WEEK 2: EVOLUTION OF NURSING THEORY •Abstract concepts – mentally constructed independent

of a specific time and place

TERMINOLOGIES
•Concrete concepts – directly experience and related to
• PHILOSOPHY - Beliefs and values that define a way of
a particular time or place
thinking and are generally known and understood by a
group or discipline
2. DEFINITION
• CONCEPT - often called the building blocks of theories
•Used to convey the general meaning of the concepts
•MODELS – are representations of the interaction of the theory
among and between the concepts showing patterns
•Theoretical definitions - this is defined based on the
• CONCEPTUAL FRAMEWORK – is a group of related theorist perspective
ideas, statements or concepts
•Operational definitions – this states how concept are
• PROPOSITION – are statements that describe the
measured.
relationship between the concepts

• DOMAIN - is the perspective or territory of a 3. ASSUMPTIONS

profession or discipline
• PROCESS – are series of organized steps, changes or
functions intended to bring about the desired result
• PARADIGM – refers to a pattern of shared
understanding and assumptions about reality and the
world
•Are accepted as truths and are based on values and
beliefs, these are statements that explain the nature of
concepts, definitions, purpose, relationship and
structure of a theory
4. PHENOMENON

• METAPARADIGM – is the most general statement of
discipline and functions as a framework in which the
more restricted structures of conceptual framework
models develop
THEORY
• A set of statement that tentatively describe, explain,
or predict relationships among concepts that have been
systematically selected and organized as an abstract
representation of some phenomenon (McEwen & Wills,
2019)
NURSING THEORIES
• Organized bodies of knowledge to define what
nursing is, what nurses do, and why do they do it.
Provide a way to define nursing as a unique discipline
that is separate from other disciplines (e.g: medicine). It
guide the practice of nursing at a more concrete and
specific level
COMPONENTS OF THEORY
1. CONCEPTS
•Interrelated concepts define a theory. Concepts are
used to help describe or label a phenomenon
•Is the term, description, or label given to describe an
idea or responses about an event, situation, process,
group of events or group of situations.
WHY ARE NURSING THEORIES IMPORTANT
•This is the basis of nursing practice today.
•It guides knowledge development and direct
education, research, and practice.
• Historically, nursing was not recognized as an
academic discipline or as a profession we view it today.
•Before, nursing was considered to be a task oriented
occupation
PURPOSE OF NURSING THEORIES
• is to improve practice by positively influenced the
health and quality of life of patient
• To develop, define and describe nursing care nursing
care and guide nursing practice and provide a basis for
clinical decision making
• Accomplishment of nursing in the past led to MIDDLE AGES
recognition of nursing and academic discipline, research
and profession

WHAT IS NURSING?

• Nursing is caring, an art, a science, client centered,

holistic, adaptive and a helping profession RENAISSANCE
• Nursing is concerned with health promotion, health
maintenance, and health restoration

• Nursing is a profession within the health care sector

focused on the care of individuals, families, and
communities so they may attain, maintain, or recover
optimal health and quality of life.
DEACONESS OF KAISERWERTH
EVOLUTION OF NURSING IN THE OTHER LAND

EARLY CIVILIZATION

THEODORE FLEIDNER

ANCIENT GREECE

FLORENCE NIGHTINGALE

HISTORY OF NURSING IN THE PHILIPPINES

• EARLY BELIEF AND PRACTICES

- Beliefs about causation of disease

ROMAN EMPIRE
- Believed in evil spirits
- Believed in special gods

• EARLY CARE OF THE SICK

 - Client who suffer certain disease was brought to
albularyo for healing
- A midwife (manghihilot) assisted client in
delivering their babies
HISTORY OF NURSING IN THE PHILIPPINES
• HEALTH CARE DURING THE SPANISH REGIME
- Hospital Real de Manila (1577)
- San Lazaro Hospital (1578)
- Hospital de Indio (1586)
- Hospital de Aguas Santas (1590)
- San Juan de Dios Hospital (1596)
• NURSING DURING THE PHILIPPINE REVOLUTION
- Josephine Bracken - Capitan Salome
- Rosa Sevila de Alvero - Agueda Kahabagan
- Doma Hilaria de Aguinaldo - Trinidad Tecson
- Dona Maria Agoncillo de Aguinaldo
- Melchora Aquino
HISTORY OF NURSING IN THE PHILIPPINES
• FILIPINO RED CROSS
- Malolos Bulacan, main chapter
- Collect war funds and some voluntary
contributions
- Provision of nursing care for Filipino wounded
soldiers
- To become a member, one must have sound
mind and at least 14 years of age
HOSPITALS AND SCHOOL OF NURSING
- Iloilo Mission Hospital School of Nursing (Iloilo,
1906)
- St Paul’s Hospital School of Nursing (Manila,
1907)
- Philippine General Hospital School of Nursing
(1907)
- St Luke’s Hospital School of Nursing (QC, 1907)
- Mary Johnston Hospital School of Nursing
(Manila, 1907)
HISTORY OF NURSING IN THE PHILIPPINES
• HOSPITALS AND SCHOOL OF NURSING
- Philippine Christian Mission Institute School of
Nursing
- San Juan de Dios Hospital School of Nursing
(Manila 1913)
- Emmanuel Hospital School of Nursing (Capiz
1913)
- Southern Island Hospital School of Nursing
(Cebu 1916)
• FIRST COLLEGES OF NURSING IN THE PHILIPPINES
- University of Santo Tomas College of Nursing
(1946)
- Manila Central University College of Nursing
(1947)
- University of the Philippines College of Nursing
(1948)
HISTORY OF NURSING IN THE PHILIPPINES
• NURSING LEADERS IN THE PHILIPPINES
- Anastasia Giron Tupas
- Cesaria Tan
- Socorro Sirilan
- Rosa Militar
- Sor Ricarda Mendoza
- Socorro Diaz
- Conchita Ruiz
- Loreto Tupaz
CURRICULUM ERA (1900s to the 1940s)
The idea of moving nursing education from hospital-
based diploma programs into colleges and universities
began to emerge during this era (Erwin,2015; Judd &
Sitzman, 2013).
RESEARCH ERA (1950s and the 1970s)

