Lourelie M.

Erediano

1. CASE STUDY OF SUSAN

The focus of Nightingale’s Environmental Theory in nursing is to alter the patient’s

environment in order to affect change in his or her health. The environmental factors that affect
health, as identified in the theory, are: fresh air, pure water, sufficient food supplies, and efficient
drainage, cleanliness of the patient and environment, and light (particularly direct sunlight). If
any of these areas is lacking, the patient may experience diminished health. A nurse’s role in a
patient’s recovery is to alter the environment in order to gradually create the optimal conditions
for the patient’s body to heal itself. In some cases, this would mean minimal noise and in other
cases could mean a specific diet. All of these areas can be manipulated to help the patient meet
his or her health goals and get healthy.

1a. The first thing to do is greet the client and then establish rapport. After being able to make a
nurse-client relationship, I would then pay attention to the uncleanliness in my client’s house.
Nightingale’s Theory prioritizes the surrounding environment in the nursing care plan because it
can affect the well-being of each family member. I will include in my health teaching the
importance of keeping the environment clean to stay away from diseases brought by
environmental factors.

1b. The environment is our main focus in this study. Based on this case, there are major issues
that need immediate action. First is the litter box in the floor which is near the changing table. I
would suggest taking that box away from the inside and placing it outside. Second is the
improper disposal of the soiled clothed diapers which are near the feeding bottles. With this
setting, the kids are prone to extracting foodborne diseases like diarrhea. Then we should also
note the unmade beds, the hotness of the room temperature and the leftover dishes in the table.
In my overall assessment of the environment, I can say that these issues can affect the well-being
of her family members so I would suggest to her to keep her house clean and orderly.

1c. Using a suggestive and non-demanding tone of conversation, I will involve my client in
planning for the necessary action in keeping her home clean. I will inform her about the risks and
benefits of sanitation at home so that she will realize by herself the importance of keeping the
environment clean and orderly. Regular visits would help me evaluate the compliance of my
client to our agreed plan. Above all, a good client relationship would help me persuade Susan to
clean and organize her house.
 Virginia Henderson’s Nursing Need Theory

Henderson’s Need Theory emphasizes the importance of patient independence so that the
patient will continue to progress after being released from the hospital.

NURSING PRACTICE:
Henderson described the role of the nurse as one of the following: substitutive, which is
doing something for the patient; supplementary, which is helping the patient do something; or
complementary, which is working with the patient to do something. All of these roles are to help
the patient become as independent as possible. She categorized nursing activities into fourteen
components based on human needs. The fourteen components of Henderson’s concept are as
follows:
1. Breathe normally. Eat and drink adequately.
2. Eliminate body wastes.
3. Move and maintain desirable postures.
4. Sleep and rest.
5. Select suitable clothes-dress and undress.
6. Maintain body temperature within normal range by adjusting clothing and modifying
environment.
7. Keep the body clean and well groomed and protect the integument.
8. Avoid dangers in the environment and avoid injuring others.
9. Communicate with others in expressing emotions, needs, fears, or opinions.
10. Worship according to one’s faith.
11. Work in such a way that there is a sense of accomplishment.
12. Play or participate in various forms of recreation.
13. Learn, discover, or satisfy the curiosity that leads to normal development and health.
14. Use the available health facilities.

Strong points: Henderson is well known for her definition of nursing, which says, “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.” It’s is very important to maximize the physical
capability of an able person after being hospitalized.

Weak points: The readiness of a patient differs from the other. Which means sometimes one
person could not accept some activities even he’s able to do so. I think mental and psychological
assessment must be done first to assess if the patient is ready for the transition. And the theory
must emphasize the importance of regular visits and follow-up checkup for patients’ re-
assessment.

