Accepted: 1 October 2017

DOI: 10.1111/jonm.12581

ORIGINAL ARTICLE

Commitment and a sense of humanity for the adaptation of

patients during hospital care

Ligia Patricia Arroyo-Marlés, PA Nurse, Health Institutions Management Specialist, Director of

Nursing1 | Maryory Guevara-Lozano, GM Nurse, Rehabilitation Management Specialist,
Masters of Nursing, Assistant Professor2  | Beatriz Pérez-Giraldo, PB Nurse, Education and
Family Counseling Specialist, Masters in Nursing with an emphasis on Family Health, Associate
Professor, Nursing Program Director2 | Beatriz Sánchez-Herrera, SB Nurse, Masters of
Science in Nursing, Gerontological Nurse Practitioner, Professor of High Academic Prestige,
Full Professor2

1
Clinic of the University of La Sabana, Chía,
Colombia Abstract
2
School of Nursing and Rehabilitation, Objective: To develop a nursing practice model for the Clinic of the University of the
University of La Sabana, Chía, Colombia
La Sabana that supports the adaptive process of patients during and after their hospital
Correspondence experience.
Maryory Guevara-Lozano, University of La
Methodology: This is a descriptive, methodological study implemented in different
Sabana, Chía Colombia
Email: maryorygl@unisabana.edu.co phases: (1) characterization of the context, (2) identification of the need for a nursing
Funding information practice model for strengthening care, (3) literature review, (4) description of the
No funding. model, and (5) validation.
Results: The context of a university hospital and international trends in the development
of a professional nursing discipline require theoretical guidance for the ongoing
improvement of the practice of nursing. The decision to apply Roy’s conceptual model
of adaptation clarifies the need for a complementary nursing practice model that
brings this macro theory closer to the assistance reality. It is also necessary to make
the vocation of service, knowledge and leadership of nursing visible whenever the
human adaptive process is a priority.
Conclusion: The University of La Sabana nursing practice model is a model focused on
the commitment and humane treatment for the adaptation of patients during hospital
care. It represents a consensus on the essentials of the nursing practice, which seek to
support the adaptive process in order to have more comprehensive welfare and
consequent improvement of the patient.

KEYWORDS
adaptation, DeCS, directed patient care, nursing, nursing care, nursing services, nursing theory

