for its application to
practice, research, education, and administration. (Alligood, 2018)

Concepts of The Nursing Process Theory/ Dynamic Nurse-Patient Relationship Theory

Orlando was the first nurse to develop her theory from actual nurse-patient
situations. It reflects her belief that practice should be based on needs of the patient and
that communication with the patient is essential to understanding needs and providing
effective nursing care. Evidence of relieving the patient’s distress (needs) is determined
by positive changes in his behavior, and that nursing actions are geared towards
improvement in the patient’s behavior. (Alligood, 2018)

CONCEPTS:
1. Professional function of nursing
-a well-defined function of the profession should be clearly stated to prevent conflicts.
Nursing activity is professional only when it deliberately achieves the purpose of helping
the patient.

2. Behavior of the patient

-any observable verbal or nonverbal behavior of the patient must be considered as an
expression of need for help (Alligood, 2018). Verbal behavior encompasses the patient’s
use of language. Nonverbal behavior includes physiological manifestations, motor
activity, and vocal tone.
- a need for help arises when a patient:
a. experiences a need that he cannot resolve
-in this case, a sense of helplessness occurs and the patient’s behavior reflects this
distress. It may stem from physical limitations caused by incomplete development and
temporary or permanent disability. It can also be caused by adverse reaction to the
setting, which comes in as a result of incorrect or inadequate understanding of the
experience.

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 b. is unable to communicate his needs effectively
-this maybe due to ambivalence, embarrassment related to the need, lack of trust in
the nurse, and inability to state the need precisely (George, 2014).
-at times, the behavior may not effectively communicate the need. This ineffective
behavior prevents the nurse from carrying out her concerns for the patient’s care.
Resolution of this ineffective patient behavior deserves high priority.

3. Immediate reaction of the nurse

-this marks the beginning of the nursing process. The nurse should not assume that her
reaction to the patient is correct; she must clearly communicate with the patient about her
reaction to obtain verification or validity.
-this reaction is comprised of three sequential parts:
a. the nurse perceives the behavior
b. the perception leads to automatic thought
c. the thought produces an automatic feeling
-this concept, thus, includes the nurse's perceptions, thoughts, and feelings. Perception,
thought, and feeling occur automatically & almost simultaneously. Therefore, the nurse
must learn to identify each part of her reaction as this will help her analyze her reaction
and response to the situation. Thus, the process becomes “logical & disciplined” rather
than intuitive.

4. Nursing process
-includes identifying the needs of the patient, response of the nurse, and nursing action.
The nurse can only proceed in doing her actions when she has correctly validated her
thoughts about the patient’s behavior. The nursing action can be carried out in two ways:

a. automatic
-those actions decided upon for reasons other than the patient's immediate need. It most
likely fails to meet the needs of the patient, and is primarily concerned with carrying out
physician’s orders, routine patient care, and general principles for health.

b. deliberative
-those actions that ascertain and meet the needs of the patient. The following are criteria
for deliberative actions:
b.1. results from correct identification of patient needs by validation
b.2. the nurse explores the meaning of the action with the patient
b.3. the nurse validates the action’s effectiveness
5. Improvement

Orlando's 4 Major Concepts

Person Health Environment Nursing
>humans are the >freedom from >a nursing situation >the function of
focus of nursing mental or physical occurs when there is professional nursing
practice discomfort and a nurse-patient is conceptualized as
feelings of contact and that both finding out and
>persons behave adequacy and well the nurse and the meeting the
verbally or being contribute to patient perceive, patient's immediate
nonverbally health think, feel, and act in need for help
the immediate

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>people are >repeated situation >providing direct
sometimes able to experiences of assistance to
meet their own having been helped individuals in
needs and that culminate over whatever setting for
nurses should be periods of time in the purpose of
concerned only with greater degrees of avoiding, relieving,
those who are improvement diminishing, or
unable to meet their curing the person's
needs sense of
independently helplessness

