THEORETICAL FOUNDATIONS IN NURSING
NURSING
• American Nurses Association (ANA; 1980)
– Nursing is the diagnosis and treatment of human
responses to actual or potential health problems
• American Nurses Association (ANA; 2003)
-Nursing is the protection, promotion and optimization of
health and abilities, preventions of illness and injury,
alleviation of suffering through the diagnosis and treatment
of human response, and advocacy in the care of individuals,
families, communities and populations
• Nightingale (1860-1969)- Nursing the act of utilizing the
environment of the patient to assist him in his recovery.
(Nightingale, 1860-1969)
• Henderson (1966)- Nursing is 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. ()
• International Council of Nurses (ICN) – Nursing
encompasses “autonomous and collaborative care of
individuals of all ages, families, groups and communities,
sick or well and in all settings.”
• Association of Deans of Philippine Colleges of Nursing
(ADPCN) Nursing is “a dynamic discipline. It is an art and
a science of caring for individuals, families, groups and
communities geared toward suffering and assisting clients
to face death with dignity and peace. It is focused on
assisting the client as he or she responds too health-illness
situations, utilizing the nursing process and guided by
ethico-legal moral principles.
• Focused in supporting communities, families and
individuals in maintaining, restoring or achieving a state of
optimum health and functioning. It is both a science and an
art that is concerned with the quality of life as defined by
the clients.
Other definitions:
-Nursing is caring
-Nursing is an art
-Nursing is a science
-Nursing is holistic
-Nursing is adaptive
-Nursing is concerned with health promotion, health
maintenance, and health restoration
-Nursing is a helping profession
-Nursing is a caring profession
-It is practiced with an earnest concern for the art of care and
the science of health
-It involves a humanistic blend of scientific knowledge, and
holistic nursing practice
Theory
-is defined as supposition or system of ideas that is proposed to
explain a given phenomenon (Kozier)
-an organized system of accepted knowledge that is composed of
concepts, propositions, definitions and assumptions intended to
explain a set of fact, event or phenomena
-a set of statement that tentatively describe, explain or predict
relationships among concepts that have been systematically selected
and organized as an abstract representation of some phenomenon.
These systematic organized perspectives serve as guides for nursing
action in administration, education, research, and practice (Power and
Knapp, 1995)
-As defined by Chinn and Kramer, it is a “creative and rigorous
structuring of ideas that projects a tentative, purposeful and
systematic view of phenomena.” This definition tries to explain the
tentativeness of a theory.
-well-substantiated explanation of some aspect of the natural world;
an organized system of accepted knowledge that applies in a variety
of situations/hypotheses
-an expectation of what should happen, barring unforeseen
circumstances
-coherent statement or set of statements that attempts to explain
observed phenomena
-an explanation for some phenomena that is based on observation,
experimentation and reasoning
-a comprehensive explanation of a given set of data that has been
repeatedly confirmed by observation and experimentation and has
gained general acceptance within the scientific community but has
not been yet decisively proven
-a construct that accounts for or organizes some phenomena
Principles
-a basic generalization that is accepted as true and can be used as a
basis for reasoning or conduct
Characteristics of a theory:
-Interrelating concepts in such a way as to create a different way of
looking at a particular phenomenon
-Logical in nature
-Generalizable- should be simple but generally broad in nature
-Basis for hypotheses that can be tested
-Enriching the general body of knowledge within the discipline
through the studies implemented to validate them
-Consistent with other validated theories, laws and principles but will
leave open unanswered questions that need to be investigated
-Can be used by practitioners to direct and enhance their practice.
Components of a theory:
1. Concept
-an idea formulated by the mind or an experience perceived and
observed.
-The building blocks of theories, it enhances one's capacity to
understand as it helps define the meaning of a word.
-Helps to describe or label phenomena
-A mental idea of a phenomenon
-A comprehensive idea or generalization
-An idea that brings diverse elements into a basic relationship
-A unit of knowledge abstracted from a set of characteristics
attributed to a class of objects, relations or entities
-A unit of thought; general idea formed in the mind
-Something understood or retained in the mind, from experience,
reasoning and/or imagination; a generalization or abstraction of a
particular set of instances or occurrences
1.a Concrete
-limited by time and space and are observable in reality,
directly observed, tangible
Ex: airplane, house
1.b Abstract
-not clearly observable, directly or indirectly and must be
defined in terms of observable concepts; intangible
-Independent of time and space
Ex: hope, love, desire, care, freedom
1.c Discrete
-or non-interval concepts that identify categories or classes of
characteristics (gender, ethnic background, religion, marital
status)
 1.d Continuous
-permit classifications of dimensions or gradation of
phenomena on a continuum (blood pressure, pain, degree of
marital conflict)
2. Definition
-Composed of various descriptions which convey a general meaning
and reduces the vagueness in understanding a set of concepts
2.a Theoretical definition
-gives meaning to a term in context of a theory
and permit any reader to assess the validity of a
definition
-are the meaning of a word based on how a certain theory or
relevant literature perceives it to be
-taken from dictionary, literature, books,
encyclopedia, journals, etc.
2.b Conceptual definition
-Tells how the concept is linked to concrete situations and
describes set of procedures that will be performed to assign
value for the concept
-Defines concepts according to how they are used in the study
-Ex. Hospital stay- time during which a person is registered
patient in a certain hospital
-Ambulation- to walk from one place to another or to move
about
2.c Operational definition
-are the meaning of a word based on the method of how it was
measured or how the person come up with that perception.
-Ex. Hospital stay – the total number of days as patient,
beginning with admission day and finishing with discharge.
