THEORETICAL FOUNDATION OF

NURSING
Lydia Hall
� Introduced the model on
Nursing: What is It?,

Click to edit the outline
� Consiststeoxfttfhorreme attenets
� The firstis Sthecaot
nurOsinugtlifnuencLteiovenls
differently inthTehtirhdreOe
uintltienrelocking circles that
conLsetviteul te aspects of the
patient 1  Fourth Outline
�
The 3 circles are: Level
Fifth Outline


�
CARE - The patients b o d y 2
L e ve l
�
CURE -The diseaseafSfeixcttihng the
 body3
Outline
�
CORE -The person of the patient
Le v e l
which is being affected b y e ach
of the
Types of theories

� Grand theories
�
These theories that have a very broad scope
�
Each of the grand theories shares the
common ground offering a structure that
enables description and explanation of essential
conceptualization of nursing
�
Examples
�
Leninger
�
Newman
�
Middle Range Theories
�
As those “that lie between the minor but necessary
working hypotheses that evolve in abundance during day to
day research and all – inclusive systematic efforts to develop
unified theory
�
Principle ideas of middle range theories are relatively simple
�
Means rudimentary straight forward ideas that sum from
the factors of discipline
�
Thus, middle range theories is basic, usable structure of ideas,
less abstract than grand theories and more abstract than
emperical generalizations or micro-range theories
�
Examples: Orlando, Peplau,Watson, Modelling and Mercer’s
Micro – Range Theory
�
Situation specific
�
Focus on specific nursing phenomenon that reflect
clinical practice and that are limited to specific
populations or to particular field of practice
�
These theories offer a blue print that is more readily
operational and or less has more accessible
utilization clinical situation
�
Example: Korean immigrant women learned to adopt
to chronic illness.
NURSING PARADIGM

�
Nursing has a model or paradigm that explains the
linkages of science, philosophy, and theory that is
accepted and applied by the discipline.
�
The elements of Nursing paradigm direct the activity
of the nursing profession, including knowledge
development, philosophy, theory, educational
experience, research, practice and literature identified
with the profession
�
Nursing identified its domain in a paradigm that
includes four linkages: the person, health, environment/
situation, and nursing
 NURSING

PERSON HEALTH ENVIRONMENT

Four Major Concepts of Nursing Theories

1. PERSON – Refers to all human beings1

2. ENVIRONMENT – Include factors that affect individuals
internally and externally2
3. HEALTH – Addresses the person’s state of well – being
4. NURSING – is central to all nursing theories.
Definitions of nursing describe what nursing is, what
nurses do, and how nurses interact with clients. It is
the “diagnosis and treatment of human responses to
actual or potential health problems” (ANA, 1995).3
 Florence Nightingale
�
Developed
aCnldickdteoscerdibitetdhetoheutlifinrest
Nursing Theoterxyt
format
udtislienaeseLe
�
Nightingale veals
w
belieSveecdontdhaOt
a reparative pro
cTeshsirdanOduttlhinaet the
manipulation of Levethl e patient’s
surroundings-
ventilatio n , w a rm t
F o urth O u tli
h ,
n e
light, diet, cleanliness, and noise
�
She focused on changing and manipulatingLevel the environment
 in order to put the patient in the best
possibleFicfothndOituiotlninse
for nature to Level
act.
�
She provided the nursing profession the “legacSyixotfhcaring”
�
Florence Nightingale = Outline
Environment Level
13 Canons
� She identified the following aspects as major areas of the physical, social, and
psychological environment that the nurse could control:

� Health of houses

� Ventilation and warming

� Light

� Noise

� Variety

� Bed and bedding

� Cleanliness or rooms and walls

� Personal Cleanliness

� Nutrition and taking food

� Chattering hopes and advices

� Observation of the sick

CONCEPTS

� ENVIRONMENT: can be defined as anything that can be

manipulated to place a patient in the best possible
condition for nature to act
� This theory has both physical and psychological components

� The physical components of the environment refer to

ventilation, warmth, light, nutrition, medicine, stimulation, room
temperature and activity

� PERSON: the one who is receiving care; a dynamic

and complex being
� Nightingale envisioned the person as comprising
physical, intellectual, emotional, social and spiritual
components
� HEALTH: Nightingale wrote, “healthy is not only to be well,
but to be able to use well every power we have.”
�
She believed in the prevention and health promotion in addition
to nursing patients from illness to health

� NURSING: Nightingale believed nursing to be a spiritual calling.

