Emilio Aguinaldo College
Bachelor of Science in Nursing – 1st Year
Theoretical Foundation of Nursing
TRANSCULTURAL NURSING THEORY
MADELEINE LEININGER
Personal Background
• Madeleine Leininger was born on July 13,
1925, in Sutton, Nebraska.
• She graduated from Sutton High School.
• She was in the U.S. Army Nursing Corps
while pursuing a basic nursing program.
Educational Background
• She earned undergraduate degrees at Mount
St. Scholastica College and Creighton
University.
• She received a Master of Science in Nursing
from the Catholic University of America in
1954.
• 1965, Leininger embarked upon a doctoral
program in Cultural and Social
Anthropology at the University of
Washington in Seattle and became the first
professional nurse to earn a Ph.D. in
anthropology
Assumptions
• Care is the central and unifying focus of
nursing.
• Caring is essential for well-being, health,
healing, growth, and facing death.
• Culture care is the broadest holistic
approach.
• Transcultural Nursing Purpose
• Caring is vital for curing and healing.
• Diverse Culture Care
• Lay and professional care knowledge that
varies transculturally.
• Culture care values are influenced by a
culture's context.
• Culturally congruent nursing care occurs
when the nurse integrates the values of the
patient, family, or community meaningfully.
• Differences and similarities exist between
nurse and patient in any human culture.
• Clients experiencing incongruent care may
show signs of cultural conflicts,
noncompliance, stress, or ethical concerns.
Major Concepts
• Transcultural Nursing
Transcultural nursing is defined as a learned
subfield or branch of nursing that focuses upon the
comparative study and analysis of cultures
concerning nursing and health-illness caring
practices, beliefs, and values to provide meaningful
and efficacious nursing care services to their
cultural values and health-illness context.
• Ethnonursing
This is the study of nursing care beliefs, values, and
practices as cognitively perceived and known by a
designated culture through their direct experience,
beliefs, and value system.
• Nursing
Nursing is defined as a learned humanistic and
scientific profession and discipline which is focused
on human care phenomena and activities to assist,
support, facilitate, or enable individuals or groups to
maintain or regain their well-being (or health) in
culturally meaningful and beneficial ways, or to
help people face handicaps or death.
• Professional Nursing Care (Caring)
Professional nursing care (caring) is defined as
formal and cognitively learned professional care
knowledge and practice skills obtained through
educational institutions that are used to provide
assistive, supportive, enabling, or facilitative acts to
or for another individual or group to improve a
human health condition (or well-being), disability,
lifeway, or to work with dying clients.
• Cultural Congruent (Nursing) Care
Cultural congruent (nursing) care is defined as those
cognitively based assistive, supportive, facilitative,
or enabling acts or decisions that are tailor-made to
fit with the individual, group, or institutional,
cultural values, beliefs, and lifeways to provide or
support meaningful, beneficial, and satisfying
health care, or well-being services.
• Health
It is a state of well-being that is culturally defined,
valued, and practiced. It reflects individuals’ (or
groups) ‘ ability to perform their daily role activities
in culturally expressed, beneficial, and patterned
lifeways.
• Human Beings
Such are believed to be caring and capable of being
concerned about others’ needs, well-being, and
Emilio Aguinaldo College
Bachelor of Science in Nursing – 1st Year
Theoretical Foundation of Nursing
survival. Leininger also indicates that nursing as a
caring science should focus beyond traditional
nurse-patient interactions and dyads to include
families, groups, communities, total cultures, and
institutions.
• Society and Environment
Leininger did not define these terms; she speaks
instead of worldview, social structure, and
environmental context.
• Worldview
Worldview is how people look at the world, or the
universe, and form a “picture or value stance” about
the world and their lives.
• Cultural and Social Structure Dimensions
Cultural and social structure dimensions are defined
as involving the dynamic patterns and features of
interrelated structural and organizational factors of a
particular culture (subculture or society) which
includes religious, kinship (social), political (and
legal), economic, educational, technological, and
cultural values, ethnohistorical factors, and how
these factors may be interrelated and function to
influence human behavior in different
environmental contexts.
• Environmental Context
Environmental context is the totality of an event,
situation, or particular experience that gives
meaning to human expressions, interpretations, and
social interactions in particular physical, ecological,
sociopolitical, and/or cultural settings.
• Culture
Culture is learned, shared, and transmitted values,
beliefs, norms, and lifeways of a particular group
that guides their thinking, decisions, and actions in
patterned ways.
• Culture Care
Culture care is defined as the subjectively and
objectively learned and transmitted values, beliefs,
and patterned lifeways that assist, support, facilitate,
or enable another individual or group to maintain
their well-being, health, improve their human
condition lifeway, or deal with illness, handicaps or
death.
• Culture Care Diversity
Culture care diversity indicates the variabilities
and/or differences in meanings, patterns, values,
lifeways, or symbols of care within or between
collectives related to assistive, supportive, or
enabling human care expressions.
• Culture Care Universality
Culture care universality indicates the common,
similar, or dominant uniform care meanings,
patterns, values, lifeways, or symbols manifest
among many cultures and reflect assistive,
supportive, facilitative, or enabling ways to help
people.
Subconcepts
• Generic (Folk or Lay) Care Systems
Generic (folk or lay) care systems are culturally
learned and transmitted, indigenous (or traditional),
folk (home-based) knowledge and skills used to
provide assistive, supportive, enabling, or
facilitative acts toward or for another individual,
group, or institution with evident or anticipated
needs to ameliorate or improve a human life way,
health condition (or well-being), or to deal with
handicaps and death situations.
• Emic
Knowledge gained from direct experience or
directly from those who have experienced it. It is
generic or folk knowledge.
• Professional Care Systems
Professional care systems are defined as formally
taught, learned, and transmitted professional care,
health, illness, wellness, and related knowledge and
practice skills that prevail in professional
institutions, usually with multidisciplinary
personnel to serve consumers.
• Etic
The knowledge that describes the professional
perspective. It is professional care knowledge.
