ASSIGNMENT

IN
THEORETICAL FOUNDATION
OF NURSING

SUBMITTED BY:
SHAIRA LAIZA N. PORTILLO
SUBMITTED TO:
LEONARDO MATUNDING

Developmental theory
Developmental theories present systematic ways of thinking about how human
beings grow from babies to adolescents to adults to elderly people, and the
various changes they undergo as they make this passage. Different developmental
theories describe different types of changes. Jean Piaget's influential theories
describe how people's intellectual development evolves over time. Lawrence
Kolhberg's theories describe moral evolution over time as people grow, and Eric
Erikson and Robert Kegan have created theories that describe how identity and
the nature of the self change with increasing maturity. We've described early
human development in detail in our Child Development Topic Center , which you
may wish to look at when you have a moment.
In general, developmental theories view development as progress from simple to
more complex understandings of the self and the world over time. Progress may
be continuous in nature, or occurring in stages, but the momentum is most
always forward toward greater, more complex understandings. For example, prior
to achieving "object permanency", babies do not understand that objects (toys,
people) continue to exist even when out of sight. Instead of looking for a toy now
covered with a blanket, they instead quickly lose interest in the toy as though it
never existed. As they grow, babies come to master the idea of object
permanency, and thereafter will begin looking for objects hidden from their view.
According to developmental theories, this sort of learning to see the world in
increasingly complicated ways continues to occur throughout the lifespan.
Though progress towards development is most certainly happening all the time,
the changes that occur are generally gradual in nature. It is only over long periods
of time that clear progress from one state to another is apparent. For this reason,
developmental theorists tend to view development in terms of stages that people
pass through. Each stage is often marked by attainment of a milestone event
(such as learning to have object permanence, to walk or talk, or to take
responsibility for one's action
 ENVIRONMENT THEORY
As the founder of modern nursing, Florence Nightingale's Environment Theory
changed the face of nursing practice. She served as a nurse during the Crimean
War, at which time she observed a correlation between the patients who died
and their environmental conditions. As a result of her observations, the
Environment Theory of nursing was born. Nightingale explained this theory in her
book, Notes on Nursing: What it is, What it is Not. The model of nursing that
developed from Nightingale, who is considered the first nursing theorist, contains
elements that have not changed since the establishment of the modern
nursing profession. Though this theory was pioneering at the time it was created,
the principles it applies are timeless.
here are seven assumptions made in the Environment Theory, which focuses on
taking care of the patient's environment in order to reach health goals and cure
illness. These assumptions are:

1. natural laws
2. mankind can achieve perfection
3. nursing is a calling
4. nursing is an art and a science
5. nursing is achieved through environmental alteration
6. nursing requires a specific educational base
7. nursing is distinct and separate from medicine
The focus of nursing in this model is to alter the patient's environment in order to
affect change in his or her health. The environmental factors that affect health, as
identified in the theory, are: fresh air, pure water, sufficient food supplies,
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. 

The Environment Theory of nursing is a patient-care theory. That is, it focuses on

the care of the patient rather than the nursing process, the relationship between
patient and nurse, or the individual nurse. In this way, the model must be adapted
to fit the needs of individual patients. The environmental factors affect different
patients unique to their situations and illnesses, and the nurse must address these
factors on a case-by-case basis in order to make sure the factors are altered in a
way that best cares for an individual patient and his or her needs. 
The ten major concepts of the Environment Theory, also identified as
Nightingale's Canons, are:

1. Ventilation and warming

2. Light and noise
3. Cleanliness of the area
4. Health of houses
5. Bed and bedding
6. Personal cleanliness
7. Variety
8. Offering hope and advice
9. Food
10.Observation
According to Nightingale, nursing is separate from medicine. The goal of nursing is
to put the patient in the best possible condition in order for nature to act. Nursing
is "the activities that promote health which occur in any caregiving situation."
Health is "not only to be well, but to be able to use well every power we have."
Nightingale's theory addresses disease on a literal level, explaining it as the
absence of comfort. 
The environment paradigm in Nightingale's model is understandably the most
important aspect. Her observations taught her that unsanitary environments
contribute greatly to ill health, and that the environment can be altered in order
to improve conditions for a patient and allow healing to occur. Nightingale's
Modern Nursing Theory also impacted nursing education. She was the first to
suggest that nurses be specifically educated and trained for their positions in
healthcare. This allowed there to be standards of care in the field of nursing,
which helped improve overall care of patients. 
 SYSTEM THEORY

General system theory, therefore, is a general science of wholeness... The

meaning of the somewhat mystical expression, “The whole is more that the sum
of its parts” is simply that constitutive characteristics are not explainable from
the characteristics of the isolated parts. The characteristics of the complex,
therefore, appear as new or emergent... - Ludwig von Bertalanffy

Systems  theory was proposed in the 1940's by the biologist Ludwig von
Bertalanffy and furthered by Ross Ashby (1964). Von Bertalanffy was reacting
against both reductionism and attempting to revive the unity of science. He is
considered to be the founder and principal author of general systems theory.

If one were to analyze current notions and fashionable catchwords, he would

find “systems” high on the list - Ludwig von Bertalanffy

von Bertalanffy (1968) wrote that a system is a complex of interacting elements

and that they are open to, and interact with their environments. In addition, they
can acquire qualitatively new properties through emergence, thus they are in a
continual evolution. When referring to systems, it also generally means that
they are self-regulating  (they self-correct through feedback). For more
information on feedback, see Perceptual Control Theory (PCT) .

System thinking is both part-to-whole and whole-to-part thinking about making

connections between the various elements so that they fit together as a whole.
For a system thinking design model, see Design Methodologies: Instructional,
Thinking, Agile, System, or X Problem?  (System Thinking is the fourth model in
the chart).
There are many different theories of nursing, but let's take a
look at some of the most prominent, and the nurses who
developed them:
1. Virginia Henderson: Often called "the Nightingale of
Modern Nursing," Henderson was a noted nursing educator
and author. Her "Need Theory" was based in practice and
her education. She emphasized the importance of increasing
a client's independence to promote their continued healing
progress after hospitalization. Her definition of nursing was
one of the first to mark the difference between nursing and
medicine. "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. She must in a
sense, get inside the skin of each of her patients in order to
know what he needs."
2. Martha Rogers: Rogers honed her theory through many
years of education. She was not only a diploma nurse, she
held a Master's of Public Health from Johns Hopkins
University and completed her Doctorate of Nursing there as
well. She saw nursing as both a science and an art. Rogers'
theory is known as that of the Unitary Human Beings.
Nursing seeks to promote symphonic interaction between
the environment and the person, to strengthen the coherence
and integrity of the human beings, and to direct and redirect
patterns of interaction between the person and the
environment for the realization of maximum health
potential. Her development of this abstract system was
strongly influenced by an early grounding in arts and
background of science along with her keen interest in space.
3. Dorothea E. Orem: Known as the Self-Care Theory, Orem's
vision of health is a state characterized by wholeness of
developed human structures and of bodily and mental
functioning. It includes physical, psychological,
interpersonal and social aspects. Her major assumptions
included that people should be self-reliant and responsible
for their own care and the care of others in their family. She said that a person's
knowledge of potential health problems is necessary for
promoting self-care behaviors. Orem defined nursing as an art, a
helping service and a technology.
4. Betty Neuman: The System Model, developed by Neuman,
focuses on the response of the client system to actual or potential
environmental stressors and the use of several levels of nursing
 prevention intervention for attaining, retaining and maintaining optimal client
system wellness. Neuman defines the concern of nursing is preventing stress
invasion. If stress is not prevented then the nurse should protect the client's
basic structure and obtain or maintain a maximum level of
wellness. Nurses provide care through primary, secondary
and tertiary prevention modes.
5. Hildegard Peplau: Four phases define
Peplau's Interpersonal Theory or nursing. She defines the
nurse/patient relationship evolving through orientation,
identification, exploitation and resolution. She views nursing as
a maturing force that is realized as the personality develops
through educational, therapeutic, and interpersonal
processes. Nurses enter into a personal relationship with an
individual when a felt need is present. Peplau's model is still
very popular with clinicians working with individuals who
have psychological problems.
6. Madeleine Leininger: One of the newer nursing
theories, Transcultural Nursing first appeared in 1978.
According to Leininger, the goal of nursing is to provide care
congruent with cultural values, beliefs, and practices.
Leininger states that care is the essence of nursing and the
dominant, distinctive and unifying feature. She says there
can be no cure without caring, but that there may be caring
with curing. Health care personnel should work towards an understanding of
care and the values, health beliefs, and life-styles of different
cultures, which will form the basis for providing culture-
specific care.
7. Patricia Benner: From Novice to Expert is probably the
simplest nursing theory to understand. Benner describes five
levels of nursing experience: novice, advanced beginner,
competent, proficient and expert. The levels reflect a movement
from reliance on abstract principles to the use of past
concrete experience. She proposes that a nurse could gain
knowledge and skills without ever learning the theory. Each
step builds on the previous one as the learner gains clinical
expertise. Simply put, Benner says experience is a
prerequisite for becoming an expert. Benner published her "Novice to Expert
Theory" in 1982.

