THEORETICAL FOUNDATIONS OF NURSING

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INTRODUCTION TO THE THEORETICAL FOUNDATIONS OF NURSING

HISTORY OF NURSING IN THE PH SAN LAZARO HOSPITAL (1578)

- Built exclusively for patients with
leprosy
HISTORY - Founded by BROTHER JUAN CLEMENTE
and administered for many years by the
Nursing history was pioneered by the culture of care Hospitalliers of San Juan de Dios.
of our country’s history. Through the face of war,
caregiving nature was developed along with our HOSPITAL DE INDIOS (1586)
incomparable love for the country. With the - Established by the FRANCISCAN ORDER
knowledge of our roots, it will challenge us to - Service was in general support by alms
understand the chosen path that we are leading to. and contributions from charitable
persons
EARLY PHILIPPINES HOSPITAL DE AGUAS SANTAS (1590)
- Established in Laguna; near a medicinal
● Early Beliefs, Practices and Care of the spring
Sick (Mysticism and Superstitions) - Founded by BROTHER J. BAUTISTA of the
● The cause of Disease was believed to be FRANCISCAN ORDER.
due to another person or with evil
spirits. They were believed to be SAN JUAN DE DIOS HOSPITAL (1596)
bewitched by “Mangkukulam or - Rendered general health services to the
Manggagaway”. public
● Herb Doctors or Priests were known to - Support was delivered from alms and
get rid of demons or evil spirits. rents
● Filipinos who become sick are usually - Founded by the BROTHERHOOD OF
cared for by the female family member. MISERICORDIA and administered by the
(Good Midwives) Hospitaliers of San Juan de Dios
● If the birth became difficult, witches
were supposed to be the cause. To PHILIPPINE REVOLUTION
disperse their influence, gunpowder was
exploded from a bamboo cane close to Many women have assumed the role of nurses in
the head of the sufferer. order to assist the wounded soldiers.
Emergence of the Filipina nurses:
SPANISH COLONIAL ERA 1. Josephine Bracken
- Provided nursing care to the
During the Spanish regime many specialized wounded night and day
hospitals were established to care for Spanish - Wife of Jose Rizal, installed a
king’s soldiers and civilians. To many elite Filipinos, field hospital in an estate
the Spanish colonial hospitals were places where house in Tejeros.
those who were not so fortunate to have homes, 2. Rosa Sevilla de Alvero
spent their last days until death. - Converted their house into
quarters for the Filipino
In 1578, male nurses were acknowledged as Spanish soldiers during the
Friars’ assistants for caring sick individuals in the Philippine-American War
hospital. These male nurses are referred to as (1899)
practicante or enfermero. 3. Dona Hilaria Aguinaldo
- Wife of Emilio Aguinaldo who
HOSPITAL REAL DE MANILA (1577) organized Filipino Red Cross
- Mainly to care for the Spanish king’s under the inspiration of
soldiers, but also admitted Spanish Mabini.
civilians; founded by GOV. FRANCISCO DE 4. Dona Maria Agoncillo de Aguinaldo
SANDE - Second wife of Emilio,
provided nursing care to
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Filipino soldiers during the
revolution
- President of the Filipino Red
Cross branch in Batangas.
5. Melchora Aquino “Tandang Sora”
- Nursed the ill and wounded
Filipino soldiers and has
brought comparisons to
Florence Nightingale
6. Capitan Salome
- A revolutionary leader in
Nueva Ecija
- Provided nursing care to the
wounded when not in combat
7. Agueda Kahabagan
- Revolutionary leader in
Laguna, provided nursing
care to her troops
8. Trinidad Tecson “Ina ng Biak-na-Bato”
- Stayed in the hospital at
“Biak-na-bato” to care for
wounded soldiers
AMERICAN COLONIAL ERA
Nursing Education provided white American women
with a sense of purpose in the colony.
American Nurses took charge and Filipino women
began to learn under careful eyes.
Americans began training the first Filipino nursing
students in 1907. Formal training in hospital school
transpires.
Hospital School of Nursing’s Formal Training
(1901-1911)
- Pensionado Act of 1903 (Act 854),
allowed Filipino nursing students to
study in the United States. Among of the
first wave of nurses who went to United
States
Iloilo Mission Hospital (1901)
- pioneered nursing education in the
Philippines
- MISS ROSE NICOLET, a graduate of New
England Hospital for Women and
Children in Boston, Massachusetts was
the first superintendent for nurses.
