Nola Pender
Background of the theory
• The Health Promotion Model (HPM)
proposed by Nola J Pender
(1982;revised, 1996) was designed to be
a "complementary counterpart to
models of health promotion."
• 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.
Assumptions of the model
1. Individuals seek to actively regulate
their own behavior.
2. Individuals in all their biopsychosocial
complexity interact with the
environment, progressively
transforming the environment and
being transformed over time.
3. Health professionals constitute a part of
the interpersonal environment, which
exerts influence on persons throughout
their life span.
4. Self-initiated reconfiguration of person-
environment interactive patterns is
essential to behavior change.
Metaparadigm
Key Concepts in Nursing Defined as a Basis for
the Health Promotion Model
• Person
A biopsychosocial organism that is partially
shaped by the environment but also seeks
to create an environment in which inherent
and acquired human potential can be fully
expressed. Thus, the relationship between
person and environment is reciprocal.
Individual characteristics as well as life
experiences shape behaviors including
health behaviors.
• Environment
The social, cultural and physical context in
which the life course unfolds. The
environment can be manipulated by the
individual to create a positive context of
cues and facilitators for health enhancing
behaviors.
• Nursing
Collaboration with individuals, families, and
communities to create the most favorable
conditions for the expression of optimal
health and high-level well-being.
• Health
The actualization of inherent and acquired
human through goal-directed behavior,
competent self-care, and satisfying
relationships with others, while
adjustments are made as needed to
maintain structural integrity and harmony
with relevant environments. Health is an
evolving life experience.
Major concepts of Health Promotion Model
Pender recognized that there are
particular behaviors that promote individual
ownership of prevention of illness and
continued awareness of personal health. The
Health Promotion Model focuses on prior
behavior and personal factors that contributed
to the outcome.
1. Individual Characteristics and
Experiences
(Individual Factors and Experiences)
• Prior related behavior- frequency of the same
or similar health behavior in the past
• Personal factors
-Biological
Inner self
-Sociocultural
Social and Cultural Aspect
-Psychological
Mind (Self esteem, seld motivation, & perceived
health)
2. Behavior- Specific Cognitions and Affect
❖ Perceived barriers to action -
perceptions of the blocks,hurdles,
and personal costs of
understanding a health behavior.
❖ Perceived self-efficacy - judgment of
personal capability to organize and
execute à particular health
behavior: self confidence in
performing the health behavior
successfully.
❖ Activity-related affect – subjective
feeling states or emotions occurring
prior to, during and following a
specific health behavior.
❖ Interpersonal influences (family,
peers, providers): norms, social
support, role models, perceptions
concerning the behaviors, beliefs,
or attitudes of relevant others in
regard to engaging in a specific
health behavior.
❖ Situational influences (options,
demand characteristics, aesthetics)
perceptions of the compatibility of
life context or the environment
with engaging in a specific health
behavior.
❖ Commitment to a plan of action --
intention to carry out a particular
health behavior including the
identification of specific strategies
to do so successfully.
 ❖ Immediate competing demands and
preferences – alternative behaviors
that intrude into consciousness as
possible courses of action just prior
to the intended occurrence of a
planned health behavior.
❖ Health promoting behavior - the
desired behavioral end point or
outcome of health decision-making
and preparation for action.
Application of theory to Practice Education
Research
• The HM provides a counterpart to
models based on illness-prevention.
• Enhances individuals' functional ability
and improves their quality of life.
• Benefits society as a whole which
include economic prosperity,
interpersonal harmony, decreased
social violence, suicide, sexually
transmitted disease, and reduced
health care costs.
• Useful in many different settings such
as workplaces, homes and health
centers.
• Research using the HPM: smoking
cessation, weight management,
exercise and stress management.
• The HPM allows for personalized
nursing interventions with care plans
designed with patient-specific goals.
• Can be used for conducting studies that
predict effective factors/barriers in
health-promotion behaviors, detect
impacts of intervention program for
improving health promotion behaviors,
test this model, and identify quality
of life.
Madeleine Leininger'S
(TRANSCULTURAL NURSING)
• The founder of the theory of
Transcultural Nursing / Culture
Care Theory
• Her theory has now developed
as a discipline in nursing.
• Evolution of her theory can be
understood from her books:
-Culture Care Diversity and
Universality (1991)
-Transcultural Nursing (1995)
-Transcultural Nursing (2002)
• Theoretical framework is
depicted in her model called
the Sunrise Model (1997).
• In 1950's Medeleine M.
Leininger, known as the
foundress of Transcultural
Nursing, noted cultural
differences between patients
and nurses while working with
emotionally disturbed children.
• This experience led to study
clinical difference in perception
of the care.
• She recognized that health and
illness states are strongly
influenced by culture and
formulated the theory of
Transcultural Nursing.
• In 1991, she published Culture
Care Diversity And Universality:
ATheory Of Nursing'
• Her theory has now developed
into a discipline in nursing.
• In 1988 Transcultural Nursing
Society initiated certification
examinations: certified
Transcultural Nurse (CTN)
Theoretical Sources
Derived from the THEORETICAL
SOURCES discipline of anthropology;
conceptualized the theory to be
relevant to nursing.
MAJOR CONCEPTS AND DEFINITIONS
1. TRANSCULTURAL NURSING - is a
comparative study of cultures to
understand similarities (culture
universal) and difference(culture-
specific) across human groups
(Leininger, 1991).
2. Culture
-Set of values, beliefs and traditions,
that are held by a specific group of
people and handed down from
generation to generation.
-also beliefs, habits, likes, dislikes,
customs and rituals learn from one's
family.
- the learned. shared and transmitted
values, beliefs, norms and life way
practices of a particular group that
guide thinking, decisions, and actions
in patterned ways.
RELIGION - Is a set of belief in a
divine or super human power (or
powers) to be obeyed and
worshipped as the creator and ruler
of the universe.
ETHNIC - refers to a group of people
who share a common and distinctive
culture and who are members of a
specific group.