INTERACTIVE THEORY
According to Michael et al (2013),[1] “The recent surge of interactionist approaches to
social cognition can be traced back to Shaun Gallagher’s proposal for a new approach
to social cognition, which he labeled ‘interaction theory’.[2] Gallagher argued that
mainstream mindreading approaches neglect the interactive contexts in which social
cognition is embedded, and thereby overlook embodied and extended processes that
are engaged in interactions, and which are important components of social cognition.”
The basic ideas of IT can be traced back to the work of Colwyn Trevarthen,[3] who
coined the term ‘primary intersubjectivity’ to refer to early developing sensory-motor
processes of interaction between infants and caregivers. Other work in developmental
psychology by Daniel Stern, Andrew N. Meltzoff, Peter Hobson, Vasu Reddy, and
others, provides important evidence for the role of interaction in social cognition. Similar
insights can be found earlier in the work of the phenomenologists, like Max
Scheler and Maurice Merleau-Ponty. IT has also motivated a rethinking in the methods
for studying social cognition in neuroscience.[4]

Colwyn Trevarthen[3] coined the term ‘primary intersubjectivity’ to refer to early

developing sensory-motor processes of interaction between infants and their caregivers.
Important cues for understanding others are provided by their facial expressions, bodily
posture and movements, gestures, actions, and in processes of neonate imitation,
proto-conversations, gaze following and affective attunement. "In most intersubjective
situations, that is, in situations of social interaction, we have a direct perceptual
understanding of another person’s intentions because their intentions are explicitly
expressed in their embodied actions and their expressive behaviors. This understanding
does not require us to postulate or infer a belief or a desire hidden away in the other
person’s mind. What we might reflectively or abstractly call their belief or desire is
expressed directly in their actions and behaviors."[5]
Sometime during the first year of life infants also start to enter into joint
attention situations and begin to pay attention to how others act and what they do with
objects in everyday contexts, and this also provides a way to understand their intentions
and contextualized actions. This is referred to as ‘secondary intersubjectivity’, which
highlights the fact that interactions often take place in cooperative contexts.[6] During
most interactions, intentions are apparent based upon the pragmatic context of the
situation in which they are occurring. We can instantly see what the other “intends” or
“wants” based upon their actions and the current context; we do not need to infer their
intentions as if they are hidden away. There is a “shared world” that we live in where we
intuitively and instinctively perceive others as minded beings like ourselves.
Interaction theory supports the notion of the direct perception of the other's intentions
and emotions during intersubjective encounters. Gallagher[7][8] argues that most of what
we need for our understanding of others is based on our interactions and perceptions,
and that very little mindreading occurs or is required in our day-to-day interactions.
Rather than first perceiving another’s actions and then inferring the meaning of their
actions (as in TT), the intended meaning is perceptible in the other person’s movements
and contextualized actions. Differences in a person’s intentions show up as differences