Nurses were encouraged to learn how to conduct

research, developing the role for nurses for that
Hildegard Peplau
specialized body ofknowledge.

GRADUATION EDUCATION ERA (1950s and the 1970s)
Focus graduate education on knowledge development.
Carving out an advanced role and basis for nursing
practice.
•In 1952, Hildegard Peplau introduced her Theory of
Interpersonal Relations that puts emphasis on the
nurse-client relationship as the foundation of nursing
practice.

THEORY ERA (1980 to the 1990s)

Continues with emphasis on development and use of

nursing theory to produce evidence for professional
practice. Particular utility of middle range theories to
guide the thought and action of nursing practice is
noted (Alligood, 2006c)

THEORY UTILIZATION ERA (21ST CENTURY)

Nursing theory guides research, practice, education,

and administration.
Virginia Henderson
HISTORY OF NURSING THEORIES
•In 1955, Virginia Henderson conceptualized the nurse’s
role as assisting sick or healthy individuals to gain
independence in meeting 14 fundamental needs, thus
her Nursing Need Theory was developed.

Florence Nightingale

•In 1860, Florence Nightingale defined nursing in her

“Environmental Theory” as “the act of utilizing the
environment of the patient to assist him in his
recovery.”
Faye Abdellah

•In 1960, Faye Abdellah published her work “Typology

of 21 Nursing Problems” that shifted the focus of
nursing from a disease-centered approach to a patient-
centered approach.
 Ida Jean Orlando

•In 1962, Ida Jean Orlando emphasized the reciprocal
relationship between patient and nurse and viewed the
professional function of nursing as finding out and
meeting the patient’s immediate need for help.
Dorothea Orem
•In 1971, Dorothea Orem states in her self care theory
that nursing care is required if the client is unable to
fulfill biological, psychological, developmental, or social
needs.

Dorothy Johnson

•In 1968, Dorothy Johnson pioneered the Behavioral Imogene King

System Model and upheld the fostering of efficient and
effective behavioral functioning in the patient to
prevent illness.
•In 1971, Imogene King‘s Theory of Goal attainment
states that the nurse is considered part of the patient’s
environment and the nurse-patient relationship is for
meeting goals towards good health.