-Ambulation – Taking six steps without assistance
3. Proposition
-Or Theoretical statement
explains the relationships of different concepts
-Proposal, plan, scheme, intention, suggestion or offer
-Ex: Children do not like to stay in the hospital because of their
injections
4. Assumption
-A statement that specifies the relationship or connection of factual
concepts or phenomena or those which the researcher or theorist
holds as TRUTH and therefore are excluded from measurement and
testing
-The “taken for granted” statements that determine the nature of the
concepts, definitions, purpose, relationships and structure of the
theory
-Ex: all patients who are not able to take good care of themselves
need nurses/caregivers
5. Purpose
-explains why the theory was formulated and specifies the context
and situation in which it should be applied
6. Model
-schematic representations of some aspects of reality
-also called ‘Conceptual framework’, is a representation of an idea or
body of knowledge based on the own understanding or perception of
a person or researcher on a certain topic, phenomena or theory. They
can be represented thru a diagram or in a narrative form which shows
how concepts are interrelated.
-set of interrelated concepts that symbolically represents and conveys
a mental image of a phenomenon.
-set of concepts and the propositions that integrate them into a
meaningful configuration
-composed of concepts or constructs that describe ideas about
individuals, groups, situations and events of particular interest or
discipline
7. Phenomenon
-an aspect of reality that can be consciously sensed or experienced
Nursing Theory
-a body of knowledge that describes or explains nursing and is used
to support nursing practice
-a group of interrelated concepts that are developed from various
studies of disciplines and related experiences and aims to view the
essence of nursing care.
-an articulated and communicated conceptualization of invented or
discovered reality in or pertaining to nursing for the purpose of
describing, explaining, predicting, or prescribing nursing cares
(Meleis, 1991)
-an organized and systematic articulation of a set of statements
related to questions in the discipline of nursing
-it is a set of concepts, definitions, relationships and assumptions or
propositions derived from nursing models or from other disciplines
and projects a purposive systematic view of phenomena by designing
specific interrelationships among concepts for the purposes of
describing, explaining, predicting, and/or prescribing
-has context, content and process (Barnaum, 1994)
Context – resembles environment to which nursing act takes
place
Content – subject of the theory
Process – method by which nurse acts in using nursing theory
Importance of nursing theories -- Nursing theory aims to:
1. Describe, predict and explain the phenomenon of nursing
(Chinn and Jacobs1978)
2. Provide the foundations of nursing practice, help to generate
further knowledge and indicate in which direction nursing should
develop in the future (Brown 1964)
3. Help to decide what we know and what we need to know
(Parsons1949)
4. Help to distinguish what should form the basis of practice by
explicitly describing nursing
5. Help provide better patient care, enhance professional status for
nurses, improve communication between nurses, and guidance for
research and education (Nolan 1996)
6. Analyze and explain what nurses do especially since the main
exponent of nursing, which is caring, cannot be measured
7. Maintain professional boundaries in nursing
Purposes of Theories:
A. In Practice/ Clinical Practice
1. Assist nurses to describe, explain and predict everyday
experiences.
2. Serve to guide assessment, intervention and evaluation of nursing
care
3. Provide rationale for collecting and valid data about the health
status of clients, which are essential for effective decision making and
implementation
4. Help to establish criteria to measure the quality of nursing care
5. Help build a common nursing terminology to use in
communicating with other health professionals
6.Enhance autonomy of nursing by defining its own independent
functions
7. Nursing theories provide better understanding for nurses of the
nature of their jobs.
Example: Trans-cultural Nursing Theory emphasizes the importance
of learning how to deal with patients from different cultures, and
serves as guide for nurses to respect the different values and beliefs
of diverse people
B. In Education
1. Provide a general focus for curriculum design
2. Guide curricular decision making
*program objectives, course objectives, course description, clinical
phenomena criteria
C. In Research
1. Offer a framework for generating knowledge and new ideas
2. Assist in discovering knowledge gaps in specific field of study
3. Offer a systematic approach to identify questions for study, select
variables, interpret findings and validate nursing interventions
Types of Theories:
A. According to Scope
1. Metatheories
-refers to a theory about a theory
-theories whose subject matters are some other theories
(Humanistic Nursing Theory by Paterson and Zderad)
2. Grand Theories
-broad in scope and complex and therefore require further
specification through research before they can be fully tested
(Chinn and Kramer, 1999)
-intended to provide structural framework for broad, abstract
ideas about nursing (Fawcett, 1995)
Ex: Self-Care Theory by Dorothea Orem
System’s Model Theory by Betty Neuman
(physical, physiological, psychological,
mental, social, cultural, developmental, &
spiritual)
3. Middle Range Theory
-a least abstract level of theoretical knowledge because they
include details specific to nursing practice
-known to have a narrower and detailed focus compared to grand
theories
Ex: Psychodynamic theory
-by Hildegard Peplau
Human-to Human Relationship Model
- by Joyce Travelbee
Transcultural Theory in Nursing
- by Madeleine Leininger
Model of Health
- by Margaret Newman
4. Micro-range theory
-most concrete and narrow in scope
-situation specific & limited to particular populations/fields of
practice
B. According to Purpose/Function (by Dickoff and James, 1968)
1. Descriptive theory/ factor- isolating theory
-describes, observes and names concepts, properties and
dimensions
-identifies and describes the major concepts of phenomena but
does not explain how or why the concepts are related
-purpose: to provide observation and meaning regarding the
phenomena
ex: What are the factors that influence smoking behavior among
teenagers?
2. Explanatory theory/ factor- relating theory
-relates concepts to one another, describe the interrelationships
among concepts or propositions and specify the associations or
relationships among concepts
-Ex: What is the relationship between the attitude of students
toward their course and their academic performance?
