MEDICAL COLLEGES OF NORTHERN PHILIPPINES

Alimannao Hills Penablanca, Cagayan

COLLEGE OF NURSING

INSTRUCTIONAL
LEARNING GUIDE

NCM 100
Theoretical Foundations
In
Nursing
FIRST SEMESTER F.Y. 2020-2021

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 MEDICAL COLLEGES OF NORTHERN PHILIPPINES
Alimannao Hills Penablanca, Cagayan
COLLEGE OF NURSING

MIDTERMS COVERAGE

Specific Instructions in the completion of each Chapter:

1. Set your learning goals. Read and understand the Intended Learning Outcomes of
each chapter. This shall serve as your checklist of acquired knowledge and skills after
completing the entire chapter, likewise, the basis of the teacher in the formulation of
the summative evaluation given at the end of each chapter.
2. Lecture notes are provided for you. BE SURE NOT TO SKIP the lecture. Read and
understand before answering the activities. You can take note those concepts that
are not clear to you and refer to your subject teacher during the specified
consultation hours.
3. Read the teacher’s insight and watch the downloaded videos saved in the flash drive
to supplement the lecture notes.
4. As you go on, you will encounter exercises that will test your knowledge and
understanding as well as your critical thinking. Read the instructions carefully, and
write your answers to the space provided at the end of Midterm coverage.
5. Compile you outputs in your Learning Portfolio to be submitted on the date set by
your teacher.
6. Should you have any queries or clarifications with the topics, please contact your
subject teacher during consultation hours (please refer to the preliminaries of this
material).

CHAPTER 1
INTRODUCTION OF NURSING THEORY

This chapter comprises of the basic concepts and terms that will be widely used in
the succeeding chapters and lessons. It will enable the learners to better understand the
subject matter.

Duration: 3.0 hours

MAJOR TOPICS SUBTOPICS

Philosophies  Florence Nightingale
 Virginia Henderson
 Faye Abdellah
 Jean Watson
Grand Theories  Madeleine Leininger
 Nola Pender

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 MEDICAL COLLEGES OF NORTHERN PHILIPPINES
Alimannao Hills Penablanca, Cagayan
COLLEGE OF NURSING

Middle-Range Theories  Hildegard Peplau

Conceptual Models
 Ida Jean Orlando
 Joyce Travelbee
 Sr. Callista Roy
 Dorothea Orem
 Martha Rogers
 Imogene King

Activities:

1. Self-Assessment Exercises
2. Theory Critiquing

Before you proceed…

Intended Learning Outcomes:

1. Identify the proponents of the different theories

2. Discuss the theory as applied to the nursing paradigms
3. Determine the assumptions made by the theorist
4. Discuss the importance of the nursing theory with emphasis on nursing practice
5. Appreciate the importance of the theory

Key Terms:

 Nursing Theorists
 Conceptual Models
 Grand Theories
 Middle Range Theories

Let’s Begin!
A. PHILOSOPHIES

I. FLORENCE NIGHTINGALE
 Was born in Florence Italy
 May 12, 1820
 was provided with very broad education
 fought the bureaucracy for bandages, food, fresh bedding, & cleaning supplies for
the soldiers during the Crimean War
 great concern for the well-being of the English soldiers
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 MEDICAL COLLEGES OF NORTHERN PHILIPPINES
Alimannao Hills Penablanca, Cagayan
COLLEGE OF NURSING

 she provided comfort for the critically ill & dying

 after the war, she established schools of nursing
 She died on August 13, 1910
 MOTHER OF MODERN NURSING ---She used the information gathered through
life experiences in the development of nursing
 GERMANY
- was the first site of organized nursing school in1836
- Pastor Theodor Fliedner; opened a hospital in Kaiserswerth Germany
- one patient, one nurse & one cook
- lack of work force led to the development of a school in nursing
- the physician spent time to teach nursing students
 GERTRUDE REICHARDT
- 1ST Matron of the Deaconess School of Nursing
- no textbooks available until 1837
- Nightingale visited Kaiserswerth for 14 days
- she entered the nursing program July 6, 1851, the 134 th nursing student
- she developed both nursing care & management skills
Approach to Nursing:
 Used her knowledge, understanding & prevalence of disease & her observation to
develop an approach to nursing
 CONTROL OF ENVIRONMENT---Individuals & family both healthy & ill
1. Ventilation & light
2. Proper disposal of sewage
3. Appropriate nutrition
 NOTES ON NURSING:
- thought to women who have personal charge of health of others
- everyday sanitary knowledge
- she wanted women to teach themselves to nurse
- In her writings, she provided much information on the influence of the
environment
Environmental Model
 Manipulation of the physical environment as a component of nursing care
Major Areas Of Environment
1. Health Of Houses
- Badly constructed houses do for the healthy what badly constructed hospitals
do for the sick. Once insure that air is stagnant & sickness is certain to follow”
- Cleanliness outside the house affects the inside
2. Ventilation & Warming
- “keep the air he breathes as pure as the external air w/o chilling him”
3. Light
- patient’s need direct sunlight
- sick people rarely lie with their face toward the wall but are much more likely
to face the window
4. Noise
- patient’s should never be waked intentionally or accidentally
- noise affects the healing
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Alimannao Hills Penablanca, Cagayan
COLLEGE OF NURSING

5. Variety
- Variety of environment was a critical aspect affecting the patient’s recovery
- effect of the body & the mind
- reading, needlework, writing, cleaning activities to relieve boredom.