Martha Rogers

•In 1970, Martha Rogers viewed nursing as both a

science and an art as it provides a way to view the
unitary human being, who is integral with the universe. Betty Neuman
•In 1972, Betty Neuman in her theory states that many
needs exist, and each may disrupt client balance or
stability. Stress reduction is the goal of the system
model of nursing practice.
Sr. Callista Roy
•In 1979, Sr. Callista Roy viewed the individual as a set
of interrelated systems who strives to maintain the
balance between these various stimuli.
Jean Watson
•In 1979, Jean Watson developed the philosophy of
caring highlighted humanistic aspects of nursing as they
intertwine with scientific knowledge and nursing
practice.
DISCIPLINE
• Is specific to academia and a branch of education, a
department or field of knowledge.
RESEARCH
Development of theory is fundamental to the
research process where it is necessary to use theory as
a framework to provide perspective and guidance to the
research study. Theory can also be used to guide the
research process by creating and testing phenomena of
interest
PROFESSION
• are responsible for regulation of standards of practice
and education based on disciplinary knowledge that
reflects safe health service to society in all settings.
WEEK 3: HISTORY AND PHILOSOPHY OFSCIENCE IN
NURSING
Philosophy of Science in Nursing
•explores the meaning of truth, the meaning of
evidence, and the meaning of life through practice.
RATIONALISM
• Knowledge is based on the use of reason or logic
• Deductive reasoning
• Theory-then-research
• There are significant ways in which our concepts and
knowledge are gained independently based on
experience
EMPIRICISM
• It talks about the central of idea of a scientific
knowledge thru sensory experiences (seeing, hearing,
fearing facts)  Theory based on the claim that
experience is the source of knowledge
• Research-then-theory
• Do not believe in intuition
• Individuals have no innate knowledge
• Ideas and knowledge develop in our minds as a result
of our sensory experience
Early Twentieth Century Views of Science and Theory
•The philosopher are focused on the analysis of theory
structure while scientist are focus on empirical research
• Theory is based on the claim that experience is the
source of knowledge
• Scientists focused on empirical research
• Positivism emerged as dominant view of science
• Theories must be tested through observation and
experimentation
Emergent views of science and Theory in the late 20th
Century
• Empiricists argue that for science to maintain its
objectivity, data, collection and analysis must be
independent of a theory
• Empiricists view phenomena objectively, collect data,
and analyze it to inductively proposed theory.
• This position is based upon objective truth existing in
the world, waiting to be discovered. Set forth a new
epistemology challenging the empiricist view proposing
that theories play a significant role in determining what
the scientist observes and how it is interpreted.
STRUCTURE OF NURSING KNOWLEDGE
•METAPARADIGM
•PHILOSOPHY
•CONCEPTUAL MODELS
•THEORY
PHILOSOPHY
•FUNCTIONS
- to communicate what the members of a
discipline believe to be true in relation to the
phenomena of interest to that discipline
- what they believe about how the knowledge
about those phenomena should be developed
- what they value with regard to their actions
and practices
CONCEPTUAL MODELS
•FUNCTIONS
- to provides a framework for reflection,
observation, and interpretation of phenomena
- it provides guidelines and guidance for YOUR
clinical practice.
THEORY
• FUNCTIONS
- theory are to narrow and more fully specify the
phenomena contained in a conceptual model
- to provide a relatively concrete and specific
structure for the interpretation of behaviors,
situations, and events.
• TYPES
- GRAND THEORIES – Are relatively abstract and
broad, though less abstract than conceptual
models. EXAMPLE: Leininger's theory of culture
care diversity and universality, Newman's
theory of health as expanding consciousness,
and Parse's theory of human becoming.
- MIDDLE RANGE THEORIES - are more concrete
and narrower than grand theories; they are
made up of a limited number of concepts and
propositions that are written at a relatively
concrete and specific level. EXAMPLE: Orlando's
theory of the deliberative nursing process,
Peplau'stheory of interpersonal relations, and
Watson's theory of human caring
WEEK 4: Philosophy, Conceptual Models
and Middle Range Theories
TERMINOLOGIES
• Philosophy - Sets forth the meaning of nursing
phenomena through analysis, reasoning and logical
presentation of concepts and ideas.
• Conceptual models - Are sets of concepts that address
phenomena central to nursing in propositions that
explain the relationship among them.
• Theory - a system of ideas intended to explain
something, especially one based on general principles
independent of the thing to be explained.
• Middle Range theory - Concepts most specific to
practice that propose precise testable nursing practice
questions and include details such as patient age group,
family situation, health condition, location of the
patient, and action of the nurse.
Components of Nursing Theories
For a theory to be a theory it has to contain a set of
concepts, definitions, relational statements, and
assumptions that explain a phenomenon. It should also
explain how these components relate to each other.
Phenomenon
A term given to describe an idea or responses about an
event, a situation, a process, a group of events, or a
group of situations. Phenomena may be temporary or
permanent. Nursing theories focus on the phenomena
of nursing
Concepts
Interrelated concepts define a theory. Concepts are
used to help describe or label a phenomenon. They are
words or phrases that identify, define, and establish
structure and boundaries for ideas generated about a
particular phenomenon. Concepts may be abstract or
concrete.
• Abstract Concepts. Defined as mentally constructed
independent of a specific time or place.
• Concrete Concepts. Are directly experienced and
related to a particular time or place.
Definitions
Definitions are used to convey the general meaning of
the concepts of the theory. Definitions can be
theoretical or operational.
• Theoretical Definitions. Define a particular concept
based on the theorist’s
perspective.
• Operational Definitions. States how concepts are
measured
Relational Statements
Relational statements define the relationships between
two or more concepts. They are the chains that link
concepts to one another.
Assumptions
Assumptions are accepted as truths and are based on
values and beliefs. These are statements that explain
the nature of concepts, definitions, purpose,
relationships, and structure of a theory.
Purposes of Nursing Theories
The primary purpose of theory in the profession of
nursing is to improve practice by positively influence the
health and quality of life of patients. Nursing theories
are also developed to define and describe nursing care,
guide nursing practice, and provide a basis for clinical
decision making. The accomplishments of nursing in the
past led to the recognition of nursing in academic
discipline, research, and profession.
In Academic Discipline
Much of the earlier nursing programs identified the
major concepts in one or two nursing models, organized
the concepts and build an entire nursing curriculum
around the created framework. The unique language in
these models was typically introduced into program
objectives, course objectives, course descriptions, and
clinical performance criteria. The purpose was to
explain the fundamental implications of the profession
and to enhance the status of the profession.
In Research
Development of theory is fundamental to the research
process where it is necessary to use theory as a
framework to provide perspective and guidance to the
research study. Theory can also be used to guide the
research process by creating and testing phenomena of
interest. To improve the nursing profession’s ability to
meet the societal duties and responsibilities, there need
to be a continuous reciprocal and cyclical connection
with theory, practice, and research. This will help
connect the perceived “gap” between theory and
practice and promote the theory-guided practice.
In Profession
Clinical practice generates research questions and
knowledge for theory. In a clinical setting, its primary
contribution has been the facilitation of reflecting,
questioning, and thinking about what nurses do.
Because nurses and nursing practice are often
subordinate to powerful institutional forces and
traditions, the introduction of any framework that
encourages nurses to reflect on, question, and think
about what they do provide an invaluable service.
Classification of Nursing Theories
There are different ways to categorize nursing theories.
They are classified depending on their function, levels of
abstraction, or goal orientation.
By Abstraction
There are three major categories when classifying
nursing theories based on their level of
abstraction: grand theory, middle-range theory, and
practice-level theory.
Grand Nursing Theories
• Grand theories are abstract, broad in scope, and
complex, therefore requiring further research for
clarification.
• Grand nursing theories do not provide guidance for
specific nursing interventions but rather provide a
general framework and ideas about nursing.
• Grand nursing theorists develop their works based on
their own experiences and the time they were living
explaining why there is so much variation among
theories.
• Address the nursing metaparadigm components of
person, nursing, health, and environment.
Middle-Range Nursing Theories
• More limited in scope (as compared to grand theories)
and present concepts and propositions at a lower level
of abstraction. They address a specific phenomenon in
nursing.
• Due to the difficulty of testing grand theories, nursing
scholars proposed using this level of theory.
• Most middle-range theories are based on the works of
a grand theorist but they can be conceived from
research, nursing practice, or the theories of other
disciplines.
Practice-Level Nursing Theories
• Practice nursing theories are situation specific
theories that are narrow in scope and focuses on a
specific patient population at a specific time.
• Practice-level nursing theories provide frameworks for
nursing interventions and suggest outcomes or the
effect of nursing practice.
• Theories developed at this level have a more direct
effect on nursing practice as compared to more abstract
theories.
1. Lack of sanitation
2. Presence of filth – contaminated water and bed
linens
3. Soldiers exposure to frostbite, louse infestations,
wound infections and opportunistic diseases.