Nurses were to assist nature to repair the patient
�
She defioned different types of nursing as “ nursing prioper” (nursing
the sick), “general nursing” (health promotion), and “midwifery nursing”
�
Nightingale viewed nursing the “Science of
environmental management”
�
Nurses were to use common sense, observation, and ingenuity to
allow nature to effectively repair the patient
�
Nightingale believed, “observation may always be improved with
training – seldom be present without training; for otherwise the
does not know what to look for
nurse
 Application
�
Miss angel gonzaga is a 25 year old female who had been admitted to the
medical unit with the chief complaint of frequent, watery stool since last
night.This is accompanied by abdominal cramps, N&V. her VS are as
follows: T=38.6, P=98, RR23, BP=100/70. she complains of weakness,
thirst, dryness of mouth. Her skin is warm, flushed, and dry. Her urine is
dark yellow in color
�
She claims, she had eaten oysters for dinner. She lives in a crowded
community close to landfill and shares toilet with 4 other families.Their
source of drinking is from pump well in the community. She does not
practice good handwashing after using the toilet. SE revealed
salmonellosis
�
She is tearful. She express great concern over her absence from her job in
a garment factory and over her health and expense for hospitalization
A. Nursing the Sick
A. Assessment

1. Fluid and electrolyte losses related to frequent,

watery stools, nausea and vomiting as manifested by
changes in the VS; weakness; dryness of mouth;
warmth, flushed, dry skin; dark-colored urine.
2. Pain related to abdominal cramps
3. Inadequate food intake related to nausea and vomiting
4. Fever (T=38.6’C) related to infection (salmonellosis)
and dehydration
 B. Plan
1. Fluid and electrolyte losses

Provide fluid and electrolyte replacement

Administer medications to relieve frequent , watery stools and nausea and
vomiting as prescribed

Provide good oral care for dryness of mouth

Promote rest to relieve weakness

Monitor intake and output.To assess fluid balance status

Provide good perianal care

1. Pain related to abdominal cramps


Provide low fiber diet ® to reduce peristalsis

Promote rest ® to reduce peristalsis and to promote comfort

Avoid gas forming foods ® flatulence worseness abdominal pain
3. Inadequate food intake

Provide small frequent feeding.This better tolerated by patients with nausea

Provide ice chips to relieve nauses

Administer antiemitic as prescribed ® relieve nausea and vomiting

3. Fever related to infection and dehydration


Provide adequate room ventilation

Keep the room airy and free of odor.

Increase fluid intake

Administer antibiotic and antipyretic as prescribed

Render TSB

Keep skin clean and dry

Change gowns and bedding
B. Physical Environment
A. Home, Community/ Neighborhood and
Workplace Assessment

1. Pure water. Assess for adequate working water system

and storage that is free from contamination
2. Cleanliness.

Assess for sanitation conditions of food sources and
preparation and hygienic practices

Assess for the means to maintain sanitation conditions of
toilets.To keep food and water supply free from
contamination
Home, Community/Neighborhood and Workplace
Plan

1. Water

Have water checked for contamination in coordination
with local Department of Health personnel

Educate the client on water purification and storage methods

Keep garbage and other refuse away from water supply or
any parts of the water system

1. Cleanliness

Educate the client on proper food handling; the
importance of handwashing especially when preparing foods
and before and after using the toilet; proper waste disposal
and personal
3. Home and workplace Assessment

Light. Assess for adequate windows and working light sources

Pure air. Assess for ventilation, offensive odors, eg. Odors of
the garbage and landfill

Water. Assess for working system that is free from contamination

Drainage. Assess the home and workplace for means to keep the
areas clean, and freedom from excessive dust, mold, mildew, pet
droppings (from cats and dogs), offensive odors, “dust catcher”
things (files of papers, unused jars, plastic container, unused old
clothes, etc)

Bed and bedding. Assess the bed for space and comfort.
Assess the bedding for cleanliness and availability of areas for
laundry and drying of bedding (for home environment only).