J Nurs Manag. 2017;1–7. © 2017 John Wiley & Sons Ltd |  1

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1 |  INTRODUCTION
The main challenge of nursing worldwide is to improve the practice,
and consequently to transform the health of the population. In order to
achieve this at the hospital level, it is necessary to consider the applica-
tion of nursing models and theories that allow for the changes required
to improve nursing care (Chan, Bowers, & Barton-­Burke, 2017), and
those needed to demonstrate the required evidence for professional
exercise to happen (Glassman, 2016). The nursing direction at the
Clinica Universidad de La Sabana (CUS), as an international reference in
the field of rehabilitation, promotes this challenge to support the adap-
tation of patients and their family caregivers in the institution. Nurses
in the CUS, aim for a continuous improvement of care, training and
research in order to apply the Christian philosophy (Clínica Universidad
de La Sabana, 2015) of promoting well-­being and respect for life.
Combining the qualities of care at the CUS throughout its history has
been a challenge addressed in conjunction with the School of Nursing
and Rehabilitation (FER) at the same university. This work has generated
advances, primarily guided by the Roy adaptation model which is deeply
humanistic and transcendent (DeSanto-­Madeya & Fawcett, 2016).
In this route of permanent improvement, nursing, as well as other
members of the clinic, have to have recognition as leaders and refer-
ence points in the health system (Clínica Universidad de La Sabana,
2015). With this in mind, the nursing department, with the support
of the nursing school, decided to make a special effort to focus on
its core task, which means caring for the human health experience
(Moreno-­Fergusson, 2013).
This decision was a focal point for the directives, managers and
nurses, while promoting a practice focused on the care of patients
and their caregivers. Both patients and caregivers needed to be better
informed, more attended and more supported in the responsibilities
the health system has given them. They needed support to adapt to
the experience they live in, in the midst of their conditions, and in the
search for a higher level of integral well-­being. Human adaptation is
necessary for them to be freer, more dignified and more autonomous
(Arrango, 2013). Likewise, the route designed by the nursing practice
model allowed for useful data to measure the results of nursing care
with empirical indicators for the quality of the nursing care follow up.
This study, developed within the framework of a teaching-­
assistance partnership between the CUS and the FER, presents the
design and development of a nursing practice model for the clinic that
responds to nurses’ agreement to provide a service that simultane-
ously reflects commitment and humanity (Universidad de La Sabana,
n.d.), and that supports the adaptive process of the patient.
2 |  METHODOLOGY
This descriptive, methodological study sought to generate a nursing
practice model that guided nursing exercise. The model was devel-
oped to be compatible with the Roy adaptation model, and to simplify
the practical application and further measurement of caring results
obtained with it (Roy, 2011). In order to do so there was a five-­stage
implementation, while experts provided support to guide the desired
scenarios into practice.
2.1 | Characterization of the context of the CUS in
its development as a university hospital
To achieve the characterization the researchers reviewed all the docu-
ments produced by the CUS’s self-­assessment in the last 2 years: the
regulations in force and the teaching assistance agreement between
the CUS and the FER.
2.2 | Identification of the need for a proprietary
model to guide nursing care
The regulations governing the nursing profession have been revised to re-
quire their own theories and technologies to guide professional practices
(Congreso de la República de Colombia, 1996). This included reflections
made in a teaching-­assistance ­exchange regarding the need to apply a
nursing model to achieve ongoing improvement of health care practices in
the CUS (Arroyo Marlés, Guevara Lozano, & Pérez Giraldo, 2016).
2.3 | Literature review
Under the Ganong parameters (Christmals & Gross, 2017), the
­researchers did an integrative literature review to answer the ques-
tion: How does the institutional performance of nursing change when
it obeys an explicit theoretical orientation?
With the support of the Meta search engine ‘Discoverer’, the group
reviewed the available literature in 32 databases that included those
of recognized prestige in the field of health. The search included the
period 1996–2016 for five DeCS descriptors: nursing care, clinical
nursing, nursing theory, nursing models and hospital. The inclusion
criteria considered refereed publications with full content available.
We found 167 articles and we selected 44 based on their title and ab-
stract, and given their relevance to the phenomenon of study, in order
to make an exhaustive analysis of the full text.
2.4 | Model description
A deductive approach was selected for the model, based on three
parameters: the hierarchy of nursing knowledge (Fawcett, 2016),
an analysis of the philosophy that guides the Roy adaptation model
and its visibility in the FER (DeSanto-­
Madeya & Fawcett, 2016)
and the Christian vision of the human person proposed by St José
María Escrivá, which guides the Universidad de La Sabana (Clínica
Universidad de La Sabana, 2015).
Initially, there was a definition of the central concepts of the model,
and then there was an addition of the related propositions in a partici-
patory manner. There was an analysis of the propositions based on their
comprehensibility and philosophical compatibility by the Roy Study Group
in the school, and the nurses of the CUS prioritized it according to their
importance and governance. They then defined relevance and appropri-
ateness based on these results in order to guide the nursing practice.
ARROYO et al.
2.5 | Validation of the care model
There was a validation of the initial approach of the model with the
patients, their family caregivers, nursing personnel of the institution
and peers from other institutions. Finally, the nurses defined commu-
nication strategy for the model.
3 | RESULTS
The Nursing Director at the CUS generates continuous improvement
in the delivery of health services (Clínica Universidad de La Sabana,
n.d.) according to an analysis of the processes and procedures located
in the director’s purview. The alliance with the FER has been strategic
throughout the period of change, and there have been some tangible
advances (Ávila, 2013; Glassman, 2016; Guevara Lozano & Arroyo Marlés,
2015; Guevara Lozano & Laverde Contreras, 2015; Moreno Fergusson
& Rey Amaya, 2012; Moreno-­Fergusson & Grace, 2016; Veloza-­Gómez,
Muñoz de Rodríguez, Guevara-­Armenta, & Mesa-­Rodríguez, 2016). These
advances go along with specialist training, participation in the critical care
programme, continuing training and the development of scientific events.
The professional practice of nursing at the clinic involves basic
sciences and disciplinary knowledge, assertive and effective commu-
nication skills, the ability to work in teams, and valid methods of organ-
isation and allocation of work to fully respond to the need for quality
care of patients and their families.
Institutionally, the intention to implement the conceptual model
of Roy has had different developments in the teaching, administra-
tive and health care roles. Therefore, we decided to seek a strategy to
facilitate its implementation by focusing attention on the subject of
care through a model for nursing practice. This model helped nurses to
focus on the patients and their caregiver’s hospitalization experience.
Based on the work required to achieve these goals, we have identi-
fied two central aspects: the guiding potential of nursing theories, with
the consequent strengthening of nursing’s autonomy (Arrango, 2013),
and nursing’s relevance to clinical practice (Moreno Fergusson & Muñoz
Rodríguez, 2016). The current level of development has led the CUS to
seek internal agreements to finalize a model that supports the continu-
ous improvement of nursing practice (Arroyo Marlés et al., 2016).
The application of a nursing model in the CUS has rendered evident
the need to prioritize the patient within the work of nursing, ­approach
care holistically, respect the human condition and strengthen nursing’s
autonomy (Guerrero-­Núñez & Cid-­Henríquez, 2015).
There have been numerous publications in English on the subject
in the last decade. These papers present descriptive theoretical de-
velopment, which includes four major categories: (1) identification of
the purpose of the application of nursing models in clinical practice,
(2) general aspects to be considered for the application of those mod-
els, (3) methodologies employed to facilitate the implementation of
the models, and (4) the roles personnel have in order to achieve the
successful implementation of the models in practice. Nursing models
are theoretical guidelines that can direct thinking and action in clini-
cal practice, and a model’s usefulness depends on the satisfaction or
|
      3
benefit obtained by instituting the model. Although the models pro-
mote professional autonomy and help to improve nursing care at the
institutional level, there is still no solid method for measuring gains.
It is worthwhile to begin building the institutional model for the CUS
based on recognizing care focused on the patient and the family, while
identifying the metaparadigmatic elements of nursing based on this care.
To accomplish this goal there were several analysis sessions between the
director and nursing coordinators, which generated a preliminary prod-
uct revised and ratified in conjunction with teachers at the FER. Based
on this process, all nursing professionals at the clinic began training in
the importance and usefulness of nursing models in nursing practice. The
Nursing Director of the clinic, with support from the school, organised
the training. In these training sessions and workshops, simple answers
to fundamental questions such as to whom, where, how, when, and why
nursing care is provided in the institution were sought, using a guide to
define the metaparadigmatic concepts of nursing (Alarcón et al., 2014).
The Nursing Director reviewed these concepts transversely, work-
ing alongside teachers at the school. This helped to identify a feature
in the concepts that was consistent with the approach in the Roy adap-
tation model and the philosophy of the Universidad de La Sabana. The
exercise showed common elements in a holistic concept of the human
being, the need to support the adaptation process, and the need to
focus on the care of patients recognizing their autonomy, respecting
their dignity and pursuing integration of all of the elements.
Once these concepts, which are shown later in the text (see Table 2),
were defined and reviewed, interviews were conducted with ten nurses
at the CUS who represented all services of the institution. The questions
posed to the nurses were how these concepts were associated with one
another. Based on their replies, the initial approach of the second compo-
nent of the model emerged, created by the initial 28 assumptions of care.
A workshop held by the Care Group of the School of Nursing and
Rehabilitation reviewed the assumptions of care to validate the com-
patibility of each assumption with the philosophical approaches of
Roy and the inspiring work of the two institutions. The 19 participants
were requested to score the incompatibility between the assumptions
and the philosophy as 1, a neutral position as 2, and an agreement
between the two as 3. Then, the study requested to make suggestions
regarding each assumption’s comprehensibility or content. In this man-
ner, an item that scored between 1% and 30% obtained a score that
was incompatible with the philosophy, 31%–60% obtained a neutral
score, and greater than 61% obtained a compatible score.
No assumptions showed incompatibility with the two philosophies
analysed. However, there were seven assumptions reviewed because
they reflected a compatibility lower than 60%. There were six other
assumptions adjusted to improve the comprehensibility and content,
while there was a need to add one more (Table 1).
Twenty-­three professionals of the CUS determined the level of im-
portance and governability, qualifying each item on a 50-­point scale.
They also determined that those items with an average higher than
41.76 were priorities (Table 1).
The concepts and assumptions that compose portions of the
Nursing Care Model of the CUS were initially defined and validated
based on this analysis (Tables 2 and 3).
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4       ARROYO et al.