• Ethnohistory
Ethnohistory includes those past facts, events,
instances, experiences of individuals, groups,
cultures, and instructions that are primarily people-
centered (ethno) and describe, explain, and interpret
Emilio Aguinaldo College
Bachelor of Science in Nursing – 1st Year
Theoretical Foundation of Nursing
human lifeways within particular cultural contexts
over short or long periods of time.

• Care

Care as a noun is defined as those abstract and

concrete phenomena related to assisting, supporting,
or enabling experiences or behaviors toward or for
others with evident or anticipated needs to
ameliorate or improve a human condition or
lifeway.

• Care

Care as a verb is defined as actions and activities

directed toward assisting, supporting, or enabling
another individual or group with evident or
anticipated needs to ameliorate or improve a human
condition or lifeway or face death.

• Culture Shock

Culture shock may result when an outsider attempts

to comprehend or adapt effectively to a different
cultural group. The outsider is likely to experience
feelings of discomfort and helplessness and some
degree of disorientation because of the differences
in cultural values, beliefs, and practices. Culture
shock may lead to anger and can be reduced by
seeking knowledge of the culture before Three modes of nursing care decisions and
encountering that culture. actions

• Cultural Imposition 1. Cultural care preservation or

Cultural imposition refers to the outsider’s efforts,
both subtle and not so subtle, to impose their own
cultural values, beliefs, behaviors upon an
individual, family, or group from another culture.
Sunrise Model of Madeleine Leininger’s Theory
The Sunrise Model is relevant because it enables
nurses to develop critical and complex thoughts
about nursing practice. These thoughts should
consider and integrate cultural and social structure
dimensions in each specific context, besides nursing
care’s biological and psychological aspects.
Maintenance
Cultural care preservation is also known as
maintenance. It includes those assistive, supporting,
facilitative, or enabling professional actions and
decisions that help people of a particular culture to
retain and/or preserve relevant care values so that
they can maintain their well-being, recover from
illness, or face handicaps and/or death.
2. Cultural care accommodation or
Negotiation
Cultural care accommodation, also known as
negotiation, includes those assistive, supportive,
facilitative, or enabling creative professional actions
and decisions that help people of a designated
culture to adapt to or negotiate with others for a
beneficial or satisfying health outcome with
professional care providers.
Emilio Aguinaldo College
Bachelor of Science in Nursing – 1st Year
Theoretical Foundation of Nursing
3. Culture care repatterning or
Restructuring
Culture care repatterning or restructuring includes
those assistive, supporting, facilitative, or enabling
professional actions and decisions that help clients
reorder, change, or greatly modify their lifeways for
new, different, and beneficial health care pattern
while respecting the clients’ cultural values and
beliefs and still providing a beneficial or healthier
lifeway than before the changes were established
with the clients.
Metaparadigm
Person
• Referred to as human being.
• Holistic being who is influenced by culture,
social structure, worldview, and
environmental context.
• The primary focus of nursing care and has
the right to receive culturally appropriate
and beneficial care.
• The person is not only an individual, but
also a member of a family, community, or
society.
Environment
• The totality of the physical, ecological,
sociopolitical, and cultural factors that affect
the person’s health and well-being.
• Also includes the care setting where the
person and the nurse interact.
Health
• A state of well-being that is culturally
defined, valued, and practiced by the person.
• Not only the absence of disease, but also the
ability to cope with illness and maintain a
harmonious balance with the environment.
• Influenced by culture and that different
cultures have different views and
expectations of health and illness.
• Dynamic and changes over time and across
situations
Nursing
• A transcultural phenomenon that requires
knowledge and skills to provide care that is
culturally congruent and beneficial to the
person.
• A humanistic and scientific discipline that
aims to serve the person and society.
Strengths
Weaknesses
Application in Nursing
Practice
In nursing practice, Madeleine Leininger's Cultural
Care Theory is applied by nurses to ensure
culturally competent care.
• Cultural Assessment
• Cultural Sensitivity
• Individualized Care Plans
• Communication
• Education
Education
In nursing education, Madeleine Leininger's
Cultural Care Theory plays a crucial role in
preparing future nurses to provide culturally
competent care.
• Curriculum Integration
• Cultural Competence Training
• Clinical Experiences
• Case Studies
• Reflective Practice
Research
In nursing research, Madeleine Leininger's Cultural
Care Theory influences studies that explore the
impact of culture on healthcare outcomes.
• Cultural Competence Assessment Tools
• Health Disparities Research
• Intervention Development
• Patient Satisfaction and Cultural Care
• Cross-Cultural Comparisons
HEALTH AS EXPANDING CONSCIOUSNESS
MARGARET A. NEWMAN
Personal Background
• born on OCTOBER 10, 1993, in Memphis,
Tennessee.
• she earned her Bachelor’s degree in 1962
from the University of Tennessee.
Emilio Aguinaldo College
Bachelor of Science in Nursing – 1st Year
Theoretical Foundation of Nursing
• she finished her Master’s degree in 1964 “HEC Praxis: The Process of Pattern
from the University of California. Recognition.”
• she received a doctorate from New York
Step 1: A mutual process of inquiry is established
University in 1971.
with a patient (patient and/or family)
• Newman is a fellow in the American
Academy of Nursing Step 2: The patient is invited to talk about
• she received the Distinguished Scholar in meaningful events and relationships in the patient's
Nursing Award from New York University, life. After the first meeting, the nurse transmutes the
the Founders Award for Excellence in narrative to a simple diagram that illustrates the
Nursing Research from Sigma Theta Tau sequential configurations of relationships and
International, and the E. Louise Grant Award events.
for Nursing Excellence from the University Step 3: The diagram is shared with the patient and
of Minnesota. the dialogue resumes freely.
Assumptions Step 4: When the patient realizes the patient's
1. Health encompasses conditions heretofore pattern, partnership is terminated.
described as illness or, in medical terms,
pathology.
2. These “pathological” conditions can be
considered a manifestation of the total
pattern of the individual.
3. The pattern of the individual that eventually
manifests itself as pathology is primary and
exists before structural or functional
changes.