-A research study about the factors affecting newborns in failing
to thrive
3. Predictive theory/ situation-relating theory
- achieved when the relationships of concepts under a certain
condition are able to describe future outcomes consistently
- generated and tested using experimental research
-Ex: Predictors in the NLE performance
-A theoretical model based on the observation of the effects of
unsanitary environmental condition on the recovery of the post-
operative patients.
4. Prescriptive theory/ situation-producing activities
-those that prescribe activities necessary to reach defined goals
-address nursing therapeutics and consequences of interventions
-commonly used in testing new nursing interventions
-ex: What measures can be proposed to improve academic
performance of nursing students?
Laurente's theory (1996) validates and explains the different
nursing management in the emergency room in relieving anxiety
among its clients.
Nursing Paradigm/Metaparadigm
-patterns or models used to show a client relationship among the
existing theoretical works in Nursing
Metaparadigm- from 2 Greek words
a. meta-with
b. paradeigma – patterns
Major Concepts of Nursing of Nursing Theories/’Nursing
Paradigm:
1. Person
- refers to all human beings
-recipients of nursing care
-they include individuals, families, communities and groups
2. Environment
-includes factors that affect individuals internally and externally
-basic settings where nursing care is provided
3. Health
-addresses the person’s state of well-being
-the holistic level of wellness that the person experiences
4. Nursing
-the interventions of the nurse rendering care in support of, or in
cooperation with the client
-Central to all nursing theories
-describe what nursing is, what nurses do and how nurses interact
with clients
 These four concepts establish a better direction and
understanding of nursing profession. The nursing paradigm embodies
the knowledge base, theory, philosophy, research, practice and
educational experience and literature identified with the profession.
These given concepts vary in accordance to the experiences and
views of different nursing theorists. Metaparadigm is the highest
level of knowledge.
Five Criteria in Evaluating a Theoretical work (Chinn and
Kramer, 1991):
1.Clarity
-consistency, semantics and structure
 Identify the major concepts and their sub concepts
 Words should be defined operationally or conceptually
 Diagrams should be clear and consistent all through out
 Assumptions should be consistent with the
defined goals of the theory (“Is the theory clearly stated?”),
(“How clear is the theory?”, (“Is it usually understood?”)
2. Simplicity
-Theory has few concepts
 Parsimony – elegant in simplicity but extensive in
content
 “How simple is the theory?”
3. Generality
-Examine the scope of concepts and goals within the theory
-The more limited the concept and goal is, the less general
the theory becomes
-The broader the scope of the theory, the greater its
significance
- “How general is the theory?”
- “How broad is the scope of the theory?”
4. Derivable consequence
-Theory and practice are meaningfully related, nursing
theory should lead itself to research testing which would
result to additional knowledge that would guide practice
-Should give direction to research and practice, create new
ideas and ought to distinguish the focus of nursing to other
professions
“How important is the theory?”
“Does the theory have a significant contribution to nursing
knowledge?”
5. Empirical Precision
-The degree in which the defined concepts are observable
in actual setting
-Can be measured by the pieces of evidence that support
the theory
- “Is the theory testable?”
- “How accessible is the theory?”
NURSING THEORISTS:
FLORENCE NIGHTINGALE- Environmental Theory
-Was born in Florence, Italy on May 12, 1820
-Died in her sleep on August 13, 1910 at the age of 90
-A linguist (excelled in mathematics and languages and was able to
read and write French, German, Italian, Greek, and Latin at an early
age), with vast knowledge in science, mathematics, literature and arts
-Well- read in philosophy, history, politics and economics
-Well-informed about the workings of government and political
science
-her mother, Frances Nightingale- hailed from a family of merchants;
father, William Shore Nightingale- wealthy landowner
-16 y/o when she realized she wanted to be a nurse after being active
in philanthropy when she was younger
-17 y/o when she refused to marry Richard Monckton Milnes
-enrolled at Institution of Protestant Deaconesses; took job at
Middlesex hospital in Harley Street, London for ailing governesses
where she was promoted superintendent w/in just a year
-during the Crimean War (October 1853, the Crimean War broke out;
British Empire against the Russian Empire for control of the Ottoman
Empire; 18,000 soldiers admitted), helped improve the unsanitary
conditions at Scutari, British base hospital at Constantinople,
reducing the death count by 2/3
-in 1860 she established St. Thomas' Hospital and the Nightingale
Training School for Nurses
-International Nurses Day, observed annually on May 12,
commemorates her birth and celebrates the important role of nurses
in health care
-her titles were:
• First Nurse Educator
• The Lady with the Lamp
• Nurse Statistician
• Matriarch/Mother of Modern Nursing
• Angel of the Crimea
• Pioneer of Modern Nursing
- Awards:
• Order of Merit (OM) by King Edward
• Freedom of the City of London
• Royal Red Cross (RRC) by Queen Victoria of Great Britain
-Books:
• Notes on Nursing: What it is and What it is Not
-most famous publication which provided direction on how
to manage the sick; included the 12 canons
• Notes on Hospitals
-focused on how to properly run civilian hospitals
• Notes on Matters Affecting the Health, Efficiency and
Hospital Administration of the British Army
-a report analyzing her experience and proposing reforms
for other military hospitals operating under poor conditions
Theoretical Sources of Nightingale’s Theory
1.Education
2.Literature
3.Intellectuals
4.Religious Beliefs
3 Major Relationships:
1. Environment to patient’
2. Nurse to environment
3. Nurse to patient
Metaparadigm in Nursing
1. Nursing
-Very essential for everybody’s well being
-The act of utilizing the environment of a patient to assist him in his
recovery
• Notes on Nursing – provided essential principles for
rendering and implementing an efficient and effective
nursing care
-She believed that every woman, at one time in her life, would be a
nurse in the sense that nursing is having the responsibility for
someone's health.