For the collaboration between the school and clinic, those items
considered to be of the highest importance and governability, and
classified as highly compatible with the guiding philosophy of the cur-
riculum are deemed strategic.
The concepts and assumptions that compose portions of the nurs-
ing care model of the CUS were initially defined and validated based
on this analysis (Tables 2 and 3).
The study matches concepts and assumptions of nursing care for
the CUS with 42 final evaluation notes of patients and their family
caregivers for the last 2 months of available service. The services rec-
ognized in these notes were warmth, companionship, care, support,
guidance, humanization, professionalism, pursuit of the well-­being of
the users, effort to forge ahead, scientific input, affection and devo-
tion. Some users confirmed their level of adaptation to note feeling at
home, and many blessed the nurses who facilitated the recovery and
well-­being of the patient. This review confirmed the priorities of care
and led to the commitment and humane treatment for the adaptation
of patients during hospital care to be the focus of the Universidad de
La Sabana nursing practice model.
The implementation socialized partial advances with the group
manager of the teaching-­assistance alliances for strengthening nurs-
ing in Colombia (Moreno-­Fergusson, 2013) and with the faculties or
schools of nursing at six universities (Arrango, 2013).
4 | DISCUSSION
The theoretical development for the advancement of nursing is
a determining factor for its improvement (Castro Carvajal, 2011;
DeSanto-­Madeya & Fawcett, 2016). This development has implications