ETHNICITY- a consciousness of
belonging to a group.
CULTURAL IDENTITY - the sense of
being part of an ethnic group or
culture.
CULTURE-UNIVERSALS-
commonalities of values,norms of
behavior, and life patterns that are
similar among different cultures.
CULTURE-SPECIFICS - values, beliefs,
and patterns of behavior that tend to
be unique to a designate culture.
MATERIAL CULTURE - refers to
objects (dress, art, religious artifacts)
NON-MATERIAL CULTURE - refers to
beliefs customs, languages, social
institutions.
CULTURAL SHOCK - the state of being
disoriented or unable to respond
to a different cultural environment
because of its sudden strangeness,
unfamiliarity, and incompatibility to
the stranger's perceptions and
expectations as it is differentiated
from others by symbolic markers
(cultures, biology, territory, religion).
ETHNIC GROUPS - share a common
social and cultural heritage that is
passed on to successive generations.
ETHNIC IDENTITY- refers to a
subjective perspective of the person's
heritage and to a sense of belonging
to a group that is distinguishable
rom other groups.
RACE - the classification of people
according to shared biologic
characteristics, genetic markers, or
features. Not all people of the same
race have the same culture.
CULTURAL AWARENESS - an in-depth
self-examination of one's own
background, recognizing biases and
prejudices and assumptions about
other people.
CULTURALLY CONGRUENT CARE-
Care that fits the people's valued life
patterns and set of meanings -which
is generated from the people
themselves, rather than
based on predetermined criteria.
CULTURALLY COMPETENT CARE - the
ability of the practitioner to bridge
cultural gaps, in caring, work with
cultural differences and enable
clients and families to there/their
meaningful and supportive caring.
ETHNONURSING- This 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 (Leinenger,
1979)
NURSING- Nursing is defined as a
learned humanistic and scientific
profession and discipline which is
focused on human care phenomena
and activities in order to assist,
support, facilitate or enable
individuals or groups to maintain or
regain their well being in culturally
meaningful and beneficial ways, or to
help people face handicaps or deaths.
HEALTH- It is a state of well-being
that is culturally defined, valued, and
practiced and which reflects the
ability of individuals or groups to
perform their daily role activities in
culturally expressed, beneficial and
patterned lifeways.
HUMAN BEINGS- Such as believed to
be caring and capable of being
concerned about needs and well
being and survival of others.
Society and Environment- These term
are not defined by Leininger. (Any
country/place that involve culture)
NURSING DECISIONS
1. Cultural preservation or
maintenance.
2. Cultural care accommodation
or negotiation.
3. Cultural care repatterning or
restructuring.
MAJOR ASSUMPTIONS
• Illness and wellness are shaped
by various factors including
perception and coping skills, as
well as the social level of the
patient.
• Cultural competence is an
important component of
nursing.
• Culture influences all spheres
of human life. It defines health,
illness,and the search for relief
from disease or distress.
• Religious and Cultural
knowledge is an important
ingredient in health care.
• The health concepts held by
many cultural groups may
result in people choosing not
to seek modern medical
treatment procedures.
• Health care provider need to
be flexible in the design of
programs, policies, and
services to meet the needs and
concerns of the culturally
diverse population, groups that
are likely to be encountered.
• Most cases of lay illness have
multiple causalities and may
require several different
approaches to diagnosis,
treatment, and cure including
folk and Western medical
interventions.
• The use of traditional or
alternate models of health care
delivery is widely varied and
may come into conflict with
Western models of health care
practice.
• Culture guides behavior into
acceptable ways for the people
in a specific group as such
culture originates and develops
within the social structure
through interpersonal
interactions.
• For a nurse to successfully
provide care for a client of a
different cultural or ethnic
background, effective
intercultural communication
must take place.
APPLICATION TO NURSING
-To develop understanding, respect
and appreciation for the individuality
and diversity of patients beliefs,
values, spirituality and culture
regarding illness, its meaning, cause,
treatment, and outcome.
-To encourage in developing and
maintaining a program of physical,
emotional and spiritual self- care
introduce therapies such as
ayurveda and pancha karma.
GOAL OF TRANSCULTURAL NURSING
"to give culturally congruent nursing
care, and to provide culture specific
and universal nursing care practices
for the health and well-being of
people or to aid them in facing
adverse human conditions, illness or
death in culturally meaningful ways."

APPLICATION OF THEORY TO
NURSING
PRACTICE
Communities are becoming more
multicultural, and health personnel
are being expected to respond to
client's diverse cultural needs.
Immigrants and people from
unfamiliar cultures are generally
expecting nurses to respect their
cultüral values, beliefs, and lifeways.
Education
Since 1980, An increasing number of
nursing curricula emphasize
transcultural nursing and care.
RESEARCH
Several research nurses are testing
transcultural nursing in US and other
countries. Many cultures have been
studied utilizing this theory.
"Care is the heart of nursing; Care is
power; Care is essential to healing (or
well-being); Care is curing; and Care is
(or should be) the central and
dominant focus of nursing and
transcultural nursing decisions and
actions."
-Leininger
MARGARET A. NEWMAN
(THEORY OF HEALTH AS EXPANDING
CONSCIOUSNESS)
" We have to embrace a new vision
of health. Our caring must be linked
with a concept of health that
encompasses and goes beyond
disease. The theory of health
as expanding consciousness provides
that perspective.
-(Newman, 2008, p. 2).
CREDENTIALS AND BACKGROUND OF
THE THEORIST
-born on October 10, 1933, in
Memphis, Tennessee.
-She earned a bachelor's degree in
home economics and English from
Baylor University in Waco, Texas, and
a second bachelor's degree in nursing
from the University of Tennessee in
Memphis (M.Newman,
curriculum vitae, 1996).
-Her master's degree in medical
surgical nursing and teaching is from
the University of California, San
Francisco.
-She earned her PhD in nursing
science and rehabilitation nursing in
1971 from New York University.
-Professor at the University of
Minnesota Minneapolis until her
retirement in 1996, where she is
Professor Emeritus.