-She also instilled an ideal attitude of thinking and acting like a nurse.
2. Person
-Predominantly described a passive patient but whenever self-care is
possible, the nurse should ask about the patient's preference.
-Believed that nurses should consider the patient's preferences
-But should perform tasks to and for the patient as well as control the
patient's environment to facilitate easy recovery.
3.Health • Continue observation in the patient's environment and make
- “Being well and using every power that the person has to the fullest changes in the plan of care needed
extent”
DISEASE: “a reparative process that nature instituted from a VIRGINIA HENDERSON- The Need Theory
want of attention” - "The unique function of the nurse is to assist the individual, sick or
-She believed that prevention of disease through environmental well, in the performance of those activities contributing to health or
control will uplift health. its recovery or to peaceful death, that he would perform unaided if he
4. Environment had the necessary strength, will or knowledge"
-She believed that the sick, poor people would benefit from -born in Kansas City, Missouri on Nov. 30, 1897
environmental improvements that address their physical and mental -died March 19 at the age of 98
aspects. -During revision of the “Textbooks of the principles and practice of
-She stressed that nurses have a special role in uplifting the social nursing” written with Bertha Harmer (1922) Henderson realized the
status of the poor by improving their living situation. need to be clear about the functions of the nurse
-Those elements external to and which affect the health of the sick -educated at the U.S. Army School of Nursing and Teachers College,
and healthy person Columbia University where she completed her B.S. and M.A.
-early advocate for psychiatric nursing
-her written works were said to be the 20th century equivalent of
Nightingale’s Canons and their Nursing Process and Thoughts:
those of the founder of modern nursing, Florence Nightingale
1. Ventilation and warmth
- Writer: Nature of Nursing
• Check the patient's body temperature, room temperature,
-75 yrs of age- directed her career to international teaching and
ventilation and foul odors.
speaking
• Create a plan to keep the room well-ventilated and free of
-Outstanding nurse of the 20th century
odor while maintaining the patient's body temperature.
-her titles were:
2. Light
• First Lady of Nursing
• Check room for adequate light. Sunlight is beneficial to the
• First Truly International Nurse
patient.
• The Nightingale of Modern Nursing
• Create and implement adequate light in the room without
• The 20th Century Florence Nightingale
placing the patient in direct light
• First full-time instructor in nursing in Virginia, early
3. Cleanliness
advocate for the introduction of psychiatric nursing in the
• Check room for dust, dampness and dirt
curriculum
• Keep room free from dust, dirt and dampness
• Outstanding teacher
4. Health of Houses
-books:
• Check surrounding environment for fresh air, pure water,
• Nursing Studies Index
drainage, cleanliness and light.
-her 12-year project book
• Remove garbage, stagnant water and ensure clean water
• Nursing Research: Survey and Assessment
and fresh air
-Honors/ Awards:
5. Noise
• She held honorary degrees from 13 universities
• Check noise level in the room and surroundings
• She was selected to American Nurses Association
• Attempt to keep noise level in minimum
Hall of Fame
6. Bed and Bedding
• In 2000, the Virginia Nurses Association recognized
• Check bed and bedding for dampness, wrinkles and soiling.
Henderson as one of fifty-one Pioneer Nurses in Virginia
• Keep the bed dry, wrinkle-free and lowest height to ensure
• Had the Sigma Theta Tau International Library named in
comfort
her honor
7. Personal cleanliness
• Attempt to keep the patient dry and clean at all times.
The Need Theory
• Frequent assessment of the patient's skin is essential to
-emphasizes the importance of increasing the patient's
maintain good skin integrity
independence so that progress after hospitalization would
8. Variety
not be delayed
• Attempt to accomplish variety in the room and with the
-identifies three major assumptions:
client.
• Nurses care for a patient until a patient can care for him or
• This is done with cards, flowers, pictures and books. Also
herself
encourage friends or relatives to engage in stimulating
• Nurses are willing to serve and that nurses will devote
activities
themselves to the patient day and night
9. Chattering hopes and advices
• Nurses should be educated at the college level in both
• Avoid talking without giving advice that is without a fact.
sciences and arts.
• Respect the patient as a person and avoid personal talk
10. Taking food
Metaparadigm in Nursing
• Check the diet of the patient. Note the amount of food and
1. Person
fluid ingested by the patient at every meal
-a patient- individual who requires assistance to achieve health and
11. Petty management
independence or in some cases a peaceful death
• This ensures continuity of care.
-must be able to maintain physiological and emotional
• Document the plan of care and evaluate the outcomes to
balance
ensure continuity
2. Health
12. Observation of the Sick
-quality of life
• Observe and record anything about the patient.
-very basic for a person to function fully
-requires independence and interdependence
-multifactor phenomenon – influenced by both internal and external
factors
-prioritize health promotion than care of the sick
3. Environment
- a healthy individual controls the environment but with illness- the
responsibility of the nurse to help the patient manage his
surroundings to protect him from harm or any mechanical injury
• To assume this role – the nurse must be educated about
safety and must be aware of different social customs and
religious practices to assess dangers
• Nurses must provide physicians data about the safety needs
of the patient
• Recommend changes regarding construction of buildings,
purchases of equipment and maintenance in order for him
or her to minimize chances of injury.