in perceptible kinematic properties of action movements.[9] A person’s emotions are not
only expressed on their faces and in their postures and gestures, but these perceptible
embodied aspects help to constitute what the emotion is. Mental states (like intentions
and emotions) are therefore not hidden away from view, they are, IT claims, in fact, and
at least in part, bodily states that are apparent in the action movements that constitute
them. For example, as phenomenologists from Max Scheler to Dan Zahavi point out,
upon seeing an angry face an observer does not first see a face that is contorted into a
scowl and then infer that the target is angry. The anger is immediately apparent on the
face of the other. The overwhelming majority of interactions in our daily lives are face-
to-face so it makes sense that our primary way of understanding one another is from a
second-person perspective rather than from the detached, theoretical, third-person
perspective described by TT and ST.

MULTIFACTORIAL PHENOMENON
HEALTH AS A MULTIFACTORIAL PHENOMENON
FACTORS AFFECTING HEALTH
A. POLITICAL
Involves one's leadership how/she rules, manages and other people in decision making.
Safety
- the condition of being free from harm, injury or loss of authority or power
2. Oppression
- unjust or cruel exercise of authority or power
3. Political will
- determination to pursue something which is for the interest of the
majority.
4. Empowerment
- the ability of a person to do something
- creating the circumstances where people can use their faculties and
abilities at the maximum level in the pursuit of common goals
B. CULTURAL
- relating to the representation of non-physical traits, such as values, beliefs, attitudes and
customs shared by a group of people and passed from the generation to the next.
Practices
- a customary action usually done to maintain or promote health like use
of anting-anting and lucky charms.
2. Beliefs
- a state or habit of mind wherein a group of people place into something
or a person.
C. HEREDITY
- the genetic transmission of traits from parents to offspring; genetically
determined.
D. ENVIRONMENT
- the sum of all the conditions and elements that make up the surroundings
and influence the development of the individuals.
E. SOCIO-ECONOMIC
- refers to the production activities, distribution of and consumption of goods
of an individual.
What is health as a multifactorial phenomenon?
Health as a multifactorial phenomenon involves several factors. These factors include
economic, socio-cultural, and environment. It also includes political factors which involve
political will and empowerment. 
 ASSIGNMENT
IN
THEORETICAL FOUNDATION
OF
NURSING

SUBMITTED BY: SHAIRA LAIZA N. PORTILLO

JEYANNE LIZ BACODIO
SUBMITTED TO:
LEONARDO MATUNDING

CHANGE THEORY
The Change Theory of Nursing was developed by Kurt Lewin, who is
considered the father of social psychology. This theory is his most
influential theory. He theorized a three-stage model of change known as
unfreezing-change-refreeze model that requires prior learning to be
rejected and replaced.
 Kurt Lewin (1890-1947) is considered as the father of social
psychology
 He was born in Germany, later emigrated to the US.
 He is well known for his writings on group dynamics, group therapy
and social psychology.
 Kurt Lewin introduced his field theory concepts, emphasizing that the
group differs from the simple sum of its parts.
 Lewin coined the term group dynamics in 1939.
 His field theory states that "one’s behavior is related both to one’s
personal characteristics and to the social situation in which one finds
oneself."