Myra Estrin Levine

About the Author
Myra Estrin Levine was born in Chicago in 1920 (Masters, 2012). She obtained a
diploma from Cook County School of Nursing in 1944. She later earned a degree of BSN
in 1949 from the University of Chicago and MSN degree from Wayne State University in
1962. Levine held positions as a private duty nurse, civilian nurse, surgical supervisor,
and director of nursing. She is the first recipient of Sigma Theta Tau's Elizabeth Russell
Belford Award for teaching excellence (Alligood, 2018).
Although she never intended to develop theory, she provided an organizational
structure for teaching medical-surgical nursing. Her famous work “The Four Conservation
Principles” was formulated in 1967. Later, in 1989, Levine published the changes and
clarifications in her theory. She received an honorary doctorate from Loyola University in
1992. Levine died on March 20, 1996 (Alligood, 2018).
Concepts of the Conservation Principle
Levine believed that the foundational belief of the sanctity of life provided the
structure for all moral systems and that all of the efforts of the healing sciences were
founded upon the holiness and wholeness of the human being. She used the term
conservation to label the framework because it was derived from the Latin word meaning
“to keep together” (Masters, 2012).
Levine viewed adaptation as the process by which conservation is achieved
(George, 2014). The goal of the conservation model is to promote adaptation and
maintain wholeness using the principles of conservation (Alligood, 2018).

CONCEPTS:
1. Adaptation
-Levine defined adaptation as the process whereby the patient maintains integrity within
the realities of the environment; it is the result of interaction between the person and his
internal and external environment (Alligood, 2018). The physiological and behavioral
responses of each individual are different under different conditions. Therefore, it is
possible to anticipate certain kinds of reactions, but the individuality or uniqueness of
responses vary.
-Adaptation includes the following characteristics:
a. historicity - adaptation is a historical process, responses are based on past
experiences and genetic pattern

b. specificity - each system has very specific responses in relation to a particular

challenge

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 c. redundancy - represents the options available to the individual to ensure continued
adaptation; if one system does not adapt, another can take over

2. Conservation
-It is the product of adaptation. It describes the way complex systems are able to continue
to function even when severely challenged. It is through conservation that persons are
able to face challenges, adapt, and maintain their uniqueness (Masters, 2012). It focuses
on achieving a balance of energy supply and demand within the biological realities unique
to the individual (Tomey & Alligood, 2010).
-The goals of conservation model are achieved through interventions geared toward the
"Four Conservation Principles" (Masters, 2012):
a. Conservation of Energy
-the individual requires a balance of energy and a constant renewal of energy to maintain
life activities

b. Conservation of Structural Integrity

-it focuses on the healing process. It involves maintaining or restoring the structure of the
body by preventing physical breakdown and promoting health. Nursing activities are
geared towards limiting injury.

c. Conservation of Personal Integrity

-includes recognition of the wholeness of each person; seeing the individual as one who
strives for recognition, respect, self-awareness, and self-determination. It encompasses
the ideas that self-worth and self-identity are important and, therefore, nurses should
show patients respect.
d. Conservation of Social Integrity
-life gains meaning through social communities and health is socially determined.
Individuals use their relationships to define themselves, and one’s identity is connected
to his social circles (ex: family, community, workplace, school, religion). Nurses fulfill
professional roles and use interpersonal relationships to conserve social integrity.

3. Wholeness (Holism)
-wholeness emphasizes a sound, organic, progressive, mutuality between diversified
functions and parts within an entirety, the boundaries of which are open and fluent. It
exists when the interaction or constant adaptations to the environment permit ease.

Levine's 4 Major Concepts

Person Health Environment Nursing
>A holistic being; >socially >the context in which >takes place
cannot be determined by the we live our lives wherever there is an
understood outside ability to function in individual who
the context of the a reasonable 3 Aspects of needs care to some
place and time in manner Environment: degree
which he is 1. operational
functioning, or >NOT just the -undetected natural >a human
separated from the absence of forces that interrupt interaction; it
influence of pathological the individual becomes
everything that is conditions 2. perceptual therapeutic when
happening around -information that is nursing

TFN Module 4: Different Views of Metaparadigm | Nursing Theories 13 | Page

him. >health is return to recorded by the interventions
self sensory organs influences
>human beings that 3. conceptual adaptation favorably
are continually -influenced by or results to
adapting in their language, culture, renewed social well-
interactions with the ideas, and being of the client
environment. The cognition
process of
adaptation results in
conservation.