Noise. Assess the area for loud, offensive and unnecessary noise
C. Psychological Environment
Assessment and Plan

�
Miss Angel Gonzaga has psychological concerns. She
is worried over her absence from her job, her health,
and expenses for hospitalization
1. Anxiety. Assess the client’s activities before illness. Attempt to
stimulate variety in the room and with the client during her
hospital stay – with cards, flowers, magazines, books, music.
Encourage visits of relatives and friends

2. Chattering hopes and advices. Refrain from giving the patient

your opinion. Provide factual information about health. Allow
her to verbalize her fears, feelings and concerns
 Critical Thinking
� Miss Sarah Alonzo, a 22 year old female had consulted the health
center because of fever since three days ago.This accompanied by
loss of appetite to eat, body malaise, headache, abdominal pains,
dizziness. Her VS sre as follows T=38.7, PR=86, RR=21, BP=90/60.
Miss alonzo claims that she had lost weight because of her fever and
loss of appetite to eat. She lives in a crowded community which is
constantly submerged in water due to floods.This causes severe
problems in sanitation and source of water supply. Laboratory test and
physical examination revealed DHF

� Miss alonzo is extremely worried because she had a neighbor who

died because of DHF few months ago. In addition, she is concerned
over financial expenses for her illness and her absence from her job as
a crew in a fastfood center. She also verbalizes difficulty of sleeping in
unfamiliar environment like the hospital
1. Nursing the Sick

Assessment

Plan

1. Physical environment

Home, community/neighborhood and workplace assessment

Home, community/neighborhood and workplace plan

1. Psychological environment

Assessment and plan

1. Nutrition
 Virginia
Henderson �
Introduced the Nature of Nursing
Model Click to edit the outline
text format
�
She identified the 14 basic
needs
 Second Outline Level
�
She
postulated tha t th e u n iq ue
T ir d O u tl in e
function of the n u r s e is to assist
L e vel
the client sick or well in the
Fourth Outline
performance of those activities
L e v el
contributing to he a l th or its
recovery, that FwifothuldOpue
client s

tlrinfoerm
unaided if they had thLeenv elcessary
strength, will or knowSliexdtghe*
 Outline
�
Virginia Henderson =L1e4veBl asic
Needs
 14 Basic needs
� Breath Normally

� Eat and drink adequately

� Eliminate Body Waste

� Move and maintain desirable postures

� Sleep and rest

� Select suitable clothes – dress and undress

� Maintain body temperature within normal range by adjusting clothing and modifying the environment

� Keep body clean and well groomed and protect the integument

� Avoid dangers in the environment and avoid injuring others

� Communication with others in expressing emotions, needs, fears, or opinions

� Worship according one’s faith

� Work in such a way that there is a sense of accomplishment

�
Play or participate in various forms of
Faye Glenn Abdellah

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cteenxttefroerdmAaptpr
oaches to
Nur s in g M o de l
S e c on d O u tli
ne Level
�
She id
eTnhtiifireddO2u1tlnin
uersing problemLesvel
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She
definedFonuurrtshinOg
austliane service to
 Linedveivliduals and
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
Sixth
�
Faye Glenn Ab d e ll a h =
O u t l in e
21
Level
 21 Nursing Problems
� To maintain good hygiene and physical comfort
� To promote optimal activity; exercise; rest and sleep
� To promote safety through prevention of accident, injury, or
other trauma and through the prevention of the spread of
infection
� To maintain good hygiene and physical comfort
� To promote optimal activity: exercise, rest and sleep
� To promote safety through the prevention of accidents,
injury, or other trauma and through the prevention of the
spread of infection
� To maintain good body mechanics and prevent and correct
�
To identify and accept positive and negative
expressions, feelings, and reactions
�
To identify and accept the interrelatedness of emotions
and organic illness
�
To facilitate the maintenance of effective verbal and non verbal
communication
�
To promote the development of productive
interpersonal relationships
�
To facilitate progress toward achievement of personal
spiritual goals
�
To create and / or maintain a therapeutic environment
�
To facilitate awareness of self as an individual with varying
physical , emotional, and developmental
�
To facilitate the maintenance of a supply of oxygen to
all body cells
�
To facilitate the maintenance of nutrition of all body cells
�
To facilitate the maintenance of elimination
�
To facilitate the maintenance of fluid and electrolyte balance
�
To recognize the physiological responses of the body to
disease conditions
�
To facilitate the maintenance of regulatory mechanisms and
functions
�
To facilitate the maintenance of sensory function.
�
To accept the optimum possible goals in the light
of limitations, physical and emotional
�
To use community resources as an aid in resolving
problems arising from illness
�
To understand the role of social problems as
influencing factors in the case of illness
Dorothy Johnson