LEWIN"S CHANGE THEORY

 His most influencial theory was his model of the change process in human
systems.
 Kurt Lewin theorized a three-stage model of change that is known as
the unfreezing-change-refreeze model  that requires prior learning to be
rejected and replaced.
 Lewin's theory states behavior as "a dynamic balance of forces working in
opposing directions. "
Kurt Lewin 9 September 1890 – 12 February 1947) was a German-American
psychologist, known as one of the modern pioneers of social, organizational, and
applied psychology in the United States.[2] Exiled from the land of his birth, Lewin
made a new life for himself, in which he defined himself and his contributions
within three lenses of analysis: applied research, action research, and group
communication were his major offerings to the field of communication.
 Lewin is often recognized as the "founder of social psychology" and was one
of the first to study group dynamics and organizational development. A Review of
General Psychology survey, published in 2002, ranked Lewin as the 18th-most
cited psychologist of the 20th century.[3]
In 1890, Lewin was born into a Jewish family in Mogilno, County of Mogilno,
Province of Poznań, Prussia (modern Poland). It was a small village of about 5,000
people, about 150 of whom were Jewish.[4] Lewin received an orthodox Jewish
education at home.[5] He was one of four children born into a middle-class
family. His father owned a small general store, and the family lived in an
apartment above the store. His father, Leopold, owned a farm jointly with his
brother Max; however, the farm was legally owned by a Christian because Jews
were unable to own farms at the time.[4]

humanistic education.[4] In 1909, he entered the University of Freiburg to study

medicine, but transferred to University of Munich to study biology. He became
involved with the socialist movement and women's rights around this time.[6] In
April 1910, he transferred to the Royal Friedrich-Wilhelms University of Berlin,
where he was still a medical student. By the Easter semester of 1911, his interests
had shifted toward philosophy. By the summer of 1911, the majority of his
courses were in psychology.[4] While at the University of Berlin, Lewin took 14
courses with Carl Stumpf.[4]

He served in the German army when World War I began. Due to a war wound, he
returned to the University of Berlin to complete his PhD, with Carl Stumpf (1848–
1936) the supervisor of his doctoral thesis. Lewin had written a dissertation
proposal asking Stumpf to be his supervisor, which Stumpf had accepted. Even
though Lewin worked under Stumpf to complete his dissertation, the relationship
between them did not involve much communication. Lewin studied associations,
will, and intention for his dissertation, but he did not discuss it with Stumpf until
his final doctoral examination.[4]
An early model of change developed by Lewin described change as a three-stage
process.[16] The first stage he called "unfreezing". It involved overcoming inertia
and dismantling the existing "mind set". It must be part of surviving. Defense
mechanisms have to be bypassed. In the second stage the change occurs. This is
typically a period of confusion and transition. We are aware that the old ways are
being challenged but we do not have a clear picture as to what we are replacing
them with yet. The third and final stage he called "freezing". The new mindset is
crystallizing and one's comfort level is returning to previous levels. This is often
misquoted as "refreezing" (see Lewin,1947). Lewin's three-step process is
regarded as a foundational model for making change in organizations. There is
now evidence, however, that Lewin never developed such a model and that it
took form after his death in 1947.[17]
There are three stages in this nursing theory: unfreezing, change, and
refreezing.

Unfreezing is the process which involves finding a method of making it possible for
people to let go of an old pattern that was somehow counterproductive. It is
necessary to overcome the strains of individual resistance and group conformity.
There are three methods that can lead to the achievement of unfreezing. The first
is to increase the driving forces that direct behavior away from the existing
situation or status quo. Second, decrease the restraining forces that negatively
affect the movement from the existing equilibrium. Thirdly, finding a combination
of the first two methods.

The change stage, which is also called "moving to a new level" or "movement,"
involves a process of change in thoughts, feeling, behavior, or all three, that is in
some way more liberating or more productive.

The refreezing stage is establishing the change as the new habit, so that it now
becomes the "standard operating procedure." Without this final stage, it can be
easy for the patient to go back to old habits.