6. Bed And Bedding

- Keep bedding clean, neat, & dry & position the patient for maximum comfort

7. Cleanliness Of Rooms And Walls

- “the greater part of nursing consists in preserving cleanliness”
- she urges removal of dust instead of relocating
- a clean room is a healthy room
8. Personal Cleanliness
- Skin is important
- excretion must be washed
- unwashed skin can poison, drying & bathing can provide great relief
- ”it is necessary to keep the pores of the skin free from all obstructing
excretions”
- “every nurse ought to wash her hands very frequently during the day
9. Nutrition And Taking Food
10. Chattering Hopes And Pieces Of Advice
11. Observation Of The Sick
12. Social Considerations

Metaparadigm In Nursing
 Nursing
- “what nursing has to do...is to put the patient in the best condition for
nature to act upon him”
- signifies the proper use of the major areas in environment
 Person
- Not defined by Nightingale specifically, but are defined in relationship to
their environment & the impact on them
 Environment
- She focused on ventilation, warmth, noise, light, & cleanliness
- All that surrounds human beings is considered in relation to his state of
health
 Health
- No definition of health specifically
- pathology teaches the harm disease has done
- “nature alone cures”
- Nursing should provide care to the healthy & ill & discussed health
promotion as an activity in which nurses should engage

Teacher’s Insight

The focus of nursing in this model is to alter the patient’s environment in order to
affect change in his or her health. The environmental factors that affect health as
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identified in the theory are: fresh air, pure water, sufficient food supplies, efficient
drainage, cleanliness of he patient and environment and light (particulary direct
sunlight). If any of these areas is lacking, the patient may experience diminished
 MEDICAL COLLEGES OF NORTHERN PHILIPPINES
Alimannao Hills Penablanca, Cagayan
COLLEGE OF NURSING

II. VIRGINIA HENDERSON

 She was the “First Lady of Nursing” and “First Truly International Nurse”.
 She began her career in Public health nursing in the Henry Street Settlement and
visiting nurse service in Washington, D.C.
 She was First Full-time Instructor in nursing in Virginia when she was at Norfolk
Protestant Hospital.
 During her years at Teacher College, Columbia University, she was an outstanding
teacher and student.
 She was Selected to the American Nurse Association Hall of Fame and had the
sigma Theta Tau international Library named in her honored.
 She introduced Textbook of the Principles and practice.
 She also directed twelve-years project entitled Nursing Study Index.
 In Nature of Nursing – she expressed her belief about the essence of nursing and
influenced the hearts and mind of those who read it.
 In 1921 – Virginia Henderson was an early advocate for introduction of psychiatric
nursing in curriculum and serve on committee to develop such a course at Eastern
State Hospital in Williamsbrug.
 Age of 75 – Henderson directed her career to international teaching and speaking.
 1988 – she was honored by the Virginia Nurse association and when the Virginia
Historical Nurse Leadership Award was presented to her.
 In 2000 – the Virginia nurse association recognize Henderson as one of fifty-one
Pioneer Nurse in Virginia

"The unique function of the nurse is to assist the individual, sick or well, in the
performance of those activities contributing to health or its recovery (or to peaceful
death) that he would perform unaided if he had the necessary strength, will or
knowledge. And to do this in such a way as to help him gain independence as rapidly
as possible”.
14 Basic Needs
 Physiological
1. Breath normally
2. Eat and drink adequately
3. Eliminate body wastes
4. Move and maintain desirable postures
5. Sleep and rest
6. Select suitable clothes - dress and undress
7. Maintain body temperature within normal range by adjusting clothing and
modifying the environment.
8. Keep the body clean and well groomed and protect the integument.
9. Avoid dangers in the environment and avoid injuring others.
10.Communicate with others in expressing emotions, needs, fears, or
opinions.
11. Learn, discover, or satisfy the curiosity that leads to normal
developmentand health and use the available health facilities.
 Sociological
12. Work in such a way that there is a sense of accomplishment.
13. Play or participate in various forms of recreation
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Alimannao Hills Penablanca, Cagayan
COLLEGE OF NURSING

 Spiritual
14.Worship according to one’s faith

Metaparadigm In Nursing
 Nursing
- Henderson asserted that nurse function independently from the physician,
but they must promote the treatment plan prescribe by the physician.
- Although part of the health team, the nurse must act independently but in
coordination with with the therapeutic plan developed by the team
 Person
- Is an individual who requires assistance to achieve health and
independence or in some case, a peaceful death.
 Environment
- Individuals in relation to families
- Supports tasks of private and public agencies
- Society expects nurses to act for individuals who are unable to function
independently
- Basic nursing care involves providing conditions under which the patient
can perform the 14 activities unaided
 Health
- Definition based on individual’s ability to function independently as
outlined in the 14 components.
- Nurses need to stress promotion of health and prevention and cure of
disease.
- Good health is a challenge.
- Affected by age, cultural background, physical, and intellectual capacities,
and emotional balance
- Impact on health by working of various social issues.

The Three Level Compromising The Nurse-Patient Relationship:

1. “The nurse as a substitute for the patient”
- In times of illness, when the patient cannot function fully, the nurse serve
as then substitute as to what the patient lack such, as knowledge, will and
strength in order to make him completed, whole independence once again.

2. “The nurse as a helper to the patient”

- In situation where the patient cannot meet his basic needs, the nurse
serve as a helper to accomplish them.
3. “The nurse as a partner with the patient”
- As a partners, the nurse and the patient formulate the plan together. Both
as an advocate and as a resource-person , the nurse can empower the
patient to make effective decisions regarding his care plan.

III. FAYE GLENN ABDELLAH

 Identified 21 nursing problems.
 Defined nursing as a service to individuals and families therefore to society.
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Alimannao Hills Penablanca, Cagayan
COLLEGE OF NURSING

 Conceptualized nursing as an Art and science.