Madeleine Leininger
About the Author
Madeleine Leininger was born in Nebraska in 1925. She began her nursing career
after she graduated with a diploma from St. Anthony’s School of Nursing in Denver,
Colorado. In 1950, she received a bachelor’s degree in biological science with a minor in
philosophy and humanistic studies from Benedictine College in Kansas. She then worked
as an instructor, staff nurse, and head nurse on a medical-surgical unit and opened a new
psychiatric unit as a director of nursing services in Nebraska. In 1954, Leininger received
a master’s degree in psychiatric nursing from Catholic University of America in
Washington, D.C. (Masters, 2012).
It was during her time in the University of Cincinnati that Leininger noticed a lack
of understanding among staff related to cultural factors influencing the behavior of
children. She observed differences in responses to care and treatments among children
from diverse cultural backgrounds. Later, Leininger taught the first course in transcultural
nursing at the University of Colorado in 1966 (Masters, 2012).

Concepts of Transcultural Nursing

The culture care diversity and universality theory has features that distinctly set it
apart from other nursing theories. It is the only theory that focuses on holistic and
comprehensive culture care. It can be used in any culture because it includes multiple
holistic factors that are universally found across cultures (Masters, 2012).

CONCEPTS:
1. Culture
-refers to the patterned lifeways, values, beliefs, norms, symbols, and practices of
individuals that are learned, shared, and usually transmitted from one generation to the
other (Alligood, 2018).
-it is learned by each generation through both formal and informal life experiences. The
practices of a particular culture often arise because of the group’s social and physical
environment. These practices and beliefs are adapted over time, but they remain constant
as long as they satisfy needs.
-the term culture awareness refers to an in-depth self-examination of one's own
background, recognizing biases and prejudices and assumptions about other people

2. Culture care
-the subjectively or objectively learned and transmitted values, beliefs, and patterned
ways of life that assist, support, or facilitate another individual to maintain well-being and
health or to deal with illness, handicaps, or death.

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-Leininger believe that cultures have both health practices that are specific to one culture
and prevailing patterns that are common across cultures that’s why she came up with the
terms diversity and universality

a. Culture care diversity

-refers to cultural variability or differences in care beliefs, meanings, patterns, values, and
lifeways within the culture (Alligood, 2018)

b. Culture care universality

-refers to the common, similar, or dominant care beliefs, meanings, patterns, values, and
lifeways that are manifest among many cultures

3. Transcultural nursing
-refers to a formal area of humanistic and scientific knowledge and practices focused on
holistic culture care and competencies to assist individuals or groups to maintain or regain
their health and to deal with disabilities or other human conditions in culturally congruent
and beneficial ways (Alligood, 2018).
-Leininger identified three modalities that guide nursing judgments, decisions, and actions
so that the nurse can provide culturally congruent care that is beneficial, satisfying, and
meaningful to the persons the nurse serves (Masters, 2012). These 3 modalities are:
a. Cultural care preservation or maintenance
-refers to those assistive, supportive, facilitative, or enabling professional actions
and decisions that help people of a particular culture to retain or maintain care
values and lifeways (Alligood, 2018)
-it retain and or preserve relevant care values so that clients can maintain their
well-being, recover from illness, or face handicaps and/or death
b. Cultural care accommodation or negotiation
-refers to assistive, supportive, facilitative, or enabling professional actions and
decisions that help people of a particular culture to adapt or negotiate with the
others for a beneficial or satisfying health outcome (Alligood, 2018)

c. Cultural care repatterning or restructuring

- refers to assistive, supportive, facilitative, or enabling professional actions and
decisions that help people of a particular culture to reorder, change, or modify life
ways for a new, different and beneficial health care pattern (Alligood, 2018)

-in providing transcultural nursing, the nurse should consider the following concepts:
a. Culturally congruent care
-care that fits the people's valued life patterns and set of meanings -which is
generated from the people themselves, rather than based on predetermined
criteria. It requires the nurse to assume the role of a learner of the client’s culture
and copartners with the client in defining care. It is also assumed that when
culturally based nursing care is beneficial and healthy, it contributes to the well-
being of the client; in contrast, when care is not culturally congruent, the client will
demonstrate signs of stress, noncompliance, cultural conflict, or ethical concerns.

b. Culturally competent care

-refers to the ability of the practitioner to bridge cultural gaps in caring, work with
cultural differences and enable clients and families to achieve meaningful and
supportive caring. Culturally competent care requires specific knowledge, skills,

TFN Module 4: Different Views of Metaparadigm | Nursing Theories 15 | Page

 and attitudes in the delivery of culturally congruent care and awareness.