-Director of Nursing for the Clinical
Research Center at the University of
Tennessee
-Acting Director of the PhD Program
in the Division of Nursing at New York
University, and -Professor- in-Charge
of the Graduate Program and
Research in Nursing at Pennsylvania
State University (M. Newman,
curriculum vitae, 2000).
HONORS AND AWARDS
-Outstanding Alumnus Award from
the University of Tennessee College
of Nursing in Memphis in 1975 and
2002;
-Distinguished Alumnus Award,
Division of Nursing, from New York
University in 1984;
-Admission to the Hall of Fame at the
University of Mississippi School of
Nursing in 1988;
-Latin-American teaching fellow in
1976 and 1977; and
-American Journal of Nursing
scholar in 1979.
-E. Louise Grant Award for Nursing
Excellence from the University of
Minnesota in 1996;
-Nursing Theorists, Portraits of
Excellence, vol. 1, 1990 videotape
series sponsored by the Helene Fuld
Health Trust (M. Newman,
Curriculum vitae, 2000; personal
communication, 2004).
-Sigma Theta Tau Founders Elizabeth
McWilliams Miller Award for
Excellence in Research in 1993; and
received the Nurse Scholar Award at
Saint Xavier University School of
Nursing in 1994 (M. Newman,
curriculum vitae, 2000).
THEORY OF HEALTH AS EXPANDING
CONSCIOUSNESS
THEORETICAL SOURCES
• Martha Rogers: Science of
Unitary Human Beings
• Hegel' Fusion of Opposites
• Bento's explication of life as
the process of expanding
consciousness
• Young's Theory of Human
Evolution
• Moss's experience of love as
the highest level of
consciousness
• Bohm’s Theory of Implicate
Order
MAJOR CONCEPTS & DEFINITIONS
HEALTH
-the "pattern of the whole" of a
person and includes disease as a
manifestation of the pattern of the
whole, based on the premise that life
is an ongoing process of expanding
consciousness (Newman, 1986).
-"a transformative process to more
inclusive consciousness"(Newman,
2008, p. 16).Health and the evolving
pattern of consciousness are the
same.
-the essence of the emerging
paradigm of health is recognition of
pattern. Newman (1994) sees the life
process as progression toward higher
levels of consciousness.
PATTERN
-information that depicts the whole
and understanding of the meaning of
all of the relationships at once (M.
Newman, personal communication,
2004).
-a fundamental attribute of all there
is, and it gives unity in diversity
(Newman,
1986).
Characteristics of pattern include
movement, diversity, and rhythm.
Pattern is conceptualized as being
somehow intimately involved in
energy exchange
and transformation (Newman, 1994).
CONSCIOUSNESS
Consciousness is both the
informational capacity of the system
and the ability of the system to
interact with its environment
(Newman,1994).
Consciousness includes not only
cognitive and affective awareness,
but also the "interconnectedness of
the entire living system which
includes physicochemical
maintenance and growth processes
as well as the immune system"
(Newman, 1990a, p. 38).
MOVEMENT-SPACE-TIME
Newman emphasizes the importance
of examining movement- space-time
together as dimensions of emerging
patterns of consciousness rather than
as separate concepts of the theory
(M. Newman, personal
communication, 2004).
MAJOR ASSUMPTIONS
1.Health encompasses conditions
heretofore 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 prior
to 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 that
person.…
METAPARADIGMS OF NURSING
NURSING
Newman emphasizes the primacy
Of relationships as a focus of nursing,
both nurse-client relationships and
relationships within clients' lives
(Newman, 2008).
"The emphasis of this process
Is on knowing/caring through pattern
recognition" (Newman, 2008, p. 10).
-The nurse-client relationship is
characterized by "a rhythmic coming
together and moving apart as clients
encounter disruption of their
organized, predictable state"
(Newman,
1999, p. 228).
-Newman has diagrammed this
nurse-client interaction of coming
together and moving apart through
the processes of recognition, insight,
and transformation
-Nurses are seen as partners in the
process of expanding consciousness,
and are transformed and have their
lives enhanced in the dialogical
process (Newman, 2008).
Within the theory, the role of the
nurse in nurse-client
interactions is seen as a "caring,
pattern-recognizing presence"
(Newman, 2008, p. 16).
PERSON
Throughout Newman's work, the
terms client, patient, person,
individual, and human being are used
interchangeably. Clients
are viewed as participants in the
transformative process.
-Persons as individuals are identified
by their individual patterns
of consciousness (Newman, 1986)
and defined as "centers of
consciousness within
an overall pattern
of expanding consciousness"
(Newman, 1986, p. 31).
ENVIRONMENT
Although environment is not
explicitly defined, it is described as
being the larger whole, which
contains the consciousness of the
individual. The pattern of person
consciousness interacts within the
pattern of family consciousness and
within the pattern of community
interactions (Newman, 1986).
 Client and environment are viewed
as a unitary evolving pattern
(Newman,
2008).
The assumption is that all matter in
the universe-environment possesses
consciousness, but at different levels.
Interpretation of Newman's view
clarifiesthat health is the interaction
pattern of a person with the
environment. Disease in a human
energy field is a manifestation of a
unique pattern of person
environment interaction.
HEALTH
Health is the major concept of
Newman's theory of expanding
consciousness.
A fusion of disease and non-disease
creates a synthesis regarded as
health(Newman, 1979, 1991, 1992).
Newman (1999) further elaborated
her view of health by stating that
"health isthe pattern of the whole,
and wholeness is" (p. 228).
"Manifest health, encompassing
disease and non-disease, can be
regarded as the explication of the
underlying pattern of person-
environment" (Newman, 1994, p.
11).
Newman (1986) illustrated the
centrality of space-time in the
following example:
Mrs. V. made repeated attempts to
move away from her husband and to
move into an educational program to
become more independent. She felt
she had no space for herself, and she
tried to distance herself (space) from
her husband. She felt she had no time
for leisure (self), was over-worked,
and was constantly meeting other
people's needs. She was submissive
to the demands and criticism of her
husband (p. 56).