T A B L E   1   Analysis of the philosophical compatibility and possibilities for nursing managers regarding the assumptions raised for the model of
nursing care for the Clínica Universidad De La Sabana [University Clinic Of La Sabana]

Philosophical compatibility Possibilities for the management and conduct of nursing

San JoseMaria Escriva

Item Callista Roy de Balaguer Total 100% Importance Governability Total 50 points

1 95% 100% 97% 22.40 21.60 44.00

2 55% 80% 68% 22.60 21.80 44.40
3 100% 90% 95% 22.00 21.00 43.00
4 90% 95% 92% 22.80 22.00 44.80
5 90% 90% 90% 22.20 20.40 42.60
6 65% 90% 77% 22.20 20.60 42.80
7 90% 85% 88% 22.00 17.80 39.80
8 35% 80% 58% 21.80 17.80 39.60
9 25% 70% 48% 21.60 18.40 40.00
10 80% 90% 85% 22.20 20.80 43.00
11 85% 80% 83% 21.40 19.20 40.60
12 70% 100% 85% 22.20 20.40 42.60
13 85% 100% 93% 22.20 20.80 43.00
14 85% 75% 80% 21.00 19.80 40.80
15 95% 70% 82% 21.00 19.00 40.00
16 90% 55% 72% 19.80 17.00 36.80
17 70% 85% 78% 21.60 20.60 42.20
18 40% 60% 50% 21.60 20.20 41.80
19 35% 70% 53% 21.00 18.00 39.00
20 85% 70% 80% 20.00 18.80 38.80
21 85% 70% 78% 21.60 18.80 40.40
22 80% 80% 80% 22.00 21.20 43.20
23 95% 75% 85% 21.60 20.60 42.20
24 90% 70% 80% 21.80 20.80 42.60
25 90% 70% 80% 21.80 19.60 41.40
26 55% 60% 58% 23.00 21.00 44.00
27 85% 85% 85% 22.00 20.20 42.20
28 100% 85% 93% 22.60 21.20 43.80
Source: Prepared by the author, 2016.
ARROYO et al. |
      5