-also includes individuals in relation to families
4. Nursing
-nurses function independently from the physician but must promote
the treatment plan prescribed by the physician
-a member of the health care team- must act independently but in
coordination with the therapeutic plan developed by the team
-special role: help both the sick and well individual from all walks of
life and from the newborn to the dying
-care given must empower the patient to gain independence as rapidly
as possible
-health care provider – the nurse must be knowledgeable in both
biological and social sciences and must have the ability to assess
basic human needs
-definition of nursing – “signature of the profession
• Nursing is to assist clients in the performance of activities
contributing to health, his recovery or peaceful death that
clients will perform unaided if they had the necessary will,
strength or knowledge
knowledge, will (to complete a task) and strength in order
to make him complete, whole and independent once again
• The nurse as helper to the patient
- when the patient cannot meet his basic needs
- assist patient meet basic needs so as to regain
independence as quickly as possible
• The nurse as partner with the patient
- the nurse and patient formulate care plan together
- nurse serves as a resource person and advocate -empowers
the patient to make effective decisions regarding his care
plans
- nurse and patient are partners with same interest: having
the patient achieve health and independence
2. Nurse- Physician Relationship
-nurse functions independently from physicians but will promote the
therapeutic plan prescribed by them
3. Nurse as a Member of the Healthcare Team
- every member of the team works independently- the nurse works as
a member of the health care team
- works and contribute in carrying out the total program of care
In Practice
 Henderson believed that nursing process is a problem- solving
process that could be used to answer the patient’s needs
• Assessment phase
- assess the patients for 14 fundamental needs and
determine what are lacking.
-nurse gathers data by observing, smelling, feeling and
hearing
• Planning phase
-plan to meet the needs fit to the doctors prescribed plan.
• Implementation
-uses the 14 basic needs in answering the factors contribute
to the illness. Assist the sick or well individual to maintain
health or recover from illness.
• Evaluation phase- decides whether goals are met or not.

14 Components of Basic Nursing Care: ERNESTINE WIEDENBACH- The Helping Art of Clinical
1. Breathe normally.  Nursing
2. Eat and drink adequately.  -born August 18, 1900 in Hamburg, Germany
3. Eliminate body waste.  -retired and moved to Florida in 1996 and died at the age of 97 on
4. Move and maintain desirable postures.  March 8, 1998
5. Sleep and rest.  -early nursing leader who is probably best known for her work in
6. Select suitable clothes dress and undress.  theory development and maternal infant nursing
7. Maintain body temperature within normal range by - “My thesis is that nursing art is not compromised of rational nor
adjusting clothing and modifying the environment.  reactionary actions but rather of deliberative action.”
8. Keep the body clean and well-groomed and protects the -immigrated from Germany when she was a young girl, until her
integument.  family moved to New York
9. Avoid changes in the environment and avoid injuring others.  -her interest in nursing began with her childhood experiences with
10. Communicate with others expressing emotions, needs, fears, or nurses. She greatly admired the private duty nurse who cared for her
opinions.  ailing grandmother
11. Worship according to one’s faith.  -captivated by the role of the nurse, she enrolled in the John Hopkin’s
12. Work in such a way that there is a sense of Hospital School of Nursing after graduating from Wellesley College
accomplishment.  in 1992 with a Bachelor’s Degree in Liberal Arts
13. Play or participate in various forms of recreation.  -she took her Master’s degree and a Certificate of Public Health
14. Learn, discover, or satisfy the curiosity that leads to Nursing at Teachers’ College at Columbia University
normal development and health and use of the available health -enrolled in the association’s School for Nurse-Midwives then
facilities. worked as a nurse-midwife in the home delivery service of the
Maternity Center Association
Nurse Relationships: -Nurse educator-advance maternity nursing at Teachers’ College
1. Nurse- Patient Relationship -wrote several articles for professional publications and remained
• The nurse as substitute for the patient active in professional nursing organizations
-when the patient cannot function fully, the nurse serves as -in 1952 – moved from New York to Connecticut-faculty of the Yale
the substitute as to what the patient lacks such as University School of Nursing; director of graduate programs in
Maternal-Newborn health nursing which began in 1956
-wrote Family-Centered Maternity Nursing-1958
-Books:
• Clinical nursing: A helping art
• Family-centered maternity nursing
-a comprehensive text on obstetrical nursing
• The nurse’s role in family planning: A conceptual base for
practice
• Nurses’ wisdom in nursing theory
4 Elements of Clinical Nursing:
1) Philosophy
-attitude toward life and reality that evolves from each nurse’s belief
and code of conduct, motivates the nurse to act, guides her thinking
about what she is to do and influences her decisions’
3 Essential Components associated with Nursing
Philosophy
• Reverence for the gift of life
• Respect for the dignity of life, worth, autonomy and
individuality of each human being
• Resolution to act dynamically in relation to
one’s belief
2) Purpose
-that which the nurse wants to accomplish through what she does-is
the overall goal toward which she is striving
and so is constant
-the reason for her being and for doing
-the why of clinical nursing and transcends the immediate intent of
her assignment or task by specifically directing her activities towards
the good of her patient
3) Practice
-those observable nursing actions that are affected by beliefs and
feelings about meeting the patient’s need for help
4) Art
-Includes:
1. Understanding patient’s needs and concerns
2. Developing goals and actions intended to enhance patient’s ability
3. Directing the activities related to the medical plan to improve the
patient’s conditions
4. Focus on prevention of complications related to recurrence or
development of new concerns
Terms used in nursing practice:
• Patient – any person who has entered the healthcare system and is
receiving help of some kind such as care, teaching, or advice
• Need-for-Help – any measure desired by the patient that has the
potential to restore or extend the ability to cope with various life
situations that affect health and wellness
• Clinical Judgment – represents the nurse’s likeliness to make sound
decisions-based on differentiating fact from assumption and
relating them to cause and effect
• Sound judgment – the result of disciplined functioning of mind and
emotions and improves with expanded knowledge and increase
clarity of professional purpose
• Nursing skills – carried out to achieve a specific patient-centered
purpose rather than completion of the skill itself being the end goal
• Identification – involves individualization of the patient, his
experiences and recognition of the patient’s perception of his
condition
• Ministration – providing the needed help
• Validation – evidence that the patient’s functional ability was
restored as a result of the help given
Metaparadigm
1. Nursing-primarily consists of identifying a patient’s need for help
• Nurse – a functioning human being who acts, thinks, and
feels
Purpose: to assist individuals in overcoming obstacles that
prevent meeting healthcare needs
2. Person – an individual who is receiving help from a member of
health profession or from a worker in the field of health
3. Health- not defined
-the definitions of nursing, patient and need-for-help and the
relationship among these concepts imply health-related concerns in
the nurse-patient situation.