-when planning nursing care for a patient, nurses must remember that the care that will
be provided must be culture specific. Oftentimes even the meticulously planned
intervention fails not because the nurse is incompetent, but simply because it is not culture
specific. The following steps can guide the nurse in providing a trans culturally competent
care:
A-dministration of medications must take into consideration some of the patient’s
beliefs and practices
Examples:
1. Catholics usually will fast on Ash Wednesday and Good Friday except for sick
patients
2. Muslims will fast during Ramadan
3. Jehovah’s witness-medications are acceptable to the extent necessary

B-e familiar with some diseases which are common in a specific race
Examples:
1. Africans- sickle cell anemia, hypertension
2. Asian- osteoporosis
3. Blacks- cervical cancer (female) prostate cancer(male)
4. Jewish- breast cancer
5. Whites- testicular cancer

C-ommunicate properly and be familiar with common communication process

across cultures
Examples:
1. Asians- rarely communicate their need for analgesics since they were taught
self-restraint
2. Hispanic women- discussions pertaining to the reproductive organs with
male relatives or health care providers are considered impolite.
3. Muslim women- prefer to talk to female doctors on matters related to
reproductive problems.

D-ietary modifications must be considered when planning nursing care!

Examples:
1. Chinese- cold desserts (yin yang) are served after surgery
2. Europeans- main meal is served midday and is usually followed by coffee
3. Jewish- Kosher diet ( no meat and dairy products at the same time)
4. Muslim- Halal diet ( no pork)

Evaluation continues throughout the nursing process and should include feedback
from the client and family. Self-evaluation by the nurse is crucial as he or she increases
skills for interaction. The nurse should consider questions such as the following:
1. Am I open to understanding ways in which the client's values differ from mine?
2. Have I given sufficient attention to communicating with the client with limited
language skills?
3. Have I had a successful client's family in the nursing process?
4. Am I incorporating the client's traditional beliefs and practices into nursing therapies?
5. Is my therapeutic relationship with the client grounded on respect for the client
regardless of cultural differences?

TFN Module 4: Different Views of Metaparadigm | Nursing Theories 16 | Page

Margaret Newman
About the Author
Margaret Newman was born in 1933 in Memphis, Tennessee. She earned a
bachelor’s degree in home economics and English from Baylor University and second
bachelor’s degree in nursing from the University of Tennessee in Memphis. Newman
earned a master’s degree in medical-surgical nursing and teaching from the University of
California, San Francisco. In 1971, she received her PhD in nursing science and
rehabilitation nursing from New York University (Masters, 2012).
Prior to her studying nursing, Newman was the primary caregiver for her mother
who has amyotrophic lateral sclerosis (ALS). During this time, she became interested in
nursing. Her theory of health as expanding consciousness was first published in 1979,
and over the course of her career she published several books, chapters, and articles on
the theory (Masters, 2012).
She received the Distinguished Scholar in Nursing Award from New York
University, the Founders Award for Excellence in Nursing Research from Sigma Theta
Tau International, and the E. Louise Grant Award for Nursing Excellence from the
University of Minnesota. Zeta Chapter of Sigma Theta Tau International has established
the Margaret Newman Scholar award to support doctoral students whose research
extends Dr. Newman’s theory. Dr. Newman has been included in Who’s Who in American
Women since 1983 and was appointed to Who’s Who in America in 1996 (Alligood, 2018).

Concepts of the Theory of Health as Expanding Consciousness

Martha Roger’s theory of Unitary Human Beings was the main basis of the
development of Newman’s theory. It proposes the view that health is a unidirectional,
unitary process of development – an expansion of consciousness that is seen as the
ability of the person to interact with the environment (Masters, 2012).

CONCEPTS:
1. Health
-encompasses disease and non disease. It can be regarded as the evolving pattern of
the person and the environment. It is a process of developing awareness of self and
environment together with an increasing ability to perceive alternatives and respond in a
variety of ways (Alligood, 2018).