T A B L E   2   Definition of the
metaparadigmatic concepts of nursing for
the Clínica Universidad De La Sabana
[University Clinic Of La Sabana]
Source: Prepared by the author, 2016
Description Clínica Universidad De La Sabana
Person Human beings: patients, caregivers, or family in conditions of vulnerability who
seek care at the Clinic of the University of La Sabana
The patient is a person or persons in whom the soul and body form an
inseparable unit
Context All circumstances of the reality of the patient that are present in the health of the
person and are evident to the nurses at the Clinic of the University of La Sabana
during care
Health Condition of well-­being and autonomy that is valued and cared for, continuously
re-­signifying the person, promoting his/her dignity and integrity
Nursing Professional discipline that provides humane service with vocation and knowl-
edge, through the process of nursing care to promote the well-­being and
autonomy of the person who receives care. For this purpose, there is a
supporting team with technical nursing knowledge

T A B L E   3   Examples of nursing care assumptions that guide the
practice at The Clinic of the University of La Sabana
Assumptions for nursing at the Clinic of the University of La Sabana
1. Nurses should administer nursing care in an interpersonal
relationship of respect and acceptance that recognizes the dignity of
the human person
3. The interaction of the nurse with patients is a fundamental element
of humanization in care
4. Nursing care for patients in the CUS should be respectful, kind,
warm and timely
The development of a nursing practice model improves interdisciplin-
ary work through the records of patient’s evolution, their care and their
family caregivers’ care. Nursing thus contributes to the well-­being of the
care subject, and supports and complements the practice of other health
professionals (Nelcy Martínez Trujillo & Maricela Torres Esperón, 2014).
Similar nursing theoretical development experiences worldwide
have reflected that having a care model to guide clinical practice fa-
cilitates decision-­
making (Mosqueda-­
Díaz, Mendoza-­
Parra, & Jofré-­
Aravena, 2014). The practice models favor the holistic nursing approach
(Espinosa Aranzales, Enríquez Guerrero, Leiva Aranzalez, López Arévalo,