� Concep
tuCalliiczkedtotheedBitethhaevio
ourtalline System
Mtoedxtelformat

� Subsytems Second Outline Level
�
Ingestive 
Third Outline
�
Eliminative Level
 Fourth Outline
�
Affiliative
Level
�
Dependence 
Fifth Outline
Level
�
Achievement 
Sixth
�
Sexual and role identityObuethlianveior
Level
�
In addition she viewed that each person strives to
achieve balance and stability both internally and
externally and to function effectively by adjusting
and adapting to environmental forces through
learned patterns of response
�
Furthermore, she believed that the patient strives to
become a person whose behavior is commensurate
with social demands; who is able to modify his behavior
in ways that support biologic imperatives; who is able
to benefit to the fullest extent during illness from the
health care professional’s knowledge and skills; and
whose behavior does not give evidence of
unecessary trauma as a consequence of illness
�
Dorothy Johnson – Behavioral Systems model
Dorothea Orem 🞂 Developed the self-care and self-
care deficit Theory

Click to edit the outline
�
She defintedxtdfeofirnmeadt self care
as the
“practice of activities that individuals
initiate and
pSecrfoonrdmOountltihneirLeovwenl
behalf in main taTinhiinrgd
lOifeu,thlienaelth and
well being.” Level
�
She
conceptualizesFtohurretehNOuurtsliing
e
systems as f
evel 
Fifth Outline
�
Wholly compensatory
Level
�
Partially compensatorySixth
�
Supportive Outline
educative Level

�
Madeline Linenger 🞂 Developed Transcultural
Nursing Model

Click to edit the outline
�
Shteexatdvfoorcmataetd that
Nursing
is a humanistic and scientific
modeSeocfohnedlpOingutalincelieL
netvel
through TspheircdifiOc
cuutllitnueral
caring prLoecveesls* to
improve or maintain
h ea l t h c on d i t io n
Fo u r t h O u tl i n e
�
Advocated tLheavtecl aring
is universal and vaFrifitehs
Outline transculturally.
LMeavjeolr concepts inclu
dSeixctahre, caring,
cultural Oanudtlcinuelt
values ural
variations Level
�
Furthermore, Leininger believed that caring serves to
ameliorate or improve human conditions and life base.
And that care is the essence and the dominant, distinctive
and unifying feature of nursing
�
Madeleine Leininger - Transcultural
Imogene King 🞂 Postulated the Goal attainment
Theory
She d escCrliibcekdtonuerdsint gthaes

�

oa uhtelilnpeing
professiotenxthfaotrmasastists
individuals
and groups
SinecsooncdieOtyuttolinaettLaien
v,el maintain, and restore
health*

Third Outline
�
In addition, kinLgevvielwed
nursing as an interaction
procFeosusrtbhetOwuetelnine
client and nurse wLheevreel by
during
 perceiving,
an d a c t insetting
g goaFlisft,
h O u t li n e
on transactions goals are
occurLeavnedl
achieved

Sixth
�
Imogene King =
GoalOAuttlaininement
Theory Level
Myra Levin 🞂 She advocated that nursing is
a human interaction and
propCosliecdk ftouer nthserovuatiloi
dciot nne
princtiepxletsfoorfmnautrsing
which are
concern e d w it h un i t y a n
d S e co of
integrity n dtheOindividual.
u t l in e
L evel
Third Outline


�
Described tLheeveFlour
Conservation PFroinucritphleOs
utline
�
Conservation Loef vEenlergy
�

Fifth Outline
Conservation of Structural
 Integrity Level

Sixth
�
Conservation of POerustolinnael
Integrity
Level

� 
 �
Conservation of energy – the human body functions by utilizing
energy.The human needs energy producing input (food, oxygen, fluids) to
allow energy utilization as output
�
Conservation of structural integrity – the human body has a
physical boundaries (skin and mucous membrane) that must be maintained
to facilitate health and prevent harmful agents from entering the body
�
Censervation of personal integrity – the nursing interventions
are based on the conservation of the individual client’s personality. Every
individual has a sense of identity, self worth and self esteem, which must
be preserved and enhanced by nurses
�
Conservation of social integrity – the social integrity of the client
reflects the family and the community in which the client functions.
Healthcare institutions may separate individuals from their family. It is
important for the nurses to consider the individual in the context of the
family