4. Removal of the pathology in itself will not
change the pattern of the individual.
5. If becoming “ill” is the only way an
individual’s pattern can manifest itself, then
that is health for the person.
Major Concepts THEORETICAL ASSERTIONS
• Health is an evolving unitary pattern of the Health as Continuous Process:
whole, including patterns of disease.
Newman asserts that health isn't a static state but an
• Pattern identified the person–environment
ongoing process of becoming more conscious and
process and is characterized by meaning.
aware.
• Consciousness is the informational capacity
of the whole and is revealed in the evolving Pattern Recognition and Meaning-Making:
pattern.
Newman emphasizes recognizing patterns in our
• Movement-Space-Time is the dimensions of
experiences to derive meaning.
emerging patterns of consciousness.
Nursing's Role in Facilitating Growth:
HEALTH AS EXPANDING CONSCIOUSNESS
Newman asserts that nurses play a vital role in
Emanating from a unitary and transformative
assisting individuals on their journey of expanding
perspective of nursing, caring partnership enables
consciousness.
nurses to identify with cancer patients as well as to
help the patients find meaning in their situation and Consciousness Expansion Despite Challenges:
their lives. In genuine patient–nurse interactions,
Newman's theory posits that even during difficult
both patients and nurses experience higher levels of
times or health crises, individuals have the potential
consciousness.
to expand their consciousness.
Metaparadigm
Emilio Aguinaldo College
Bachelor of Science in Nursing – 1st Year
Theoretical Foundation of Nursing
Person
• “The human is unitary, that is cannot be
divided into parts, and is inseperable from
larger unitary field.”
• “Persons as individual, and human beings as
a species are identified by their patterns of
consciousness.”
• “The person does not possess consciousness
- the person is consciousness.”
• Persons are “centers of consciousness”
within an overall pattern of expanding
consciousness.
Environment
• Environment is described as a “universe of
open systems.”
Health
• “Health and illness are synthesized as health
- the fusion on one state of being (disease)
with its opposite (non-disease) results in
what can be regarded as health.”
Nursing
• Nursing is “caring in the human health
experience.”
• Nursing is seen as a partnership between the
nurse and client, with both grow in the
“sense of higher level of consciousness.”
Strengths
Weaknesses
Application in Nursing
1. Holistic Patient-Centered Care
2. Life Pattern Recognition
3. Growth and Reflection
4. Preventive Advocacy
5. Support in Challenges
6. Collaborative Care Planning
7. Nurse Self-Reflection
HUMAN BECOMING THEORY
Rosemarie Rizzo Parse
Personal Background
• Educated at Duquesne University, Pittsburgh
• MSN and Ph.D. from University of
Pittsburgh
• Published her theory of nursing, Man-
Living-Health in 1981
• Name changed to Theory of Human
Becoming in 1992
• Editor and Founder, Nursing Science
Quarterly
• Has published eight books and hundreds of
articles about Human Becoming Theory
• Professor and Niehoff Chair at Loyola
University, Chicago
Assumptions
ABOUT MAN
• The human is coexisting while
coconstituting rhythmical patterns with the
universe.
• The human is open, freely choosing
meaning in situation, bearing responsibility
for decisions.
• The human is unitary, continuously
coconstituting patterns of relating.
• The human is transcending
multidimensionally with the possibles
ABOUT BECOMING
• Becoming is unitary human-living-health.
• Becoming is a rhythmically coconstituting
human-universe process.
• Becoming is the human’s patterns of relating
value priorities.
• Becoming is an intersubjective process of
transcending with the possibles.
• Becoming is unitary human’s emerging
THREE MAJOR ASSUMPTIONS OF HUMAN
BECOMING
1. MEANING
• Human Becoming is freely choosing
personal meaning in situations in the
intersubjective process of living value
priorities.
• Man’s reality is given meaning through lived
experiences.
• Man, and environment cocreate.
2. RHYTHMICITY
Emilio Aguinaldo College
Bachelor of Science in Nursing – 1st Year
Theoretical Foundation of Nursing
• Human Becoming is cocreating rhythmical
patterns of relating in mutual process with
the universe.
• Man and environment cocreate (imaging,
valuing, languaging) in rhythmical patterns.
3. TRANSCENDENCE
• Human Becoming is cotranscending
multidimensionally with emerging possibles.
• Refers to reaching out and beyond the limits
that a person sets.
• One constantly transforms.
Major Concepts
SUMMARY OF THE THEORY
• Human Becoming Theory includes Totality
Paradigm
➢ Man is a combination of biological,
psychological, sociological and spiritual
factors
• Simultaneity Paradigm
➢ Man is a unitary being in continuous,
mutual interaction with environment
• Originally Man-Living-Health Theory
SYMBOL OF HUMAN BECOMING THEORY
Black and White
• opposite paradox significant to ontology of
human becoming and green is hope.
Center joined
• co created mutual human universe process at
the ontological level & nurse-person
process.
Green and black swirls intertwining
• human-universe co creation as an ongoing
process of becoming.
Metaparadigm
Person
- Open being who is more than and different
from the sum of the parts
Environment
- Everything in the person and his experiences
- Inseparable, complimentary to and evolving
with
Health
- Open process of being and becoming.
Involves synthesis of values
Nursing
- A human science and art that uses an
abstract body of knowledge to serve people.
Strengths
• Humanistic & interactive approach
• Individuals are humans before patients.
• Encourages patients to explore their
perceptions of their own unique experience.
• Does not look to fix the current problem,
rather strives to maintain one’s quality of
life.
• Guides the nurse to "be with" the patient
during their experience.
• Useful in education and research
• Separates nursing from other theories.
• Provides guidelines of care
Weaknesses
• Theory rarely produces quantifiable results.
• method practicing is not practical to the
novice nurse.
• Terminology is difficult to comprehend.
• not applicable or suitable for acute
emergency nursing practice
• Does not use the nursing process.
Application in Nursing
Practice
• A transformative approach to all levels of
nursing
• Differs from the traditional nursing process,
particularly in that it does not seek to “fix”
problems.