21 Nursing Problems
1. To maintain good hygiene
2. To promote optimal activity; exercise rest and sleep
3. To promote safety
4. To maintain good body mechanics
5. To facilitate the maintenance of a supply of oxygen
6. To facilitate maintenance of nutrition
7. To facilitate maintenance of elimination
8. To facilitate the maintenance of F&E balance
9. To recognize the physiologic responses of the body to disease condition
10. To facilitate the maintenance of regulatory mechanisms and functions
11. To facilitate the maintenance of sensory function
12. To identify and accept the positive and negative expressions, feelings and
reactions
13. To identify and accept the interrelatedness of emotions and illness
14. To facilitate the maintenance of effective verbal and non-verbal communication
15. To promote the development of productive interpersonal relationship
16. To facilitate the progress towards achievement of personal spiritual goals
17. To create and maintain a therapeutic environment
18. To facilitate awareness of self as an individual with varying needs
19. To accept the optimum possible goals
20. To use community resources as an aid in resolving problems arising from illness
21. To understand the role of social problems as influencing factors

IV. JEAN WATSON PhD, RN, FAAN, HNC

 Theorist was born in West Virginia, US
 Educated: BSN, University of Colorado, 1964,
 MS, University of Colorado, 1966,
 PhD, University of Colorado, 1973
 Distinguished Professor of Nursing
 Endowed Chair in Caring Science at the University of Colorado Health Sciences
Center.
 Fellow of the American Academy of Nursing.
 Previously, Dean of Nursing at the University Health Sciences Center and President of
the National League for Nursing
 Undergraduate and graduate degrees in nursing and psychiatric-mental health
nursing and PhD in educational psychology and counseling. She has six (6) Honorary
Doctoral Degrees.
 Her research has been in the area of human caring and loss.
 In 1988, her theory was published in “nursing: human science and human care”.
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Alimannao Hills Penablanca, Cagayan
COLLEGE OF NURSING

 Jean Watson’s Theory of Transpersonal Caring also called Theory of Human

 Caring or The Caring Model was developed in 1979.

Theory of Human Caring or The Caring Model

 It emphasizes the humanistic aspects of nursing in combination with scientific

knowledge
 Watson designed this theory to bring meaning and focus to nursing as a distinct
health profession
 Watson believes that: “Caring” is an endorsement of professional nurses identity
 According to Watson, the nurse’s role is to:
- Establish a caring relationship with patients
- Treat patients as holistic beings (body, mind and spirit)
- Display unconditional acceptance
- Treat patients with a positive regard
- Promote health through knowledge and intervention
- Spend uninterrupted time with patients: “caring moments”

1. The formation of a humanistic- altruistic system of values.

2. The installation of faith-hope.
3. The cultivation of sensitivity to one’s self and to others.
4. The development of a helping-trust relationship
5. The promotion and acceptance of the expression of positive and negative
feelings.
6. The systematic use of the scientific problem-solving method for decision making
7. The promotion of interpersonal teaching-learning.
8. The provision for a supportive, protective and /or corrective mental, physical,
socio-cultural and spiritual environment.
9. Assistance with the gratification of human needs.
10. The allowance for existential-phenomenological forces

The Seven Assumption

1. Caring can be effectively demonstrated and practiced only interpersonally.
2. Caring consists of carative factors that result in the satisfaction of certain human
needs.
3. Effective caring promotes health and individual or family growth.
4. Caring responses accept person not only as he or she is now but as what he or she
may become.
5. A caring environment is one that offers the development of potential while allowing
the person to choose the best action for himself or herself at a given point in time.
6. Caring is more “ healthogenic” than is curing. A science of caring is complementary
to the science of curing.
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Alimannao Hills Penablanca, Cagayan
COLLEGE OF NURSING

7. The practice of caring is central to nursing

Ten Primary Carative Factors

1. The formation of a humanistic- altruistic system of values. (concern for the welfare
of other, selflessness)
– Begins developmentally at an early age with values shared with the parents.
– Mediated through one’s own life experiences, the learning one gains and
exposure to the humanities.
– Is perceived as necessary to the nurse’s own maturation which then promotes
altruistic behavior towards others
2. The installation of faith-hope.
– Is essential to both the carative and the curative processes.
– When modern science has nothing further to offer the person, the nurse can
continue to use faith-hope to provide a sense of well-being through beliefs
which are meaningful to the individual.
3. The cultivation of sensitivity to one’s self and to others.
– Explores the need of the nurse to begin to feel an emotion as it presents
itself.
– Development of one’s own feeling is needed to interact genuinely and
sensitively with others.
– Striving to become sensitive, makes the nurse more authentic, which
encourages self-growth and self-actualization, in both the nurse and those
with whom the nurse interacts.
– The nurses promote health and higher level functioning only when they form
person to person relationship
4. The development of a helping-trust relationship
– Strongest tool is the mode of communication, which establishes rapport and
caring.
– Characteristics needed to in the helping-trust relationship are:
– Congruence
– Empathy
– Warmth
– Communication includes verbal, nonverbal and listening in a manner which
connotes empathetic understanding
5. The promotion and acceptance of the expression of positive and negative feelings.
– “Feelings alter thoughts and behavior, and they need to be considered and
allowed for in a caring relationship”.
– Awareness of the feelings helps to understand the behavior it engenders.
6. The systematic use of the scientific problem-solving method for decision making
– The scientific problem- solving method is the only method that allows for
control and prediction, and that permits self-correction.
– The science of caring should not be always neutral and objective
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Alimannao Hills Penablanca, Cagayan
COLLEGE OF NURSING