ROSEMARIE RIZZO PARSE
(Man-living-theory)
4:24 PM
INTRODUCTION
• The Parse theory of human
becoming guides nurses.In
their practice to focus on
quality of life as it is described
and lived (Karen &
Melnechenko, 1995).
• Rosemarie Rizzo Parse first
published the theory in 1981 as
the "Man-living-health" theory
(ICPS)
• The name was officially
changed to "the human
becoming theory" in 1992 to
remove the term "man," after
the change in the dictionary
definition of the word from its
former meaning of
"humankind."
ABOUT THE THEORIST
- 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 Three Major Assumptions of Human
hundreds of articles about Human Becoming
Becoming Theory Transcendence- being beyond the
- Professor and Niehoff Chair at limit
Loyola University, Chicago -Powering
THEORY DEVELOPMENT -Originating
-The human becoming theory was -Transforming
developed as a human Rhythmcity(rhythmicity)- rhythmical
science nursing theory in the quality or character
tradition of Dilthey, Heidegger, -Revealing-Concealing
Sartre, Merleau-Ponty, and Gadamer -Enabling-Limiting
and Science of Unitary Human Beings -Connecting-Separating
by Martha Rogers . Meaning-being meant
-The assumptions underpinning the -Imaging
theory were synthesized -Valuing
from works by the European -Languaging
philosophers, Heidegger, Parse's Theory of Humanbecoming
Sartre, and Merleau-Ponty, along Structuring
with works by the pioneer Meaning
American nurse theorist, Martha Imaging
Rogers. valuing
-The theory is structured around Reality
three abiding themes: body language
meaning, rhythmicity, and Languaging
transcendence. Personal realms of
ASSUMPTIONS universe
About man Reflective
-The human is coexisting while Confirming
coconstituting rhythmical patterns Not confirming
with the universe. Speaking
-The human is open, freely choosing Silence
meaning in situation, bearing Moving
responsibility for decisions. Stillness
-The human is unitary, continuously
coconstituting patterns of relating. Configuring
-The human is transcending Rhythmical Patterns
multidimensionally with the possibles of Relating
About Becoming Revealing
-Becoming is unitary human-living- Concealing
health. Enabling
-Becoming is a rhythmically Limiting
coconstituting human-universe Connecting
process. Separating
-Becoming is the human's patterns of Living in Rhythm
relating value priorities. Patterns of Relating
-Becoming is an intersubjective Aid Sisciosing
process of transcending with the
possibles.
-Becoming is unitary human's
emerging
Cotranscending with SUMMARY OF THE THEORY
Possibles - Human Becoming Theory includes
Powering Totality Paradigm
Transforming o Man is a combination of
Familiar biological, psychological,
Unfamiliar sociological and spiritual
Unique Paths factors
Shifting Perspectives -Simultaneity Paradigm
Pushing o Man is a unitary being in
Resisting continuous, mutual interaction
Affirming with environment
Not Affirming -Originally Man-Living-Health Theory
Being
Nonbeing NURSING PARADIGMS
Originating AND PARSE'S THEORY
Certainty Person
Uncertainty - Open being who is more than and
Confirming different from the sum of
Not Confirming the parts
Environment
Principle 1: Structuring - Everything in the person and his
meaning is the imaging experiences
and valuing of - Inseparable, complimentary to and
languaging. evolving with
Principle 2: Configuring Health
rhythmical patterns is the -Open process of being and
revealing-concealingand becoming. Involves synthesis of
enabling-limiting of values
connecting-separating. Nursing
Principle 3: - A human science and art that uses
Cotranscending with an abstract body of
possibles is the powering knowledge to serve people.
and originating of
SYMBOL OF HUMAN
BECOMING THEORY (Yin & Yang)
Black and white - opposite paradox
significant to ontology of human
becomingand green is hope
Centerjoined -co created mutual
-Concepts in the squares: Powering human uníverse process at the
emerges with the revealing- ontological level & nurse person
concealing of imaging. process
-Concepts in the ovals: Originating Green and black swirls intertwining
emerges with the enabling-limiting of human-universe co creation as an
valuing. ongoing process of becoming
-Concepts in the triangles:
Transforming emerges with the
languaging of connecting-separating.
 a 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

CRITIQUE
• Congruence with personal
values
STRENGTHS -Nurse must subscribe to this world
* Differentiates nursing from other view to truly use it
disciplines • Congruence with other
- Practice - Provides guidelines of care professional values
and useful - Complements and competes with
administration other health care professionals values
- Useful in Education -Exoteric foundations
- Provides research methodologies - Esoteric utility
Provides framework to guide inquiry • Congruence with social values
of other -Fulfills society's expectations of
theories (grief, hope, laughter, etc.) nursing role
• Social Significance
WEAKNESSES -Makes a substantial difference in the
- Research considered to be in a lives of clients and nurses
"closed circle"
- Rarely quantifiable results - Difficult IDA JEAN ORLANDO
to compare to (Nursing Process Discipline)
other research studies, no control
group, standardized Nursing Process Discipline Theory
questions, etc.
- Does not utilized the nursing
process/diagnoses
- Negates the idea that each person
engages in a unique
lived experience
- Not accessible to the novice nurse
- Not applicable to acute, emergent
care Definitions
Distress is the experience of a patient
APPLICATION whose need has not been
- Nursing Practice met.
- A transformative approach to all
levels of nursing Nursing role is to discover and meet
the patient's immediate need
for help. • Body language
-Patient's behavior may not represent • Facial Expression
the true need.