� Myra LEVIN – Conservation

�
“conserve the
Hildegard Peplau

� In trCodlicukcetdo
tehdeitInthteropeurtslionneal
Modteexl t format
� She dSeeficnoendd
nOuurstilninge Laesvealn
interpersoTnhailrd
Opruotclienses of
therapeutiLcevel interactions
between
in di v idanua l wh o
Fo u r th O u t lin
’s
e
sick or in n ee d of health
services and L v ael nurse
especially
 
F if t h O utlintoe
e du c a t e d
L e v e l
recognize and r e s p ond
to
the need for he lpSixth


Outline
Level
�
She identified the four phases of the nurse-
client relationship namely
� Orientation – the nurse and the client initially do not
know each other’s goal and testing the role each will
assume1

� Identification – the client responds to the professionals or

the significant others who can meet the identified needs2

� Exploitation – the client utilizes all available resources to move

toward a goal of maximum health or functionality

� Resolution – Refers to the termination phase of the nurse

– client relationship3
�
Hildegard PepLau – Interpersonal Model
Martha Rogers 🞂 Conceptualized the Science of Unitary
Human Beings
� Energy Click to edit the outline

Fiel d text format
�
Human Field*
 Second Outline Level
�
Environmental Field*

Third Outline
� Unitary Man is an field in constant
enLervgeyl
interaction with the
envFiroounrmtheOntutline
Level
� The unitary human being and the
environment are
integral aFnidfththOeruetfloinre


viewed as a whole* Level

�
Furthermore, she believed that human being is charSaicxttehrized by
the
aOndcapacity
t h o for
u abstraction and imagery, language
ght,
u t li n e
sensation and emotion
Level
 
Click to edit the outline
text format
 Second Outline Level

Third Outline
Level
 Fourth Outline
Level

Fifth Outline
Level
�
Martha ROgers – UNItary 
Sixth
maN Outline
Level
Sister Callista Roy
�
Presented the adaptation model
She viewe d eCaclihckpetrosoendiats
�


tuhneifioedutline biopsychosotceiaxl
tsyfostremmaitn constant interaction
with a c h a n gin g
S ec o n d O
e n v ir on m en t 1
u t l in e L ev e l
�
The system
consistsTohfirindpuOt,uctolinnterol
process, output and fee d b
L ev e l
ack
�
In addition she advocateFdotuhratthalOl
puetolpinlee have certain needs
whicLhevtheely endeavor to meet in
order to maintain integrity2

Fifth Outline
� Accordingly she believed that adaptive human behaviorLeisvdeilrected
as an attempt to maintain homeostatis or integrity of the individual by
conserving energy and promoting the survival, growth,Sixth

production and
mastery of human system Outline
� RAM – Roy’s Adaptation Model Level
� Nursing operates in all three circles, but it shares them
with other professions to different degrees

� Care – nurturance ntuhresinogu*

Canldicekxctluosiveedtiot tline
� Core – involves thetethxetrafpoerumticautse of self
and
emphasizes the use of r efl e c ti on *
S e c o n d Outline
Level
� Cure – Pathological conditions are focuses on
Third
nursing related to the physician’s orders*
Outline
Level
� Second, relates to the core postu la t e o f he r
F ou r th O
t he o ry
u tl in e
� As the patient needs less mLedeivcael lcare, he or
 she needs more professional Nursing care and
teaching
�
Third , wholly professional nursing care will hasten
recoLveervyel
� Describes the concept of team nursing, which give sSitxhteh
care of less complicated cases to caregivers with les s
training
O utline
Level
�
Lydia HALL – CaRE, CoRE,
CuRE
Ida Jean Orlando (Pellitier)

� Conce
ptCulaiclikzetdoTehdeitDthyen
aomuticline Nurse –
tePxatiefonrtmRaetlationship
Model 
Second Outline Level
� She
believedthTahtirthdeOnurlsineehelps
patients meet aLepveerlceived
need
that
patientsthe
cFanonuortthmOeeutlifnoer
themselves
Level
� She observed that
helplessness*
thFeifntuhrOseutline provides
Level direct
assistLanevcel to meet an
immediatenSeiexdthfor help in
order to alleviate dOisutrtelinsse
or
�
She also indicated that nursing actions can be
automatic1 or deliberative2
�
She also advocated that the three elements composing
nursing situation are: client behavior, nurse reaction
and nurse action
�
Ida Jean Orlando – Nursing Process Theory
 Jean Watson
� Conceptualized the Human Caring
Model
(NCurliscinkgt:oHuemdiatnthSecieonu


ctelinaned Human Ctaerxet). format


� Second
She emphasized Outlinethe
that nursing Level
application of theTharirtdanOduhtulimnean
Science through Ltreavneslpersonal
caring transactions to help person
achieve mind-body  soul
F o u r th Outline
harm o n y *
Level
� She included health
proFmifothtioOnuatnlidne treatment of
Level
illness in nursing
� She believed that a person is valued being to be cared for,
respected, nurtured, understood and assisted; a fullySfiuxntchtional
 integrated self Outline
� Jean Watson –Science and Philosophy of Caring Level
 10 Carative Factors in Nursing