7. The promotion of interpersonal teaching-learning.

– The caring nurse must focus on the learning process as much as the teaching
process.
– Understanding the person’s perception of the situation assist the nurse to
prepare a cognitive plan.
8. The provision for a supportive, protective and /or corrective mental, physical, socio-
cultural and spiritual environment.
– Watson divides these into eternal and internal variables, which the nurse
manipulates in order to provide support and protection for the person’s mental
and physical well-being.
– The external and internal environments are interdependent.
– Nurse must provide comfort, privacy and safety as a part of this carative
factor
9. Assistance with the gratification of human needs.
– It is based on a hierarchy of need similar to that of the Maslow’s.
– Each need is equally important for quality nursing care and the promotion of
optimal health.
– All the needs deserve to be attended to and valued
10. The allowance for existential-phenomenological forces.
– Phenomenology is a way of understanding people from the way things appear
to them, from their frame of reference.
– Existential psychology is the study of human existence using
phenomenological analysis.
– This factor helps the nurse to reconcile and mediate the incongruity of viewing
the person holistically while at the same time attending to the hierarchical
ordering of needs.
– Thus the nurse assists the person to find the strength or courage to confront
life or death.

Teacher’s Insight

In Caring Science, we as nurses need as much knowledge in caring as we do

in curing. When we put caring into science, we provide the best care for our patients.

Watson believes it is essential that we “Pause to Care!” Before any patient

interaction, center yourself on the compassion you need to provide not only to your
patients, but to yourself as well. In the busy day and age we live in, this is so very
important! Remember that every human being needs to be heard, seen, know that
they matter, and needs to have touch. Look at your patients beyond their physical
disease process and truly apply the principle of caring for that patient. Being present
with your patients is important too.
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Alimannao Hills Penablanca, Cagayan
COLLEGE OF NURSING

Watson’s Ordering of Needs

Lower order needs (biophysical needs)
– The need for food and fluid
– The need for elimination
– The need for ventilation
Lower order needs (psychophysical needs)
– The need for activity-inactivity
– The need for sexuality
Higher order needs (psychosocial needs)
– The need for achievement
– The need for affiliation
– Higher order need (intrapersonal-interpersonal need)
– The need for self-actualization

Metaparadigm In Nursing
 Person/Human being
Human being refers to “….. a valued person in and of him or herself to be cared for,
respected, nurtured, understood and assisted; in general a philosophical view of a
person as a fully functional integrated self. He, human is viewed as greater than and
different from, the sum of his or her parts”.
 Health
Watson adds the following three elements to WHO definition of health:
– A high level of overall physical, mental and social functioning
– A general adaptive-maintenance level of daily functioning
– The absence of illness (or the presence of efforts that leads its absence)
 Environment/society
According to Watson, caring (and nursing) has existed in every society.
A caring attitude is not transmitted from generation to generation.
It is transmitted by the culture of the profession as a unique way of coping with its
environment.
 Nursing
“Nursing is concerned with promoting health, preventing illness, caring for the sick
and restoring health”.
It focuses on health promotion and treatment of disease. She believes that holistic
health care is central to the practice of caring in nursing.
She defines nursing as…..
“A human science of persons and human health-illness experiences that are
mediated by professional, personal, scientific, esthetic and ethical human
transactions”.

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 MEDICAL COLLEGES OF NORTHERN PHILIPPINES
Alimannao Hills Penablanca, Cagayan
COLLEGE OF NURSING

B. GRAND THEORIES

V. MADELEINE LEININGER
 Developed the Transcultural Nursing Model.
 Advocated that nursing is a humanistic and scientific mode of helping a client
through specific cultural caring process to improve or maintain a health condition.
 Leininger is the founder of the transcultural nursing movement in education research
and practice.

Transcultural Nursing

Focus - cultural dynamics that influence the nurse–client relationship.

(area of study and practice focused on comparative cultural care (caring)
values, beliefs, and practices of individuals or groups of similar or different
cultures are compared)
Goal – culturally congruent holistic care.
Provide culture-specific and universal nursing care practices to promote well-
being or to help people face unfavorable human conditions in culturally
meaningful ways'

Teacher’s Insight
Navigating the unique cultural needs of your patients is very vital before
rendering care to them. Without doing so, you might accidentally offend your
patients or their families by not knowing about a crucial cultural practice and you
could also witness something that goes against your personal beliefs and
convictions and different from the nursing philosophies and principles that can at
the same time affect the delivery of health care. Thus, it is very important to
gather the cultural beliefs of your clients during the collection of data and health
history taking. Second, respect their cultural practices as long as it does not
threaten or contribute to risking their health status.

VI. NOLA PENDER

The Major Concepts and Definitions of the Health Promotion Model

 The health promotion model (HPM) proposed by Nola J Pender (1982; revised, 1996)
was designed to be a “complementary counterpart to models of health protection.”
 It defines health as a positive dynamic state not merely the absence of disease.
Health promotion is directed at increasing a client’s level of well being.

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 MEDICAL COLLEGES OF NORTHERN PHILIPPINES
Alimannao Hills Penablanca, Cagayan
COLLEGE OF NURSING

 The health promotion model describes the multi dimensional nature of persons as
they interact within their environment to pursue health.

A. Individual Characteristics and Experience

 Prior related behaviour
 Frequency of the similar behaviour in the past.
 Direct and indirect effects on the likelihood of engaging in health promoting
behaviors.
Personal Factors
– Personal factors categorized as biological, psychological and socio-cultural. These
factors are predictive of a given behavior and shaped by the nature of the target
behaviour being considered.
Personal biological factors
– Include variable such as age gender body mass index pubertal status, aerobic
capacity, strength, agility, or balance.
Personal psychological factors
– Include variables such as self esteem self motivation personal competence perceived
health status and definition of health.
Personal socio-cultural factors
– Include variables such as race ethnicity, acculturation, education and socioeconomic
status.