• Ability to see patients’ perspective allows
nurse to “be with” patient and guide them
toward desired health outcomes.
• Nurse-person relationship cocreates
changing health patterns.
Research
• Enhances understanding of human lived
experience, health, quality of life and quality
of nursing practice.
• Expands the theory of human becoming.
• Builds new nursing knowledge about
universal lived experiences which may
Emilio Aguinaldo College
Bachelor of Science in Nursing – 1st Year
Theoretical Foundation of Nursing
ultimately contribute to health and quality of
life.
CONSERVATION MODEL
MYRA ESTRINE LEVINE
Personal Background
• Born on 1920 in Chicago
• In 1944, Myra Estrin Levine received her
diploma in nursing from the Cook County
School of Nursing.
• Finished her Bachelor of Science in Nursing
from the University of Chicago in 1949.
• Her Masters of Science in Nursing was
granted to her from Wayne State University
in Detroit in 1962.
Conservation Model
Principles
• The conservation of energy of the
individual.
• The conservation of the structural integrity
of the individual.
• The conservation of the personal integrity of
the individual.
• The conservation of the social integrity of
the individual.
Assumptions
Assumptions About Individuals
- Each individual “is an active participant in
interactions with the environment…
constantly seeking information from it.”
(Levine, 1969)
- The individual “is a sentient being, and the
ability to interact with the environment
seems ineluctably tied to his sensory
organs.”
- “Change is the essence of life, and it is
unceasing as long as life goes on. Change is
characteristic of life.”
Assumptions About Nursing
- “Ultimately, the decisions for nursing
intervention must be based on the unique
behavior of the individual patient.”
- “Patient-centered nursing care means
individualized nursing care. It is predicated
on the reality of common experience: every
man is a unique individual, and as such he
requires a unique constellation of skills,
techniques, and ideas designed specifically
for him.”
Major Concepts
• Adaptation
Adaptation is the process of change and integration
of the organism in which the individual retains
integrity or wholeness. It is possible to have degrees
of adaptation.
• Conservation
Conservation includes joining together and is the
product of adaptation, including nursing
intervention and patient participation to maintain a
safe balance.
• Energy
Refers to balancing energy input and output to
avoid excessive fatigue. It includes adequate rest,
nutrition, and exercise.
• Personal Integrity
Personal integrity is a person’s sense of identity and
self-definition. Nursing intervention is based on the
conservation of the individual’s personal integrity.
• Social Integrity
Social integrity is life’s meaning gained through
interactions with others. Nurses intervene to
maintain relationships.
• Structural Integrity
Structural integrity: Healing is the process of
restoring structural integrity through nursing
interventions that promote healing and maintain
structural integrity.
Emilio Aguinaldo College
Bachelor of Science in Nursing – 1st Year
Theoretical Foundation of Nursing
Subconcepts
• Historicity
Adaptation is a historical process. Responses are
based on past experiences, both personal and
genetic.
• Specificity
Adaptation is also specific. Each system has
particular responses. The physiologic responses that
“defend oxygen supply to the brain are distinct from
those that maintain the appropriate blood glucose
levels.”
• Redundancy
Although the changes that occur are sequential, they
should not be viewed as linear. Rather, Levine
describes them as occurring in “cascades” in which
there is an interacting and evolving effect in which
one sequence is not yet completed when the next
begins.
• Energy Conservation
Nursing interventions are based on the conservation
of the patient’s energy.
• Holism
The singular yet integrated response of the
individual to forces in the environment.
• Homeostasis
Stable state normal alterations in physiologic
parameters respond to environmental changes; an
energy sparing state, a state of conservation.
• Modes of Communication
The many ways information, needs, and feelings are
transmitted among the patient, family, nurses, and
other health care workers.
• Therapeutic Interventions
Interventions that influence adaptation favorably,
enhancing the adaptive responses available to the
person.
Metaparadigm
Person
The person is a unique individual in unity, integrity,
feeling, belief, thinking, and whole.
Environment
The environment includes both the internal and
external environment. Three Aspects of
Environment Drawn upon Bates’ (1967)
Classification:
• The operational environment consists of the
undetected natural forces and that impinge
on the individual.
• The perceptual environment consists of
information that is recorded by the sensory
organs.
• The conceptual environment is influenced
by language, culture, ideas, and cognition.
Health
Health is the pattern of adaptive change of the
whole being.
Nursing
Nursing is the human interaction relying on
communication, rooted in the individual human
being’s organic dependency in his relationships with
other human beings.
Strengths
- Levine has interrelated the concepts of
adaptation, conservation, and integrity in a
way that provides a nursing view different
from that of the adjunctive disciplines with
which nursing shares these concepts.
- Levine’s work is logical. One thought or
idea flows from the previous one and into
the next.
Weaknesses
There are many concepts with comparatively
unspecified relationships and unstated assumptions.
Application in Nursing
Practice
It guides nurses to concentrate on the importance
and responses at the level of the person. Nurses
fulfill the theory's purpose by conserving energy,
structure, and personal and social integrity.
Nursing as Caring
Anne Boykin & Savina Schoenhofer
Personal Background
Anne Boykin
Emilio Aguinaldo College
Bachelor of Science in Nursing – 1st Year
Theoretical Foundation of Nursing
• For the last three decades, Anne Boykin
served as the founding Dean and Professor
at the Christine E. Lynn College of Nursing
at Florida Atlantic University.
• She also held the position of Director of the
Christine E. Lynn Center for Caring, which
aimed to enhance the humanization of care
through teaching, research, and service.
• As a Dean, She actively demonstrated her
dedication to nursing through administrative
work, research, teaching, and services.
Savina Schoenhofer
• In the early 1960s, she spent three years in
the Amazon region of Brazil working as a
volunteer in Community development.
• In 1990, Savina co-founded Nightingale
Songs, as an early platform for expressing
the beauty of nursing through poetry and
prose.
Historical Background
• Anne Boykin and Savina Schoenhofer
developed the Theory of Nursing as Caring,
emphasizing the significance of caring in
nursing practice.
• The theory emphasizes that caring is
essential for promoting health, preventing
illness, and facilitating healing.