2. Pattern
-depicts the whole, and understanding of the meaning of all relationships at once.
Whatever manifests itself in a person’s life is the explication of the underlying pattern
within the person (Alligood, 2018).
-pattern recognition occurs within the observer. Although we may predict the next event
in a sequence on the basis of knowledge of the sequence, we cannot make such
predictions with certainty because additional information is needed. Newman suggests
that more of the pattern is revealed as the time frame is expanded.

3. Consciousness
-the informational capacity of the system and the ability of the system to interact with the
environment. It includes not only cognitive and affective awareness, such as thinking and
feeling, but also the interconnectedness of the entire system that includes biochemical
maintenance and growth processes (Alligood, 2018).
-as human beings develop, consciousness grows or expands; as consciousness
expands, the more it coexists with the universe.

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 4. Movement-Space-Time
-it is important to examine movement-space-time as dimensions of emerging patterns of
consciousness (Alligood, 2018).
-movement is an essential property of matter and the change that occurs between two
states of rest (George, 2008). It is a reflection of consciousness that indicates inner
organization or disorganization of persons; it communicates the harmony or a person’s
pattern with the environment (Masters, 2012).
-time and timing is considered as an index of consciousness. It is important that one is
fully present in the moment because all experiences are manifestations of the process of
higher consciousness (Masters, 2012).
-space is discussed in conjunction with time and movement.

Newman’s 4 Major Concepts

Person Health Environment Nursing
>“The human is unitary, >“Health and illness >Environment is >Nursing is “caring in the
that is cannot be are synthesized as described as a human health
divided into parts, and health - the fusion on “universe of open experience”.
is inseparable from the one state of being systems” >Nursing is seen as a
larger unitary field” (disease) with its partnership between the
opposite (non- nurse and client, with
>“Persons as disease) results in both grow in the “sense
individuals, and human what can be of higher levels of
beings as a species are regarded as health”. consciousness”
identified by their
patterns of
consciousness”

>“The person does not

possess
consciousness-the
person is
consciousness”.

>Persons are “centers

of
consciousness” within
an overall pattern of
expanding
consciousness”

Hildegard Peplau
About the Author
Hildegard Peplau was born in 1900 in Pennsylvania as the daughter of immigrant
parents. She graduated with a diploma from Pottstown Hospital School of Nursing in
1931. In 1943, she received a bachelor of arts degree in interpersonal psychology from
Bennington College, Vermont, followed by a master of arts degree in psychiatric nursing
from Teachers College, Columbia University in 1947. In 1953, she received an EdD in
curriculum development, also from Columbia University (Masters, 2012).

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 Peplau is considered the mother of psychiatric nursing. She participated in the
development of the National Mental Act of 1946. Her theory was built upon her personal
and practice experiences, including her experiences with professionals from psychiatry,
medicine, education, and sociology. This theory was influenced by Freud, Maslow, and
Sullivan’s interpersonal relationship theories, and by the psychoanalytical model
(Masters, 2012).
Peplau was honored for her many contributions to the profession of nursing and
was elected fellow in the American Academy of Nurses and Sigma Theta Tau. Peplau
died at the age of 89 in 1999 in her home in California (Masters, 2012).

Concepts of the Interpersonal Relations Theory

The theory of Interpersonal Relations focuses on the relationship between the
nurse and the patient. Peplau addresses all of nursing’s metaparadigm concepts, but
remains primarily concerned with one aspect of nursing: how persons relate to one
another. According to Peplau, the nurse-patient relationship is the center of nursing
(Masters, 2012).

CONCEPTS:
1. Phases in nurse-patient relationships
a. Orientation phase
-This is the initial interaction between the nurse and the patient wherein the later has a
felt need and expresses the desire for personal assistance.
-in some cases, this need may not be readily identified or understood by the individuals
who are involved. It is in this phase that the nurse needs to assist the patient to realize
what is happening.
-at the end of this phase, the nurse and the patient concurrently strive to identify the
problem and are becoming more comfortable with one another

b. Working phase
-phase where perceptions and expectations of both the nurse and patient takes place.
Throughout this phase, both the patient and nurse must clarify each other’s perceptions
and expectations.
-the patient’s response to the nurse can be one of the three:
b.1. participate with and be interdependent with the nurse
b.2. be autonomous and independent from the nurse
b.3. be passive and dependent on the nurse
-throughout this phase, the patient works collaboratively with the nurse to meet
challenges and work toward maximum health. Thus, the nurse aids the patient in using
services to help solve the problem.

c. Termination phase
-this is where the nurse and the patient terminate their therapeutic relationship as the
patient’s needs have already been met by the collaborative efforts between the nurse and
the patient.
-the patient becomes independent from the nurse.
-occurs only with the successful completion of the previous phases.