4. Environment – not addressed
-it is implied that the environment may produce obstacles resulting in
the person experiencing a need-for-help.
LYDIA HALL- Care, Core and Cure Model
- “Patients should receive care ONLY from professional nurses.
Nursing involves interacting with a patient in a complex process of
teaching and learning. Care is focused on individuals, families, and
communities. And care is focused on maintaining optimal health and
quality life from birth to end of life.”
- September 21, 1906 – February 27, 1969
-earned BS and MD in Teacher’s College at Columbia University
-represented her theory of nursing by drawing three interlocking
circles; each circle representing a particular aspect of nursing: CARE,
CORE, and CURE.
-Awards/ Honors:
• Teacher’s College Nursing Education Alumni Association
(TCNEAA) Achievement in Nursing Practice Award
• Inductee of American Nurses Association (ANA) Hall of
Fame
The Care Circle
 The nurturing component of care and is exclusive to
nursing.
 It involves the concept of “mothering” and provide for
teaching-learning activities.”
 The professional nurse provides bodily care for the patient
and helps the patient to complete such basic daily biologic
activities like eating, bathing, elimination, and dressing.
 The nurse’s goal is the comfort of the patient.
 Providing care for the patient at the basic needs level
presents the nurse and the patient with an opportunity for
closeness. As closeness develops the patient can share and
explore feelings with the nurse. This opportunity to explore
feelings represents the teaching-learning aspect of
nurturing.
The Core Circle
 The core circle of patient care is based on social sciences.
 Involves therapeutic use of self
 The nurse is able to help the patient verbally express
feelings regarding the disease process and its effects, as
well as discuss the patient’s role in recovery or healing
process.
 The patient is able to maintain who they are (SELF-
IDENTITY)
 The patient is able to develop a maturity level when the
nurse listens to him /her and acts as sounding board.
 The patient is able to make informed or conscious decisions
based on understood and accepted feelings and motivations.
 The professional nurse, by use of the reflective technique
helps the patient look at and explores feelings regarding
his/her current health status and related potential changes in
lifestyle.
 The motivation and energy necessary for healing exist
within the patient, rather than in the health care team.
The Cure Circle
 The cure circle of patient care is based in the pathological
and therapeutic sciences and is shared with other members
of the health team.
 The professional nurse helps the patient and family through
the medical, surgical, and rehabilitative prescriptions made
by the physician. During this aspect of nursing care, the
nurse is an active advocate of the patient.
 The nurse’s role during the cure aspect takes on a negative
quality like avoidance of pain rather than a positive quality
like comforting.
 This is negative in the sense that the patient views the nurse
as a potential cause of pain, e.g. one who is involved in
such actions as administering injections, versus the
potential comforter who provides care and comfort in the
care circle.
Interaction of the Three Aspects of Nursing
 Hall emphasizes the importance of total person approach.
 Likewise, importance is placed on all three aspects of
nursing be viewed as functioning in an interrelated manner.
 The three aspects interact and the circles representing them
change size, depending on the patient’s total course of
progress.
 The size of the circles represents the degree to which the
patient is progressing in each of the three areas.
 Only nursing is defined as the function necessary to carry
out care, core and cure.
Concepts
Person: The individual human who is16 years old or older and past
the acute stage of long-term illness is the focus of nursing
care in Hall’s theory.
• The source of energy and motivation for healing is the
individual care for recipient, not the health care provider.
• The individual is unique, capable of growth and learning,
and requiring a total person approach.
Health: A state of self-awareness with conscious selection of
behaviors that is optimal for the individual.
• Hall stresses the need to help the person explore the
meaning of his/her behavior to identify and overcome
problems through developing self-identity and maturity.
Environment/Society: is dealt with in relation to the individual
• Hall is credited with developing the concept of Loeb Center
because she assumed that the hospital environment during
treatment of acute illness creates a difficult psychological
experience for the ill individual.
• Loeb Center focuses on providing an environment that is
conducive to self-development. In such setting, the focus of
the action of the nurses is the individual, so that any action
taken in relation to society or environment are for the
purpose of assisting the individual in attaining a personal
goal.
Nursing: is identified as consisting of participation in the
care, core, and the cure aspects of patient care
• Care is the sole function of nurses, whereas core and cure
are shared with other members of the health care team.
• The major purpose of care is to achieve an interpersonal
relationship with the individual that will facilitate the
development of core.
FAYE GLENN ABDELLAH- Twenty-One Nursing Problems
- “I never wanted to be a medical doctor because I could do all I
wanted to do in nursing, which is a caring profession.”
-Born on March 13, 1919 in New York City
-Died on February 24, 2017; age of 97
-it was her experience of witnessing the historic explosion of the
German passenger airship, Hindenberg, when she was only 18 years
old, in Lakehurst, New Jersey not far from her native New York, that
inspired her choice of career
-Finished basic nursing education-magna cum laude – 1942 from
Fitkin Memorial Hospital School of Nursing-New Jersey
-1945- BSN
-1947- MA
-1955 Doctor of Education (Teachers College, Columbia Univ.