Limitations: For me, it is more of time constraints and staff availability. The moment the patient
comes home, it might be hard to check on how well our patient is doing their tasks alone. With
the increasing number of patients, doing it one by one is time consuming and seems to be
impossible.
 Hildegard Peplau’s The Theory of Interpersonal Relations

The four components of the theory are: person, which is a developing organism that tries
to reduce anxiety caused by needs; environment, which consists of existing forces outside of the
person, and put in the context of culture; health, which is a word symbol that implies forward
movement of personality and other other human processes toward creative, constructive,
productive, personal, and community living.

Nursing Practice: Her framework suggested that interaction phenomena that occur during
patient-nurse relationships have qualitative impact on patient outcomes. It includes seven nursing
roles, which show the dynamic character roles typical in clinical nursing.

The Seven Nursing Roles are:

1. The stranger role, in which the nurse receives the patient the way a stranger is met in
other situations, and provides an atmosphere to build trust;
2. The resource role, in which the nurse answers questions, interprets data, and gives
information;
3. The teaching role, in which the nurse gives instructions and provides training;
4. the counseling role, in which the nurse helps the patient understand the meaning of
current circumstances, as well as provides guidance and encouragement in order for
change to occur;
5. The surrogate role, in which the nurse acts as an advocate on behalf of the patient;
6. The active leadership role, in which the nurse helps the patient take responsibility for
meeting treatment goals; and
7. The technical expert role, in which the nurse provides physical care for the patient and
operates equipment.

Strong points: For those who become nurses to work with people, studying Hildegard Peplau’s
model of nursing can be very useful. By better understanding the seven roles of nursing, they can
apply different roles in different situations, which will ensure that their patients receive the best
care possible, and will ultimately speed along treatment and recovery.

Weak Points: For me this is a good model for nurses but it takes time to practice such different
roles simultaneously. It might be a little too much for a newbie so I suggest the theory has to
emphasize the importance of good supervision done by head nurses to their subordinates. Other
than that, this theory creates a role model nurse which is good for the overall welfare of the
patient.

Limitations: Having the skills and knowledge of the different roles is useful, but nursing field is
evolving and ever changing because of the advent of evidence-based practice and research.
Therefore, continuing education and time and money-spending trainings must be conducted to
further enhance the nurses’ capability in all aspects of nursing roles.
 Ida Jean Orlando’s Deliberative Nursing Process
Her theory is set in motion by the behavior of the patient. According to the theory, all
patient behavior can be a cry for help, both verbal and non-verbal, and it is up to the nurse to
interpret the behavior and determine the needs of the patient.

Nursing Practice:
The Deliberative Nursing Process has five stages that have been adopted to the nursing practice
today: assessment, diagnosis, planning, implementation, and evaluation.
In the assessment stage, the nurse completes a holistic assessment of the patient’s needs. The
nurse collects both subjective and objective data about the patient. The diagnosis stage uses the
nurse’s clinical judgment about health problems. The diagnosis can then be confirmed using
links to defining characteristics, related factors, and risk factors found in the patient’s
assessment. The planning stage addresses each of the problems identified in the diagnosis. Each
problem is given a specific goal or outcome, and each goal or outcome is given nursing
interventions to help achieve the goal. By the end of this stage, the nurse will have a nursing care
plan. In the implementation stage, the nurse begins using the nursing care plan. Finally, in the
evaluation stage, the nurse looks at the progress of the patient toward the goals set in the nursing
care plan. Changes can be made to the nursing care plan based on how well the patient is
progressing toward the goals. If any new problems are identified in the evaluation stage, they can
be addressed, and the process starts over again for those specific problems.

Strong Points: The goal of this model is for a nurse to act deliberately rather than automatically.
This way, a nurse will have a meaning behind the action which means the patient gets care
geared specifically toward his or her needs at that time. This nursing process is also one that can
easily be adapted to different patients with different problems, and can be stopped at any time,
depending on the patient’s progress or health.

Weak Points: This theory entails us to do an appropriate nursing care plan. Nursing care has to
be flexible. Not only does a nursing care plan depend on the needs of the patient at the time of
admittance, but it also needs to be able to change when and if any complications come up during
the treatment and recovery process. This is a good thing but needs practice and experience.