• These theories are interrelated with concepts from

middle-range theories or grand theories.

By Goal Orientation

Theories can also be classified based on their goals, they

can be descriptive or prescriptive.

WEEK 5: NURSING PHILOSOPHIES

FLORENCE NIGHTINGALE • The lady of/WITH the lamp – because she made ward
rounds during the night
Modern Nursing
• In Scutari she became critically ill with crimean fever –
typhus or brucellosis

• After the war – she established st. thomas hospital

and kings college hospital In London.

Major Assumptions

1. Nursing – Every woman at one time in her life would

be a nurse in the sense that nursing is being responsible
for someone else’s health.

2. Person – Patient. The nurse was in control of and

responsible for the patient’s environmental
• credentials and background surroundings.
• Founder Of Modern Nursing 3. Health – Being well and using every power to the
Environmental Problems fullest extent. She envisioned the maintenance of
health through prevention of disease by environmental
control and social responsibility.

4. Environment – Nursing was to assist nature in healing

the patient. Create and maintain a therapeutic
environment. Her assumptions and understanding
about the environmental conditions were most relevant
to her philosophy.

• The role of nursing is to facilitate "the body’s

reparative
processes" by manipulating client’s environment.
Theoretical Assertions
• Disease was a reparative process
• Disease was nature’s effort to remedy a process of
poisoning or decay or a reaction against the conditions
in which a person was placed.
MAJOR CONCEPTS & DEFINITIONS
• Theory focused on environment. (Surroundings)
• Five essential components of environmental health
• Pure air
• Light
• Cleanliness
daily, their clothing to be clean and wash their hands
frequently
Acceptance by the Nursing Community
1. Practice – remain the foundation of nursing practice
today.
2. Education – three experimental schools were
established in the US in 1873
• Bellevue Hospital in New York
• New Haven Hospital in Connecticut
• Massachusetts Hospital in Boston - good practice
could result only from good education
3. Research – empirical approach to solving problems of
health care delivery.

• Efficient drainage - “Environmental Theory”

• Pure water Jean Watson

Philosophy and Theory of Transpersonal Caring

1. PURE AIR – “Keep the air he breathes as pure as the
external air, without chilling him”
• Emphasis on proper ventilation
• Measuring the patient’s body temperature through
palpation of extremities to check for heat loss.
• Margaret Jean Harman Watson
• Born and grew up in Welch, West Virginia
• University of Colorado BSN in 1964, Master’s Degree
in 1966 and doctorate degree in 1973.

• good fire, opening windows and properly positioning

the patient.

2. LIGHT – direct sunlight. To achieve the beneficial

effects of sunlight, nurses were instructed to move and
position patients to expose them to sunlight.

3. CLEANLINESS – patient, nurse and environment. A

dirty environment was a source of infection through the Books
organic matter it contained. 1. Nursing: The Philosophy and Science of Caring (1979)
4. EFFICIENT DRAINAGE – appropriate handling and – 10 Carative Factors
disposal of bodily excretions and sewage were required
to prevent contamination of the environment.