-The nurse validates his/her Presenting behavior-problematic
understanding of the need with the situation
patient. • To find out the immediate
need for help the nurse
Nursing actions directly or indirectly must first recognize the situation as
provide for the patient's problematic
immediate need. • The presenting behavior of the
patient, regardless of the form
An outcome is a change in the in which it appears, may
behavior of the patient indicating represent a plea for help
either a relief from distress or an • The presenting behavior of the
unmet need, patient, the stimulus, causes an
Observable verbally and nonverbally. automatic internal response in
the nurse, and the nurses
3 Basic Elements behavior causes a response in
The Patient Behavior the patient
The Nurse Reaction Nurse Reaction
The Nurse's Actions " Stimulated by patient's behavior"
Sequential parts
CONCEPTS •Perception: perceives behavior
• Function of professional through senses
nursing -organizing principle • Thoughts about the perception
Presenting behavior – • Thoughts produces automatic
problematic situation feeling
• Immediate reaction - internal
response Nursing process Immediate reaction -
discipline investigation internal response
• Improvement – resolution • Person perceives with any one
of his five sense organs an
object or objects
• The perceptions stimulate
automatic thought
• Each thought stimulates an
automatic feeling
• Then the person acts
• The first three items taken
Patient Behavior together are defined as the
-" A plea for help" person's immediate reaction
Verbal Nurse's Actions
• Complaints " Actions are appropriate to meet the
• Requests need for help"
• Refusals The nurse can act in two ways:
• Demands • Automatic
Nonverbal • Deliberative
• Comments Function of professional nursing -
• Physiologic manifestation organizing principle
• Finding out and meeting the
patients immediate needs for
help
• “Nursing...is responsive to
individuals who suffer or
anticipate a sense of
helplessness, it is focused on
the process of care in an
immediate experience, it is
concerned with providing
direct assistance toindividuals
in whatever setting they are
found for the purpose of
avoiding, relieving, diminishing
or curing the individuals sense
of helplessness.-Orlando
• Nursing therapeutics - Direct
function : initiates a process of
helping the patient express the
specific meaning of his
behavior in ordee ascertain his
distress and helps the patient
explore the distress in order to
ascertain the help he requires
so tyay his distress may be
relieved.
• Indirect function - calling for
help of others,whatever help
the patient may require for his
need to be met
• Nursing therapeutics-
Disciplined and professional
activities - automatic activities
plus matching of verbal
and nonverbal responses,
validation of perceptions,
matching of thoughts and
feelings with action
Automatic activities -
perception by five senses,
automatic thoughts, automatic
reeling, action
Nursing Metaparadigm
Person
- developmental beings
with needs,
individuals have their
own subjective
perceptions and
feelings that may not
be observable directly
- Humans in need are
the focus of nursing
practice
Health
-sense of adequacy or
well being. Fulfilled
needs. Sense of
comfort.
- Health. Orlando
focused on illness. She
indicated that nursing
deals with the
individual whenever
there is a need for help.
A sense of helplessness
replaces the concept of
health or illness as the
initiator of a need for
nursing
Environment
- not defined directly
but implicitly in the
immediate context for
a patient.
-Society. Deals with
the interaction
between the nurse
and a patient in an
immediate situation
ASSESSMENT
-Nurse Reaction (EXPLORED
WITH PATIENT)
DIAGNOSIS
-NEED FOR HELP
 PLANNING IMPLEMENTATION
COMPARISON
NURSE ACTION
STRENGTHS
• Use of her theory assures that
patient will be treated as
individuals and that they will
have active and constant input
into their own care
• Prevents inaccurate diagnosis
or ineffective plans because
the nurse has to constantly
explore her reactions with the
patient
• Assertion of nursing's
independence as a profession
and her belief that this
independence must be based
on a sound theoretical frame
work
• Guides the nurse to evaluate
her care in terms of objectively
observable patient outcome
PRACTICE
• Clearly applicable to nursing
practice.
• Basis of practice in hospitals.
• Used at the patient care level,
managerial level, and nursing
division level.
EDUCATION
• Orlando's process recording
has made a significant
contribution to nursing
education.
• Process recording - a tool to
facilitate self-evaluation of
whether or not the process
discipline was used.
RESEARCH
• Enjoyed considerable
acceptance by the nursing
profession in the area of
research and has been applied
to a variety of research
settings.
Sister Carolina S. Agravante
Agravante's CASAGRA
Transformative Leadership Mode
Background of the Theorist
- 1964 - BS Nursing degree in St.
Paul College, Manila
- 1967 to 1969 - Master's Degree
in Nursing Education at
Catholic University of America asa
full-fledged scholar.
Maria Lourdes Agustin
- 2002 - Doctoral Degree in
Philosophy at University of the
Philippines Manila - the sameyear
her theory was published
- Dean, College of Nursing, St. Paul
College, Manila (1978
1981)
- Director / Principal, St. Paul
College of Nursing (1970 - 1977)
-At present, President of St. Paul
College llocos Sur.
WHAT PROMPTED SISTER
CAROLINA AGRAVANTE TO DO
THE THEORY?
- The present day demands in the
nursing profession challenge
nursing educators to revisit their
basic responsibility of educating
professional nurses who are
responsive to technological,
educational and social
changes happening in the
Philippines society today.
- The reopening of the doors of
foreign market to Filipino nurses,
migration made
easy, attractive salaries and
benefits way beyond what
hospitals can afford to give.
- The formation of new nursing
leaders is urgently needed;
leaders with new vision who will
venture new traits and who have
gone through new formation in
order to serve the society as
professional nurse.
The Transformative Leadership
Theory
- The CASAGRA Transformative
Leadership Model: Servant
Leader Formula & the Nursing
Faculty's Transformative
Leadership Behavior CArolina S.
AGRAvante= CASAGRA
- The theory "CASAGRA
Transformative Leadership" is a
psycho spiritual model. It is coined
after the name of the investigator:
-"Focus on the type of leadership
in nursing that can challenge the
values of the changing world…
-The model is a Three-Fold
Transformation Leadership
Concept rolled into one,
comprising of the following
elements:
- Servant-Leader Spirituality
- Self-Mastery expressed in a
vibrant care complex;
- Special Expertise level in the
nursing field one is engaged in.
- The conceptual framework is logical
because the variables are very well
explained on how transformative-
leadership model be applicable
through care complex, transformative
teaching servant-leader spirituality,
and servant-leader behavior.