Limitations: This model provides a framework for nursing, but the use of her theory does not
exclude nurses from using other nursing theories while caring for patients. This model can be
used alongside other theories necessary for a specific care we have to render.
 Carolina S. Agravante CASAGRA TRANSFORMATIVE LEADERSHIP

Nursing Practice: The theory focuses on the type of leadership in nursing that can
challenge the values of the changing world. 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. Nursing Education and profession is faced with a new concern that is globalization
of nursing services for the international market. A person with dynamic care complex is the
cornerstone of nursing leadership. It is necessary given as a stimulant in the performance of all
activities. Transformative teaching is the guide that is desired for the modern educative process
designed to form the millennium professional nurse. The transformative leadership

Strong Points:
The theory provides a good concept and task for the information of the nurse leaders/ clinical
instructors that will teach the baccalaureate level to have mind and heart of a true nursing leader.
It is significant for the nursing educators to achieve the mission and vision of their institution. It
also provides a deeper reflection to each personality. This model can be used in other discipline
and profession that requires leadership in creating change necessary to fit for the evolving world.

Weak Points:
Since Agravante is a nun; her respondents are mostly Roman Catholics and Christian Nursing
educators. Philippines has a lot of religion but this study only focuses on the traditions and
practices common to the Catholic church. So whenever the theory is introduced to other nurses
of different religion, they might feel reluctant to undergo the sessions and teachings given by this
theory. The theory should have been more open to other religious belief.

Limitations: The respondents both the control and the study groups were selected from the same
faculty in the two schools. It is highly possible that experience could have been discussed
casually in faculty room and in some way maybe contaminated the intervention.
Lourelie M. Erediano

Midterm Examination

Situation no. 1 The request of an 82-year-old woman who begged to let her dog visit her inside
the hospital.

Answers:

1. Considering my patient’s case: Lower leg burns due to cooking accident: which is very
sensitive and prone to contracting secondary infections because of altered integumentary
defense, I would decline her request in a slow sensible manner. Based on Nightingale’s Theory
of keeping the environment clean, my patient is most probably placed on a reverse isolation
room because of her burns. As a nurse, I know that dogs can easily transmit germs to my
patient. Although this stresses the importance of our own regular hand washing at work, it also
raises a question of whether the risk of spreading germs outweighs the benefits dogs offer
patients.

2. Nursing diagnoses and Interventions

 Imbalanced Nutrition: Less than Body Requirements due to Unwillingness to eat
First thing to do is contact an expert as to how much nutritional needs based on patient’s
BMI we have to prepare. Because our patient has emotional factors, a nurse should provide
companionship and lend an ear for the patient to speak her feelings and thoughts then validate
the patient’s feeling regarding the impact of her current situation on inability to consume
nutritious foods.
 Ineffective Coping: Inadequate support system
The nurse and the patient should work together in the need to recognize the stress of unable
to see her dog accordingly to come with the most effective strategy that will work best for her.
At the end of the day, the patient can identify personal strengths and accepts support through the
nursing relationship because she lacks family to rely with. Appropriate nursing intervention
should start providing chances to express concerns, fears, feeling, and expectations.

3. As her primary nurse, I will involve her in the planning for her discharge. Considering her age
and the fact that she is living alone in a house with only a dog as companion, I would ask her to
live in a home for the aged facility. It is safer for her because people would be there to take care
of her.

4. As an advocate, with her consent and permission, I would personally refer my patient to an
institution where I know she will be safe and well taken care of. She might be a little weak to
perform daily task on her own and she is at risk of falls and accidents, thus giving her a new
home that will adopt her is my main priority.