5. PURE WATER – advocated bathing the patients on a

frequent, even daily basis. Also the nurse must bathe

Theoretical Sources
• Caring moment can be transpersonal – each person
feels a connection with the other at the spirit level.
• Healing – directly related to the individual’s evolving
personhood.
• She uses handwashing as a ritual to pause for a
moment and become receptive to interactions with the
patient.
• “the Caring Moment is most evident within the
transpersonal Caritas energetic field model.”
- One’s consciousness, intentionality, energetic
heart-centered presence is radiating a field
beyond the two people and situation, affecting
the larger field
- four aspects of caring – moral ideal,
intentionality, ontological competencies,
healing art and healing space in transpersonal
caring
Theoretical Assertions
• NURSING – Consist of knowledge, thought, values,
philosophy, commitment and action with some degree
of passion. Using the 10 carative factors, the nurse
provides care to various patients.
• PERSONHOOD – views person as a unity of
mind/body/spirit/nature. The body is a living spirit that
manifests one’s being in the world
• HEALTH – unity and harmony within the mind, body
and spirit, associated with the degree of congruence
between the self as perceived and the self as
experienced.
• ENVIRONMENT – healing spaces can be used to help
others transcend illness, pain and suffering. The aim of
the environment is to create healing places.
Marilyn Anne Ray
Theory of Bureaucratic Caring
• Marilyn Anne Dee Ray was born in Hamilton, Ontario,
Canada.
• Graduated from St. Joseph Hospital School of Nursing
in 1958.
• She finished her BSN and MSN at University of
Colorado School of Nursing – she met Dr. Madeleine
Leininger.
Theoretical Sources
• Ray’s interest in caring as a topic was stimulated by
her work with Leininger in 1968 focusing on
transcultural nursing and
ethnographic-ethnonursing research methods.
• she used ethnographic methods in combination with
phenomenology and grounded theory to generate
substantive and formal grounded theories, resulting in
the theory of bureaucratic caring
Major Concepts and Definitions
• Caring is A complex, transcultural, relational process,
grounded in an ethical, spiritual context. Caring is
inevitable within a culture or society, such as, personal
culture, hospital organizational culture, and society
culture.
• Physical - this factor is related to the physical state of
being, which includes, biological and psychological
patterns. The reason is that, both the human mind and
body are interrelated, showing a pattern that influences
the other.
• Economic - related factors of the definition of caring
include money, budget, insurance systems, limitations,
and guidelines imposed by managed care.
• Person – spiritual and cultural being
• Health – is not simply the consequences of a physical
state of being
• Nursing - Holistic, relational, spiritual and ethical
caring that seeks the good of self and others in complex
community, organization and bureaucratic sources.
Theory of Bureaucratic Caring
• Caring in nursing is contextual and is influenced by the
organizational structure.
• The theory emphasizes the holistic nature of an
organization rather than simple cause-effect
relationships of individual actions.
• Spiritual-ethical caring by nurses, the ultimate goal of
which is the promotion of well-being through caring,
has a positive effect on health care organizations and
can become an economic resource.
Patricia Benner
Caring, Clinical Wisdom and Ethics in Nursing Practice
• Patricia E. Benner, R.N., Ph.D., FAAN is a professor
emerita at the University of California, San Francisco.
• Born in Hampton, Virginia.
• Ba in Nursing - Pasadena College/Point Loma College
• MS in med/surg nursing from UCSF
• Phd -1982 from UC Berkeley
• AN AMERICAN MULTI AWARDED NURSE LEADER,
WRITER, &RESEARCHER, RANKED AS THE 4TH MOST
INFLUENTIAL NURSE BY THE READERSHIP OF THE
JOURNAL NURSING STANDARD IN THE UNITED
KINGDOM.
Philosophy
• A philosophy of nursing who believes that “ the nurse-
patient relationship is not a uniform, professionalized
blueprint but rather a kaleidoscope of intimacy in some
of the most dramatic, poignant, & mundane moments
of life”
• Benner adapted the Dreyfus model to clinical nursing
practice. The Dreyfus brothers developed the Skill
Acquisition model by studying the performance of chess
masters and pilots in emergency situations.
• Benner’s model is situational and describes five levels
of skill acquisition and development: (1) novice, (2)
advanced beginner, (3) competent, (4) proficient, and
(5) expert.
• Benner’s approach to knowledge development that
began with from novice to expert began a growing,
living tradition for learning from clinical nursing practice
through collection and interpretation of exemplars.
• Nursing,
major concepts
•
NURSING- NURSING IS VIEWED AS A CARING PRACTICE
WHOSE
SCIENCE IS GUIDED BY THE MORAL ART & ETHICS OF
CARE &
RESPONSIBILTY.A CARING RELATIONSHIP, AN ENABLING
CONDITION OF
CONNECTION & CONCERN.NURSING PRACTICE AS THE
CARE & STUDY
OF THE LIVED EXPERIENCE OF HEALTH, ILLNESS, &
DISEASE
• health suffering.
PERSON - A PERSON IS A SELF- INTERPRETING BEING,
THAT IS, THE
PERSON DOES NOT COME INTO THE WORLD
PREFEFINED BUT GETS
DEFINED IN THE CLOURSE OF LIVING A LIFE.
• HEALTH - HEALTH IS DEFINED AS WHAT CAN BE
ASSESSED, WHEREAS WELL-BEING IS THE HUMAN
EXPERIENCE OF HEALTH OR WHOLENESS.
• ENVIRONMENT - SHE BELIEVES THAT THE TERM
SITUATION IS TO BE USED RATHER THAN
ENVIRONMENT.PERSONAL INTERPRETATION OF THE
SITUATION IS BOUNDED BY THE WAY THE INVIDUAL IS
IN IT OF PAST , PRESENT, & FUTURE.SITUATION/ BEING
SITUATED CONVEYS A SOCIAL ENVIRONMENT WITH
SOCIAL DEFINITION & MEANINGFULNESS
KATIE ERIKSSON
THEORY OF CARITATIVE CARING
• Eriksson was born on November 18, 1943, in
Jakobstad, Finland.
• 1965 graduated at the Helsinki Swedish School of
• 1967 completed her Public Health Nursing specialty
education.
Caritative Caring
• Caritas refers when caring for the human being in
• True caring, occurs when the one caring in a spirit of
caritas alleviates the suffering of the patient.