• It focuses on the interconnectedness of
individuals and their environments,
promoting holistic care and a humanistic
approach to nursing.
• The theory encourages nurses to view
individuals as whole beings with unique
experiences and values, fostering a deeper
understanding of the patient-nurse
relationship.
Assumptions
• Persons are caring by virtue of their
humanness.
• Persons are whole or complete in the
moment.
• Persons live caring, Moment to moment.
• Personhood is living life grounded in caring.
• Personhood is enhanced through
participating in nurturing relations with
caring others.
• Nursing is both a discipline and a
profession.
Major Concepts
• DISCIPLINE OF KNOWLEDGE
➢ Nursing is viewed as a discipline of
knowledge and professional practice
centered on nurturing individuals in
caring.
➢ Nursing communities share a common
value system expressed in their unique
focus on knowledge and practice.
• GENERAL INTENTION
➢ The overarching intention of nursing is
to know individuals as caring and to
support and sustain them in living and
growing in caring.
➢ Nursing, according to the Theory of
Nursing as Caring, emphasizes
intentional and authentic presence,
focusing on the nurturance of persons.
• PERSPECTIVE OF PERSONS AS
CARING
➢ All individuals are fundamentally caring,
expressing care in a constant process of
growth.
➢ Understanding individuals as living and
growing in caring is foundational to
nursing.
• NURSING SITUATION
➢ the locus of all nursing knowledge and
actions, a shared, lived experience
enhancing personhood.
➢ involves a relational context where
values, intentions, and actions of
individuals in the nursing relationship
are situated.
• PERSONHOOD
➢ Personhood is a process grounded in
caring, implying authenticity and
openness to unfolding possibilities for
caring.
➢ Within the nursing situation, shared
lived experiences enhance personhood,
fostering growth in caring for both the
nurse and the one nursed.
• DIRECT INVITATION
➢ Direct invitations in the nursing situation
open the relationship to genuine caring
between the nurse and the one nursed.
➢ These invitations, expressed in the
personal language of the nurse, focus on
what is meaningful for the one being
nursed.
Emilio Aguinaldo College
Bachelor of Science in Nursing – 1st Year
Theoretical Foundation of Nursing
• CALL FOR NURSING
➢ Calls for nursing are perceived in the
mind of the nurse, requiring
intentionality and authentic presence.
➢ Responding to calls involves
acknowledging and affirming the person
living caring in unique ways in the
immediate situation.
• CARING BETWEEN
➢ Caring between the nurse and the one
nursed nurtures personhood,
emphasizing presence and intentionality.
➢ Nursing in its fullest sense occurs within
the context of caring between, where
constant and mutual unfolding enhances
the loving relationship.
• NURSING RESPONSE
➢ The nurse responds to the nursing call
with the intention of knowing the other
person as caring.
➢ Nursing responses are co-created in the
immediacy of what truly matters,
shaping unique expressions of caring
nurturance.
• STORY TELLING FOR KNOWING
NURSING
➢ Storytelling is a method for knowing
nursing, serving as a medium for all
forms of nursing inquiry.
➢ Nursing stories embody the lived
experience of nursing situations,
preserving the depth and complexity of
the caring relationship.
➢ The nursing situation, as a unit of
knowledge, is re-created in narrative
form, allowing for reflection and
creativity in advancing understanding.
Subconcepts
Metaparadigm
Person
- Persons are viewed as caring by virtue of
their humanness.
- Persons are not viewed as segmented into
parts, but rather as a whole.
Environment
- Although not clearly defined, the
environment is referred to as the
environmental pressure in relation to nursing
roles.
Health
- A well-being state of a person. We can attain
overall health through proper caring in all
aspects of life.
Nursing
- The intention of nursing is “nurturing
persons who are living and growing in care
Application in Nursing
Practice
NURSE-PATIENT RELATIONSHIP
The fullness of nursing as a shared relationship
emerges in the caring between. In coming to know
self and others as caring persons, persons living
caring uniquely and growing in caring, the nurse
integrates personal, ethical, sociopolitical, empirical
and aesthetic knowing.
CONNECTEDNESS
The nurse practicing within the caring context
described here will most often be interfacing with
the health care system in two ways: first, to
communicate nursing in ways that can be
understood; and second, to articulate nursing
service as a unique contribution within the system
in such a way that the system itself grows to support
nursing.
DELIBERATIVE NURSING PROCESS
THEORY
IDA JEAN ORLANDO
Personal Background
• Born on August 12, 1926.
• She dedicated her life to studying nursing
and graduated in 1947.
• Bachelor of Science degree in public health
nursing from St. John’s University in 1951.
• In 1954, she completed her Master of Arts in
Mental Health consultation from Teachers
College, Columbia University.
• While studying, she also worked
intermittently and sometimes concurrently
as a staff nurse in OB, MS, ER, as a general
hospital supervisor, and as an assistant
director and a teacher of several courses.
Emilio Aguinaldo College
Bachelor of Science in Nursing – 1st Year
Theoretical Foundation of Nursing
Assumptions
• When patients cannot cope with their needs
on their own, they become distressed by
feelings of helplessness.
• In its professional character, nursing adds to
the distress of the patient.
• Patients are unique and individual in how
they respond.
• Nursing offers mothering and nursing
analogous to an adult who mothers and
nurtures a child.
• The practice of nursing deals with people,
the environment, and health.
• Patients need help communicating their
needs; they are uncomfortable and
ambivalent about their dependency needs.
• People can be secretive or explicit about
their needs, perceptions, thoughts, and
feelings.
• The nurse-patient situation is dynamic;
actions and reactions are influenced by both
the nurse and the patient.
• People attach meanings to situations and
actions that aren’t apparent to others.
• Patients enter into nursing care through
medicine.
• The patient cannot state the nature and
meaning of his or her distress without the
nurse’s help or him or her first having
established a helpful relationship with the
patient.
• Any observation shared and observed with
the patient is immediately helpful in
ascertaining and meeting his or her need or
finding out that he or she is not in need at
that time.