-A person with dynamic care complex
is the cornerstone of nursing
leadership. According to care
complex of Agravante, caring
personality rests on the possession of
a care complex with in a person as an
energy source of caring.
- A person with dynamic care
complex is the cornerstone of nursing
leadership. According to care
complex of Agravante, caring
personality rests on the possession of
a care complex with in a person
as an energy source of caring.
- The framework explains and
predicts the continuous formation of
nursing leadership behavior in
nursing faculty that will eventually
affect their teaching function.
-Servant-leadership formula runs
parallel to the generic elements of
the transformative-leadership model.
-Transformative teaching is the guide
that desired for the modern
educative process designed to form
the millennium professional
nurse.
• The CASAGRA Transformative
Leadership Theory is classified
as a Practice Theory basing on
the characteristics of a Practice
Theory stated by McEwen
(2007), which are the
following:
A. Complexity / Abstractness, Scope
- Focuses on a narrow view of reality,
simple and straightforward;
B. Generalizability/Specificity
- Linked to a special populations or
an identified field of practice;
C. Characteristic of Scope
- Single, concrete concept that is
operationalized;
D. Characteristic of Proposition
- Propositions defined;
E. Testability
- Goals or outcomes defined and
testable;
F. Source of Development
- Derived from practice or deduced
from middle range theory or grand
theory.
Importance in Education, Practice
and Research
➢ It is significant to the nurse
educators. It will help them to
achieve the vision-mission as a
network of innovative,
competent empowered
educators towards excellence
in national and global
development.
➢ " The theory could be the
answer in the modern-world
challenges in nursing education
that is centered on the
teaching of Jesus, a paradigm
of peace.
➢ Nursing students will be
assured of similar leadership
formation that will be provided
to them by the nursing
educators who advocated the
CASAGRATransformative
Leadership model.
➢ Transformative teachers are
basically who looks into
herself, sees her assumptions
and feelings in the light of the
nursing profession in the
modern days, how her own
philosophy of life affects
professional life with her
students
Sample research utilizing the
theory of Sr. Agravante
➢ The study was conducted to
determine the effects of the
CASAGRA transformative
leadership model for nursing
faculty on the servant
leadership behavior of the
nursing faculty.
➢ The quasi-experimental two-
group pre-test post-test design
was utilized in the study.
➢ The study population consisted
of 30 nursing faculty , divided
into control and study group
randomly selected to
participate in the Servant-
leader formula for nursing
faculty.
CONCLUSION
• MEANING OF THE THEORY
-Based on the study, the effect of the
CASAGRA Leadership model using the
servant leader model on the
leadership behavior of the nursing
faculty, the care complex in the
personality of the nursing faculty is
highly correlated to their
leadership behavior.
DR. CARMELITA DIVINAGRACIA
(ADVANCE NURSE PRACTITIONER'S
COMPOSURE BEHAVIOR AND
PATIENT'S WELLNESS OUTCOME)
BACKGROUND OF THE THEORIST
▪ Association of the Deans
Philippine Colleges of Nursing
 (ADPCN) Former President-
Nursing-
▪ Dean of University of the East
Ramon Magsaysay Memorial
Medical Center, Inc.
(UERMMMC) College of
Nursing-
▪ Member of CHED 'Technical
committee on Nursing
Education
▪ Has been lauded for
developing the art and
competency of teaching
nursing.
Award
✓ Recipient of the Anastacia
Giron Tupas Award given by
the Philippine
NursingAssociation (PNA) in
2008.
ADVANCE NURSE PRACTICIONERS'
COMPOSURE BEHAVIOR AN
PATIENT'S WELLNESS OUTCOME
Objective of the study
✓ Determine the effects of
composure behavior of the
advance nurse practitioner on
the wellness outcome of the
selected cardiac patients.
Significance of the Study
✓ Nursing as a healthcare
profession would prove its
worth of being at par in quality
performance with other
healthcare professionals.
Study Population
✓ Adult Cardiac Patients
admitted and confined at the
Philippines Heart center,
Coronary CareUnit.
Definition of Terms
• Advance Nurse Practioners
✓ BSN graduate
✓ Licensed and has a clinical
experience of at least 2 years in
the clinical area
✓ Has undergone special training
in critical area
✓ Set of behaviors or nursing
measures that the nurse
demonstrates to selected
cardiac patients
Composure Behaviors
• Are sets of behaviors of nursing
measures that the nurse
demonstrates to selected
patients.
• COMPOSURE is an acronym
which stands for COmpetence,
Presence and Prayer, Open-
mindedness, Stimulation,
understanding, Respect
and Relaxation, Empathy.
• A condition of being in a state
of well- being, a coordinated
and integrated living pattern
that involves the dimension of
wellness.
Wellness status
• A condition of being in a state
of well-being, coordinated and
integrated living pattern that
involves the dimension of
wellness.
Based on several analysis, the
following conclusions are
made:
• The socio-demographic
characteristics specifically
gender, and age are related to
 wellnes outcome of adult
cardiac patients.
• A signifiant difference exists in
the pretest postest scores of
the wellness outcome after the
COMPOSURE BEHAVIOR
intervention in the 3 groups.
At the Heart of WELLNESS CULTURE is
a Nurse
SISTER LETTY G. KUAN
(RETIREMENT AND ROLE
DISCONTINUITIES)
"I have grown and sown and now I
can reap the reward and blessing of a
life lived in joy and love, for I too have
made others grow.”
• Dr. Letty G. Kuan is a nurse.
Born on November 19, 1936 in
Katipunan-Dipolog, Zamboanga
del Norte.
• Master degree in Nursing and
Guidance and Counseling. She
also holds a Doctoral degree in
Education. HAs a vast
contribution to theUniversity
of the Philppines College of
Nursing Faculty and Academic
achievements.
• She is now a Professor
Emeritus, a title awarded on to
a few who met the strict
criteria.