• It is not equated to service with quality and

compensation.

• Love- Charity-faith-hope

Published Books

• The Idea Of Caring

• The Suffering Human Being

• THE BASICS IN CARITATIVE CARING ETHICS ARE: Contributions and Writings

•CARING, NURSING & MEDICINE:

- HUMAN DIGNITY
- CARING COMMUNION HISTORICALPHILOSOPHICAL ESSAYS.
- INVITATION & RESPONSIBILITY • MORAL PRACTICE & DOCUMENTATION IN PRACTICAL
Major Assumptions NURSING.

- Nursing – viewed as love and charity
- Person – human being is an entity of body-soul
and spirit
- Environment - ETHOS/HOME, HUMAN BEING’S
INNERMOST SPACE WHERE IT APPEARS
NAKEDNESS.
- Health - soundness, freshness, & well being
Karl Marie Martinsen
Philosophy of Caring
• A NORWEGIAN NURSING THEORIST
STANDS PROVOCATIVELY IN THEIR COUNTRY ON A
DEBATE THAT NURSING EDUCATION CURRICULUM WILL
BE CHANGED TO 4 year degree.
• A philosophy of nursing which stand for “nursing’ is
founded on caring for life, on neighbourly love.
Philosophy of Caring
• THE METAPARADIGM THAT REFERS: NURSING COULD
BE CALLED THE “ TRINITY OF CARING”
• CARING IS FUNDAMENTAL TO NURSING & TO OTHER
WORK OF A CARING NATURE - metaparadigm
• ACCORDING TO THIS THEORY, THE THREE
COMPONENTS OF “TRINITY OF CARING” ARE OF THE
FOLLOWING.
- relational
- practical
- Moral
Major Concepts
• Person – the body is a unit of soul and flesh
• Health – it does IT DOES NOT ONLY REFLECT THE

• One of her major social & nursing concerns while CONDITION OF THE ORGANISM, IT IS ALSO AN
practicing was social inequalities in general & in the EXPRESSION OF THE CURRENT LEVEL OF COMPETENCE
health service in particular . IN MEDICINE

• Environment - IN SPACE ARE FOUND TIME,

AMBIENCE, & POWER

NURSING CONCEPTUAL MODELS

Myra Estrin Levine

• Myra Estrin Levine proposed four principles of vary in degree, and not all are successful. Conservation
conservation. The process by which conservation is is the outcome.
achieved is adaptation and the desired outcome is
Adaptation has three characteristics
integrity or wholeness. Adaptation includes responses
based on past experiences (historicity), specific to the • Historicity
need (specificity), and with a variety of levels of possible
response (redundancy). The principles of conservation • Specificity
relate to the conservation of energy, structural
• Redundancy
integrity, personal integrity, and social integrity of the
individual. Conservation Model of Nursing

• Adaptation – critical for conserving wholeness in the

midst of constant environmental change.

• Nursing care focuses on the management of

integrated hoslistic responses like:

1. Fight or flight

2. Response to stress

3. Sensory response

Three major concepts

• Wholeness (Holism)