• Nurses are concerned with the needs the
patient is unable to meet on his or her own.
Goal
To develop a theory of effective nursing practice.
Major Concepts
• Function of professional nursing -
organizing principle
• Presenting behavior - problematic situation
• Immediate reaction - internal response
• Nursing process discipline investigation
• Improvement - resolution
Subconcepts
5 Stages Deliberative Nursing Process Theory
1. Assessment
In the assessment stage, the nurse completes a
holistic assessment of the patient’s needs.
2. Diagnosis
The diagnosis stage uses the nurse’s clinical
judgment about health problems.
3. Planning
The planning stage addresses each of the problems
identified in the diagnosis.
4. Implementation
In the implementation stage, the nurse begins using
the nursing care plan.
5. Evaluation
Finally, in the evaluation stage, the nurse looks at
the patient’s progress toward the goals set in the
nursing care plan.
Metaparadigm
Person
- developmental beings with needs
Environment
- not defined directly on her theory
Health
- sense of helplessness as a necessity for
nursing
Nursing
- It is responsive to individuals who suffer or
anticipate a sense of helplessness.
- process of care in an immediate experience
Strengths
• Patient-Centered Approach
Orlando's nursing theory emphasizes the
importance of focusing on the patient's needs,
experiences, and responses, putting the patient
at the center of care.
• Adaptability
Orlando's theory can be adapted across various
nursing settings and patient populations,
Emilio Aguinaldo College
Bachelor of Science in Nursing – 1st Year
Theoretical Foundation of Nursing
showcasing its flexibility and applicability in
diverse healthcare contexts.
• Interpersonal Relations
Her theory underscores the significance of
nurse-patient relationships. Orlando highlights
the nurse's ability to understand patient
behaviors and verbal/non-verbal cues, fostering
effective communication.
Weaknesses
• Subjectivity
Orlando's theory relies heavily on the nurse's
perception and interpretation of patient behaviors.
This subjectivity may lead to variations in
application and understanding among different
nurses.
• Limited Scope
Some critics argue that Orlando's theory focuses
predominantly on the immediate nurse-patient
interaction and may not fully address broader
systemic or environmental factors influencing
patient care.
• Emphasis on Verbalization
Orlando places significant emphasis on the
verbalization of patient needs. This might not fully
capture the experiences of patients who may
struggle with expressing themselves verbally,
potentially limiting the theory's applicability in
certain cases.
COGNITIVE DEVELOPMENT THEORY
JEAN PIAGET
Historical Background
Born in the late 1800s in Switzerland, he published
his first scientific paper at 11. Piaget gained early
exposure into child intellectual development while
assisting Alfred Binet and Theodore Simon in
standardizing the renowned IQ test.
Piaget's interest with child cognitive development
was inspired from observing his nephew and
daughter, shaping his hypothesis that children's
minds were not merely smaller versions of adult
minds.
Piaget pioneered the recognition that children's
thinking differs from adults', challenging the
historical view of treating children as smaller
versions of adults.
Piaget proposed stages of intelligence growth,
highlighting both qualitative and quantitative
differences between the thinking of young and older
children.
Piaget observed that children were not less
intelligent, they simply think differently. Einstein
praised this 'genius' idea. Piaget's stages explain
how children's cognitive development evolves from
action-based processes to changes in mental
operations, marking progress in cognitive abilities
throughout their growth.
4 Stages of Cognitive Development
1. SENSIMOTOR STAGE
sensorimotor stage occurs first and is
defined as the period when infants “think”
by means of their senses and motor actions.
2. PREOPERATIONAL STAGE
In the preoperational stage, children use
their new ability to represent objects in a
wide variety of activities, but they do not yet
do it in ways that are organized or fully
logical.
3. CONCRETE OPERATIONAL STAGE
stage wherein children can mentally work
with real objects and events. However,
they're not yet able to systematically think
about representations of things. The ability
to manipulate abstract representations
develops later, during adolescence.
4. FORMAL OPERATIONAL STAGE
The child gains the ability to reason not just
about tangible things but also about
hypothetical or abstract concepts. This stage
is named "formal operational" as it marks
the period when individuals can mentally
work with abstract forms or representations.
Emilio Aguinaldo College
Bachelor of Science in Nursing – 1st Year
Theoretical Foundation of Nursing
4 Factors of Cognitive Development
• SCHEMAS
Patterns of thinking and behavior
• ASSIMILATION
Taking new information
• ACCOMODATION
Describe what occurs when new information or
experiences cause you to modify your existing
schemas.
• EQUILIBRATION
Describes the cognitive balancing of new
information with old knowledge.
Importance
1. Educational Guidance:
Piaget's stages help teachers create age-
appropriate lessons, aligning with children's
cognitive development.
2. Active Learning Emphasis:
Piaget promotes hands-on learning,
encouraging activities that engage children in
constructing their own knowledge.
3. Insights into Cognitive Processes:
Piaget's theory offers insights into how
children's thinking changes, aiding educators
and parents in supporting growth.
4. Environmental Interaction:
Emphasizes the role of the environment in
cognitive development, guiding the design of
stimulating learning environments.
5. Ongoing Research and Critique:
Piaget's theory stimulates ongoing research,
with critiques contributing to its evolution and
relevance in understanding cognitive
development.
Application in Nursing
Practice
Cognitive Development Theory is a branch of
psychology that focuses on how children acquire,
store, and use knowledge.
PSYCHOANALYTIC THEORY
SIGMUND FREUD
Personal Background
Born: May 6, 1856
Birthplace: Freiberg, Moravia
Structural Theory
Freud's structural theory postulated the existence of
the id, ego, and superego.
ID
• First to develop
• Completely unconscious
• Contains all drives
• Ruled by pleasure principle
• No awareness of reality
EGO
• Second structure to develop
• Operates on reality principle
• Mediates conflict among id, ego, and superego
• Provides reality testing
• Defends against anxiety
SUPEREGO
• Third structure to develop
• Self-criticism based on moral values
• Self-punishment
• Self-praise based on ego ideal
• Most functions are unconscious
PSYCHOSEXUAL DEVELOPMENT
- Freud believed that personality developed
through a series of childhood stages in
which the pleasure-seeking energies of the
id become focused on certain erogenous
areas. An erogenous zone is characterized as
an area of the body that is particularly
sensitive to stimulation.