5.Weak Points: Based on the case study, I think there is no consideration of the emotional and
psychological aspects in the nursing care because it is too focus about the importance of
environmental sanitation. Nowadays, therapeutic dogs are being considered in the hospital
visitations as long as their scrubbed and groomed properly.
6. Nightingale stated that nursing “ought to signify the proper use of fresh air,
light, warmth, cleanliness, quiet, and the proper selection and administration
of diet – all at the least expense of vital power to the patient.” She would
have defined the problem as infectious, environmental hazard and diet crisis
then she would focus her analysis in the significance of Environmental
sanitation and keeping it safe for the patient.

Lydia Hall’s Core, Cure and Care

1. The Core, Cure and Care Theory of Lydia Hall is an independent but interconnected circles
she formulated combining her knowledge in both Psychiatry and Nursing.

 The core is the patient receiving nursing care. The core has goals set by him or herself
rather than by any other person, and behaves according to his or her feelings and values.
 The cure is the attention given to patients by medical professionals. Hall explains in the
model that the cure circle is shared by the nurse with other health professionals, such
as physicians or physical therapists. These are the interventions or actions geared toward
treating the patient for whatever illness or disease he or she is suffering from.
 The care circle addresses the role of nurses, and is focused on performing the task of
nurturing patients. This means the “motherly” care provided by nurses, which may
include comfort measures, patient instruction, and helping the patient meet his or her
needs when help is needed.

2. Yes. Her theory gives nursing profession a framework that will signify the three most
important bodies in the health care. Lydia Hall’s model appears to be completely and simply
logical. Her work may be viewed as the philosophy of nursing. The three Cs (care, core and cure)
in this theory were unique. In all the circles of the model, the nurse is present, although focus of
the nurse’s role is on the care circle. This theory puts emphasis on the importance of the total
patient rather than looking at one part or aspect. 

3. If I will be assigned in the community, for example I have a pregnant patient, and then she will
be the core that I need to establish rapport with, make regular appointments and visit for her
prenatal checkup. Then our meetings would be considered as the cure. Together with my
colleagues, the Physician and the midwife, we will render the necessary medical intervention for
our patient. In the care circle, it would focus to me as a nurse giving my independent
interventions for her.
Lourelie M. Erediano

Final Examination

The case of Ms. Brown.

1. Rosemarie Rizzo Parse’s Human Becoming Theory guides the nurse to focus her nursing care
on the quality of life as it is described and lived by the patient. We got to take into consideration
the meaning of Ms. Brown’s disease based on her perspective. Human becoming is freely
choosing personal meaning in situations in the inter-subjective process of living value priorities.
This allows the nurse to be “with” the patient, and guide him or her toward the health goals. The
nurse-patient relationship co-creates changing health patterns. Nurses live the art of human
becoming in presences with the unfolding of meaning, synchronizing rhythms, and
transcendence.

2. Questions:
 How do you feel about your disease?
 How would you feel if you tell your daughter about your diagnosis?
 Will it lighten or further burden your thoughts if you speak about it?
 Are you scared of how she might react?
 What are the things that make you feel tired?
 What are the things that you do to cope with such illness?

Asking these sensitive questions to my patient would help me understand her deeper.
It is my task to know how well she’s living her life despite being diagnosed by a severe illness
that could cost her own life.

3. A human living his/her daily task with whatever comes in life acknowledges the learned
values and uses it to set a moral standard in the community. Respect is the key to uphold
humanity, that despite the differences, diversities and various perceptions of every human life,
he/she respects the uniqueness in each and everyone. The beauty of this model is it gives the
nurse the opportunity to understand the deeper meaning and quality of life.
Lourelie M. Erediano

CASE No. 2:

Sister Callista Roy’s Adaptation Model

Roy explained that adaptation occurs when people respond positively to environmental
changes, and it is the process and outcome of individuals and groups who use conscious
awareness, self-reflection, and choice to create human and environmental integration.

1. He has an injury that resulted in quadriplegia or paralysis of the four limbs. His physiologic
function is altered to the extent that he becomes independent even in feeding himself. In order to
respond positively to environmental changes, a he must adapt. In this case, he needs a personal
assistant who will help him do his daily task and needs.