A. Behavioural Specific Cognition and Affect

Perceived Benefits Of Action
– Anticipated positive outcomes that will occur from health behaviour.
Perceived Barriers To Action
– Anticipated, imagined or real blocks and personal costs of understanding a given
behaviour
Perceived Self Efficacy
– Judgment of personal capability to organise and execute a health-promoting
behaviour. Perceived self efficacy influences perceived barriers to action so higher
efficacy result in lowered perceptions of barriers to the performance of the behavior.
Activity Related Affect
– Subjective positive or negative feeling that occur before, during and following
behavior based on the stimulus properties of the behaviour itself. Activity-related
affect influences perceived self-efficacy, which means the more positive the
subjective feeling, the greater the feeling of efficacy. In turn, increased feelings of
efficacy can generate further positive affect.
Interpersonal Influences
– Cognition concerning behaviours, beliefs, or attitudes of the others. Interpersonal
influences include: norms (expectations of significant others), social support
(instrumental and emotional encouragement) and modelling (vicarious learning
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Alimannao Hills Penablanca, Cagayan
COLLEGE OF NURSING

through observing others engaged in a particular behaviour). Primary sources of

interpersonal influences are families, peers, and healthcare providers.
Situational Influences
– Personal perceptions and cognitions of any given situation or context that can
facilitate or impede behaviour. Include perceptions of options available, demand
characteristics and aesthetic features of the environment in which given health
promoting is proposed to take place. Situational influences may have direct or
indirect influences on health behaviour.

C. MIDDLE RANGE THEORIES

VII. HILDEGARD PEPLAU PhD, RN, FAAN (1909 - 1999)

 MOTHER OF PSYCHIATRIC NURSING ( Founder of Mordern Psychiatric Nursing)

 FAAN - Fellow of the American Academy of Nursing
 Made extraordinary and sustained contributions to nursing and health care
throughout their career
 Nursing leaders in EDUCATION, MANAGEMENT, PRACTICE and RESEARCH
 PhD – Doctor of Philosophy
 Born in Reading, Pennsylvania on September 1, 1909
 Graduated from the Pottstown, Pennsylvania Hospital
 Worked as an Operating room Supervisor at Pottstown Hospital
 Received a B.A. in interpersonal Psychology from Bennington College, Vermont, in
1943
 M.A. (Psychiatric Nursing) from Teachers College, Columbia, New York, in 1947
 Ed. D in curriculum Development from Columbia in 1953
 During World Was II, Hildegard Peplau was a member of the Army Nurse Corps and
worked in a neuropsychiatric hospital in london, England
 She also did work at Bellevue and Chestnut Lodge Psychiatric Facilities and was in
contact with renowned psychiatrist :
o Freida-Riechman
o Harry Stack Sullivan
 Holds numerous awards and position:
- The only nurse to serve the ANA as executive director and later as president
- Served two terms on the Board of the International Council of Nurses (ICN).
- In 1997, she received nursing's highest honor, the Christiane Reimann Prize, at
the ICN Quadrennial Congress.
- In 1996, the American Academy of Nursing honored Peplau as a "Living Legend,"

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 MEDICAL COLLEGES OF NORTHERN PHILIPPINES
Alimannao Hills Penablanca, Cagayan
COLLEGE OF NURSING

- In 1998, the ANA inducted her into its Hall of Fame

 Retired in 1974
 Died peacefully on March 17, 1999 at her home in Sherman Oaks Californina
after a brief of illness

Psychodynamic nursing

 Understanding of ones own behavior

 To apply principles of human relations to the problems that arise at all levels of
experience
 Nursing is an interpersonal process because it involves interaction between two
or more individuals with a common goal.
 The nurse and patient work together so both become mature and knowledgeable in
the process.
 The attainment of goal is achieved through the use of a series of steps following a
series of pattern.
 According to Peplau, nursing is therapeutic in that it is a healing art, assisting an
individual who is sick or in need of health care.

Metaparadigm In Nursing
4. Nursing
- A significant therapeutic interpersonal process. It functions cooperatively
with other human process that make health possible for individuals in
communities
5. Person
a. A developing organism that tries to reduce anxiety caused by needs

Environment
- Existing forces outside the organism and in the context of culture
6. Health
- A word symbol that implies forward movement of personality and other
ongoing human processes in the direction of creative,
constructive, productive, personal and community living.
Roles of nurse
 Stranger : receives the client in the same way one meets a stranger in other life
situations provides an accepting climate that builds trust.
 Teacher : who imparts knowledge in reference to a need or interest

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Alimannao Hills Penablanca, Cagayan
COLLEGE OF NURSING

 Resource Person : one who provides a specific needed information that aids in the
understanding of a problem or new situation
 Counselors : helps to understand and integrate the meaning of current life
circumstances ,provides guidance and encouragement to make changes
 Surrogate : helps to clarify domains of dependence interdependence and
independence and acts on clients behalf as an advocate.
 Leader : helps client assume maximum responsibility for meeting treatment goals in
a mutually satisfying way

Theory of Interpersonal Relations

 Middle range descriptive classification theory

 Influenced by Harry Stack Sullivan's theory of inter personal relations (1953)
 Also influenced by Percival Symonds , Abraham Maslow's and Neal Elger Miller
 Identified four sequential phases in the interpersonal relationship:
1. Orientation
2. Identification
3. Exploitation
4. Resolution