- These are called psychosexual stages
because each stage represents the fixation of
libido (roughly translated as sexual drives or
instincts) on a different area of the body. As
a person grows physically, certain areas of
their body become important as sources of
potential frustration, pleasure, or both.
The Oral Stage
Age Range: Birth to One Year
Erogenous Zone: Mouth
During the oral stage, the infant's primary source of
interaction occurs through the mouth, so the rooting
and sucking reflex is especially important.
The Anal Stage
Age Range: 1 to 3 years
Erogenous Zone:
Emilio Aguinaldo College
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Theoretical Foundation of Nursing
Bowel and Bladder Control
During this stage, the primary focus is on
controlling bladder and bowel movements. The
child has to learn to control their bodily needs. A
sense of accomplishment and independence.
The Phallic Stage
Age Range: 3 to 6 years
Erogenous Zone: Genitals
During this stage, the primary focus of the libido is
on the genitals. At this age, children also begin to
discover the differences between males and females.
The Latent Period
Age Range: 6 to Puberty
Erogenous Zone:
Sexual Feelings Are Inactive
During this stage, the superego continues to develop
while the id's energies are suppressed. Children
develop social skills, values, and relationships with
peers and adults outside of the family.
The Genital Stage
Age Range: Puberty to Death
Erogenous Zone:
Maturing Sexual Interests
The onset of puberty causes the libido to become
active once again. During the final stage of
psychosexual development, the individual develops
a strong sexual interest in the opposite sex.
Theory of Narcissism
Narcissism can be referred to as erotic pleasure that
is acquired through contemplation or admiration of
one’s own body or self.
Primary Narcissism
When one desires to fulfill their own needs.
Secondary Narcissism
When one expects others to fulfill those needs and
desires.
• Problems in the transition from one to the
other can lead to pathological narcissistic
disorders in adulthood.
Topographical Theory
Three mental regions based on their connection to
conscious thought.
Conscious Level
Encompasses mental activity and content that is
readily available to immediate perception.
Pre-conscious Level
Involves mental content and processes that are not
currently conscious but can be easily accessed when
attention is directed towards them.
Unconscious Level
Refers to a set of mental processes and content that
operates outside of consciousness.
Application in Nursing
Practice
• Therapeutic Communication
• Know Coping Mechanisms
• Exploring Patient Histories
• Aid Psychological Stress
• Promoting Self-Reflection
PRESCRIPTIVE THEORY: THE HELPING
ART OF CLINICAL NURSING
ERNESTINE WIEDENBACH
1.THE CENTRAL PURPOSE
• Defines the quality of health the nurse
desires to affect her patient.
• It is a concept that the nurse puts into words,
believes in, and accepts as a standard against
the value of her actions.
• This reflects the “NURSE’S PHILOSOPHY
OF CARE”
2. THE PRESCRIPTION FOR THE
FULFILLMENT OF THE CENTRAL
PURPOSE
• The appropriate nursing actions are selected
to create and implement a care plan in
accordance with the central purpose.
• These actions may be “voluntary” or an
bintended response or “involuntary” or
unintended response PRESCRIPTIVE
THEORY
➔Mutually identified actions – agreed upon by
the practitioner or nurse and patient
Emilio Aguinaldo College
Bachelor of Science in Nursing – 1st Year
Theoretical Foundation of Nursing
➔Recipient-directed actions – in which the
recipient directs the way the action is carried out
➔Practitioner-directed actions – in which the
practitioner carries out the action
3. THE REALITIES – THE ASPECTS OF THE
SITUATION THAT INFLUENCE THE
CENTRAL PURPOSE
➢ After the nurse determines the central
purpose and has developed the prescription,
she considers the following realities:
➔The AGENT or nurse practitioner who performs
the nursing action
➔The RECIPIENT or the patient who is
vulnerable and is dependent on others for help
➔The GOAL or directed outcomes the nurse
wishes to achieve
➔The MEANS or actions, skills, experiences that
empower the nurse to achieve the desired goals
➔The FRAMEWORK consists of human,
environmental, professional and organizational
facilities
Major Concepts
• PATIENT - Any individual who is recieving
help of some kind, be it care, instruction or
advice from a member of the health
profession or from a worker in the field of
health.
• NEED-FOR-HELP - any measure desired
by the patient that has the potential to restore
or extend the ability to cope with various life
situations that affect health and wellness.
• NURSE - a functioning human being.
• KNOWLEDGE - knowledge encompasses
all that has been perceived and grasped by
the human mind.
• JUDGMENT - clinical judgment represents
the nurse’s likeliness to make sound
decisions.
• NURSING SKILLS – nursing skills are
carried out to achieve a specific patient-
centered purpose rather than completion of
the skill itself being the end goal.
• PERSON - each person (whether nurse or
patient), is endowed with a unique potential
to develop self-sustaining resources.
4 MAIN ELEMENTS TO CLINICAL
NURSING
PHILOSOPHY
• The nurse's philosophy was their attitude
and belief about life and how that affected
reality for them.
• Philosophy is what motivates the nurse to
act in a certain way.
PURPOSE
• Nurses' purpose is that which the nurse
wants to accomplish through what she does.
• It is all of the activities are directed towards
the overall good of the patient.
PRACTICE
• observable nursing actions that are affected
by beliefs and feelings about meeting the
patient's need for help.
ART OF NURSING
• understanding patients' needs and concerns.
• developing goals and actions intended to
enhance patients' ability.
• to direct the activities related to the medical
plan.
• prevention of complications related to
reoccurrence or development of new
concerns.
3 ESSENTIAL COMPONENTS ASSOCIATED
WITH NURSING PHILOSOPHY
• Reverence for life
• Respect for the dignity, worth, autonomy,
and individuality of each human being
• Resolution to act on personally and
professionally held beliefs.