2. Nursing roles
-Peplau originally described these roles that emerge during the phases of the nurse-
patient relationship (Masters, 2012):

TFN Module 4: Different Views of Metaparadigm | Nursing Theories 19 | Page

a. Teacher
-one who imparts knowledge concerning a need or interests

b. Counselor
-this role strengthens the nurse-patient relationship as the nurse becomes a listening
friend, an understanding family member, and someone who gives sound and empathic
advises

c. Leader
-one who carries out the process of initiation and maintenance of group goals through
interaction

d. Resource person
-the nurse provides specific answers to questions, especially health information, and
interprets the treatment or medical plan of care

e. Surrogate
-one who takes the place of another

f. Technical expert
-the nurse provides physical care using clinical skills

3. Pattern integration
-identification of patterns within the interpersonal relationship between two or more
persons that link or bind them and enable them to transform energy into patterns of action
that bring satisfaction or security in the face of a recurring problem. Four types of
integrating patterns are possible (Masters, 2012).
a. Complementary
-occurs when the behavior of one person fits with and complements the behavior of the
other

b. Mutual
-occurs when the same or similar behaviors are used by both persons

c. Alternating
-occurs when different behaviors used by two persons alternate between the two persons

d. Antagonistic
-occurs if the behaviors of two persons do not fit but the relationship continues

Peplau’s 4 Major Concepts

Person Health Environment Nursing
A person is an “Health” is a word Peplau has a narrow Nursing is a human
organism that lives in that symbolizes perception of the relationship
an unstable movement of environment, which between an
equilibrium. personality and other is a major limitation individual who is
ongoing human of her theory. She sick, and a nurse
processes that implicitly defined it as who is educated to
directs the person “forces existing recognize and to

TFN Module 4: Different Views of Metaparadigm | Nursing Theories 20 | Page

 towards creative, outside the organism respond to the need
constructive, and and in the context of for help.
productive culture from which
community living. norms, customs, and
beliefs are acquired.”

Joyce Travelbee
About the Author
She postulated the Interpersonal Aspects of Nursing Model. She advocated the
goal of nursing individuals or family in preventing or coping with illness, regaining health,
finding meaning in illness, or maintaining maximal degree of health.
She further viewed that interpersonal process is a human-to-human relationship
formed during illness and “experience of suffering.” She believed that a person is a
unique, irreplaceable individual who is in a continuous process of becoming, evolving and
changing.

Concepts of the Human-to-Human Relationship Model

Travelbee based the assumptions of her theory on the concepts of existentialism
by Soren Kierkegaard and logotherapy by Viktor Frankl. Existential theory believes that
humans are constantly faced with choices and conflicts and is accountable to the choices
we make in life.

CONCEPTS:
1. Suffering
-"An experience that varies in intensity, duration and depth ... a feeling of unease, ranging
from mild, transient mental, physical or mental discomfort to extreme pain and extreme
tortured ..."

2. Meaning
-Meaning is the reason as oneself attributes

3. Nursing
-is to help man to find meaning in the experience of illness and suffering; has a
responsibility to help individuals and their families to find meaning. The nurses' spiritual
and ethical choices, and perceptions of illness and suffering, is crucial to helping to find
meaning.

4. Hope
-Nurse's job is to help the patient to maintain hope and avoid hopelessness.
-Hope is a faith that can and will be changed that would bring something better with it.
-Hope's core lies in a fundamental trust in the outside world, and a belief that others will
help someone when you need it.
-Six important factors characteristics of hope are:
a. It is strongly associated with dependence on other people.
b. It is future oriented.
c. It is linked to elections from several alternatives or escape routes out of its situation.
d. The desire to possess any object or condition, to complete a task or have an
experience.
e. Confidence that others will be there for one when you need them.