Orientation Phase
 During this phase, the individual has a felt need and seeks professional assistance
 The nurse helps the individual to recognize and understand his/ her problem and
determine the need for help
 Problem defining phase: identifies problem
 Starts when client meets nurse as stranger
 Defining problem and deciding type of service needed
 Client seeks assistance ,conveys needs ,asks questions, shares preconceptions and
expectations of past experiences
 Nurse responds, explains roles to client, helps to identify problems and to use
available resources and services
 Activities:
• Nurse and patient come together as strangers;
• Meeting initiated by patient who expresses a “felt need”;
• Work together to recognize,
• Clarify and define facts related to need
Identification Phase
 The patient identifies with those who can help him/ her.
 The nurse permits exploration of feelings to aid the patient in undergoing illness as
an experience that reorients feelings and strengthens positive forces in the
personality and provides needed satisfaction.
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 Selection of appropriate professional assistance

 Patient begins to have a feeling of belonging and a capability of dealing with the
problem which decreases the feeling of helplessness and hopelessness
 Activities:
• Patient participates in goal setting;
• has feeling of belonging and selectively responds to those who can meet his
or her needs.
Exploitation Phase
 During this phase, the patient attempts to derive full value from what he/ she are
offered through the relationship.
 The nurse can project new goals to be achieved through personal effort and power
shifts from the nurse to the patient as the patient delays gratification to achieve the
newly formed goals.
 Use of professional assistance for problem solving alternatives
 Advantages of services are used is based on the needs and interests of the patients
 Individual feels as an integral part of the helping environment
 They may make minor requests or attention getting techniques
 The principles of interview techniques must be used in order to explore, understand
and adequately deal with the underlying problem
 Patient may fluctuates on independence
 Nurse must be aware about the various phases of communication
 Nurse aids the patient in exploiting all avenues of help and progress is made towards
the final step
 Activity:
• Patient actively seeks and draws knowledge and expertise of those who can
help
Resolution Phase
 Termination of professional relationship
 The patients’ needs have already been met by the collaborative effect of patient and
nurse
 Now they need to terminate their therapeutic relationship and dissolve the links
between them.
 Sometimes may be difficult for both as psychological dependence persists
 Patient drifts away and breaks bond with nurse and healthier emotional balance is
demonstrated and both becomes mature individuals
 Activity:
• Occurs after other phases are completed successfully. This leads to termination of
the relationship.

Teacher’s Insight
Nursing can be a very stressful career and it takes a solid collection of
interpersonal skills to handle the tasks of dealing with patients, their family and 18
friends and other medical personnel.
Nurses are often the first person an injured or ill person interacts with, no matter if
it’s at a medical facility or a Doctor’s office.
It is essential nurse’s arm themselves with the best arsenal of skills to deal with the

MEDICAL COLLEGES OF NORTHERN PHILIPPINES

Alimannao Hills Penablanca, Cagayan
COLLEGE OF NURSING

VIII. IDA JEAN ORLANDO

 Theorist, Ida Jean Orlando was born in 1926.

 Ida J. Orlando was one of the first nursing theorists to write about the nursing
process.
 Nursing diploma - New York Medical College
 BS in public health nursing - St. John's University, NY,
 MA in mental health nursing - Columbia University, New York.
 Associate Professor at Yale School of Nursing and Director of the Graduate Program
in Mental Health Psychiatric Nursing.
 Project investigator of a National Institute of Mental Health grant entitled:
Integration of Mental Health Concepts in a Basic Nursing Curriculum.
 Her theory was published in her 1961 book, The Dynamic Nurse-Patient Relationship.
 Further development of her theory at McLean Hospital in Belmont, MA as Director of
a Research Project: Two Systems of Nursing in a Psychiatric Hospital. The results
were conceptualized in her 1972 book titled: The Discipline and Teaching of Nursing
Processes
 A board member of Harvard Community Health Plan, and served as both a national
and international consultant
 Theorethical Sources
- Paplau’s focus of interpersonal relationships in nursing
- Paplau acknowledged the influence of Harry Stack Sullivan on the
development of her ideas
- Symbolic interactionism – Chicago school
 Use of field methodology
- John Dewey’s theory of inquiry
 Major Dimensions
- The role of the nurse is to find out and meet the patient's immediate need
for help.
- The patient's presenting behavior may be a plea for help; however, the
help needed may not be what it appears to be.
- Therefore, nurses need good judgment to explore with patients the
meaning of their behavior.
- This process helps nurse find out the nature of the distress and what help
the patient need

Nursing Process

Assessment
 Systematic and continuous collection, validation and communication of client data
as compared to what is standard/norm
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Purpose: to establish a data base

Types Of Assessment:
1. Initial Assessment – assessment performed within a specified time on admission
Ex: Nursing admission assessment
Physical assessment on admission
Physician’s history & physical examination
2. Problem-Focused Assessment – use to determine status of a specific problem
identified in an earlier assessment
Ex: Fluid intake & urine output (problem on urination-assess)
(Diuresis/polyuria, Dysuria, Anuria, Oliguria)
Snellens test (Visual Acuity)
3. Emergency Assessment – rapid assessment done during any physiologic/physiologic
crisis of the client to identify life threatening problems.
Ex: Assessment of a client’s airway, breathing status & circulation after a cardiac
arrest
4. Time-Lapsed Assessment – reassessment of client’s functional health pattern
– Done several months after initial assessment to compare the clients current status
to baseline data previously obtained.
Types of Data:
1. Subjective Data – Symptom/Covert data
– Information from the client’s point of view or are described by the person
experiencing it.
– Information supplied by family members, significant others, other health
professionals are considered subjective data.
Example: pain, dizziness, ringing of ears/Tinnitus
(-) guarding behavior
(-) facial Grimace

2. Objective Data – Sign/Overt data

– Those that can be detected, observed or measured/tested using accepted
standard or norm.
Example: pallor, diaphoresis, BP=150/100, yellow discoloration of skin
Pain scale – 0/10
“Hindi na masakit ang tiyan ko” as verbalized by the patient
Patient reports of dizziness
Patient has wobbling gait
“Masakit ang tiyan ko” as verbalized by the patient
Petechiae
Methods of Data Collection:
1. Interview