IDENTIFICATION OF A PATIENT'S NEED
FOR HELP
1. Observation of presenting behaviors and
symptoms
2. Exploration of the meaning of those
symptoms with the patient
3. Determining the causes of discomfort
4. Determining the patient's ability to resolve
the discomfort or if the patient has a need
for help.
3 FACTORS OF WEIDENBACH’S THEORY
Emilio Aguinaldo College
Bachelor of Science in Nursing – 1st Year
Theoretical Foundation of Nursing
THE CENTRAL PERSON
• Defines the quality of health the nurse
desires to affect her patient.
• It is a concept that the nurse puts into words,
believes in, and accepts as a standard against
the value of her actions.
• This reflects the "Nurse's Philosophy Of
Care"
THE PRESCRIPTION FOR THE
FULFILLMENT OF THE CENTRAL
PURPOSE
• The appropriate nursing actions are selected
to create and implement a care plan in
accordance with the central purpose.
• These actions may be "voluntary or an
intended response or involuntary" or
unintended response.
VOLUNTARY ACTIONS
• Mutually Identified Actions - Agreed upon
by the practitioner or nurse and the patient.
• Recipient-Directed Actions - In which the
recipient directs the way the action is carried
out.
• Practitioner-Directed Actions - In which
the practitioner carries out the action.
THE REALITIES THE ASPECTS OF THE
SITUATION THAT INFLUENCE THE
CENTRAL PURPOSE
• The AGENT or nurse practitioner whol
performs the nursing action.
• The RECIPIENT or the patient who is
vulnerable and is dependent on others for
help.
• The GOAL or directed outcomes the nurse
wishes to achieve.
• The MEANS or actions, skills, experiences
that empower the nurse to achieve the
desired goals.
• The FRAMEWORK consists of human,
environmental, professional and
organizational facilities
Metaparadigm
Person
In Wiedenbach's theory, the person refers to the
patient or the individual receiving care. This
encompasses the physical, emotional, and social
aspects of the individual's well-being.
Environment
In Wiedenbach's theory refers to the external factors
influencing the patient's health and well-being. This
includes the physical, social, cultural, and economic
aspects that can impact the patient's health.
Health
In Wiedenbach's theory, is viewed as a dynamic
state that involves the patient's overall well-being. It
goes beyond the absence of illness and incorporates
physical, mental, and social dimensions.
Nursing
Nursing, according to Wiedenbach, is an art and a
science that focuses on assisting individuals in
meeting their health needs. It involves the
application of knowledge and skills to provide
individualized care and support.
Strengths
• Patient-Centered Approach: Wiedenbach's
theory focuses on individualized care,
prioritizing the patient's unique needs.
• Emphasis on the Nurse's Role: It highlights
the nurse's responsibility in understanding
and meeting patient needs through clinical
expertise and a compassionate approach.
• Holistic Care: The theory encourages a
holistic view of patient care, considering not
just physical needs but also emotional,
social, and spiritual aspects.
Weaknesses
• Lack of Clarity in Application: Some critics
suggest that the theory lacks clarity in
practical application due to its abstract
nature, making it challenging to translate
into specific nursing practices.
• Limited Scope: Wiedenbach's theory might
not encompass the complexity of modern
healthcare settings, which involve
interdisciplinary teams and rapidly evolving
technologies.
• Potential for Subjectivity: The theory's
emphasis on individualized care might lead
to subjective interpretations, making it
challenging to establish consistent
guidelines for nursing practice.
Emilio Aguinaldo College
Bachelor of Science in Nursing – 1st Year
Theoretical Foundation of Nursing
Application in Nursing identity
and roles
Practice Early Intimacy Love Establish
Education adulthood vs. intimacy
12-29 isolation and
Research relationshi
ps with
PSYCHOSOCIAL DEVELOPMENT others
ERIK ERIKSON Middle Generativi Care Contribute
age 30-64 ty vs. to society
Personal Background stagnation and be part
of a family
• Born on June 15, 1902, in Frankfurt
Old age Integratio Wisdom Assess and
• German-American child psychoanalyst
65 n vs. make sense
Stage Basic Virtue Descriptio onward despair of life and
Conflict n meaning of
Infancy Trust vs. Hope Trust (or contributio
0-1 year mistrust mistrust) ns
that basic
needs, Strengths
such as
nourishme 1. The theory provides an integrated and broad
nt and framework for social development.
affection,
will be 2. It gives an understanding of the stages
met. involved in human development throughout
Early Autonom Will Develop a a lifespan.
childhood y vs. sense of
1-3 years shame/do independe 3. It showcases the identity crisis that
ubt nce in individuals go through during the different
many tasks stages of development
Play age Initiative Purpose Take 4. It asserts the importance of culture and
3-6 years vs. guilt initiative
society and its influence on one’s
on some
development.
activities-
may 5. It gives a better understanding of the
develop cognitive structure of human beings.
guilt when
unsuccessf 6. It enables individuals to have a better
ul or understanding of life and develop directions
boundaries
oversteppe Weaknesses
d 1. While moving from one stage to another, the
School Industry Competen Develop theory lacks explanation.
age vs. ce self-
2. Better elaboration is required for the impact
7-11 years inferiority confidence
of culture on development.
in abilities
when 3. There is a lack of elaboration between the
competent connections of all the stages.
or sense of Application
inferiority
when not The application of Erik Erikson's Stages of
Adolescen Identity Fidelity Experimen Psychosocial Development involves comprehending
ce vs. t with and and analyzing an individual's life encounters and
12-18 confusion develop difficulties within the framework of these stages.
years This approach finds relevance in diverse settings,
Emilio Aguinaldo College
Bachelor of Science in Nursing – 1st Year
Theoretical Foundation of Nursing
including psychology, education, counseling, and
personal growth. Erikson's theory highlights the
importance of skillfully navigating the psychosocial
challenges at each stage to achieve a well-rounded
and emotionally healthy development. The results
of each stage play a pivotal role in shaping an
individual's overall welfare and life contentment.
Erikson’s theory of psychosocial development has
been widely applied in fields.
• Education
• Social Work
• Counseling
• Parenting