- In 1944, graduate nurses took the first
Nurse Board Examination at the Iloilo
Mission Hospital.
St. Paul’s Hospital School of Nursing (1907)
- Provided general hospital services and
opened a training school for nurses in
1908, with MOTHER MELANIE as
superintendent and MISS CHAMBERS as
principal.
Philippine General Hospital School of Nursing (1907)
- Opened classes in nursing under the
Auspices of the Bureau of Education
- In 1906, MARY COLEMAN MASTERS, an
educator advocated for the idea of
training Filipino girls for the profession
of nursing with the approval of
government officials, she also opened a
dormitory for girls enrolled at the
Philippine Normal Hall and the University
of the Philippines.
St. Luke’s Hospital School of Nursing (1907)
- The school opened with 3 girls admitted.
These three girls had their first year in
combined classes with the PGH School of
Nursing and St. Pauls’ Hospital School of
Nursing.
- MISS HELEN HICKS was the first principal.
MRS. VITALIANA BELTRAN was the first
Filipino superintendent of nurses and DR.
JOSE FORES was the first medical director
of the hospital.
Mary Johnston Hospital and School ofNursing (1907)
- The nurses training course began with 3
Filipino young girls fresh elementary as
their first students.
- SISTER REBECCA PARRISH together with
registered nurse ROSE DUDLEY and
GERTUDE DREISBACH, organized the Mary
Johnston School of Nursing.
THE START OF THE NURSING PRACTICE
(1911-1921)
Promulgation of Act No. 2493 which amends Medical
Law (Act No. 310) allowing the regulation of nursing
practice transpired during this period.
1919
The First True Nursing Law was enacted through Act
2808. During this period the Boar Examiners for
Nursing was also created. The first nursing board
examination was given in 1920. The first executive
officer of the Board Examiners for Nurses is a
physician.
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Mary Chiles Hospital School of Nursing (1911)
- The hospital was established by DR. WN
LEMON in a small house on Azcarraga
Sampaloc, Manila.
- In 1913, MISS MARY CHILES of Montana
donated a large sum of money with
which the preset building at Gastambide
was bought.
San Juan de Dios Hospital School of Nursing (1913)
- Through the Initiative of DR. BENITO
VALDEZ, the board of inspectors and the
executive board of the hospital passed a
resolution to open a nursing school.
- The school has been run by the
DAUGHTERS OF CHARITY since then.
SISTER TACIANA TINANES was the first
Directress of the School.
Emmanuel Hospital School of Nursing (1913)
- The American Baptist Foreign Mission
Society sent DR. PH LERRIGO to Capiz for
the purpose of opening a hospital. MISS
ROSE NICOLET assisted him.
- MISS CLARA PEDROSO was the first
principal
- Offered 3 years training course for an
annual fee of Php 100.
Southern Islands Hospital School of Nursing (1918)
- The hospital was established in 1911
under the Bureau of Health. The school
opened in Cebu in 1918 with ANASTACIA
GIRON-TUPAS as the organizer. MISS
VISITACION PEREZ was the first principal.
A MUCH ESTABLISHED PROFESSIONAL ORGANIZATION
(1921-1931)
● The Filipino Nurses Association was
established
● The Philippine Journal of nursing
● Amendment of certain sections of the Act
2008 was conducted in 1922 under Act
3025 passed by the 5th Legislature - An
Act regulating the practice of Nursing
Profession in the Philippine Islands,
which necessitates all nurses who are
practicing the profession to register
yearly. In 1929, the organization
became a member of the International
Council of Nurses.
1966
- FNA became Philippine Nurses
Association (PNA).
- The Philippine Journal of Nursing was
established.
1929
- The Filipino Nurses Association became a
member of the International Council of
Nurses
PUBLIC HEALTH NURSING DEVELOPMENT
(1931-1941)
In 1933, the nursing institution increased their
requirement. During this period, they have
implemented that to enter nursing education an
applicant must be able to complete secondary
education.
The first collegiate nursing graduates of the
Philippines graduated from University of the
Philippines School of Public Health Nursing in 1938.
PROLIFERATION OF NURSES AS A WORKFORCE
(1951-1971)
The Philippine Nursing Law was approved under
Republic Act No.877 on June 19,1953. Then further
amendment was created in 1966 which limits that
practice among nurses 21 years old and above.
Celebration of Nurses’ Work which was proclaimed
by PRES. CARLOS P. GARCIA under Proclamation No.
539.