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COLLEGE OF NURSING

– A planned, purposeful conversation/communication with the client to get

information, identify problems, evaluate change, to teach, or to provide support or
counselling.
2. Observation
– use to gather data by using the 5 senses and instruments
Sources Of Data:
1. Primary source – data directly gathered from the client using interview and physical
examination.
2. Secondary source – data gathered from client’s family members, significant others,
client’s medical records/chart, other members of health team, and related care
literature/journals.
Diagnosing
 Is the 2nd step of the nursing process
 The process of reasoning or the clinical act of identifying problems
 Identifies health care needs
 Analyze assessment information and derive meaning from this analysis.
Types of Nursing Diagnosis:
1. Actual Nursing Diagnosis – a client problem that is present at the time of the nursing
assessment. It is based on the presence of signs and symptoms.
– Constipation r/t long term use of laxative.
– Ineffective airway clearance r/t to viscous secretions
2. Potential Nursing Diagnosis – evidence about a health problem is incomplete or
unclear. It requires more data to support or reject it; or the causative factors are
unknown. Problem is only considered possible to occur
– Possible nutritional deficit
– Possible low self-esteem r/t loss job
3. Risk Nursing Diagnosis – is a clinical judgment that a problem does not exist,
therefore no S/S are present instead RISK FACTORS are present
*Risk factors indicates that a problem is only is likely to develop unless nurse intervene
or do something about it. No subjective or objective cues are present therefore the
factors that cause the client to be more vulnerable to the problem is the etiology of a
risk nursing diagnosis.
– Risk for Constipation r/t inactivity and insufficient fluid intake
Planning
 To identify client goals; to determine priorities of care; to design nursing strategies
to achieve expected outcomes of care; to determine outcome criteria-
 SMART –Specific, Measurable, Attainable and Realistically Time-bound.
– Ex: to reduce fever within the baseline data of 37 by giving prn antipyretic
medication and performing tepid sponge bath for 4 hrs
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Implementation
 To complete nursing actions necessary for accomplishing plan
 Reassess client.
 Review and modify existing care plan.
 Perform nursing actions.
*Nursing actions – directed towards providing for the patient’s immediate
need
Evaluation
 To determine extent to which expected outcomes have been achieved.

One of the fundamental principles for developing critical thinking is the

nursing process,” Vest says. “It needs to be a lived experience in the learning
environment.”

Nursing students often find that there are multiple correct solutions to a problem.
The key to nursing is to select the “the most correct” solution—one that will be the
most efficient and best fit for that particular situation. You will often find yourself in
situations where there are few “correct” forms of care, but one that is most
appropriate. Using the nursing process, students can narrow down their options
to select the best one.

IX. JOYCE TRAVELBEE

 Born in 1926,
 A psychiatric nurse, educator and writer.
 In 1956, she completed her Bachelor of Science degree in nursing education at
Louisiana State University and her Master of Science Degree in Nursing from Yale
University in 1959.
 She started a doctoral program in Florida in 1973.
 Unfortunately, she was not able to finish the program because she died later that
year. She passed away at the prime age of 47 after a brief sickness.
 In 1952, Travelbee started to be an instructor focusing in Psychiatric Nursing at
Depaul Hospital Affiliate School, New Orleans, while working on her baccalaureate
degree. Besides that, she also taught Psychiatric Nursing at Charity Hospital School
of Nursing in Louisiana State University, New York University and University of
Mississippi. In 1970,she was named Project Director at Hotel Dieu School of Nursing
in New Orleans. Travelbee was the director of Graduate Education at Louisiana State
University School of Nursing until her death.
 In 1963, Travelbee started to publish various articles in nursing journals. Her first
book entitled: Interpersonal Aspects of Nursing was published in 1966 and 1971.
 In 1969, she had her second book published entitled: Intervention in Psychiatric
Nursing : Process in the One-to-One Relationship.
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Human to Human Relationship Model

 In her human-to-human relationship model, the nurse and the patient undergoes
the following series of interactional phases:

Original Encounter
 This is described as the first impression by the nurse of the sick person and vice-
versa. The nurse and patient see each other in stereotyped or traditional roles.
Emerging Identities
 This phase is described by the nurse and patient perceiving each other as unique
individuals. At this time, the link of relationship begins to form.
Empathy
 Travelbee proposed that two qualities that enhance the empathy process are
 Similarities of experience
 the desire to understand another person
 This phase is described as the ability to share in the person’s experience. The result
of the empathic process is the ability to expect the behavior of the individual with
whom he or she empathized.
Sympathy
 Sympathy happens when the
 Nurse wants to lessen the cause of the patient’s suffering.
 “When one sympathizes, one is involved but not incapacitated by the
involvement.” The nurse should use a disciplined intellectual approach together with
therapeutic use of self to make helpful nursing actions.
.

Teacher’s Insight
The terms empathy and sympathy are often confused. Although both of the words
deal with the relationship a person has to the feelings and experiences of another
person One is considered to be of more therapeutic than the other.

Both sympathy and empathy have roots in the Greek term páthos meaning
“suffering, feeling.”Sympathy is largely used to convey commiseration, pity, or
feelings of sorrow for someone else who is experiencing misfortune. You feel bad for
them … but you don’t know what it is like to be in their shoes. Empathy on the other
hand is now most often used to refer to the capacity or ability to imagine oneself in
the situation of another, experiencing the emotions, ideas, or opinions of that person.