10. The CUS must have a nursing service that responds to the
requests of the patient and family who require care
13. The Clinica Universidad de La Sabana must address the patient in
a personal manner with profound respect for his/her dignity and
safely to promote, restore, or maintain health.
25. To favour adaptation, it is necessary that the moments in which
nurses have more nurse–patient interaction are moments of care
29. All actors should fully consider the person of the nurse due to its
importance, so that he/she can provide adequate care
Source: Prepared by the author, 2016
in the educational and clinical fields of nursing which require continuous
improvement (Lorch & Pollak, 2014; Moreno Fergusson & Muñoz
Rodríguez, 2016; Sancho Cantus & Prieto Contreras, 2012). In this
sense, the practice model devised at the CUS is an important step for
strengthening the development of the professional discipline of nursing.
The model developed at the CUS is a nursing practice or functional
type of model, compatible with the Roy’s adaptation model, and its
development and content respond to existing international standards
(Eun-­Ok, 2015). This nursing practice model does not replace Roy’s
theoretical model, it only facilitates and complements its application.
In this case, the proposed model defines a simple route that guides the
practice of nursing within the institution. The model is also a manage-
ment tool because it implies collective nursing participation, it is easy
to understand and it is prone to monitoring; this theoretical develop-
ment helps leaders design and measure nursing practice evaluation
indicators (Alarcón et al., 2014).
& Castañeda Rodríguez, 2015); they help improve satisfaction levels and
clinical outcomes of nursing care (Evans, 2016). Moreover, these models
guide nursing care, facilitating its ­understanding and providing a pro-
fessional identity (Alarcón et al., 2014; Cann & Gardner, 2012; Shalala,
2014; Shoqirat, 2015); they also render nursing more visible and sus-
ceptible to improve (Ariza, 2013: Ausili, Sironi, Rasero, & Coenen, 2012).
However, an analysis of world experience on the implementation
of professional nursing models in the last 2 years, reflects that this
theoretical development performed under the nursing paradigm, does
not have strong evidence to support it (Abumaria, Hastings-­Tolsma, &
Sakraida, 2015; Bender, 2016; Chan et al., 2017; Duhamel, Dupuis,
Turcotte, Martinez, & Goudreau, 2015; English, 2016; Glassman,
2016; Hodge, Campbell, & Tobar, 2016; Mathieu, Bell, Ramelet, &
Morin, 2016; Rhéaume et al., 2015; Rheingans, 2016; Roche, Spence
Laschinger, & Duffield, 2014; Schaffner, Tillett, & Volz, 2016; Slatyer,
Coventry, Twigg, & Davis, 2016). In general, the authors recommend
the use of the conditions of the practice of nursing, as well as the
participative approach, for the implementation of a nursing practice
model, in the same way the present study used them.
As we can see here, a model of professional practice generates a
common language for nursing that allows for the communication of
its development in regard to the desired scenario. Since these nursing
models focus practice on the subjects of care, they foster a collective
vision for approaching them, facilitating leadership, and contributing to
professional development and teamwork. On the other hand, they help
systemic thinking in which the subject, the context, the goal of care and
the commitment, as well as nursing itself, are included synchronously.
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6       ARROYO et al.
5 |  CONCLUSION
The Universidad de La Sabana nursing practice model focused on
commitment and humanity for the adaptation of patients during hos-
pital care. It expresses a nursing consensus at the Clinica Universidad
de La Sabana regarding the essence of practice, and draws attention
to the continuous improvement of nursing within the framework of
an institution that bases its vocation and reason for being on care,
service, teaching and research.
This model is an expression of what nursing seeks to achieve in the
institution, as a component of the excellence of service that reflects
its philosophy.
This model facilitates the adaptive process in care subjects in order
to achieve comprehensive well-­being during the hospital experience.
It provides a route of operation and expresses a philosophy of care.
The Universidad de La Sabana nursing practice model allows nursing
to live up to the commitment and humaneness through each encoun-
ter. It also helps mutual growth between the care recipient and the
caregiver. This practice model is compatible with the Roy adaptation
model of higher conceptual hierarchy, which also supports the pur-
pose of nursing care excellence in a university hospital.
This practice model of nursing will be useful if it is applied by nurses
in the unit and if it is perceived by users of their services. However, in
order to demonstrate its impact it is necessary to develop clinical and
management indicators. These indicators must focus on the caring
subjects and their adaptation and well-­being process.
The application of theory in nursing practice should be a part of
professional training. This type of practice model facilitates the use of
simulation techniques with scenarios similar to those found in working
life, and are valuable inputs for training students in the theoretical ap-
plication for nursing care improvement.
Incorporating the model of practice into processes of induction
and re-­induction, and articulating it with the evaluation of the nursing
staff, will strengthen their administrative capacity. The development of
indicators that measure the improvement of practice based on sound
evidence is necessary. Therefore, in addition to the implementation of
these models, it is important to review the trend of their indicators with
studies that are not only descriptive, but also predictive and prescriptive.
This would serve to strengthen nursing knowledge and administration.
CO NFLI CT OF I NTERE ST
No conflict of interest.
O RCI D
Maryory Guevara-Lozano  http://orcid.org/0000-0002-9559-5697
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How to cite this article: Arroyo-Marles LP, Guevara-Lozano
M, Pérez-Giraldo B, Sánchez-Herrera B. Commitment and a
sense of humanity for the adaptation of patients during
hospital care. J Nurs Manag. 2017;00:1–7. https://doi.
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