-First nurse and first woman to serve as DEPUTY SURGEON
GENERAL OF THE US
-1960-desire to promote client-centered all – inclusive nursing care-
making the idea, nursing as a true humanitarian service to
individuals, to families and therefore to society.
-Nursing – a science and an art that molds the attitudes, intellectual
capabilities (knowledge) and technical know-how (skill) of the
individual nurse into the desire and capacity to assist people, sick or
well and to deal with their health needs
-Honor/ Awards:
• Inductee, American Nurses Association Hall of Fame
• Inductee, National Women's Hall of Fame
• Living Legend, American Academy of Nursing
-Books:
• Better Patient Care Through Nursing Research
• Preparing Nursing Research for the 21st Century:
Evolution, Methodologies, Challenges
• New Directions in Patient-centered Nursing: Guidelines for
Systems of Service, Education, and Research
Nursing as a complete humanitarian service includes:
• Be acquainted with the nursing problems of the patient
• Choose the definite courses of action to make in the scope of
relevant nursing principles
• Make available continuous care of the individual’s health needs
• Give continuous care to relieve pain and discomfort and
provide immediate security for the individual
• Regulate the total nursing care plan to meet the patient’s
tailored needs
• Serve the individual to become more self-determining in
achieving & maintaining a healthy state of mind and body
• Inform nursing personnel, family and support system to provide
individual act for oneself within perceived limitations
• Facilitate the individual to adapt to limits and emotional
problems
• Team up with different allied health profession in working with
the diagram for optimum health on local, state, national and
international levels
• Engage in non-stop evaluation and research to develop nursing
techniques and to create new techniques to serve the health
needs of different people
Metaparadigm in Nursing
• Person
-Individuals – beneficiary of care; apex of nursing service
• Health
-center and purpose of nursing services
-total health needs, healthy state of mind and body (state when
the individual has no unmet needs and no anticipated or
actual impairments)
• Environment
-included in planning for optimum health on local, state,
national and international levels
 -Individual- the core of nursing service
• Nursing
-grouped into 21 problem areas for nurse to work out their
judgment and appropriate care
-all-inclusive service that is based on the disciplines of art and
science that serves individuals, sick or well with their health
needs
-is the utilization of the problem-solving techniques with chief
nursing problems related to the health requirements of clients
3 Chief Concepts:
1. Health
2. Nursing problems
-Health needs
• Overt- obvious/ observable
• Covert- hidden
3. Problem solving
-Medium for the nursing problems as the client is geared
in the direction of health which is the outcome
• Covert – unseen or masked one
• Overt – obvious or can-be-seen condition
 Core of nursing – identifying and answering overt and covert
nursing problems
 Solving the covert problems may solve the overt problems
 Nursing problems is more in tune with nursing goals and nursing
functions than client-centered problems
 The theory is more nursing-centered than client-centered
Problem-Solving Process includes:
1. Identifying the problem
2. Selecting relevant data
3. Devising hypotheses
4. Testing hypotheses through the assortment of data
5. Revising hypotheses when necessary on the basis of conclusions
from the data
Typology of Twenty-One Nursing Problems
1. To maintain good hygiene and physical comfort
2. To promote optimal activity: exercise, rest and sleep
3. To promote safety through prevention of accident, injury, or other,
trauma, and through the prevention of the spread of infection
4. To maintain good body mechanics and prevent and correct
deformity
5. To facilitate the maintenance of a supply of oxygen to all body
cells
6. To facilitate the maintenance of nutrition of all body cells
7. To facilitate the maintenance of elimination
8. To facilitate the maintenance of fluid & electrolyte balance
9. To recognize the physiological responses of the body to disease
conditions-pathological, physiological and compensatory
10. To facilitate the maintenance of the regulatory mechanism and
functions
11. To facilitate the maintenance of sensory function
12. To identify and accept positive and negative expressions, feelings
and reactions
12. To identify and accept interrelatedness of emotions and organic
illness
13. To identify and accept interrelatedness of emotions and organic
illness
14. To facilitate the maintenance of effective verbal and nonverbal
communications
15. To promote the development of productive interpersonal
relationships
16. To facilitate progress toward achievement and personal spiritual
goals
17. To create or maintain a therapeutic environment
18. To facilitate awareness of self as an individual with varying
physical, emotional and developmental needs
19. To accept the optimum possible goals in the light of limitations,
physical and emotional
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 in
the cause of illness
JEAN WATSON- Philosophy and Science of Caring
 Caring in nursing conveys physical acts but embraces the mind-
body-spirit as it reclaims the embodied spirit as its focus of
attention
-born in Southern West Virginia with the name Margaret Jean
Harmon
-earned BSN in 1964; MS in Psychiatric Mental Health Nursing in
1966 and PhD in educational psychology and counseling in 1973
-a distinguished Professor and Director of Center of Human Caring
School of Nursing, University of Colorado Health Science Center,
Denver.
-Awards:
• American Academy of Nursing's 'Living Legend' Award
• International Kellogg Fellowship Award in Australia
• Fulbright Research Award in Sweden
• National League for Nursing (NLN) Martha E. Rogers
Award
-Books:
• Nursing: The Philosophy and Science of Caring
- embraced the 10 carative factors but evolved to include
“caritas,” making explicit connections between caring and love
• Human Science and Human Care – A Theory of Nursing
• Postmodern Nursing and Beyond
• Instruments for Assessing and Measuring Caring in
Nursing and Health Sciences
Metaparadigm
• Person
-Human being – valued person in and of him to be cared for,
respected, nurtured and understood and assisted
-a fully functional integrated self
• Environment
-provides the values that determine how one should behave and
what goals one should strive toward
-values are affected by change in social, cultural and spiritual
arenas which in turn affects the perception of the person and can
lead to stress
-caring has existed in every society
 A caring attitude is not transmitted from generation to
generation by genes. It is transmitted by the culture of the
profession as a unique way of coping with its environment.