NURSING PROFESSION DEVELOPMENT
(1971-2001)
The Presidential Decree No. 223, establishment of
the agency, Professional Regulation Commission.
The Philippine Nursing Act of 1991 was also
amended under Republic Act No. 7164 which
expanded nursing practice to other roles.
The qualification of nurses or faculty’s academe was
also updated to Master’s Degree in Nursing or
equivalent.
Nursing Certification Council in 1999 under the
Board of Nursing through Resolution No. 14 which
supervises the new programs’ implementation
conducted by the Specialty Certification Boards. This
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improvement also prompted the start of Advanced
Practice Nursing (APN) in the Philippines.
WORLD WAR 2
It made public health nurses in Manila assigned to
devastated areas to attend the sick and wounded. A
lot of public health nurses joined the guerillas (just
like in US) or went to hide in the mountains during
this time.
1946
- Post war records of the Bureau of Health
showed that there were 308 public
health nurses and 38 supervisors
compared to pre war 556 public health
nurses and 38 supervisors.
U.S. Colonial Patterns in Philippine Nursing
Education soon returned after the U.S. reclaimed the
country from Japan in 1945 and even after the
Philippines gained independence from the U.S. July
4, 1946. Thereafter, the start of 1st Colleges in the
Philippines.
● University of Santo Tomas College of
Nursing (1946)
● Manila Central University College of
Nursing (1947)
● University of the Philippines Manila -
College of Nursing (1948)
NURSING DEVELOPMENT
(1951-1971)
The increasing number of nurses in the Philippines
have also brought about the celebration of Nurses
week which was proclaimed by PRES. CARLOS P.
GARCIA under Proclamation No. 539
PHILIPPINE NURSING ACT (2002)
- Enacted under the Republic Act No. 9173
which entails changes on existing
policies under Republic Act No. 7164.
- Changes underscore the requirements for
Faculty and Dean of the Colleges of
Nursing, as well as conduct for Nursing
Licensure Exam.
IN A GLANCE
1909
Three female graduated as “qualified
medical-surgical nurses”
1919
The 1st Nurses Law (Act No. 2808) was enacted
regulating the practice of the nursing profession in
the Philippine Islands. (June and December Boards)
1920
The 1st board examination for nurses conducted at
UP COLLEGE OF MEDICINE AND SURGERY. 68 passed
out of 93 examinees. 93.5% highest rating.
1921
Filipino Nurses Association was established as the
National Organization of Filipino Nurses.
1953
Republic Act 877, known as the “Nursing Practice
Law” was approved.
PRESENT WORKPLACE
The nursing career offers a wide variety of roles and
broader scope of responsibilities.
The health care technology is far more than
advanced and the focus of management not only
for the patients but everything that comes in and
out of OR.
Outside OR, Occupational Health Nurse and member
of Quality Assurance was tested in a working
facility. Nurses are more exposed to complex and
multifaceted issues that impact the healthcare
system.
As we become a globally demand profession, we are
more challenged to advance our studies to MSN/MAN
or even PhD.
“We are now more than a nursing cap, we are a
dynamic profession that a nation should be proud
of.”
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HISTORY OF PHILOSOPHY AND SCIENCE
HISTORICAL VIEWS OF THE NATURE OF SCIENCE
Epistemology
- Is a branch of Philosophy concerned
with the theory of knowledge in
philosophical inquiry.
- Methods, Credibility and the Scope
- Investigates what distinguishes, justified
belief, and opinion. “What is true and
what is belief”
Two competing philosophical foundations of
science, rationalism and empiricism, have evolved in
the era of modern science with several variations.
Rational
- Somehow base the source of knowledge
from reason
- Believed in intuition
- Individuals have innate knowledge or
concepts
Empiricism
- Somehow base the source of knowledge
from experience
- Does not believe in intuition
- Individuals have no innate knowledge
RATIONALISM
Rationalist Epistemology (scope of knowledge)
- Emphasizes the importance of a priori
(something to be known without
experience or sense data ) reasoning as
the appropriate method for advancing
knowledge.
● Deductive Reasoning (cause-and-effect)
(General to Specific Rationalism)
● Theory-then-research strategy
● Innate, reason and deduction
Case/ Application:
Theory: Poor hand washing technique will result in
spreading diseases to all patients
Reason: Do you agree? Will you refute? Can you
prove this theory? If yes, why? If not, why?
EMPIRICISM
The empiricist view is based on the central idea that
scientific knowledge can be derived only from
sensory experience (I.e., seeing, feeling, hearing
facts).