� Forming humanistic – altruistic value system

� Instilling faith- hope

� Cultivating sensitivity to self and others

� Developing helping – trust relationship

� Promoting expression of feelings

� Using problem – solving for decision making

� Promoting teaching - learning

� Promoting supportive environment

� Assisting with gratification of human needs

� Allowing for existential- phenomenological forces

Rosemarie Rizzo Parse

� IntroducedCtlihcek Stcoieendcite
tohfehouumtlain Becoming text
format
� She emphasizeSdecforened
cOhuoticlieneofLevel personal
meaningTihnirrdelOatuintglinvealue
properties, co-crLeeatvienlg of
rhythmical patterns,
i n e x c ha ng e
F o u rt h O u tline
with the environmen t , a n d
contrascending in many L edimensions
v e l 
� She
F if believed
t h O uthat each cahsopicoessoibpielintiecserutnafionldo*p
tl ine
p o r t u nit ie s
 while closing others Level
🞂 
Sixth
Since each individual makes his or her own personal choices,
Outline
the role of the nurse is that of guide, not a decision maker
Level
� Rosemarie Riso Parse –Theory OF HUMAN BeCOminG
Joyce Travelbee
�
She postulaCtelidckthtoe
Iendtietrtpheersoountalilne
aspects of NteuxrtsfionrgmMaot
del.
�
She
advocatedStehcaotntdheOguotalilnoef
Level Nursing is to
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u r t h O utline
illness, or m a in taining maximal
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 
� She further
F i fth O viewed
u t linthat
e interpersonal process
i s a hu m a n –
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to – human relationship formed during illness a n d
“experience of 
Sixth
suffering”* Outline
🞂
The H2H in nursing situations, is the means through which
the purpose of nursing is accomplished Level
� The H2H relationship is established when the nurse and
the recipient of her care attain a rapport after having
progressed through the stages of original encounter,
emerging identities, empathy and sympathy. (continuum
of suffering)
� Transitory feeling of displeasure

� Extreme anguish

� Malignant phase of despairful not caring

� Terminal Phase of apathetic indifference

� She believed that a person is a unique, irreplaceable

individual who is in a continuous process of becoming,
Patricia Benner

� Dr
Patri ciaClBicekntnoeerdiitntthreoo


duutcliende the
te x t fo r m
concep t t h a t e x perta t
nurses
develop
skilsSeacnodndunOduetlrinsetaLnedveinl
g
of patient oTvh tOimuteline
care 
eirrd
through a soundLeevdelucational
base as well as a
 mFuoltuirttuhdOeuotlfine

� She further explains

ethxaptetrhieendceevesl.opmenLteveof lknowledge

F i ft h O
in applied disciplines such as medicine and n u r s in g
u tline
is
� She proposed that onLeevceol uld
composed of the extension of practical knowledge
g a i n k n o w le d g e
(know how) through r e s ea r c h an d t h e
a n d s Sk ix il tlhs

c h ar a c t e riz(" ationk no w i n g h o w ") w
and
i t hO o u ut ltineever
understanding of th e "k n o w h ow " o f
c l in i c a l
experience. learning the theory
("Lkenveol wing
 Benner’s Stages of clinical competence

� Stage 1: Novice
� Beginners have had no experience of the situations in
which they are expected to perform. Novices are
taught rules to help them perform.
� The rules are context-free and independent of specific
cases; hence the rules tend to be applied universally.
� The rule-governed behavior typical of the novice is
extremely limited and inflexible.
� As such, novices have no "life experience" in the
application of rules."Just tell me what I need to do and
I'll do
� Stage 2: Advanced Beginner
�
Advanced beginners are those who can
demonstrate marginally acceptable performance,
those who have coped with enough real situations
to note, or to have pointed out to them by a
mentor, the recurring meaningful situational
components.
�
These components require prior experience
in actual situations for recognition.
�
Principles to guide actions begin to be formulated.
�
The principles are based on
� Stage 3: Competent
� Competence, typified by the nurse who has been on the job in
the same or similar situations two or three years, develops when
the nurse begins to see his or her actions in terms of long-
range goals or plans of which he or she is consciously aware.