• Health
-refers to unity and harmony within the mind, body and souls
-associated with the degree of congruence between self as
perceived and as experienced
-With 3 elements:
• a high level of over-all physical, mental and social
functioning
• a general adaptive-maintenance level of daily functioning
• The absence of illness
• Nursing
-a human science of people and human health-illness experiences
that are mediated by professional, personal, scientific, aesthetic
and ethical human care transactions

7 Assumptions and 10 carative factors
Basic Assumptions
• Caring can be effectively demonstrated and
practiced interpersonally
• Effective caring promotes health and individual
or family growth
• Caring responses accept a person not only as he
or she is now but as what he or she may become
• 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
• Caring is more healthogenic than is curing
• The practice of caring is central to nursing
Ten Carative Factors
• Formation of a Humanistic-altruistic system of values
-satisfaction through giving and extension of the sense of
self
• Instillation of faith-hope
-facilitates the promotion of holistic nursing care and
positive health within the patient population
• Cultivation of sensitivity to one’s self and to other
-recognition of feelings leads to self-actualization through
self-acceptance for both the nurse and the patient
• Development of a helping-trusting, human caring
relationship
-crucial for transpersonal caring
-trusting relationship promotes and accepts the expression
of both positive and negative feelings
-involves congruence, empathy, non-possessive warmth
and effective communication
-promotion and acceptance of the expression of positive
and negative feelings
• Systematic use of a creative problem-solving caring process
-use of nursing process
• Promotion of transpersonal teaching-learning
-separates caring from curing
-allows patient to be informed and shifts the responsibility
for wellness and health to the patient
• Provision for a supportive, protective and corrective
mental, physical, societal and spiritual environment
• Assistance with gratification of human needs
• Allowance for existential-phenomenological-spiritual
forces
PATRICIA BENNER- From Novice to Expert
- born on August 1942 in Hampton, Virginia
-While in college, she first became interested in nursing when she
had the opportunity to work as an admitting clerk at a hospital in
Pasadena, California
- credits Virginia Henderson as the person who greatly influenced
her thinking in nursing
-is an internationally noted researcher and lecturer on health,
stress and coping, skill acquisition and ethics
- is the Thelma Shobe Endowed Chair in Ethics and
Spirituality in the Department of Social and Behavioral Sciences
in the School of Nursing at the University of California, San
Francisco
- Received a B.A. in nursing from Pasadena College, an M.S. in
nursing from the University of California, San Francisco, and a
Ph.D. in education from the University of California, Berkeley
-Book:
• From Novice to Expert: Excellence and Power in
Clinical Nursing Practice,
 Nursing is concerned with the social sentiment body that
dwells in finite human worlds; that gets sick and recovers;
that is altered during illness, pain and suffering; and that
engages with the world differently upon recovery.
METAPARADIGM IN NURSING
1. NURSING – enabling condition of connection and concern
which shows a high level of emotional involvement in the
nurse-client relationship.
 Nursing Practice – the care and study of the lived
experience of health, illness and disease and their
relationships.
2. PERSON – a self-interpreting being who does not come into
the world predefined but gets defined in the course of living a
life.
3. Health - “what can be assessed”
 Well- being – Human experiences of health or
wholeness.
 Illness – human experience of loss or dysfunction
 Disease – what can be assessed at the physical level
4. Environment - “situation”, It suggests a social environment with
social definition and meaning.
SKILLS ACQUISITION IN NURSING
1. NOVICE
-the person has no background experience of the situation
he is involved.
-has difficulty discriminating between relevant and
irrelevant aspects of the situation.
-level where student nurses belong!
-nurses at higher levels can be novice if placed in
unfamiliar situations.
2. ADVANCE BEGINNER
-person has sufficient experience to easily understand
aspects of the situation.
-clinical situations are viewed as a CHALLENGE of their
abilities.
-they feel more responsible for managing patient care yet
still rely on those with more experience.
-newly graduated nurses belong to this level!
3. COMPETENT
-competent performance considers consistency,
predictability and time management as essential
component.
-a sense of mastery is acquired through planning and
predictability.
-increased level of efficiency is evident.
-competent nurse develops new rules and reasoning
procedures for a plan while applying learned rules.
-competent nurse displays more responsibility for the
patient.
-active teaching and learning is significant to help nurses
shift from competent to proficient.
4. PROFICIENT
-person perceives the situation as a whole rather than in
terms of aspects.
-performance is guided by Maxims (concise rules of
conduct).
-person identifies the most significant aspects and has a
better understanding of the situation based on background
understanding.
-they no longer rely on preset goals for organization.
 -they show increased confidence in their knowledge and
skills.
-there is much more involvement with the patient and
family.
5. EXPERT
-person no longer relies on analytical principles like rules,
guidelines and maxims to connect her understanding of a
situation to an appropriate action.
-there is INTUITIVE GRASP of the problem.
Key Aspects:
• Demonstrate a clinical grasp and resource-based practice
• Possess embodied knowledge
• See the big picture
• See the unexpected

DOMAINS OF NURSING PRACTICE

1. Helping Role
2. Teaching and coaching function
3. Diagnostic client-monitoring function
4. Effective management of rapidly changing situations
5. Administering and monitoring therapeutic interventions and
regimens
6. Monitoring and ensuring quality of health care practices
7. Organizational and work role competencies