2. Self-Concept: The patient may feel hopeless because of his situation. He was supposed to
have a meeting for a contract negotiation of a professional football team. He used to be able to
enjoy life without having someone to assist him. This aspect is a priority. As a nurse, I have to
check if the patient is appropriately coping with his disability psychologically. The norms of our
health are not constant, it is changing everyday and it differs from person to person. With
positive attitude, he will be able to accept his situation if he has come to the point of acceptance
of his injury. Life goes on.

3. Interdependence: Since the patient is now dependent to an assistant who is usually a family
member, he has to build a therapeutic relationship that would affect his overall well-being. This
person will contribute to his development of self-worth and a source of strength. Everyday, he
will be struggling to find meaning in his life and it will be good for him to have someone who
will support him all the way to his adaptation. A physical therapist may also be hired to exercise
his body and prevent muscle atrophy.

4. Role Function: He must have been fit and active before the injury because of his line of
profession. Now that he is paralyzed, his role function will all be gone. But with positive
outlook, he could think of an idea that will keep him busy and entertain. Since he is inclined with
sports, he might have the brain to be a sport analyst, coach, or any role that doesn’t need him to
stand or walk.

Interventions:
1. Assist him in doing his physiological tasks in a supportive manner that doesn’t make him
feel useless.
2. Give him ears to listen in his grieving process to help him cope effectively until he is able
to accept his disability.
3. Give him regular visits for follow-up checkup and continue planning for his faster
recovery.
 4. Give him suggestions as to how to keep himself busy and entertained while he has
nothing to do yet.

Madeleine Leininger was born on July 13,

1925 in Sutton, Nebraska. She earned several
degrees, including a Doctor of Philosophy, a Doctor
of Human Sciences, a Doctor of Science, and is a
Registered Nurse. She is a Certified Transcultural
Nurse, a Fellow of the Royal College of Nursing in
Australia, and a Fellow of the American Academy of
Nursing.

Early in her career, Madeleine

Leininger recognized the importance of the element
of caring in the profession of nursing. Through her
observations while working as a nurse, she identified
a lack of cultural and care knowledge as the missing
component to a nurse’s understanding of the many
variations required in patient care to support
compliance, healing, and wellness.

Leininger’s Culture Care Theory attempts to provide culturally congruent nursing care
through “cognitively based assistive, supportive, facilitative, or enabling acts or decisions that
are mostly tailor-made to fit with individual, group’s, or institution’s cultural values, beliefs, and
lifeways.” The intent of the care is to fit with or have beneficial meaning and health outcomes for
people of different or similar culture backgrounds.
Culturally congruent care is possible when the following occurs in the nurse-patient
relationship: “Together the nurse and the client creatively design a new or different care lifestyle
for the health or well-being of the client. This mode requires the use of both generic and
professional knowledge and ways to fit such diverse ideas into nursing care actions and goals.
Care knowledge and skill are often repatterned for the best interest of the clients. Thus all care
modalities require coparticipation of the nurse and clients (consumers) working together to
identify, plan, implement, and evaluate each caring mode for culturally congruent nursing care.
These modes can stimulate nurses to design nursing actions and decisions using new knowledge
and culturally based ways to provide meaningful and satisfying wholistic care to individuals,
groups or institutions.”
Leininger’s model has developed into a movement in nursing care called transcultural
nursing. In 1995, Leininger defined transcultural nursing as “a substantive area of study and
practice focused on comparative cultural care (caring) values, beliefs, and practices of
individuals or groups of similar or different cultures with the goal of providing culture-specific
and universal nursing care practices in promoting health or well-being or to help people to face
unfavorable human conditions, illness, or death in culturally meaningful ways.”
 Leininger developed new terms for the basic concepts of her theory. The concepts
addressed in the model are:
 Care, which assists others with real or anticipated needs in an effort to improve a human
condition of concern, or to face death.
 Caring is an action or activity directed towards providing care.
 Culture refers to learned, shared, and transmitted values, beliefs, norms, and lifeways to a
specific individual or group that guide their thinking, decisions, actions, and patterned ways of
living.
 Culture Care is the multiple aspects of culture that influence and help a person or group to
improve their human condition or deal with illness or death.
 Culture Care Diversity refers to the differences in meanings, values, or acceptable forms of care
in or between groups of people.
 Culture Care Universality refers to common care or similar meanings that are evident among
many cultures.
 Nursing is a learned profession with a disciplined focus on care phenomena.
 Worldview is the way people tend to look at the world or universe in creating a personal view of
what life is about.
 Cultural and Social Structure Dimensions include factors related to spirituality, social structure,
political concerns, economics, educational patterns, technology, cultural values, and ethnohistory
that influence cultural responses of people within a cultural context.
 Health refers to a state of well-being that is culturally defined and valued by a designated culture.
 Cultural Care Preservation or Maintenance refers to nursing care activities that help people from
particular cultures to retain and use core cultural care values related to healthcare concerns or
conditions.
 Cultural Care Accommodation or Negotiation refers to creative nursing actions that help people
of a particular culture adapt or negotiate with others in the healthcare community in an effort to
attain the shared goal of an optimal health outcome for patients of a designated culture.
 Cultural Care Re-Patterning or Restructuring refers to therapeutic actions taken by culturally
competent nurses. These actions help a patient to modify personal health behaviors towards
beneficial outcomes while respecting the patient’s cultural values.