● Inductive Reasoning (collection of facts
precedes attempts to formulate
generalizations)
● Research-then-theory strategy
● Gathering of facts through experience
and observation and then formulating
theories
Case/Application:
Differential Diagnosis
Patient: 31 years old productive cough for 2 weeks,
low grade fever occurring every afternoon, vital
signs all in normal range. Weight, clinical
observations.
Diagnostics: X-rat (Clear)
History: Smoker for 15 years, 1 pack of cigars
everyday.
EARLY TWENTIETH CENTURY VIEWS OF SCIENCE AND
THEORY
During the first half of this century, Philosophers
focused on the analysis of theory structure, whereas
Scientists focused on empirical research.
Positivism
- A term first used by Comte, emerged as
the dominant view of modern science.
The logical empiricists offered a more lenient view
of logical positivism and argued that theoretical
propositions (proposition affirms or denies
something) must be tested through observation and
experimentation.
The scientist first sets up an experiment; observes
what occurs, reaches a preliminary hypothesis to
describe the occurrence; runs further experiments to
test the hypothesis and finally corrects or modifies
the hypothesis in light of the results.
Brown (1977) 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.
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Example:
An elderly patient has been in a trauma and appears
to be crying. The nurse on admission observes that
the patient has marks on her body and believes that
she has been abused; the orthopedist has viewed an
x-ray and believes that the crying patient is in pain
due to a fractured femur that will not require
surgery only a closed reduction; the chaplain
observes the patient crying and believes the patient
needs spiritual support.
Paradigm Shift
- Science progresses from a pre-science,
then to a normal science, then to a
crisis, then to a revolution, and then to a
new normal science. Once normal
science develops, the process begins
again when a crisis erupts and leads to
revolution, and a new normal science
emerges once again. (Kuhn, 1970)
Samples:
● Early mobilization of critically ill
patients shows better patient outcomes
● Use of betadine swab for cord care
● Airway Breathing Circulation to
Circulation – Airway – Breathing
NURSING AS AN ART
- This is what you do for the patient.
- Bedside care
- Not just about aesthetics
NURSING AS A SCIENCE
- Why do we do these things?
- We give medicines because we study
pharmacology and not just give it to the
patient
THEORY OF NURSING
THEORY
- Powers and Knapp (1995), defined theory
as "a set of statements that tentatively
describe, explain, or predict
relationships among concepts that have
been systematically selected and
organized as an abstract representation
of some phenomenon.
NURSING THEORIES
- Nursing theories are organized bodies of
knowledge to define what nursing is,
what nurses do, and why they do it.
- Nursing theories provide a way to define
nursing as a unique discipline that is
separate from other disciplines (e.g.,
medicine).
- It is a framework of concepts and
purposes intended to guide nursing
practice at a more concrete and specific
level.
Definition of Terms
● Philosophy: These are beliefs and values
that define a way of thinking and are
generally known and understood by a
group or discipline.
● Theory: A belief, policy, or procedure
proposed or followed as the basis of
action. It refers to a logical group of
general propositions used as principles
of explanation. Theories are also used to
describe, predict, or control phenomena.
● Concept: Concepts are often called the
building blocks of theories. They are
primarily the vehicles of thought that
involve images.
● Models: Models are representations of
the interaction among and between the
concepts showing patterns. They present
an overview of the theory’s thinking and
may demonstrate how theory can be
introduced into practice.
● Conceptual Framework: A conceptual
framework is a group of related ideas,
statements, or concepts. It is often used
interchangeably with the conceptual
model and with grand theories.
● Proposition: Propositions are statements
that describe the relationship between
the concepts.
● Domain: The domain is the perspective
or territory of a profession or discipline.
● Process: Processes are organized steps,
changes, or functions
intended to bring about the desired
result.
● Paradigm: A paradigm refers to a
pattern of shared understanding and
assumptions about reality and the world,
worldview, or widely accepted value
system.
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● Metaparadigm: A metaparadigm is the
most general statement of discipline and
functions as a framework in which the
more restricted structures of conceptual
models develop. Much of the theoretical
work in nursing focused on articulating
relationships among four major
concepts: person, environment, health,
and nursing.
HISTORY OF NURSING THEORIES
● Florence Nightingale (1860)
○ defined nursing in her
“Environmental Theory” as
“the act of utilizing the
patient’s environment to
assist him in his recovery.”