� For the competent nurse, a plan establishes a perspective, and

the plan is based on considerable conscious, abstract, analytic
contemplation of the problem.

� The conscious, deliberate planning that is characteristic of this

skill level helps achieve efficiency and organization.

� The competent nurse lacks the speed and flexibility of the

proficient nurse but does have a feeling of mastery and the ability
to cope with and manage the many contingencies of clinical
nursing.
�
The competent person does not yet have enough experience
� Stage 4: Proficient
� The proficient performer perceives situations as wholes rather than
in terms of chopped up parts or aspects, and performance is guided
by maxims.

� Proficient nurses understand a situation as a whole because they

perceive its meaning in terms of long-term goals.

� The proficient nurse learns from experience what typical events

to expect in a given situation and how plans need to be modified
in response to these events.

� The proficient nurse can now recognize when the expected normal
picture does not materialize.

� This holistic understanding improves the proficient nurse's decision

making; it becomes less labored because the nurse now has a
perspective on which of the many existing attributes and aspects in
the present situation are the important
�
Stage 5:The Expert
�
The expert performer no longer relies on an analytic
principle (rule, guideline, maxim) to connect her or his
understanding of the situation to an appropriate action.
�
The expert nurse, with an enormous background of experience,
now has an intuitive grasp of each situation and zeroes in on the
accurate region of the problem without wasteful consideration
of a large range of unfruitful, alternative diagnoses and solutions.
�
The expert operates from a deep understanding of the total
situation.The chess master, for instance, when asked why he or
she made a particularly masterful move, will just say: "Because
it felt right; it looked good."
�
The performer is no longer aware of features and rules;'
his/her performance becomes fluid and flexible and highly
proficient.
�
This is not to say that the expert never uses analytic tools. Highly
Rozzano Locsin
🞂 
Click to edit the outline

Credteextnfotrmiaat ls
 Second Outline Level
�
PhD: nTh eOurtlisnei
U  iirv ty
d
Level

of the Fourth Outline


Level
Philippine sLevel
Fifth Outline

(1988) - MOutline
Saixtnh


ila,
PhilippinesLevel
�
Teaching
�
Philosophies of Science Grounding Nursing
�
Introduction to Nursing as Discipline and Profession
�
Nursing Research
�
Arts as Healing Modalities in Nursing
�
Philosophical & Theoretical Foundations of Advanced
Practice Nursing
�
Advancing Technology, Caring, and Nursing
�
Research interest
�
Experiences of Caring for/Being Cared for
� Awards

� Academic Excellence Award, Philippine American Society, 2010

� Balik Scientist (Returning Scientist) Program, Department of Science &

Technology, Philippines 2009

� University Research of the Year - Professor, Scholarly & Creative Works,

FAU 2006

� Outstanding Alumni Award – Lifetime Achievement in Nursing Education

St. Paul University of Dumaguete, Dumaguete City, Philippines 2004

� Fulbright Alumni Initiative Award Center for International Exchange of

Scholars,Washington, D.C. 2004-2006

� Edith Moore Copeland Award for Excellence in Creativity (Founders Award)

Sigma Theta Tau International Honor Society of Nursing - Indianapolis (37th
Biennial Convention – November 1-5) 2003

� Julita V. Sotejo Medallion of Honor: Lifetime Achievement Award University of

the Philippines, Nursing Alumni International Inc., Los Angeles, California
2003
� He describes nursing as caring through technological
competency
� In his chapter, Locsin described how technological
competency in nursing practice is an expression of caring.
� He outlined his theory in his book by stating “the
practice of the 21st century nursing is conducted in
environment that rely on complex biomedical machine
technology, practice environments that differ vastly
from those of an earlier era.
� The core of nursing, the basic service of nursing, however
has not changed.
� Caring continues to be the most essential and the most
direct expression of nursing service.
� Nurses now face the challenge of creating an
environment of personal care in the context of highly
sophisticated, although impersonal, health care technology
� He provided a description of nursing practice, and implied
the potential for objectification of clients due to
technological competency.
� Locsin explored the dichotomy between technology
and caring, and through references to current literature
about nursing as caring, he developed a harmonious
merger of this dichotomy