The theory’s culturalogical assessment provides a holistic, comprehensive overview of

the client’s background. The assessment addresses the following:

 communication and language

 gender considerations
 sexual orientation
 ability and disability
 occupation
 age
 socioeconomic status
 interpersonal relationships
 appearance
 dress
 use of space
 foods and meal preparation and related lifeways
 Leininger proposes that there are three modes for guiding nurses judgments, decisions, or
actions in order to provide appropriate, beneficial, and meaningful care: preservation and/or
maintenance; accommodation and/or negotiation; and re-patterning and/or restructuring. The
modes have greatly influenced the nurse’s ability to provide culturally congruent nursing care, as
well as fostering culturally-competent nurses.

Leininger’s model makes the following assumptions:

1. Care is the essence of nursing and a distinct, dominant, and unifying focus.
2. Caring is essential for well-being, health, healing, growth, and to face death.
3. Culture care is the broadest holistic means by which a nurse can know, explain, interpret,
and predict nursing care phenomena to guide nursing care practices.
4. Nursing is a transcultural, humanistic, and scientific care discipline and profession with
the central purpose to serve human beings worldwide.
5. Caring is essential to curing and healing. There can be no curing without caring.
6. Culture care concepts, meanings, expressions, patterns, processes, and structural forms of
care are different and similar among all cultures of the world.
7. Every human culture has lay care knowledge and practices and usually some professional
care knowledge and practices which vary transculturally.
8. Culture care values, beliefs, and practices are influenced in the context of a particular
culture. They tend to be embedded in such things as worldview, language, spirituality,
kinship, politics and economics, education, technology, and environment.
9. Beneficial, healthy, and satisfying culturally-based nursing care contributes to the well-
being of individuals, families, and communities within their environmental context.
10. Culturally congruent nursing care can only happen when the patient, family, or
community values, expressions, or patterns are known and used appropriately, and in
meaningful ways by the nurse with the people.
11. Culture care differences and similarities between the nurse and patient exist in any human
culture worldwide.
12. Clients who experience nursing care that fails to be reasonably congruent with their
beliefs, values, and caring lifeways will show signs of cultural conflicts, noncompliance,
stresses and ethical or moral concerns.
13. The qualitative paradigm provides new ways of knowing and different ways to discover
the epistemic and ontological dimensions of human care.
The Culture Care Theory defines nursing as a learned scientific and humanistic profession that
focuses on human care phenomena and caring activities in order to help, support, facilitate, or
enable patients to maintain or regain health in culturally meaningful ways, or to help them face
handicaps or death.