• Has a Clinical Fellowship and
Specialization in
Neuropsychology in university
of Paris, France (Salpetriere
hospital).
• Neurogerontology in
Watertown, New York (Good
Samaritan Hospital) and
Syracuse University, New York.
• She authored several books
giving her insights in the areas
of Gerontology, Care of Older
Persons and Bioethics and
Essence of Caring. As a former
member of the Board of
Nursing, her legacy to the
Nursing Community is without
a doubt, indisputable.
Basic Assumptions and Concepts
Physiological Age
-Is the endurance of cells and
tissues to withstand the wear-
and-tear phenomenon of the
human body. Some individuals
are gifted with the strong
genetic affinity to stay young
for a long time.
Age
Biological
• Also called Physiological Age
• Description of an individual's
development & maturation
• Influenced by genetic,
environmental & lifestyle
factors; e.g. Nutrition, exercise,
smoking, sleeping habits etc
Chronological
• Number of years since birth
• I.e. Age based on calendar
date on which you were born
dd/mm/yyyy)
• Differs from Biological age as
doesn't consider factors that
influence ageing
Role
• Refers to the set of shared
expectations focused upon a
particular position.
• These may include beliefs
about what goals or values the
position incumbent is to pursue
and the norms that will govern
his behavior.
• It is also the set of shared
expectations from the retiree's
socialization experiences and
the values internalized while
preparing for the position as
well as the adaptations to the
expectations socially defined
for the position itself.
• For every social role, there is
complementary set of roles in
the social structure among
which interaction constantly
occurs.
 Change of Life • Family Constellation means the
• Is the period between near type of family composition
retirement and postretirement described either close knit or
years. extended family where three
• In medico-physiologic terms, or more generations of family
this equates with the members live under one roof;
climacteric period of or distanced family, whose
adjustment and readjustment members live in separate
to another tempo of life. dwelling units; or nuclear type
Retiree of family where only husband,
• Is an individual who has left the wife and children live together.
position occupied for the past • Self-Preparation (according to
years of productive life Webster' dictionary) it is
because he/she has reached preparing of self to the possible
the prescribed retirement age outcomes in life.
or has completed the required
years of service.
Role Discontinuity
• Is the interruption in the line of
status enjoyed or role
performed. The interruption
may be brought about by an
accident, emergency, and
change of position or
retirement.
Coping Approaches
• Refer to the interventions or
❖ Retirement is an inevitable
measured applied to solve a
change in one's life. It is
problematic situation or state
evident in the increasing
in order to restore or maintain
statistics of aging population
equilibrium and normal
accompanied by related
functioning.
disabilities and increased
Determinants of positive
dependence.
perceptions in retirement and
❖ This developmental stage, even
positive reactions toward role
at the later part of life, must be
discontinuities.
considered desirable and
• Health Status refer to
satisfying through the
physiological and mental state
determination of factors that
of the respondents, classified
will help the person enjoy his
as either sickly or healthy.
remaining years of life.
• Income (economic level) refers ❖ It is of primary importance to
to the financial affluence of the prepare early in life by
respondent which can be cultivating other role options at
classified as poor, moderate or age 50 or 60 in order to have a
rich rewarding retirement period
• Work status (According to even amidst the presence of
Webster' dictionary) status of role discontinuities by this age
an individual according to group.
his/her work.
❖ Family constellation is a
positive index regarding
retirement positively and also
reacting to role discontinuities.
• In the Philippines, the
family undoubtedly
stands as the security or
trusting bank where all
members, young and old
can always run and get
help.
• When one retires, the
shock of the role
discontinuities is
softened because the
family not only cushions
the impact, but also
offers gainful
substitutes, as in
o providing monetary support,
o absorbing emotional strains
o that often times with
o discontinuities and other forms
of surrogating.
❖ Income has a high
correlation with both the
perception of retirement
and reactions towards role
discontinuities.
o Since income is one of the
factors that secure the outlook
of individual, efforts must be
exerted to save and spend
money wisely while still
actively earning in order to
have some reserved when one
grows old.
o It implies that retirement
pensions should be adjusted to
meet demands of the elderly.
o This should be done in order to
have a more relevant and
realistic pension and benefits
adjustment.
❖ Work status goes hand in
hand with economic
security that generated
decent compensation.
o For the retired, it implies that
retirement should be
conceptualized as a period of
no work because capabilities to
function get sharpened and
refined as they practice it on a
regular basis.
o Work enhances the aspects of
self-esteem and contributes to
the feeling of wellness even
and old age.
What to do?
o To cope with the changes
brought by retirement, one
must cultivate interest in
recreational activities to
channel feelings of depression
or isolation and facing realities
through confrontation with
some issues.
o To perceive retirement
positively, it requires early
socialization of the various
roles we take in life. The best
place to start is at home
extending to schools,
neighborhoods, the community
and society in general
o In retirement, their fellow
retirees are their own best
advocates. To facilitate this,
barriers to full participation in
the areas where important
decisions are rich should be
eliminated in order to give
recognition and appreciation
of knowledge, wisdom,
experience and values which
are the social assets that make
the retired age and the
custodians' folk wisdom.
o Government agency to
construct holistic
preretirement preparation
program which will take care of
the retiree's finances,
psychological, emotional, and
social needs.
o Retirement should be
recognized as the fulfillment of
 every individual's birthright
and must be lived
meaningtully.
• This program emphasizes a
Carmencita M Abaquin
(PREPARE ME Holistic Nursing
Interventions)
To nursing…may be able to
provide the care that our clients
need in maintaining their quality
of life and being instrumental in
"birthing" them to external life.
BACKGROUND OF THE THEORIST.
• Carmencita M Abaquin is a
nurse with MAster's Degree
in Nursing obtained from
the University of the
Philippnes College of
Nursing.
• An expert in Medical
Surgical Nursing with
subspecialty in Oncologic
Nursing, which made her
known here and abroad.
She had served the
University of the Philippines
College of Nursing, as
faculty and held the
position as Secretary of the
College of Nursing.