• Adaptation
• Conservation
• psychosocial assessment should focus on – diagnosis.
information needed to plan appropriate treatment
• nursing diagnosis – need for conservation
Wholeness
• To understand the whole person, one must first
understand the parts of the whole. Levine used
Erickson’s description of wholeness as an open system
she believed that humans respond in “ an integrated,
singular fashion to environmental changes”
• this should be the goal of all nursing care.
Adaptation
• Adaptation is the process of change whereby the
individual retains his integrity within the realities of his
internal and external environment” .All adaptations
• Trophicognosis – the proposal of the usage of the
term to use as the scientific method to develop a
nursing care judgment as an alternative to nursing
Conservation
• “Conservation describes the way complex systems are
able to continue to function even when severely
challenged (Levine, 1973).The primary goal of
conservation is maintaining wholeness and
uniqueness.Nursing actions reflecting this model are
directed at helping the client conserve
• principles:
- Energy - fatigue
- Personal Integrity – losing control of the
situation
- Structural Integrity
- Social Integrity – sharing your feelings to
supportive people
Martha Rogers • It specifies a worldview and philosophy used to
identify the phenomena of concern to the discipline of
Science of Unitary Beings nursing .
• Martha Roger’s theory Science of Unitary Human • She postulated that human beings are dynamic energy
Beings is mainly focusing on the four concepts and fields that are integral with environmental fields
principles of homeodynamic that are
• Today she is thought of as “ahead of her time, in and
• energy fields out of this world.
• openness,

• pattern,

• pandimensioal,

• integrality,

• resonancy,

• and helicy

• unitary human beings - The term that refers the

irreducible, indivisible, pandimensional energy field
identified by pattern and manifesting characteristics
that are specific to the whole.

• environmental field - The term that refers the

Major Concepts
• Rogerian model – abstract system of ideas from which
from which to approach the practice of nursing. It
stresses the totality of experience and existence that is
relevant in todays health care system.
irreducible, indivisible, pandimensional energy field
identified by pattern and integral with the human field.
• passive health - terms to symbolize wellness and the
absence of disease and major illness.
Imogene King
Theory of Goal Attainment

• critical thinking pattern three components:
• “Nursing is a process of action, reaction and
interaction by which nurse and client share information
about their perception in a nursing situation” and “a
process of human interactions between nurse and client
whereby each perceives the other and the situation, and
through communication, they set goals, explore means,
and agree on means to achieve goals.”

The Science of Unitary Human Beings

 • ENVIRONMENT - Is the background for human
interactions. It is both external to, and internal to, the
individual.

Interacting System

• Personal system - perception, self, growth and

development, body image, space, and time.

• Interpersonal system - interaction, communication,

transaction, role, and stress.
Assumptions
• Social system - organization, authority, power, status,
• (1) The focus of nursing is the care of the human being and decision making.
(patient).

• (2) The goal of nursing is the health care of both

individuals and groups.

• (3) Human beings are open systems interacting with

their environments constantly.

• (4) The nurse and patient communicate information,

set goals mutually, and then act to achieve those goals.
This is also the basic assumption of the nursing process.

• (5) Patients perceive the world as a complete person

making transactions with individuals and things in the
environment. Dorothea Orem

Theory of Self-Care- (grand theory)

• (6) Transaction represents a life situation in which the
perceiver and the thing being perceived are • Self care - it demonstrates practices of all the activities
encountered. It also represents a life situation in which that individual’s initiate and perform on their behalf in
a person enters the situation as an active participant. maintaining life, health and well being.
Major Concepts • The ability to perform self-care actions is called Basic
• NURSING - Is a process of action, reaction, and Conditioning Factors.
interaction whereby nurse and client share information • What is the condition that indicates that a person
about their perceptions in the nursing situation. needs nursing care?
• HEALTH - Is a dynamic life experience of a human
being, which implies continuous adjustment to stressors
in the internal and external environment through
optimum use of one’s resources to achieve maximum
potential for daily living.