○ In the 1950s, there was a
consensus among nursing
scholars that nursing needed
to validate itself through the
production of its own
scientifically tested body of
knowledge
● Hildegard Peplau (1952)
○ introduced her Theory of
Interpersonal Relations that
emphasizes the nurse-client
relationship as the
foundation of nursing
practice.
● Virginia Henderson (1955)
○ 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.
● Faye Abdellah (1960)
○ published her work “Typology
of 21 Nursing Problems”,
which shifted the focus of
nursing from a
disease-centered approach to
a patient-centered approach.
● Ida Jean Orlando (1962)
○ emphasized the Nursing Care
Plan (reciprocal relationship
between patient and nurse)
and viewed nursing’s
professional function as
finding out and meeting the
patient’s immediate need for
help.
● Dorothy Johnson (1968)
○ pioneered the Behavioral
System Model and upheld the
fostering of efficient and
effective behavioral
functioning in the patient to
prevent illness.
● Martha Rogers (1970)
○ 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.
● Dorothea Orem (1971)
○ stated in her Self-Care Deficit
Theory that nursing care is
required if the client is
unable to fulfill biological,
psychological,
developmental, or social
needs.
● Imogene King (1971)
○ Imogene King‘s Theory of
Goal Attainment stated that
the nurse is considered part
of the patient’s environment
and the nurse-patient
relationship is for meeting
goals towards good health.
● Betty Neuman (1972)
○ in her Systems Model 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
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● Sr. Callista Roy (1979)
○ viewed the individual as a set
of interrelated systems that
maintain the balance
between these various
stimuli, Adaptation Model
Theory
● Jean Watson (1979)
○ developed the Philosophy of
caring, highlighted
humanistic aspects of nursing
as they intertwine with
scientific knowledge and
nursing practice.
COMPONENTS OF NURSING THEORIES
● Phenomenon
○ A term given to describe an
idea or response 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
independently 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 statements explain the
nature of concepts,
definitions, purpose,
relationships, and structure
of a theory.
NURSING METAPARADIGM
Person: the recipient of nursing care and may
include individuals, patients, groups, families, and
communities.
Nursing: the attributes, characteristics, and actions
of the nurse providing care on behalf of, or in
conjunction with, the client.
Environment (or situation): defined as the internal
and external surroundings that affect the client.
Health: defined as the degree of wellness or
well-being that the client experiences.
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WHY ARE NURSING THEORIES IMPORTANT
Nursing theories are the basis of nursing practice
today. In many cases, nursing theory guides
knowledge development and directs education,
research, and practice. Historically, nursing was not
recognized as an academic discipline or as a
profession we view today. Before nursing theories
were developed, nursing was considered to be a
task-oriented occupation. The training and function
of nurses were under the direction and control of
the medical profession.
PURPOSES OF NURSING THEORIES
The primary purpose of theory in nursing is to
improve practice by positively influencing 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. In the past, the
accomplishments of nursing led to the recognition
of nursing as an academic discipline, research, and
profession.
CLASSIFICATION OF NURSING THEORIES
By Abstraction
● Grand Nursing Theories
○ Grand theories are abstract, broad in
scope, and complex, therefore requiring
further research for clarification.
○ Grand nursing theories do not guide
specific nursing interventions but
rather provide a general framework
and nursing ideas.
○ Grand nursing theorists develop their
works based on their own experiences
and their time, 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 (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 a grand theorist’s works, 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 focus 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
than more abstract theories.
○ These theories are interrelated with
concepts from middle-range theories or
grand theories.
By Goal Orientation
● Descriptive Theories
○ Descriptive theories are the first level of
theory development. They describe the
phenomena and identify its properties
and components in which it occurs.
○ Descriptive theories are not
action-oriented or attempt to produce or
change a situation.
○ There are two types of descriptive
theories:
■ Factor-isolating theory
● Descriptive theories
● Also known as
category-formulating or
labeling theory.
● Theories under this category
describe the properties and
dimensions of phenomena.
Example: case studies, literature
review, phenomenology,
ethnography
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■ Explanatory theory
● Explanatory theories describe and
explain the nature of relationships
of certain phenomena to other
phenomena.
● Situation-relating Theories (Predictive
theories, promoting or inhibiting
theories)
○ Predicts the occurrence of a
phenomenon when the cause
is present.
○ Experimental research is used
to generate and test them in
most cases.
● Situation-relating Theories (Prescriptive
Theories)
○ Address nursing therapeutics
and consequences of
interventions.
○ "prevents" the occurrence of
the phenomenon by
controlling or eliminating
possible causes.