• Her latest appointment as
Chairman of the Board of
Nursing speaks of her
competence and integrity in
the field she has chosen.
Basic Assumptions and Concepts:
• PREPARE ME (Holistic
Nursing Interventions) are
the nursing interventions
provided to address the
multidimensional problems
of cancer patients that can
be given in any setting
where patients choose to be
confined.
holistic approach to nursing
care. PREPARE ME has the
following components;
➢ Presence
-Being with another
person during the
times of need. This
includes therapeutic
communication,
active listening, and
touch.
➢ Reminisce Therapy
- Recall of past
experiences, feelings
and thoughts to
facilitate adaptation
to present
circumstances.
➢ Prayer
-praying
➢ Relaxation-Breathing
- Techniques to
encourage and
elicit relaxation for
the purpose of
decreasing
undesirable signs and
symptoms such as
pain, muscle tension,
and anxiety.
➢ Meditation
-Encourages an elicit
form of relaxation for
the purpose of
altering patient's level
of awareness by
focusing on an image
or thought to
 facilitate inner sight or dimension integrated to the cancer
which helps establish patient. Her quality of life can also be
connection and assessed in this aspect thus it must be
relationship with given consideration in the
God. It may be done provision of care.
through the use of Health.
music and other -The concept of her theory revolves
relaxation around illness, particularly cancer and
techniques. the provision of holistic care to
➢ Values Clarification improve quality of life despite their
- Assisting another terminal cases.
individual to clarify -Quality of life is defined as a
his own values about multifaceted construct that
health and illness in encompasses the individuals
order to facilitate capabilities and abilities of
effective decision enriching life when it can no longer
making skills. be prolonged.
-Through this, the -This includes proper care and
patient develops an maintaining integrity of the
open mind that will body, mind and spirit despite the
facilitate acceptance limitations brought about
of disease state or by the present condition.
may help deepen or -The quality of life is seen through the
enhance values. patient's many dimensions.
-The process of values Nursing.
clarification helps one -The goal of nursing care is the
become internally improvement of quality of life for
consistent by advance stage cancer patients
achieving closer despite their current situation.
between what we do -Her concept of providing holistic
and what we nursing care in addressing the
feel. multidimensional problems that
Metaparadigms and Interventions cancer patients face is summarized
Person/Patient in the acronym PREPARE ME.
-Her theory is specific to patients in
advanced stages of cancer. They are
holistic being with physical,
psychological, social, religious, level
of independence, and environmental
aspects.
-Patients who are terminally-ill or
those with incurable diseases as with
cancer must be approached in
multifaceted care to improve their -PREPARE ME theory provides a
quality of life. framework on non-pharmacologic,
Environment. non-surgical approach of care to
-Just like all the other paradigms, advanc cases of cancer patients.
environment was not defined -The focus is not on cure but on
accurately. Nevertheless we can assisting the patient to explore her
assume that environment is an aspect humanity and internal serenity as one
is faced with the challenge of life and
death.
-Nurses must be seen not as mere
caregivers but facilitators of peaceful
acceptance of condition.
Findings and Recommendations
-Terminally ill patients require holistic
approach of nursing that
encompasses the different aspects of
man namely physical, psychological,
social, religious, level of
independence, environment, and
spiritual. In this premise, patients
with incurable illness, specifically
cancer patients, require a whole
faceted care that will improve the
quality of life.
-PREPARE ME Interventions are said
to be effective in
improving the quality of life of cancer
patients. This can be
further applied not only with
terminally-ill patients but also
promisingly introduced to those
patients with acute and
chronic diseases ad those with
prolonged hospital stays.
- The utilization of the intervention as
a basic part of care given to cancer
patients is recommended, as well as
the incorporation of the intervention
in the basic nursing curriculum in the
care of these patients.
-The said components of PREPARE
ME must be introduced and focused
during training of nurses in the
academe and practice to answer the
needs of this special kind of clients.
-Development of training programs
for care providers, as well as health
care professionals where intervention
is a part of treatment modalities, is
also RECOMMENDED.
- For patients, an honest view and
feedback regarding their illness and
management, and obtaining their
perceptions can lead to improvement
of services and
communicationbetween patients
with advanced progressive cancer,
their families and health team.
-Supportive environment where
patients with advanced progressive
cancer and the terminally-ill patients
can attain dignity of dying with peace
while their families are given the
necessary support they need to cope
up with.
-Thus, healthcare professionals and
family members have to provide this
kind of venue whether in the home of
hospital setting. This will maintain a
holistic-support for this special type
of clients
Cecilia Laurente's Theory of
Nursing Practice and Career
Background of the theorist
• 1967- Graduate BSN at
Uniersity of the Philippines
• 1973- #asters of Nursing
• 1968-1969-Staff nurse
• 1970-1972-(ead Nurse 1973-
1976-Nursing Supervisor at
Philippine General Hospital
• 1977-1979-Metro!olitan
Hos!ital in Michigan US)
• 1979-Instructor at University of
the Philippines College of
Nursing
• 1966--2002 ean of College of
Nursing in UP Manila
Background of the theory
-The theory was from her study, the
Categorization of Nursing Activities as
Observes in Medical-Surgical Ward
Units in selected Government and
Private Hospitals in Metso Manila,
which was conducted from January to
June year 1987.
-Communication is key when getting
nurses to engage patients and
families in their care.
-Research to develop the guide that
communication gaps between
patients and caregivers can occur
when hospitals do not address the
issues that patients think are most
important. ANother factor is the
available few
Nursing Theory:"Categorization of
Nursing Activities as Observed in
Medical-Surgical Ward Units
in Selected Government and
Private Hospitals in Metro
Manila."
Concepts of the Theory
Anxiety
-A mental state of fear or
nervousness about what might
happen.
Nursing Caring Behavior that affect
patient Anxiety
Presence
-Person to person contact
between the client and the nurse.
Concern
-Development in the time through
mutual trust nurse and patient.
Stimulation
-Nurse stimulation through words
tops the powerful resources of
energy of person for
healing.