For the two, empathy is more of therapeutic use than sympathy. Meaning for nurses,
we should be aware that we must understand our patient’s feelings by trying to put 23
our self in their situation to better understand their needs but not to be sympathetic
to their situation in anyway.
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Rapport
 Rapport is described as nursing interventions that lessens the patient’s suffering.
 The nurse and the sick person are relating as human being to human being.
 The sick person shows trust and confidence in the nurse. “A nurse is able to
establish rapport because she possesses the necessary knowledge and skills required
to assist ill persons, and because she is able to perceive, respond to, and appreciate
the uniqueness of the ill human being.”

Note that the above stated interactional phases are in consecutive order and
developmentally achieved by the nurse and the patient as their relationship with one
another goes deeper and more therapeutic
D. CONCEPTUAL MODEL/S

X. DOROTHEA OREM
Self Care and Self Deficit Theory
 Self-care – is the performance or practice of activities that individuals initiate and
perform on their behalf
– The human’s ability or power to engage in self-care
 3 Classifications of Nursing Systems:
- Wholly compensatory – for people who are socially dependent on others
for their existence and well being
- Partly compensatory – both nurse and patient perform care measures
- Supportive – educative – where the nurse is able to perform or can and
should learn to perform required measures of self-care but cannot do so
without assistance

XI. MARTHA ROGERS

 Conceptualizes the science of unitary human beings.
 Nursing as an art and science that is humanistic and humanitarian. It is directed
toward the unitary human and is concerned with the nature and direction of human
development.
 The goal of every nurse is to participate in the process of change.

XII. IMOGENE KING

 Postulated the goal attainment model.
 Described nursing as a helping profession that assists the individuals and groups in
society to attain, maintain, and restore health.
 Nursing is a process of action, reaction and interaction whereby nurse and client
share information about their perception in the nursing situation.

Goal Attainment Theory

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 Believes that there are 3 interacting systems:

 Individual (Personal System)

 Group (Interpersonal System)
 Society (Social Systems)

XIII. SISTER CALLISTA ROY

 Born at Los Angeles on October 14, 1939 as the 2nd child of Mr. and Mrs. Fabien
Roy.
 At age 14 she began working at a large general hospital, first as a pantry girl, then
as a maid, and finally as a nurse's aid.
 She entered the Sisters of Saint Joseph of Carondelet.
 she earned a Bachelor of Arts with a major in nursing from Mount St. Mary's College,
Los Angeles in 1963.
 a master's degree program in pediatric nursing at the University of California ,Los
Angeles in 1966.
 She also earned a master’s & PhD in Sociology in 1973 & 1977 ,respectively
 Sr. Callista had the significant opportunity of working with Dorothy E. Johnson
 Johnson's work with focusing knowledge for the discipline of nursing convinced Sr.
Callista of the importance of describing the nature of nursing as a service to society
and prompted her to begin developing her model with the goal of nursing being to
promote adaptation.

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ADAPTATION THEORY

 System-a set of parts connected to function as a whole for some purpose.

 Stimulus-something that provokes a response, point of interaction for the human
system and the environment
 Focal Stimuli-internal or external stimulus immediately affecting the system
 Contextual Stimulus-all other stimulus present in the situation.
 Residual Stimulus-environmental factor, that effects on the situation that are
unclear.

 Regulator Subsystem-automatic response to stimulus (neural, chemical, and

endocrine)
 Cognator Subsystem-responds through four cognitive responds through four
cognitive-emotive channels (perceptual and information processing, learning,
judgment, and emotion)
 Behavior -internal or external actions and reactions under specific circumstances

 Physiologic-Physical Mode
– Behavior pertaining to the physical aspect of the human system
– Physical and chemical processes
– Nurse must be knowledgeable about normal processes
– 5 needs (Oxygenation, Nutrition, Elimination, Activity & Rest, and Protection)
 Self Concept-Group Identity Mode
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– The composite of beliefs and feelings held about oneself at a given time. Focus
on the psychological and spiritual aspects of the human system.
– Need to know who one is, so that one can exist with a state of unity, meaning,
and purposefulness of 2 modes (physical self, and personal self)
 Role function Mode
– Set of expectations about how a person occupying one position behaves toward a
occupying another position. Basic need-social integrity, the need to know who
one is in relation to others
 Interdependence Mode
– Behavior pertaining to interdependent relationships of individuals and groups.
Focus on the close relationships of people and their purpose.
– Each relationship exists for some reason. Involves the willingness and ability to
give to others and accept from others.
– Balance results in feelings of being valued and supported by others. Basic need -
feeling of security in relationships

 Adaptive Responses-promote the integrity of the human system.

 Ineffective Responses-neither promote not contribute to the integrity of the
human system
 Coping Process-innate or acquired ways innate or of interacting with the changing
of environment

Reminders: Before proceeding to the exercises, if you have other topics not fully clear to
you, feel free to browse again on the topics and you can also do additional readings from
other textbooks and references. No cheating in the self- assessment exercises. Answer it on
your own without looking at your notes. Good Luck!

REFERENCES:
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COLLEGE OF NURSING

TEXTBOOK:
Nursing Theories and their Works 9th ed, Alligood, 2018

Other References:
1. Theoretical basis for nursing 5th ed. (R) Mcewen 2019
2. Fundamentals of nursing 9th ed. (T) Potter 2017
3. Kozier and Erb's Fundamentals of Nursing: Concepts, Process, and Practice volume 1+
vol 2 (T) Bermam, 2016
4. Kozier & Erb’s Fundamentals of Nursing Concepts, Process and Practice 9th ed. (T)
Berman, A 2014

Journals :
1. American Journal of Nursing
2. Philippine Journal of Nursing Education
3. The Journal for Nurse Practitioners

Website:
1. www.nurseslabs.com

2. medicinenet.com
3. nursing-theory.org
4. www.nursingguide.html

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