CLASSIFICATION ACCORDING TO MELEIS
● Needs-Based Theories: The needs theorists
were the first group of nurses who thought of
giving nursing care a conceptual order.
Theories under this group are based on
helping individuals to fulfill their physical
and mental needs. Theories of Orem,
Henderson, and Abdella are categorized
under this group. Need theories are criticized
for relying too much on the medical model of
health and placing the patient in an overtly
dependent position.
● Interaction Theories: These theories
emphasize nursing on the establishment and
maintenance of relationships. They
highlighted the impact of nursing on patients
and how they interact with the environment,
people, and situations. Theories of King,
Orlando, and Travelbee are grouped under
this category.
● Outcome Theories: These theories describe
the nurse as controlling and directing patient
care using their knowledge of the human
physiological and behavioral systems. The
nursing theories of Johnson, Levine, Rogers,
and Roy belong to this group.
CLASSIFICATION ACCORDING TO ALLIGOOD
● Nursing Philosophy: It is the most abstract
type and sets forth the meaning of nursing
phenomena through analysis, reasoning, and
logical presentation. Works of Nightingale,
Watson, Ray, and Benner are categorized
under this group.
● Nursing Conceptual Models: These are
comprehensive nursing theories that are
regarded by some as pioneers in nursing.
These theories address the nursing
metaparadigm and explain the relationship
between them. Conceptual models of Levine,
Rogers, Roy, King, and Orem are under this
group.
● Grand Nursing Theories: These are works
derived from nursing philosophies,
conceptual models, and other grand theories
that are generally not as specific as
middle-range theories. Works of Levine,
Rogers, Orem, and King are some of the
theories under this category.
● Middle-Range Theories: Are precise and
answer specific nursing practice questions.
They address the specifics of nursing
situations within the model’s perspective or
theory from which they are derived. Examples
of Middle-Range theories are those of Mercer,
Reed, Mishel, and Barker.
NURSING THEORIST AND THEIR WORKS
Florence Nightingale
- Founder of Modern Nursing and Pioneer of
the Environmental Theory.
- Defined Nursing as "the act of utilizing the
environment of the patient to assist him in
his recovery."
- Stated that nursing "ought to signify the
proper use of fresh air, light, warmth,
cleanliness, quiet, and the proper selection
and administration of diet - all at the least
expense of vital power to the patient."
- Identified five (5) environmental factors:
fresh air, pure water, efficient drainage,
cleanliness or sanitation, and light or direct
sunlight.
Hildegard E. Peplau
- Pioneered the Theory of Interpersonal
Relations
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- Peplau's theory defined Nursing as "An
interpersonal process of therapeutic
interactions between an individual who is
sick or in need of health services and a nurse
specially educated to recognize, respond to
the need for help."
- Her work is influenced by Henry Stack
Sullivan, Percival Symonds, Abraham Maslow,
and Neal Elgar Miller.
- It helps nurses and healthcare providers
develop more therapeutic interventions in
the clinical setting.
Virginia Henderson
- Developed the Nursing Need Theory
- Focuses on the importance of increasing the
patient's independence to hasten their
progress in the hospital.
- Emphasizes the basic human needs and how
nurses can assist in meeting those needs.
- "The nurse is expected to carry out a
physician's therapeutic plan, but
individualized care is the result of the
nurse's creativity in planning for care."
Faye Glenn Abdellah
- Developed the 21 Nursing Problems Theory
- "Nursing is based on an art and science
that molds the attitudes, intellectual
competencies, and technical skills of the
individual nurse into the desire and ability
to help people, sick or well, cope with their
health needs."
- Changed the focus of nursing from
disease-centered to patient- centered and
began to include families and the elderly in
nursing care.
- The nursing model is intended to guide care
in hospital institutions but can also be
applied to community health nursing, as
well.
Lydia E. Hall
- Developed the Care, Cure, Core Theory is
also known as the "Three Cs of Lydia Hall.“
- Hall defined Nursing as the "participation
in care, core and cure aspects of patient
care, where CARE is the sole function of
nurses, whereas the CORE and CURE are
shared with other members of the health
team." The major purpose of care is to
achieve an interpersonal relationship with
the individual to facilitate the
development of the core.
- The "care" circle defines a professional
nurse's primary role, such as providing
bodily care for the patient. The "core" is
the patient receiving nursing care. The
"cure" is the aspect of nursing that
involves the administration of medications
and treatments.