TFN Module 4: Different Views of Metaparadigm | Nursing Theories 21 | Page

 f. The hoping person is in possession of courage to be able to acknowledge its
shortcomings and fears and go forward towards its goal

5. Communications
-"a strict necessity for good nursing care"

6. Using himself therapeutic

-"one is able to use itself as a therapeutic."
-Self-awareness and self-understanding, understanding of human behavior, the ability to
predict one's own and others' behavior are important in this process.

7. Targeted intellectual approach

-Nurse must have a systematic intellectual approach to the patient's situation.

In her human-to-human relationship model, the nurse and the patient undergo the
following series of interactional phases:
a. Original Encounter- this is described as the first impression by the nurse of the
sick person and viceversa the nurse and patient see each other in stereotyped or
traditional roles.

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

c. Empathy- this phase is described as the ability to share in the person’s

experience.

d. Sympathy- It happens when the nurse wants to lessen the cause of the patient’s
suffering. It goes beyond empathy. The nurse at this time should use a disciplined
intellectual approach together with therapeutic use of self to make helpful nursing
actions.

e. Rapport- this is described as nursing interventions that lessens the patient’s

suffering. The nurse and the sick person are relating as human beings to human
beings. The sick person shows trust and confidence in the nurse.

Travelbee’s 4 Major Concepts

Person Health Environment Nursing
Person is defined as a >Health is >Environment is not >"an interpersonal
human being. subjective and clearly defined. process whereby the
Both the nurse and the objective. professional nurse
patient are human >Subjective health practitioner assists an
beings. is an individually individual, family or
defined state of well- community to prevent or
being in accord with cope with experience or
self-appraisal of illness and suffering, and
physical-emotional- if necessary, to find
spiritual status. meaning in these
experiences.
>Objective health is

TFN Module 4: Different Views of Metaparadigm | Nursing Theories 22 | Page

 an absence of
discernible disease,
disability of defect
as measured by
physical
examination,
laboratory tests and
assessment by
spiritual director or
psychological
counselor.

REFERENCES
Alligood, M.R. (2018) Nursing theorists and their work. 9 th Edition. Elsevier Singapore Pte. Ltd
Butts, J.B. and Rich K.L. (2018) Philosophies and theories for advanced nursing practice. 3 rd
Edition. Jones and Bartlett Pub.; Sudbury, MA.
Chinn, Peggy L. (2015) Knowledge development in nursing: theory and process. 9th Edition.
Mosby Elsevier.
George, J.B. (2014) Nursing theories: the base for professional nursing practice. 6th
Edition. Pearson Education, Inc. Phil. Ed.
Johnson, Betty M. (2015) An introduction to theory and reasoning in nursing. 4 th Edition. Mosby
Elsevier.
Masters, K. (2012) Nursing theories: a framework for professional practice. Jones and Bartlett
Learning; Sudbury, MA.
Mc Kenna, Hugh P. (2014) Fundamentals of nursing models, theories, and practice. 2 nd Edition.
Mosby Elsevier.
Meleis, A.I. (2018) Theoretical nursing: development & progress. 6th Edition. Lippincott Williams
& Wilkins.
Peterson, Sandra J. Middle range theories: application to nursing research and practice. 4 th
Edition. Mosby Elsevier.
Sitzman, K. (2017) Understanding the work of nurse theorist: a creative beginning. 3 rd Edition.
Jones & Bartlett Publishers; Sudbury, MA.
Walker, L. and Avant K. (2019) Strategies for theory construction in nursing. 6 th Edition. Prentice
Hall; Boston, USA.

Prepared by:

Rochelle G. Gumabon R.N., M.N. Sarah S. Nares, R.N., M.N.

NCM 0100 Instructor NCM 0100 Instructor

Peer Reviewed by:

Rolando L. Lopez, Jr., R.N., M.N. Sherwin M. Quizon, R.N., M.N.

CON, Faculty Member CON, Faculty Member

Reviewed and Evaluated by:

Ma. Corazon M. Tanhueco, R.N., M.A.N

Level I Coordinator

Debbie Q. Ramirez, R.N., Ph.D.

Assistant Dean, College of Nursing

Approved by:

Zenaida S. Fernandez, R.N., Ph.D.

Dean, College of Nursing

TFN Module 4: Different Views of Metaparadigm | Nursing Theories 23 | Page