• PERSON – INDIVIDUAL - Are social beings who are

rational and sentient.
Universal self-care requisite:
• Maintenance of sufficient intake of air.
• Maintenance of sufficient intake of food.
• Prevention of hazards to human life, human
functioning, and human well-being.
• NURSING SYSTEM - is considered to be the unifying
theory that includes all of the essential elements of self-
care deficit nursing theory.
Major Concepts
• Human being – humanity - an integrated whole
composed of an internal physical, psychological and
social nature with varying degrees of self care ability
• Health - as a state of well being, which refer to a
person's condition of existence, characterized by
contentment, pleasure, happiness, movement towards
self ideals.
• Nursing - its an art through which the practitioner of
nursing gives specialized assistance to persons with
disabilities that needed greater than ordinary assistance
to meed the daily needs for self care
• Environment - the surrounding of the patients may
affect their ability to perform their self-care activity.
DOROTHY JOHNSON
BEHAVIORAL SYSTEM MODEL
• Dorothy first proposed her model of nursing care in
1968 as fostering of “the efficient and effective
behavioral functioning in the patient to prevent illness".
• She also stated that nursing was “concerned with man
as an integrated whole and this is the specific
knowledge of order we require”.
• In 1980 Johnson published her conceptualization of
“behavioral system of model for nursing”where she
explains her definitions of the behavioral system model.
4 ASSUMPTIONS OF THE SYSTEM
• First, there is “organization, interaction,
interdependency and integration of the parts and
elements of behaviors that go to make up the system ”
• A system “tends to achieve a balance among the
various forces operating within and upon it', and that
man strive continually to maintain a behavioral system
balance and steady state by more or less automatic
adjustments and adaptations to the natural forces
impinging upon him.”
• A behavioral system, which both requires and results
in some degree of regularity and constancy in behavior,
is essential to man that is to say, it is functionally
significant in that it serves a useful purpose, both in
social life and for the individual.
• Last, “system balance reflects adjustments and
adaptations that are successful in some way and to
some degree.”.
Sister Callista Roy
Adaptation Model of Nursing
• Sister Callista Roy model sees the individual as a set of
interrelated systems who strives to maintain a balance
between various stimuli.
Major Concepts
• Person - humans are holistic beings that are in
constant interaction with their environment.
• Environment - is defined as conditions, circumstances,
and influences that affect the development and
behavior of humans as an adaptive system.
• Focal stimuli are that which confronts the human
system and requires the most attention.
• Contextual stimuli are characterized as the rest of the
stimuli that present with the focal stimuli and
contribute to its effect.
• Residual stimuli are the additional environmental
factors present within the situation, but whose effect is
unclear. This can include previous experience with
certain stimuli.
• Health - is defined as the state where humans can
continually adapt to stimuli.
• Nursing - nurses are facilitators of adaptation.
• Adaptation - is the “process and outcome whereby
thinking and feeling persons as individuals or in groups
use conscious awareness and choice to create human
and environmental integration.”
• Internal Process
• Regulator subsystem – physiological coping
• Cognator subsystem – mental coping
Four Adaptive Modes
1. Physiological-physical mode
2. Self-concept group identity mode
3. Role function mode
4. Interdependence mode
Levels of Adaptation
1. Integrated process
2. Compensatory process
3. Compromised process
The Four Major Concepts
• “Human being” as having two major systems, the
biological system and the behavioral system. It is role of
the medicine to focus on biological system where as
nursling's focus is the behavioral system.
• “Society” relates to the environment on which the
individual exists. According to Johnson an individual’s
behavior is influenced by the events in the environment
• “Health” is a purposeful adaptive response, physically
mentally, emotionally, and socially to internal and
external stimuli in order to maintain stability and
comfort.
• “Nursing” has a primary goal that is to foster
equilibrium within the individual. Nursing is concerned
with the organized and integrated whole, but that the
major focus is on maintaining a balance in the behavior
system when illness occurs in an individual.
Betty Neuman
Neuman System Model
• Is a nursing theory based on the individual's
relationship to stress, the reaction to it, and
reconstitution factors that are dynamic in nature. the
concept of a whole person and an open system
approach. The concept is aimed towards the
development of a person in a state of wellness having
the capacity to function optimally by adaptation with
environmental stimuli causing illnesses back to a state
of wellness
Major Concepts
• Nursing - requires a holistic approach that considers
all factors affecting a client's health—physical,
physiological, psychological, mental, social, cultural,
developmental and spiritual well-being.
• Person - as an individual family community or the
society.
• Health - as dynamic in nature in which the person’s
health is as the level of health continuum—wellness or
illness.
• Environment - can be an internal and external.
Stressors are the forces created by the environment.
Stressors are tensions that produce alterations in the
normal flow of the environment. These stressors can
be:
- Intrapersonal - occurs within the self and
comprises of man as a psycho-spiritual being
- Interpersonal - occurs between one or more
individual and consists of man as a social being
- Extrapersonal - occurs outside the individual
and may include environmental factors
System Model in Nursing Practice
1. Client variables
- Physiological, sociocultural developmental and
spiritual—function to achieve stability in
relation to the environmental stressors
experienced by the client.
2. Lines of resistance
- acts when the normal line of defense is invaded
by too much stressor causing alteration in the
normal health pattern to facilitate coping and
overcome the stressors that are present within
the individual.
3. Normal line of defense
- acts in coordination with the normal wellness
state. It is the normal reaction of the client in
response to stress – the baseline determinants
of wellness within the health continuum.
4. Flexible line of defense
- helps the body to adjust to situations that
threaten the imbalance within the client's
stability
5. Stressors
- stressors are forces that produce tensions,
alterations or potential problems causing
instability within the clients system.
6. Reaction
- reactions are the outcomes or produced results
of certain stressors and actions of the lines
resistance of a client. It can be positive or
negative depending on the degree of reaction
the client produces to adjust and adapt with the
situation.
A. Negentropy is set towards stability or wellness
b. Egentropy is set towards disorganization of the
system producing illness
7. Prevention
 - prevention is used to attain balance within the
continuum of health

8. Reconstitution

- A state of returning back to old health self.

Three Levels of Prevention

• A. Primary prevention – focuses on foreseeing the

result of an act or situation and preventing its
unnecessary effects as possible. It also aims to
strengthen the capacity of a person to maintain an
optimum level of functioning while being interactive
with the environment. Ex. Health promotion and
disease prevention.

B. Secondary prevention – focuses on helping alleviate

the actual existing effects of an action that altered the
balance of health. It aims to reduce environmental
influences that cause an alteration in the stability of the
client. Ex. Early diseases detection and prompt
treatment.

C. Tertiary prevention – focuses on the actual

treatments or adjustments to facilitate strengthening of
person after being exposed to stressor. Aims to prevent
regression and recurrence of the disease. Ex.
Rehabilitation