Joyce Travelbee
- States in her Human-to-Human
Relationship Model that the purpose of
nursing was to help and support an
individual, family, or community to prevent
or cope with the struggles of illness and
suffering and, if necessary, to find
significance in these occurrences, with the
ultimate goal being the presence of hope.
- Nursing was accomplished through
human-to-human relationships.
- Extended the interpersonal relationship
theories of Peplau and Orlando
Ida Jean Orlando
- She developed the Nursing Process Theory.
- "Patients have their own meanings and
interpretations of situations, and
therefore nurses must validate their
inferences and analyses with patients
before drawing conclusions.”
- Allows nurses to formulate an effective
nursing care plan that can also be easily
adapted when and if any complexity
comes up with the patient.
- According to her, persons become patients
requiring nursing care when they have
needs for help that cannot be met
independently because of their physical
limitations, negative reactions to an
environment, or experience that prevents
them from communicating their needs.
- The role of the nurse is to find out and
meet the patient's immediate needs for
help.
Jean Watson
- She pioneered the Philosophy and Theory
of Transpersonal Caring.
- "Nursing is concerned with promoting
health, preventing illness, caring for the
sick, and restoring health."
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- Mainly concerns with how nurses care for
their patients and how that caring
progresses into better plans to promote
health and wellness, prevent illness and
restore health.
- Focuses on health promotion, as well as
the treatment of diseases.
- Caring is central to nursing practice and
promotes health better than a simple
medical cure.
Myra Estrin Levine
- According to the Conservation Model,
“Nursing is human interaction."
- Provides a framework within which to
teach beginning nursing students.
- Logically congruent, externally and
internally consistent, has breadth and
depth, and is understood, with few
exceptions, by professionals and
consumers of health care.
Martha E. Rogers
- Theory of Unitary Human Beings
- In Roger's Theory of Human Beings, she
defined Nursing as "an art and science
that is humanistic and humanitarian.”
- The Science of Unitary Human Beings
contains two dimensions: the science of
nursing, which is the knowledge specific
to the field of nursing that comes from
scientific research; and the art of nursing,
which involves using nursing creatively to
help better the lives of the patient.
- A patient can't be separated from his or
her environment when addressing health
and treatment.
Dorothea E. Orem
- In her Self-Care Theory, she defined
Nursing as "The act of assisting others in
the provision and management of
self-care to maintain or improve human
functioning at the home level of
effectiveness."
- Focuses on each individual's ability to
perform self-care.
- Composed of three interrelated theories:
(1) the theory of self-care, (2) the
self-care deficit theory, and (3) the theory
of nursing systems, which is further
classified into wholly compensatory,
partially compensatory, and
supportive-educative.
Imogene M. King
- Conceptual System and Middle-Range
Theory of Goal Attainment
- "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."
- Focuses on this process to guide and
direct nurses in the nurse-patient
relationship, going hand-in-hand with
their patients to meet good health goals.
- Explains that the nurse and patient go
hand-in-hand in communicating
information, set goals together, and then
take actions to achieve those goals.
Patricia Benner
- Patricia Benner developed a concept
known as "From Novice to Expert."
- This concept explains that nurses develop
skills and an understanding of patient
care over time from a combination of a
strong educational foundation and
personal experiences.
- Dr Benner proposed that a nurse could
gain knowledge and skills without
actually learning a theory.
- She describes this as a nurse "knowing
how" without "knowing that." She further
explains that the development of
knowledge in fields such as nursing is
made up of the extension of knowledge
through research and understanding
through clinical experience.
Katie Eriksson
- The Theory of Caritative Caring was
developed by Katie Eriksson.
- This model of nursing distinguishes
between caring ethics, the practical
relationship between the patient and the
nurse, and nursing ethics.
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- Nursing ethics are the ethical principles
that guide a nurse's decision-making
abilities.
- Caritative caring consists of love and
charity, which is also known as caritas,
and respect and reverence for human
holiness and dignity.
- According to the theory, suffering that
occurs as a result of a lack of caritative
care is a violation of human dignity.
Betty Neuman
- In Neuman's System Model, she defined
nursing as a "unique profession in that is
concerned with all of the variables
affecting an individual's response to
stress."
- The focus is on the client as a system
(which may be an individual, family,
group, or community) and on the client's
responses to stressors
- The client system includes five variables
(physiological, psychological,
sociocultural, developmental, and
spiritual). It is conceptualized as an inner
core (basic energy resources) surrounded
by concentric circles that include lines of
resistance, a normal defense line, and a
flexible line of defense.
Sister Callista Roy
- In Adaptation Model, Roy defined nursing
as a "health care profession that focuses
on human life processes and patterns and
emphasizes the promotion of health for
individuals, families, groups, and society
as a whole."
- Views the individual as a set of
interrelated systems that strives to
maintain a balance between various
stimuli.
- Inspired the development of many
middle-range nursing theories and
adaptation instruments.
Dorothy Johnson
- The Behavioral System Model defined
Nursing as "an external regulatory force
that acts to preserve the organization
and integrate the patients' behaviors at
an optimum level under those conditions
in which the behavior constitutes a threat
to the physical or social health or in
which illness is found."
- Advocates to foster efficient and
effective behavioral functioning in the
patient to prevent illness and stresses the
importance of research-based knowledge
about the effect of nursing care on
patients.
Madeleine M. Leninger
- Culture Care Theory of Diversity and
Universality
- Defined transcultural nursing as "a
substantive area of study and practice
focused on comparative cultural care
(caring) values, beliefs, and practices of
individuals or groups of similar or
different cultures to provide
culture-specific and universal nursing
care practices in promoting health or
well-being or to help people to face
unfavorable human conditions, illness,
or death in culturally meaningful ways."
- Involves learning and understanding
various cultures regarding nursing and
health-illness caring practices, beliefs,
and values to implement significant and
efficient nursing care services to people
according to their cultural values and
health-illness context.
- It focuses on the fact that various
cultures have different and unique
caring behaviors and different health
and illness values, beliefs, and patterns
of behaviors.
Margaret A. Newman
- Health as Expanding Consciousness
- “Nursing is the process of recognizing
the patient in relation to the
environment, and it is the process of the
understanding of consciousness."
- "The theory of health as expanding
consciousness was stimulated by
concern for those for whom health as
the absence of disease or disability is
not possible..."
- Nursing is regarded as a connection
between the nurse and patient, and both
grow in the sense of higher levels of
consciousness.
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Rosemarie Rizzo Parse
- Human Becoming Theory
- "Nursing is a science, and the performing
art of nursing is practiced in relationships
with persons (individuals, groups, and
communities) in their processes of
becoming."
- Explains that a person is more than the
sum of the parts, the environment, and
the person is inseparable and that
nursing is a human science and art that
uses an abstract body of knowledge to
help people.
- It centered around three themes:
meaning, rhythmicity, and transcendence.
Ramona T. Mercer
- Maternal Role Attainment-Becoming a
Mother
- "Nursing is a dynamic profession with
three major foci: health promotion and
prevention of illness, providing care for
those who need professional assistance
to achieve their optimal level of health
and functioning, and research to
enhance the knowledge base for
providing excellent nursing care.”
- "Nurses are the health professionals
having the most sustained and intense
interaction with women in the maternity
cycle."
- Maternal role attainment is an
interactional and developmental process
occurring over time. The mother
becomes attached to her infant, acquires
competence in the caretaking tasks
involved in the role, and expresses
pleasure and gratification. (Mercer,
1986).
- Provides proper health care
interventions for nontraditional mothers
for them to favorably adopt a strong
maternal identity.
LOCAL THEORIES
● Sister Carolina S. Agravante
○ CASAGRA Transformative Leadership
Model: Servant-Leader Formula and the
Nursing Faculty’s Transformative
Leadership Behavior
■ CASAGRA was based on her name
● Carmelita C. Divinagarcia
○ COMPOSURE Behaviors Model.
■ COMPOSURE
COM - Competence
P - Presence & Prayer
O - Open-mindedness
S - Stimulation
U- Understanding
R - Respect & Relaxation
E - Empathy
● Sister Letty G. Kuan - Retirement and
Role Discontinuity Model
○ Preparation to another phase of life
(retirement)
○ How to fill the gap in helping the
patient prepare for the discontinuity
of his/her role and his/her aging.
● Carmencita M. Abaqyuin - PREPARE ME
Holistic Nursing Interventions
○ She developed this theory for cancer
patients.
○ Nurses should help the patient
investigate their being towards
tranquility.
○ Help them accept their life and
death situation
■ PREPARE ME
P - Presence
RE - Reminisce Therapy
PA - Prayer
RE - Relaxation
ME - Meditation
● Cecilia Marcaida Laurente - Theory of
Nursing Practice and Career
○ Focuses on anxiety/mental
state of a patient
○ Alleviating the anxiety that
the patients are feeling when
they are facing illness.